Player is loading...
A-1286 Scaphoid non-union: vasularized or not
Max Haerle, Germany
Wednesday, June 13, 2018 · 3:05 p.m. · 13m 13s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
thank you very much stefan uh yes informants treatment goes wrong or
00:00:04
uh and treat it a wrong treated sky for aids
00:00:07
uh we may go to non unions and the the question was is there any every
00:00:12
the evidence for wes to rise bone graft or non was derives from graft
00:00:16
to make a long story short there's no evidence so we can stop here but uh i
00:00:20
think we should be one little bit uh trying perhaps a historical review to see um
00:00:27
what's happened what happens when we have a um
00:00:30
nonunion and uh and what we hear a
00:00:33
no quite sure that none unions on along going generally end up in that
00:00:39
yeah yeah i osteoarthritis and therefore should be uh somehow fixed
00:00:44
we know that there are different classifications of non unions
00:00:48
harvard's one and i don't know ones are
00:00:51
the ones which are most classify then the the the problem here is naturally always
00:00:57
the little proximal poll a and i was cooler probable
00:01:02
that crosses which we will highlight for the run
00:01:05
to get bone healing in a bone which do not want
00:01:09
to heal the discussion is going on since many years
00:01:13
on one hand we talk about the stability we have to achieve great stability and compression
00:01:19
put compression of the two bones to heal on the other hand we need west hilarity biology to heal
00:01:26
and therefore we can end the bone grafts to help healing numbers to rise and was to rise bumper
00:01:33
so historically natalie has started with these uh bone grafts just a bony chips sponges bone
00:01:40
um which uh uh can be harvested traditionally from the older crest or from the disk radius
00:01:46
and then um the rules say yeah um and and that was done more by the dorsal part and then
00:01:51
rule say uh the explains that we could also take it cortical sponges craft from the only actress
00:01:57
input from the palmer parts table eyes internally discover it and bring it so for healing
00:02:03
in uh that word instruments develops to harvest a bone graft
00:02:08
a very easily if you just need sponges bone and
00:02:11
then i'm forgetting stability as uh herman uh described
00:02:16
first tool was a screw which was not can you later then to place it well it was quite an in
00:02:22
and and challenge with these chicks uh to to place them well so that was an improvement uh and uh but
00:02:28
but the headless um the uh screw which gives the
00:02:32
maximum of compression was uh uh the big achievement
00:02:36
to get more stability in these period people when we're only talking about stability and since we have a
00:02:41
can you like to screw the placement it's much easier and a wrong placement can be avoided easy
00:02:49
they were then screws developed still but the the the companies were were making
00:02:53
um the uh kind of competition who gets more compression so uh yeah
00:02:58
too much compression we found then out is also not a good thing because
00:03:02
uh if you squeeze it too much uh no more biology will be in there so
00:03:07
uh it's always a balance between stability and biology also talking about these implants
00:03:13
and then another procedure was in non unions to respect really widely
00:03:18
uh not in with much use to me just a little opening but to respect
00:03:22
really wide leading on an union area and to preteen according to sponges graph
00:03:27
and plays well your compressions screw and this was the standard procedure for most of the
00:03:32
uh non unions especially in the ways dear yeah and it is still today
00:03:37
yeah i'm diego uh described that with an audio screw but the later than other screws
00:03:43
again that this is just an example how you can do that and restore the heightened the length
00:03:48
and the axes i'm off um this guy for it uh and and correcting the non union
00:03:54
so what's colour eighty something really important martin liner has made is beautiful drawings and uh
00:04:00
and based on studies of government we know that they're a little whistles
00:04:04
going into despair for it and they are quite in queens
00:04:09
the most of them come from the distal part and and bring was
00:04:13
hilarity from the distal poll to the proximal poll a more frequently
00:04:19
and this is probably a reason why when we have a fracture of the
00:04:25
sky for it we interrupt laughable and in by interrupting the blood flow from distant proximal
00:04:32
um we get the uh backbone healing and this is the for
00:04:35
this is the probe problem actually not only in fractures
00:04:39
but also in non unions and then you know strips out of that and more in
00:04:43
this proximal more is the chance that you get at a wrestler proximal poll fragment
00:04:49
the west polarisation in general is an argument in the wrist
00:04:53
which is dated because why is there non unions of
00:04:57
away we have keen backs and so one so there is a debate going on uh about all this
00:05:03
but for a concerning uh the staff would then people have said well if we have a a lack of
00:05:09
not whistles in these bones why shouldn't we bring back there was killed every t.
00:05:14
and hoary was uh one of the first trying just to put
00:05:17
a whistle inside and uh and saw by animal experiments
00:05:22
that this would be a an achievement would would give better bone healing and uh a bone formation
00:05:28
and there are quite a bit at the right number of uh experiments then
00:05:33
which say that vascular bone graft enhance blood flow of these bones on long term
00:05:39
and there is a quite an interesting study one of of many uh which has been a
00:05:44
a than on the rabbit model and they tried to find out what's the difference
00:05:49
between west rise non was to rise out of graphs casino graphs and so one and
00:05:54
they they made a big study and they put in these graft and his rabbit
00:05:57
and uh they found that out to graft fused more rapidly sure
00:06:02
but um and then the rescue lyrically sorry the west gilded west
00:06:06
to rise bone graft are uh the one when sure
00:06:11
but a new bone formation incorporation of the grabbed and someone
00:06:16
so this despite uh uh uh
00:06:21
and and and and in adding this uh
00:06:23
for example uh also american colleagues
00:06:27
stays until today's state that best to rise bone graft do a
00:06:32
better job then base is the non words for us but
00:06:37
that you you look for evidence in clinician clinical studies
00:06:42
there are no if there is no evidence is just a comparison of of of my
00:06:47
technique in your technique and so one but there are real evidence is not there
00:06:51
but anyway on the basis of this um a scientific the experiment of experience
00:06:58
many many bone graft have been developed for the palmer side and from the dorsal side
00:07:02
and uh it's good to know uh quite a number of them
00:07:05
we just remember that we can harvest them from from
00:07:09
any kind of little archery we finder out the rest um uh i have a lot of experience
00:07:14
with the power graph first describe like woman which is just on the distal border of the
00:07:19
provided what right is that it runs there and can then here
00:07:24
the harvested a little bone graft which is west will rise by
00:07:30
i'd a little artery that transfers carpal artery
00:07:36
the transfers carpal artery can be with the sizzle harvested on on on different sides
00:07:41
and then uh harvested with a good bone block uh and and can be let's say the the um
00:07:49
the the optimal solution for all palmer approaches you do to discuss for it
00:07:54
naturally for big big uh um boneless uh electricity still demanding but you can see here
00:08:02
that here is is quite the conspirators uh um bone graft you can harvest
00:08:07
uh it's it's a big enough to fall for many of these of these um nine unit
00:08:13
once placed it in there you can fix it then with the k. y. or you can squeeze it in press fit and you can make
00:08:19
a scroll and you have a bone graft which is one scroll right to have your stability and you have good chance for bone healing
00:08:27
so um we have tried so this is an example here just the i'm not very good was to
00:08:34
rise proximal pole and um vesta right bone graft and
00:08:38
bone healing achieved and material to come out
00:08:42
so we have tried to find out which is viewing and so one and it was difficult doing this kind of
00:08:49
of scientific research on these patients multi operated different places and
00:08:54
this and that that's uh not really easy but we
00:08:56
found that the number of previous surgeries and the proximal poll naturally makes the difference this is for sure
00:09:04
and if we look at this paper they are also saying same thing
00:09:09
is a six centimetre bone should it be one scroll rise can it survive
00:09:14
or does it need let's cover supply no evidence also here so
00:09:20
at the end it isn't actually surgical experience and for my uh surgical experience master is a raft
00:09:26
uh give good union uh give a short delay is and and if i and um
00:09:31
um uh i have a doubt of uh at the rest arise proximal bone
00:09:37
i think i can uh user westward bone to re
00:09:41
west arise even if that uh is not proven
00:09:45
um if i have the choice i try to do more to was go right then the non risk
00:09:51
so that what little bits the the algorithm what we said in simple things
00:09:54
we can duplicate but we can do the anterior wedge a graph thing
00:09:59
and the rest were bone graft and then there are illusions of this today of all
00:10:03
in in the suburbs of urging procedures was the was the right femur graft
00:10:08
and um and that was for many years the the things we hair so
00:10:13
um i was doing a lot of us collapsible raft and now these guys
00:10:17
come with the arduous coptic experience so let's look what that is
00:10:20
i just got big experience means that you go in the mid card
00:10:24
to join with the larger scope you see your fracture line in
00:10:27
there you clean the the the the the non union side to go
00:10:31
in there with little instruments you clean it out very well
00:10:35
and then uh you harvest some um a a bone graft on the
00:10:39
dorsal side you're still the cleaning you see this is quite
00:10:43
longer and it's a little bit of a demanding but uh if you clean it
00:10:49
out well you get the real uh refreshed bone uh doing this artist cup
00:10:55
and you can harvested from there but i have some free to injure the radial artery
00:11:00
so generally are wrested from the north side of the list has to work all
00:11:03
and um i put in first like a wire then i put it in
00:11:09
a traction tower i a look inside i repositioned okay wire if necessary
00:11:14
and you can easily put the bone graft the non restaurants
00:11:18
can sociable rough in the scuffle it fracture and um
00:11:23
that's uh i'll be uh people think it's difficult but it's not difficult
00:11:28
it's quite easy you can squeeze it in their portal is not
00:11:31
to to use water in this case if not it's get washed out but you can really position that uh at the right position
00:11:37
and uh and then you um fix it some people use glue but uh i don't think that is necessary
00:11:44
and then you can fix it uh or with a screw in the right place or with k. wires
00:11:50
and uh there are many people now use kate are really using k. wires especially
00:11:55
for the difficult proximal poll fragments where the the the the the um
00:12:00
the part of the screw which uh is the proximal part
00:12:03
can not be inserted completely in the proximal fragment
00:12:07
and will of white bone healing um that many people
00:12:11
like in this case would probably perhaps use k.
00:12:14
wires to make that he'll like in this case and it has healed not perfect shape but he'll
00:12:19
and got him back stability so our just got big grafting without any vascular supply to the draft
00:12:26
does does its job uh and uh is minimally ways of
00:12:30
had many many uh other advantages naturally more experience here
00:12:34
must also confirmed is a is a good uh um uh we should we have nowadays from into
00:12:41
the painting is coming back to a renaissance uh which we have a a totally lost
00:12:47
and uh to the algorithm we had in our head now probably you
00:12:51
have to to to add that in the more simple cases
00:12:54
or just topical um a bone grafting without was colour to use a good thing
00:12:59
as soon as it gets more difficult and it's good bigger bone loss or you have a bachelor rigid problem
00:13:05
i still tend to go forward to rise to the bone grafts thank you very much for your attention
Conference Program
S77 Session introduction
Stephan Schindele, Switzerland
June 13, 2018 · 2:20 p.m.
140 views
A-1284 Review of imaging of the wrist
Andreas Schweizer, Switzerland
June 13, 2018 · 2:21 p.m.
181 views
A-1285 Acute scaphoid fractures when and how to fix
Hermann Krimmer, Germany
June 13, 2018 · 2:48 p.m.
245 views
A-1285 Q&A
Hermann Krimmer, Germany
June 13, 2018 · 3:02 p.m.
A-1286 Scaphoid non-union: vasularized or not
Max Haerle, Germany
June 13, 2018 · 3:05 p.m.
271 views
A-1286 Scaphoid non-union: vasularized or not - Q&A
June 13, 2018 · 3:18 p.m.
126 views
A-1287 Partial and total wrist fusion
Hermann Krimmer, Germany
June 13, 2018 · 3:22 p.m.
152 views
