Traumatische und posttraumatische Spezialfälle am Ellbogen


Traumatische und posttraumatische Spezialfälle am Ellbogen

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Drei versierte Extremitätenchirurgen stellen hier ihre Lösungsvorschläge zu traumatischen und posttraumatischen Spezialproblemen vor.

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Als instabile Osteosynthese im Bereich des Ellenbogengelenks definieren wir eine nicht übungsstabile Osteosynthese. Kräfte, die bei einer funktionellen Nachbehandlung auf die Fraktur wirken, führen bei den betroffenen Patienten zu sekundären Dislokationen und/oder Frakturheilungsstörungen. Daneben kommt es zu Implantatlockerungen und -brüchen. Eine Osteosynthese kann primär, d. h. bereits unmittelbar postoperativ, oder sekundär instabil sein.
The authors describe a technique for repair of the biceps tendon rupture from the radial tuberosity. A single anterior incision, limited volar dissection, and implantable bone anchors were used. With this technique, the authors have repaired the distal biceps tendon in 5 men (mean age, 39 years). Four patients were laborers and 1 was an athlete. Mechanism of injury was a single traumatic event with an unanticipated large load being applied to the flexed arm. Four patients were treated acutely and 1 was treated 6 months after injury. All patients returned to preinjury activity levels by 5 months after repair of the tendon. Clinically, all repairs remained intact (mean followup, 2.5 years). Range of motion was symmetric. No evidence of associated nerve injuries, heterotopic bone formation, or olecranon tenderness occurred. Subjective, as well as objective, results were excellent in those 5 patients whose distal biceps tendon was repaired by the single volar incision and implantable anchors.
We report ten cases of rupture of the distal part of the tendon of biceps brachii in patients aged from 27 to 58 years. MRI allowed assessment of the degree of retraction of the tendon which was related to the integrity of the bicipital expansion. When the retraction exceeded 8 cm the expansion was always ruptured. When there was doubt, or in longstanding injury, MRI allowed the lesions to be defined. Surgical repair was by reinsertion on the radial tuberosity at one or two fixation points in eight patients and reinsertion on the anterior brachial muscle in one. The other patient refused surgery. The MRI findings were confirmed at operation. Use of fixation points allowed minimal intervention, thereby reducing the risk of damaging the radial nerve. One year after operation, dynamometric evaluation of the strength of flexion and supination confirmed that the best results were obtained by reinsertion to the radial tuberosity.
Distal rupture of the tendon of the biceps brachii
  • Le Huec
  • D Moinard
  • M Liquois
  • F Zipoli
  • B Chaveaux
  • Le Rebeller
  • D Huec Le