Player is loading...
A-1287 Partial and total wrist fusion
Hermann Krimmer, Germany
Wednesday, June 13, 2018 · 3:22 p.m. · 17m 21s
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
now we are coming to the ends of means what we have to do the fall season roots
00:00:04
percy just uh it doesn't work and what kind of cell which we have very little
00:00:10
and that's usually partial or total wrist fusion and
00:00:17
when we are looking what happens when a longstanding skate with non union
00:00:22
did not heal it ends up in its neck wrist nowadays we differentiate between snack and slack
00:00:28
it's a similar pattern but it's different but anyway it combines in
00:00:34
the progressive stages rate you call and it cobble degenerative changes
00:00:39
and long time in the paucity only solution was a total wrist fusion
00:00:44
and actually it was a married of cork watson pro what's on the uh is working all was working
00:00:51
hard for to the east coast nearby ca university i visited me in in nineteen ninety two
00:00:58
and he analyst sees had ounce of a
00:01:01
longstanding skate we'd nonunion unscathed luna dissociation
00:01:05
and he did not only analysts city also brought all the solution for it
00:01:09
to preserve at least some motion which is in the in the majority pain free
00:01:16
is the original x. ray from in the right way to do it in the time when uh resulted
00:01:22
in there and it was just thirty minutes surgery and to put in it says k. y. s.
00:01:27
without any x. rayed control i would recommend it but he
00:01:32
was really a very false and experienced a surgeon
00:01:36
and the key point for this procedure is that we have
00:01:41
satisfied all says degenerative changes we have not all parts destroyed but
00:01:47
we have some parts of itself is specially to redo lou
00:01:50
michel and and the reason for that is fed to reduce cave
00:01:54
which only it's some kind of a a lipstick john
00:01:58
various sear rachel niche on to some kind of a spherical each on and
00:02:02
that means is a displacement during the cobble collapse we have
00:02:07
no all a reduction of solo transmission area and for
00:02:12
that reason this joint usually is pretty self
00:02:16
can see eighteen c. t. scans is the case eight we um yes after macabre fusion
00:02:22
you can see is a distorted rages cave which on and just to preserve redo lunatic on
00:02:29
and the key point for the procedure of course is restoring silly made
00:02:32
from is told to easy position that really we we have a
00:02:38
a possibility of a preserve motion both spots that means and it also in uh one more aspect
00:02:45
and this is how it should look that means that you have the united
00:02:51
because all the time and we had our unit in that position
00:02:58
this was our first paper published and you can see also
00:03:02
my console appeal that's the time you all of this out and it was already in nineteen ninety two
00:03:08
and we what we found it's a follow up was it preserved range of motion of thirty and
00:03:14
agree of extension and so the t. v. so flexion improve crude
00:03:17
strings and a significant pain relief and there is no change
00:03:23
uh till today the only change what we saw was a long time follow up is that
00:03:29
the grips fangs improves by time up to seventy to eighty percent
00:03:36
and some years later we checked it also wasn't there score
00:03:40
and he found a significant less disability into macabre fusion
00:03:45
and nowadays a wrist fusion it is only in rare
00:03:49
cases of primary treatment thoughts like or snake rates
00:03:54
and from afar martinique sir is also a publication
00:03:58
in nineteen and the and the twelve massive
00:04:03
found was a long time follow up on your conversion rate less than ten percent
00:04:09
so this procedure seems to be if it's done in a probably really reliable
00:04:15
of course you know all these problems it sometimes a little bit technically mom thing
00:04:21
and one problem is if you skate for it is not completely removed saying you really haven't changed and
00:04:27
it's a regular style it and other problems also to dawson aspect if
00:04:34
you're complicating unit is not reduce in the proper position and
00:04:40
impeachment of occur of course of course that's it off let's back if
00:04:44
your copy take sticks out of that brought the called the rule
00:04:49
non union is also significant problem and for that reason you really need
00:04:55
a standard that's techniques we will focus on that afterwards and
00:05:00
this was a technique be then we started to use okay what else could at least
00:05:06
three k. was too complicated when it and one to the remote right
00:05:11
as it is it trying to to the track read from and
00:05:16
to improve this situation that means to uh bring up a more stable situation
00:05:22
of course i was married very some at thames and one was to spite of late
00:05:28
in ninety nine but it's it's that time it was still very brightly implant and
00:05:35
produced infringement at the docile aspect and so the report
00:05:40
in the literature short complications up to fifty percent
00:05:44
by loosening nonunion operating shouldn't but the recovery boston foster so what was the result
00:05:51
many and the same was a case for us surgeons status which protect okay rice
00:05:58
not have by time yet always want to improve a little bits this
00:06:03
technique and it's a time we had available set locking implants
00:06:08
and it's a philosophy was to improve same plans by incorporating sort locking mechanism
00:06:14
in to the stabilisation to really have a stable
00:06:18
fixation and to to reduce a nonunion rate
00:06:22
and probably do have a little bit of foster recovery and this is one
00:06:27
possibility it's are much smaller plate it's it's ugly of floor plate
00:06:32
which incorporates it's a locking mechanisms loose in the two
00:06:37
point all n. two points we need to screws
00:06:40
and there is a special instrument where we can uh fixed displayed in that
00:06:46
set position just a shot promises a technique it's a daughter approach
00:06:51
so we opened up so for us to and how the second extensive compartment
00:06:58
and the next step is to look for the indoors is enough
00:07:02
in such a case it's our enemy because probably or reception there is
00:07:07
no more need for it because it's at this point chime
00:07:10
and of course as apart cause a wrist innovation he is excise
00:07:17
and then we use a lot of laps it means that also approach running
00:07:22
i've got a guy against the ligaments and then we have a perfect overview
00:07:28
next step is complete remove losses cave would ins cable made
00:07:32
this is your asian usually it's it's possible to remove
00:07:35
it as one p. is inscribed with non union of course you have to do it step by step
00:07:41
and you can use their own draw from says k. for it
00:07:45
but i recommend usually at first that always to use scandalous bone graft
00:07:50
from the three eight years because the qualities much data but if there is lack
00:07:56
of candles bone graft and of course you can additionally use a catalyst bogart
00:08:02
then you have to check search online and in this situation is is next read
00:08:06
and insist situation of course is that rate you lou niche
00:08:10
on should be preserved if you do this procedure
00:08:15
next time is removed off the cartilage with sometimes it's very hard to do
00:08:20
because simple versus cable is very soft and furry type
00:08:24
and you really have to keep in mind to really break up this part of poland
00:08:30
and since some years we use to thrill that it's cave us eliminate to
00:08:36
really pray tops of on and to make it open for healing
00:08:40
and then you have introduce you uh can't respond croft because you never can reach it
00:08:46
after reduction and next that is to reduce the rate
00:08:51
against a copy tape and it should really
00:08:54
go like it kept over the head of the copy to it and then you have to go for
00:08:59
fixation if this is very difficult same your crime and additionally used to the joystick then what
00:09:07
and then i prefer to run as a wire rate use when it completely a because it's very easy
00:09:13
to get in this position and if it's not stable enough saying you
00:09:18
call but that's okay well right which room into the lunatic
00:09:22
then you have two greens the bat so this would could please uh
00:09:25
put position this should be checked on the x. ray because the
00:09:29
saloon it is not in the correct position same you will not
00:09:33
have a good cleaning the outcome afterwards and then you rename
00:09:38
for that of the plate and read only d. s.
00:09:43
you need not to keep because by remaining you
00:09:46
return to reduce yeah area where you want to have only you afterwards can see yeah the bad
00:09:54
and then with this instrument or just of go back with his instrument really k. that can guide
00:10:01
this flower played and then you bring in you ought to schools one it was it when it when it was a copy take
00:10:09
and when the screws on the right position as senior thing you can remove u.
00:10:14
k. y. s. and putting you on other screws and then use locking screws
00:10:20
the first two screws on on looking to catch that played against the board and the others are locking screws
00:10:26
this is a situation is a clinical exam but then you have to check it if there is any
00:10:32
kind of meetings maybe and if you want to correct position says should not be the case
00:10:38
the advantage is that you can shop and a little bit so for post operative a treatment
00:10:44
but in our hands it takes also is a
00:10:49
significant time and it's not a case that
00:10:53
sarah recoveries much faster than music a virus part any weight
00:10:58
you don't need a second surgery and this is also an
00:11:01
advantage for the for the patient and here another example
00:11:07
really always is important that you have to do with it into dallas i had correct position this is
00:11:13
also is next week and again it's a it's a plate and to post operative check of stability
00:11:21
so i'll from the technique in finding you it's very important that
00:11:25
you really complete removal of this cave would just on
00:11:29
said you really fresh maps and it cover trying to use
00:11:33
that real especially for the lake to break up second
00:11:36
at this point and to bring it really neutral position and then you can have a stable and rigid position
00:11:44
and displayed is helpful and it gives you really
00:11:48
good stability by incorporating said talking technique anyway
00:11:54
despite all the ball press there is still some need for total wrist fusion especially
00:11:59
then you have to store it right you're copper and meet coverage on
00:12:03
he's seen in a uh_huh two years following very limited location
00:12:08
which usually is not so case it's probably really but if
00:12:12
it's desolate treatments and it can cool and long time
00:12:17
and i say oh wrist fusion plate it came up on the market in the beginning of societies
00:12:23
and really proved says procedures significantly was number one
00:12:28
sometimes problems can awkward with this plate and one problem is
00:12:34
because you only had me screw what's the matter cobble
00:12:38
sometimes i can lose anymore quirk and then us a problem of a redo
00:12:43
and another problem can be it's it seems each aren't
00:12:48
this is an example this patient had five times surgery
00:12:52
finally to k. p. c. m. c. joint fixed
00:12:57
because sometimes after recess for a fusion because these joined up rich
00:13:02
say become painful and then say need another type of situation
00:13:09
and we all know this paper from not sure of nuclear which proposed
00:13:13
publish it was awesome to say follow top forty seven wrist
00:13:19
whereas it seems he was incorporated say found twenty nine unions
00:13:23
eleven vessel to magic and the other so the forests
00:13:27
but at the same c. was chip bridge only one was symptomatic answer recommendation was
00:13:33
not to incorporate says you can see that in
00:13:37
to the fusion five to remove the cartilage
00:13:41
in other possibilities to to solves this problem to completely is
00:13:46
there ought to completely exclude sissy and see chimed
00:13:51
from the fusion as you can see here was displayed displayed is also poly axial a plate which
00:13:58
doesn't reach the c. m. c. chimed lease it
00:14:02
completely on patch and also exclude these problems
00:14:06
and there's a lot of possibilities with this fixed angle screws
00:14:11
yeah you can really get stave to reach each fixation in the corpus and the advantage also
00:14:18
set reasonable usually no need for bone graft from the oppressed yes just look at bancroft
00:14:24
is it different grapes long one short one the revision plate
00:14:28
which is straight and his is so the docking technique
00:14:33
and especially from these boards here you can reach separate use
00:14:40
into the room it didn't really get a stable fixation
00:14:45
of course you have to remove so cartilage it's a radio
00:14:48
cobbler chime donate skate for it then copy take and
00:14:53
normally bone graft from the radio side of the radius is
00:14:58
sufficient and then you can bring in your screws
00:15:02
and again here this is the example where you really get this group
00:15:07
which is pretty shape in the plate sousa rages into sydney roommate
00:15:12
and this significantly improves stick that station basically need the example
00:15:19
an important step and the post operative x. ray is too
00:15:25
check c. c. and c. china because we know the problems were about we don't want to write any screw
00:15:31
into c. m. c. tried because this can be system was of the system problems as you can see
00:15:40
and also in savage of four of failed proximal wrote
00:15:45
come back to me where you already had moves
00:15:48
approximate caught the role it's very helpful and to be honest it makes it worse each yeah
00:15:54
more simple because in such a case you only have to
00:16:00
if you use it one sites it means you only have to fuse it's a copy take and the radius
00:16:06
and for that reason they also want to bring up a plate on the market
00:16:11
is specially for these principles uh which is mainly supported by product cable or
00:16:18
because his idea is is that usually in total wrist fusion we
00:16:23
have to use it really destroyed proximal call the roll
00:16:27
and the easiest one is to remove it and trust you fuse only
00:16:31
copy take is reduced and then is a special short plate
00:16:36
and this freight plate usually is helpful in rheumatoid surgery
00:16:42
that we have to deal with various softball
00:16:45
for for example where you cannot get to reach its the sensation it's a corpus
00:16:50
this is an example room with the patient but you have at the same times
00:16:54
the possibility to bring up your screws in a locking mechanism different direction
00:17:00
uh in our c. released be at a coat clinical outcome yet
00:17:06
no problems are also seems each on of course not
00:17:09
every patient had a union put to union rate was quite high
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
