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36. Olekranonfrakturen

Author

Hackl, M., Rausch, V., Ries, C., Müller, L., and Wegmann, K.

Abstract

Olekranonfrakturen stellen eine häufige Ellenbogenverletzung dar; ihre Therapie erfolgt üblicherweise operativ. Bei geriatrischen Patienten ist, abhängig von der Frakturform, eine konservative Behandlung zu diskutieren. Die anatomischen Besonderheiten der proximalen Ulna müssen im Rahmen der operativen Therapie berücksichtigt werden. Die Zuggurtung gilt als Standardverfahren für einfache Frakturen und erzielt gute klinische Ergebnisse. Die Plattenosteosynthese ist v. a. bei komplexeren Frakturen indiziert. Sie erlaubt eine stabilere Osteosynthese und wird daher heutzutage auch für einfache Frakturen von vielen Operateuren bevorzugt. Beide Verfahren führen mehrheitlich zur Notwendigkeit einer Materialentfernung infolge persistierender Weichteilirritationen. Moderne Niedrigprofilplatten könnten die Anzahl an Materialentfernungen durch bessere Weichteildeckung reduzieren. Die bisher diesbezüglich verfügbaren klinischen Daten sind vielversprechend, jedoch begrenzt. Olecranon fractures represent a common elbow injury and they are usually treated operatively. Depending on fracture morphology conservative therapy can be considered in geriatric patients. When surgical treatment is performed the anatomical features of the proximal ulna have to be taken into consideration. Tension band wiring is considered a standard procedure for simple fractures and provides good clinical results. Plate osteosynthesis is indicated for more complex fracture patterns. Nowadays, many surgeons prefer plate fixation over tension band wiring even for simple fractures as it leads to a more stable fixation. Both methods frequently require hardware removal for persisting soft tissue irritation. The use of modern low-profile plates could reduce the need for implant removal due to better soft tissue coverage. The available clinical data regarding low-profile plates are promising but limited.

Published
2024
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50. Elbow prosthesis after acute fractures Indications and technique

Author

Leschinger, T., Hackl, M., Lanzerath, F., Krane, F., Harbrecht, A., Wegmann, K., Mueller, L. P., Leschinger, T., Hackl, M., Lanzerath, F., Krane, F., Harbrecht, A., Wegmann, K., and Mueller, L. P.

Abstract

Good to very good clinical results can be achieved in older patients with the implantation of a total elbow prosthesis in cases of distal humeral fractures by taking the morphological features of the fractures, the bone quality as well as the individual patient requirements and variables into account. The most commonly used design is the cemented semiconstrained linked total elbow endoprosthesis. The unlinked prosthesis design and hemiarthroplasty require intact or adequately reconstructable musculoligamentous structures or condyles and a preserved or replaced radial head. The recommended weight limit after total elbow prosthesis as well as potential intraoperative and postoperative complications must be considered and discussed with the patients. A secondary total elbow arthroplasty is also possible after primary conservative treatment approaches, e.g., in the case of contraindicated surgery in the fracture situation, persistent pain and functional restrictions. This article provides an overview of the technique and the appropriate indications.

Published
2022

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