Typische Frakturen und Luxationen am Ellenbogengelenk und deren Behandlung

Diagnosis and treatment of injuries to the elbow joint place high demands on the treating physicians. The complex anatomy of the elbow joint enables a wide range of movement and complex functions in everyday and professional life. These must be restored in the event of injury.Clinical and imaging-based diagnostic procedures serve to classify typical injuries of this joint according to a large variety of different pathologies. These include fractures of the distal humerus, the proximal ulna, and the radial head, as well as dislocations and dislocation fractures.The following article gives an overview of the most common of these injuries.     

Injury in rugby league

It was the purpose of this review to document the range, incidence, location and mechanism of injury occurring in the sport of rugby league. Rugby league is a collision sport played in Europe and the Pacific regions including Australia. The sport is well established and has competitions ranging from junior to elite professional. Due to the contact nature of the game, injury is relatively common. The most common injuries are musculotendinous in nature and afflict the lower limb more frequently than elsewhere. Despite the high incidence of minor (sprains/strains) to moderate musculoskeletal injury (fracture, ligament and joint injury) and minor head injuries such as lacerations, nasal fractures and concussions, rare more serious spinal cord and other injuries causing death have also been recorded. The literature on rugby league injury is small but growing and suffers from a lack of consistent definition of what an injury is, thereby causing variability in the nature and incidence/prevalence of injury. Information is lacking on the injury profiles of different age groups. Importantly, there has been little attempt to establish a coordinated injury surveillance program in rugby league in the junior or professional levels. The implementation of such programs would require a universal definition of injury and a focus on important events and competitions. The implementation could provide important information in the identification and prevention of risk factors for injury.     

Little league elbow: valgus overload injury in the paediatric athlete

This article describes a variety of elbow injuries often seen in young, throwing athletes. Understandings of normal skeletal development, as well as the biomechanics of throwing, provide a basis on which to evaluate, diagnose and manage "little league elbow". With emphasis on an anatomically-based differential diagnosis, the pathologic forces placed upon the young thrower's elbow, and the subsequent injury patterns, are reviewed. Medial side injuries are the most common and relate to chronic forces of valgus overload produced during the early and late cocking phases of throwing. The majority of this force is placed on the medial epicondyle and produces age-dependent injury patterns, such as apophysitis in childhood and epicondylar avulsion fractures in the more mature athlete. With repetitive valgus overload, lateral side injuries such as Panner's disease and osteochondritis dissecans of the capitellum and radial head become more apparent. These injuries relate to the compressive forces produced by the late cocking and early acceleration phases of throwing. Finally, posterior injury patterns consistent with olecranon apophysitis and posteromedial impingement, as well as flexion and capsular contracture, can be seen. The key in the treatment of "little league elbow" is prevention and this responsibility lies not only with the evaluating or team physician, but also with the coach, trainer, parents and officials. Proper throwing mechanics must be emphasised at an early age, and the determinants of elbow injury among young pitchers better understood. Early recognition and proper treatment of such injuries will then prevent later sequelae or functional disability.     

Distal clavicle fracture radiography and treatment: a pictorial essay

Fractures of the distal clavicle represent 15–30% of all clavicle fractures. The local osseoligamentous anatomy and deforming forces result in increased risk of delayed union and nonunion than fractures in other parts of the clavicle. These factors also contribute to challenges in fracture repair. Understanding these injuries and their imaging features enhances care and ensures patients are directed to appropriate management. We review the anatomy of the distal clavicle and surrounding ligaments, options for radiographic evaluation, relevant classification systems, and current concepts in management. Illustrative examples of specialized views are provided. Pediatric acromioclavicular joint pseudosubluxation is also reviewed, with findings specific to that injury.     

A 1‐year prospective analysis of injuries in amateur and elite fistball

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport‐specific exposure, 240 players reported 492 injuries, representing an overall injury rate of 12.2 injuries/1000 h of exposure. Most injuries were classified as bagatelle injuries (67.8%). The majority of the injuries were located in the knee (23.5%) followed by the elbow (11.9%) and the hip (11.5%). Ankle injuries resulted in the longest impairment from sports participation. The most common types of injury were abrasions (38.2%), contusions (21.1%), distortions (7.5%) and muscle strains (6.9%). Wrong or insufficient equipment (15.0%) was the most commonly mentioned causes of injury. The data indicate that the injury risk in fistball is rather high; however, the sport should not be considered a high‐risk sport because most of the injuries are slight and do not prevent the players from training or competition. Injury prevention strategies should include the development of fistball‐specific protective equipment with focus on the knee and elbow joint.     

Hand injury patterns in softball players using a 16 inch ball

Softball is a popular recreational and competitive sport among both men and women. The injury rate in softball players is as high as that in baseball and basketball players. We conducted a retrospective analysis of 119 hand injuries in 108 patients treated at the University of Chicago hand clinic. All of the injuries were caused by the impact of a 16 inch circumference softball. Of the 119 injuries, 87 (73%) had bone involvement. Operative treatment was required in 26 (22%) injuries, 23 involving fractures and 3 involving soft tissue only. There was one (3.8%) operative complication. Of all injuries, 101 (86%) involved the finger joints, including 46 (39%) injuries to the distal interphalangeal (DIP) joint, 48 (40%) to the proximal interphalangeal (PIP) joint, and 7 (6%) to the metacarpophalangeal (MCP) joint. The most common DIP joint injury was a mallet injury. This fracture, the most common single type of injury in our series, accounted for 27% of all injuries. Of all mallet injuries, 86% were fractures. The most common PIP joint injury was a volar plate fracture, the second most common injury in our series. Variables such as the patient's sex, dominance or nondominance of hands, and early or late season play were not associated with a higher risk of injury. Certain parts of the hand, such as the more ulnar digits and the DIP and PIP joints, were at particularly high risk of injury.     

Pediatric elbow fractures: MRI evaluation

Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11–12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8]. Most elbow fractures suspected to be unstable by clinical and radiographic evaluation are operated upon without additional imaging. Occasionally, arthrography or computed arthrography are used to assess epiphyseal extension and cartilaginous malignment [1, 3, 4]. Because of its ability to depict cartilage, MRI provides a noninvasive means of gaining information regarding the nonossified epiphysis. The purpose of this article is to present our preliminary experience using magnetic resonance imaging (MRI) for the detection of articular extension of elbow fractures and determination of displacement of fragments.     

191例儿童肘关节创伤X线诊断及预后评估

目的：回顾性研究儿童肘关节创伤X线诊断,方法：收集儿童肘关节创伤X线资料191例,其中骨骺损伤60例,髁上骨折112例,肘关节脱位12例,尺骨鹰嘴骨折并桡骨小头骨折2例,和桡骨小头脱位5例。结果：肘关节囊脂肪垫X线征阳性109例;53例骨骺分离合并有干骺端骨折;髁上骨折愈合复便发现肘内翻畸形24例,骨化性肌炎11例,结论：肘关节囊脂肪垫X线征阳性是肘关节骨折或脱位的一个重要间接征象,出现率达575;肘关节骨骺损伤中大多数合并有干骺端骨折（88．3％）;髁上骨折肘内翻发生率低,而骨化性肌炎较常见。     

Uniquely pediatric upper extremity injuries

The pediatric population is prone to unique upper extremity injuries that are not typically seen in adults. The normal dynamic maturation pattern of ossification centers and open physis can potentially confuse radiologists who are not familiar with the pediatric patients. In this review article, we discuss the normal anatomy and commonly encountered acute and chronic upper extremity injuries such as supracondylar distal humeral fracture and osteochondritis dissecans, in pediatric patients. Diagnosing the correct type of fracture (e.g., buckle vs Salter-Harris) is important for proper management of the injury. With an increasing number of adolescents participating in competitive sports, specific sports related injuries such as little league shoulder, gymnast wrist, and medial epicondyle apophysitis, are also discussed in this review. We examine late complications of injuries, such as physeal bar formation and fishtail deformity of the distal humerus.     

Acromioclavicular joint instability—reconstruction indications and techniques

Injuries to the acromioclavicular joint are common and may lead to instability or degenerative changes requiring surgical intervention. The spectrum of injury ranges from sprain to disruption of the acromioclavicular and coracoclavicular ligaments, which provide horizontal and vertical stability to the distal clavicle. Most injuries are the result of direct trauma to the acromioclavicular joint. The majority of injuries can be nonoperatively managed. However, with significant disruption to the surrounding supportive structures, painful instability may result. Multiple stabilization procedures for the acromioclavicular joint have been described. Many of these techniques have fallen out of favor due to high complication rates. Common reconstruction techniques include either coracoclavicular ligament reconstruction with or without clavicle resection (ie, modified Weaver-Dunn) or coracoclavicular stabilization (ie, with Bosworth screw) with repair or reconstruction of the coracoclavicular ligaments. The purpose of this paper is to review the basic anatomy, biomechanics, and treatment of acromioclavicular joint instability.     

肘关节骨折-脱位

单纯的肘关节脱位通过非手术治疗可能取得满意疗效,遗留的后遗症较少.而肘关节骨折-脱位即复杂肘关节脱位,即肘关节脱位合并有桡骨或(和)尺骨骨折时,治疗较为棘手,并常需要手术治疗,较容易发生并发症.该损伤可能分为4个常见的类型,确定损伤的类型有助于决定理想的治疗方案.治疗肘关节骨折-脱位的原则包括:(1)恢复肱尺关节,复位肘关节脱位,尺骨近端(冠状突、鹰嘴)骨折的复位内固定;(2)如果肱尺关节不能恢复到正常,通过复位内固定或置换治疗桡骨头骨折,恢复其对肘关节的稳定作用;(3)侧副韧带损伤应该予以修复.     

Radiologic review of total elbow, radial head, and capitellar resurfacing arthroplasty

The use of metal and pyrolytic carbon radial head implants, capitellar resurfacing, and total elbow arthroplasty has become common in contemporary orthopedic surgery practice. The goal of total elbow arthroplasty is to decrease pain and restore an acceptable range of motion to the elbow joint. Rheumatoid arthritis is the primary indication for total elbow arthroplasty; newer indications include primary or posttraumatic osteoarthritis, fracture nonunion, acute comminuted fractures of the elbow, and postoperative resection of a neoplasm. Unlike total elbow arthroplasty, radial head replacement is most commonly performed in patients with trauma. Radial head fractures account for 33% of all elbow fractures in adults and are often associated with ligament disruption and valgus instability at the elbow. The goals of capitellar resurfacing arthroplasty include prevention of secondary osteoarthritis of the radiocapitellar joint and erosion in patients with radial head arthroplasty. Effective postoperative radiologic assessment of these different types of elbow reconstructions requires an understanding of their basic component design, physiologic purpose, and normal postoperative appearance, as well as the appearance of complications. Radiologists may have little training and experience with these new orthopedic devices.     

Management of clavicle fractures

Fractures of the clavicle are relatively common injuries that can occur in patients of all ages. The history and physical examination remain the primary means of diagnosing this injury. Plain radiographs are helpful to confirm the diagnosis and to provide information regarding fracture classification, prognosis, and treatment options. The emphasis of this article is on the management of these injuries. Historically, only unstable distal clavicle fractures were treated operatively. However, recent well-conducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and non-union, compared with non-operative treatment. For clavicle fractures managed non-operatively, the sling-and-swathe or figure-of-eight splints remain appropriate options. Multiple factors should be considered when counseling an athlete on the appropriate time to return to sports participation after a clavicle fracture.     

肩肘背带外固定治疗锁骨外端骨折及肩锁关节脱位

锁骨外端骨折或肩锁关节脱位后,由于斜方肌的作用,锁骨外端或骨折近端向上向背侧移位,复位后不易固定。作者采用自制肩肘背带外固定治疗锁骨外端骨折13例和肩锁关节脱位8例,由于纵形背带压锁骨向下,肘托托肘关节向上,使骨折或脱位得到整复,4～8周后除去外固定进行功能练习,平均随访10个月,均取得满意效果。     

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete‐days

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7‐day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete‐days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete‐days (95% CI 24.0–42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8–29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.     

Incidence of injury in junior and senior rugby league players

Rugby league is an international collision sport played at junior, amateur, semi-professional and professional levels. Due to the high numbers of physical collisions and tackles, musculoskeletal injuries are common. A large percentage of injuries result in long-term employment and study limitations, medical costs and loss of income. Review articles addressing the applied physiology of rugby league and common rugby league injuries have been published. However, both of these review articles have focused on the professional rugby league player. This review addresses the extent of the injury problem in rugby league in all levels of competition (i.e. junior, amateur, semi-professional and professional). The incidence of rugby league injuries typically increases as the playing level is increased. The majority of studies have shown that the head and neck is the most common site of match injuries in senior rugby league players, while knee injuries are the most common site of injury in junior rugby league players. Muscular injuries are the most common type of injury sustained by senior rugby league players, while junior rugby league players more commonly sustain fractures. Injuries are most commonly sustained in tackles, by the tackled player. Thigh and calf strains are the most common injuries sustained during rugby league training, while overexertion is the most common cause of training injuries. Player fatigue may influence the incidence of injury, with most sub-elite (amateur and semi-professional) rugby league injuries occurring in the second half of matches or the latter stages of training sessions. The majority of training injuries occur in the early stages of the season, while match injuries occur in the latter stages of the season, suggesting that changes in training and playing intensity may influence the incidence of injury in rugby league. Injury prevention studies are required to reduce the incidence, severity and cost of rugby league injuries. These injury prevention strategies could include coaching on defensive skills, correct tackling technique, correct falling technique and methods to minimise the absorption of impact forces in tackles. Game-specific attacking and defensive drills practised before and during fatigue may also encourage players to make appropriate decisions under fatigued conditions and apply learnt skills during the pressure of competitive matches. Further studies investigating risk factors for injury in junior and senior rugby league players, injuries sustained by specific playing positions and the influence of injuries on playing performance are warranted.     

Golf and racquet sports injuries

There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.     

Unique distal clavicular fracture in an active-duty military population

We present a series of distal clavicle fractures in which the coracoclavicular ligaments remain intact to the proximal segment, but the distal aspect of the clavicle is displaced superiorly. The fractures sustained in this series are not described in any of the multiple classification systems currently in use for clavicular fractures. We present a series of 2 active-duty patients who sustained nearly identical distal clavicle fractures during Army combatives training. A 23-year-old male was treated successfully with nonoperative therapy and returned to deployment within 2 months. A 23-year-old female failed nonoperative treatment and was successfully treated with an operative open distal clavicle resection. This rare fracture attributed to a specific mechanism of injury has a potential to be commonly encountered in active-duty patients taking part in mandatory combatives programs.     

Mountain biking injuries in rural England

BACKGROUND: Off road mountain biking is now an extremely popular recreation and a potent cause of serious injury. AIM: To establish the morbidity associated with this sport. METHODS: Data were collected prospectively over one year on all patients presenting with an injury caused by either recreational or competitive off road mountain biking. RESULTS: Eighty four patients were identified, 70 males and 14 females, with a mean age of 22.5 years (range 8-71). Most accidents occurred during the summer months, most commonly in August. Each patient had an average of 1.6 injuries (n = 133) and these were divided into 15 categories, ranging from minor soft tissue to potentially life threatening. Operative intervention was indicated for 19 patients (23%) and several required multiple procedures. The commonest injuries were clavicle fractures (13%), shoulder injuries (12%), and distal radial fractures (11%). However, of a more sinister nature, one patient had a C2/3 dislocation requiring urgent stabilisation, one required a chest drain for a haemopneumothorax, and another required an emergency and life saving nephrectomy. CONCLUSION: This sport has recently experienced an explosion in popularity, and, as it carries a significant risk of potentially life threatening injury across all levels of participation, the use of protective equipment to reduce this significant morbidity may be advisable.     

肘关节“恐怖三联征”的诊断和治疗

目的：通过对13例患者临床资料进行系统性回顾分析,探讨肘关节“恐怖三联征”的诊断、治疗策略以及术后康复。方法我科2010年3月～2013年9月,共收治这类损伤13例,均采取手术内外固定治疗。其中桡骨头骨折按Mason和Hotchkiss分类法：Ⅰ型7例,Ⅱ型4例,Ⅲ型2例。尺骨冠状突骨折按Regan和Morry分类法：Ⅰ型4例,Ⅱ型6例,Ⅲ型3例。本组病例中均合并有肘内外侧副韧带的损伤。13例均采取了手术内外固定治疗,以2.0、2.7、3.0mm螺钉分别固定冠状突骨折和桡骨头骨折,其中2例因桡骨头粉碎骨折无法修复,行桡骨小头置换术,内外侧副韧带损伤均采用带线锚钉固定,13例病例均使用带铰链的外支架屈肘90°前臂旋转中立位固定,术后即在外固定支架保护下行肘关节屈伸功能锻炼,4周后拆除外固定支架主动行肘关节屈伸和旋转功能锻炼。结果经3个月～3年随访,骨折愈合,肘关节稳定,无疼痛,肘关节屈伸幅度平均120°,前臂旋转幅度平均110°。 Mayo肘关节功能评分（MEPS）显示,优10例,良2例,差1例。结论肘关节“恐怖三联征”不仅有桡骨头及冠状突骨折,同时伴有肘内外侧副韧带损伤,肘关节稳定性差。只有通过对骨及韧带稳定结构的重建,配合及早正规的功能锻炼,肘关节功能才能获得满意的效果。