Arthroscopy: today the gold-standard in wrist joint surgery. Ivan Tami. Swiss Medical Network. Musculoskeletal Conference, Bern.

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1 Arthroscopy: today the gold-standard in wrist joint surgery Ivan Tami Swiss Medical Network Musculoskeletal Conference, Bern March 31, 2017

2 «great men founded schools. To be remembered, they must spread their knowledge.» Ivo Pitanguy, M.D.,

3

4 Wrist ganglion cyst

5 Wrist ganglion cyst

6 Wrist ganglion cyst

7 Wrist ganglion cyst

8 Imaging: sonography

9 Imaging: MRI

10 Treatment: - aspiration of fluid - injection of corticosteroid Recurrence 1:2

11 Treatment: open surgery

12 Treatment: surgery Ganglio cyst Ligament Scaphoid Pedicle Lunate

13 Treatment: arthroscopy

14 Treatment: arthroscopy

15 Treatment: arthroscopy

16 Rehabilitation After surgery - Cast weeks day and night weeks only at night - Hand Therapy - from the beginning assisted mobilisation - start with strengthening after 6 weeks

17 Injury of the Triangular FibroCartilage Complex (TFCC)

18 Clinical presentation Ulnar-sided wrist pain snapping clunking grip strength Impaired function P/S

19 Clinical examination DRUJ instability ulnar fovea sign

20 Clinical examination DRUJ instability ulnar fovea sign distal ulna ballottment test

21 Imaging for TFCC

22 Imaging: MRI complete TFCC tear Courtesy of F. Del Grande, EOC CH-Lugano

23 Diagnosis: arthroscopy Gold standard

24 Diagnosis: arthroscopy

25 Diagnosis: arthroscopy Hook test 1,2 positive TFCC tear negative No tear Arthroscopic Management of Ulnar Pain. F. del Piñal et al.

26 Diagnosis: arthroscopy Hook test 1,2 positive TFCC tear negative No tear 1 Atzei A et al. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. JHS Eur Atzei A et al. Foveal TFCC tear classification and treatment. Hand Clin 2011

27 Diagnosis: arthroscopy Trampoline test 1 positive TFCC tear negative No tear Arthroscopic Management of Ulnar Pain. F. del Piñal et al.

28 Diagnosis: arthroscopy Trampoline test 1 positive TFCC tear negative No tear 1 Hermansdorfer JD et al. Management of chronic peripheral tears of the TFCC. JHS Am 1991

29 Palmer classification of TFCC Lesions 1 I Traumatic injury A: central perforation B: ulnar avulsion C: distal avulsion D: radial avulsion II Degenerative injury 1 Palmer AK. Triangular fibrocartilage complex lesions: a classification. JHS Am 1989

30 Atzei-EWAS classification of TFCC 1 Palmer Class IB Palmer Class II 1 Atzei A. New Trends in arthroscopic management of 1-B TFCC injuries with DRUJ instability. JHS Eur 2009

31 Atzei-EWAS classification of TFCC Atzei Class I: suture ligament-to-capsule Acute injuries

32 Surgical treatment: suture (ligament-to-capsule)

33 Surgical treatment: suture (ligament-to-capsule) Repair: suture ligament-to-capsule

34 Atzei-EWAS classification of TFCC Atzei Class II and III: foveal refixation

35 Surgical treatment: foveal refixation Repair: foveal refixation Nakamura T. et al. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 2011

36 Surgical treatment: foveal refixation

37 Open versus arthroscopic repair Lucchetti R. Marc Comparison Garcia-Elias between open and arthroscopicassisted foveal Institut triangular Kaplan, fibrocartilage Barcelona complex repair for posttraumatic distal radio-ulnar joint instability. JHS Eur 2014

38 Rehabilitation Sport and heavy works tasks > 3 months 1-3 weeks long-arm cast neutral rotation elbow F/E 4-6 weeks short cast start wrist F/E assisted forearm rotation 7-10 weeks Short cast at night resume daily activities

39 Take home message Clinical assessment MRI +/- arthrography Arthroscopic repair 3-6 months rehabilitation The author declares that the research for and communication of this independent body of work does not constitute any financial or other conflict of interest.

40 Distal radius fractures

41 Decision making

42 Imaging for decision making

43 Imaging for decision making

44 N. Bizzotto, I. Tami et al. 3D Printing of bone fractures: a new tangible realistic way for preoperative planning and education. Surg. Innov. 2015

45 N. Bizzotto, I. Tami et al. 3D Printed models of distal radius fractures. Injury 2016

46 Implants Titanium Anatomical design 2 distal rows Multidirectional angle system

47 Implants Courtesy of Medartis

48 Implants

49 Surgery Fracture reduction Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010

50 Surgery Don t give up just wash out the joint and Japan clean it of blood!

51 Surgery

52 Surgery Bone grafting Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010

53 Surgery Bone grafting

54 Surgery Bone grafting

55 Surgery Treatment of the associated ulnar sided lesions K. Kasapinova et al. The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. J Hand Surg Eur. 2016

56 Surgery Treatment of the associated ulnar sided lesions T. Westphal et al. Unrepaired fracture of the styloid process of the ulna: not a bad treatment result at distal radius fracture. Unfallchirurg. 2011

57 Surgery Treatment of the associated ulnar sided lesions

58 Arthroscopically assisted osteosynthesis

59 Rehabilitation

60 Take home message Sometimes doing less is more but sometimes you can do more with less! Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010

61 Thank you for your attention! The author declares that the research for and communication of this independent body of work does not constitute any financial or other conflict of interest.

62 www. manoegomito.ch

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