Estabilización de la luxación inveterada de la quinta articulación carpo-metacarpiana mediante tenosuspensión con banda de extensor cubital del carpo

Resumen

Las fracturas luxaciones de la articulación carpometacarpiana (CMC) del 5° dedo pasan desapercibidas con frecuencia. El diagnóstico y tratamiento tardíos conlleva con frecuencia malos resultados funcionales por dolor, pérdida de fuerza de prensión y el desarrollo de artrosis CMC. El tratamiento de las luxaciones inveteradas es un reto. Se han propuesto numerosas técnicas quirúrgicas al respecto. Presentamos una modificación de una tenoplastia de supensión, utilizando una banda del tendón del Extensor Carpi Ulnaris. Creemos que esa técnica tiene varias ventajas sobre otros procedimientos paliativos. En primer lugar, se preserva la movilidad del 5° metacarpiano que se estabiliza sólo por ligamentoplastia al 4° metacarpiano. En segundo lugar, mantiene la longitud del 5° radio. En tercer lugar, admite una variante en la que la realización de túneles óseos en 4° y 5° metacarpiano favorece una mejor alineación, evitando la disrotación del 5° dedo. Pensamos que esa técnica es el mejor tratamiento en las luxaciones inveteradas de la 5ª articulación CMC.

Abstract

Fracture-dislocations of the little finger carpometacarpal (CMC) joint are commonly missed. Delayed diagnosis and treatment will usually result in an undesirable outcome of pain, reduced grip strength, and degenerative arthritis. Treatment of the old dislocations of the fifth carpometacarpal joint is challenging. Numerous surgical techniques have been proposed. Here, we present a modification of a CMC joint suspensionplasty, using a partial slip of the Extensor Carpi Ulnaris tendon. We believe this technique has several advantages compared with other palliative surgical procedures. First, mobility of the fifth metacarpal is greatly preserved because the fifth metacarpal is stabilized only by the ligament substitute against the fourth metacarpal. Second, the length of the fifth ray can be maintained effectively. Third, malrotation of the little finger can be prevented by drilling the holes of the fifth and fourth metacarpals in the proper direction. We believe this surgical technique could be a better treatment option for old dislocation of the fifth CMC joint.

Palabras Clave

articulación carpo-metacarpiana - luxación inveterada - tenosuspension

Keywords

carpo-metacarpal joint - old dislocation - tenosuspension

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