Unterarmschaftfrakturen

Unterarmschaftfrakturen zählen zu den häufigen Verletzungen Erwachsener und entstehen meist durch Sturz oder direktes Trauma. Sie erfordern eine präzise Diagnostik und differenzierte Therapieentscheidung, die häufig in einer operativen Therapie resultiert. Besondere Beachtung gilt der Stellung der Fragmente, um Funktionseinschränkungen und Komplikationen zu vermeiden.

Abstract

Fractures of the forearm shaft are common injuries in everyday clinical practice. Surgical stabilization is usually performed to ensure smooth interaction between the radius and ulna. Compression plate osteosynthesis is used to enable early functional follow-up treatment. Concomitant injuries of the DRUG or PRUG must be reliably excluded or treated accordingly. In the postoperative course, nerve lesions, infections or pseudarthrosis can significantly impair the outcome, especially after open, multi-fragmentary fractures. Early metal removal carries the risk of refractures of the forearm shaft.

Kernaussagen

• Unterarmschaftfrakturen sind häufige Verletzungen im klinischen Alltag.

• Zur Sicherstellung des reibungslosen Zusammenspiels von Radius und Ulna erfolgt in der Regel die operative Stabilisierung.

• Um eine frühfunktionelle Nachbehandlung zu ermöglichen, kommen in der Regel Kompressionsplattenosteosynthesen zum Einsatz.

• Begleitverletzungen des distalen (DRUG) bzw. proximalen Radioulnargelenks (PRUG) müssen sicher ausgeschlossen oder entsprechend mitbehandelt werden.

• Im postoperativen Verlauf können Nervenläsionen, Infektionen oder Pseudarthrosen das Outcome, vor allem nach offenen, mehrfragmentären Frakturen, deutlich beeinträchtigen.

• Frühzeitige Metallentfernungen bergen das Risiko von Refrakturen am Unterarmschaft.

Schlüsselwörter

Radiusfraktur - Ulnafraktur - AO/OTA-Klassifikation - Monteggia-Äquivalent-Verletzung - Kompartmentsyndrom

Keywords

radius fracture - ulnar fracture - Monteggia-like fracture - compartment syndrome

Publication History

Article published online:
08 August 2025

• Literatur

• 1 Meisinger C, Wildner M, Stieber J. et al. Epidemiology of peripheral fractures. Orthopade 2002; 31: 92-99
• 2 Paulsen F, Waschke J. , Hrsg. Sobotta – Atlas der Anatomie. Band 1: Allgemeine Anatomie und Bewegungsapparat. München: Elsevier Health Sciences; 2017
• 3 Marsh JL, Slongo TF, Agel J. et al. Fracture and dislocation classification compendium – 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21(10 Suppl.): S1-S133
• 4 Tsismenakis T, Tornetta 3rd P. Galeazzi fractures: is DRUJ instability predicted by current guidelines?. Injury 2016; 47: 1472-1477
• 5 Boyd HB, Boals JC. The Monteggia lesion: a review of 159 cases. Clin Orthop Relat Res 1969; 66: 94-100
• 6 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24: 742-746
• 7 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58: 453-458
• 8 Tscherne H, Oestern H. [A new classification of soft-tissue damage in open and closed fractures (author's transl)]. Unfallheilkunde 1982; 85: 111-115
• 9 Weckbach A, Blattert T. [Forearm shaft fracture of the adult]. Unfallchirurg 2002; 105: 627-640
• 10 Sellei R, Hildebrand F, Pape HC. [Acute extremity compartment syndrome: current concepts in diagnostics and therapy]. Unfallchirurg 2014; 117: 633-649
• 11 Zalavras CG. Prevention of infection in open fractures. Infect Dis Clin North Am 2017; 31: 339-352
• 12 Chang Y, Bhandari M, Zhu KL. et al. Antibiotic prophylaxis in the management of open fractures: a systematic survey of current practice and recommendations. JBJS Rev 2019; 7: e1
• 13 Obremskey W, Molina C, Collinge C. et al. Current practice in the management of open fractures among orthopaedic trauma surgeons. Part A: initial management. A survey of orthopaedic trauma surgeons. J Orthop Trauma 2014; 28: e198-e202
• 14 Lack WD, Karunakar MA, Angerame MR. et al. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma 2015; 29: 1-6
• 15 Kleber C, Trampuz A. Antibiotikaprophylaxe in der Orthopädie und Unfallchirurgie – was, wann und wie lange applizieren?. OP-Journal 2014; 30: 8-10
• 16 Hoff WS, Bonadies JA, Cachecho R. et al. East Practice Management Guidelines Work Group: update to practice management guidelines for prophylactic antibiotic use in open fractures. J Trauma 2011; 70: 751-754
• 17 Messner J, Papakostidis C, Giannoudis PV. et al. Duration of administration of antibiotic agents for open fractures: meta-analysis of the existing evidence. Surg Infect (Larchmt) 2017; 18: 854-867
• 18 Bucholz RW. , Hrsg. Rockwood and Green’s Fractures in Adults. Two Volumes plus integrated Content Website (Rockwood, Green, and Wilkins’ Fractures). Philadelphia: Wolters Kluwer Health; 2012
• 19 Cai XZ, Yan SG, Giddins G. A systematic review of the non-operative treatment of nightstick fractures of the ulna. Bone Joint J 2013; 95-B: 952-959
• 20 Kruppa C, Bunge P, Schildhauer TA. et al. Low complication rate of elastic stable intramedullary nailing (ESIN) of pediatric forearm fractures: a retrospective study of 202 cases. Medicine (Baltimore) 2017; 96: e6669
• 21 Perren SM. The concept of biological plating using the limited contact-dynamic compression plate (LC-DCP). Scientific background, design and application. Injury 1991; 22: 1-41
• 22 Bauer R, Kerschbaumer F, Poisel S. Operative Approaches in orthopedic Surgery and Traumatology. Stuttgart: Thieme; 1987
• 23 Anantavorasakul N, Lans J, Wolvetang NHA. et al. Forearm plate fixation: should plates be removed?. Arch Bone Jt Surg 2022; 10: 153-159
• 24 Vasara H, Stenroos A, Aspine S. et al. Both-bone forearm shaft fractures treated with compression plate fixation in adults: a systematic review on adverse events and outcomes. JB JS Open Access 2024; 9: e24.00129
• 25 Vasara H, Aspinen S, Kosola J. et al. Adverse events after surgical treatment of adult diaphyseal forearm fractures: a retrospective analysis of 470 Patients. JB JS Open Access 2023; 8: e22.00115
• 26 Marcheix PS, Delclaux S, Ehlinger M. et al. Pre- and postoperative complications of adult forearm fractures treated with plate fixation. Orthop Traumatol Surg Res 2016; 102: 781-784
• 27 Brinker MR, O’Connor DP, Monla YT. et al. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 2007; 21: 557-570
• 28 Ring D, Allende C, Jafarnia K. et al. Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am 2004; 86: 2440-2445
• 29 Kloen P, Wiggers JK, Buijze GA. Treatment of diaphyseal non-unions of the ulna and radius. Arch Orthop Trauma Surg 2010; 130: 1439-1445
• 30 Ryskalin L, Fulceri F, Morucci G. et al. Treatment of delayed union of the forearm with extracorporeal shockwave therapy: a case report and literature review. Front Endocrinol (Lausanne) 2023; 14: 1286480
• 31 Ma XY, Liu B, Yu HL. et al. Induced membrane technique for the treatment of infected forearm nonunion: a retrospective study. J Hand Surg Am 2022; 47: 583.e1-583.e9
• 32 Zhang Q, Yin P, Hao M. et al. Bone transport for the treatment of infected forearm nonunion. Injury 2014; 45: 1880-1884
• 33 Dohn P, Khiami F, Rolland E. et al. Adult post-traumatic radioulnar synostosis. Orthop Traumatol Surg Res 2012; 98: 709-714