Arthroscopy: today the gold-standard in wrist joint surgery Ivan Tami Swiss Medical Network Musculoskeletal Conference, Bern March 31, 2017
«great men founded schools. To be remembered, they must spread their knowledge.» Ivo Pitanguy, M.D., 1923-2016
Wrist ganglion cyst
Wrist ganglion cyst
Wrist ganglion cyst
Wrist ganglion cyst
Imaging: sonography
Imaging: MRI
Treatment: - aspiration of fluid - injection of corticosteroid Recurrence 1:2
Treatment: open surgery
Treatment: surgery Ganglio cyst Ligament Scaphoid Pedicle Lunate
Treatment: arthroscopy
Treatment: arthroscopy
Treatment: arthroscopy
Rehabilitation After surgery - Cast - 1-2 weeks day and night - 3-6 weeks only at night - Hand Therapy - from the beginning assisted mobilisation - start with strengthening after 6 weeks
Injury of the Triangular FibroCartilage Complex (TFCC)
Clinical presentation Ulnar-sided wrist pain snapping clunking grip strength Impaired function P/S
Clinical examination DRUJ instability ulnar fovea sign
Clinical examination DRUJ instability ulnar fovea sign distal ulna ballottment test
Imaging for TFCC
Imaging: MRI complete TFCC tear Courtesy of F. Del Grande, EOC CH-Lugano
Diagnosis: arthroscopy Gold standard
Diagnosis: arthroscopy
Diagnosis: arthroscopy Hook test 1,2 positive TFCC tear negative No tear Arthroscopic Management of Ulnar Pain. F. del Piñal et al.
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 2009 2 Atzei A et al. Foveal TFCC tear classification and treatment. Hand Clin 2011
Diagnosis: arthroscopy Trampoline test 1 positive TFCC tear negative No tear Arthroscopic Management of Ulnar Pain. F. del Piñal et al.
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
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
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
Atzei-EWAS classification of TFCC Atzei Class I: suture ligament-to-capsule Acute injuries
Surgical treatment: suture (ligament-to-capsule)
Surgical treatment: suture (ligament-to-capsule) Repair: suture ligament-to-capsule
Atzei-EWAS classification of TFCC Atzei Class II and III: foveal refixation
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
Surgical treatment: foveal refixation
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
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
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.
Distal radius fractures
Decision making
Imaging for decision making
Imaging for decision making
N. Bizzotto, I. Tami et al. 3D Printing of bone fractures: a new tangible realistic way for preoperative planning and education. Surg. Innov. 2015
N. Bizzotto, I. Tami et al. 3D Printed models of distal radius fractures. Injury 2016
Implants Titanium Anatomical design 2 distal rows Multidirectional angle system
Implants Courtesy of Medartis
Implants
Surgery Fracture reduction Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010
Surgery Don t give up just wash out the joint and Japan clean it of blood!
Surgery
Surgery Bone grafting Del Piñal et al. Arthroscopic Management of Distal Radius Fracture. 2010
Surgery Bone grafting
Surgery Bone grafting
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
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
Surgery Treatment of the associated ulnar sided lesions
Arthroscopically assisted osteosynthesis
Rehabilitation
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
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.
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