Perkutane Behandlung geschlossener instabiler Basisfrakturen der Fingermittelglieder

ZusammenfassungDie Behandlung von Fingerfrakturen ist in doppelter Hinsicht anspruchsvoll. Fehlstellungen und Inkongruenzen von Gelenken führen häufig zu ernsthaften funktionellen Einschränkungen und sollten daher nicht toleriert werden. Auf der anderen Seite wird der operative Zugang zur Fraktur häufig durch die unmittelbare Nähe wichtiger Funktionsgewebe wie Nerven, Gefäße, Bandapparat und Sehnen begrenzt. Der vorliegende Artikel enthält eine Auswahl von Behandlungsmöglichkeiten, die sich nach Auffassung der Autoren vor dem Hintergrund einer großen Klinik bewährt haben mit Hinweisen auf alternative Verfahren und das Vorgehen in besonderen Situationen ohne Anspruch auf Vollständigkeit.

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“…Methode der Wahl: Gedeckte Aufstößelung nach Hintringer ( Abb. 4 ) + K-Drähte und/oder dynamischer Fixateur 5 , 6 ( Abb. 5 ).…”

Section: Mehrfragmentäre Mittelgliedbasisfrakturenunclassified

Differentialtherapeutische Zugänge zur Frakturversorgung an der Hand – Wann macht man was?

Pillukat¹,

Mühldorfer-Fodor²,

Schoonhoven³

2022

Handchir Mikrochir Plast Chir

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“…Finger proximal interphalangeal joint (PIP) reconstruction after destruction of parts of the joint, additional soft tissue, extensor tendon and ligament injuries, remains challenging [1][2][3][4][5][6][7][8]. Surgical techniques include implant arthroplasty [9][10][11][12][13][14][15][16], arthrodesis [17][18][19][20], non-vascularized bone and joint transfer [21][22][23], and free vascularized joint transfer [24,25].…”

Section: Introductionmentioning

confidence: 99%

Non-vascularized partial joint transfer for Finger Proximal Interphalangeal joint reconstruction: a series of 9 patients

Leclère

Haug

Meier

et al. 2019

Arch Orthop Trauma Surg

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Introduction Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. Materials and methods Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. Results Mean follow-up period was 4.0 years (range 1.2-7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip-and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. ConclusionIn this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.

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Frakturen der Mittelhandknochen

Quadlbauer,

Keuchel-Strobl

2024

Expertenwissen Handchirurgie

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Perkutane Behandlung geschlossener instabiler Basisfrakturen der Fingermittelglieder

Cited by 5 publications

References 23 publications

Differentialtherapeutische Zugänge zur Frakturversorgung an der Hand – Wann macht man was?

Differentialtherapeutische Zugänge zur Frakturversorgung an der Hand – Wann macht man was?

Non-vascularized partial joint transfer for Finger Proximal Interphalangeal joint reconstruction: a series of 9 patients

Frakturen der Mittelhandknochen

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