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Kollateralbandverletzungen der Fingergrundgelenke

Collateral ligament injuries of the metacarpophalangeal joints

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Zusammenfassung

Kollateralbandverletzungen der Fingergrundgelenke sind selten. Die Diagnose erfolgt klinisch und anhand von Standardröntgenaufnahmen. Leitsymptome sind lokale Schmerzen und die Gelenkinstabilität. Eine Instabilität wird klinisch durch Aufklappbarkeit in 90° Beugung des Gelenks nachgewiesen. Bei Grad-I-Verletzungen ist die Stabilität bei Überdehnung des Bandes oder kleineren partiellen Rissen erhalten. Grad-II-Verletzungen zeigen eine Aufklappbarkeit des Gelenks mit deutlichem Anschlag aufgrund einer Teilruptur, Grad-III-Verletzungen eine Aufklappbarkeit ohne festen Anschlag infolge einer kompletten Ruptur.

Grad-I- und II-Verletzungen sowie undislozierte knöcherne Ausrisse werden konservativ für 6 Wochen mit einer Achterschlaufe behandelt. Bei persistierender Instabilität oder Grad-III-Verletzungen erfolgt die Bandnaht oder -refixation. Kleinere Avulsionsfragmente werden entfernt und das Kollateralband knöchern refixiert. Größere Fragmente werden durch entsprechende Implantate fixiert. Eine adäquate Therapie führt zu guten Ergebnissen. Selbst bei chronischen Rissen ist die Rekonstruktion mit lokalem Material oder Sehnentransplantaten in der Regel erfolgreich.

Abstract

Collateral ligament injuries of the metacarpal joints of the fingers are rare conditions. The injury should be diagnosed by clinical investigation and standard radiographs. Leading symptoms are local tenderness and joint instability. Instability is verified by clinical stress testing of the metacarpophalangeal joint in 90° of flexion. In Grade I injuries stability is preserved due to ligament attenuation or small partial tears. Grade II injuries show laxity with firm endpoint according to incomplete tear. In Grade III injuries instability without endpoint can be found as a result of complete tears. Radiographs may show avulsed bone fragments.

In Grade I and II tears or non- displaced avulsion fragments treatment is conservative with buddy taping for 6 weeks. In case of persistent instability or grade III tears suturing or refixation of the ligament are performed. Small avulsion fragments are removed and the ligament is fixed to the bone. Greater avulsion fragments are fixed by suitable small implants. Adequate treatment will lead to reliable good results. Even in chronic tears reconstruction with local material or tendon transplants is usually successful.

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Literatur

  1. Delaere OP, Suttor PM, Degolla R et al (2003) Early surgical treatment for collateral ligament rupture of metacarpophalangeal joints of the fingers. J Hand Surg Am 28:309–315

    Article  PubMed  Google Scholar 

  2. Lourie GM, Gaston RG, Freeland AE (2006) Collateral ligament injuries of the metacarpophalangeal joints of the fingers. Hand Clin 22:357–364

    Article  PubMed  Google Scholar 

  3. Doyle JR, Atkinson RE (1989) Rupture of the radial collateral ligament of the metacarpo-phalangeal joint of the index finger: a report of three cases. J Hand Surg Br 14:248–250

    Article  PubMed  CAS  Google Scholar 

  4. Hsieh YF, Draganich LF, Piotrowski GA, Mass DP (2000) Effects of reconstructed radial collateral ligament on index finger mechanics. Clin Orthop Relat Res 379:270–282

    Article  PubMed  Google Scholar 

  5. Gaston RG, Lourie GM (2006) Radial collateral ligament injury of the index metacarpophalangeal joint: an underreported but important injury. J Hand Surg Am 31:1355–1361

    Article  PubMed  Google Scholar 

  6. Schmidt H-M, Lanz U (2003) In: Schmidt H-M, Lanz U (Hrsg) Chirurgische Anatomie der Hand. Thieme, Stuttgart, S 164–172

  7. Tamai K, Ryu J, An KN et al (1988) Three-dimensional geometric analysis of the metacarpophalangeal joint. J Hand Surg Am 13:521–529

    Article  PubMed  CAS  Google Scholar 

  8. Dubousset JF (1981) The digital joints. In: Tubiana R (Hrsg) The hand. Saunders, Philadelphia, pp 191–201

  9. Freeland AE, Hobgood ER (2004) Complete tear of the radial collateral ligament of the third metacarpophalangeal joint. Orthopedics 27:733–736

    PubMed  Google Scholar 

  10. Minami A, An KN, Cooney WP 3rd et al (1984) Ligamentous structures of the metacarpophalangeal joint: a quantitative anatomic study. J Orthop Res 1:361–368

    Article  PubMed  CAS  Google Scholar 

  11. Doyle JR, Botte MJ (2003) Surgical anatomy of the hand and upper extremity. Lippincott, Wiliams & Wilkins, Philadelphia

  12. Hintringer W, Leixnering M (1991) Knöcherne oder ligamentäre Verletzungen am Mittelgelenk und ihre Behandlung. Handchir Mikrochir Plast Chir 23:59–66

    PubMed  CAS  Google Scholar 

  13. Schubiner JM, Mass DP (1989) Operation for collateral ligament ruptures of the metacarpophalangeal joints of the fingers. J Bone Joint Surg Br 71:388–389

    PubMed  CAS  Google Scholar 

  14. Beauperthuy GD, Burke EF (1997) Alternative method of repairing collateral ligament injuries at the metacarpophalangeal joints of the thumb and fingers. Use of the Mitek anchor. J Hand Surg Br 22:736–738

    Article  PubMed  CAS  Google Scholar 

  15. Theumann NH, Pessis E, Lecompte M et al (2005) MR imaging of the metacarpophalangeal joints of the fingers: evaluation of 38 patients with chronic joint disability. Skeletal Radiol 34:210–216

    Article  PubMed  Google Scholar 

  16. Ishizuki M (1988) Injury to collateral ligament of the metacarpophalangeal joint of a finger. J Hand Surg Am 13:444–448

    Article  PubMed  CAS  Google Scholar 

  17. Stener B (1962) Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am 44:869–879

    Google Scholar 

  18. Wolf BA, Cervino AL (1988) Rupture of the radial collateral ligament of the fifth metacarpophalangeal joint. Ann Plast Surg 21:382–387

    Article  PubMed  CAS  Google Scholar 

  19. Dray G, Millender LH, Nalebuff EA (1979) Rupture of the radial collateral ligament of a metacarpophalangeal joint to one of the ulnar three fingers. J Hand Surg Am 4:346–350

    PubMed  CAS  Google Scholar 

  20. Riederer S, Nagy L, Buchler U (1998) Chronic post-traumatic radial instability of the metacarpophalangeal joint of the finger. Long-term results of ligament reconstruction. J Hand Surg Br 23:503–506

    Article  PubMed  CAS  Google Scholar 

  21. Gross DL, Moneim M (1998) Radial collateral ligament avulsion fracture of the metacarpophalangeal joint in the small finger. Orthopedics 21:814–815

    PubMed  CAS  Google Scholar 

  22. Lane CS (1977) Detecting occult fractures of the metacarpal head: the Brewerton view. J Hand Surg Am 2:131–133

    PubMed  CAS  Google Scholar 

  23. Clavero JA, Alomar X, Monill JM et al (2002) MR imaging of ligament and tendon injuries of the fingers. Radiographics 22:237–256

    PubMed  Google Scholar 

  24. Pfirrmann CW, Huser M, Szekely G et al (2002) Evaluation of complex joint motion with computer-based analysis of fluoroscopic sequences. Invest Radiol 37:73–76

    Article  PubMed  Google Scholar 

  25. Heuck A, Schmitt R, Hahn P (2004) Weichteilläsionen durch Überlastung und Sport: Läsionen der Metakarpophalangealgelenke II–V. In: Schmitt R, Lanz U (Hrsg) Bildgebende Diagnostik der Hand, 2. Aufl. Thieme, Stuttgart, S 324–336

  26. Sawant N, Kulikov Y, Giddins GE (2007) Outcome following conservative treatment of metacarpophalangeal collateral ligament avulsion fractures of the finger. J Hand Surg Eur Vol 32(1):102–104

    Article  PubMed  CAS  Google Scholar 

  27. Kang L, Rosen A, Potter HG, Weiland AJ (2007) Rupture of the radial collateral ligament of the index metacarpophalangeal joint: diagnosis and surgical treatment. J Hand Surg Am 32:789–794

    Article  PubMed  Google Scholar 

  28. Kuhn KM, Dao KD, Shin AY (2001) Volar A1 pulley approach for fixation of avulsion fractures of the base of the proximal phalanx. J Hand Surg Am 26:762–771

    Article  PubMed  CAS  Google Scholar 

  29. Hsieh YF, Draganich LF, Mass DP (2000) The effects of transection and reconstruction of the ulnar collateral ligament complex on the position of the proximal phalanx of the thumb during simulated tip pinch. J Hand Surg Am 25:313–321

    Article  PubMed  CAS  Google Scholar 

  30. Green DP (1983) Dislocations and ligamentous injuries of the hand. In: Evarts CM (ed) Surgery of the musculoskeletal system. Churchill Livingston, New York, pp 119–183

  31. Sakuma M, Nakamura R, Inoue G, Horii E (1997) Avulsion fracture of the metacarpophalangeal joint of the finger. J Hand Surg Br 22:667–671

    Article  PubMed  CAS  Google Scholar 

  32. Gee TC, Pho RW (1982) Avulsion- fracture at the proximal attachment of the radial collateral ligament of the fifth metacarpophalangeal joint – a case report. J Hand Surg Am 7:526–527

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland

    T. Pillukat & K-J Prommersberger

  2. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    M. Schädel-Höpfner & J. Windolf

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  1. T. Pillukat
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  2. M. Schädel-Höpfner
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  3. J. Windolf
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  4. K-J Prommersberger
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Correspondence to T. Pillukat.

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Pillukat, T., Schädel-Höpfner, M., Windolf, J. et al. Kollateralbandverletzungen der Fingergrundgelenke. Unfallchirurg 115, 616–622 (2012). https://doi.org/10.1007/s00113-012-2174-3

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  • DOI: https://doi.org/10.1007/s00113-012-2174-3

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