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ABSTRACT: Ellenbogensteifen können sich aufgrund vieler Ursachen entwickeln, z.B. intraartikulären und extraartikulären Frakturen,
Weichteilverletzungen, nach langer Immobilisierung, Verbrennungen, Infektionen, entzündlichen Gelenkerkrankungen, bei Arthrose
und heterotopen Ossifikationen.
Die systematische Einteilung der Ellenbogensteifen erfolgt üblicherweise in extrinsische (die Gelenkkapsel und extraartikulären
Weichteile betreffend) und intrinsische Kontrakturen (die Synovialis und das Gelenk bildenden Strukturen betreffend) sowie
in Mischformen.
Die Indikation zur operativen Intervention besteht, wenn die Erkrankung zu einer ausgeprägten Funktionsstörung führt, die
durch konservative Maßnahmen nicht mehr zu verbessern ist. Nach exakter Analyse der zugrunde liegenden Ursache, der betroffenen
Kompartimente und Strukturen sowie der individuellen Bedürfnisse kann eine Operation als arthroskopische Arthrolyse, offene
Arthrolyse, mit einer Endoprothese, einem Distraktionsbewegungsfixateur, einer Interpositionsarthroplastik oder mit kombinierten
Verfahren durchgeführt werden.
An elbow can become stiff for a variety of reasons, such as intra-articular or extra-articular fractures, soft-tissue trauma,
prolonged immobilization, thermal injury, infection, inflammatory arthritis, osteoarthrosis and heterotopic bone formation.
Elbow stiffness is usually classified into extrinsic (affecting the capsule and extra-articular soft tissues), intrinsic (affecting
the synovial and intra-articular structures) and mixed forms.
Indications for operative treatment have to be considered in cases of failed conservative treatment with severe functional
deficits. The choice of operative treatment has to be based on a thorough analysis of the underlying cause, the affected structures,
the pathogenesis and the individual needs. Options are an arthroscopic or open arthrolysis, endoprostheses, hinged external
fixators, interposition arthroplasty or combinations of these procedures.
SchlüsselwörterEllenbogen–Steife–Funktionsstörung–Arthrolyse–Kombinierte Verfahren
KeywordsElbow–Stiffness–Functional disorder–Arthrolysis–Combined procedures
Der Orthopäde 04/2012; 40(4):282-290. · 0.51 Impact Factor
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ABSTRACT: Fehlschläge nach einer operativen Behandlung von einer Schulterinstabilität haben oft vielfältige Ursachen: Eine konstitutionelle
Prädisposition, ein erneutes Trauma, eine falsche Primärdiagnose, eine insuffiziente Voroperation oder eine falsche Nachbehandlung
können beteiligt sein. Entscheidend für den Erfolg der Revision ist eine sorgfältige Fehleranalyse und eine zielgerichtete
Operation, bei der alle wegweisenden Veränderungen erkannt und angegangen werden. Das Management nach einer fehlgeschlagenen
operativen Stabilisierung muss sich am pathologischen Substrat orientieren und dabei eine höhere Komplikationsrate und eine
geringere Erfolgsrate als bei einem Primäreingriff berücksichtigen.
Im Einklang mit der Literatur fanden wir in einer retrospektiven Untersuchung von 61 offenen Revisionen nach überwiegend arthroskopischer
Voroperation nach über 4Jahren bei 6Patienten (9,8%) erneute Luxationen. Bei je einem Patienten waren ein adäquates Trauma
und ein Krampfanfall als Ursache der Luxation festzustellen. Drei weitere Patienten zeigten bei genauerer Untersuchung primär
übersehene Hinweise auf eine Bindegewebserkrankung.
Operative repair of shoulder instability may fail because of multiple causes: a constitutional predisposition, a new trauma,
incorrect diagnosis, inadequate operative techniques or inappropriate rehabilitation can be involved. The key to successful
revision surgery is a thorough analysis of errors of the primary repair and the revision also has to deal with the decisive
pathological factors. The management of revision surgery after failed surgery for patients with instability has to focus on
the decisive pathological factors and has to take a higher complication rate and lower success rate than primary repairs into
account.
In agreement with the literature a retrospective investigation of 61 open revision surgeries after an average follow up of
more 4 years showed recurrent dislocations in 6 patients (9.8%). One of these patients had an adequate trauma and a seizure
as the cause of dislocation. After thorough examination three patients revealed signs of a primarily overlooked connective
tissue disorder.
Der Orthopäde 04/2012; 38(1):75-82. · 0.51 Impact Factor
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ABSTRACT: An elbow can become stiff for a variety of reasons, such as intra-articular or extra-articular fractures, soft-tissue trauma, prolonged immobilization, thermal injury, infection, inflammatory arthritis, osteoarthrosis and heterotopic bone formation. Elbow stiffness is usually classified into extrinsic (affecting the capsule and extra-articular soft tissues), intrinsic (affecting the synovial and intra-articular structures) and mixed forms. Indications for operative treatment have to be considered in cases of failed conservative treatment with severe functional deficits. The choice of operative treatment has to be based on a thorough analysis of the underlying cause, the affected structures, the pathogenesis and the individual needs. Options are an arthroscopic or open arthrolysis, endoprostheses, hinged external fixators, interposition arthroplasty or combinations of these procedures.
Der Orthopäde 04/2011; 40(4):282-90. · 0.51 Impact Factor
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ABSTRACT: Operative repair of shoulder instability may fail because of multiple causes: a constitutional predisposition, a new trauma, incorrect diagnosis, inadequate operative techniques or inappropriate rehabilitation can be involved. The key to successful revision surgery is a thorough analysis of errors of the primary repair and the revision also has to deal with the decisive pathological factors. The management of revision surgery after failed surgery for patients with instability has to focus on the decisive pathological factors and has to take a higher complication rate and lower success rate than primary repairs into account.In agreement with the literature a retrospective investigation of 61 open revision surgeries after an average follow up of more 4 years showed recurrent dislocations in 6 patients (9.8%). One of these patients had an adequate trauma and a seizure as the cause of dislocation. After thorough examination three patients revealed signs of a primarily overlooked connective tissue disorder.
Der Orthopäde 02/2009; 38(1):75-8, 80-2. · 0.51 Impact Factor
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ABSTRACT: Pseudarthroses of the clavicle after fractures of the medial third often present with local pain, compromised shoulder function, or neurovascular symptoms. Reconstruction of normal clavicular anatomy and solid fusion is a prerequisite for good clinical outcome after surgical treatment. In this study, 24 patients with clavicular pseudarthrosis were treated with the anatomical precontoured Meves plate. In 11 patients, additional bone grafting was done.
Nineteen patients could be reexamined with a mean follow-up of 74.5 months. In all of them, solid fusion was achieved.
The Constant score improved from 70.4 points preoperatively up to 82.5 points postoperatively (89.3% age-related). Sixteen patients were satisfied or very satisfied with the operative result.
In our patients, secure healing of clavicular nonunion was achieved with the anatomical precontoured Meves plate, with good or excellent clinical outcomes.
Der Orthopäde 06/2008; 37(5):457-61. · 0.51 Impact Factor
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ABSTRACT: Infections of the shoulder joint are rare but nevertheless carry a high risk of complications. Successful therapy is mostly operative and should be planned according to the causes, stage, and expansion of the infection and the expected spectrum of bacteria. Moreover, the patient's general condition and previous illnesses must be considered. Patients with rheumatoid arthritis and immunotherapy are especially at risk for complications and require special attention. Shoulder infections and periprosthetic infections can be treated with arthroscopy, with open debridement, or, in the case of periprosthetic infections, with one- or two-stage exchange procedures. In cases of noncontrollable infections, resection arthroplasty or arthrodesis can be performed as a last resort. Results and possible complications are described herein, including those based on our own results.
Der Orthopäde 09/2007; 36(8):700-7. · 0.51 Impact Factor
