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Verletzungen der Grundgelenke und ihre Folgen

Metacarpophalangeal joint injuries and sequelae

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Zusammenfassung

Verletzungen der Daumen- und Fingergrundgelenke sind knöcherner oder ligamentärer Natur. Bei adäquater Diagnosestellung und Behandlung können sie folgenlos ausheilen. Jedoch treten bei falscher bzw. fehlender Diagnosestellung und Therapie chronische Instabilitäten, Dislokationen, Einsteifungen sowie konsekutive Arthrosen und Funktionseinschränkungen auf. Sie können zu erheblicher Beeinträchtigung der Greiffunktion führen. In der vorliegenden Arbeit werden aktuelle pathophysiologische Grundlagen sowie Konzepte der Diagnostik und Therapie akuter und chronifizierter Verletzungen der Daumen und Fingergrundgelenke erarbeitet. Frakturen mit Gelenkbeteiligung und zur Refixierung ausreichend großer Fragmente werden ebenso wie Torsionsdifferenzen und Instabilitäten in der Regel operativ versorgt. Persitierende Instabilitäten werden durch Bandplastiken sekundär stabilisiert, Arthrosen am Daumengrundgelenk versteift. An den Fingergrundgelenken steht der Bewegungserhalt im Vordergrund. Gängige Rettungsoperationen bei Arthrosen sind hier die Denervation, Resektionsarthroplastik und mit Einschränkungen der Gelenkersatz, bei Kontrakturen mit intakter Gelenkfläche die systematische Arthrolyse. Auch bei chronischen Zuständen können an Daumen und Fingergrundgelenk mit adäquater Behandlung noch gute funktionelle Ergebnisse resultieren.

Abstract

Injuries of the metacarpophalangeal joints of the thumb and fingers are of a bony or ligamentous nature. They can heal without subsequent problems if correctly diagnosed and treated but incorrect or absent diagnostics and therapy can result in chronic instability, dislocation, fusion as well as subsequent arthritis and functional limitations. They can lead to substantial impairment of the gripping function. Fractures with inclusion of joints and with fragments sufficiently large for refixation are as a rule treated operatively just as differences in torsion and instability. Persisting instabilities are secondarily stabilized by ligamentoplasty and arthritis of the metacarpophalangeal joint of the thumb is treated by fusion. For metacarpophalangeal joints of the fingers the main concern is preserving motion. Established salvage operations for arthritis include denervation, resection arthroplasty and systematic arthrolysis for impairment of the joint and contractures with intact joint surfaces. Even in chronic conditions, with appropriate treatment good functional results for metacarpophalangeal joints of the thumb and fingers can be achieved. This article presents the current pathophysiological principles and concepts for diagnostics and therapy of acute and chronic injuries of the metacarpophalangeal joints of fingers and thumbs.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Meier gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Ortenau-Klinikum Offenburg, Ebertplatz 12, 77654, Offenburg, Deutschland

    R. Meier , MHBA

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Correspondence to R. Meier , MHBA.

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Meier, R. Verletzungen der Grundgelenke und ihre Folgen. Unfallchirurg 117, 307–314 (2014). https://doi.org/10.1007/s00113-013-2507-x

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