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Войти в исследования Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... · 2020
[Results following isolated fourth ray resection].
СтатьяНазвание и аннотация: Перевод в очереди
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Mayr-Riedler Michael Stephan, Prommersberger Karl-Josef, van Schoonhoven Jörg
Аннотация
BACKGROUND: After partial resection of the fourth finger ray, many hand surgeons perform a transposition of the fifth ray to the position of the fourth ray. Others, us included, resect the fourth ray in total through exarticulation in the carpometacarpal joint and tightly readapt the deep transverse metacarpal ligament, assuming that the gap between the third and fifth metacarpal bones will be sufficiently reduced through spontaneous radial translocation of the fifth ray. The aim of this retrospective study was to examine the clinical, radiological and patient-reported results after total resection of the fourth ray with adaption of the deep transverse metacarpal ligament.
PATIENTS AND METHODS: Seven patients (three women, four men) with a mean age of 50 (26-62) years were reached for a follow-up examination after a mean of 43 (2-174) months. Parameters assessed included finger movement, hand strength, sensitivity (Tinel sign, Semmes-Weinstein monofilament), dexterity (nine-hole peg test), pain (at rest and during stress, phantom pain, weather sensitivity) and patient-reported functional and cosmetic outcome. Radiological assessment included measurement of the distance between the heads and bases of metacarpal bones III and V before and directly after surgery and at follow-up.
RESULTS: The only complication encountered was a mild wound healing disorder in one patient, which was controlled conservatively. Sensitivity was not impaired in any patient and no patient showed signs of neuromas. Finger movement for both flexion and extension was slightly impaired in two patients. Mean grip and pinch strength was 61 (54-78) % and 65 (35-122) % compared with the unaffected hand. The mean DASH score was reduced from 42.2 preoperatively to 27.5. Dexterity was slightly reduced with a nine-hole peg test prolonged by 23 % compared with the unaffected hand. At follow-up, the intermetacarpal gap was reduced by a mean of 67 % between the bases and by 50 % between the heads of metacarpal bones III and V. Patients rated the cosmetic appearance of the hand as very good.
CONCLUSION: Total resection of the fourth finger ray with soft tissue adaption enables a sufficient closure of the intermetacarpal gap without rotational malalignment and results in good to very good functional and cosmetic outcomes and a low complication rate.
PATIENTS AND METHODS: Seven patients (three women, four men) with a mean age of 50 (26-62) years were reached for a follow-up examination after a mean of 43 (2-174) months. Parameters assessed included finger movement, hand strength, sensitivity (Tinel sign, Semmes-Weinstein monofilament), dexterity (nine-hole peg test), pain (at rest and during stress, phantom pain, weather sensitivity) and patient-reported functional and cosmetic outcome. Radiological assessment included measurement of the distance between the heads and bases of metacarpal bones III and V before and directly after surgery and at follow-up.
RESULTS: The only complication encountered was a mild wound healing disorder in one patient, which was controlled conservatively. Sensitivity was not impaired in any patient and no patient showed signs of neuromas. Finger movement for both flexion and extension was slightly impaired in two patients. Mean grip and pinch strength was 61 (54-78) % and 65 (35-122) % compared with the unaffected hand. The mean DASH score was reduced from 42.2 preoperatively to 27.5. Dexterity was slightly reduced with a nine-hole peg test prolonged by 23 % compared with the unaffected hand. At follow-up, the intermetacarpal gap was reduced by a mean of 67 % between the bases and by 50 % between the heads of metacarpal bones III and V. Patients rated the cosmetic appearance of the hand as very good.
CONCLUSION: Total resection of the fourth finger ray with soft tissue adaption enables a sufficient closure of the intermetacarpal gap without rotational malalignment and results in good to very good functional and cosmetic outcomes and a low complication rate.