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Radiologische Diagnostik beim Handgelenktrauma

Radiological procedures in the traumatised wrist

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Zusammenfassung

Verletzungen des Handgelenks sind als Folge der komplexen anatomischen Verhältnisse auf engem Raum schwierig zu diagnostizieren und erfordern eine exakte Beurteilung. Ausgehend von der klinischen Untersuchung können gezielt konventionelle Röntgendiagnostik und Schichtbildverfahren eingesetzt werden. Bei knöchernen Verletzungen ist heute die Spiralcomputertomographie mit multiplanaren Reformatierungen Technik der Wahl. Die Indikation zur Magnetresonanztomographie ist mit gezielter Fragestellung bei der Abklärung von Band- und Weichteilverletzungen oder zur Klärung der Durchblutungssituation und Vitalität zu stellen. Andere Untersuchungsmodalitäten spielen am Handgelenk aktuell eine untergeordnete Rolle. Technische und methodische Innovationen ermöglichen eine zunehmend genauere Visualisierung von Verletzungsart, -ausmaß sowie -klassifikation und damit eine gezieltere Therapie. Voraussetzung zum gezielten Einsatz sind jedoch eine differenzierte Beurteilung und Kenntnis der zur Verfügung stehenden Verfahren.

Abstract

Injuries of the wrist are difficult to diagnose because of the complex and narrow anatomic structures. On the basis of precise clinical examination, X-rays, CT and MRI are valuable additional tools that can be used. In the case of bone injury, spiral computer tomography with multiplanar reformatting is currently the method of choice. MRI is indicated for the identification of soft tissue or ligamentous injury and avital fragments or necrosis. Other diagnostic tools for the wrist are currently of minor importance. Technical and methodological innovations allow ever better visualisation and classification of lesions, as well as their extent, thus enabling more targeted therapy. However, prerequisites of effective use include differential assessment and precise knowledge of the procedures.

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Literatur

  1. Bartelmann U, Kalb K, Schmitt R, Fröhner S (2001) Radiologische Diagnostik der Lunatumnekrose. Handchir Mikrochir Plast Chir 6:365–378

    Article  Google Scholar 

  2. Bley T, Springer O, Kopp J, Horch R (2003) 3D-CT bei Handgelenksfrakturen. Chir Allgemeine 4:13–16

    Google Scholar 

  3. Breitenseher MJ, Trattnig S, Gabler C et al (1997) MRI in radiologically occult scaphoid fractures. Initial experiences with 1.0 Tesla (whole body-middle field equipment) versus 0.2 Tesla (dedicated low-field equipment). Radiologe 10:812–818

    Article  Google Scholar 

  4. Buck-Gramcko D (1985) Scapholunäre Dissoziation. Handchir Mikrochir Plast Chir 4:194–199

    Google Scholar 

  5. Compson JP, Waterman JK, Heatley FW (1997) The radiological anatomy of the scaphoid. Part 2: Radiology. J Hand Surg [Br] 1:8–15

    Google Scholar 

  6. Cooney WP, Bussey R, Dobyns JH, Linscheid RL (1987) Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop 214:136–147

    PubMed  Google Scholar 

  7. Corso SJ, Savoie FH, Geissler WB et al (1997) Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy 1:78–84

    Article  Google Scholar 

  8. De Quervain F (1902) Beitrag zur Kenntnis der kombnierten Frakturen und Luxationen der Handwurzelknochen. Monatschr Unfallheilkd Invalidenwesen 9:3–15

    Google Scholar 

  9. Frahm R, Lowka K, Vinee P (1992) Computerized tomography diagnosis of scaphoid fracture and pseudarthrosis in comparison with roentgen image. Handchir Mikrochir Plast Chir 2:62–66

    Google Scholar 

  10. Garcia-Elias M, An KN, Amadio PC et al (1989) Reliability of carpal angle determinations. J Hand Surg [Am] 6:1017–1021

    Google Scholar 

  11. Gilula LA (1979) Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol 3:503–517

    Google Scholar 

  12. Hahn P, Schmitt R, Kall S (2001) Stener lesion yes or no? Diagnosis by ultrasound. Handchir Mikrochir Plast Chir 1:46–48

    Article  Google Scholar 

  13. Hilgert RE, Dallek M, Radonich H, Jungbluth KH (1998) Trendy inline skating sports. Pattern of injuries and groups at risk. Unfallchirurg 11:845–850

    Article  Google Scholar 

  14. Hindman BW, Kulik WJ, Lee G, Avolio RE (1989) Occult fractures of the carpals and metacarpals: demonstration by CT. AJR Am J Roentgenol 3:529–532

    Google Scholar 

  15. Hocker K, Renner J (1995) Fracture of the lunate – a rare injury. Handchir Mikrochir Plast Chir 5:247–253

    Google Scholar 

  16. Imaeda T, Nakamura R, Shionoya K, Makino N (1996) Ulnar impaction syndrome: MR imaging findings. Radiology 2:495–500

    Google Scholar 

  17. Johnstone DJ, Thorogood S, Smith WH, Scott TD (1997) A comparison of magnetic resonance imaging and arthroscopy in the investigation of chronic wrist pain. J Hand Surg [Br] 6:714–718

    Google Scholar 

  18. Klein HM, Vrsalovic V, Balas R, Neugebauer F (2002) Imaging diagnostics of the wrist: MRI and arthrography/arthro-CT. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2:177–182

    Article  Google Scholar 

  19. Krimmer H, Trankle M, Schober F, Van Schoonhoven J (1998) Ulna impaction syndrome therapy: decompressive surgical procedures of the head of the ulna. Handchir Mikrochir Plast Chir 6:370–374

    Google Scholar 

  20. Krimmer H, Schmitt R, Herbert T (2000) Scaphoid fractures – diagnosis, classification and therapy. Unfallchirurg 10:812–819

    Article  Google Scholar 

  21. Levinsohn EM, Rosen ID, Palmer AK (1991) Wrist arthrography: value of the three-compartment injection method. Radiology 1:231–239

    Google Scholar 

  22. Lichtman DM, Degnan GG (1993) Staging and its use in the determination of treatment modalities for Kienbock’s disease. Hand Clin 3:409–416

    Google Scholar 

  23. Linsenmaier U, Rock C, Euler E et al (2002) Three-dimensional CT with a modified C-arm image intensifier: feasibility. Radiology 1:286–292

    Article  Google Scholar 

  24. Manaster BJ (1991) The clinical efficacy of triple-injection wrist arthrography. Radiology 1:267–270

    Google Scholar 

  25. Mann FA, Kang SW, Gilula LA (1992) Normal palmar tilt: is dorsal tilting really normal? J Hand Surg [Br] 3:315–317

    Google Scholar 

  26. Mayfield JK, Johnson RP, Kilcoyne RK (1980) Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg [Am] 3:226–241

    Google Scholar 

  27. McGuigan FX, Culp RW (2002) Surgical treatment of intra-articular fractures of the trapezium. J Hand Surg [Am] 4:697–703

    Google Scholar 

  28. Meier R, Krimmer H (2002) Die Ulnaverkürzungsosteotomie. Operat Orthop Traumatol 14:205–214

    Article  Google Scholar 

  29. Meier R, Lanz U, Krimmer H (2002) Teilfusionen am Handgelenk – eine Alternative zur Totalarthrodese. Unfallchirurg 9:762–774

    Article  Google Scholar 

  30. Meier R, Schmitt R, Christopoulos G, Krimmer H (2002) Darstellung skapholunärer Verletzungen im Arthro-MRT im Vergleich zur Handgelenksarthroskopie. Handchir Mikrochir Plast Chir 6:381–385

    Article  Google Scholar 

  31. Meier R, Prommersberger KJ, Krimmer H (2003) Teil-Arthrodesen von Skaphoid, Trapezium und Trapezoideum (STT-Fusion). Handchir Mikrochir Plast Chir 35(5):323–327

    Article  CAS  PubMed  Google Scholar 

  32. Meier R, Schmitt R, Christopoulos G, Krimmer H (2003) TFCC-Läsionen: Wertigkeit der Arthro-MRT im Vergleich zur Handgelenksarthroskopie. Unfallchirurg 3:190–194

    Article  Google Scholar 

  33. Meier R, Kfuri M Jr, Geerling J et al (2005) Intraoperative 3D Bildgebung am Handgelenk mit einem mobilen isozentrischen C-Bogen. Handchir Mikrochir Plast Chir 4:256–259

    Article  Google Scholar 

  34. Metz VM, Mann FA, Gilula LA (1993) Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications. AJR Am J Roentgenol 4:819–822

    Google Scholar 

  35. Monahan PR, Galasko CS (1972) The scapho-capitate fracture syndrome. A mechanism of injury. J Bone Joint Surg Br 1:122–124

    Google Scholar 

  36. Nishikawa S, Toh S, Miura H et al (2001) Arthroscopic diagnosis and treatment of dorsal wrist ganglion. J Hand Surg [Br] 6:547–549

    Google Scholar 

  37. O’Callaghan BI, Kohut G, Hoogewoud HM (1994) Gamekeeper thumb: identification of the Stener lesion with US. Radiology 2:477–480

    Google Scholar 

  38. Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg [Am] 2:153–162

    Google Scholar 

  39. Rikli D, Regazzoni P (1999) Distal radius fractures. Schweiz Med Wochenschr 20:776–785

    Google Scholar 

  40. Robertson C, Ellis RE, Goetz T et al (2002) The sensitivity of carpal bone indices to rotational malpositioning. J Hand Surg [Am] 3:435–442

    Google Scholar 

  41. Rock C, Kotsianos D, Linsenmaier U et al (2002) Studies on image quality, high contrast resolution and dose for the axial skeleton and limbs with a new, dedicated CT system (ISO-C-3 D). Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2:170–176

    Article  Google Scholar 

  42. Rominger MB, Bernreuter WK, Kenney PJ, Lee DH (1993) MR imaging of anatomy and tears of wrist ligaments. Radiographics 6:1233–1246

    Google Scholar 

  43. Sanders WE (1988) Evaluation of the humpback scaphoid by computed tomography in the longitudinal axial plane of the scaphoid. J Hand Surg [Am] 2:182–187

    Google Scholar 

  44. Schmitt R, Lanz U (2004) Bildgebende Diagnostik der Hand. Thieme, Stuttgart

  45. Schmitt R, Fellner F, Obletter N et al (1998) Diagnosis and staging of lunate necrosis. A current review. Handchir Mikrochir Plast Chir 3:142–150

    Google Scholar 

  46. Schweitzer ME, Brahme SK, Hodler J et al (1992) Chronic wrist pain: spin-echo and short tau inversion recovery MR imaging and conventional and MR arthrography. Radiology 1:205–211

    Google Scholar 

  47. Shih JT, Lee HM, Hou YT, Tan CM (2001) Arthroscopically-assisted reduction of intra-articular fractures and soft tissue management of distal radius. Hand Surg 2:127–135

    Article  Google Scholar 

  48. Sim E, Zechner W (1991) Computerized tomography after surgical management of scaphoid fractures and pseudarthroses with implants in place. Method and results in 15 cases. Handchir Mikrochir Plast Chir 2:67–73

    Google Scholar 

  49. Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 2:243–248

    Article  Google Scholar 

  50. Stener B (1962) Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint. J Bone Joint Surg Am 869–879

  51. Taleisnik J (1980) Post-traumatic carpal instability. Clin Orthop 149:73–82

    PubMed  Google Scholar 

  52. Teisen H, Hjarbaek J, Jensen EK (1990) Follow-up investigation of fresh lunate bone fracture. Handchir Mikrochir Plast Chir 1:20–22

    Google Scholar 

  53. Treitl M, Stäbler A, Reiser M (2002) Bildgebende Diagnostik der Handwurzel. Radiol up2date 1:93–120

    Article  Google Scholar 

  54. Vahlensieck M, Peterfy CG, Wischer T et al (1996) Indirect MR arthrography: optimization and clinical applications. Radiology 1:249–254

    Google Scholar 

  55. Valeri G, Ferrara C, Carloni S et al (1999) Magnetic resonance arthrography in chronic wrist pain. Radiol Med (Torino) 1–2:19–25

  56. Watson HK, Ashmead D, Makhlouf MV (1988) Examination of the scaphoid. J Hand Surg [Am] 5:657–660

    Google Scholar 

  57. Zanetti M, Gilula LA, Hodler J (2001) Palmar tilt of the distal radius: influence of off-lateral projection. Radiology 220:594–600

    Article  CAS  PubMed  Google Scholar 

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  1. Klinik und Poliklinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    R. Meier & H. Jansen

  2. Radiologische Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland

    M. Uhl

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  1. R. Meier
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Correspondence to R. Meier.

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Meier, R., Jansen, H. & Uhl, M. Radiologische Diagnostik beim Handgelenktrauma. Radiologe 49, 1063–1084 (2009). https://doi.org/10.1007/s00117-008-1776-9

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