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Die Schwanenhals- und die Knopflochdeformität an den rheumatischen Langfingern

Swan-neck and buttonhole deformities on rheumatic long fingers

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Zusammenfassung

Patienten des rheumatischen Formenkreises entwickeln häufig Fingerfehlstellungen im Sinne einer Schwanenhals- oder Knopflochdeformität. Es besteht ein stadienhafter Verlauf, der zunächst noch die aktive, später die passive Korrektur zulässt und zuletzt in kontrakten Fehlstellungen endet. Die Aktivitäten des täglichen Lebens sind dabei oft stark eingeschränkt. Die Pathologie der Schwanenhalsdeformität wird am Metakarpophalangealgelenk initiiert, während die Synovialitis des proximalen Interphalangealgelenks den Ausgangspunkt der Knopflochproblematik darstellt.

Operativ sind in den Frühstadien Schleimhautresektionen der Gelenke und Weichteilbalancierungseingriffe angezeigt. Im Verlauf werden aufwendige Rekonstruktionen notwendig, gelegentlich in Verbindung mit prothetischem Ersatz oder Arthrodesen, damit die Fingerfunktionen einigermaßen erhalten werden können.

Abstract

Patients suffering from rheumatoid arthritis in many cases develop typical swan-neck and buttonhole deformities. In the further course of the disease we observe several stages. In the beginning active and later passive correction are still possible, while ultimately a fixed contracture is present. The activities of daily life may be severely reduced. The pathology of the swan-neck deformity is initiated at the level of the metacarpophalangeal joint, while at the origin of the buttonhole deformity the synovitis of the proximal interphalangeal joint is obvious. In the early stages, synovectomy and balancing of the soft tissues are surgically indicated. In advanced stages, complicated soft tissue reconstruction in combination with alloarthroplasty or arthrodeses may become necessary to allow for sufficient finger function.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik, Frankfurt am Main

    S. Rehart, C. Braune & H. Effenberger

  2. Abteilung Rheumaorthopädie, Nordwestdeutsches Rheumazentrum, St.-Josef-Stift, Sendenhorst

    A. Hilker

  3. Oberarzt der Orthopädischen Universitätsklinik, Abteilung für Rheumaorthopädie, Marienburgstr. 2, 60528, Frankfurt am Main

    S. Rehart

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  1. S. Rehart
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  2. C. Braune
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  3. A. Hilker
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  4. H. Effenberger
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Correspondence to S. Rehart.

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Rehart, S., Braune, C., Hilker, A. et al. Die Schwanenhals- und die Knopflochdeformität an den rheumatischen Langfingern. Orthopäde 34, 39–46 (2005). https://doi.org/10.1007/s00132-004-0742-0

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  • DOI: https://doi.org/10.1007/s00132-004-0742-0

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