Die standardisierte Arthroskopie des Handgelenks Technik und Dokumentation Operative Orthopädie und Traumatologie December 2014, Volume 26, Issue 6, pp 539–546 | Cite as S. Löw (1) Email author (
[email protected]) A. Herold (1) C. Eingartner (1) 1. Sektion Handchirurgie, Klinik für Orthopädie und Unfallchirurgie, Caritas-Krankenhaus, Bad Mergentheim, Deutschland Operative Techniken First Online: 03 December 2014 Received: 19 January 2014 Revised: 17 May 2014 Accepted: 03 June 2014 798 Downloads 25 Citations
Zusammenfassung Operationsziel Minimal-invasiver Zugang zum Handgelenk zur Diagnostik und Therapie verschiedenster Handgelenkpathologien.
Indikationen Diagnostik des Knorpelzustands, intraartikulärer ligamentärer Strukturen, posttraumatischer und entzündlicher Krankheitszustände sowie unklarer chronischer Schmerzzustände des Handgelenks. Therapie des Ulnaimpaktionssyndroms, dorsaler Ganglien, additiv bei der Frakturbehandlung und bei unterschiedlichsten Handgelenkeingriffen.
Kontraindikationen Weichteilinfekte am Handgelenk. Starke narbige Verziehungen im Zugangsbereich können den Zugang behindern.
Operationstechnik Rückenlagerung, senkrechte Aufhängung in Neutralstellung des Unterarms bei in 90° gebeugtem Ellenbogen, axialer Zug von 3–4 kg. Stichinzisionen der Haut, stumpfe Präparation durch die Kapsel, Einbringen der Optik über Portal 3–4 und des Arbeitsinstrumentariums über Portal 4– 5, analog mediokarpal radial wie ulnar. NaCl, CO2 oder Raumluft als Arthroskopiemedium. Diagnostischer Rundgang mit standardisierter Untersuchung aller Gelenkabschnitte. Standardisierte schriftliche sowie qualitativ hochwertige Bild- und/oder Videodokumentation zur Verbesserung der Nachvollziehbarkeit der erhobenen Befunde durch Dritte.
Weiterbehandlung Handgelenkgipsschiene für 1 Woche, Schonung für weitere 2 Wochen, dann Belastungssteigerung.
Schlüsselwörter Handgelenk Interobserver-Reliabilität Ulnaimpaktionssyndrom Skapholunäres Band Minimal-invasive Operationsverfahren Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1007/s00064-014-0311-6 (https://doi.org/10.1007/s00064-014-0311-6) für autorisierte Leser zusätzliche Dateien abrufbar.
Standard wrist arthroscopy Technique and documentation
Abstract Objective Minimally invasive approach to the wrist in order to diagnose and treat different wrist pathologies.
Indications Diagnosis of unclear chronic pain syndromes, cartilage status, intra-articular ligament structures as well as post-traumatic and inflammatory conditions of the wrist. Treatment of ulnar impaction syndrome, dorsal ganglia and also in fracture treatment and various different wrist interventions.
Contraindications Soft tissue infections around the wrist, severe scarring may impede access to the joint.
Surgical technique Supine position with the forearm upright and in neutral position, the elbow flexed by 90°, axial traction of 3–4 kg. Superficial stab incision, blunt preparation through joint capsule, insertion of optic through 3–4 portal and probe through 4–5 portal, and radial and ulnar midcarpal portals, respectively. Either sodium chloride, CO2 or air is used as arthroscopy medium. Diagnostic round with standardized examination of all parts of the joint. Standardized written and high quality photo and/or video documentation to facilitate understandability of the findings.
Postoperative management Forearm cast for 1 week, limited load for 2 more weeks, then load is increased to normal.
Keywords Wrist joint Interobserver reliability Ulnar impaction syndrome Scapholunate ligament Minimally invasive surgical procedures
Notes Einhaltung ethischer Richtlinien Interessenkonflikt. S. Löw, A. Herold und C. Eingartner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Supplementary material .
Video 1: Beispiel einer 27-jährigen Patientin mit ulnokarplen Schmerzen rechts ohne erinnerliches Trauma: radiokarpal. (MPEG 117MB) .
Video 2: Beispiel einer 27-jährigen Patientin mit ulnokarplen Schmerzen rechts ohne erinnerliches Trauma: mediokarpal. (MPEG 115MB) .
Video 3: Beispiel eines 55-jährigen Patienten mit radiokarpalen Schmerzen nach einem Verdrehtrauma des rechten Handgelenkes 6 Wochen zuvor: radiokarpal. (MPEG 246MB) .
Video 4: Beispiel eines 55-jährigen Patienten mit radiokarpalen Schmerzen nach einem Verdrehtrauma des rechten Handgelenkes 6 Wochen zuvor: mediokarpal. (MPEG 138MB)
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Copyright information © Springer-Verlag Berlin Heidelberg 2014
About this article Cite this article as: Löw, S., Herold, A. & Eingartner, C. Oper Orthop Traumatol (2014) 26: 539. https://doi.org/10.1007/s00064-014-0311-6 DOI (Digital Object Identifier) https://doi.org/10.1007/s00064-014-0311-6 Publisher Name Springer Berlin Heidelberg Print ISSN 0934-6694 Online ISSN 1439-0981 About this journal Reprints and Permissions
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