Pseudarthrosen und komplikationsbehaftete Verläufe nach Mittelhandfrakturen

Abstract

It is not uncommon for fractures of the metacarpal bones to develop complications and they are therefore at risk of developing a delayed union or pseudarthrosis which delay the course of healing. Currently, no clear treatment algorithm is existing. We recommend a stepwise approach: hypertrophic, an unstable pseudarthrosis should be treated by osteosynthetic stabilization and if necessary supplemented by spongioplasty. An atrophic pseudarthrosis requires a more complex strategy. A manageable size of bony defect in the presence of sufficient perfusion of surrounding soft tissue can be treated by cancellous bone transplantation or in the case of larger bony defects and a sufficient soft tissue situation with a corticocancellous graft from the iliac crest in combination with a bridging plate osteosynthesis. Large bony defects with poorly perfused surrounding soft tissue require a free vascularized bony and cutaneous tissue transfer. The use of modern approaches, such as administration of bone morphogenic protein (BMP) or treatment with extracorporeal shock wave therapy or low energy ultrasound therapy also have to be considered. Due to the many modern therapeutic approaches, a current evaluation of this topic is, however, inevitable.