Palmarer Zugang zur Implantation einer Silikonendoprothese am Fingermittelgelenk

Objective

The implantation of a silicone endoprosthesis at the middle finger joint through a palmar approach without harming the sensitive extensor aponeurosis.

Indications

In cases of significant, treatment-resistant, functionally limiting symptoms and significant restriction of motion due to radiologically confirmed joint destruction of the middle finger joint.

Contraindications

General surgical contraindications, markedly insufficient collateral ligament apparatus, axial malalignment in the coronal plane of more than 30°, absence of function in the flexor or extensor tendons, extensive osteolysis, contracted complex deformities.

Surgical technique

Modified palmar skin incision according to the Bruner technique. Mobilization of the ulnar and radial neurovascular bundles. Dissect and mobilize an intact tendon sheath distal to the A2 annulus, taking care to preserve the flexor tendons. Synovialectomy of the proximal interphalangeal (PIP) joint. Exposure and Resection of the proximal phalangeal head. Debridement of the former joint cavity. Dissection of the middle and proximal phalanges. Insertion of a trial prosthesis and reduction of the joint. If this reveals a good fit with free mobility and sufficient lateral stability with a physiological finger axis, the definitive implant can be inserted. Reconstruction of the tendon sheath.

Postoperative management

Fitting of a metacarpal brace, physiotherapist-guided mobilization, gradual increase in weight-bearing starting in the 7th postoperative week.

Results

Follow-up examinations of silicone prosthesis implantations via the palmar approach at the finger PIP joint demonstrated clinical outcomes that were at least comparable to those known from the dorsal approach.