Zusammenfassung
Trotz aller Fortschritte in der Behandlung der distalen Radiusfraktur ist die Ausheilung in Fehlstellung weiterhin eine der häufigsten Komplikationen. Auch wenn nicht alle fehlverheilten Radiusfrakturen zu Beschwerden führen, so klagen doch die meisten betroffenen Patienten über eine Einschränkung der Handgelenkbeweglichkeit und Unterarmdrehung, eine verminderte Griffkraft und Schmerzen. Dies sollte Anlass für eine sorgfältige klinische Untersuchung und penible Auswertung der Röntgenaufnahmen sein und gegebenenfalls zu einer weiteren Diagnostik führen. Die Palette der Behandlungsmöglichkeiten reicht von Operationen, die lediglich der Schmerzreduktion dienen, über Eingriffe, die die Funktion verbessern, ohne die Fehlstellung zu beseitigen, bis hin zu Eingriffen, deren Ziel die weitgehende Wiederherstellung der anatomischen Verhältnisse am Handgelenk ist, allen voran die Radiuskorrekturosteotomie. Die Radiuskorrekturosteotomie führt zu einer signifikanten Verbesserung der Handgelenk- und Unterarmfunktion, der groben Kraft und zu einer deutlichen Reduktion der Schmerzen. Die Resultate sind umso günstiger, je besser das radiologische Ergebnis ausfällt.
Abstract
Despite all progress in the treatment of distal radius fractures, malunion is still one of the most common complications. It may be true that not all non-anatomically aligned fractures of the distal radius are causing disabilities. However, most patients with a distal radial malunion complain about loss of wrist motion and forearm rotation, loss of grip strength, and pain. These complaints should lead to a sophisticated clinical examination and a careful evaluation of the radiographs of the wrist, and - if needed - to further investigations. Treatment options are procedures solely aimed to diminish pain, procedures aimed to improve wrist and forearm function without restoration of the anatomic relationships, and procedures aimed to restore the anatomy of the wrist joint, especially corrective osteotomy of the radius. Radial corrective osteotomy improves significantly wrist and forearm function, grip strength, and diminishes pain. The clinical results are as good or better than the radiological results.
Schlüsselwörter
fehlverheilte Radiusfraktur - Radiuskorrekturosteotomie - radio‐skapho‐lunäre Fusion - Handgelenkdenervation
Key words
malunion of the distal radius - corrective osteotomy of the distal radius - radio‐scapho‐lunate fusion - wrist denervation
Literatur
-
1
Adams B, Berger R A.
An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability.
J Hand Surg [Am].
2002;
27
243-251
-
2
Adams B D.
Effects of radial deformity on distal radioulnar joint mechanics.
J Hand Surg [Am].
1993;
18
492-498
-
3
af Ekenstam F, Hagert C G.
The distal radio-ulnar joint. The influence of geometry and ligament on simulated Colles' fracture. An experimental study.
Scand J Plast Reconstr Surg.
1985;
19
27-31
-
4
Athwal G S, Ellis R E, Small C F, Pichora D R.
Computer-assisted distal radius osteotomy.
J Hand Surg [Am].
2003;
28
951-958
-
5
Bade H, Lobeck F.
Gelenkflächenverhalten der Articulatio radioulnaris distalis bei fehlgestelltem distalen Radius.
Unfallchirurgie.
1991;
17
213-217
-
6 Baumgarten A. Beeinträchtigungen des N. medianus bei der fehlverheilten Radiusfraktur. Inaugural-Dissertation, Bayerische Ludwig-Maximilian-Universität Würzburg. 2003
-
7
Beyermann K, Prommersberger K J, Krimmer H, Lanz U.
Radio-scapho-lunate fusion as treatment of posttraumatic radiocarpal arthrosis.
Eur J Trauma.
2000;
26
169-175
-
8
Bilic R, Zdravkovic V, Boljevic Z.
Osteotomy for deformity of the radius: computer-assisted three-dimensional modelling.
J Bone Joint Surg [Br].
1994;
76
150-154
-
9
Bronstein A J, Trumble T E, Tencer A F.
The effect of distal radius fracture malalignment on forearm rotation: A cadaveric study.
J Hand Surg [Am].
1997;
22
258-262
-
10
Campbell W C.
Malunited Colles' fractures.
JAMA.
1937;
109
1105-1108
-
11
DiBenedetto M R, Lubbers L M, Ruff M E, Nappi J F, Coleman C R.
Quantification of error in measurements of radial inclination and radial-carpal distance.
J Hand Surg [Am].
1991;
16
399-400
-
12
Durman D C.
An operation for correction of deformities of the wrist following fracture.
J Bone Joint Surg.
1935;
17
1014-1016
-
13
El-Karef E.
Staged reconstruction for malunited fractures of the distal radius.
J Hand Surg [Br].
2005;
30
73-78
-
14 Fernandez D L, Geissler W B, Lamey D M. Wrist instability with or following fractures of the distal radius. Büchler U Wrist Instability. London; Martin Dunitz 1996: 181-192
-
15
Fernandez D L.
Correction of post-traumatic wrist deformity in adults by ostetomy, bone-grafting, and internal fixation.
J Bone Joint Surg [Am].
1982;
64
1164-1178
-
16
Fernandez D L.
Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius.
J Bone Joint Surg [Am].
1988;
70
1538-1551
-
17
Frahm R, Drescher E.
Radiologische Diagnostik nach komplizierter distaler Radiusfraktur unter besonderer Berücksichtigung der Computertomographie.
Fortschr Röntgenstr.
1988;
148
295-300
-
18
Garcia-Elias M, Lluch A, Ferreres A, Paini-Zorli I, Rahimtoola Z O.
Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy.
J Hand Surg [Am].
2005;
30
8-15
-
19
Gelberman R H, Salamon R B, Jurist J M, Posch J L.
Ulnar variance in Kienböck's disease.
J Bone Joint Surg [Am].
1975;
57
674-676
-
20
Hagert C G.
Distal radius fracture and the distal radioulnar joint - Anatomical considerations.
Handchir Mikrochir Plast Chir.
1994;
26
22-26
-
21
Horas U, Stahl J P, Pelinkovic D.
Korrektur fehlverheilter distaler Radiusfrakturen durch Osteotomie und Interposition eines Beckenkammspanes von radiopalmar.
Unfallchirurg.
2001;
104
34-40
-
22
Jupiter J B, Fernandez Dl.
Complications following distal radial fractures.
J Bone Joint Surg [Am].
2001;
83
1244-1264
-
23
Jupiter J B, Ring D.
A comparison of early and late reconstruction of malunited fractures of the distal end of the radius.
J Bone Joint Surg [Am].
1996;
78
739-748
-
24
Jupiter J B, Ruder J, Linda L, Roth D A.
Computer-generated bone models in the planning of osteotomy of multidirectional distal radius malunions.
J Hand Surg [Am].
1992;
17
406-415
-
25
Jupiter J B, Rüedi T.
Intraoperative distraction in the treatment of complex nonunions of the radius.
J Hand Surg [Am].
1992;
17
416-422
-
26
Kazuki K, Kusunoki M, Shimazu A.
Pressure distribution in the radiocarpal joint measured with a densitometer designed for pressure-sensitive film.
J Hand Surg [Am].
1991;
16
401-408
-
27
Kihara H, Palmer A K, Werner F W, Short W H, Fortino M D.
The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation.
J Hand Surg [Am].
1996;
21
40-47
-
28
Lanz U, Kron W.
Neue Technik zur Korrektur in Fehlstellung verheilter Radiusfrakturen.
Handchirurgie.
1976;
8
203-206
-
29 Lanz U. The carpal tunnel syndrom. Tubiana R The Hand. Vol. IV. Philadelphia; Saunders 1991: 463-486
-
30
Linscheid R L, Dobyns J H, Beabout J W, Bryan R S.
Traumatic instability of the wrist: Diagnosis, classification and pathomechanics.
J Bone Joint Surg [Am].
1972;
54
612-632
-
31
Luchetti R.
Corrective osteotomy of malunited distal radius fractures using carbonated hydroxyapatite as an alternative to autogenous bone grafting.
J Hand Surg [Am].
2004;
29
825-834
-
32
Mann F A, Kang S W, Gilula L A.
Normal palmar tilt: Is dorsal tilting really normal?.
J Hand Surg [Br].
1992;
17
315-317
-
33
Melendez E M.
Opening-wedge osteotomy, bone graft, and external fixation for correction of radius malunion.
J Hand Surg [Am].
1997;
22
785-791
-
34
Miyake T, Hashizume H, Inoue H, Shi Q, Nagayama N.
Malunited Colles' fracture. Analysis of stress distribution.
J Hand Surg [Br].
1994;
19
737-742
-
35
Müller L P, Klitscher D, Rudig L, Mehler D, Rommens P M, Prommersberger K J.
Locking plates for corrective osteotomy of malunited dorsally tilted distal radial fractures: a biomechanical study.
J Hand Surg [Br].
2006;
31
556-561
-
36
Nagy L, Büchler U.
Long term results of radioscapholunate fusion following fractures of the distal radius.
J Hand Surg [Br].
1997;
22
705-710
-
37
Pennig D, Gausepohl T, Mader K.
Die Korrektur der fehlgeheilten distalen Radiusfraktur.
Osteosynthese International.
1997;
5
143-150
-
38
Pillukat T, Schoonhoven van J, Prommersberger K-J.
Ist die Korrekturosteotomie der fehlverheilten distalen Radiusfraktur auch beim älteren Menschen indiziert?.
Handchir Mikrochir Plast Chir.
2007;
39
42-48
-
39
Pogue D J, Viegas S F, Patterson R M, Peterson P D, Jenkins D K, Sweo T D, Hokanson J A.
Effects of distal radius fracture malunion on wrist joint mechanics.
J Hand Surg [Am].
1990;
15
721-727
-
40
Prommersberger K J, Fernandez D L.
Nonunion of distal radius fractures.
CORR.
2004;
419
51-56
-
41
Prommersberger K J, Fröhner S C, Schmitt R R, Lanz U.
Rotational deformity in malunited fractures of the distal radius.
J Hand Surg [Am].
2004;
29
110-115
-
42 Prommersberger K J, Fröhner S C, Schoonhoven van J, Schmitt R. Trauma des distalen Unterarmabschnittes. Schmitt R, Lanz U Bildgebende Diagnostik der Hand. Stuttgart; Thieme-Verlag 2003: 176-191
-
43
Prommersberger K J, Lanz U.
Biomechanik der fehlverheilten distalen Radiusfraktur.
Handchir Mikrochir Plast Chir.
1999;
31
221-226
-
44
Prommersberger K J, Lanz U.
Corrective osteotomy of the distal radius through a volar approach.
Tech Hand Upper Extr Surg.
2004;
8
70-77
-
45 Prommersberger K J, Pillukat T. Fractures of the distal radius. Ring D, Cohen M Fractures of the Wrist and Hand. New York; M. Dekker 2006: 137-187
-
46
Prommersberger K J, Ring D, del Pino J G, Capomassi M, Slullitel M, Jupiter J B.
Corrective osteotomy for intraarticular malunion of the distal part of the radius - Surgical technique.
J Bone Joint Surg [Am].
2006;
88 (Suppl 1, Part 2)
202-211
-
47
Prommersberger K J, Schoonhoven van J, Lanz U.
Outcome after corrective osteotomy for malunited fractures of the distal end of the radius.
J Hand Surg [Br].
2002;
27
55-60
-
48
Prommersberger K J, Schoonhoven van J, Laubach S, Lanz U.
Corrective osteotomy for malunited, palmarly displaced fractures of the distal radius.
Eur J Trauma.
2001;
27
16-24
-
49
Ring D, Prommersberger K J, del Pino J G, Capomassi M, Slullitel M, Jupiter J B.
Corrective osteotomy for intra-articular malunion of the distal part of the radius.
J Bone Joint Surg [Am].
2005;
87
1503-1509
-
50
Ring D, Prommersberger K J, Jupiter J B.
Posttraumatic radial club hand.
J Surg Orthop Adv.
2004;
13
161-165
-
51
Ring D, Roberge C, Morgan T, Jupiter J B.
Osteotomy for malunited fractures of the distal radius: a comparison of structural and non-structural autogenous bone graft.
J Hand Surg [Am].
2002;
27
216-222
-
52
Rozental T D, Bozentka D J, Katz M A, Steinberg D R, Beredjiklian P K.
Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.
J Hand Surg [Am].
2001;
26
244-251
-
53
Schabus R, Kwasny O, Wagner M, Piza H.
Differenzierte Behandlung des posttraumatischen Karpaltunnelsyndroms.
Handchir Mikrochir Plast Chir.
1987;
19
217-220
-
54
Schober F, Schoonhoven van J, Prommersberger K J, Lanz U.
Die Hemiresektions-Interpositionsarthroplastik nach Bowers zur Behandlung der posttraumatischen Arthrose des distalen Radioulnargelenks nach distaler Radiusfraktur.
Handchir Mikrochir Plast Chir.
1999;
31
378-382
-
55
Schoonhoven van J, Fernandez D L, Bowers W H, Herbert T J.
Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis.
J Hand Surg [Am].
2000;
25
438-446
-
56
Schoonhoven van J, Herbert T J, Fernandez D L, Prommersberger K J, Krimmer H.
Ulnar head prosthesis.
Orthopäde.
2003;
32
809-815
-
57
Schoonhoven van J, Prommersberger K J, Lanz U.
Die Bedeutung des distalen Radioulnargelenks bei rekonstruktiven Eingriffen nach fehlverheilten körperfernen Speichenbrüchen.
Orthopäde.
1999;
28
864-871
-
58
Shea K, Fernandez D L, Jupiter J B, Ring D.
Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius.
J Bone Joint Surg [Am].
1997;
79
1816-1826
-
59
Short W H, Palmer A K, Werner F W, Murphy D J.
A biomechanical study of distal radial fractures.
J Hand Surg [Am].
1987;
12
529-534
-
60
Taleisnik J, Watson H K.
Midcarpal instability caused by malunited fractures of the distal radius.
J Hand Surg [Am].
1984;
9
350-357
-
61
Tang J B, Ruy J, Omokawa S, Han J, Kish V.
Biomechanic evaluation of wrist motor tendons after fractures of the distal radius.
J Hand Surg [Am].
1999;
24
121-132
-
62
Viegas S F.
A minimally invasive radial osteotomy for treatment of distal radius fracture malunion.
Tech Hand Upper Extr Surg.
1997;
1
70-76
-
63
Wada T, Isogai S, Kanaya K, Tsukahara T, Yamashita T.
Simultaneous radial closing wedge and ulnar shortening osteotomies for distal radius malunion.
J Hand Surg [Am].
2004;
29
264-272
-
64
Werner F W, Glisson R R, Murphy D J, Palmer A K.
Force transmission through the distal radioulnar carpal joint: effect of ulnar lengthening and shortening.
Handchir Mikrochir Plast Chir.
1986;
18
304-308
-
65
Werner F W, Palmer A K, Fortino M D, Short W H.
Force transmission through the distal ulna: Effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius.
J Hand Surg [Am].
1992;
17
423-428
-
66
Wright T.
Osteotomy for distal radius malunion.
Tech Hand Upper Extr Surg.
2000;
4
222-235
-
67
Yasuda M, Masada K, Iwakiri K, Takeuchi E.
Early corrective osteotomy for a malunited Colles' fracture using a volar approach and calcium phosphate bone cement: a case report.
J Hand Surg [Am].
2004;
29
1139-1142
-
68
Zimmermann R, Gabl M, Arora R, Rieger M.
Computerassistierte Planung und Korrekturosteotomie nach fehlverheilter distaler Radiusfraktur.
Handchir Mikrochir Plast Chir.
2003;
35
333-337
Priv.-Doz. Dr. med. Karl-Josef Prommersberger
Klinik für Handchirurgie
Salzburger Leite 1
97615 Bad Neustadt/Saale
Email: hael@handchirurgie.de
