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Handchir Mikrochir Plast Chir 2020; 52(05): 382-391
DOI: 10.1055/a-1250-8137
Übersichtsarbeit

Klinische und bildgebende Diagnostik der Kahnbeinfraktur und -pseudarthrose

Clinical and imaging methods in diagnostics of scaphoid fracture and non-union
Stefan Georg Fodor
1   Klinik für Diagnostische Radiologie, Rhön Klinikum Campus Bad Neustadt
,
Georgios Christopoulos
1   Klinik für Diagnostische Radiologie, Rhön Klinikum Campus Bad Neustadt
,
Lukas Lehmkuhl
1   Klinik für Diagnostische Radiologie, Rhön Klinikum Campus Bad Neustadt
,
Karl-Josef Prommersberger
2   Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt
,
Marion Mühldorfer-Fodor
2   Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt
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Zusammenfassung

Klinische und radiologische Diagnostik sind die Grundlage jeder differenzierten Therapieplanung karpaler Pathologien. Gerade bei der Kahnbeindiagnostik sind nicht nur die Auswahl und korrekte Durchführung der bildgebenden Verfahren entscheidend, sondern es müssen auch deren methodische Limitationen berücksichtig werden. Kaum eine andere Fraktur wird so häufig nicht erkannt, da nicht abgeklärt oder übersehen. Gleichzeitig führen die Folgen einer verspätet und/oder nicht behandelten Kahnbeinfraktur zu aufwändigen, nicht immer erfolgreichen Folgetherapien und langfristig zu funktionellen Einschränkungen. Diese Arbeit gibt einen Überblick über die klinische und bildgebende Diagnostik bei Kahnbeinfrakturen und -pseudarthrosen.

Abstract

Clinical and radiological diagnostics are the base of a differentiated treatment of carpal disorders. With special regard to diagnostics of the scaphoid, not only the choice and the correct implementation of the imaging methods are crucial, but also their methodical limitations have to be taken into account. No other common fracture is more often undiagnosed, because neglected or overlooked. Concomitantly, delayed or untreated scaphoid fractures require demanding therapies in the sequel and may lead to functional restrictions in the long-term. This review article aims to discuss the clinical and imaging diagnostics for scaphoid fractures and non-union.

Schlüsselwörter

Kahnbeinfraktur - Kahnbeinpseudarthrose - Diagnostik - Computertomographie - Kernspintomographie

Key words

Scaphoid fracture - scaphoid non-union - diagnostics - computed tomography - magnetic resonance tomography


Publication History

Received: 15 August 2020

Accepted: 21 August 2020

Article published online:
29 September 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Reigstad O, Grimsgaard C, Thorkildsen R. et al. Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions. Hand Surg 2012; 17: 331-335
    CrossrefPubMedGoogle Scholar
  • 2 Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am 2012; 37: 1095-1100 quiz 1101
    CrossrefPubMedGoogle Scholar
  • 3 Suh N, Grewal R. Controversies and best practices for acute scaphoid fracture management. J Hand Surg Eur Vol 2018; 43: 4-12
    CrossrefPubMedGoogle Scholar
  • 4 Kahl T, Razny FK, Benter JP. et al. Diagnostik des Skaphoids. Fraktur, Pseudarthrose, Durchblutung, Perfusion. Der Orthopäde 2016; 45: 938-944
    CrossrefPubMedGoogle Scholar
  • 5 Mehling IM, Sauerbier M. Der posttraumatische karpale Kollaps: SLAC- und SNAC-Wrist. Handscan 2015; 04: 137-152
    PubMedGoogle Scholar
  • 6 Jamjoom BA, Davis TRC. Why scaphoid fractures are missed. A review of 52 medical negligence cases. Injury 2019; 50: 1306-1308
    CrossrefPubMedGoogle Scholar
  • 7 Unay K, Gokcen B, Ozkan K. et al. Examination tests predictive of bone injury in patients with clinically suspected occult scaphoid fracture. Injury 2009; 40: 1265-1268
    CrossrefPubMedGoogle Scholar
  • 8 Steenvoorde P, Jacobi C, van Doorn L. et al. Pilot study evaluating a clinical decision tool on suspected scaphoid fractures. Acta Orthop Belg 2006; 72: 411-414
    PubMedGoogle Scholar
  • 9 Mühldorfer-Fodor M. AGA-Komitee-Ellenbogen-und-Hand. Die Untersuchung des Handgelenks. https://www.youtube.com/watch?v=nkmY7hnwM9Q&t=41s Stand: 05.08.2019
    PubMedGoogle Scholar
  • 10 Mallee WH, Henny EP, van Dijk CN. et al. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis. J Hand Surg Am 2014; 39: 1683-1691.e2
    CrossrefPubMedGoogle Scholar
  • 11 Schmitt R, Rosenthal H. Bildgebende Diagnostik der Skaphoidfraktur nach der aktuellen S3-Leitlinie. Handscan 2016; 05: 243-258
    PubMedGoogle Scholar
  • 12 Toth F, Sebestyen A, Balint L. et al. Positioning of the wrist for scaphoid radiography. Eur J Radiol 2007; 64: 126-132
    CrossrefPubMedGoogle Scholar
  • 13 AWMF-Leitlinie Skaphoidfrkatur, Registierungsnummer 012–016, Entwicklungsstufe S3. https://www.awmf.org/leitlinien/detail/ll/012–016.html Stand: 01.10.2015
    PubMedGoogle Scholar
  • 14 Lozano-Calderón S, Blazar P, Zurakowski D. et al. Diagnosis of scaphoid fracture displacement with radiography and computed tomography. J Bone Joint Surg Am 2006; 88: 2695-2703
    CrossrefPubMedGoogle Scholar
  • 15 Hodgkinson DW, Kurdy N, Nicholson DA. et al. ABC of emergency radiology. The wrist. BMJ 1994; 308: 464-468
    CrossrefPubMedGoogle Scholar
  • 16 Welling RD, Jacobson JA, Jamadar DA. et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 2008; 190: 10-16
    CrossrefPubMedGoogle Scholar
  • 17 Mallee WH, Wang J, Poolman RW. et al. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. The Cochrane database of systematic reviews 2015; 2015: Cd010023
    PubMedGoogle Scholar
  • 18 Mallee WH, Mellema JJ, Guitton TG. et al. 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures. Arch Orthop Trauma Surg 2016; 136: 771-778
    CrossrefPubMedGoogle Scholar
  • 19 Karle B, Mayer B, Kitzinger HB. et al. Kahnbeinfrakturen – wann operativ, wann konservativ? CT-basierte Klassifikation. Handchir Mikrochir Plast Chir 2005; 37: 260-266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Wieschollek S, Kalb K-H, Christopoulos G. et al. Interrater-Reliabilität bei der Beurteilung von Skaphoidfrakturen in CT-Aufnahmen des Skaphoids in der Ebene des Handgelenkes vs. in der Ebene der langen Achse des Skaphoids. Handchir Mikrochir Plast Chir 2018; 50: 169-173
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Krimmer H, Schmitt R, Herbert T. Kahnbeinfrakturen – Diagnostik, Klassifikation und Therapie. Der Unfallchirurg 2000; 103: 812-819
    CrossrefPubMedGoogle Scholar
  • 22 Mallee W, Doornberg JN, Ring D. et al. Comparison of CT and MRI for diagnosis of suspected scaphoid fractures. J Bone Joint Surg Am 2011; 93: 20-28
    CrossrefPubMedGoogle Scholar
  • 23 Ali M, Ali M, Mohamed A. et al. The role of ultrasonography in the diagnosis of occult scaphoid fractures. J Ultrason 2018; 18: 325-331
    CrossrefPubMedGoogle Scholar
  • 24 Kwee RM, Kwee TC. Ultrasound for diagnosing radiographically occult scaphoid fracture. Skeletal Radiol 2018; 47: 1205-1212
    CrossrefPubMedGoogle Scholar
  • 25 Ha AS, Lee AY, Hippe DS. et al. Digital Tomosynthesis to Evaluate Fracture Healing: Prospective Comparison With Radiography and CT. AJR Am J Roentgenol 2015; 205: 136-141
    CrossrefPubMedGoogle Scholar
  • 26 Geijer M, Börjesson AM, Göthlin JH. Clinical utility of tomosynthesis in suspected scaphoid fracture. A pilot study. Skeletal Radiol 2011; 40: 863-867
    CrossrefPubMedGoogle Scholar
  • 27 Compton N, Murphy L, Lyons F. et al. Tomosynthesis: A new radiologic technique for rapid diagnosis of scaphoid fractures. Surgeon 2018; 16: 131-136
    CrossrefPubMedGoogle Scholar
  • 28 Kraus R, Böhringer G, Meyer C. et al. Die Frakturen des Tuberculum ossis scaphoidei. Handchir Mikrochir Plast Chir 37: 79-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Zura R, Xiong Z, Einhorn T. et al. Epidemiology of fracture nonunion in 18 Human Bones. JAMA Surg 2016; 151: e162775
    CrossrefPubMedGoogle Scholar
  • 30 Arsalan-Werner A, Sauerbier M, Mehling IM. Skaphoidfraktur und Skaphoidpseudarthrose. Trauma und Berufskrankheit 2016; 18: 376-385
    CrossrefPubMedGoogle Scholar
  • 31 Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fracture. J Bone Joint Surg Br 1996; 78: 519-529
    CrossrefPubMedGoogle Scholar
  • 32 Slade 3rd JF, Dodds SD. Minimal invasive management of scaphoid nonunions. Clin Orthop Relat Res 2006; 445: 108-119
    CrossrefPubMedGoogle Scholar
  • 33 Klimsa C, Canova M, Schibli S. Os scaphoideum bipartitum mit Osteonekrose des proximalen Anteils – Differenzialdiagnose zur Pseudarthrose. Handchir Mikrochir Plast Chir 2014; 46: 62-63
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Singh AK, Davis TR, Dawson JS. et al. Gadolinium enhanced MR assessment of proximal fragment vascularity in nonunions after scaphoid fracture: does it predict the outcome of reconstructive surgery?. J Hand Surg Br 2004; 29: 444-448
    CrossrefPubMedGoogle Scholar
  • 35 Rancy SK, Schmidle G, Wolfe SW. Does Anyone Need a Vascularized Graft?. Hand clinics 2019; 35: 323-344
    CrossrefPubMedGoogle Scholar
  • 36 Smith ML, Bain GI, Chabrel N. et al. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am 2009; 34: 1037-1043
    CrossrefPubMedGoogle Scholar
  • 37 Schmidle G, Ebner HL, Klauser AS. et al. Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery. Arch Orthop Trauma Surg 2018; 138: 1395-1405
    CrossrefPubMedGoogle Scholar
  • 38 Megerle K, Worg H, Christopoulos G. et al. Gadolinium-enhanced preoperative MRI scans as a prognostic parameter in scaphoid nonunion. J Hand Surg Eur Vol 2011; 36: 23-28
    CrossrefPubMedGoogle Scholar
  • 39 Schmitt R, Fellner F, Obletter N. et al. Die Skaphoidpseudarthrose: Klassifikation und Staging mittels CT und MRT. Rontgenpraxis; Zeitschrift fur radiologische Technik 1997; 50: 18-24
    PubMedGoogle Scholar
  • 40 Rancy SK, Swanstrom MM, DiCarlo EF. et al. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol 2018; 43: 32-40
    CrossrefPubMedGoogle Scholar
  • 41 Schmitt R, van Schoonhoven J. Skaphoidpseudarthrose. In: Schmitt R, Lanz U. Hrsg. Bildgebende Diagnostik der Hand. 3., vollständig überarbeitete und erweiterte Auflage. Georg Thieme Verlag; Stuttgart: 2014
    Google Scholar