44° Congresso Nazionaledella Società Italiana di Chirurgia della ManoMalformazioni Congenite Materiali e Nuove
Tecnologie
44° Congresso Nazionaledella Società Italiana di Chirurgia della ManoMalformazioni Congenite Materiali e Nuove
Tecnologie
MILANO 11-14 Ottobre 2006
PALAZZO MEZZANOTTE
MILANO 11-14 Ottobre 2006
PALAZZO MEZZANOTTE
New Surgical Technique About Thumb’ Osteoarthrosis
Autori: M. Rubino*, A. Civani**, G. De Montis**,
L. Biglieni** , M. Moretti*, S. Bardella*.(*I Div. Ortopedia, Osp. S. Martino, Genova; **Clin. Ortopedica, Università
degli Studi, Genova)
New Surgical Technique About Thumb’ Osteoarthrosis
Autori: M. Rubino*, A. Civani**, G. De Montis**,
L. Biglieni** , M. Moretti*, S. Bardella*.(*I Div. Ortopedia, Osp. S. Martino, Genova; **Clin. Ortopedica, Università
degli Studi, Genova)
Rhizoarthrosis Classification:
DellDellEatonEatonBrunelliBrunelli
Rhizoarthrosis Classification:
DellDellEatonEatonBrunelliBrunelli
Clinical RelievesClinical Relieves
painfunctional loss in pinching TM instability (Grinding test +)
painfunctional loss in pinching TM instability (Grinding test +)
Surgical indicationsSurgical indications
- Prosthesis of TM- Prosthesis of TM
- Arthrodesis
- Arthrodesis
- Tendon arthroplasty- Tendon arthroplasty
- Arthroscopic technique- Arthroscopic technique
Variants of techniqueVariants of technique
Arthrodesis disadvantagesArthrodesis disadvantages
-TS joint overload particularly unuseful in young patients
- Inability in adduction of the thumb
- Metacarpal head relief when the hand leans on flat surface
-TS joint overload particularly unuseful in young patients
- Inability in adduction of the thumb
- Metacarpal head relief when the hand leans on flat surface
Tendon arthroplastyTendon arthroplasty
CRF Tendinitis in 40% to 60% until 7-8 months after surgery
Reflex sympathetic dystrophy in prone subjects
CRF Tendinitis in 40% to 60% until 7-8 months after surgery
Reflex sympathetic dystrophy in prone subjects
Need of a new technique Need of a new technique failed attempts of TM
arthrodesis
bony segments mobility in presence of implants
pain and functional limitation good recovery by removal implant
leaving articular surfaces decorticated and covered by a coat of fibrous tissue that restore integrally the
TM joint function
Innovative idea:The search of a surgical technique that
aims to obtain immediately the conditions before described and not as secondary to
a failed attempt of arthrodesis
For these reasons we have named this technique
“ PSEUDOARTHRODESIS “
Innovative idea:The search of a surgical technique that
aims to obtain immediately the conditions before described and not as secondary to
a failed attempt of arthrodesis
For these reasons we have named this technique
“ PSEUDOARTHRODESIS “
Pseudoarthrodesis Pseudoarthrodesis
- removing by hand-saw cartilage of trapezium and basis of the first metacarpal
-Temporary blocking with K wires ( 25 days) strictly without going beyond the TS joint
-motion immediately granted and guided by a taping in painless range until the stitches removal
- removing by hand-saw cartilage of trapezium and basis of the first metacarpal
-Temporary blocking with K wires ( 25 days) strictly without going beyond the TS joint
-motion immediately granted and guided by a taping in painless range until the stitches removal
Dorsal - radial approachDorsal - radial approach
Paying attention to the Paying attention to the radial nerve sensitive radial nerve sensitive branchesbranches
Hand-sawHand-saw
Minimal bone Minimal bone resectionresection
Avoiding Avoiding shortening of the shortening of the
thumbthumb
ANY KIND OF IMMOBILIZATION
Early motion granted and guided by a taping in painless range for the first 10-12 days
ANY KIND OF IMMOBILIZATION
Early motion granted and guided by a taping in painless range for the first 10-12 days
We have been using this technique for two years (at the beginning alternated with Weilby-Ceruso technique)
During the last year we managed all rhizhoarthrosis with this new technique, as results completely satisfy us
We have been using this technique for two years (at the beginning alternated with Weilby-Ceruso technique)
During the last year we managed all rhizhoarthrosis with this new technique, as results completely satisfy us
Association with trapezium scaphoidal
arthrosis
Weilby-Ceruso.
Association with trapezium scaphoidal
arthrosis
Weilby-Ceruso.
Cases
81 cases:
32 arthrodesis failed ( 24 with cambre, 8 with plates and screw of 2 o 2.7 mm ) in the last 13 years
49 rhizoarthrosis managed with pseudoarthrodesis in the last 2 years (3 “Z” thumbs)
Cases
81 cases:
32 arthrodesis failed ( 24 with cambre, 8 with plates and screw of 2 o 2.7 mm ) in the last 13 years
49 rhizoarthrosis managed with pseudoarthrodesis in the last 2 years (3 “Z” thumbs)
- 45 days with K wires- one K wire has a grip on the scaphoid- one K wire does not allow the MF iperextension
- 45 days with K wires- one K wire has a grip on the scaphoid- one K wire does not allow the MF iperextension
Results
- Pain: immediately absent without motion; until the second-third month durring strong pinching
- Strength in pinch: equal or superior than the other side between the second and fourth month
-Fisiological range of motion: optimal within the second month in hard patients too
- Results lasting in time
Results
- Pain: immediately absent without motion; until the second-third month durring strong pinching
- Strength in pinch: equal or superior than the other side between the second and fourth month
-Fisiological range of motion: optimal within the second month in hard patients too
- Results lasting in time
- Simple
- Economic
- Easy post-surgical management
- Changeable in according to the case
by position of K wires, time of immobilization, use of taping
- Simple
- Economic
- Easy post-surgical management
- Changeable in according to the case
by position of K wires, time of immobilization, use of taping
ConclusionsConclusions
Technique: Technique: