The Hand Small Joint Arthrodesis

2. The HandSmall Joint Arthrodesis Reza Sh. Kamrani Orthopaedic surgeon Hand surgeon AO Congress 25 Apr 2004

3. Hand Function GRASP Mobility to mold the object

4. Small joint arthrodesis of hand • Indication • Pain • Instability • Deformity • Loss of neuromuscular control • Function & Cosmetic impairment • Trauma • Contraction ( Burn, RA, Infection, … ) • Nerve palsy

5. Trauma

6. Congenital Neglected synductyly

8. Rheumatoid hand

9. Soft tissue injury

10. Tendon substance loss

11. Residual deformity Cosmetic

12. Electrical burn

13. Industrial injury

14. Long standing deformity

15. Ulnar nerve palsy

16. Finger’s joints • - DIP There is no indication for arthroplasty • - PIP • - MP The most important joint for finger mobility

17. DIP There is no indication for arthroplasty • Specific indications • Isolated FDP rupture • Chronic mallet finger

18. Terminal tendon reduction

19. DIP arthrodesis

20. DIP There is no indication for arthroplasty • Specific indications • Isolated FDP rupture • Chronic mallet finger • Position • 0 deg Extension

22. DIP There is no indication for arthroplasty • Specific indications • Isolated FDP rupture • Chronic mallet finger • Position • 0 deg Extension • Alternative options • Tenodesis

23. PIP • Specific indication • Rigid boutonniere deformity • Central slip substance loss

24. Dorsal hand injury

25. Central slip loss PIP

26. PIP • Specific indication • Rigid boutonniere deformity • Central slip substance loss • Position • Contraversy • Cascade from 40 to 55 deg. • All in 40 deg. • 5-10 deg supination in index and middle fingers

27. PIP • Specific indication • Rigid boutonniere deformity • Central slip substance loss • Position • Contraversy • Cascade from 40 to 55 deg. • All in 40 deg. • 5-10 deg supination in index and middle fingers • Alternative options • Arthroplasty

28. Recurent intra-osseus hemangioma

29. Osteo-cartilagr auto graft Destroyed joint

30. Free PIP joint transfer

31. MP The most important joint in finger motion • Specific indication • Failed arthroplasty • Position • Cascade from 25 to 40 deg. • Without rotation or deviation • Alternative option • Artroplasty is more reliable and satisfactory

32. Post traumatic tendon adhesion

33. Extensor tenolysis

34. Rheumatoid hand

35. MP arthroplasty

36. Technique • Arthrodesis The prime requisites of a good digital arthrodesis: - a painless and stable union - in a proper position - in a reasonable space of time Moberg

37. Technique • Approaches: • DIP dorsal H , Y , transverse – cut the terminal tendon • PIP dorsal split tendon app. • MP dorsal radial side of tendon • CMC dorsal transverse • 1st CMC radiovolar curvilinear

38. Different approaches of DIP

40. Dorsal app.

41. Extensor split app.

42. Technique • Preparation of bone surface • Fixation method • Bone graft

43. Surface preparation • Cancellous to cancellous contact

44. Cancellous to cancellous bone contact

45. Surface preparation • Cancellous to cancellous contact • Good position • Flat angled • Chevron • Cup and Cone

46. Flat cut Cup and Cone

47. Flat cut in exact correct angle

48. Surface preparation • Cancellous to cancellous contact • Good position • Flat angled • Chevron • Cup and Cone • Full flexion to deliver the ends

49. Hyper flexion of the joint

50. Hyperflexion of the joint to remove articular surface