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Radioskapholunäre Arthrodese mit Entfernung des distalen Skaphoidpols von palmar

Palmar radioscapholunate arthrodesis with distal scaphoidectomy

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Zusammenfassung

Operationsziel

Arthrodese zwischen Skaphoid, Lunatum und Radius mittels winkelstabiler Platte und Entfernung des distalen Skaphoidpols von palmar zur Behandlung einer posttraumatischen oder degenerativen radiokarpalen Arthrose.

Indikationen

Isolierte radiokarpale Arthrose, bei intaktem Mediokarpalgelenk nach fehlverheilten distalen Speichenfrakturen, rheumatoider Arthritis und „scapholunate advanced collapse“ (SLAC) bis Stadium II.

Kontraindikationen

Mediokarpalarthrose, fehlende Compliance des Patienten, SLAC ab Stadium III, Osteitis.

Operationstechnik

Der distale Speichenabschnitt und das Skaphoid werden durch einen beugeseitigen Zugang zwischen Flexor carpi radialis Sehne und A. radialis dargestellt. Nach Ablösen des M. pronator quadratus, Eröffnen der Gelenkkapsel und Korrektur einer evtl. vorhandenen Fehlstellung des Lunatums wird das Skaphoid mit dem Lunatum temporär mit einem Bohrdraht fixiert. Das distale Skaphoidviertel wird mit dem Meißel osteotomiert und entfernt, die palmare Lippe der distalen Speiche abgemeißelt und anschließend der Knorpel zwischen Skaphoid, Lunatum und Radius abgetragen. Nach temporärer Bohrdrahtarthrodese zwischen Radius, Lunatum und Skaphoid wird die winkelstabile Low-profil-Platte (z. B. palmare 2.5 TriLock RSL Fusion Platte [Medartis® Aptus®, Basel, Schweiz]) unter Bildwandlerkontrolle positioniert und im Gleitloch fixiert. Das Skaphoid und Lunatum werden mit je 2 Schrauben in der Platte distal fixiert, der Carpus wird mit einem Codman-Distraktor nach distal geschoben und die Spongiosa eingebracht. Abschließend wird die Platte am Schaft mit winkelstabilen Schrauben fixiert.

Weiterbehandlung

Ruhigstellung in einer Unterarm(‑Kunststoff)-Schiene für 5 Wochen. Nach 2 Wochen Nahtentfernung und Beginn mit aktiver Handtherapie für das Handgelenk. Normale Belastung des Handgelenkes nach 12 Wochen.

Ergebnisse

Durch die radioskapholunäre (RSL) Arthrodese kann bei Vorliegen einer isolierten Radiokarpalarthrose eine deutliche Reduktion der Schmerzsymptomatik bei erhaltener Restbeweglichkeit des Handgelenkes erreicht werden.

Abstract

Objective

Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint.

Indications

Osteoarthritis limited to the radiocarpal joint with intact mediocarpal joint after malunited intra-articular distal radius fractures, rheumatoid osteoarthritis, scapholunate advanced collapse (SLAC) up to stage II.

Contraindications

Mediocarpal osteoarthritis, poor patient compliance, SLAC from stage III, osteitis.

Surgical technique

The palmar RSL arthrodesis is performed using the palmar approach between the flexor carpi radialis tendon and the radial artery. After releasing the pronator quadratus muscle, a longitudinal capsulotomy is performed and the radiocarpal joint is inspected. After correction of a volar or dorsal intercalated segmental instability of the lunate, the lunate is temporarily fixed to the scaphoid using a K-wire. The distal quarter of the scaphoid and the palmar rim of the distal radius is resected and the cartilage between the scaphoid, lunate and distal radius is removed. The scaphoid and lunate are temporarily fixed to the distal radius using K‑wires. Under image intensifier control the angular stable low-profile plate (e.g., volar 2.5 Trilock RSL Fusion plate [Medartis® Aptus® Basel, Switzerland]) is fixed to the distal radius in the long-leg hole. The scaphoid and lunate are fixed distally with two screws each. The carpus is pushed distally using a Codeman distractor and the cancellous bone graft is impacted. Finally, the shaft is fixed with angular stable screws.

Postoperative management

Immobilization using a plaster cast or thermoplastic short-arm orthosis for 5 weeks. After 2 weeks, the orthosis can be removed during hand therapy with active wrist and finger exercises. Normal activities permitted after 12 weeks.

Results

Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows a high union rate and pain relief while maintaining good residual mobility of the wrist.

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Literatur

  1. Berkhout MJ, Shaw MN, Berglund LJ et al (2010) The effect of radioscapholunate fusion on wrist movement and the subsequent effects of distal scaphoidectomy and triquetrectomy. J Hand Surg Eur Vol 35:740–745. https://doi.org/10.1177/1753193410370926

    Article  CAS  PubMed  Google Scholar 

  2. Borisch N (2016) Arthroscopic resection of occult dorsal wrist ganglia. Arch Orthop Trauma Surg 136:1473–1480. https://doi.org/10.1007/s00402-016-2539-0

    Article  PubMed  Google Scholar 

  3. Borisch N, Jacob HA (2015) Wrist kinematics after radiolunate arthrodesis. Arch Orthop Trauma Surg 135:1033–1041. https://doi.org/10.1007/s00402-015-2244-4

    Article  PubMed  Google Scholar 

  4. Calfee RP, Leventhal EL, Wilkerson J et al (2008) Simulated radioscapholunate fusion alters carpal kinematics while preserving dart-thrower’s motion. J Hand Surg Am 33:503–510. https://doi.org/10.1016/j.jhsa.2007.12.013

    Article  PubMed  PubMed Central  Google Scholar 

  5. Court-Brown CM, McQueen MM (2008) Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma 64:1517–1521. https://doi.org/10.1097/TA.0b013e3181469840

    Article  PubMed  Google Scholar 

  6. Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: a review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162. https://doi.org/10.1007/s00402-013-1766-x

    Article  CAS  PubMed  Google Scholar 

  7. Figl M, Weninger P, Jurkowitsch J et al (2010) Unstable distal radius fractures in the elderly ratient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma 68:992–998. https://doi.org/10.1097/TA.0b013e3181b99f71

    Article  PubMed  Google Scholar 

  8. Garcia-Elías M, Lluch A (2001) Partial excision of scaphoid: is it ever indicated? Hand Clin 17:687–695

    PubMed  Google Scholar 

  9. Garcia-Elias M, Lluch A, Ferreres A et al (2005) Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg Am 30:8–15. https://doi.org/10.1016/j.jhsa.2004.09.001

    Article  PubMed  Google Scholar 

  10. Gordon LH, King D (1961) Partial wrist arthrodesis for old ununited fractures of the carpal navicular. Am J Surg 102:460–464. https://doi.org/10.1016/0002-9610(61)90537-2

    Article  CAS  PubMed  Google Scholar 

  11. Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5

    Article  PubMed  Google Scholar 

  12. Bain GI, Sood A, Yeo CJ (2014) RSL fusion with excision of distal scaphoid and triquetrum: a cadaveric study. J Wrist Surg 3:37–41. https://doi.org/10.1055/s-0033-1364095

    Article  PubMed  PubMed Central  Google Scholar 

  13. Knirk JL, Jupiter JB (1986) Intra-articular fractures of the of the in young adults. J Bone Joint Surg Am 68:647–659

    CAS  PubMed  Google Scholar 

  14. Kilgus M, Weishaupt D, Künzi W, Meyer VE (2003) Erfahrungen mit der radiokarpalen Teilarthrodese nach Gordon und King im Langzeitverlauf. Handchir Mikrochir Plast Chir 35:317–322. https://doi.org/10.1055/s-2003-43117

    Article  CAS  PubMed  Google Scholar 

  15. Köhler S, Koch K, Arsalan-Werner A et al (2017) Wrist arthrodesis with a fixed-angle, “low-profile” fusion plate without carpometacarpal joint fixation. Oper Orthop Traumatol 29:416–430. https://doi.org/10.1007/s00064-017-0517-5

    Article  PubMed  Google Scholar 

  16. Larsen CF, Jacoby RA, McCabe SJ (1997) Nonunion rates of limited carpal arthrodesis: a meta-analysis of the literature. J Hand Surg Am 22:66–73. https://doi.org/10.1016/S0363-5023(05)80181-9

    Article  CAS  PubMed  Google Scholar 

  17. Löw S, Herold A, Eingartner C (2014) Die standardisierte Arthroskopie des Handgelenks. Oper Orthop Traumatol 26:539–546. https://doi.org/10.1007/s00064-014-0311-6

    Article  PubMed  Google Scholar 

  18. Lutz M, Erhart S, Deml C, Klestil T (2016) Arthroskopisch gesteuerte Osteosynthese der dislozierten intraartikulären distalen Radiusfraktur. Oper Orthop Traumatol 28:279–290. https://doi.org/10.1007/s00064-016-0448-6

    Article  CAS  PubMed  Google Scholar 

  19. MacIntyre NJ, Dewan N (2016) Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 29:136–145. https://doi.org/10.1016/j.jht.2016.03.003

    Article  PubMed  Google Scholar 

  20. McCombe D, Ireland DC, McNab I (2001) Distal scaphoid excision after radioscaphoid arthrodesis. J Hand Surg Am 26:877–882. https://doi.org/10.1053/jhsu.2001.27762

    Article  CAS  PubMed  Google Scholar 

  21. Mühldorfer-Fodor M, Ha HP, Hohendorff B et al (2012) Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole. J Hand Surg Am 37:2233–2239. https://doi.org/10.1016/j.jhsa.2012.08.009

    Article  PubMed  Google Scholar 

  22. Nagy L, Büchler U (1997) Long-term results of radioscapholunate fusion following fractures of the distal radius. J Hand Surg Br 22:705–710

    CAS  PubMed  Google Scholar 

  23. Palmer AK, Werner FW, Murphy D, Glisson R (1985) Functional wrist motion: a biomechanical study. J Hand Surg Am 10:39–46. https://doi.org/10.1016/S0363-5023(85)80246-X

    Article  CAS  PubMed  Google Scholar 

  24. Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J (2016) Die palmare winkelstabile Plattenosteosynthese bei Extensionsfrakturen des distalen Radius. Oper Orthop Traumatol 28:47–64. https://doi.org/10.1007/s00064-015-0433-5

    Article  CAS  PubMed  Google Scholar 

  25. Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar radioscapholunate arthrodesis and distal scaphoidectomy after malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031

    Article  Google Scholar 

  26. Quadlbauer S, Pezzei C, Hintringer W et al (2018) Clinical examination of the distal radioulnar joint. Orthopade 47:628–636. https://doi.org/10.1007/s00132-018-3584-x

    Article  CAS  PubMed  Google Scholar 

  27. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317

    Article  Google Scholar 

  28. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1

    Article  CAS  PubMed  Google Scholar 

  29. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3051-5

    Article  PubMed  Google Scholar 

  30. Schermann H, Kadar A, Dolkart O et al (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2

    Article  PubMed  Google Scholar 

  31. Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z

    Article  PubMed  Google Scholar 

  32. Soong M, van Leerdam R, Guitton TG et al (2011) Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 36:3–9. https://doi.org/10.1016/j.jhsa.2010.09.033

    Article  PubMed  Google Scholar 

  33. Sturzenegger M, Büchler U (1991) Radio-scapho-lunate partial wrist arthrodesis following comminuted fractures of the distal radius. Ann Chir Main Memb Super 10:207–216. https://doi.org/10.1016/S0753-9053(05)80285-6

    Article  CAS  PubMed  Google Scholar 

  34. Watson-Jones R (1955) Injuries of the wrist. In: Watson-Jones R (Hrsg) Fractures & joint injuries, 4. Aufl. The Williams and Wilkins Company, Baltimore, S 617

    Google Scholar 

  35. Watson HK, Ryu J (1986) Evolution of arthritis of the wrist. Clin Orthop Relat Res 202:57–67

    Google Scholar 

  36. Wei DH, Raizman NM, Bottino CJ et al (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: a prospective randomized trial. J Bone Joint Surg Am 91:1568–1577. https://doi.org/10.2106/JBJS.H.00722

    Article  PubMed  Google Scholar 

  37. Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yajima H, Kobata Y, Shigematsu K et al (2004) Radiocarpal arthrodesis for osteoarthritis following fractures of the distal radius. Hand Surg 9:203–209

    PubMed  Google Scholar 

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Authors and Affiliations

  1. AUVA Unfallkrankenhaus Lorenz Böhler – European Hand Trauma Center, 1200, Wien, Österreich

    Stefan Quadlbauer, Martin Leixnering, Rudolf Rosenauer, Josef Jurkowitsch, Thomas Hausner & Christoph Pezzei

  2. Ludwig Boltzmann Institut für Experimentelle und Klinische Traumatologie, AUVA Research Center, 1200, Wien, Österreich

    Stefan Quadlbauer, Rudolf Rosenauer & Thomas Hausner

  3. Austrian Cluster for Tissue Regeneration, 1200, Wien, Österreich

    Stefan Quadlbauer, Rudolf Rosenauer & Thomas Hausner

  4. Abteilung Orthopädie und Traumatologie, Paracelsius Medizinische Universität, 5020, Salzburg, Österreich

    Thomas Hausner

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  1. Stefan Quadlbauer
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  2. Martin Leixnering
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  4. Josef Jurkowitsch
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Correspondence to Stefan Quadlbauer.

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Interessenkonflikt

S. Quadlbauer, M. Leixnering, R. Rosenauer, J. Jurkowitsch, T. Hausner und C. Pezzei geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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F. Unglaub, Bad Rappenau

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Quadlbauer, S., Leixnering, M., Rosenauer, R. et al. Radioskapholunäre Arthrodese mit Entfernung des distalen Skaphoidpols von palmar. Oper Orthop Traumatol 32, 455–466 (2020). https://doi.org/10.1007/s00064-020-00651-1

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