This prospective study assessed whether patients with severe proximal interphalangeal joint contracture (#10878;60 degrees ) due to Dupuytren's disease which persisted after fasciectomy alone benefited from an additional capsuloligamentous release. Forty-three patients with 43 severely contracted proximal interphalangeal joints underwent operative correction followed by a standardized postoperative rehabilitation programme. All were followed for 6 months. In 11 patients correction of the proximal interphalangeal joint to 20 degrees could not be achieved by fasciectomy alone, and an additional capsuloligamentous release was performed which effectively corrected all their residual flexion contractures. There were no statistically significant differences between the capsulotomy and the non-capsulotomy group with respect to the residual proximal interphalangeal joint contracture at the end of surgery, or at their last follow-up examination.
Radioscapholunate (RSL) arthrodesis must be considered an appropriate procedure in painful radiocarpal arthrosis following comminuted fractures of the distal radius. Despite total wrist fusion, it offers the possibility to exclusively eliminate the destroyed articulation preserving a certain degree of motion in the midcarpal joint.Accordingly, 22 patients with painful posttraumatic arthrosis of the radiocarpal joint underwent RSL fusion between 1992 and 1998. Average follow-up was 18.7 months. Postoperatively, total range of wrist motion decreased by an average of 21° E-F and 6° U-R deviation. Average grip strength of the affected wrist improved from 31.9 to 51.1 kPa. There was a considerable decrease of pain during activity and at rest. Using the DASH questionnaire, an average of 25.7 points was reached. Radiologic examination revealed no major signs of arthritis at the midcarpal joint. In one patient, nonunion as well as reactivation of deep infection secondary to an infection sustained during surgical stabilization of the initial radial fracture were recorded.In our opinion, however, RSL fusion represents a good alternative to total wrist fusion, since valuable wrist motion is preserved.
Zusammenfassung OperationszielVersteifung des Radiokarpalgelenks zur Schmerzreduktion unter Erhaltung der Beweglichkeit im Mediokarpalgelenk. IndikationenSchmerzhafte Arthrose des Radiokarpalgelenks, insbesondere bei Stufenbildung der Gelenkfläche nach intraartikulärer distaler Radiusfraktur. Alternative Behandlungsmöglichkeiten -orthopädietechnische und medikamentöse Maßnahmen, Handgelenkdenervation -sind bereits ausgeschöpft oder werden abgelehnt. Kontraindikationen Patient mit sog. Arthrodesenhülse schmerzfrei und zufrieden. Arthrotische Veränderungen auch im Mediokarpalgelenk. Operationstechnik Streckseitiger Zugang zum Handgelenk. Resektion der Radiusgelenkfläche und der proximalen Gelenkflächen des Os scaphoideum und Os lunatum. Interposition von autogener Spongiosa und Osteosynthese des Handgelenks mit Kirschner-Drähten. Gegebenenfalls Ausgleich einer Verkürzung des Radius durch Interposition eines autogenen Knochenblocks aus dem Beckenkamm und Korrektur einer Achsenfehlstellung der Handwurzelknochen. Weiterbehandlung Ruhigstellung im Unterarmgipsverband mit Einschluss des Daumengrundgliedes für 8 Wochen; anschließend Physiotherapie zur Verbesserung der Beweglichkeit im Mediokarpalgelenk. Ergebnisse Zwischen Juni 1992 und Dezember 1998 wurde bei 22 Patienten mit isolierter posttraumatischer Radiokarpalarthrose eine radioskapholunäre Arthrodese durchgeführt. 18 Patienten mit einem Durchschnittsalter von 46 (27-73) Jahren konnten nach durchschnittlich 19 (6-66) Monaten nachuntersucht werden. Bei 17 Patienten kam es primär zur knöchernen Durchbauung; eine Pseudarthrose heilte nach Revision aus; 66 Monate postoperativ zeigte sich bei einer Patientin eine subchondrale Sklerosierung der distalen Gelenkfläche des Os lunatum als Zeichen einer beginnenden mediokarpalen Arthrose. Abstract ObjectiveFusion of the radiocarpal joint for elimination or alleviation of wrist pain while maintaining residual motion of the midcarpal joint.
Reconstruction of the articular anatomy can be extremely difficult in distal radius fractures with severe comminution of both the dorsal and palmar cortices. In these cases, neither open reduction using an unilateral approach nor closed reduction with ligamentotaxis and fixateur externe will be successful. Reconstruction of both the dorsal and palmar cortical column is necessary. Sixteen of nineteen patients with unstable bicolumnar distal radius fractures treated by a combined plate osteosynthesis were studied retrospectively. Follow-up time averaged 32.5 months (8 to 74). At the time of re-examination the average grip strength and range of motion were reduced by 30% compared with the uninjured side. The average DASH-score was 11.2 points. Radiographic measurements revealed a satisfactory restoration of the radius concerning length and form. There were no signs of higher graded arthrosis.
Purpose. Evaluation of effectiveness of capsuloligamentous release in severe PIP joint contractures in Dupuytren's disease. Method. Prospective study to compare the clinical outcome of eleven patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom an additional capsulotomy was performed to reduce a residual flexion contracture of the PIP joint of 20 degree and more after release and excision of all diseased fascia, with the outcome of 32 patients with severe contracture of the PIP joint due to Dupuytren's disease, in whom the PIP joint contracture could be reduced by fasciectomy alone. Preoperatively all patients had a severe flexion contracture (60 degrees or greater) of one PIP joint. All patients underwent standardized operative treatment and postoperative extension splinting program for six months. Follow-up examinations included assessment of active range of motion at two, four, ten, 16 and 24 weeks after surgery. Results. In the noncapsulotomy group, preoperative contracture averaged 70.6 degrees and intraoperative residual contracture averaged 2 degrees. In the capsulotomy group, preoperative contracture averaged 78.6 degrees. Intraoperative residual contracture averaged 61.8 degrees before and 2 degrees after capsulotomy. At the final follow-up examination, PIP joint flexion contracture averaged 15 degrees in the noncapsulotomy group compared to 16 degrees in the capsulotomy group. Conclusion. Residual flexion contracture of a PIP joint after release and excision of all diseased fascia in Dupuytren's disease can be reduced by capsuloligamentous release. The data of this study showed no significant differences in the outcome at the final follow-up examination between patients with and without capsulotomy. Therefore, we recommend capsulotomy as treatment of residual flexion contracture of the PIP joint in Dupuytren's disease.
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