Handgelenkarthrodese mit winkelstabiler „Low-profile“-Platte ohne karpometakarpale Fusion

Abstract

Total wrist arthrodesis was performed using a fixed-angle fusion plate without CMC III joint fixation in 28 patients (21 men, 7 women). A follow-up of 14/28 patients was performed at a mean of 21 (3-39) months postoperatively. Grip strength improved from 14 (0-38) kg preoperatively to 22 (12-40) kg postoperatively. The average postoperative DASH score was 40 (6-72) points. Pain measured with the VAS scale (0-10) improved from an average of 7 (3-10) points preoperatively to 2 (0-6) points postoperatively. Overall, 13/14 patients were satisfied with the treatment; 26/28 patients achieved primary bony consolidation. Postoperative complications found in 9 of 28 patients: 2 nonunion, pain in the CMC II (n = 3) or III (n = 1) joints, 2 screw breakage, 1 postoperative bleeding and 1 infection. Both cases of nonunion healed after plate removal, re-osteosynthesis with a straight wrist arthrodesis plate, bridging the CMC III joint, and a bone graft from the iliac crest. All patients with CMC II joint pain were pain-free after removal of the protruding screw. One patient had chronic pain in the CMC III joint despite plate removal. In the 2 cases with screw breakage, no issues caused. In one patient, after primary bony consolidation, removal of the plate was performed for extensor tenolysis and not as a result of the broken screw. In the second patient, removal of the plate after primary bony consolidation was unnecessary as the patient was pain-free in the area of the broken screw, yet a protruding screw in the CMC II joint cavity was removed.

Die vollständige Arthrodese des Handgelenkes

“…Aufgrund der Ergebnisse von Nagy u. Büchler sollten diese nur bei arthrotischen Veränderungen einbezogen werden, da ansonsten bei ausbleibender karpometakarpaler Konsolidierung eine persistierende Schmerzsymptomatik resultieren kann 12 13 . Moderne winkelstabile, „Low-Profile“-Platten, die ausschließlich distal am Karpus fixiert werden, begünstigen dieses Vorgehen 14 15 .…”

“…Ausgehend von 100 000 Belastungszyklen bis zur knöchernen Heilung einer Handgelenkversteifung sollte es bei Einsatz der neuen Handgelenkarthrodesenplatte zur knöchernen Ausheilung kommen, bevor ein Implantatversagen auftritt. Auch zeigen erste klinische Studien, dass eine Ruhigstellung von nur 2–3 Wochen erforderlich ist 14 .…”

“…Die aktuellen klinischen Ergebnisse einschließlich der Patientenzufriedenheit sowie die biomechanischen Eigenschaften der neuen Osteosynthesematerialen sind vielversprechend 14 24 .…”

Salvage procedure after malunited distal radius fractures and management of pain and stiffness

“…This is a well-established procedure to treat pain relief in patients with advanced pancarpal degeneration or posttraumatic osteoarthritis. But it is a permanent solution [25,[59][60][61]. The internal fixation of total wrist arthrodesis was first described by Mannerfelt and Malmsten [62] in 1971.…”

Wrist Arthrodesis Using the Medartis Carpometacarpal Joint Sparing Plate

“…2 Recently, Medartis produced a CMCJ sparing plating system (Figure 1) that offers a lower profile (2.5 mm) with a greater number of carpal fixation points compared with traditional CMCJ spanning plating systems (2.7 mm/3.3 mm). 9 This design also avoids spanning the CMCJ, which may lead to failure over a mobile articulation. 11 It is proposed that multiple multidirectional and angular locking options enable a surgeon to perform stable wrist fixation and therefore increase surgical union rates and overall patient satisfaction.…”