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Dislozierte Frakturen der Metacarpalia II–V

Ergebnisse nach übungsstabiler Osteosynthese mit einem elastisch-stabilen intramedullären Nagel (ESIN) bei Kindern und Jugendlichen

Dislocated fractures of metacarpals II–V

Outcome after operative treatment with an elastic stable intramedullary nail (ESIN) in children and adolescents

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Trauma und Berufskrankheit

Zusammenfassung

Zwischen 01/2002 und 08/2009 wurden 51 Kinder und Jugendliche mit 57 geschlossenen Frakturen der Metacarpalia (MC) mittels einem elastisch-stabilen intramedullären Nagel (ESIN) operiert und nachuntersucht (MC V n=37, MC IV n=11, MC III n=1, MC II n=8). Neben den subkapitalen (n=39) wurden sowohl basisnahe (n=11) als auch diaphysäre Brüche (n=7) behandelt. Nach geschlossener Reposition wurden die Frakturen mit einem elastisch-stabilen intramedullären Titannagel (Stärke 2 mm oder 2,5 mm) versorgt und ohne Immobilisierung nachbehandelt. Bei allen Patienten gelang eine Wiederherstellung der Achse der Mittelhandknochen, ebenso wiesen sie in der Nachuntersuchung eine komplett freie Beweglichkeit und Funktionsfähigkeit der Finger auf. Bei 2 Patienten, bei denen aufgrund zu lang belassener Nagelenden eine Hautperforation drohte, erfolgte eine vorzeitige Metallentfernung, bei einem weiteren bestand postoperativ eine bis zur Nachuntersuchung voll reversible Hypästhesie im Hypothenarbereich. Komplikationen wie Infektionen, Pseudarthrosen oder Bewegungseinschränkungen traten nicht auf. Somit profitieren Kinder und Jugendliche bei Frakturen der MC nach geschlossener Reposition von der technisch einfachen Osteosynthese mit einem elastisch-stabilen Nagel.

Abstract

Between January 2002 and August 2009 a total of 51 children and adolescents with 57 closed fractures of the metacarpals (MC) II-V were treated with a single elastic stable nail and followed up prospectively (MC V n=37, MC IV n=11, MC III n=1, MC II n=8). Of the fractures 39 were located at the distal part of the MC, 11 were located proximally and 7 in the diaphysis. After closed reduction of all fractures they were treated with an elastic stable nail 2 mm or 2.5 mm in size without further immobilization. All patients except a 7-year-old girl with polytrauma were treated as outpatients. At follow-up no child showed a deformation of axis or rotational deviation, all patients reached a complete free range of motion (ASSH TAF score system) and good functional results. There were two cases of skin irritation due to a false technique which required nail removal without significant loss of reduction. In one case hypaesthesia of the superficial branch of the ulnar nerve was temporary. No infections, second operative procedures, pseudarthrosis or limited range of motion occurred. Children and adolescents with a dislocated fracture of metacarpals profit from operations with one elastic intramedullary nail. This method can be offered as an effective and safe alternative in the treatment of closed displaced fractures of the II-V metacarpals without significant complications but immediate mobilization.

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Rapp, M., Unger, A., Kiene, J. et al. Dislozierte Frakturen der Metacarpalia II–V . Trauma Berufskrankh 14, 51–56 (2012). https://doi.org/10.1007/s10039-011-1737-9

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  • DOI: https://doi.org/10.1007/s10039-011-1737-9

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