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Die Kraftübertragung am Handgelenk nach Skaphoid-, Trapezium- und Trapezoideumfusion

Force distribution following scaphotrapeziotrapezoid arthrodesis (triscaphe arthrodesis)

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Zusammenfassung

Die Fusion von Skaphoid, Trapezium und Trapezoideum (STT) wird zur Stabilisierung der radialen Säule und Entlastung des radiolunären Gelenkabschnitts postuliert. Die mittelfristigen Auswirkungen auf das Radiokarpalgelenk sind letztendlich jedoch unklar.

Sechs Patienten wurden durchschnittlich 5 Jahre nach STT-Fusion mittels CT-Osteoabsorptiometrie untersucht. Die STT-Fusion erfolgte in 4 Fällen bei Lunatumnekrose Stadium IIIb und in 2 Fällen bei STT-Arthrose.

Alle Patienten zeigten an den nicht versteiften Handgelenken 2 Dichtemaxima und ein Mineralisierungsmaximum in der Fovea lunata und der Fossa scaphoidea. An der teilversteiften Seite lag bei allen Patienten nur ein Dichtemaximum vor. Dieses befand sich in 5 Fällen in der Fossa scaphoidea, in 1 Fall je zur Hälfte in der Fossa scaphoidea und der Fovea lunata.

Mit der STT-Fusion kann die Kraftübertragung am Handgelenk auf die radiale Säule übertragen werden. Der radiolunäre Gelenkabschnitt wird weitgehend entlastet.

Abstract

Scaphotrapeziotrapezoid (STT) arthrodesis has been proposed to stabilise the radial column and to redirect the load away from the lunate. Midterm effects on force transmission are still unclear.

Six patients who were treated with triscaphe arthrodesis were examined after an average of 5 years using CT osteoabsorptiometry of both wrists. STT arthrodesis had been performed in four cases with Kienböck’s disease type IIIb and in two cases of scaphotrapeziotrapezoid arthritis.

At all contralateral wrists peak mineralisations were found beyond the lunate fossa and in the scaphoid fossa of the distal radius. At the side with STT arthrodesis there was only one peak. In five cases this density maximum was beyond the scaphoid fossa and in one case half beyond the lunate and half beyond the scaphoid fossa.

Triscaphe arthrodesis allows load transmission from the lunate to the radial column.

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Danksagung

Wir Bedanken uns bei Herrn PD Dr. Schmidt und bei Herrn Dr. Fröhner, Institut für Diagnostische und Interventionelle Radiologie, Rhön Klinikum AG, Bad Neustadt an der Saale, für die Erhebung der CT-Schichtungen, die Erlaubnis zur Benutzung der Bildverarbeitungssysteme des Instituts und die technische Unterstützung.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule, Hannover

    R. Meier, M. Busche, C. Krettek & C. Probst

  2. Klinik für Handchirurgie, Bad Neustadt an der Saale

    R. Meier & H. Krimmer

  3. Institut für Diagnostische und Interventionelle Radiologie, Bad Neustadt an der Saale

    R. Schmitt

  4. Unfallchirurgische Klinik, Medizinische Hochschule, 30625, Hannover

    R. Meier

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  1. R. Meier
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  2. M. Busche
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  3. C. Krettek
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  4. C. Probst
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  6. H. Krimmer
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Correspondence to R. Meier.

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Meier, R., Busche, M., Krettek, C. et al. Die Kraftübertragung am Handgelenk nach Skaphoid-, Trapezium- und Trapezoideumfusion. Unfallchirurg 108, 456–460 (2005). https://doi.org/10.1007/s00113-004-0901-0

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