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A-1127 President's Lecture: What 37 years with Hand Surgery have taught Me: Controversial Procedures that I still Perform and Procedures that I have Abandoned
Michel Boeckstyns, Copenhagen, Denmark
Thursday, June 14, 2018 · 2:04 p.m. · 26m 30s
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as president
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thank you max
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um
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i just have to keep on time um thank you very much and i'm actually uh i
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my first contact with hand surgery as a resident was in nine clean a seventy eight
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uh and of course as you a very well no hand
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surgery has gone through dramatic changes during the following yes
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when i started we treated almost all collies fractures with costs
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uh uh then we moved to external fixation and
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now it's palmer plate at that time
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uh me operas copy hardly had forgotten what do we do now we
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do a lot of wonderful things with the options group interest
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micro surgery had started but has gone to a fantastic
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development as well so many things have changed
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i will not think talk about all of these because uh
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uh this would bring to debate a much too far
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i would talk about uh for topics that uh i went through
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and when i uh the that might be very debatable and uh some
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of them i have abandoned some of them i still before
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the is the treatment office c. m. c. one opposed to arthritis there is a topic off
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now i've compressions the release of deeper trance contractual and talk to restart or prostate
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in nineteen eighty i was working with a guy called what crack an egg
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and he was a wonderful ought to be dicks sargent and he treated
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uh since you wanna awestruck tried this with the caffeine yeah prostheses
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and i was fascinated by that so i made a read a a four webster the off these cases
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and published it uh after a while in the journal of a hand surgery
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uh today this would instead shots it was a small material
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twenty eight cases uh it was sweet respective and
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today to you it was on control but i'm still proud of it why because i think i'm not sure
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but i think this was the first time we had
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a survival curve in a soldier had surgical publication
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this is what after a while i uh became the fellow with a anti yes i do
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that is one of the pioneers of the suspension opera prosody
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you might know his name is is is publication as you
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can see 'em at that time we used reprints
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doesn't exist anymore and he was uh the the author today are almost as many all
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those aspirations in a paper that was not the case in the in these days
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what did by d. do well you had to remove a
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number of fails uh swanson silicone uh uh prostheses
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so he said i put this one champagne and now i have to take swanson
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out and what do i do with this gap well he made a straight
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with a rapping about the a. f. c. r. around t. a. p. l. and making
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a not to put into gap and then use it why not do this primarily
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any called the procedures once in a in swanson out in one station without
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swanson he was he had your it was a nice guy yeah it
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okay uh uh of course i want to do that and i did that for many years
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uh and we showed up in a fashion barcelona in a nearly seven
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sorry no barcelona in a two thousand that uh the was
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uh if you should be green decrease of pain but that it took a long time now this is
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today common knowledge that was not the case at that time uh but it takes
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a whole thing yeah before uh it's a great strides because got
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good again and a big before being the c. p. s.
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and we also show that great strings actually increases compared to pretty up attractively
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in those days we met one believe that did a drawback of
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suspension ought hopelessly was that you lose strength that's because
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uh nobody had made perspective investigations comparing
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property values to end value should
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this was later published in the journal of hands she again but then
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in plots came back and we uh felt tempted to use
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the at the place where i was working and uh
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that was not the place of why be anymore uh
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we felt tempted to to use the electra implants
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this is a metal on mental in plots and we put in a number of these
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after a while we realised that had probably not be a very good idea
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this was the survival curve after five years six percent
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of uh of the employers was still in place
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but i think we have removed uh most of the uh of the scenes so we abandon that
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and came back to vibe or not
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at that time also tim davies or works happy at uh and he compared
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uh that is suspension after prostate with simple test subject to me
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and showed very clearly that there was no difference you may as well do a simple trap rejected me as
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a suspension without touching independence and this is being conference
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a lot of times ever since nasty yeah
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in the congress off a a lot in budapest we had a book on um the instructor
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calls book on the evidence based data in a hand surgery in therapy and there
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it was concluded very clearly that comparing to object to me with l. r. t.
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i. a ligament reconstruction tended into position to simple type project to me
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the analysis was not able to assert that any difference in terms of
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tons of strings patients global asp assessment or range of motion
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so
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i begin to make objective nice simple topic dummies and have done that every six
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and i am very happy with it so there's been a long journey
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to come back to stops where everything began began uh in nineteen forty
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seven with the publication of braces on simple happy check to me
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and sometimes i think of this as widely in n. y. b. out in one station without water
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sorry wider
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rest in peace so um tomorrow of course we need new solutions we
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need more investigation you implants and we need to find out
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on which indication we have to use which put procedure is is not all clear tomorrow we have a
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i mean i think an interesting keep it uh in this room that's a four thirty p. m.
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and after that we have three papers on c. n. c. one attracts if your interest
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uh well uh what about the surgery of nerve compression seem drops
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well a couple turns simple this is the most common
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uh the most investigated the most published of
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all uh not compresses involved so there's no the bait on everything we know all of it
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maybe i come back to that but what about the on and off this is not so
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easy now so rewarding your first physiology is not so helpful as in carpal tunnel
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not to speak about the pro data to erase syndrome a
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um a head of the median nerve below the elbow
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or do radio tunnel syndrome
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what about that it's not a a an easy subject and what about these quite
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well uh quite relaxed was a syndrome or triangle that uh uh uh
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uh uh what is called a triangular uh uh interval
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syndrome or do you all tennis and wrong
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and what about all these the also make a a course
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a head and neck and shoulder and i'm paying
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and then the cervical roots cervical syndrome it maybe
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related to a lot of complicated things like
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a post traumatic stress a syndrome or disease or a post concussion syndrome
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i thought i could thor i think outlet syndrome in many other things it is complicated stuff
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not to speak about double question multiple crash
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shall we do multiple decompression softness well for some years i was
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involved in all of this and made multiple multiple be compressions
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and i have convinced that i've helped patients really
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but not all of them and i tell you this was very
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for me a rewarding a surgery and i stopped doing it
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um tomorrow we have a debate on a or symposium on difficult pain problems
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co directed by a yard bomb if you are interested
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in that it is at a four thirty also
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uh and we have had to pay a symposium on the anterior interest
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just a simple and a passage turner's syndrome also difficult stuff maybe
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yeah we have a a a future with new uh imaging procedures
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to help us and also it this brings me back on but carpal tunnel what i want to talk to you about
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you are still the bates
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about your physiology also no graffiti or am ah when to use
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it how to use it what do they tell you
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can carpal tunnel syndrome be work related is every correlation with smoking
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et cetera et cetera i want to tell you about
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e. c. t. r. versus o. c. t. out endoscopy versus open a carpal tunnel release
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in the early nineties boom was a huge debate into fish and
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everywhere else about this subject sometimes it became really emotional
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uh uh people showed tech tester fees that were
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uh done with the endoscopy get a procedure
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and i think actually this was a generation a conflict uh the new generation
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performing artist could be endoscopy in the old guys having difficulties with it because the beat
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open cobble carpal tunnel release is they have done it for ages without any problems
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we made a and a review of the literature comprises me if you include showed that do where uh
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a few more complications uh after the endoscopy procedure impeccably series
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and also including a a case noise
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but only uh the trends that strange and a price these yeah they disappeared again
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um what any advantages we made a prospective study
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that showed that a tree we compared three procedures in i. r. c. t.
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uh so large incision small incision and and scope procedure
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and they all gave the same uh results
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very parallel um
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in terms of price these yeah and in terms of grips trains for example say upright to paint also but
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it was very clear that the endoscopy procedure a permitted a a much faster return
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to work after a few weeks two three weeks compared to the other procedures
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this is all was also being the dealt with king the
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a book of the of the last year's instructional course
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well uh uh uh uh uh say this is off a
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nine make analyses on the subject was a mate
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and it shows in almost all need to analysis that the endoscopy
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uh the procedure that made it a foster return to work
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it was called although it was come the proven in that way uh it was concluded that the deep
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eight over the subject superiority off d. c. t. r. over o. c. d. r. remains open
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what if against the evidence supporting bit outcome for easy guys before yes
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but uh do you this as a a a efficient as a o. c. d. ah
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but there isn't much stronger evidence that in the long term the two procedures give similar outcomes
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non the less the list there is a clear and strong evidence that there is a faster recovery and early
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early or returned to work for when you see the ah then it was awesome in the room
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who does the c. t. i. as a primary as a procedure it is
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as good in terms of results but you uh uh a return
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faster to your well into your daily activities only a few people sit
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we i do it most people still do you know seating now
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i am so happy to perform a easy to how a lot of this procedure
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and i will continue to do it as a my standard procedure
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for carpal tunnel syndrome however debatable it still may be
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so that was a procedure that i have not abandoned and i'm happy to perform it almost every day
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what about the the channels
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well let's go back and got this is a very old slides from the seventies or eighties or something
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um it's a classical uh uh a fat chick to me limited vasectomy for
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the treatment of the bitterness contract yeah 'cause be this stand that procedure
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and this was the result in a a to all result then
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it's it looks promising yes but it's not always like that
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even people always show good weasels result maybe like this
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and that happened for me also i think it happens for everybody when
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you do fishy to me and you do you do we currencies
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i was sad about that but i found some con
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fourteen does poke and satisfactory results in hand surgery
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yeah it shows that
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along what uh eleven hundred skills british uh and surgeons
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the results for the operation of a contraction of the little
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finger p. i. p. joins gaze the same results
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all was in twenty five percent of the cases in these
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what primary cases so we don't speak about the currencies
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so maybe it was a a place for improvement for the of the treatment of utah's contraction
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certainly uh in the beginning of the two thousands there was a request
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from big patients with two patrols to uh have performed need official to me
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was one clinic far away from here that had started that and we went to paris to study thing in paris
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it was uh in the up without line was yeah it was real
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metallurgy it's performing need official to me you can see that why
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let me hopes sorry sorry don't look at this you get a a
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limited this in fact she no because in a lot of jewelry
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uh that's not really what we like to do so but we were convinced about
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the results that was really nice to see so we started doing it
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we use crossbow and no jewelry and a good uh this
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infection and uh we were happy but in these yes
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uh neither fisher to me was not very popular um in a surgical uh so cause it was kind of
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strange and the uh the people didn't really believe in it now did we
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had been doing fishy to me is for us it was certainly does
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i don't do
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phi psi came with collection ace i think you may say it was a rather aggressive marketing
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and certainly need official to be became the standard procedure the
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gold standard to which everything had to be compact
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that's how it goes
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no it just didn't work there was no but anyway this and that this
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and that and then the question is why is coverage it is
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beta cheaper easier faster and more durable than targeting this needle fess up to me
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um i i think the uh on say is has not been found yet here uh recently
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in two thousand and seventeen was a publication from the clinic i mentioned before that showed
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that there was no difference uh between need official to
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be on collects mistreatment for pippin joints here and
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to moral there is a session on uh the pete ross and there there is a a paper
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also from this country screen it here in copenhagen that concludes that a quality maze has uh
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lower recurrence rate than the and need official so
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we don't know the answer but we know that ah a great number of our cities on uh the way
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most of them i think show that there is no real difference
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so all i still use colour to this but i don't use it for simple calls yeah i
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use definitely need official to be but we if you have a recurrence is difficult cases
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that are not easy to treat with fishy to me really da risky
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to treat with a a fishy to me and difficult with the
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the official b. i. s. use collapsing base like this case
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and of course this guy that was a a separate that he was
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several times already before you have a skin graft do you have
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uh the scarring and everything but that was the result it was uh it
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of course not perfect but it was improved and now he is uh able to gospel
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uh an object without his little finger being too much in it in the way
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so um i still use collages um i'll use collection
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is for uh these kind of problems i
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however debatable this still use
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next subject that is this the total we started prostate
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the it is all about keeping the distraught the wrist in motion
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we started prostate has undergone a tremendous development in designs
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from the seventies where we used as you recall not a plastic and until
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now where we talk about third or fourth a generation out of boston
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razor classical curve of new technology it starts with a somebody sorry
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uh and publishing promising results which creates into jansen
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and uh what we use it on all kind of uh uh indications
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in uh many numbers until we realised that to our problems
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that uh our challenges and than the number of cases performed a diminishes
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it it seems that the use of total we started plastic is communicated in two thousand ten ten
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and one of the courses is of course that the medical treatment of
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rheumatoid arthritis uh has made the c. via remote towards wrist disappear
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where do i stand that not okay well that there is a
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general agreement on that totally stop the prosody really spain
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recess motion improves trains and improves function to these factors
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but did they get the big course on which indications in terms of h. profession diagnoses
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and is the uh longevity acceptable and is it better at the end than total wrist fusion
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knock on starts losing of the distal component and the very prosthetic
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was july's is a subject that has interested me a lot
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i have studied it together with a young hats back from you all
00:22:43
in on the the motion on top rusty and that resulted in
00:22:47
up a belief that the last year last is is a typical problem
00:22:52
for the remote and utter plastic i don't think that's true but
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it's the only out across where it really it has been a investigated systematically
00:23:03
it may be very small and this is maybe not uh this is regular loses it maybe not be not on
00:23:09
a austere rises maybe the it improper was not impacted completely
00:23:13
data which is not important but a few cases
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a two hour to forty four cases developed a more important uh after last
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is as you can see here like a bubble all around the prostheses
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that is more concerned i and as i can show you here you can see it with any kind of
00:23:34
impasse sometimes they say this is damn i can see
00:23:37
only disease uh which means uh uh that
00:23:41
uh probably a clean a particles start and amy
00:23:45
immunological reaction that causes us to license
00:23:49
you can see here with the uh you've also to sorry
00:23:53
brine uh oh the by x. holes in the system
00:23:59
but also with the mo take into mo take two is no polyethylene it's better on that though
00:24:05
but of course also metal part because could start a such a reaction
00:24:12
in most cases this uh us july says uh uh remain stable
00:24:16
stable as is often one but as you can see here
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this is off the four yes enough to six yes it has moved but the the distal component the couple
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component is fixated only by a small pick schools don't
00:24:30
contribute to fixation because they are not locked
00:24:34
so the risk of losing is great with this board fixation at that time
00:24:39
and it happens like here that the uh compo component subsides into the astral lies
00:24:48
and then of course you have to do something and that maybe fusion
00:24:52
or an you implement the ah savage savage possibilities
00:24:59
so if you look at the revision with the revision raised
00:25:03
to the literature you can't find anything any number
00:25:08
ranging from zero to one hundred percent provision on
00:25:12
force three third or fourth generation implements
00:25:17
i rely on my on the um uh the revision or survival curve which says that
00:25:25
up at ten to twelve years there is a sieve survival of about eighty percent
00:25:31
up to you to decide is that acceptable or not we're not talking about apes in each then it would not
00:25:36
be acceptable but we are talking about the wrist where
00:25:40
we has only fusion as the uh other possibility
00:25:48
and where do i stand now well
00:25:51
i would still recommend totally to offer prostate on the right
00:25:55
indications and that preferably would be an elderly patients
00:26:00
retired all with the low professional load and having a bone stock a good bone stock
00:26:07
this guy had would be a good example a good indication and yes
00:26:12
believe me if i had a distraught list i would prefer a
00:26:16
total restart a prostitute up to a total waste fusion
00:26:21
thank you very much was nice to have you here and thank you for listening to me
Conference Program
A-1127 President's Lecture: What 37 years with Hand Surgery have taught Me: Controversial Procedures that I still Perform and Procedures that I have Abandoned
Michel Boeckstyns, Copenhagen, Denmark
June 14, 2018 · 2:04 p.m.
137 views
A-1128 Honorary Lecture: The human hand: the most wonderful tool of nature
Zsolt Szabo, Miskolc, Hungary
June 14, 2018 · 2:31 p.m.
A-1129 Past, Present and Future of Hand Microsurgery
P. N. Soucacos, Greece
June 14, 2018 · 2:52 p.m.
A-1130 The Future of Hand Surgery
Henk P Giele, Oxford, UK
June 14, 2018 · 3:21 p.m.
226 views