Skaphoidfrakturen und Skaphoidpseudarthrosen

 

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Zusammenfassung

Die Skaphoidfraktur stellt mit 80 % die häufigste Fraktur der Handwurzelknochen dar. Da frische Skaphoidverletzungen häufig nur diskrete klinische Symptome aufweisen, kann es zu einer verspäteten Frakturerkennung und damit auch Behandlung kommen. Hieraus können sich Skaphoidpseudarthrosen oder nachfolgende Handgelenkarthrosen bis hin zum karpalen Kollaps entwickeln. Eine gründliche klinische Untersuchung sowie eine adäquate radiologische Diagnostik sind daher unerlässlich für die Erkennung und Behandlung von Skaphoidfrakturen. Eine primäre CT-Untersuchung ist dabei obligat. Die Skaphoidfrakturen werden anhand der CT-Klassifikation nach Krimmer u. Herbert unterteilt. Je nach Frakturform ist ein konserva tives oder operatives Vorgehen indiziert. Eine konservative Behandlung ist bei allen stabilen Skaphoidfrakturen möglich. Operativ sollten alle instabilen Bruchformen behandelt werden. Hierzu gibt es verschiedene Formen der operativen Zugangswege und der Osteosynthese. Skaphoidpseudarthrosen sollten operativ durch Osteosynthese und Spongiosaplastik rekonstruiert werden, um die Entwicklung eines karpalen Kollaps zu verhindern.

Abstract

Scaphoid fractures are by 80 % the most common fractures of the carpal bones. Detection and treatment can be delayed due to only slight clinical symptoms, which are often shown by acute injuries of the scaphoid. Pseudarthrosis of the scaphoid developing arthrosis of the wrist or even a carpal collapse can be the consequence. An in-depth clinical examination and adequate radiological diagnostics are essential for the detection and the treatment of scaphoid fractures. A primary examination by CT scan is obligatory. The classification of Krimmer/Herbert in the CT is used to subdivide the scaphoid fractures. Depending on the appearance of the fracture a conservative or surgical approach is indicated. All stable fractures of the scaphoid can be treated conservatively. In all forms of unstable scaphoid fractures surgery is recommended. Different ways of surgical approaches and osteosyntheses are described. Pseudarthrosis of the scaphoid should be surgically reconstructed with osteosynthesis in combination with bone graft to prevent a carpal collapse.

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