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A-1277 Ulnar shortening
Michael Sauerbier, Germany
Wednesday, June 13, 2018 · 1:09 p.m. · 15m 36s
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are much forthcoming for this introduction good afternoon ladies and gentlemen um
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these are my disclosures and what i'm gonna do is to give
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you an overview about the indications of on or shortening astronomy
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concerning the biometric mechanics we all know that on a
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positive variance i'm up to two millimetres increases
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uh loads in could every studies to on a couple loading up to forty two percent and this was
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um detected by andy palmer and his group in the eighties and um
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acquired on a plus variances due to regular shortening after discourages
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fractures essex abreast injuries or a buffer is real injuries
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the definition of a on our infection syndrome
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is naught carpal compression with actual compression
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of the t. f. c. c. between the on the head and the
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do not try creature area as you can see on the left uh sketches
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and uh this situation leads to a chronic pathology of the t. f. c. c.
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um this year is this area where the patients to have their pain and you can
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see already here in this plane x. ray if there's assist at the wounded
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and this is how it may look um actress cop weekly but we can talk about this later on
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um concerning the evaluation of on a sided wrist
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pain it's quite similar to the t.
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h. c. c. tear it's a swelling limitation of range of motion tenderness around p.
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on my head and the track with them and also
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painted passive and active on on the the asian
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the two significant test for on a couple infections interim the former time some people said
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on a couple button and um a pressure at the four wheel insertion between
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the online network we term and the f. c. we see you tendons richard burger was publishing this
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test um many years ago and also a positive on
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a grinding test in on other variation combined with
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pressure predation and stupid nation and the patients to where the pain in this area
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what are the standard imaging per season uh procedures
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one of the standard wrist right your graph stated versus
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a dynamic stress in posterior and enter your view
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this is a regular x-ray here and this is as you can see uh was
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stressed and the older couple loading is very significant when patients have a ball
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in their hand this is how we do it here oh i'm sorry go back
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and um besides x. ray analysis is also m. r. i. may be helpful
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and uh and am or i may see your it
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this is and the hyper density of the lunar
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the area the on aside learned area due to this infection of the t. h. c. c.
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uh in between on the head and wanted but um what has to be where
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that some radiologists easily uh find out that it might be keen
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box disease but if that's only at the own outside
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it's not talking box it's always a and on up a
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infection syndrome either a dynamic or static on our action
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um what are the possibilities for treatment
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one is as always conservative management what loading
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off the rest and lit anti inflammatory
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medication splintering cory because their weights but um in most circumstances it doesn't
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work out and in the long term surgery is um the only reliable
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option the first um part of operative therapy usually is restored ross groupie
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followed by a joint labelling procedures which i will talk about in the minute
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and this is the technique of rest called the t. f. c.
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c. is the breed it um whether shaver and the punch
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and uh it's then unload it this is um
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some inter operative use with um the rapture or or
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some degenerative um situations of that particular test
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and this again is the on the side of the loon it uh
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as it looks quite often when there's significant on our action
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um one of the most time based procedure of course
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is the owner shortening or still to me
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but also um there is another possibility to do a joint level
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in procedure it's called the bay for procedure we're just
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a little part of the online had it it's excise in the beginning it was done as an open procedure
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but uh these days um most people do it across copy cliche
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the oldest procedure the most time based procedure of course is the owner
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shortening or call on a recession and that milk in a
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nineteen forty one published this uh in the journal of bone and joint surgery american
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this is the technique of the open whether procedure again published by paul
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fell than in nineteen ninety two we don't use it quite often
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um i want to show you a few pictures here how it is done at risk optically
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with the shaver here and the where it fig bar can be
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now the video should run
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well doesn't work
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now it's it's already breed it in the distance area and just
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see here the online had and then the next that is
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to do greeted with the burr and then you really can respect up to three to four millimetres across
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complicated but it's a procedure and the joint and
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it maybe lead to a pretty arthritic condition
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and um the list um the literature is a quite difficult to interpret it
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well this is how it uh may look this is a fifty eight years old patient with an on ramp actions and from
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and he and the wave it underwent a way first procedure which was done that's was
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completely here you see also the tonight with the patient did have his problems
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um the most executed procedure of course is
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the owner shortening astronomy it's and
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uh it's a procedure which is out of the d. r. u. j. and i think this is um very
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sufficient way to do joint level link um the indications are listed here
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and what is very important to know that it's not a
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good indication for this parade is fractured with mel emulation
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all the display radius doctor prowler we'll talk about these indications
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what to do with mel and relations in a minute
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um our indications are on the variance developmental or acquired
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on a plus persistent pain twelve weeks after after
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us was coptic surgery or the t. f. c. c. and this year for example is definitely
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not an indication because it's mel emulation after disk radius vector and this should
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be a done with the corrective astronomy not with all the shortening
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these are the typical once and um among trimmer
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i modified b. a surgeon to approach for not shortening in two thousand to a lot of people
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that they're on a short things always from the dorsal side of the um i'll not but um he
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started to use it from all only and i was part of that team at the time
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when i started it it's done from all the palmer because a soft tissue
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coverage is much better than on the um extends or tendon side
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there is a um and the because you are to me in the distal third and remove lovable anywhere for
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um interoffice fixation with the special played and the like screw these were the body beginnings
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with these um uh with this uh uh screws on and plates and techniques
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and this is a patient six month after such a procedure another case
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and you see here the online faction problem
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and this is how it looked with the okay let's marking
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played um post offered to flee after six months
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we now use a new system uh from them that are
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just company um it's a locking plate um very
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fan low profile and it has a compression spindle and the technique
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is relatively um sufficient and i just want to show you
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our approach we use the skin incision along this up to ten
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years border of the owner proximal um it's centimetres long
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then fashion incision between e. c. u. n. f. c. u. i'm careful
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stripping all the on up areas to white bone nutrition problems
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um then positioning all the plate approximately one centimetre to the
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sigmoid knowledge in certain of the distal cortical screw
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which is seen here fixation on the plate proximity and
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just really with the screws here and um
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this is the guide for doing the astronomy you see we use it
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for not ugly costco to me it can be done also
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with the straight ninety degrees i by the way and this is how it is done
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um the desired with all this only can be set with a screwdriver on the list your tummy guide here
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um then you remove the astronomy guide lose the proximal screw
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and then do compression of the gap with that spindle and later on
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put intellects to remove your still me guide skins which are
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and um this is how it looks intro operative lee then see here the like screw
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um so this is a case just a presentation patient has on a couple uh interaction
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see the m. r. i. here
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the hot hadn't that's rock uh a process copy and um
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it didn't help overall so we decided to shorten the all now
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and this is the uh immediate post operative right your graph
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it's the eight months post op uh to flee the gap is close and there's complete bony consolidation
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um the second case same problem
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um there is is here at the chip sissy palmer to be lesion how literally isn't the even
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at the loon it that's typical for online traction and this is is post operative radio graph
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and this is five months post op with good bony consolation or post
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operative protocol includes uh below l. balls plan for three weeks
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i'm not everybody's doing that but we still we're still a little bit conservatively
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and then early active range of motion exercise floating after three month
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and back uh two full activity after bony union hardware removal
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may be not necessary but at least we leave the plates for eighteen months
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this is um result for months post op productively with good range of motion
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and this is another patient twelve weeks after on the shortening still to me if you compare
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um the way for procedure with all not shortening astronomy
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is the relatively good results which are green but the
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serious for on a shorting astronomy is a much
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a bigger in the literature however um there's some um non union rates
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up to ten between ten and twenty percent in the literature
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um our on results in twenty seven patients in the last couple of years
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didn't show any non union we were quite satisfied with or results they're all also some plates
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uh well i'm in the former generation and um the pain scores are good
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what we also detected in another's got the study in forty patients that if the plates are on
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the dorsal side we would have more hardware removals and these are the patients with unlocking plate
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fifty seven seventeen patients also no non unions that's the average age
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and the results are very satisfied with the return to work right which is or um five month
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so in conclusion the owner shortening procedure is a good procedure downloads the on the couple joint
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and on lamp actions and from um there's no indication
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for this after distal radius fractures with mel union
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and a hardware removal with that would be wise
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maybe necessary to do to the patients comforts
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and uh i think the latest play developments make the procedure much more easy
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way for procedure only has its place in minor all up lots
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but i'm sure that not everybody is a big fan of it because the
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A-1277 Ulnar shortening
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