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Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks nach Bowers

The Hemiresection-Interposition Arthroplasty of the Distal Radioulnar Joint

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung der Unterarmdrehung und Schmerzreduktion am distalen Radioulnargelenk durch Resektion der Gelenkflächen des Ulnakopfes unter Erhalt oder Refixation des ulnokarpalen Komplexes und Interposition eines Kapsel-Retinakulum-Lappens zwischen Incisura ulnaris des Radius und distaler Ulna.

Indikationen

Schmerzhafte Arthrosen des distalen Radioulnargelenks.

Kontraindikationen

Longitudinale Instabilitäten des Unterarms, z.B. bei Essex- Lopresti-Läsionen oder nach Radiuskopfresektionen. Posttraumatische ulnare Translokation des Carpus.

Operationstechnik

Eröffnung des distalen Radioulnargelenks durch den Boden des fünften Strecksehnenfachs unter Bildung eines ulnar gestielten Kapsel-Retinakulum-Lappens. Erhalt des vierten und sechsten Strecksehnenfachs. Resektion der gelenktragenden Teile des Ellenkopfes unter Erhalt des Processus styloideus ulnae und des Ansatzes des ulnokarpalen Bandkomplexes (TFCC [„triangular fibrocartilage complex“]). Gegebenenfalls Refixation oder Rekonstruktion des ulnokarpalen Bandkomplexes. Interposition des Kapsel-Retinakulum-Lappens zwischen Radius und Ulna. Stabilisation der distalen Ulna durch Naht der dorsalen Anteile des Interponats an die dorsale Lippe der Incisura ulnaris des Radius.

Weiterbehandlung

Ruhigstellung in einer Oberarmgipsschiene in 45° Supinationsstellung des Unterarms für 4 Wochen. Anschließend werden Pronation und Supination mit einer thermoplastischen, Ulna und Radius ulnar umgreifenden Schiene unter Freilassung des Radio- und Ulnokarpalgelenks für weitere 4 Wochen begrenzt. Danach Steigerung des Bewegungsumfangs und der Belastung bis zur Vollbelastung.

Ergebnisse

Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks reduziert den Schmerz signifikant und erhöht die Grobkraft. Bei präoperativer Einschränkung der Umwendbewegung kann der Bewegungsumfang durch die Operation deutlich gesteigert werden. Eine Instabilität des Ulnaendes kann verbleiben bzw. resultieren, was aber nur bei einem Teil der Patienten leichte Beschwerden verursacht. Die Patientenzufriedenheit ist hoch bei gutem funktionellem Ergebnis.

Abstract

Objective

Restoration of forearm rotation and pain relief at the distal radioulnar joint by resection of the joint surfaces of the ulnar head, interposition of a capsular-retinacular flap, and preservation or reconstruction of the ulnocarpal complex.

Indications

Painful osteoarthritis of the distal radioulnar joint.

Contraindications

Longitudinal instability in the forearm, e.g., Essex-Lopresti lesions or after radial head resection. Posttraumatic ulnar subluxation of the carpus.

Surgical Technique

Exposition of the distal radioulnar joint via the floor of the fifth extensor compartment and preparation of an ulnarbased capsular-retinacular flap. Preservation of the fourth and sixth extensor compartment. Resection of the jointbearing areas of the ulnar head preserving the ulnar styloid and the triangular fibrocartilage complex (TFCC). If necessary, refixation or reconstruction of the TFCC. Interposition of the capsular-retinacular flap between the distal radius and ulna. Stabilization of the distal ulna by suture fixation of the dorsal part of the flap to the dorsal rim of the sigmoid notch.

Postoperative Management

Immobilization in a long arm cast with 45° forearm supination for 4 weeks. Afterwards, forearm pronation and supination are further limited for 4 weeks by a splint. Following that period, the range of motion and the load are raised to normal levels.

Results

The hemiresection-interposition arthroplasty of the distal radioulnar joint improves the range of forearm rotation. Pain is significantly reduced and grip strength increased. Instability of the distal ulna may persist or result; however, this gives rise to moderate complaints only in some patients. Patients’ satisfaction is high and the functional results are good.

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Authors and Affiliations

  1. Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt an der Saale, Germany

    Thomas Pillukat & Jörg van Schoonhoven

  2. Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97616, Bad Neustadt, Germany

    Thomas Pillukat

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  1. Thomas Pillukat
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  2. Jörg van Schoonhoven
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Correspondence to Thomas Pillukat.

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Pillukat, T., van Schoonhoven, J. Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks nach Bowers. Orthop Traumatol 21, 484–497 (2009). https://doi.org/10.1007/s00064-009-1913-2

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  • DOI: https://doi.org/10.1007/s00064-009-1913-2

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