Operative Behandlung der Krallenhand mittels Lassoplastik

Abstract

From April 2003 to June 2012 a total of 17 patients, 8 female and 9 male were surgically treated for claw deformity. The dominant hand was affected in seven patients. The average age was 46 ± 15 (22-80) years, the average interval from onset of ulnar palsy to lassoplasty was 61 ± 91 (3-288) months. The final follow-up was performed after an average of 42 ± 32 (2-112) months. Claw deformity was resolved in 14 out of the 17 patients. The grip strength was on average 58 ± 28 % (11-96 %) of the unaffected hand, the mean disabilities of the arm, shoulder and hand (DASH) score was 32 ± 18 (5-68) points and the degree of patient satisfaction 7 ± 2 (0-10). According to own results and those in the literature lassoplasty can be recommended for the treatment of claw deformity.

Volar Plate Capsulodesis With Internal Brace Augmentation for the Claw Hand

“…Both the loss of extension in the PIP and DIP joints and the loss of flexion in the MCP joints make it difficult to grasp objects. 1,2 Improved synchronous finger joint movements are attainable if the MCP joints are forced into slight flexion, resulting in enhanced extension of the PIP joints aided by the extrinsic extensor tendons. One takes advantage of this mechanism in clinical examination of the extensor mechanism around the PIP joint (the Bouvier test) as well as in nonoperative treatment of the claw hand (ie, MCP joint blocking, lumbrical bar splint).…”

“…3 Surgical procedures are based on the same principle to prevent hyperextension of the MCP joints and reverse the claw hand posture. 1,2,4 Surgical options for treatment of the claw hand include both dynamic and static procedures. 1,4,5 Although numerous dynamic procedures have been described, only a few are practically used in the correction of the claw hand.…”

“…1,2,4 Surgical options for treatment of the claw hand include both dynamic and static procedures. 1,4,5 Although numerous dynamic procedures have been described, only a few are practically used in the correction of the claw hand. 2,[6][7][8] Two of the more commonly performed operations include transfer of a wrist motor with tendon graft extensions (4-tail graft) and transfer of a flexor digitorum superficialis muscle-tendon unit from an unaffected finger to 1 or 2 involved fingers.…”

“…Surgical fusion of the MCP joint is therefore rarely performed in favor of other static procedures that prevent hyperextension of the MCP joint, but still permit joint flexion. 1 The main disadvantage of a soft tissue procedure is that over time, the utilized tissue can attenuate and the clawing can recur. 1 Augmenting the traditional volar plate capsulodesis with an internal brace at the MCP joint may help to address this problem.…”

“…1 The main disadvantage of a soft tissue procedure is that over time, the utilized tissue can attenuate and the clawing can recur. 1 Augmenting the traditional volar plate capsulodesis with an internal brace at the MCP joint may help to address this problem. An internal brace utilizes the placement of a suturetape over the volar plate that acts to reinforce the capsulodesis while healing occurs.…”