M F Langer1, K Hermann2, S Oeckenpöhler2, B Wieskötter2. 1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Sektion Handchirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland. langer.martin@ukmuenster.de. 2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Sektion Handchirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland.
Abstract
OBJECTIVE: Restoration of ulnar collateral ligament stability of the metacarpophalangeal (MP) joint of the thumb with elimination of palmar subluxation while retaining mobility for chronic instability without osteoarthritis. INDICATIONS: Acquired or congenital chronic instability of the MP joint of the thumb with compelling reasons for joint preservation and against arthrodesis, e.g., an arthrodesis or arthritis of adjacent joints. CONTRAINDICATIONS: Arthritis of the thumb MP joint. Contractures of the MP joint. Low natural range of motion of the joint (compared to the contralateral hand). Additional palmar instability with significant hyperextensibility. Infections. Lesions to the median and/or ulnar nerve with impaired active mobility. SURGICAL TECHNIQUE: Anatomical reconstruction of the ulnar collateral ligament and the accessory collateral ligament using a tendon graft (palmaris longus tendon). Ulnar approach, transosseous course of the tendon graft and elimination of subluxation. POSTOPERATIVE MANAGEMENT: Splint for 5 weeks and hand therapy. RESULTS: Of 12 patients undergoing this type of ligament reconstruction, all achieved good stability and pain-free range of motion, which was 60-95% of the contralateral hand. This surgical procedure has few complications and is considered reliable.
OBJECTIVE: Restoration of ulnar collateral ligament stability of the metacarpophalangeal (MP) joint of the thumb with elimination of palmar subluxation while retaining mobility for chronic instability without osteoarthritis. INDICATIONS: Acquired or congenital chronic instability of the MP joint of the thumb with compelling reasons for joint preservation and against arthrodesis, e.g., an arthrodesis or arthritis of adjacent joints. CONTRAINDICATIONS: Arthritis of the thumb MP joint. Contractures of the MP joint. Low natural range of motion of the joint (compared to the contralateral hand). Additional palmar instability with significant hyperextensibility. Infections. Lesions to the median and/or ulnar nerve with impaired active mobility. SURGICAL TECHNIQUE: Anatomical reconstruction of the ulnar collateral ligament and the accessory collateral ligament using a tendon graft (palmaris longus tendon). Ulnar approach, transosseous course of the tendon graft and elimination of subluxation. POSTOPERATIVE MANAGEMENT: Splint for 5 weeks and hand therapy. RESULTS: Of 12 patients undergoing this type of ligament reconstruction, all achieved good stability and pain-free range of motion, which was 60-95% of the contralateral hand. This surgical procedure has few complications and is considered reliable.
Entities:
Keywords:
Ligament reconstruction; Palmaris longus ligament; Range of motion; Surgical procedure; Thumb
Authors: C K Spies; B Hohendorff; S Löw; L P Müller; J Oppermann; P Hahn; F Unglaub Journal: Oper Orthop Traumatol Date: 2017-06-14 Impact factor: 1.154
Authors: M F Langer; S Oeckenpöhler; C K Spies; J G Grünert; S Breiter; J Glasbrenner; B Wieskötter Journal: Oper Orthop Traumatol Date: 2019-02-26 Impact factor: 1.154