Frakturendoprothetik am Ellbogengelenk

Zusammenfassung

Dislozierte instabile Frakturen am Ellbogengelenk werden i. d. R. operativ versorgt. Wenn es die Frakturform und die Knochenqualität zulassen, wird meist eine Osteosynthese mit Schrauben und Platten durchgeführt. Eine Osteosynthese führt aber nur dann zu einem guten funktionellen Ergebnis, wenn die erzielte Stabilität eine frühfunktionelle Nachbehandlung ermöglicht. Bei Frakturen mit Trümmerzonen stellt, insbesondere beim betagten Patienten mit Osteoporose, die primäre Frakturendoprothese eine gute Behandlungsalternative dar. Hier zeigt am distalen Humerus die Datenlage Vorteile für ein primär prothetisches Vorgehen. Die zementierten teilverblockten Ellbogentotalendoprothesen zeichnen sich in dieser Patientengruppe durch eine frühe Gebrauchsfähigkeit des Armes und gute Langzeitergebnisse aus. Es ist aber derzeit noch von einer begrenzten Belastbarkeit auszugehen. Am Radiuskopf ist bei nicht stabil rekonstruierbaren Mehrfragmentfrakturen der prothetische Ersatz indiziert, da meist ligamentäre und ossäre Begleitverletzungen vorliegen. Die Wiederherstellung der radialen Abstützung ist in diesen Fällen für eine balancierte Kraftübertragung und eine ausreichende Stabilität des Ellbogengelenks erforderlich. Nur in jenen seltenen Fällen, in denen bei geriatrischen Patienten mit komplexer Radiuskopffraktur keine Bandverletzung oder Verletzung der Membrana interossea vorliegt, kann eine Radiuskopfresektion ebenfalls zu guten Ergebnissen führen.

Abstract

Most displaced unstable fractures of the elbow need surgical treatment. The preferred method is to use anatomical reconstruction and stabilisation with screws and plates, in so far as this is feasible with the individual fracture pattern and bone quality. Good clinical results may only be obtained if stability allows early movement and functional after-treatment. In elderly patients with complex fracture pattern and poor bone quality due to osteoporosis, primary prosthetic replacement is an excellent alternative. There is some evidence that primary arthroplasty for comminuted fractures in elderly people is advantageous. Semiconstrained total elbow prosthesis fixed by cement usually leads to early restoration of function and good long-term results. Nevertheless some restrictions to weight lifting must be accepted. Radial head prostheses are indicated in patients with non-reconstructable, multiple fragmentation of the radial head, as there are concomitant ligamentous or bony injuries in most of these cases. In these cases, reconstruction of the radial column is necessary to achieve balanced force transmission over the elbow joint, as well as sufficient stability. In orthogeriatric patients with complex fractures of the radial head but absence of ligamentous injuries or rupture of the interosseous membrane, resection of the radial head may also lead to good results.

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