Prothetische Versorgung des proximalen Radius – Tipps und Tricks

Radiuskopffrakturen gehören zu den häufigsten Verletzungen der oberen Extremität. Bei nicht rekonstruierbaren Frakturen oder nach fehlgeschlagener Osteosynthese kann der Radiuskopf prothetisch ersetzt werden. Dieser Artikel befasst sich mit der Indikation, dem Zugangsweg, der Implantatwahl und der Technik der Implantation einer Radiuskopfprothese sowie der Behandlung von Begleitverletzungen. Zudem werden die häufigsten Komplikationen und deren Behandlungsmöglichkeiten besprochen.

Abstract

Fractures of the radial head are among the more common injuries of the upper extremity. Their incidence is increasing, and these fractures are often associated with ligamentous injuries or occur as part of complex injury patterns, such as the terrible triad, Monteggia-like lesions, or Essex-Lopresti injuries. Radial head fractures are classified according to the Mason/Johnston system. In cases where the fracture is not reconstructable, or when osteosynthesis fails, radial head arthroplasty may be indicated.

Several prosthetic designs are available, each offering unique features. These include differences in polarity, modularity, and shaft fixation techniques, such as cemented, cementless, or „intentionally loose“ fixation. This article, supported by case reports, highlights the indications, surgical approach, and implantation techniques for radial head arthroplasty. Additionally, common pitfalls are discussed, along with strategies to prevent or manage them. These pitfalls include postoperative elbow stiffness, elbow joint instability, and prosthetic overstuffing.

Kernaussagen

• Radiuskopffrakturen sind häufig mit Begleitverletzungen verbunden, die unbedingt berücksichtigt werden müssen, oder sie treten als Teil komplexer Verletzungsmuster auf, wie z. B. der Terrible Triad, Monteggia-like-Läsionen oder Essex-Lopresti-Verletzungen.

• Radiuskopffrakturen werden nach dem Mason-Johnston-System klassifiziert.

• Einfache Radiuskopffrakturen (Mason Typ I) werden meist konservativ behandelt.

• Auch bei komplexeren Radiuskopffrakturen sollte die osteosynthetische Versorgung in Erwägung gezogen werden.

• Radiuskopfprothesen werden meist bei komplexen Frakturen oder sekundär nach gescheiterter Osteosynthese implantiert.

• Bei der Wahl der Radiuskopfprothese stehen verschiedene Designs zur Verfügung mit jeweils spezifischen Unterschieden, etwa in der Polarität, der Modularität und der Schaftbefestigungstechniken (zementierte, zementfreie oder „Intentionally-loose“-Fixierung. Die Wahl ist immer eine individuelle Entscheidung des Operateurs.

• Insbesondere das Overstuffing muss bei der Implantation von Radiuskopfprothesen vermieden werden. Weitere häufige Risiken sind die Gelenksteife, Lockerung und Instabilität.

Schlüsselwörter

Radiuskopffraktur - Endoprothetik - Ellenbogensteife - Ellenbogeninstabilität

Keywords

radial head fracture - arthroplasty - elbow stiffness - elbow instability

Publication History

Article published online:
04 February 2025

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