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Mediokarpale Teilarthrodese mit winkelstabiler Plattenosteosynthese

Midcarpal partial arthrodesis with locking plate osteosynthesis

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Erhalt einer Restbeweglichkeit und Schmerzreduktion im Handgelenk bei fortgeschrittenem karpalem Kollaps (SLAC, „scapho-lunate advanced collapse“ oder SNAC, „scaphoid non-union advanced collapse“).

Indikationen

Fortgeschrittene radio- und mediokarpale Arthrose, SLAC/SNAC 2–3.

Kontraindikationen

Arthrotische Veränderungen an der proximalen Gelenkfläche des Lunatum bzw. der korrespondierenden Gelenkfläche des Radius (Fossa lunata).

Operationstechnik

Dorsale Längsschnittführung und Eröffnen der Handgelenkkapsel unter Verwenden eines radial-gestielten Kapsellappens. Resektion des Skaphoids. Entknorpeln der korrespondierenden Gelenkflächen zwischen Kapitatum und Lunatum sowie zwischen Hamatum und Triquetrum. Gewinnung und Einbringen von Radiusspongiosa. Reposition des Lunatums. Einbringen der Platte und Besetzen der Schraubenlöcher. Verschluss der Handgelenkkapsel. Unterarmgipsschiene in Neutralstellung. Postoperative Physiotherapie aus einer Lagerungsschiene heraus in einem Ausmaß von 20-0-20° Extension-Flexion. Die Lagerungsschiene sollte für 8 Wochen zum Schutz angelegt werden.

Ergebnisse

Vollständige knöcherne Konsolidierung in der Röntgenkontrolle bei allen 11 Patienten 12 Wochen postoperativ. Keine implantatbasierten Komplikationen. In einem Fall musste ein postoperatives Karpaltunnelsyndrom operativ versorgt werden. Die postoperativen Bewegungsumfänge zeigten mit Extension-Flexion 53° ± 18° (47 % der gesunden Seite) und Radial-Ulnarduktion 30 ± 5° (58 % der gesunden Seite) insgesamt zufriedenstellende Ergebnisse. Die Werte der visuellen analogen Schmerzskala VAS betrugen postoperativ in Ruhe 0,7 ± 1,2 und 4,3 ± 2,8 bei Belastung. Die Grobkraft betrug 19 ± 14 kg (56 % der nichtoperierten Seite) und der DASH-Wert („Disabilities of the Arm, Shoulder, Hand“) 33 ± 24.

Abstract

Objective

Preservation of residual mobility and pain reduction in the wrist in advanced carpal collapse (scapholunate advanced collapse, SLAC or scaphoid nonunion advanced collapse, SNAC).

Indications

Advanced osteoarthritis of the radiocarpal and intercarpal articulations, SLAC/SNAC stages 2–3.

Contraindications

Arthrotic alterations to the proximal joint surface of the lunate bone or the corresponding joint surface of the radius (lunate fossa).

Surgical technique

Dorsal longitudinal incision and exposure of the wrist capsule using a radial pedunculated capsular flap. Resection of the scaphoid bone. Chondrolysis of the corresponding joint surface between the capitate bone and the lunate bone as well as between the hamate bone and the triquetral bone. Harvesting and insertion of radial cancellous bone. Repositioning of the lunate bone. Introduction of the plate and filling of the screwholes. Closure of the wrist capsule. Neutral placement of a lower arm plaster cast. Postoperative physiotherapy from out of the supporting cast to an extent of 20-0-20° extension-flexion. For protection the support cast should remain in place for 8 weeks.

Results

Complete consolidation of the bone in the X‑ray control in all 11 patients 12 weeks postoperatively. No implant-based complications. In one case a postoperative carpal tunnel syndrome had to be surgically treated. The postoperative extent of mobility showed overall satisfactory results with extension-flexion of 53° ± 18° (47% of the healthy side) and radial-ulnar abduction 30 ± 5° (58% of the healthy side). The postoperative values on the visual analog pain scale (VAS) were 0.7 ± 1.2 at rest and 4.3 ± 2.8 under load bearing. The gripping power was 19 ± 14 kg (56% of the non-operated side) and the disabilities of the arm, shoulder, hand (DASH) value was 33 ± 24.

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Authors and Affiliations

  1. Klinik für Hand‑, Plastische und Rekonstruktive Chirurgie – Schwerbrandverletztenzentrum, BG‑Unfallklinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    J.-F. Hernekamp, U. Kneser, T. Kremer &  B. Bickert

Authors
  1. J.-F. Hernekamp
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  2. U. Kneser
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  3. T. Kremer
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  4. B. Bickert
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Correspondence to J.-F. Hernekamp.

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Interessenkonflikt

J.-F. Hernekamp, U. Kneser, T. Kremer und B. Bickert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Redaktion

F. Unglaub, Bad Rappenau

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R. Himmelhan, Mannheim

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Hernekamp, JF., Kneser, U., Kremer, T. et al. Mediokarpale Teilarthrodese mit winkelstabiler Plattenosteosynthese. Oper Orthop Traumatol 29, 409–415 (2017). https://doi.org/10.1007/s00064-017-0514-8

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  • DOI: https://doi.org/10.1007/s00064-017-0514-8

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