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Z Orthop Unfall 2018; 156(02): 214-222
DOI: 10.1055/s-0043-120926
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Isolierte Radiuskopffraktur

Radial Head Fracture – Management Recommendations
Markus Gühring
1   Chirurgische Klinik, Klinik im Kronprinzenbau, Reutlingen
,
Ulrich Stöckle
2   Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen
,
Patrick Ziegler
2   Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen
› Author Affiliations
Further Information

Publication History

Publication Date:
12 December 2017 (online)

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Zusammenfassung

Der Radiuskopf nimmt für die funktionelle Anatomie von Ellenbogen und Unterarm eine zentrale Rolle ein. Er stellt neben den Seitenbändern und dem Processus coronoideus einen wichtigen Stabilisator des Ellenbogengelenks dar. Entsprechend der Bedeutung des Radiuskopfs für die Funktion des Ellenbogengelenks ist eine differenzierte Therapie der Radiuskopffraktur unabdingbar. In diesem Artikel sollen sowohl Diagnostik als auch Klassifikation der Radiuskopffraktur, Behandlungsalgorithmen und Techniken der Rekonstruktion in Abhängigkeit der Frakturmorphologie dargestellt werden.

Abstract

The radial head is pivotal in the functional anatomy of the elbow and forearm. It is an important stabiliser, together with the collateral ligaments and the processus coronoideus. Due to the pivotal importance, optimal therapies are essential for the function of elbow and forearm, independently of trauma severity. The present article presents current diagnostic testing, classifications and treatment options for radial head fractures.

Schlüsselwörter

Ellenbogen - Radiuskopffraktur - Instabilität - konservative Therapie - operative Therapie

Key words

elbow - radial head fracture - instability - conservative treatment - surgical treatment
 

  • Literatur

  • 1 Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 2004; 86-A: 975-982
    PubMedGoogle Scholar
  • 2 Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 1983; 11: 315-319
    CrossrefPubMedGoogle Scholar
  • 3 Galik K, Baratz ME, Butler AL. et al. The effect of the annular ligament on kinematics of the radial head. J Hand Surg Am 2007; 32: 1218-1224
    Google Scholar
  • 4 Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 1991; (265): 187-195
    PubMedGoogle Scholar
  • 5 Wegmann K, Ries C, Mueller LP. et al. Die Radiuskopffraktur. Differenziertes Behandlungskonzept unter Berücksichtigung ligamentärer Begleitverletzungen. Arthroskopie 2013; 26: 211-218
    CrossrefPubMedGoogle Scholar
  • 6 Amis AA, Miller JH. The mechanisms of elbow fractures: an investigation using impact tests in vitro. Injury 1995; 26: 163-168
    CrossrefPubMedGoogle Scholar
  • 7 Ambacher T, Maurer F, Weise K. [Treatment results after primary and secondary resection of the radial head]. Unfallchirurg 2000; 103: 437-443
    CrossrefPubMedGoogle Scholar
  • 8 Hotchkiss RN. Displaced fractures of the radial head: internal fixation or excision?. J Am Acad Orthop Surg 1997; 5: 1-10
    CrossrefPubMedGoogle Scholar
  • 9 Iftimie PP, Calmet Garcia J, de Loyola Garcia Forcada I. et al. Resection arthroplasty for radial head fractures: Long-term follow-up. J Shoulder Elbow Surg 2011; 20: 45-50
    CrossrefPubMedGoogle Scholar
  • 10 Herbertsson P, Josefsson PO, Hasserius R. et al. Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am 2004; 86-A: 1925-1930
    PubMedGoogle Scholar
  • 11 Herbertsson P, Josefsson PO, Hasserius R. et al. Uncomplicated Mason type-II and III fractures of the radial head and neck in adults. A long-term follow-up study. J Bone Joint Surg Am 2004; 86-A: 569-574
    PubMedGoogle Scholar
  • 12 Kaas L, Turkenburg JL, van Riet RP. et al. Magnetic resonance imaging findings in 46 elbows with a radial head fracture. Acta Orthop 2010; 81: 373-376
    CrossrefPubMedGoogle Scholar
  • 13 Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br 1951; 33 B: 244-247
    PubMedGoogle Scholar
  • 14 Goswami GK. The fat pad sign. Radiology 2002; 222: 419-420
    CrossrefPubMedGoogle Scholar
  • 15 Osborne G, Cotterill P. Recurrent dislocation of the elbow. J Bone Joint Surg Br 1966; 48: 340-346
    PubMedGoogle Scholar
  • 16 Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 1954; 42: 123-132
    CrossrefPubMedGoogle Scholar
  • 17 Johnston GW. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J 1962; 31: 51-56
    PubMedGoogle Scholar
  • 18 Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 1986; 68: 669-674
    CrossrefPubMedGoogle Scholar
  • 19 Müller ME, Koch P, Nazarian S, Schatzker J. The comprehensive Classification of Fractures of long Bones. Berlin, Heidelberg, New York, Tokio: Springer; 1990
    Google Scholar
  • 20 Davidson PA, Moseley jr. JB, Tullos HS. Radial head fracture. A potentially complex injury. Clin Orthop Relat Res 1993; (297): 224-230
    PubMedGoogle Scholar
  • 21 Ring D. Displaced, unstable fractures of the radial head: fixation vs. replacement – what is the evidence?. Injury 2008; 39: 1329-1337
    CrossrefPubMedGoogle Scholar
  • 22 van Riet RP, Morrey BF. Documentation of associated injuries occurring with radial head fracture. Clin Orthop Relat Res 2008; 466: 130-134
    CrossrefPubMedGoogle Scholar
  • 23 OʼDriscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop Relat Res 2000; (370): 34-43
    PubMedGoogle Scholar
  • 24 Dehlinger FI, Ries C, Hollinger B. LUCL-Bandplastik mit Trizepssehnentransplantat zur Therapie der posterolateralen Rotationsinstabilität am Ellenbogen. Oper Orthop Traumatol 2014; 26: 414-429
    CrossrefPubMedGoogle Scholar
  • 25 Ikeda M, Oka Y. Function after early radial head resection for fracture: a retrospective evaluation of 15 patients followed for 3–18 years. Acta Orthop Scand 2000; 71: 191-194
    CrossrefPubMedGoogle Scholar
  • 26 Ring D. Open reduction and internal fixation of fractures of the radial head. Hand Clin 2004; 20: 415-427
    CrossrefPubMedGoogle Scholar
  • 27 Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am 2002; 84-A: 1811-1815
    PubMedGoogle Scholar
  • 28 Koslowsky TC, Schliwa S, Koebke J. Presentation of the microscopic vascular architecture of the radial head using a sequential plastination technique. Clin Anat 2011; 24: 721-732
    CrossrefPubMedGoogle Scholar
  • 29 Businger A, Ruedi TP, Sommer C. On-table reconstruction of comminuted fractures of the radial head. Injury 2010; 41: 583-588
    CrossrefPubMedGoogle Scholar
  • 30 Zunkiewicz MR, Clemente JS, Miller MC. et al. Radial head replacement with a bipolar system: a minimum 2-year follow-up. J Shoulder Elbow Surg 2012; 21: 98-104
    CrossrefPubMedGoogle Scholar
  • 31 Beingessner DM, Dunning CE, Gordon KD. et al. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 2004; 86-A: 1730-1739
    PubMedGoogle Scholar
  • 32 King GJ, Zarzour ZD, Patterson SD. et al. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty 2001; 16: 112-116
    CrossrefPubMedGoogle Scholar
  • 33 Doornberg JN, Linzel DS, Zurakowski D. et al. Reference points for radial head prosthesis size. J Hand Surg Am 2006; 31: 53-57
    PubMedGoogle Scholar
  • 34 OʼDriscoll SW, Jupiter JB, Cohen MS. et al. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 2003; 52: 113-134
    PubMedGoogle Scholar
  • 35 Gebauer M, Rücker AH, Barvencik F. et al. [Therapy for radial head fractures]. Unfallchirurg 2005; 108: 657-667
    CrossrefPubMedGoogle Scholar
  • 36 Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect 1995; 44: 175-185
    PubMedGoogle Scholar
  • 37 Herbertsson P, Josefsson PO, Hasserius R. et al. Displaced Mason type I fractures of the radial head and neck in adults: a fifteen- to thirty-three-year follow-up study. J Shoulder Elbow Surg 2005; 14: 73-77
    CrossrefPubMedGoogle Scholar
  • 38 Liow RY, Cregan A, Nanda R. et al. Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols. Injury 2002; 33: 801-806
    CrossrefPubMedGoogle Scholar
  • 39 Schneiders W, Stryer V, Olbrich A. et al. [Open reconstruction of radius head fractures with and without accompanying ligament instability. Treatment results]. Unfallchirurg 2013; 116: 1085-1091
    CrossrefPubMedGoogle Scholar
  • 40 Popovic N, Lemaire R, Georis P. et al. Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface. J Bone Joint Surg Am 2007; 89: 2469-2476
    PubMedGoogle Scholar
  • 41 Esser RD, Davis S, Taavao T. Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma 1995; 9: 318-323
    CrossrefPubMedGoogle Scholar
  • 42 Janssen RP, Vegter J. Resection of the radial head after Mason type-III fractures of the elbow: follow-up at 16 to 30 years. J Bone Joint Surg Br 1998; 80: 231-233
    CrossrefPubMedGoogle Scholar
  • 43 Karlsson MK, Herbertsson P, Nordqvist A. et al. Long-term outcome of displaced radial neck fractures in adulthood: 16–21 year follow-up of 5 patients treated with radial head excision. Acta Orthop 2009; 80: 368-370
    CrossrefPubMedGoogle Scholar
  • 44 Zarattini G, Galli S, Marchese M. et al. The surgical treatment of isolated mason type 2 fractures of the radial head in adults: comparison between radial head resection and open reduction and internal fixation. J Orthop Trauma 2012; 26: 229-235
    CrossrefPubMedGoogle Scholar
  • 45 Ikeda M, Sugiyama K, Kang C. et al. Comminuted fractures of the radial head. Comparison of resection and internal fixation. J Bone Joint Surg Am 2005; 87: 76-84
    CrossrefPubMedGoogle Scholar
  • 46 Lindemann-Sperfeld L, Jansch L, Genest M. et al. [Differential therapy in radial head fractures]. Zentralbl Chir 2002; 127: 218-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am 1979; 61: 63-68
    CrossrefPubMedGoogle Scholar
  • 48 Grewal R, MacDermid JC, Faber KJ. et al. Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes. J Bone Joint Surg Am 2006; 88: 2192-2200
    PubMedGoogle Scholar
  • 49 Schofer MD, Peterlein CD, Kortmann HR. [Radial head prosthesis – treatment of comminuted radial head fractures combined with elbow instability]. Z Orthop Unfall 2008; 146: 760-767
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Van Glabbeek F, Van Riet RP, Baumfeld JA. et al. Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg Am 2004; 86-A: 2629-2635
    PubMedGoogle Scholar