[Reconstructive surgery of malunited joint fractures of the hand]

Malunion of fractures, joint fractures and pseudoarthroses leads to therapy-resistant pain during function and loading, especially in the wrist, with a risk of early arthrosis. In spite of the extraordinary adaptability of the hand, malunion in the axis and rotation can lead, for example, to cross-finger malfunction. Because of the relatively thin layer of soft tissue, secondary operations to correct the axis, rotation and the length of the phalanx are possible. Each reoperation on the hand diminishes the blood flow, and the anatomical structures change with cicatrices. Thus, the risk of damaging blood vessels or nerves is increased. Operative correction of the position, arthroplasties, joint prostheses, arthrodeses, arthrolyses and denervation are all part of the operative repertoire. It is necessary to repair the joint surface as well as the capsule-ligament structures. Furthermore, we also express our opinion regarding the indications and contraindications of secondary operations. We discuss the risks and complications during operations and especially stress the aspect of having enough patient information. Finally, we describe the operative techniques in special cases. The necessity for reconstructive secondary operations is increasing as more and more replantations are being done and hand lesions in polytraumatized patients are being neglected. To date, not enough attention has been given to these problems in the scientific literature.