Paul von Aegina berichtete bereits im 17. Jahrhundert, dass alles, was über Klavikulafrakturen zu schreiben wäre, bereits geschrieben worden sei. Der Patient müsse lediglich auf dem Rücken gelagert und eine Mischung aus Olivenöl, Taubenkot, Schlangenöl und anderen Wirkstoffen lokal appliziert werden.Etwa 90% aller Frakturen des Schlüsselbeins heilen problemlos unter konservativer Therapie. Umso wichtiger ist es, therapiebedürftige Begleitverletzungen nicht zu übersehen und die Frakturen, in denen eine Operationsindikation besteht, zu erkennen. Ziel der vorliegenden Arbeit ist es, über die Prinzipien und anerkannten Standards der Behandlung der Schlüsselbeinfrakturen einen aktuellen und umfassenden Überblick zu geben. Funktionelle AnatomieDie Ossifikation der Klavikula beginnt bereits in utero. Das Längenwachstum vollzieht sich v. a. in der medialen Epiphyse, die erst nach dem 20. Lebensjahr verknöchert. Die Klavikula ist über ihre gesamte Länge direkt unter der Haut gelegen. Ihr Verlauf ist von oben betrachtet S-förmig, von vorne gerade und waagerecht. Der ᭤ Knochenquerschnitt ist medial groß und röhrenförmig. Er bietet den direkt darunter im kostoklavikulären Raum durchlaufenden neurovaskulären Strukturen sowie der Pleurakuppe idealen Schutz. Im mittleren Drittel findet sich der vulnerable Übergang zu einem dünneren und flach ovalen Querschnitt (Abb. 1). Funktion der KlavikulaSäugetiere, die auf Schwimmen oder Laufen spezialisiert sind, benötigen offensichtlich kein Schlüsselbein. Dagegen sind Lebewesen, die fliegen oder klettern und somit auf einen gezielten Einsatz der oberen Extremität angewiesen sind, mit einer Klavikula ausgestattet. Auch wenn beim Menschen einzelne Fälle beschrieben wurden, in denen nach Entfernung der Klavikula eine vollkommen normale Funktion des Armes beobachtet werden konnte [18], muss der Klavikula doch eine wesentliche Rolle im präzisen, kraftvollen und zugleich variablen Einsatz des Arms zugeschrieben werden. Sie ist die einzige knöcherne Verbindung zwischen Rumpf und Arm, lateralisiert und positioniert den Arm und gewährt ihm zusätzliche Freiheit. Bei der Abduktion ᭤ Knochenquerschnitt Schutz der neurovaskulären Strukturen.Lateralisierung, Positionierung und Stabilisierung des Arms.
In a prospective study a total of 124 unstable fractures of the distal radius were treated with a fixed angle palmar T-plate (Synthes Ltd., Switzerland). A total of 100 distal radius fractures were evaluated radiologically and clinically after a mean of 10 months after surgery. Loss of correction between postoperative and follow-up radiographs was assessed. The mean loss of the initial volar tilt was 3+/-4 degrees, the loss of radial inclination 0.4+/-2 degrees. The radial shortening was 1+/-1 mm. Flexion and extension of the injured wrist had recovered to an average of 81% of the normal, contralateral side. Radial and ulnar deviation were limited to 84%, pronation and supination reached 91%. Mass grip strength recovered to an average of 74% of the normal side. Using the functional outcome score according to Sarmiento,we obtained 15% excellent,56% good, 28% fair and 1% poor results. The complication rate was 10%. In conclusion, the operative treatment of unstable extra- and intraarticular fractures of the distal radius by fixed angle T-plateosteosynthesis shows good radiological and functional results.
Distal fracture of the radius is an injury to a complex joint that is comprised functionally of four partial joints and makes it possible for the hand to move in all directions. The injuries to bone and cartilage and to the stabilizing ligamentous structures and the surrounding soft tissue vary as functions of the impact responsible, the mechanism of injury, and any previous illnesses. The objectives of treatment are restoration of pain-free, unrestricted and lasting function of the wrist and lower arm and avoidance of the typical complications. Stable fractures are treated by conservative means, while unstable fractures with fragmentation are realigned in a closed procedure and then stabilized by internal or external fixation. In the case of fractures in bones affected by osteoporosis it is usually not necessary to make good a metaphyseal defect when specially adapted fixed-angle plates are used. Complex intraarticular AO type C3 fractures with multiple fragments frequently require a two-step procedure with primary closed realignment, an external fixator spanning the joint, and subsequent extensive diagnostic examinations to ascertain any concomitant injuries and allow a decision on the definitive treatment that is most suitable for the type of injury present.
Klavikulafrakturen Redaktion J. Bauch, Hannover M. Betzler, Essen J. Jähne, Hannover P. Lobenhoffer, HannoverDie Beiträge der Rubrik "Weiter-und Fortbildung" sollen dem Facharzt als Repetitorium dienen und dem Wissenstand der Facharztprüfung für den Arzt in Weiterbildung entsprechen.Die Rubrik beschränkt sich auf gesicherte Aussagen zum Thema.
From May 1999 to November 2001 an anatomical attachment of a ruptured distal biceps tendon to the radial tuberosity was performed through a limited anterior approach in 8 male patients with an age of 37 to 47 years. Through a small incision in the cubital fossa (3-4 cm) the remaining synovial sheet of the biceps tendon was followed to insert absorbable anchor hooks into the radial tuberosity. The distal biceps tendon then was anatomically reattached. Instruments for arthroscopic Bankart-repair were used. There were no specific complications like neurovascular damage or significant functional impairment. The contour of the biceps muscle was restored in all cases. 3 out of 7 patients developed mild heterotopic ossifications without functional deficits. In our experience the presented technique is a possible minimal invasive procedure of distal biceps tendon repair without major complications and with good functional results.
Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.