Zusammenfassung
Traumatische Rupturen des TFCC können unterteilt werden in Läsionen, die keine Instabilität des DRUG verursachen und Läsionen, die einer Avulsion der ulnoradialen Bänder entsprechen und zu einer klinisch – zumindest bei subtiler Untersuchung – nachweisbaren Instabilität des DRUG führen. Zur Behandlung der Instabilität wurden in den letzten Jahren Verfahren zur Reinsertion des TFCC bzw. des ulnoradialen Bandapparats entwickelt, die verlässlich die Schmerzen bessern oder beseitigen und die Funktion und Belastbarkeit des Arms weitgehend wiederherstellen. Allerdings muss nicht jede traumatische Ruptur operativ versorgt werden. Eine Reinsertion ist auch nach mehreren Monaten noch möglich. Kontraindikationen, besonders Fehlstellungen des Knochens nach früherer Unterarmfraktur oder Ulna-Impaction-Situation, sind sorgfältig zu beachten.
Diagnostik und Operationsindikation werden diskutiert sowie eine Übersicht über die verschiedenen Techniken gegeben.
Abstract
Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or—very rarely—from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ. Several arthroscopic and open repair techniques have been described in the last years. Contraindications such as the ulna—plus—situation or instability due to even minor degrees of malunion after fractures of the forearm bones must be kept in mind.
An overview is given of the pathological anatomy, diagnosis, indications and suturing techniques.
Abbreviations
- DRUG:
-
Distales Radioulnargelenk
- ECU:
-
Extensor carpi ulnaris
- PDS:
-
Polydioxanon
- PSU:
-
Processus styloideus ulnae
- SSF:
-
Strecksehnenfach
- TFCC:
-
„Triangular fibrocartilage complex“
- UVO:
-
Ulnaverkürzungsosteotomie
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Danksagung
Herzlichen Dank an Anna Kiraly und an Dr. Szabolz Kiraly für die anschaulichen Zeichnungen.
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Tünnerhoff, HG. Nahttechniken am Diskus. Orthopäde 47, 655–662 (2018). https://doi.org/10.1007/s00132-018-3595-7
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DOI: https://doi.org/10.1007/s00132-018-3595-7