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

TM joint luxationTM joint luxation

Hand-sawHand-saw

Minimal bone Minimal bone resectionresection

Avoiding Avoiding shortening of the shortening of the

thumbthumb

Trapezium Trapezium cartilage resectioncartilage resection

Quadrangular space Quadrangular space

1,4 or 1,6 mm K wires1,4 or 1,6 mm K wires

without going beyond the TS joint!without going beyond the TS joint!

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

K Wires removal after 25 days

K Wires removal after 25 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)

“Z”

Thumb

“Z”

Thumb

- 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: