Qualitätssicherung und Management von Handverletzungen aus der Sicht des Handchirurgen

Trauma und Berufskrankheit - Die Hand stellt das wichtigste Werkzeug und auch ein bedeutendes Kommunikationsorgan des Menschen dar. Ist die Hand verletzt, ist nicht nur das Alltagsleben der...     

Die operative Behandlung des Bennettschen Verrenkungsbruches

Ohne Zusammenfassung      

Proximale Metakarpalfrakturen mit Gelenkbeteiligung

Intraarticular fractures of the base of the first metacarpal that have healed in displaced position quickly lead to posttraumatic arthritis. After satisfactory closed reduction a percutaneous pin fixation is sufficient, if necessary combined with fixation of the first metacarpal. If closed reduction cannot be obtained, open reduction with pin fixation, or rigid fixation with screws or plates, is advisable. Displaced fractures of the metacarpal base of the fingers also lead to posttraumatic arthritis with a weak grip. Displaced fractures and dislocated fractures require reduction and percutaneous or internal fixation with K-wires and possibly additional pin fixation of the carpometacarpal joints.     

Daumenrekonstruktion durch kontinuierliche Verlängerung des ersten Mittelhandknochens

Summary Goal of Surgery Reconstruction of the amputated thumb through continuous distraction with an Ilizarov ring fixator. Indications Traumatic loss of thumb at the level of the proximal half of the proximal phalanx. Contraindications Insufficient soft tissue coverage of stump. Stiff saddle joint. Positioning and Anaesthesia Tourniquet. Brachial plexus or general anaesthesia. Surgical Technique Installation of a ring fixator. Incomplete osteotomy at mid shaft of first metacarpus with chisel and completion through osteoclasia by twisting the chisel. Preserve palmar periosteum. Deepening of first web space if necessary after removal of external fixator. Use of Z-plasty and proximal transfer of adductor pollicis insertion. Postoperative Management After 1 week continuous lengthening 0.7 mm/day in 3 daily increments. After removal of fixator plaster cast for 2 weeks. Possible Complications Improper installation of fixator. Incomplete osteotomy. Too rapid or too slow distraction. Pin tract infection. Deep infection. Results Over a 2 year period 10 lengthenings. Average follow-up 23 months (10 to 36 months). Average gain in length 38.1 mm. Average length of treatment 163 days. Deepening of web space in 7 patients. Force of grasp 64% of opposite side. Pin tract infection: 4, too early removal of fixator: 1, revision of scar: 1 and correction of stump: 1. All patients were satisfied with the result but for scar at web space.

     

Pollicization of index finger after traumatic thumb amputation

Objectives  

Reconstruction of a functionally and esthetically satisfying thumb by pollicization of the index finger.