Avaskuläre Osteonekrosen der oberen Extremität bei Kindern und Jugendlichen

T. Wirth

doi:10.1055/s-0037-1621691

Osteologie, Inhaltsverzeichnis

Osteologie 2012; 21(04): 247-252
DOI: 10.1055/s-0037-1621691

Osteonekrosen

Schattauer GmbH

Avaskuläre Osteonekrosen der oberen Extremität bei Kindern und Jugendlichen

Avascular osteonecroses of the upper extremities in children and adolescents

Authors

T. Wirth

¹Orthopädische Klinik, Olgahospital, Klinikum Stuttgart

Abstract

Zusammenfassung

Avaskuläre Osteonekrosen der oberen Extremität gehören zu den selteneren Prädilektionsstellen der ischämischen Knochenerkrankungen. Die häufigsten sind der Morbus Panner, die Osteochondrosis dissecans des Capitellum humeri und die Lunatummalazie. Einseitige sportliche Belastungen oder repetitiveÜberlastungen sind Hauptursache. Die Therapie erfolgt generell stadienabhängig und beinhaltet konservative Maßnahmen ebenso wie eine sehr breite und den gegebenen Befunden angepasste Palette chirurgischer Prozeduren. Bei rechtzeitiger Diagnose und stadiengerechter Therapie ist die Prognose sehr gut.

Summary

Avascular osteonecroses oft the upper extremity are less common localisation of ischaemic bone diseases. The most frequently found entities are Panner's disease, osteochondritis dissecans of the capitellum humeri and Kienböck's disease. Perpetually sportive loads and repetitive stress are the main causes. The treatment is always stage-related and uses conservative measures as well as a well adapted bunch of different surgical procedures. With timely diagnosis and a stagerelated treatment in hand the overall prognosis is very good.

Schlüsselwörter

Avaskuläre Osteonekrose - Morbus Panner - Osteochondrosis dissecans - Lunatummalazie

Keywords

Avascular osteonecrosis - Panner's disease - osteochondrosis dissecans - Kienböck's disease

Volltext

Referenzen

Literatur
1 Bain GI, Begg M. Arthroscopic assessment and classification of Kienböck's disease. Tech Hand Up Extrem Surg 2006; 10: 8-13.
2 Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sports Med 2001; 20: 565-590.
3 Bonzar M, Firrell JC, Hainer M. et al. Kienböck disease and negative ulnar variance. J Bone Joint Surg Am 1998; 80: 1154-1157.
4 Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003; 85: 58-69.
5 Debeer P, Brys P. Osteochondritis dissecans of the humeral head: clinical and radiological findings. Acta Orthop Belg 2005; 71: 484-488.
6 Drescher WR, Falliner A, Zantop T. et al. Little league shoulder syndrome in an adolescent cricket player. Br J Sports Med 2004; 38: E14.
7 Ganter M, Reichelt A. Osteochondrosis dissecans of the humeral head. Z Orthop Ihre Grenzgeb 1996; 134: 73-75.
8 Gogus A, Ozturk C. Osteochondritis dissecans of the glenoid cavity: a case report. Arch Orthop Trauma Surg 2008; 128: 457-460.
9 Haraldsson S. On osteochondrosis deformans juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand 1959; 38: 1-232.
10 Horii E, Garcia-Elias M, Bishop AT. et al. Effect on force transmission across the carpus in procedures used to treat Kienbock's disease. J Hand Surg Am 1990; 15: 393-400.
11 Hultén O. Über anatomische Variationen der Handgelenkknochen. Acta Radiol Scand 1928; 9: 155-168.
12 Iwasaki N, Kato H, Kamishima T, Minami A. Sequential alterations in magnetic resonance imaging findings after autologous osteochondral mosaicplasty for young athletes with osteochondritis dissecans of the humeral capitellum. Am J Sports Med 2009; 37: 2349-2354.
13 Iwasaki N, Yamane S, Nishida K. et al. Transplantation of tissue-engineered cartilage for the treatment of osteochondritis dissecans in the elbow: outcomes over a four-year follow-up in two patients. J Shoulder Elbow Surg 2010; 19: e1-e6.
14 Jones KJ, Wiesel BB, Sankar WN, Ganley TJ. Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes. J Pediatr Orthop 2010; 30: 8-13.
15 Kobayashi K, Burton KJ, Rodner C. et al. Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 2004; 12: 246-254.
16 Kozlowski K, Middleton R. Familial osteochondritis dissecans: a dysplasia of articular cartilage?. Skeletal Radiol 1985; 13: 207-210.
17 Lesley N, Lichtman D. Klassifikation und Behandlung des Morbus Kienböck: EineÜbersichtüber die vergangenen 100 Jahre und ein Blick in die Zukunft. Handchir Mikrochir Plast Chir 2010; 42: 171-176.
18 Lichtman DM, Alexander AH, Mack GR, Gunther SF. Kienböck's disease—Update on silicone replacement arthroplasty. J Hand Surg Am 1982; 7: 343-347.
19 Mahirogullari M, Chloros GD, Wiesler ER. et al. Osteochondritis dissecans of the humeral head. Joint Bone Spine 2008; 75: 226-228.
20 Nobuta S, Ogawa K, Sato K. et al. Clinical outcome of fragment fixation for osteochondritis dissecans of the elbow. Ups J Med Sci 2008; 113: 201-208.
21 Ovesen J, Olsen BS, Johannsen HV. The clinical outcomes of mosaicplasty in the treatment of osteochondritis dissecans of the distal humeral capitellum of young athletes. J Shoulder Elbow Surg 2011; 20: 813-818.
22 Ozalp T, Yercan HS, Okçu G. The treatment of Kienböck disease with vascularized bone graft from dorsal radius. Arch Orthop Trauma Surg 2009; 129: 171-175.
23 Panner HJ. A peculiar affection of the capitellum humeri resembling Calvé-Perthes disease of the hip. Acta Radiol 1929; 10: 234-242.
24 Rabarin F, Saint Cast Y, Cesari B. et al. Capitate osteotomy in Kienböck's disease in twelve cases. Clinical and radiological results at five years follow-up. Chir Main 2010; 29: 67-71.
25 Satake H, Takahara M, Harada M, Maruyama M. Preoperative Imaging Criteria for Unstable Osteochondritis Dissecans of the Capitellum. Clin Orthop Relat Res. 2012 Jul 7. [Epub ahead of print]
26 Schmitt R, Heinze A, Fellner F. et al. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol 1997; 25: 92-103.
27 Shimada K, Tanaka H, Matsumoto T. et al. Cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. J Bone Joint Surg Am 2012; 94: 992-1002.
28 Smith MG. Osteochondritis of the humeral capitulum. J Bone Joint Surg Br 1964; 46: 50.
29 Takahara M, Ogino T, Sasaki I. et al. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res 1999; 363: 108-115.
30 Takahara M, Mura N, Sasaki J. et al. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am 2007; 89: 1205-1214.