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Bandplastik bei Instabilität des Sattelgelenks

Ligament reconstruction for trapeziometacarpal joint instability

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung der Stabilität und Verhinderung von Subluxationen des Sattelgelenks (erstes Karpometakarpalgelenk, CMC-I) unter Erhalt der Beweglichkeit

Indikationen

Posttraumatische, erworbene oder angeborene Instabilitäten des CMC-I-Gelenks.

Kontraindikationen

Vorliegen einer Arthrose des CMC-I-Gelenks. Neurogen oder muskulär bedingte Funktionsstörungen der Thenarmuskulatur sowie sonstige Kontrakturen im Sattelgelenkbereich. Infektionen.

Operationstechnik

Radiopalmarer Zugang zum Sattelgelenk, Reposition und transossäre Bandplastik mit einem distal gestielten Sehnenstreifen des M. abductor pollicis longus.

Weiterbehandlung

Ruhigstellung in der Gipsschiene für 5 Wochen.

Ergebnisse

Diese Bandplastik liefert meist gute und sehr gute Ergebnisse. Nur in einem von 24 Fällen kam es zu einer Auslockerung. Die Bandrekonstruktion des Karpometakarpalgelenks des Daumens minderte den Schmerz und stellte die Stabilität unter Erhalt des funktionellen Bewegungsausmaßes bei Patienten mit chronischer Instabilität wieder her.

Abstract

Objective

Restoring stability and preventing subluxation/dislocation of the trapeziometacarpal (first carpometacarpal = CMC-I) joint while preserving mobility.

Indications

Posttraumatic, acquired or congenital instability of the CMC-I joint.

Contraindications

Existence of osteoarthritis of the CMC-I joint. Neurogenic or muscular origin dysfunction of thenar muscles and other contractures the CMC-I area. Infections.

Surgical technique

Radiopalmar approach to the CMC-I joint, reduction, and transosseous ligament reconstruction with a distally pedicled tendon strip from the abductor pollicis longus muscle.

Postoperative management

Splint immobilization for 5 weeks.

Results

This procedure generally results in good or very good outcomes. Of 24 patients, only one patient experienced rupture of the ligament reconstruction. Ligament reconstruction for the carpometacarpal joint of the thumb relieves pain and restores stability while preserving functional range of motion in patients with chronic instability.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Sektion Handchirurgie und Mikrochirurgie, Universitätsklinikum Münster, Münster, Deutschland

    M. F. Langer, B. Wieskötter, K. Herrmann & S. Oeckenpöhler

Authors
  1. M. F. Langer
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  2. B. Wieskötter
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  3. K. Herrmann
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  4. S. Oeckenpöhler
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Corresponding author

Correspondence to M. F. Langer.

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Interessenkonflikt

M.F. Langer, B. Wieskötter, K. Herrmann und S. Oeckenpöhler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Redaktion

F. Unglaub, Bad Rappenau

Zeichner

M. F. Langer, Münster

Caption Electronic Supplementary Material

64_2015_418_MOESM1_ESM.m4v

Schmerzhafte Sattelgelenksinstabilität mit Subluxationen bei Belastungen bei einer 34-jährigen Frau. Der Film zeigt das Sattelgelenk in der Durchleuchtung vor der Operation, die Bandplastik aus einem Sehnenstreifen der Abductor-pollicis-longus-Sehne und die Rö-Durchleuchtung des Sattelgelenks am Ende der Operation (m4v 914mb) .m4v

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Langer, M.F., Wieskötter, B., Herrmann, K. et al. Bandplastik bei Instabilität des Sattelgelenks. Oper Orthop Traumatol 27, 414–426 (2015). https://doi.org/10.1007/s00064-015-0418-4

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  • DOI: https://doi.org/10.1007/s00064-015-0418-4

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