Operative Orthopadie und Traumatologie · 2026
[Palmar approach for silicone interposition arthroplasty of the finger middle joint].
Аннотация на английскомСтатьяОбзорНазвание и аннотация: Перевод в очереди
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Ayache Ali, Spies Christian K, Cavalcanti Kußmaul Adrian, Unglaub Frank
Аннотация
OBJECTIVE: The implantation of a silicone endoprosthesis at the middle finger joint through a palmar approach without harming the sensitive extensor aponeurosis.
INDICATIONS: In cases of significant, treatment-resistant, functionally limiting symptoms and significant restriction of motion due to radiologically confirmed joint destruction of the middle finger joint.
CONTRAINDICATIONS: General surgical contraindications, markedly insufficient collateral ligament apparatus, axial malalignment in the coronal plane of more than 30°, absence of function in the flexor or extensor tendons, extensive osteolysis, contracted complex deformities.
SURGICAL TECHNIQUE: Modified palmar skin incision according to the Bruner technique. Mobilization of the ulnar and radial neurovascular bundles. Dissect and mobilize an intact tendon sheath distal to the A2 annulus, taking care to preserve the flexor tendons. Synovialectomy of the proximal interphalangeal (PIP) joint. Exposure and Resection of the proximal phalangeal head. Debridement of the former joint cavity. Dissection of the middle and proximal phalanges. Insertion of a trial prosthesis and reduction of the joint. If this reveals a good fit with free mobility and sufficient lateral stability with a physiological finger axis, the definitive implant can be inserted. Reconstruction of the tendon sheath.
POSTOPERATIVE MANAGEMENT: Fitting of a metacarpal brace, physiotherapist-guided mobilization, gradual increase in weight-bearing starting in the 7th postoperative week.
RESULTS: Follow-up examinations of silicone prosthesis implantations via the palmar approach at the finger PIP joint demonstrated clinical outcomes that were at least comparable to those known from the dorsal approach.
INDICATIONS: In cases of significant, treatment-resistant, functionally limiting symptoms and significant restriction of motion due to radiologically confirmed joint destruction of the middle finger joint.
CONTRAINDICATIONS: General surgical contraindications, markedly insufficient collateral ligament apparatus, axial malalignment in the coronal plane of more than 30°, absence of function in the flexor or extensor tendons, extensive osteolysis, contracted complex deformities.
SURGICAL TECHNIQUE: Modified palmar skin incision according to the Bruner technique. Mobilization of the ulnar and radial neurovascular bundles. Dissect and mobilize an intact tendon sheath distal to the A2 annulus, taking care to preserve the flexor tendons. Synovialectomy of the proximal interphalangeal (PIP) joint. Exposure and Resection of the proximal phalangeal head. Debridement of the former joint cavity. Dissection of the middle and proximal phalanges. Insertion of a trial prosthesis and reduction of the joint. If this reveals a good fit with free mobility and sufficient lateral stability with a physiological finger axis, the definitive implant can be inserted. Reconstruction of the tendon sheath.
POSTOPERATIVE MANAGEMENT: Fitting of a metacarpal brace, physiotherapist-guided mobilization, gradual increase in weight-bearing starting in the 7th postoperative week.
RESULTS: Follow-up examinations of silicone prosthesis implantations via the palmar approach at the finger PIP joint demonstrated clinical outcomes that were at least comparable to those known from the dorsal approach.