Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure.
Methods
Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05.
Results
The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory.
Conclusion
Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
K-wires
Kirschner wires
PRWHE
Patient Rated Wrist/Hand Evaluation
Introduction
Metacarpal fractures account for 25–50% of all hand fractures and negatively impact hand function and ability to work [1, 2]. These fractures rarely result in non-unions [3] but are associated with malalignment: varus, valgus, procurvatum, recurvatum, and rotational deformity [4, 5]. Rotational malalignment should be carefully avoided, as it interferes with power gripping [6]. Approximately 85% of metacarpal fractures can be managed without surgery [7]. However, prolonged immobilization may result in stiffness, pressure sores, and compartment syndrome [8]. Ideally treatment should allow early active mobilisation [9]. Surgery is indicated when the fracture is otherwise non-reducible, in instances of polytrauma or open fracture, in cases of shortening with extension lag or rotation, and with concomitant injury to nerves, vessels, and soft tissue [10, 11]. Various treatment methods have been proposed for metacarpal fractures, including the use of interfragmentary compression screws, plates, external fixators, and Kirschner wires (K-wires) [12‐15]. K-wires are still widely used; they are usually introduced percutaneously and can be used in a variety of ways: cross K-wire, intramedullary, transverse, longitudinal (anterograde or retrograde), or combined with a cerclage wiring [16‐20]. Previous studies, which described percutaneous transverse pinning using two K-wires distally and one proximally for treatment of closed displaced fractures of the neck of the fifth metacarpal bone (boxer’s fracture), showed excellent functional and anatomic outcomes [21, 22].
In our institution, we undertake percutaneous transverse pinning in all non-articular metacarpal fractures of the head, neck and shaft. The technique involves the reduction of the fracture under fluoroscopy and fixation with 2–3 differently distributed K-wires, proximal and distal to the fracture. The wires are advanced to the far cortex of the metacarpal adjacent to the one to be treated. The patients can mobilise the fingers and hand immediately after the procedure. The surgical procedure is easy to master, and the results are cosmetically and functionally satisfactory. We investigated the surgical outcomes in terms of Patient Rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation.s We hypothesised that percutaneous transverse pinning provided excellent results at short-term follow-up.
Anzeige
Materials and methods
Study design
Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. All procedures were performed by two fully trained surgeons (AA and GC), as day-cases, with close reduction under image intensification, and transverse percutaneous osteosynthesis with K-wires. Patients without rotational displacement or palmar angulation of the fracture less than 30° were excluded. All patients received a pre- and post-operative evaluation both clinically and radiographically. Three radiographic views were taken: anteroposterior, oblique and lateral hand views. The PRWHE is scored so that the pain and function items are weighted equally [23]. This is achieved by dividing the sum score for the function by two before adding it to the sum of the pain score. The total PRWHE score grades from 0 (no pain/disability) to 100 (greatest pain/disability). The PRWHE is reliable and valid [24] and is easy and quick for the patient to perform [25, 26]. Before surgery, all patients included in the study signed an informed consent form that explained the operative procedure, functional and cosmetic expectations, and possible complications related to the surgery, consenting also to be part of any outcome research. The procedures were performed as day surgery with peripheral anaesthesia (peripheral nerve blocks or brachial plexus anaesthesia), which allowed patients to be discharged within 24 h. At the last follow-up, three orthopaedic surgeons (AP; GV; GA) evaluated all 56 patients to assess possible limitations in daily activities, degree of pain, return to work, changes in grip strength, satisfaction with the type of treatment received, and whether any cosmetic dissatisfaction was present.
Surgical procedure
All patients underwent loco-regional anaesthesia. As antibiotic prophylaxis, 2 g of intravenous cefazolin were administered before surgery. Closed reduction of the fracture was performed under image intensification. In some fractures, especially spiral or severely displaced (11 of 56), open reduction was necessary, performing a dorsal mini-incision to reduce the fracture as anatomically as possible. The most important target was to correct the rotational deformity. Fixation was performed with 1 or 2 K-wires 1.2 mm in diameter proximal to the fracture and with 1 or 2 K-wires distal the fracture to avoid displacement in the sagittal plane of the distal portion of bone. The K-wires were advanced through the fractured metacarpal up to the far cortex of the adjacent metacarpal (Figs. 1 and 2).
Fig. 1
Fourth metacarpal spiral fracture. a post-operative radiography; b and c 1-month post-operative radiography; d and e 3-month post-operative radiography
Fourth metacarpal spiral fracture. a post-operative radiography; b and c 1-month post-operative radiography; d and e 3-month post-operative radiography
Final imaging and clinical examinations were performed to check the rotation of the finger in an extended and semi-flexed position; then, the K-wires were cut and bent on the skin (Fig. 3). Patients were given a soft bandage to protect the K-wires and soft tissues for two to four weeks, with the metacarpophalangeal joints free. Patients were encouraged to mobilise the fingers in the immediate postoperative period.
Fig. 3
Fifth metacarpal fracture. Clinical evaluation of MCP joint mobility after insertion of K-wires in extension and flexion
Patients were discharged on the same day of surgery. The first clinical follow-up was performed after one to two weeks to evaluate the patient’s mobility and to inspect the K-wire entry wounds. A second clinical and radiographic examination was performed 30–35 days after surgery to assess the state of consolidation of the fracture and to program the removal of the K-wires, which took place either on the same day or six weeks after surgery. All patients were allowed to use the injured hand during this period, avoiding weightlifting and forced grips. After the removal of the K-wires, physiotherapy was recommended.
Anzeige
Statistical analysis
The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05.
Results
Between March 2017 and February 2022, 56 patients, 48 males (85.7%) and eight females (14.3%), underwent percutaneous transverse pinning for unstable metacarpal fractures and were included in this study (Fig. 4). The mean age was 40.21 ± 17.9 years (range of 16 to 86 years) (Table 1).
Patient rated wrist/hand evaluation: PRWHE; p-value: p
In all patients, a single metacarpal was involved. The dominant hand was affected in 64% of patients (N = 36). The fracture pattern was oblique (short or long) in 40% of the patients and transverse in 32%; the remaining 28% were spiral or comminuted fractures. The anatomical site of the fractures was the non-articular head in 12 patients (21%), the neck in 19 patients (34%) and the shaft in 25 patients (45%). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The PRWHE score was collected at one month, three months and 12 months after surgery. The mean PRWHE score was 6.5 ± 1.8 at the last follow-up. The overall decrease during follow-up in PRWHE score was statistically significant (p < 0.05).
At the final follow-up, 54 patients had a mean extension of 2° (range 4–0°) of the metacarpophalangeal joints, and 90° of flexion. All patients had full flexion of the interphalangeal joints. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. Grip strength remained unchanged in 88% of the patients (49 out of 56), and all of them returned to work or their normal daily activities within two months after surgery. 96% of the patients showed a high degree of satisfaction with the surgical technique and the post-operative treatment received.
Two patients showed limitations in extension and flexion of the metacarpophalangeal with pain. In both patients, the fractures were clinically and radiographically healed, and the patients were encouraged to continue with physiotherapy. One patient presented a superficial infection at the K-wire insertion site, which improved with oral antibiotic therapy and removal of the K-wire at 28 days. A non-traumatic fracture of a second metacarpal occurred 4–5 days after K-wire removal in a patient operated with percutaneous transverse pinning for a fracture of the third metacarpal. The new fracture was transverse, in the location where one of the k-wires from the index surgery passed through bone, and was treated by another traverse pinning. No other complications were observed during the follow-up.
Discussion
The present study reports the results of percutaneous transverse pinning for non-articular metacarpal fractures. The functional outcomes of all patients were excellent. Fractures of the neck of the 5th metacarpal (boxer’s fracture) are the most frequent [27], but long oblique and irreducible transverse fractures are the most unstable [28, 29]. Operative management for metacarpal fractures is indicated depending on the degree of volar angulation, shortening and displacement [30]. Excessive volar angulation can result in dorsal deformity with a prominent palmar metacarpal head and decreased grip strength [31, 32]. The degrees of volar angulation for each digit that may be considered for surgical fixation are 15° for the second metacarpal, 25° for the third metacarpal, 35° for the fourth metacarpal, and 45° for the fifth metacarpal [30]. An angulation defect greater than 30° for the fifth metacarpal is associated with a decrease in grip strength and range of motion [33].
Several surgical options exist for fixating metacarpal fractures: K-wire percutaneous fixation, (locking) plate fixation, and intramedullary fixation with headless compression screws. No consensus currently exists on the optimal method for metacarpal fracture fixation [34]. Different K-wires pinning treatments have been described: cross pinning, crucifix retrograde or antegrade pinning (Kapandji technique), and bouquet pinning with one or more antegrade K-wires [35‐37]. Kapandji used an intramedullary axial K-wire with a curved tip to maintain the proximal fragment and reduce its angulation in flexion, and a transverse K-wire, perpendicular to the previous K-wire, through the head of the fifth metacarpal and into the head of the fourth metacarpal to reduce malrotation [38]. The K-wire technique is minimally invasive and is associated with a good post-operative range of motion [39], but it shows drawbacks such as pin-site infection, nonunion/malunion, the need to protect exposed pins, and prolonged immobilisation [8, 40]. The technique we used does not include an intramedullary longitudinal K-wire, which increases the risk of damage to the metacarpophalangeal joint and extensor apparatus and necessitates larger-diameter K-wires.
Miniplate fixation can be used when significant comminution precludes closed reduction and percutaneous pinning [30], and allows the most biomechanically stable construct [41], but may be associated with stiffness, avascular necrosis of the metacarpal head, extensor tendon injury, nonunion/malunion, and hardware irritation [6, 42]. Intramedullary fixation antegrade or retrograde is an alternative minimally invasive technique for the treatment of unstable extra-articular fractures of the metacarpals and allows early active mobilisation [12, 43]. Both K-wire fixation and miniplate fixation are equally effective in terms of total active motion and range of motion when used in closed metacarpal and phalangeal fractures [44‐46]. Nonetheless, functional impairment requiring reoperation was reported in ORIF-treated patients [47]. Furthermore, ORIF takes longer and requires longer hospital stays [48]. There is no consensus among hand surgeons about the single most effective technique, though the evidence supports the use of percutaneous pins over ORIF with plates and screws in the management of such metacarpal fractures [49, 50].
Anzeige
Our patients experienced excellent clinical results and a very low complication rate. This is encouraging, even considering the lack of other studies on this surgical technique. Transverse pinning was first described by Lamb in 1973, who reported 39 diaphyseal fractures treated in this fashion, with no non-unions or infection [51]. We report one superficial infection at the K-wire insertion site. Pin-site infection is less common when the K-wires are buried beneath the skin (17.6% of exposed K-wire infection cases vs 8.7% of buried K wire cases) [52], but not all patients may tolerate this, and removal can be less straight forward.
This study has some limitations. First, there was no comparison with other techniques, such as miniplate fixation or intramedullary fixation. Only two studies described percutaneous transverse pinning limited to closed boxer fractures, with good clinical and anatomic outcomes. Another important limitation of this study was the short-term follow-up. We are aware that the highest level of evidence for the effectiveness of our or the other surgical treatment, such as cross pinning, crucifix pinning, and bouquet pinning, can only be produced employing a randomised study trial design. However, despite the constraints of our setting, we are confident that the results are valid and reliable. The recruitment process was rigorous, data collection was performed in a strict scientific fashion, we used validated outcome measures, and the results obtained are clinically relevant. Further high-quality clinical trials are required to validate these results on a larger scale.
Conclusions
Percutaneous transverse pinning for non-articular metacarpal fractures showed excellent functional and anatomic outcomes and can be considered satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale.
Declarations
Conflict of interest
The authors declare no conflict of interest.
Anzeige
Ethical approval
The present study was approved by the South Campania Ethics Committee (ID: 0094277, January 16, 2017).
Consent to participate
The present study was conducted in accordance with principles expressed in the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardian(s).
Consent to publish
All authors have read and agreed to the published version of the manuscript.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Day C SP (2011) Fractures of the metacarpals and phalanges. Wolfe S, (Ed). Green’s operative hand surgery. 6th ed. Philadelphia. Elsevier Churchill Livingstone
2.
Migliorini F, Rath B, Tingart M, Niewiera M, Colarossi G, Baroncini A (2019) Injuries among volleyball players: a comprehensive survey of the literature. Sport Sci Health. https://doi.org/10.1007/s11332-019-00549-xCrossRef
Igeta Y, Ichihara S, Hara A, Suzuki M, Otani S, Maruyama Y, Nozawa M (2021) New linked-wire-type external fixator (the Ichi-fixator system) for metacarpal fractures: case series and literature review. J Hand Surg Asian Pac 26(3):403–409. https://doi.org/10.1142/S2424835521500399CrossRef
14.
Lese AB, Waggy CA (2021) Hand and finger injuries: metacarpal fractures. FP Essent 500:13–20PubMed
Scale A, Kind A, Kim S, Eichenauer F, Henning E, Eisenschenk A (2022) Intramedullary single-Kirschner-wire fixation in displaced fractures of the fifth metacarpal neck (Boxer’s fracture). JBJS Essent Surg Tech. https://doi.org/10.2106/JBJS.ST.20.00050CrossRefPubMedPubMedCentral
17.
van Bussel EM, Houwert RM, Kootstra TJM, van Heijl M, Van der Velde D, Wittich P, Keizer J (2019) Antegrade intramedullary Kirschner-wire fixation of displaced metacarpal shaft fractures. Eur J Trauma Emerg Surg 45(1):65–71. https://doi.org/10.1007/s00068-017-0836-0CrossRefPubMed
18.
Baydar M, Aydin A, Sencan A, Orman O, Aykut S, Ozturk K (2021) Comparison of clinical and radiological results of fixation methods with retrograde intramedullary Kirschner wire and plate-screw in extra-articular metacarpal fractures. Jt Dis Relat Surg 32(2):397–405. https://doi.org/10.52312/jdrs.2021.40CrossRefPubMedPubMedCentral
19.
Curtis BD, Fajolu O, Ruff ME, Litsky AS (2015) Fixation of metacarpal shaft fractures: biomechanical comparison of intramedullary nail crossed K-wires and plate-screw constructs. Orthop Surg 7(3):256–260. https://doi.org/10.1111/os.12195CrossRefPubMedPubMedCentral
Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A (2003) Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma 55(3):509–513. https://doi.org/10.1097/01.TA.0000029368.40479.A2CrossRefPubMed
22.
Potenza V, Caterini R, De Maio F, Bisicchia S, Farsetti P (2012) Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning. Injury 43(2):242–245. https://doi.org/10.1016/j.injury.2011.10.036CrossRefPubMed
23.
MacDermid JC, Tottenham V (2004) Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther 17(1):18–23. https://doi.org/10.1197/j.jht.2003.10.003CrossRefPubMed
24.
Finsen V, Hillesund S, Fromreide I (2018) The reliability of remembered pre-operative patient-rated wrist and hand evaluation (PRWHE) scores. Orthop Rev (Pavia) 10(4):7682. https://doi.org/10.4081/or.2018.7682CrossRefPubMed
25.
Weinstock-Zlotnick G, Page C, Ghomrawi HM, Wolff AL (2015) Responsiveness of three patient report outcome (PRO) measures in patients with hand fractures: a preliminary cohort study. J Hand Ther 28(4):403–410. https://doi.org/10.1016/j.jht.2015.05.004CrossRefPubMed
26.
Packham T, MacDermid JC (2013) Measurement properties of the Patient-rated wrist and hand evaluation: rasch analysis of responses from a traumatic hand injury population. J Hand Ther 26(3):216–223. https://doi.org/10.1016/j.jht.2012.12.006CrossRefPubMed
Chiu YC, Hsu CE, Ho TY, Ting YN, Wei BH, Tsai MT, Hsu JT (2021) Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture. Medicine (Baltimore) 100(39):e27375. https://doi.org/10.1097/MD.0000000000027375CrossRefPubMed
Foucher G, Chemorin C, Sibilly A (1976) A new technic of osteosynthesis in fractures of the distal 3d of the 5th metacarpus. Nouv Presse Med 5(17):1139–1140PubMed
36.
Winter M, Balaguer T, Bessiere C, Carles M, Lebreton E (2007) Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur 32(6):709–713. https://doi.org/10.1016/J.JHSE.2007.07.011CrossRef
Kapandji AI (1993) Osteosynthesis using perpendicular pins in the treatment of fractures and malunions of the neck of the 5th metacarpal bone. Ann Chir Main Memb Super 12(1):45–55. https://doi.org/10.1016/s0753-9053(05)80260-1CrossRefPubMed
39.
Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P (2010) Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res 96(5):506–512. https://doi.org/10.1016/j.otsr.2010.02.009CrossRefPubMed
40.
Botte MJ, Davis JL, Rose BA, von Schroeder HP, Gellman H, Zinberg EM, Abrams RA (1992) Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res 276:194–201CrossRef
41.
Jones WW (1987) Biomechanics of small bone fixation. Clin Orthop Relat Res 214:11–18CrossRef
del Pinal F, Moraleda E, Ruas JS, de Piero GH, Cerezal L (2015) Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 40(4):692–700. https://doi.org/10.1016/j.jhsa.2014.11.023CrossRefPubMed
44.
Ahmed Z, Haider MI, Buzdar MI, Bakht Chugtai B, Rashid M, Hussain N, Ali F (2020) Comparison of miniplate and K-wire in the treatment of metacarpal and phalangeal fractures. Cureus 12(2):e7039. https://doi.org/10.7759/cureus.7039CrossRefPubMedPubMedCentral
45.
Xu J, Zhang C (2015) Retraction note: Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis. J Orthop Surg Res 10:43. https://doi.org/10.1186/s13018-015-0183-yCrossRefPubMedPubMedCentral
46.
Wang W, Zeng M, Yang J, Wang L, Xie J, Hu Y (2021) Clinical efficacy of closed reduction and percutaneous parallel K-wire interlocking fixation of first metacarpal base fracture. J Orthop Surg Res 16(1):454. https://doi.org/10.1186/s13018-021-02600-5CrossRefPubMedPubMedCentral
47.
Greeven AP, Bezstarosti S, Krijnen P, Schipper IB (2016) Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review. Eur J Trauma Emerg Surg 42(2):169–175. https://doi.org/10.1007/s00068-015-0507-yCrossRefPubMed
48.
Wang D, Sun K, Jiang W (2020) Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures. J Int Med Res 48(3):300060519887264. https://doi.org/10.1177/0300060519887264CrossRefPubMed
49.
Melamed E, Joo L, Lin E, Perretta D, Capo JT (2017) Plate fixation versus percutaneous pinning for unstable metacarpal fractures: a meta-analysis. J Hand Surg Asian Pac 22(1):29–34. https://doi.org/10.1142/S0218810417500058CrossRef
50.
Gu S, Zhou L, Huang Y, Xie R (2021) The curative effect analysis of a modified Kirschner wires and locking plate internal fixation method for the fifth metacarpal neck fracture. J Orthop Surg Res 16(1):491. https://doi.org/10.1186/s13018-021-02627-8CrossRefPubMedPubMedCentral
Ridley TJ, Freking W, Erickson LO, Ward CM (2017) Incidence of treatment for infection of buried versus exposed kirschner wires in phalangeal, metacarpal, and distal radial fractures. J Hand Surg Am 42(7):525–531. https://doi.org/10.1016/j.jhsa.2017.03.040CrossRefPubMed
Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).
Laut einer Querschnittstudie leiden rund 7% der in Deutschland lebenden über 16-Jährigen unter chronischen Schmerzen, die ihren Alltag stark beeinträchtigen. Außer biologischen scheinen auch psychische und soziale Faktoren mit sogenanntem High-Impact Chronic Pain assoziiert zu sein.
Langzeitdaten der Framingham Heart Study mit einer Nachbeobachtung von bis zu sieben Jahrzehnten belegen eine dosisabhängige Assoziation zwischen Schädel-Hirn-Traumata und der langfristigen Mortalität, die maßgeblich durch demenzbedingte Todesursachen bestimmt wird.
Die Versorgung von Kindern mit dislozierten Frakturen des medialen Epicondylus ist umstritten. Trotz geringer Evidenz wird häufig die operative Fixierung empfohlen. In der SCIENCE-Studie haben Forschende nun untersucht, ob die Operation tatsächlich funktionelle Vorteile bringt.
Rupturen der Rotatorenmanschette zählen zu den häufigsten Schultererkrankungen. Je nach Alter sind die Ursachen unterschiedlich. Welche Empfehlungen die neue S2k-Leitlinie für Diagnostik, OP-Indikation und Therapie gibt, erklärt Prof. Dennis Liem im Interviewformat MedTalk Leitlinie KOMPAKT der Zeitschrift Orthopädie und Unfallchirurgie.
