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Initiales Management der traumatischen ventralen Schultererstluxation

Initial management of traumatic ventral shoulder dislocation

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Zusammenfassung

Hintergrund

Die Therapiekonzepte der primärtraumatischen ventralen Schulterluxation werden in der Literatur weiterhin kontrovers diskutiert. Während über die Abläufe des initialen Managements weitestgehend Einigkeit herrscht, ist die folgende Therapieplanung von unterschiedlichen Faktoren abhängig.

Ziel der Arbeit

In dieser Übersichtsarbeit sollen die entscheidenden Aspekte zum initialen Vorgehen in der Rettungsstelle, der klinischen und radiologischen Diagnostik sowie die sich daran anschließenden Behandlungsmöglichkeiten erläutert werden.

Material und Methoden

Eine strukturierte Literaturrecherche mit Auswertung entsprechender klinischer und Grundlagenstudien unter Berücksichtigung der eigenen klinischen Erfahrung diente der Erstellung dieses Beitrags.

Ergebnisse

Zur Diagnosestellung ist neben einer fokussierten Anamnese und klinischen Untersuchung ein Nativröntgen in 2 Ebenen zielführend. Auf mögliche Nervenschädigungen oder Frakturen sollte vor und nach Reposition geachtet und diese dokumentiert werden. Das Repositionsmanöver nach Matsen ist aufgrund der schonenden Durchführung zu empfehlen. Im seltenen Fall einer irreponiblen Luxation durch eine Weichteil- oder knöcherne intraartikuläre Interposition kann eine offene Reposition notwendig werden. Das weitere therapeutische Vorgehen richtet sich entscheidend nach dem Alter, Aktivitätsniveau und Begleitpathologien, welche das Risiko einer Rezidivluxation bestimmen. Bei knöchernen Begleitverletzungen sowie jungen und sportlich aktiven Patienten wird die operative Schulterstabilisierung empfohlen.

Schlussfolgerungen

Ein strukturierter Behandlungsablauf ist für das initiale Management der primärtraumatischen ventralen Schulterluxation essenziell. Ein allgemein gültiger Therapiealgorithmus für die weitere Behandlung existiert nicht. Unter Berücksichtigung instabilitätsassoziierter und patientenspezifischer Faktoren sollte die Therapie individuell festgelegt werden.

Abstract

Background

In the current literature a consensus on the specific management of primary anterior traumatic shoulder instability has not been reached. While the steps of the initial diagnostic and therapeutic procedures are mostly well-defined, a variety of factors need to be considered for the planning of further treatment.

Objective

This article aims at giving an overview of the essential aspects of the initial management in the rescue center, clinical and radiological diagnostic procedures and the subsequent treatment options.

Material and methods

The content of this article is based on our own clinical experiences in combination with a systematic literature search for relevant clinical and baseline studies.

Results

Besides a detailed anamnesis and clinical examination, X‑rays in two planes are important for the diagnosis. Potential nerve injuries or fractures need to be borne in mind before and after reduction of the joint and documented accordingly. The Matsen’s maneuver can be recommended as it enables a careful repositioning. In rare cases of an irreducible shoulder dislocation due to soft tissue or bony articular interpositions, an open reduction might be necessary. Further therapeutic concepts should be adapted to patient age, activity level and accompanying pathologies, which determine the risk of a recurrent dislocation. A surgical approach for stabilization of the shoulder is highly recommended in cases of concomitant bony defects as well as in young and physically active patients.

Conclusion

A well-structured treatment plan is essential for the initial management of primary anterior traumatic shoulder instability. A generally applicable algorithm for further management is not yet established. The treatment should therefore be individually planned based on patient-specific characteristics.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    M. Minkus, E. Böhm,  P. Moroder &  M. Scheibel

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  1. M. Minkus
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  2. E. Böhm
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  3. P. Moroder
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  4. M. Scheibel
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Correspondence to M. Scheibel.

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Interessenkonflikt

M. Minkus und E. Böhm geben an, dass kein Interessenkonflikt besteht. PD Dr. med. univ. P. Moroder ist Berater der Firma Arthrex. Univ.-Prof. Dr. med. M. Scheibel ist Berater der Firma Arthrex und der Firma DJOGlobal.

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

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Minkus, M., Böhm, E., Moroder, P. et al. Initiales Management der traumatischen ventralen Schultererstluxation. Unfallchirurg 121, 100–107 (2018). https://doi.org/10.1007/s00113-017-0405-3

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