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44° Congresso Nazionale della Societ à Italiana di Chirurgia della Mano Malformazioni Congenite Materiali e Nuove Tecno PowerPoint Presentation
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44° Congresso Nazionale della Societ à Italiana di Chirurgia della Mano Malformazioni Congenite Materiali e Nuove Tecnologie. New Surgical Technique About Thumb ’ Osteoarthrosis Autori: M. Rubino*, A. Civani**, G. De Montis**, L. Biglieni** , M. Moretti*, S. Bardella*.

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44° Congresso Nazionale della Societ à Italiana di Chirurgia della Mano Malformazioni Congenite Materiali e Nuove Tecno


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44° Congresso Nazionaledella Società Italiana di Chirurgia della ManoMalformazioni Congenite Materiali e Nuove Tecnologie

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)

MILANO 11-14 Ottobre 2006

PALAZZO MEZZANOTTE

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Rhizoarthrosis Classification:

Dell EatonBrunelli

pain

functional loss in pinching TM instability (Grinding test +)

Clinical Relieves

Surgical indications

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Variants of technique

- Arthrodesis

- Prosthesis of TM

- Tendon arthroplasty

- Arthroscopic technique

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Arthrodesis 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
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Tendon arthroplasty

CRF Tendinitis in 40% to 60% until 7-8 months after surgery

Reflex sympathetic dystrophy in prone subjects

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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

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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 “

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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
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Dorsal - radial approach

Paying attention to the radial nerve sensitive branches

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Hand-saw

Minimal bone resection

Avoiding shortening of the thumb

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ANY KIND OF IMMOBILIZATION

Early motion granted and guided by a taping in painless range for the first 10-12 days

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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.

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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 pseudoarthrodesisin the last 2 years (3 “Z” thumbs)

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“Z”

Thumb

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- 45 days with K wires- one K wire has a grip on the scaphoid- one K wire does not allow the MF iperextension

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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
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Conclusions

- Simple

- Economic- Easy post-surgical management- Changeable in according to the case

by position of K wires, time of immobilization, use of taping

Technique: