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Palmare Mittelgliedbasisimpressionsfraktur des Fingers

Pathobiomechanische Überlegungen und Therapiemöglichkeiten

Palmar depression fracture at the base of the middle phalanx of the finger

Pathobiomechanical considerations and therapy options

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Trauma und Berufskrankheit

Zusammenfassung

Zur Behandlung der Mittelgliedbasisimpressionsfraktur, die immer mit einer dorsalen Subluxation einhergeht, wurden zahlreiche operative und nichtoperative Verfahren beschrieben. Eine gute Funktion kann nur erreicht werden, wenn eine frühzeitige Diagnose gestellt werden kann und die Behandlung frühzeitig einsetzt. Wichtigstes Therapieziel sind die Aufhebung oder Beseitigung der dorsalen Subluxation. Die anatomische Gelenkrekonstruktion ist aufgrund des Zugangsweges sehr schwierig und sollte nur von sehr erfahrenen Handchirurgen durchgeführt werden. Nach der Operation ist eine frühzeitige Übungsbehandlung notwendig. Als Operationsverfahren haben sich die „dynamische Traktionsbehandlung“ einerseits und die „offene Gelenkrekonstruktion“ andererseits durchgesetzt. Die Gesamtbeweglichkeit des Mittelgelenkes liegt nach Ausheilung im Durchschnitt zwischen 75° und 85°. Aber auch heute noch bleibt diese Verletzung auch für den erfahrenen Handchirurgen eine Herausforderung.

Abstract

Numerous surgical and non-surgical procedures have been described for the treatment of depression fractures at the base of the middle phalanx, which are always associated with dorsal subluxation. Good function can only be achieved when an early diagnosis is made and treatment is initiated promptly. In the latter, elimination of the dorsal subluxation is the most important goal. Anatomic joint reconstruction is very challenging due to restricted access and should only be performed by very experienced hand surgeons. Early exercise therapy is necessary following surgery. As far as surgical options are concerned,“dynamic traction” on the one hand and“open joint reconstruction” on the other represent the established procedures. Once healed, total mobility of the proximal interphalangeal joint is averagely between 75° und 85°. However, this injury still remains a challenge even for experienced hand surgeons.

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Langer, M., Surke, C., Raschke, M. et al. Palmare Mittelgliedbasisimpressionsfraktur des Fingers. Trauma Berufskrankh 11 (Suppl 3), 366–370 (2009). https://doi.org/10.1007/s10039-009-1539-5

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