Fingermittelgelenkarthrodese mittels Drahtnaht mit und ohne zusätzlichen Kirschnerdraht – Eine vergleichende biomechanische Studie

Zusammenfassung

Hintergrund Die Arthrodese stellt für das destruierte proximale Interphalangealgelenk eine schnelle und sichere Therapie dar. Eine Vielzahl unterschiedlicher Verfahren zur Arthrodese mit unterschiedlichem chirurgischem Aufwand ist beschrieben. Als sicherste Verfahren zählen komprimierende Verfahren.

Ziel Ziel dieser Arbeit war es, mittels realitätsnaher Krafteinleitung die Primärstabilität beider Arthrodesenverfahren zu vergleichen.

Material und Methoden Es wurden Arthrodesen an insgesamt 72 Fingern von insgesamt 9 Handpaaren formalin-alkohol-fixierter Ganzkörperspender untersucht. Zur besseren Vergleichbarkeit erfolgte ein chirales Matching. Getestet wurde die Primärstabilität in Extensions-, Abduktions-, und Rotationsbelastung mit einer 2-Punkt-Kraftaufnahme. Das maximale an der Arthrodese einwirkende Drehmoment wurde als Bruchlast definiert und mithilfe des gepaarten t-Tests verglichen.

Ergebnisse und Schlussfolgerung Die mittels Kirschnerdraht verstärkten Arthrodesen zeigten eine signifikant höhere Bruchlast in Extension und Abduktion. Beide Verfahren zeigten durchschnittliche Bruchlasten, die über der physiologischen Belastung am proximalen Interphalangealgelenk liegen. Auch wenn die alleinige intraossäre Drahtnaht für die Klinik ausreichende biomechanische Eigenschaften zeigt, sollte ein querer K-Draht verwendet werden, um die höchst mögliche Primärstabilität zu erzielen.

Abstract

Background Arthrodesis can be considered the fastest and safest surgical treatment for degenerative destruction of the proximal interphalangeal joint. For this procedure, a variety of surgical strategies have been described. Protocols for compression arthrodesis by intraosseous wiring are known to have the best outcomes. Biomechanical effects of reinforcing the arthrodesis using Kirschner wires have been controversially discussed.

Purpose This study aims to compare these two procedures with respect to primary stability under physiological stress in vitro.

Material and methods In total, 72 fingers from 9 pairs of hands of formalin-ethanol fixed body donors were used for the study. To achieve comparability, these were chirally matched. After arthrodesis, primary stability was evaluated during a two-point application of rotational, abducting and extending forces. Peak torque values acting on the arthrodesis were defined as the breaking load and compared by a paired Student t-test.

Results and conclusion Kirschner-wire reinforced arthrodeses showed significantly higher breaking loads for extension and abduction than those within the control group. Nevertheless, both methods achieved breaking loads above the physiological load level in the area of the proximal interphalangeal joint. Even though sole intraosseous wiring can be considered biomechanically adequate, we suggest reinforcement using a transverse Kirschner wire to enhance the primary stability.

Schlüsselwörter

Fingermittelgelenksarthrodese - PIP-Arthrodese - Drahtnaht - Drahtnaht plus K-Draht - biomechanische Testung

Key words

PIP arthrodesis - wire suture - wire suture and K wire - biomechanical testing

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