Pillukat T, Schädel-Höpfner M, Windolf J, Prommersberger K-J
Klinik für Handchirurgie, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
Unfallchirurg. 2012 Jul;115(7):616-22. doi: 10.1007/s00113-012-2174-3.
Collateral ligament injuries of the metacarpal joints of the fingers are rare conditions. The injury should be diagnosed by clinical investigation and standard radiographs. Leading symptoms are local tenderness and joint instability. Instability is verified by clinical stress testing of the metacarpophalangeal joint in 90° of flexion. In Grade I injuries stability is preserved due to ligament attenuation or small partial tears. Grade II injuries show laxity with firm endpoint according to incomplete tear. In Grade III injuries instability without endpoint can be found as a result of complete tears. Radiographs may show avulsed bone fragments.In Grade I and II tears or non- displaced avulsion fragments treatment is conservative with buddy taping for 6 weeks. In case of persistent instability or grade III tears suturing or refixation of the ligament are performed. Small avulsion fragments are removed and the ligament is fixed to the bone. Greater avulsion fragments are fixed by suitable small implants. Adequate treatment will lead to reliable good results. Even in chronic tears reconstruction with local material or tendon transplants is usually successful.
手指掌指关节的侧副韧带损伤是罕见病症。该损伤应通过临床检查和标准X线片进行诊断。主要症状为局部压痛和关节不稳定。通过对掌指关节在90°屈曲位进行临床应力测试来证实不稳定情况。在I级损伤中，由于韧带变细或小的部分撕裂，稳定性得以保留。II级损伤根据不完全撕裂表现为有牢固终点的松弛。在III级损伤中，由于完全撕裂可发现无终点的不稳定。X线片可能显示撕脱的骨碎片。对于I级和II级撕裂或无移位的撕脱碎片，采用邻指固定6周的保守治疗。如果存在持续不稳定或III级撕裂，则进行韧带缝合或重新固定。小的撕脱碎片予以切除，韧带固定于骨。较大的撕脱碎片用合适的小植入物固定。充分的治疗将带来可靠的良好效果。即使是慢性撕裂，采用局部材料或肌腱移植进行重建通常也会成功。
