Bruch des Sprungbeines häufigste Fussverletzung des Snowboarders – Operation statt Gipstherapie senkt Arthroserate
In der letzten Dekade hat sich Snowboarden zu einer äußerst populären Wintersportart entwickelt. Kürzlich konnte eine epidemiologische Studie aus Schweden aufzeigen, dass die Häufigkeit des Snowboardens in der schwedischen Population von 5 Prozent im Jahr 1990 auf 26 Prozent im Jahr 1999 zugenommen hat. Snowboarden wird in der sportorthopädischen Welt als eine der risikoreichen Sportarten angesehen. Die typische Fußverletzung in dieser Sportart ist die Fraktur (Bruch) des Processus lateralis tali (Sprungbein), die häufig mit einer lateralen Distorsion des Sprunggelenks (Aussenknöchels) verwechselt werden kann. Bei dieser Verletzung handelt es sich um einen Bruch des Sprungbeins am Außenbereich des Rückfusses.
Aufgrund der generellen Zunahme der Anzahl Snowboarder hat auch diese Verletzung in den Wintersport-Skigebieten in den letzten Dekaden deutlich zugenommen. In der orthopädisch-sportmedizinischen Fachliteratur herrscht zurzeit dennoch alles andere als Einigkeit über den genauen Mechanismus dieser Verletzung sowie das geeignete Therapiemanagement des jeweiligen Bruchtyps. Auch konnte bis heute keine Gruppe die Mittel- und Langzeitfolgen einer solchen Verletzung nachweisen.
In einer sportorthopädischen Studie konnte Dr. Victor Valderrabano zeigen, dass es hierbei stets um die Verletzung des vorderen Beines auf dem Board handelt (zu 65 Prozent das linke Bein – “regular”-Stellung, zu 35 Prozent das rechte Bein – “goofy”-Stellung), welches beim Auftreffen jeweils eine Aufprallskraft in Längsrichtung des Beines sowie eine Dorsalflexion des Sprunggelenks erleidet. Dabei fällt typischerweise der Snowboarder nach vorne parallel zur Längsachse des Bretts, meist nach einem “Jump” oder bei einem unerwarteten vorderen Hindernis. Um den Processus lateralis tali gegen die hintere untere Sprunggelenksfacette zu brechen, braucht es noch eine Außendrehung des Unterschenkels sowie eine Eversion (Außendrehung) des Fußes. Die Kombination all dieser biomechanischen Faktoren führen auf der Piste zur besagten Fraktur. Dr. Valderrabano konnte weiter nachweisen, dass in 75 Prozent der Fälle die verunglückten Fahrer eine Softboot-Ausrüstung trugen.
Durch das in Dr. Valderrabanos Studie vorgeschlagene Therapie-Management konnte die Rate an posttraumatischer Arthrose im unteren Sprunggelenk im Vergleich zu anderen weltweiten Gruppen deutlich gesenkt werden. Das Prinzip basiert auf einer tendentiell orthopädisch-chirurgischen Therapie mit Schraubenfixation bei Fällen mit einem großen Bruchfragment. Diese stellen auch den häufigsten Frakturtyp dar. Hier konnte Dr. Valderrabano nachweisen, dass die konservative Gipstherapie im Vergleich zur operativen Therapie schlechtere Resultate zeigt und eine Erhöhung der Arthroserate mit sich bringt. Wichtig für den von Valderrabano vorgeschlagenen Algorithmus ist die Durchführung eines Computertomogramms, welches eine Typisierung und genaue Analyse der Fraktur erlaubt.
Um in einer Praxis oder Unfallstation nicht die Diagnose “Fraktur des Processus lateralis tali” zu verpassen oder mit einer “schweren lateralen OSG-Distorsion” zu verwechseln, empfiehlt Dr. Valderrabano eine gründliche Patientenerfragung im Hinblick auf Unfallmechanismus, eine genaue Untersuchung des Snowboarders, die Durchführung des von ihm beschriebenen Processus lateralis tali-Stresstest (dieser imitiert die oben erwähnten biomechanischen Faktoren), bei Verdacht die Verordnung einer dreifachen Röntgenserie (OSG ap, seitlich, Broden-view) und bei Bestätigung die Durchführung eines Computertomogramms.
Diese Studie wurde in der Schweiz in einer Zusammenarbeit zwischen der Orthopädisch-Traumatologischen Klinik des Spital Davos und der Orthopädisch-Traumatologischen Abteilung der Orthopädischen Universitätsklinik Basel durchgeführt. Involviert in diese Forschungsarbeit waren: Dr. Victor Valderrabano/Calgary, Dr. Thomas Perren/Davos, Dr. Christian Ryf/Davos, Dr. Paavo Rillmann/Davos, Professor Dr. Beat Hintermann/Basel.
1. November 2004
Zur Person Dr. Victor Valderrabano:
Dr. Victor Valderrabano ist Mitarbeiter des Human Performance Laboratory und des Orthopädischen Department der Universität Calgary/Canada sowie Mitarbeiter der Orthopädischen Universitätsklinik Basel/Schweiz; er ist Verfasser von mehreren Publikationen im Bereich der Fußorthopädie/-Sportmedizin/-Biomechanik, Referent von unzähligen internationalen Vorträgen und Träger von mehreren wissenschaftlichen Preisen, darunter dem GOTS-Michael Jäger-Forschungspreis 2001; er ist Mitglied des GOTS-Vorstandes, Web-Beauftragter der GOTS (www.gots.org) und GOTS-Sekretariat-Mitarbeiter; Dr. Victor Valderrabano ist zu erreichen unter: E-mail: v.valderrabano@bluewin.ch.
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