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A-1144 Accelerated recovery in athletic hand injuries. Clinical cases
Robert Gvozdenovic, Denmark
Thursday, June 14, 2018 · 12:24 p.m. · 15m 30s
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huh huh
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now i uh slightly change the name of my presentation eh to
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be not only technically cases but also techniques because eh when
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i uh before i came here as some days ago i yeah but the question for uh for colleague of mine
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eh do i treat the athletic and injuries differently and the and others
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and this presentation is not about that this uh presentation here
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is about how the uh uh uh sports injuries then i seen in my product is
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uh and had an impact on me uh it to choose a how to treat the patients better
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and how to uh to get them back to work at the faster so eh these presentations
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are about the atlantic and then the cases are about the death athletic injuries
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but that the techniques that we use uh we use the model put our patients
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i don't have any disclosures in this presentation eh the patients primary goal
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in in the athletes i used to call back and want
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to try it again and to play and i mean the the
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searchers primary goal has to be the same uh how big
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get there as fast as possible in order to do uh there's a good first you have
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we'll have to have a good team had multi disciplinary approach is very eh essential
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and that's what we have in our institution we have
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a dedicated on only but dedicated operating theatre
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in their seats and we have a dedicated hand therapist and when we have that then everything else
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is up to the doctor and the eh and we develop some of that minimally invasive techniques
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and we try to get them and as minimal as a um you know decision time as possible
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and every a single patients also they get let
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the uh cases which we have occasionally
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uh it has to be treated a custom made so everybody has
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a personally made program eh i'm in recovery in the recovery
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eh i only have a few cases and the only one is a cute and the
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rest is a chronic uh some of the most this specific injuries in updates
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we are uh starting with a a first case of course full which uh
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eh is important today yeah the first day of the whole tradition
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this is the um match between two national teams a friendly match and these are the
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player the get hit by a ball not didn't had like it seems but
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in the rest and then uh when you come to the praxis three or four
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days later we uh i just thought the it's a common shop for proctor
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but uh fortunately we uh in the the
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eh or cities can and we discovered not only that the
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eh and build factories multi a fractional but also involves
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both the radio the colourful and that is to write a couple joint just allowed to lodge on sorry
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so uh we perform a a transcript be assisted fixations sorry about the uh the the technical
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problems in the photos and i will uh thinks uh to pocket p. now who
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really had located a doing this and i think it was possible to uh
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to put the the probe and the two exact fixate this
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a fracture and put the provision repaint and then yeah
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everything looks better even these uh lose of uh the cartilage and bone
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exactly true component to could come better on the on the place
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no we could eh easily to the other fixation but uh we discussed different
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different the options and we uh choose the plate for him and he wants to go
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to to a trained a couple weeks after so the next
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case is a chronic uh u. c. l. injury
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and a it was a case of a boxer it where you're you're as
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old wheat sure has been operate it yeah acutely in a another hospital
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and then he come back with this uh it's still with
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some pain and instability uh and um my uh
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co worker and associated moment or a major buttons and i uh we
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published a paper for four years ago about the new method of
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during the quarter ligament reconstruction where we uh basically used a part where you stand on
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and only can else uh would we replace the graph in the better
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as seen of the last picture and then when we um i put
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the graph through the canals we usually placed a fixation anchor
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or sorry biting the bases screw or now which is actually to peak school because
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the biting cases crew the the the
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did some problems with says cystic formation so now we
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you speak not not by today's and longer
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but we are usually performed the fixation from the right deal side not from dollar
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uh in because if the tendon cracks during the fixation process
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all early then your last because you have to short graft if you put it from the
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opposite side and it cracks then you still have three centimetres back and
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then you can say to probably by being more cautious or maybe
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the and whitening do the bone call and then you go back over early
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and fix it from all sides we obliged in the in the sprint after one to two weeks
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and for for the two weeks and then uh the the physiotherapy yeah start it's
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tied actually oh all read you the second week and comparing to the
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yeah come more 'cause there to let us um previously where the that the was
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a problem with the stiffness of the m. c. p. joints and the
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with this of pinch up to fifty percent of some cases
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yeah and also some recent works which shows the loss of a and b. joint motion up to twenty
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percent in this is without that i'd be joint but there is also problems
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or to even the problem with a a laxity in that
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third uh uh um you know of their cases um
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we uh is c. and the specifics the speech a case
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have the same uh has trained to the pick strength to before and after the surgery
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and the almost the same uh rage abortion a very
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uh uh a happy patient without any pain
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so this is the the result of the our serious level of uh some twenty patients and
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you can see the grip to strengthen the pain strength was the save before laughter
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yeah and the minimal loss of a rip the of the
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motion in boats in p. and i'd be joint
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the next case is a a thirty year old woman which is a veterinarian and
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she sustained the t. f. c. c. injury what she was doing climbing
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yeah yeah i'm trying to uh the ease uh um her passion with the whole family describing and
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i was told the this one that was this the woman who planned the mostly in denmark
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so we operate is here for the t. s. a. c. injury
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artist cop equally and uh we've found the positive folk test
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and she had the symptoms of the way and a classic uh for
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well paying a as usual so uh we establish a technique
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uh yeah uh which is a a call all of total technique um we place the key
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wire and the the calculation of twenty twenty five percent not like in this picture above
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and then you should also see uh the the uh the the injuries not like this on the
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picture i just bar the pictures from object but um i usually don't draw a line
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here on the although i place the probe into the joint and i look at the on the draw
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the line and then i'll i i have this as a guideline and of the the painting
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yeah we uh drill with a kind of like it uh huh root of three point zero
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millimetre and then we uh now push the t. s. e. c. lasted through the canal
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to the uh a t. f. c. c. and make a a two speeches
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one with a lasso inside and another with a a five away so it's
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a bit um is something like yeah it looks on the picture just
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uh below the injury he without the crack because this crap is not seen actually
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the uh the crack is on donate to the t. f. c. c. is the raw
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be attached from before well uh probably a attachment so uh when we um
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uh retract a box things out of the joint then we feet
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the t. s. is a lasso with the firewire and and pull back everything uh
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through the canal and now we have a established one stage now we can
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come to the joint with slightly rotate and yeah can come here
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through here and through here and then we do this second
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stage and make it crisscrossed debacle fixation so now everything
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has to be fixated on the on and to
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do this we use a a partial cocker with that the eye on the tip of it
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and then we um moon plays the fibre white through the people the and caressing here
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and now we can tension the fixation and we can use is slightly you i did put a hummer
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and then it into the uh pretty drill hole of two point millimetre into the
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older and then everything is nice and safe now so this is the um
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before uh everything is fixed you see the the crossed a fixation
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and now everything is fixed a nice after the fixation
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um she come back to a climbing and uh she was operating in left the rest
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and she the achieve almost the same the um a restraint as on the opposite side but should
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completely trust disgraced and cheaper to call send small
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horses uh without any problem is happy
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this picture is taken up box seven seven half a month after the operation
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and if you're interested in more details about techniques that there is a poster in
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this fresh about it and the last case it is a case of
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eighteen year old man uh who was a it is a professional football people
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with a a a form of all the sort rows of the rest
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of the props more course sorry of this car for a possible
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yeah we perform i a topic is already the
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out a task optically assisted uh to treatment
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and after the everything is clean in the integer this is the
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and see the n. c. a. a uh you you view
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and the instrumentation is truly one to a portal uh that we took
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some graph from the list list a stockbroker from the radius
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and then after the graph was taking we transport to graft as as as in small portions
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of the spunk is blown into the one to port on the uh back to joint
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and we establish the fixation without a key wire and and with the kind you know it it's uh
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a compression screw everything was fixed like this so that this uh particular patients
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the heel in less than six weeks five weeks in five days
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we don't have a problem with this got the the the splint this is the stage of performance
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you could the perform o. four weight bearing good push ups as you see
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i don't know the the technique use uh also describing the poster here in in this fashion
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and printed to preliminary results now i get this that now is an
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a little i'm bree review of the results which the should be
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presenting in later uh in some future um presentations we actually looked at the uh
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minimally invasive uh techniques of a sort of throws is uh an unknown union of the sky for it
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we find a out the rest of that respectively that we uh the
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the totally tricky sixteen patients uh eight with a pair of tennis an eight with a
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i just copied method and we for the difference in the um the
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the type from indirect operation in in the bartenders group it was
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a relatively fresh cases but in others copy group but even if you we take this uh
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a fifteen year old and a nonunion if you take it out when uh the
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the the difference was about uh something about ten months between these groups
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and uh we could do statistics uh uh despite the small numbers of cases
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in the menu me a analysis show the a certificate its significance and in the pretenders group
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uh they healed in approximately eleven weeks while we uh actually find the feeling of uh
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in in the in the a. is the hottest topic group of less than eight weeks ago
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though with one patient age group without healing him
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so uh this is just a going to be present in the in the in some other meetings
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the take home message from today is to uh to every patient has to
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to to have a at it i just treatment and rehabilitation is tragedy
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and the out with the other okay for using the evidently a basic techniques
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and then finally if it means that you have to the use and an
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additional hour or maybe an hour and a quarter in the operating theatre
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duties because uh it uh it can mean they needed disagrees going to
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spend the patients some months maybe or some weeks of uh
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either position and and pay thank you i yeah i want you to uh have spent the somewhere in some quiet place
Conference Program
A-1141 Athletic hand injuries
Mike Hayton, Wrightington, UK
June 14, 2018 · 11:43 a.m.
A-1142 Injuries in Ball Sports
Grégoire Chick, Switzerland
June 14, 2018 · 11:59 a.m.
A-1143 Prevention, bracing and rehabiltation
William Geissler, USA
June 14, 2018 · 12:17 p.m.
A-1144 Accelerated recovery in athletic hand injuries. Clinical cases
Robert Gvozdenovic, Denmark
June 14, 2018 · 12:24 p.m.
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