Die vollständige Versteifung des Handgelenks mit der AO-Handgelenk-Arthrodesenplatte

Abstract

26 (18 men, eight women) of the authors' first patients with arthrodesis of the wrist using the AO fusion plate were reexamined after a mean follow-up time of 18 months (minimum 6, maximum 32 months). The mean modified Mayo Wrist Score was 47 points (minimum 20, maximum 70 points), the DASH Score (Disabilities of the Arm, Shoulder and Hand) averaged 46 points (minimum 4, maximum 81 points). 20 of the 26 patients were satisfied, but not all patients were completely free of pain. Eight out of a total of ten patients (seven men, three women) with a bilateral wrist arthrodesis were reexamined after a mean follow-up time of 66 months (minimum 27, maximum 74 months). The DASH Score was 55 points on average (minimum 38, maximum 73 points). All patients stated that their clinical situation had improved and that they were able to manage their daily activities without help. So it can be concluded that bilateral arthrodesis of the wrist is a valuable option, if all other possibilities are exhausted.

Die Resektion der proximalen Handwurzelreihe mit Ersatz des Kapitatum-Pols durch eine Pyrocarbonkappe (RCPI) beim fortgeschrittenen karpalen Kollaps

“…Bleibt jedoch die erhoff te Schmerzreduktion nach der Handgelenkdenervation aus oder ist sie nur von kurzer Dauer, so kann doch eine Komplettversteifung notwendig werden. Die Handgelenkprothetik ist einerseits von einer hohen Komplikationsrate und andererseits einer kurzen Standzeit gekennzeichnet, sodass sie bis dato nur in speziellen Fällen als Alternative zur Handgelenksversteifung gesehen werden kann [ 16 ] . Die osteochondrale Rekonstruktion der Fossa lunata oder des proximalen Kapitatumpols bleiben Ausnahmesituationen vorbehalten, deren Ergebnisse in Fallberichten beschrieben wurden [ 11 , 12 , 14 ]…”

Secondary and salvage procedures in nerve injuries

“…Then secondary and salvage procedures can be selected, despite the time from injury the same result can be expected. These procedures can be contraindicated in very old cases; in patients that adopted well to the impairment ant this kind of surgery can produce unimportant change with the risk of complications (Kalb and Prommersberger, 2009). In my opinion and experience, most of patients don't know and are not informed about possibilities of hand function improvement after nerve injury.…”

“…(Brand, 1988). Recently, dedicated plates are promoted to achieve perfect initial and long lasting stability, this fixation is precontured and low-profile and give an option of choosing most appropriate wrist position (Kalb and Prommersberger, 2009). Dorsal approach is used and at least central column should be prepared for fusion with cartilage removal up to CMC III joint.…”

“…Fusion is followed on X-rays and usually achieved between 3 to 6 months but bone remodeling can last up to 1 year. Some of the complications can be also expected, mostly delayed union or loss of fixation, rarely infection (Kalb and Prommersberger, 2009). Fusion of other joints is used only in severe or failed cases as salvage procedures (MP, IP joints).…”

Editorial: Handgelenkseingriffe

“…Beiträge zum distalen Radioulnargelenk [10], zur vollständigen Handgelenksversteifung [8] und zur Ruhigstellung des Handgelenks mit Gipsverbänden [5] runden das Themenheft ab. Das vorliegende Heft erhebt nicht den Anspruch, vollständig zu sein.…”