Klassifikation und Therapie von ellengelenknahen Verletzungen

Fractures and luxations in the range of the upper arm and forearm close to the elbow are rare in adults. The early diagnosis and correct therapy is very important to restore the function of the complex elbow joint. Distal humeral fractures AO type B and C often go along with neurological lesions. The therapy as a rule is open reduction and internal fixation. The most common classification of olecranon fractures is named after Schatzker. The classification considers the type of osteosynthesis, which is needed subject to the number of fracture fragments. Fractures of the processus coronoideus are often associated with luxation of the elbow and are classified according to Regan and Morrey. Depending on fracture type and level of stability of the elbow joint, conservative or operative therapy is recommended. The Mason classification is widely accepted for fractures of the radial head. The simple type of fracture is treated conservatively, while dislocated fractures and more fragmented fractures necessitate osteosynthesis or resection. In cases of joint instability after resection, a radial head prosthesis should be implanted. Separately the Monteggia injury, the Essex-Lopresti injury and "terrible triad" injury as severe combined lesions of the elbow joint are reviewed. All types of injuries are frequently under-diagnosed at first visitation and result in poor functional outcome. Luxation of the elbow joint requires a rapid reposition after analgesic sedation.