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Behandlungsstrategie bei karpometakarpalen Luxationsfrakturen

Treatment strategy for carpometacarpal fracture dislocation

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Zusammenfassung

Karpometakarpale Luxationsfrakturen des 2. bis 5. Strahls sind seltene Verletzungen. Die Röntgenuntersuchung der Hand in den Standardebenen bildet in vielen Fällen das Ausmaß solcher Schädigungen nur unvollständig ab, so dass diese Verletzungen häufig übersehen werden. Deshalb wird bei klinischem und radiologischem Verdacht, aber auch bei bereits gesicherter Diagnose, eine Computertomographie zur Erkennung des gesamten Verletzungsausmaßes und von Begleitschäden empfohlen. Vorrangiges Ziel der Behandlung ist die Wiederherstellung der Gelenkanatomie und eine sichere Stabilisierung, um spätere Einschränkungen der Handfunktion zu verhindern. Eine frühzeitige Versorgung mit röntgenologisch kontrollierter Reposition und sicherer Retention führt in der Regel zu guten Behandlungsergebnissen. Zu den Behandlungsstrategien zählen geschlossene und offene Repositionsverfahren sowie die Stabilisierungen durch Drähte, Schrauben und Platten.

Abstract

Carpometacarpal (CMC) fracture dislocations of the 2nd through 5th ray are rare injuries whose extent is regularly underestimated in the initial radiographic evaluation of the hand. Obtaining a computed tomography scan is imperative due to the radiographic underrepresentation of the full bone and joint injury. Restoration of bone and joint anatomy of the affected region is of paramount import to prevent joint deterioration and loss of hand durability and dexterity. Early surgical intervention can lead to good functional results. Different operative treatment strategies exist with a common approach being Kirschner wire, screw or plate fixation after closed or open fracture reduction and joint relocation.

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Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    S.V. Gehrmann,  J.-P. Grassmann, J. Schneppendahl, J. Windolf, M. Hakimi & M. Schädel-Höpfner

  2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    R.A. Kaufmann

Authors
  1. S.V. Gehrmann
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  2. J.-P. Grassmann
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  3. J. Schneppendahl
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  4. R.A. Kaufmann
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  5. J. Windolf
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  6. M. Hakimi
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  7. M. Schädel-Höpfner
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Correspondence to J.-P. Grassmann.

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Gehrmann, S., Grassmann, JP., Schneppendahl, J. et al. Behandlungsstrategie bei karpometakarpalen Luxationsfrakturen. Unfallchirurg 114, 559–564 (2011). https://doi.org/10.1007/s00113-011-2006-x

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  • DOI: https://doi.org/10.1007/s00113-011-2006-x

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