Die Entwicklung unseres therapeutischen Konzeptes bei der Behandlung von Epicondylus-ulnaris-Frakturen

Abstract

50 patients with epicondylus ulnaris fractures are analysed. 4 types of fracture are recognised. The results of therapy are often described in literature much more optimistically than in reality. The first critical examination and the selection of therapy, mostly a surgical intervention, had a great influence on mobility of the elbow joint, on strength and subjective perception. The results could only be assessed after three years. Complications of concomitant injuries - nerve lesion and ligament/capsule structures - were discussed with regard to surgical approach.

Die Behandlung der Apophysenabrissverletzung des Epicondylus ulnaris im Kindesalter

“…All fractures consolidated within 6 weeks. [1,10,14], gehen andere bei diesen Frakturen grundsätzlich konservativ vor, falls eine geschlossene Reposition des intraartikulär eingeschlagenen Apophysenfragments des Epicondylus ulnaris bei Grad-III-und -IV-Frakturen gelingt [6,11,13]. Letzteres ist prinzipiell möglich, weil die Apophyse des Epicondylus ulnaris praktisch nicht zum Längenwachstum des Ellenbogengelenks beiträgt [11].…”

“…There is wide agreement on conservative treatment of grade I fractures as well as on surgical approaches for cases with complete lesions of the ulnar nerve and the need for reduction of an intraarticularly located apophyseal fragment in grade III-IV fractures. While some authors argue for surgical treatment of all grade II-IV fractures [1,10,14], others choose to treat these injuries conservatively as a matter of principle, provided closed reduction of the intraarticular fragment of the medial epicondyle can be achieved in grade III and IV fractures [6,11,13]. This is a viable approach because the apophysis of the medial epicondyle contributes almost nothing to the growth in length of the elbow joint [11].…”

“…Mehrere Studien zeigten sowohl nach operativer als auch nach konservativer Behandlung dislozierter Apophysenabrissverletzungen des Epicondylus ulnaris [1,2,5,6,12] überwiegend exzellente oder gute Ergebnisse. Gesichert erscheint, dass ein intraartikuläres Belassen oder die Exzision eines in das Gelenk eingeschlagenen Apophysenfragments zu schlechten Langzeitergebnissen führt [2,3].…”

“…Several studies show excellent or good results after both surgical and conservative treatment of dislocated apophyseal avulsion injuries [1,2,5,6,12]. It seems certain that leaving an intraarticular fragment or excision of such a fragment leads to poor long-term results [2,3].…”