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Erschienen in: Der Unfallchirurg 7/2017

29.06.2017 | Radiusköpfchenfraktur | CME

Ellenbogenluxationsfrakturen

verfasst von: PD Dr. S. Siebenlist, K. F. Braun

Erschienen in: Die Unfallchirurgie | Ausgabe 7/2017

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Zusammenfassung

Bedingt durch die komplexe Anatomie des Ellenbogens stellen Luxationsfrakturen eine herausfordernde Verletzung sowohl für den Operateur als auch für den Patienten dar. Das Ausmaß der knöchernen und der kapsuloligamentären Verletzung muss sorgfältig analysiert werden, um einen zielführenden Behandlungsalgorithmus erstellen zu können. Dabei ist die genaue Kenntnis der gelenkstabilisierenden Strukturen, der operativen Zugangswege und der osteosynthetischen Versorgungsmöglichkeiten essenziell, um eine frühfunktionelle Nachbehandlung zu ermöglichen und verletzungsspezifische Komplikationen zu vermeiden. Eine verzögerte Therapie kann schwerwiegende posttraumatische Funktionsstörungen nach sich ziehen und in einer persistierenden Gelenkinstabilität und/oder Sekundärarthrose enden. Ziel der chirurgischen Therapie von Luxationsfrakturen des Ellenbogens muss daher die anatomische Gelenkreposition und -retention sein, die eine übungsstabile, aktive Bewegung im gesamten Bewegungsumfang ermöglicht.
Literatur
1.
Zurück zum Zitat Mason M (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. J Bone Joint Surg Br 42:123–132CrossRef Mason M (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. J Bone Joint Surg Br 42:123–132CrossRef
2.
Zurück zum Zitat Chen NC, Ring D (2015) Terrible triad injuries of the elbow. J Hand Surg Am 40(11):2297–2303CrossRefPubMed Chen NC, Ring D (2015) Terrible triad injuries of the elbow. J Hand Surg Am 40(11):2297–2303CrossRefPubMed
3.
Zurück zum Zitat Pierrart J, Begue T, Mansat P, GEEC (2015) Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases. Injury 46(Suppl 1):S8–S12CrossRefPubMed Pierrart J, Begue T, Mansat P, GEEC (2015) Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases. Injury 46(Suppl 1):S8–S12CrossRefPubMed
4.
Zurück zum Zitat Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, Larrainzar-Garijo R (2011) Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop 35(6):851–860CrossRefPubMed Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, Larrainzar-Garijo R (2011) Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop 35(6):851–860CrossRefPubMed
5.
Zurück zum Zitat Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stockle U, Lucke M (2010) Comminuted fractures of the proximal ulna – preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 41(12):1306–1311CrossRefPubMed Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stockle U, Lucke M (2010) Comminuted fractures of the proximal ulna – preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 41(12):1306–1311CrossRefPubMed
6.
Zurück zum Zitat Siebenlist S, Stöckle U, Lucke M (2009) Problematik osteoporotischer Frakturen am Ellenbogen. Obere Extremität 4:160CrossRef Siebenlist S, Stöckle U, Lucke M (2009) Problematik osteoporotischer Frakturen am Ellenbogen. Obere Extremität 4:160CrossRef
7.
Zurück zum Zitat O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73(3):440–446CrossRefPubMed O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73(3):440–446CrossRefPubMed
8.
Zurück zum Zitat Mittlmeier T, Beck M (2009) Dislocation of the adult elbow joint. Unfallchirurg 112(5):487–505CrossRefPubMed Mittlmeier T, Beck M (2009) Dislocation of the adult elbow joint. Unfallchirurg 112(5):487–505CrossRefPubMed
9.
Zurück zum Zitat Rhyou IH, Kim YS (2012) New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc 20(12):2535–2541CrossRefPubMed Rhyou IH, Kim YS (2012) New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc 20(12):2535–2541CrossRefPubMed
10.
Zurück zum Zitat Schreiber JJ, Potter HG, Warren RF, Hotchkiss RN, Daluiski A (2014) Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. J Hand Surg Am 39(2):199–205CrossRefPubMed Schreiber JJ, Potter HG, Warren RF, Hotchkiss RN, Daluiski A (2014) Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. J Hand Surg Am 39(2):199–205CrossRefPubMed
11.
Zurück zum Zitat Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD (2004) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am 86–A(6):1122–1130CrossRefPubMed Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD (2004) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am 86–A(6):1122–1130CrossRefPubMed
12.
Zurück zum Zitat McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 12(4):391–396CrossRefPubMed McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 12(4):391–396CrossRefPubMed
13.
Zurück zum Zitat Coonrad RW, Roush TF, Major NM, Basamania CJ (2005) The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 14(3):312–317CrossRefPubMed Coonrad RW, Roush TF, Major NM, Basamania CJ (2005) The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 14(3):312–317CrossRefPubMed
14.
Zurück zum Zitat Osborne G, Cotterill P (1966) Recurrent dislocation of the elbow. J Bone Joint Surg Br 48(2):340–346PubMed Osborne G, Cotterill P (1966) Recurrent dislocation of the elbow. J Bone Joint Surg Br 48(2):340–346PubMed
15.
Zurück zum Zitat Schreiber JJ, Paul S, Hotchkiss RN, Daluiski A (2015) Conservative management of elbow dislocations with an overhead motion protocol. J Hand Surg Am 40(3):515–519CrossRefPubMed Schreiber JJ, Paul S, Hotchkiss RN, Daluiski A (2015) Conservative management of elbow dislocations with an overhead motion protocol. J Hand Surg Am 40(3):515–519CrossRefPubMed
16.
17.
Zurück zum Zitat Yan M, Ni J, Song D, Ding M, Liu T, Huang J (2015) Radial head replacement or repair for the terrible triad of the elbow: which procedure is better? ANZ J Surg 85(9):644–648CrossRefPubMed Yan M, Ni J, Song D, Ding M, Liu T, Huang J (2015) Radial head replacement or repair for the terrible triad of the elbow: which procedure is better? ANZ J Surg 85(9):644–648CrossRefPubMed
18.
Zurück zum Zitat Watters TS, Garrigues GE, Ring D, Ruch DS (2014) Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Clin Orthop Relat Res 472(7):2128–2135CrossRefPubMed Watters TS, Garrigues GE, Ring D, Ruch DS (2014) Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Clin Orthop Relat Res 472(7):2128–2135CrossRefPubMed
19.
Zurück zum Zitat Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–56PubMedPubMedCentral Johnston GW (1962) A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 31:51–56PubMedPubMedCentral
20.
Zurück zum Zitat Burkhart KJ, Franke S, Wegmann K et al (2015) Mason I fracture – a simple injury? Unfallchirurg 118(1):9–17CrossRefPubMed Burkhart KJ, Franke S, Wegmann K et al (2015) Mason I fracture – a simple injury? Unfallchirurg 118(1):9–17CrossRefPubMed
21.
Zurück zum Zitat Burkhart KJ, Wegmann K, Muller LP, Gohlke FE (2015) Fractures of the radial head. Hand Clin 31(4):533–546CrossRefPubMed Burkhart KJ, Wegmann K, Muller LP, Gohlke FE (2015) Fractures of the radial head. Hand Clin 31(4):533–546CrossRefPubMed
22.
Zurück zum Zitat Leschinger T, Müller LP, Hackl M, Scaal M, Schmidt-Horlohé K, Wegmann K (2017) Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest. J Shoulder Elbow Surg 26(4):604–610 Leschinger T, Müller LP, Hackl M, Scaal M, Schmidt-Horlohé K, Wegmann K (2017) Concomitant injury of the annular ligament in fractures of the coronoid process and the supinator crest. J Shoulder Elbow Surg 26(4):604–610
23.
Zurück zum Zitat O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134 O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134
24.
Zurück zum Zitat Babst R, Schraner C, Beeres FJ (2017) Operative treatment of terrible triad injury of the elbow : open reduction and internal fixation. Oper Orthop Traumatol 29(2):125–137CrossRefPubMed Babst R, Schraner C, Beeres FJ (2017) Operative treatment of terrible triad injury of the elbow : open reduction and internal fixation. Oper Orthop Traumatol 29(2):125–137CrossRefPubMed
25.
Zurück zum Zitat Mathew PK, Athwal GS, King GJ (2009) Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg 17(3):137–151CrossRefPubMed Mathew PK, Athwal GS, King GJ (2009) Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg 17(3):137–151CrossRefPubMed
26.
Zurück zum Zitat Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS (2014) Can we treat select terrible triad injuries nonoperatively? Clin Orthop Relat Res 472(7):2092–2099CrossRefPubMedPubMedCentral Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS (2014) Can we treat select terrible triad injuries nonoperatively? Clin Orthop Relat Res 472(7):2092–2099CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Chan K, Faber KJ, King GJ, Athwal GS (2016) Selected anteromedial coronoid fractures can be treated nonoperatively. J Shoulder Elbow Surg 25(8):1251–1257 Chan K, Faber KJ, King GJ, Athwal GS (2016) Selected anteromedial coronoid fractures can be treated nonoperatively. J Shoulder Elbow Surg 25(8):1251–1257
28.
Zurück zum Zitat Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Muscle forces and pronation stabilize the lateral ligament deficient elbow. Clin Orthop Relat Res 388:118–124CrossRef Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Muscle forces and pronation stabilize the lateral ligament deficient elbow. Clin Orthop Relat Res 388:118–124CrossRef
29.
Zurück zum Zitat Lindenhovius AL, Jupiter JB, Ring D (2008) Comparison of acute versus subacute treatment of terrible triad injuries of the elbow. J Hand Surg Am 33(6):920–926CrossRefPubMed Lindenhovius AL, Jupiter JB, Ring D (2008) Comparison of acute versus subacute treatment of terrible triad injuries of the elbow. J Hand Surg Am 33(6):920–926CrossRefPubMed
30.
Zurück zum Zitat Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G (2009) The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg Am 91(6):1448–1458CrossRefPubMed Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G (2009) The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg Am 91(6):1448–1458CrossRefPubMed
31.
Zurück zum Zitat Businger A, Ruedi TP, Sommer C (2010) On-table reconstruction of comminuted fractures of the radial head. Injury 41(6):583–588CrossRefPubMed Businger A, Ruedi TP, Sommer C (2010) On-table reconstruction of comminuted fractures of the radial head. Injury 41(6):583–588CrossRefPubMed
32.
Zurück zum Zitat Crönlein M, Zyskowski M, Beirer M, Imhoff F, Pförringer D, Sandmann GH, Kirchhoff C, Biberthaler P, Siebenlist S (2017) Using an anatomical preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 137(6):789. doi:10.1007/s00402-017-2693-z CrossRefPubMed Crönlein M, Zyskowski M, Beirer M, Imhoff F, Pförringer D, Sandmann GH, Kirchhoff C, Biberthaler P, Siebenlist S (2017) Using an anatomical preshaped low-profile locking plate system leads to reliable results in comminuted radial head fractures. Arch Orthop Trauma Surg 137(6):789. doi:10.​1007/​s00402-017-2693-z CrossRefPubMed
33.
Zurück zum Zitat Gessmann J, Konigshausen M, Schildhauer TA, Seybold D (2016) Chronic bony instability of the elbow joint. Orthopäde 45(10):822–831CrossRefPubMed Gessmann J, Konigshausen M, Schildhauer TA, Seybold D (2016) Chronic bony instability of the elbow joint. Orthopäde 45(10):822–831CrossRefPubMed
34.
Zurück zum Zitat Gray AB, Alolabi B, Ferreira LM, Athwal GS, King GJ, Johnson JA (2013) The effect of a coronoid prosthesis on restoring stability to the coronoid-deficient elbow: a biomechanical study. J Hand Surg Am 38(9):1753–1761CrossRefPubMed Gray AB, Alolabi B, Ferreira LM, Athwal GS, King GJ, Johnson JA (2013) The effect of a coronoid prosthesis on restoring stability to the coronoid-deficient elbow: a biomechanical study. J Hand Surg Am 38(9):1753–1761CrossRefPubMed
35.
Zurück zum Zitat Bellato E, O’Driscoll SW (2017) Prosthetic replacement for coronoid deficiency: report of three cases. J Shoulder Elbow Surg 26(3):382–388CrossRefPubMed Bellato E, O’Driscoll SW (2017) Prosthetic replacement for coronoid deficiency: report of three cases. J Shoulder Elbow Surg 26(3):382–388CrossRefPubMed
36.
Zurück zum Zitat Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG (2014) Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res 472(7):2084–2091CrossRefPubMedPubMedCentral Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG (2014) Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res 472(7):2084–2091CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Heck S, Gick S, Dargel J, Pennig D (2011) Die Behandlung der akuten Luxation und Luxationsfraktur des Ellenbogens. Unfallchirurg 114:114–122CrossRefPubMed Heck S, Gick S, Dargel J, Pennig D (2011) Die Behandlung der akuten Luxation und Luxationsfraktur des Ellenbogens. Unfallchirurg 114:114–122CrossRefPubMed
38.
Zurück zum Zitat Hackl M, Damerow D, Leschinger T, Scaal M, Müller LP, Wegmann K (2015) Radial nerve location at the posterior aspect of the humerus: an anatomic study of 100 specimens. Arch Orthop Trauma Surg 135(11):1527–1532CrossRefPubMed Hackl M, Damerow D, Leschinger T, Scaal M, Müller LP, Wegmann K (2015) Radial nerve location at the posterior aspect of the humerus: an anatomic study of 100 specimens. Arch Orthop Trauma Surg 135(11):1527–1532CrossRefPubMed
39.
Zurück zum Zitat Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE (2016) Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction. Am J Sports Med 44(3):735–741 Dugas JR, Walters BL, Beason DP, Fleisig GS, Chronister JE (2016) Biomechanical Comparison of Ulnar Collateral Ligament Repair With Internal Bracing Versus Modified Jobe Reconstruction. Am J Sports Med 44(3):735–741
40.
Zurück zum Zitat Lee JM, Yi Y, Kim JW (2015) Arthroscopically assisted surgery for coronoid fractures. Orthopedics 38(12):742–746CrossRefPubMed Lee JM, Yi Y, Kim JW (2015) Arthroscopically assisted surgery for coronoid fractures. Orthopedics 38(12):742–746CrossRefPubMed
41.
Zurück zum Zitat Carroll MJ, Athwal GS, King GJ, Faber KJ (2015) Capitellar and trochlear fractures. Hand Clin 31(4):615–630CrossRefPubMed Carroll MJ, Athwal GS, King GJ, Faber KJ (2015) Capitellar and trochlear fractures. Hand Clin 31(4):615–630CrossRefPubMed
42.
Zurück zum Zitat McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ (2005) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am 87(Suppl 1 (Pt 1)):22–32CrossRefPubMed McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ (2005) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am 87(Suppl 1 (Pt 1)):22–32CrossRefPubMed
43.
Zurück zum Zitat Chen HW, Bi Q (2016) Surgical outcomes and complications in treatment of terrible triad of the elbow: comparisons of 3 surgical approaches. Med Sci Monit 22:4354–4362CrossRefPubMedPubMedCentral Chen HW, Bi Q (2016) Surgical outcomes and complications in treatment of terrible triad of the elbow: comparisons of 3 surgical approaches. Med Sci Monit 22:4354–4362CrossRefPubMedPubMedCentral
44.
Zurück zum Zitat Park MC, Ahmad CS (2004) Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am 86–A(10):2268–2274CrossRefPubMed Park MC, Ahmad CS (2004) Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am 86–A(10):2268–2274CrossRefPubMed
45.
Zurück zum Zitat O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197 O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197
46.
Zurück zum Zitat Lenich A, Imhoff AB, Siebenlist S (2016) Post-traumatic osteoarthritis of the elbow joint : endoprosthetic options in young patients. Orthopäde 45(10):844–852CrossRefPubMed Lenich A, Imhoff AB, Siebenlist S (2016) Post-traumatic osteoarthritis of the elbow joint : endoprosthetic options in young patients. Orthopäde 45(10):844–852CrossRefPubMed
Metadaten
Titel
Ellenbogenluxationsfrakturen
verfasst von
PD Dr. S. Siebenlist
K. F. Braun
Publikationsdatum
29.06.2017
Verlag
Springer Medizin
Erschienen in
Die Unfallchirurgie / Ausgabe 7/2017
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-017-0373-7

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