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A-1278 Corrective osteotomy radius extra-articular
Hermann Krimmer, Germany
Wednesday, June 13, 2018 · 1:25 p.m. · 17m 16s
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00:00:00
good afternoon ladies and gentleman and welcome to our segment educational day of the fashion
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and so last one in budapest was a big success and we all thirty can repeated this here again
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my name is someone grandma and i'm working in says south of germany the city is called raymond spoke
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it's near was a bit lake and not far away from the border to austria and switzerland
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and what a what a nice air at work and of course one of
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our topic is wrist and that's the reason why i'm here my disclosure
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and now my topic is me move to the other bones that means you focus now
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on the rages that need this corrective austere to me it's a just radius
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first of all we have to analyse indications and of course it's my union
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and we have to differentiate between extra articulate a mile
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unions that mean dorsal displacement well palmer displacement
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in dramatic hello this is a topic of our next talk
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and special indications which of course but across the rest
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or congenital model formation like some modern deformity and in the end something very
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special set means model formation or sit this the radio not john
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this was so typical pattern this so frequently in the
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past that means a conservative retreated basically fracture
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initially perfectly reduce and finally it and against the same out positions and before and
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we have to keep in mind sit it's always on the on outside yes uh complaints as a patient
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uh are not that's a rate aside and this is caused by on that actually already at
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and by in congruence see also this radio on not showing
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which leads to painful limitation proven to be nation and says of course is an indication
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for corrective austere to me now what has changed looking back in the past
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we had to wait till we had to perform correctional still to me
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did we really had this table bony consolidation distillate because we didn't f. locking devices
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and of course indication was pain and functional disability and prerequisite
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at that time was no restriction of hand function
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that mean complete faced and stretching of the fingers and now see a pay uh since there is some
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uh changes we is so in your device we have available very well known now we have says fixed
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angle devices which have proved so well you for treatment
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of this rages fractures and also says to
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billy dee off display it's because we now have incorporated
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to rose the stanley gives us a possibility to
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call for a year surgery this is for example an example for so correction played we use
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it has to distill rose and really has a high amount of stability
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and nowadays i think we can preferably go for early correction
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said we don't lose time from patients point of view
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and we can go also in a lot of cases without bone graft
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and how what what the technique we use a radio palm up to approach and
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in case of correction are said to me the expanded a little bit this early because
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we need a little bit better overview on the retail side of separate use
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then it's very important detachment of separate you rate yeah less because he prevents our reduction
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and what we always to be open apps it thirty extensive compartment to avoid
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a secondary rupture of c. p. l. tendon which can be caused
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by how much almighty us the autumn is side all also by a
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slight uh impeachment allows a ration by c. or steel to me
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and then it's a technique is so plate is pretty mounted in to this site
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correction that means if you have a malign colouration of twenty five degrees
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we mount our plate on the palm aside standing up thirty five degrees and
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it's sometimes not said easy to really precise mounts
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a blade in this this site correction angry
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and for that reason we have created especially instrument which
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is mounted in the most proximal also played
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and but that we really can precisely it just all a correction hanging you can see it in drop to play
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and then after the last the odd to me which is done proximal to the this the role then we can
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just the plate to the chest and then we have corrected what we want to have
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and to change with these the plates now is that we can leave these caps open
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can see here is a small caps of course it's not a problem but in the
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past at least we had to use on craft to avoid a secondary dislocation
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and it takes at least three to four months set this gap is bridged bible me
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and even if there is no contact on the palm aside became
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uh or the switched over to leave also sees in space open
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because inmates experience if you have solid a pony structure
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it with he units and it will stay in the desired position and you see your example endeavour young patient
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maybe just left one centimetre open and he keyed in to same position
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without secondary dislocation and that's really what has changed with these implants
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some uh special tips and tricks is especially when you have to see the ear model
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formation you have you really uh about fifty degrees and then it's very important to
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precisely check your side of c. or still to me and there is a high risk said you
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ron was you austria to me in that sick might not sure that this radio
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on actual and when you don't market and for that reason it's very helpful
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to mark the distal border of so sigmoid notch to avoid these complication
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and then the same technique if you also want to change or
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correct so rachel inclination you mount your plate in the
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other direction and then it's the same principle you bring it back position of concerning c. o. c. r. to me
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it should run at least half of c. angry of
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some opposition can see uses is the inclination
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this is the angle of c. or still to me because we want afterwards
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to have a triangular shape it's a daughter side of separate use
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and it's very important to keep in mind set the new mount
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your plate this silly to run you out screws parallel
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exactly parallel to that particular surveys because otherwise you penetrate such on
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and of course these caps when as a morse and one centimetre we still
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use the counsellors bone graft but it's not necessary to
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fill the whole get it's just enough when you
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fill the gap at a small diameter and for this we use especially harvester which
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allows us to weekly hobbyist so candles bone graft you can see here
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and we removes the cortex on one side and then you put it in
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and then we really have a good stability and v. n. can expect
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pony eating after three to five months as you can see
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now indication this was a patient became six and a half weeks after
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says plato says and this is which of course wasn't done in a really good
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manners the screws up to show up we really have again a dislocation at
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the dorsal side and he is main major complaint was the c. v. a couple time
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to but he also repress ended the signs of the c. o. p. s. sometimes
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and in this case nowadays you don't only go for couple time rees
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because we respect some opposition of so this re just as a major cause of the c. o.
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p. s. and then we also go for correctional still to me as a disarray just
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and this could be done in this case without bone graft and we had
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a rabbit pain relief post operative and the movement of the hand function
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and this was a finder inside and this is also a
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big advantage of this technique and the patients are very
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a thankful on a shortening market always give us is talk indicated in right
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use radius more information only when that this radius is in normal position
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these are indications post dramatic and you cross arrest
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after a fracture it's a young age
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and of course to d. makes a decision you meet a lot of you if there's is so
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far okay so then on a shortening is a good option as you can see here
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our results in our preliminary study showed that
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even when we left there get open
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that we didn't had the problem of secondary dislocation and nowadays
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we leave opposite effect often up to eight millimetres
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maybe now of about two hundred and forty correction austere to me is in that
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way and the experience or for wap state on the same that it
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look always not only owns a bestowed part
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keep the whole for arm in mind this is uh
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twenty one years old maybe you are the most percent it was
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missus c. v. yep my position of the radios that means
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of course shortening of the radios and an increased palm langley nation
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and then one might think is or indication of a corrective austere to meet this to
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first of all we have to think about what his cost this mark position
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and looking on so all farm it was this kind of a fracture here it's a shaft
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and then of course what ever we should regard to keep in mind
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set be binary correctly should always call at the part was it
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a side that's a factual corrupt and it says case we just went in at the fracture level
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you made it will be costly ought to me send we lang since the radius was especially clam putting a regular play
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and then the uh does the part was just okay no one
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craft so always look on the whole patient including also
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the elbow chimed especially when you have problems as a rule
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is to be nation so for extorted below my union
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what place change time soon as possible as soon as necessary
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palm approach and i think nowadays we can leave gaps up to eight millimetres open
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for example when you have a c. v. osteoporosis of course you should fill it up to spawn graph
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in the end some special considerations that means gross arrest them ah formation
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this is a fifteen year old boy this is my information
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course play a fracture of separate us and of course this is not an indication for correctional stuck to me of that
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is made using a one procedure because we would need a
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larger very big bone graft and really a crest
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and we also have some problems does the tension of silly commands and physically indication
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for a distraction austere to me via the use it in that way
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where we mounted our external fix it in one direction and it's very
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important because of forces during lang sending our is strong
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to at least stable has it this one pain in the
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second plane to avoid attending it's a distal part
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and send me lang cement in a period of about six to eight weeks
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and when we have regained the lengths we remove civic fix it up
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and put on a plate because heating in the external fix it or sometimes need six to nine months
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and this is not really affordable for the patient and this is a really solid and
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also from the function it was so for quite okay and also here one might sink
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regular inclination is so far okay one can go for on our shortening
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but it's very young patient be prefer really anatomically reconstruction also
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according to the tension of the ligaments and tendons and
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this is also done by a correction lang something and you can see
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your whole laps to get is well i'm power lots a polygraph
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would be needed when you go for correction last year to me of
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that does the radius and finally it's preached by a plate
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modern give the former t. is also a frequently now
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you wanted to indication for correction hostile to me
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and we see here's a typical pattern was a model lingo formality
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so the deformities caused mainly by this normal tendering of
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the ligaments sometimes also by up normal models
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and you can see and is three d. reconstruction the problems that means eliminate first set is
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to fall proximal and tended to the palm aside and the principle of correctional state to me
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is to lift up this part and to rotate it in at all sort of way
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and this is done in that way make the austere to me
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proximal to sigmoid notch send really stop like open park on the
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on the side and then you put on the plate and
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as already mentioned you can't leave these caps because this is young people it is stable need the
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structural open and that we can expect point he
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your another example c. via model formation off the
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cost but the model deformity and this is a three d. print you can see yeah
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so the really sea view the increased inclination and the palmer rotation off the
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does the parts that make the set and this is a correction austere to me in that way time in an open oak
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open book manna that mm socio please running here and then
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really stop so reduced to its on the same level
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yes the ah now finally in c. and this is the last uh cases
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this is a problem we are long time we didn't have a real
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solution young people say come to us see are complaining pains
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wrist looks quite normal and no limitation of former rotation part so
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compression test it's this radio on much on this positive
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and then you look here you seizes on a minus variance and
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this model formation of said this to you on actually
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and this also very frequently lead to what rose is in the district you are not trying
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and this is our young people you are looking for a solution and
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what we found what's helpful is also correction hostage to me it's a distillate use
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because in general i you just only see enhancement but no damage
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to saying is in the c. t. answer principle is
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that you realise the pressure in the distal radio or not you want as you can see yeah
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and this is done by a correction hostage to me this shortening
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and all night shift off the proximate parts or eight years
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because you realise but that that tension all the ligaments
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we have published just couldn't when you go
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says a short running says the technique it's uh uh oh close match austere to me
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as you can see uses all now a translation of the shaft and by that you really get
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uh some kind of a remote earning at at this rate you wanna charm and
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and the release of the pressure and when you compare it with the
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re operative situation you can see you this remote drilling and city
Conference Program
S01 Session introduction
Wolfgang Hintringer, Austria
June 13, 2018 · 1:07 p.m.
536 views
A-1277 Ulnar shortening
Michael Sauerbier, Germany
June 13, 2018 · 1:09 p.m.
313 views
A-1278 Corrective osteotomy radius extra-articular
Hermann Krimmer, Germany
June 13, 2018 · 1:25 p.m.
279 views
A-1279 Corrective osteotomy radius intra-articular
Radek Kebrle, Czech Republic
June 13, 2018 · 1:42 p.m.
229 views
A-1280 Case discussion
Wolfgang Hintringer, Austria
June 13, 2018 · 1:57 p.m.
132 views