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Rettungsoperationen und deren Differenzialindikation am distalen Radioulnargelenk

Salvage procedures for the distal radioulnar joint and their specific indications

  • Leitthema: Der ulnare Handgelenkschmerz
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Zusammenfassung

Die häufigste Ursache für die Entstehung der Arthrose des distalen Radioulnargelenkes (DRUG) ist die in Fehlstellung verheilte distale Radiusfraktur. Eine vollständige Wiederherstellung der Funktion des DRUG kann weder durch Ulnakopfresektion, Hemiresektions-Interpositions-Arthroplastik, Kapandji-Sauvé-Operation noch durch endoprothetischen Ersatz des Ulnakopfes erreicht werden. Die Bewertung der einzelnen Methoden muss sich an der Komplikationsrate orientieren. Die wesentliche Komplikation der resezierenden Verfahren besteht in der biomechanischen Destabilisierung des distalen Unterarmgefüges mit sekundärer, schmerzhafter Instabilität des distalen Ulnaendes, und zwar für die Ulnakopfresektion erheblich häufiger als für die anderen Therapieverfahren. Wir sehen daher keine Indikation mehr für die vollständige Entfernung des Ulnakopfes. Nach Ergebnissen und Häufigkeit der sekundären Instabilität für die Hemiresektions-Interpositionsarthroplasik und die Kapandji-Sauvé-Operation sind diese Methoden gleichwertig. Bei vorbestehender Instabilität des DRUG oder erheblicher Achsenfehlstellung favorisieren wir die Hemiresektions-Interpositions-Arthroplastik. Studien ergaben, dass durch den endoprothetischen Ersatz des Ulnakopfes eine sekundäre Instabilität behoben, oder, bei primärer Verwendung, vermieden werden kann. Die Hauptindikation ist die Revision bei schmerzhafter, sekundärer Instabilität des distalen Ulnaendes. Bis zum Vorliegen von Langzeitergebnissen begrenzen wir den primären endoprothetischen Ersatz des Ulnakopfes auf spezielle Indikationen.

Abstract

The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. Therefore, anatomical reconstruction of the joint in acute or secondary correction osteotomy for malunited fractures of the distal radius should be performed to avoid the development of the arthrosis. Numerous clinical studies have demonstrated a similar reduction of the clinical symptoms for all procedures. Therefore, classification of the different procedures has to consider the number of complications. Biomechanically, partial resection of the distal ulna will destabilize the distal radioulnar context and clinically may lead to painful radioulnar and/or dorsopalmar instability of the distal ulnar stump. Biomechanically and clinically, this complication, next to secondary extensor tendon ruptures, has to be expected far more often following complete resection of the ulnar head than in the alternative procedures. We do not see any remaining indication for complete resection of the ulnar head. Clinical results and the occurrence of painful instability of the distal ulnar stump have been reported almost identically for the hemiresection-interposition technique and the Kapandji Sauvé procedure. Therefore, both procedures appear to be equally suitable for the treatment of painful arthrosis of the distal radioulnar joint. In patients with a preexisting instability of the distal radioulnar joint, or a major deformity of the radius or the ulna, we prefer to perform the hemiresection-interposition-technique. In these conditions we consider the remaining contact of the triangular fibrocartilage complex with the distal end of the ulna a biomechanical advantage to reduce the risk of secondary instability. Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.

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Literatur

  1. Prommersberger K-J, Moossavi S, Lanz U (1999) Ergebnisse der Korrekturosteotomie fehlverheilter Extensionsfrakturen der Speiche an typischer Stelle. Handchir Mikrochir Plast Chir 31: 234–240

    Article  CAS  PubMed  Google Scholar 

  2. Bade H, Lobeck F (1991) Gelenkflächenverhalten der Articulatio radioulnaris distalis bei fehlgestelltem distalen Radius. Unfallchirurgie 17: 213–217

    CAS  PubMed  Google Scholar 

  3. Bronstein AJ, Trumble TE, Tencer AF (1997) The effects of distal radius fracture malalignement on forearm rotation: a cadaveric study. J Hand Surg Am 22: 258–262

    CAS  PubMed  Google Scholar 

  4. Hirahara H, Neale PG, Lin YT, Cooney WP, An KN (2003) Kinematic and torque-related effects of dorsally angulated distal radius fractures and the distal radial ulnar joint. J Hand Surg Am 28: 614–621

    Article  PubMed  Google Scholar 

  5. Kihara H, Palmer AK, Werner FW, Short WH, Fortino MD (1996) The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation. J Hand Surg Am 21: 40–47

    CAS  PubMed  Google Scholar 

  6. Munesada S, Oka Y, Terada H, Rokuuma N (1983) Rotation of the forearm in fracture of the distal radius: clinical and experimental studies.In: Nakamura R, Linscheid RL, Miura T (eds) Wrist disorders. Current concepts and challenges. Springer, Berlin Heidelberg New York Tokio, pp 227–231

  7. Schoonhoven J van, Prommersberger K-J, Lanz U (1999) Die Bedeutung des distalen Radioulnargelenks bei rekonstruktiven Eingriffen nach fehlverheilten körperfernen Speichenbrüchen. Orthopäde 28: 864–871

    Google Scholar 

  8. Hagert CG (1987) The distal radioulnar joint. Hand Clin 3: 41–50

    CAS  PubMed  Google Scholar 

  9. Skahen III. JR, Palmer AK, Werner FW, Fortino MD (1997) The interosseous membrane of the forearm: Anatomy and function. J Hand Surg Am 22: 981–985

    PubMed  Google Scholar 

  10. Nakamura T, Yabe Y, Horiuchi Y (1999) In vivo MR studies of dynamic changes in the interosseous membrane of the forearm during rotation. J Hand Surg Br 24: 245–248

    Article  CAS  PubMed  Google Scholar 

  11. Schoonhoven J van, Lanz U (1998) „Rund um den Ellenkopf“: Verletzungsmuster und Klassifikationen. Handchir Mikrochir Plast Chir 30: 351–360

    PubMed  Google Scholar 

  12. Hagert CG (1994) Distal radius fracture and the radioulnar joint—anatomical considerations. Handchir Mikrochir Plast Chir 26: 22–26

    CAS  PubMed  Google Scholar 

  13. Palmer AK, Werner FW (1984) Biomechanics of the distal radioulnar joint. Clin Orthop 187: 26–35

    PubMed  Google Scholar 

  14. Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD (1998) Pressure distribution in the distal radioulnar joint. J Hand Surg Am 23: 909–913

    CAS  PubMed  Google Scholar 

  15. Buck-Gramcko D (1990) On the priorities of publications of some operative procedures on the distal end of the ulna. J Hand Surg Br 15: 416–420

    CAS  PubMed  Google Scholar 

  16. DiBenedetto MR, Lubbers LM, Coleman CR (1991) Long-term results of the minimal resection Darrach procedure. J Hand Surg Am 16: 445–450

    CAS  PubMed  Google Scholar 

  17. Tulipan DJ, Eaton RG, Eberhart RE (1991) The Darrach procedure defended: technique redefined and long-term follow-up. J Hand Surg Am 16: 438–444

    CAS  PubMed  Google Scholar 

  18. Pachucki A, Matuschka H, Russe F (1991) Die Ellenköpfchenresektion—Indikation und Behandlungsergebnisse. Handchir Mikrochir Plast Chir 23: 318–320

    CAS  PubMed  Google Scholar 

  19. Schiltenwolf M, Martini AK, Bernd L, Lukoschek M (1992) Ergebnisse nach Ellenköpfchenresektion. Z Orthop 130: 181–187

    CAS  PubMed  Google Scholar 

  20. Ekenstam F af, Engkvist O, Wadin K (1982) Results from resection of the distal end of the ulna after fractures of the lower end of the radius. Scand J Plast Reconstr Surg 16: 177–181

    Google Scholar 

  21. Minami A, Ogino T, Minami M (1987) Treatment of distal radioulnar disorders. J Hand Surg Am 12: 189–196

    CAS  PubMed  Google Scholar 

  22. Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD (1988) Failed distal ulna resections. J Hand Surg Am 13: 193–200

    CAS  PubMed  Google Scholar 

  23. Field J, Malkowski RJ, Leslie IL (1993) Poor results of Darrach’s procedure after wrist injuries. J Bone Joint Surg 75-B: 53–57

    Google Scholar 

  24. Craigen MAC, Stanley JK (1995). Distal ulnar instability following wrist arthrodesis in men. J Hand Surg Br 20: 155–158

    CAS  PubMed  Google Scholar 

  25. Bell MJ, Hill RJ, McMurtry RY (1985) Ulnar impingement syndrome. J Bone Joint Surg 67-B: 126–129

    Google Scholar 

  26. Lees VC, Scheker LR (1997) The radiological demonstration of dynamic ulnar impingement. J Hand Surg Br 22: 448–450

    Google Scholar 

  27. Pring DJ, Williams DJ (1986) Closed rupture of extensor digitorum communis tendon following excision of distal ulna. J Hand Surg Br 11: 451–452

    CAS  PubMed  Google Scholar 

  28. Newmeyer WL, Green DP (1982) Rupture of digital extensor tendons following distal ulnar resection. J Bone Joint Surg 64-A: 178–182

    Google Scholar 

  29. Sauerbier M, Fujita M, Hahn ME, Neale PG, Berger RA (2002) The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study. J Hand Surg Br 27: 307–316

    Article  CAS  PubMed  Google Scholar 

  30. Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA (2002) Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 27: 425–434

    Article  PubMed  Google Scholar 

  31. Petersen MS, Adams BD (1993) Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg Am 18: 328–334

    CAS  PubMed  Google Scholar 

  32. Sauerbier M, Berger RA, Fujita M, Hahn ME (2003) Radioulnar convergence after distal ulnar resection. Mechanical performance of two commonly used soft tissue stabilizing procedures. Acta Orthop Scand 74: 420–428

    Article  PubMed  Google Scholar 

  33. Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC (2004) The distal radioulnar joint as a load-bearing mechanism—a biomechanical study. J Hand Surg Am 29: 85–95

    Article  PubMed  Google Scholar 

  34. Bowers WH (1985) Distal radioulnar joint arthroplasty: The hemiresection-interposition technique. J Hand Surg Am 10: 169–178

    CAS  PubMed  Google Scholar 

  35. Watson HK, Ryu J, Burgess RC (1986) Matched distal ulnar resection. J Hand Surg Am 11: 812–817

    CAS  PubMed  Google Scholar 

  36. Fernandez DL (1988) Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of the radius. J Bone Joint Surg 70-A: 1538–1551

    Google Scholar 

  37. Minami A, Suzuki K, Suenaga N, Ishikawa J (1995) Hemiresection-interposition arthroplasty for osteoarthritis of the distal radioulnar joint. Int Orthop 19: 35–39

    CAS  PubMed  Google Scholar 

  38. Minami A, Kaneda K, Itoga H (1991) Hemiresection-interposition arthroplasty of the distal radioulnar joint associated with repair of triangular fibrocartilage complex lesions. J Hand Surg Am 16: 1120–1125

    CAS  PubMed  Google Scholar 

  39. Schoonhoven J van, Kall S, Schober F, Prommersberger K-J, Lanz U (2003) Die Hemiresektions-Interpositionsarthroplastik als Rettungsoperation bei Arthrose des distalen Radioulnargelenkes. Handchir Mikrochir Plast Chir 35: 175–180

    Article  PubMed  Google Scholar 

  40. Faithfull DK, Kwa S (1992) A review of distal ulnar hemiresection arthroplasty. J Hand Surg Br 17: 408–410

    CAS  PubMed  Google Scholar 

  41. Imbriglia JE, Matthews D (1993) Treatment of chronic post-traumatic dorsal subluxation of the distal ulna by hemiresection-interposition arthroplasty. J Hand Surg Am 18: 899–907

    CAS  PubMed  Google Scholar 

  42. Watson HK, Gabuzda GM (1992) Matched distal ulna resection for posttraumatic disorders of the distal radioulnar joint. J Hand Surg Am 17: 724–730

    CAS  PubMed  Google Scholar 

  43. Sauvé L, Kapandji M (1936) Nouvelle technique de traitement chirurgical des luxationes récidivantes isolées de l’extrémité inférieure du cubitus. J Chir 47: 589–594

    Google Scholar 

  44. Wüstner-Hofmann MC, Schober F, Hofmann AK (2003) Die Wertigkeit der Operation nach Kapandji unter Berücksichtigung von klinischer Nachuntersuchung und postoperativer Knochendichtemessung. Handchir Mikrochir Plast Chir 35: 147–156

    Article  PubMed  Google Scholar 

  45. Carter PB, Stuart PR (2000) The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint. J Bone Joint Surg 82-B: 1013–1018

    Google Scholar 

  46. Gordon L, Levinsohn DG, Moore SV, Dodds RJ, Castleman LD (1991) The Sauve-Kapandji procedure for the treatment of posttraumatic distal radioulnar joint problems. Hand Clin 7: 397–403

    CAS  PubMed  Google Scholar 

  47. Minami A, Suzuki K, Suenaga N, Ishikawa J (1995) The Sauvé-Kapandji procedure for osteoarthritis of the distal radioulnar joint. J Hand Surg Am 20: 602–608

    CAS  PubMed  Google Scholar 

  48. Daecke W, Martini AK, Streich NA (2003) Die Kapandji-Sauvé-Operation bei der chronischen Dysfunktion des distalen Radioulnargelenkes unter besonderer Berücksichtigung der Langzeitergebnisse. Handchir Mikrochir Plast Chir 35: 164–169

    Article  CAS  PubMed  Google Scholar 

  49. Zimmermann R, Gschwentner M, Arora R, Gabl M, Pechlaner S (2003) Klinische Langzeitergebnisse der Kapandji-Sauvé-Operation. Handchir Mikrochir Plast Chir 35: 157–163

    Article  CAS  PubMed  Google Scholar 

  50. Sanders RA, Frederick HA, Hontas RB (1991) The Sauvé-Kapandji procedure: a salvage operation for the distal radioulnar joint. J Hand Surg Am 16: 1125–1129

    CAS  PubMed  Google Scholar 

  51. Nakamura R, Tsunoda K, Watanabe K, Horii E, Miura T (1992) The Sauvé-Kapandji procedure for chronic dislocation of the distal radio-ulnar joint with destruction of the articular surface. J Hand Surg Br 17: 127–132

    CAS  PubMed  Google Scholar 

  52. Waizenegger M, Schranz P, Barton NJ (1993) The Kapandji procedure for post-traumatic problems. Injury 24: 662–666

    CAS  PubMed  Google Scholar 

  53. Mikkelsen SS, Lindblad BE, Larsen ER, Sommer J (1997) Sauvé-Kapandji operation for disorders of the distal radioulnar joint after Colles‘ fracture. Acta Orthop Scand 68: 64–66

    CAS  PubMed  Google Scholar 

  54. Lamey DM, Fernandez DL (1998) Results of the modified Sauvé-Kapandji procedure in the treatment of chronic posttraumatic derangement of the distal radioulnar joint. J Bone Joint Surg 80-A: 1758–1769

    Google Scholar 

  55. Schoonhoven J van, Herbert TJ, Krimmer H (1998) Neue Konzepte der Endoprothetik des distalen Radioulnargelenkes. Handchir Mikrochir Plast Chir 30: 387–392

    PubMed  Google Scholar 

  56. Schoonhoven J van, Fernandez DL, Bowers WH, Herbert TJ (2000) Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 25: 438–446

    PubMed  Google Scholar 

  57. Schoonhoven J van, Herbert TJ, Prommersberger KJ, Krimmer H (2003) Ulnakopfprothese. Orthop 32: 809–815

    Article  Google Scholar 

  58. Smet L de, Peeters T (2003) Salvage of failed Sauvé-Kapandji procedure with an ulnar head prosthesis: report of three cases. J Hand Surg Br 28: 271–273

    Article  PubMed  Google Scholar 

  59. Grechenig W, Peicha G, Fellinger M (2001) Primary ulnar head prosthesis for the treatment of an irreparable ulnar head fracture dislocation. J Hand Surg Br 26: 269–271

    Article  CAS  PubMed  Google Scholar 

  60. Masaoka S, Longsworth SH, Werner FW, Short WH, Green JK (2002) Biomechanical analyses of two ulnar head prostheses. J Hand Surg Am 27: 845–853

    Article  PubMed  Google Scholar 

  61. Bowers WH (1991) Instability of the distal radioulnar articulation. Hand Clin 7: 311–327

    CAS  PubMed  Google Scholar 

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  1. Klinik für Hand- und Fußchirurgie, St.-Franziskus-Hospital, Münster

    J. van Schoonhoven

  2. Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt/Saale

    U. Lanz

  3. Orthopädische KlinikII—Klinik für Hand- und Fußchirurgie—des St.-Franziskus-Hospitals, Hohenzollernring 72, 48145, Münster

    J. van Schoonhoven

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van Schoonhoven, J., Lanz, U. Rettungsoperationen und deren Differenzialindikation am distalen Radioulnargelenk. Orthopäde 33, 704–714 (2004). https://doi.org/10.1007/s00132-004-0660-1

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