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Skaphoidpseudarthrose ohne Durchblutungsstörung

Management und Standardverfahren der primären Behandlung
  • S. Yarar-SchlickeweiEmail author
  • K. H. Frosch
  • C. Schlickewei
Leitthema

Zusammenfassung

Die Skaphoidpseudarthrose ist eine ernst zu nehmende und schwerwiegende Komplikation oft insuffizient behandelter oder zu spät diagnostizierter Skaphoidfrakturen. Ihre Behandlung ist anspruchsvoll und sollte durch in der Handchirurgie erfahrene Ärzte erfolgen. Die anatomische Form, die retrograde Blutversorgung und die Biomechanik des Skaphoids erschweren die Heilung. Eine verzögerte oder ausbleibende Frakturheilung des Skaphoids führt zu anhaltenden Schmerzen, Bewegungseinschränkungen und degenerativen Veränderungen im Bereich der Handwurzelknochen und des Handgelenks. Ziel der Behandlung ist die knöcherne Ausheilung der Pseudarthrose unter Rekonstruktion der anatomischen Form und Wiederherstellung der axialen Ausrichtung des Skaphoids. Wichtig ist die differenzierte Anwendung unterschiedlicher Therapieoptionen. Voraussetzungen hierfür sind die sorgfältige Diagnostik sowie die individuelle Klassifizierung der pathologischen Veränderung und der morphologischen Merkmale der Pseudarthrose. Unerlässlich ist die radiologische schnittbildgebende Untersuchung mithilfe der Computertomographie. In der Literatur findet sich kein einheitliches Konzept zur Therapie der Skaphoidpseudarthrose. Die Datenlage erlaubt es nicht, ein signifikant überlegenes Behandlungsverfahren festzulegen. Die häufigste angewendete operative Therapie zur Behandlung der Skaphoidpseudarthrose ist die autologe Knochentransplantation, kombiniert mit einer Schraubenfixierung. Die vorliegende Arbeit gibt einen Überblick über das Management und die Standardverfahren in der primären Behandlung von Skaphoidpseudarthrosen ohne Durchblutungsstörung.

Schlüsselwörter

Humpback-Deformität Avaskuläre Knochennekrose Knochentransplantation Kompressionsschrauben Kirschner-Drähte 

Scaphoid pseudarthrosis without circulatory disorder

Management and standard procedure for primary treatment

Abstract

Nonunion of the scaphoid is a severe complication of often insufficiently treated scaphoid fractures or those which have been diagnosed too late. The treatment of scaphoid nonunion is challenging und should be performed by experienced hand surgeons. The anatomical shape, the retrograde blood supply and the biomechanics of the scaphoid complicate the healing process. A delayed union or nonunion of the fractured scaphoid leads to persistent pain, restricted mobility and degenerative changes of carpal bones and wrist. The goal of treatment is bony healing of the pseudarthrosis with reconstruction of the anatomical shape and restoration of the axial alignment of the scaphoid. A prerequisite is the right choice of the different treatment options available. Fundamental to this is a careful pretherapeutic assessment as well as an individual classification of the pathological alterations and the morphological features of the nonunion. For this purpose, radiological cross-sectional imaging by means of computed tomography is essential. There is no consensus in the literature about the treatment of scaphoid nonunion. The available data do not enable the establishment of a superior treatment procedure. The most common surgical procedure used to treat scaphoid nonunion is autologous bone grafting combined with screw fixation. This article provides an up to date overview of the management and standard procedures for the primary treatment of scaphoid nonunion without a circulatory disorder.

Keywords

Humpback deformity Avascular necrosis of bone Bone transplantation Compression screws Kirschner wires 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Yarar-Schlickewei, K.H. Frosch und C. Schlickewei geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • S. Yarar-Schlickewei
    • 1
    Email author
  • K. H. Frosch
    • 1
  • C. Schlickewei
    • 1
  1. 1.Unfall‑, Hand- und WiederherstellungschirurgieUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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