Transcript عرض تقديمي من PowerPoint - Muayad Kadhim's WebSite

ARTHRODESIS
1
ARTHRODESIS
2
INDICATIONS
Indications for shoulder fusion have diminished
over the years because of:
the excellent results of shoulder arthroplasty.
the near elimination of poliomyelitis and
tuberculosis.
the improved techniques for shoulder
stabilization.
ARTHRODESIS
3
ARTHRODESIS
4
Contraindications
Osteonecrosis.
Charcot arthropathy(nonunion rate is
high).
Ipsilateral elbow fusion.
Contralateral shoulder fusion.
ARTHRODESIS
5
We agree that the position of rotation is the
most critical factor in obtaining optimal function.
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SURGICAL TECHNIQUES
the limited contact between the glenoid
fossa and humeral head can be
improved by including the acromion in
the fusion mass.
Firm internal fixation usually eliminates
the need for bone grafting and external
fixation.
ARTHRODESIS
8
Used as
graft
COMPRESSION TECHNIQUES—EXTERNAL
FIXATION
TECHNIQUE 1 (Charnley and Houston)
ARTHRODESIS
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5 to 6
weeks
cast 12
weeks
ARTHRODESIS
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COMPRESSION TECHNIQUES—INTERNAL
FIXATION
TECHNIQUE
1 (Cofield)
ARTHRODESIS
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45 Degrees
TECHNIQUE 1 (Cofield)
ARTHRODESIS
spica cast
12 to 16
weeks
12
AFTERTREATMENT:
• A pelvic band extending from the nipples to the
pubic symphysis is applied.
• With the elbow flexed 90 degrees, a cylinder
cast is applied to the upper extremity.
• The extremity is suspended by two wooden
struts, or a cock-up wrist splint is used.
• At 1 to 2 weeks after surgery, a plastic
shoulder spica cast is applied and worn until
union is achieved, 12 to 16 weeks after
surgery.
ARTHRODESIS
13
TECHNIQUE 2
(Uematsu)
Position 20 degrees of
abduction, 30 degrees of
flexion, and 40 degrees of
internal rotatio
Used as
graft
A cast
3 months
ARTHRODESIS
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the distal
acromion as
avascularized
graft
A shoulder
spica 8-10
weeks
TECHNIQUE 3 (Mohammed)
ARTHRODESIS
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Apply
bone grafts
No cast
TECHNIQUE 4 (AO Group)
ARTHRODESIS
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60 D
Position 30
degrees of
flexion, 30
degrees of
abduction, and
30 degrees of
internal
rotation.
Do not
osteotomize
the acromion
A shoulder spica
cast 6weeks
TECHNIQUE 5 (Richards et al.)
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ARTHRODESIS
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POSITION
For unilateral arthrodesis of the elbow, a
position of 90 degrees of flexion is desirable.
Bilateral elbow arthrodesis rarely is indicated
because of resultant functional limitations. If
indicated, one elbow should be placed in 110
degrees of flexion to permit the patient to
reach the mouth and the other should be
placed in 65 degrees to aid in personal
hygiene.
ARTHRODESIS
21
AGraft:1.5 x 9 cm
Fitting cast
8 weeks
TECHNIQUE 1 (Steindler)
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Grafts:8 mm x 7.5-10 cm
Fitting cast 8
weeks
TECHNIQUE 2 (Brittain)
ARTHRODESIS
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Fitting cast
8 weeks
TECHNIQUE 3 (Staples)
ARTHRODESIS
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Technique for fusion in
tuberculous arthritis of
elbow.
TECHNIQUE
4(Arafiles)
ARTHRODESIS
use the resected
epicondylar and
olecranon fragments
as bone grafts
a long arm
cast for 3
months
25
The fixator and pins
6 to 8 weeks
a long arm cast
until the
arthrodesis is
solid
TECHNIQUE 5 (Müller et al.)
ARTHRODESIS
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The plate and
screws 1year only
Apply bone
graft
TECHNIQUE 6 (Spier)
The most common indication was a high-energy, open,
infected injury with
associated bone loss.
ARTHRODESIS
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Complications
Complications of elbow arthrodesis
include:
• Delayed union.
• Nonunion.
• Malunion.
• Neurovascular injury .
• Painful prominent hardware .
• Skin breakdown.
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Contraindications
include :
• An open physis of the distal radius( The distal
radial physis close approximately 17 years of
age).
• After partial destruction of the physis ,the
remaining part may be excised to prevent
unequal growth.
• An elderly patient with a sedentary lifestyle,
especially if the nondominant wrist is
involved.
ARTHRODESIS
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POSITION
Usually 10 to 20 degrees of extension
(dorsiflexion) with the long axis of the third
metacarpal shaft aligned with the long axis of
the radial shaft (allow maximum grasping
strength).
In general, neutral to 5 degrees of ulnar
deviation is preferred.
If bilateral wrist fusions are indicated, the
positions of the wrists should be determined
by the needs of the patient( The neutral
position).
ARTHRODESIS
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The straight plate is employed when a large intercalary graft is
required for a traumatic or tumorous defect.
The short carpal bend is used in small wrists and those in which
the proximal row has been resected.
The longer carpal bend is used in large wrists.
ARTHRODESIS
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TECHNIQUE
1 (AO Group)
cancellous bone
harvested from the
excised bone
A cast (10 to 12
weeks)
ARTHRODESIS
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80%
Supporting the
fusion site with
Kirschner wires or
staples.
cast or splint
for 12 to 16
weeks
bone graft is not
necessary.
TECHNIQUE 2 (Louis et al.)
ARTHRODESIS
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cast or splint
for 12 to 16
weeks
2.5x4cm
If the wrist is unstable,
insert a nonthreaded
Kirschner wire
TECHNIQUE
3 (Haddad and Riordan)
ARTHRODESIS
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Place an outer cortical piece
of iliac bone graft
Cast 6-8weeks
TECHNIQUE 4 (Watson and Vendor)
ARTHRODESIS
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ARTHRODESIS
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ARTHRODESIS
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INDICATIONS
Damaged by injury or disease.
Pain.
Deformity.
Instability makes motion a liability rather than
an asset.
Arthrodesis is used most often for the
proximal interphalangeal joint because
motion in this joint is so important.
When the metacarpophalangeal joint is
destroyed, if good muscle strength is present,
arthroplasty is indicated more often than
arthrodesis.
ARTHRODESIS
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POSITION
The metacarpophalangeal joint should be
fixed in 20 to 30 degrees of flexion.
The proximal interphalangeal joints should be
fixed from 25 degrees of flexion in the index
finger to almost 40 degrees in the small finger
(less flexion in the radial fingers than in the
ulnar fingers).
The distal interphalangeal joints are fixed in
15 to 20 degrees of flexion.
ARTHRODESIS
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Ball-socket Or
Cup-cone
Splint2-3days
TECHNIQUE (Stern et al.; Segmüller,
Modified)
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A, Phalangeal osteotomy.
B, Hole for 25- or 26gauge stainless steel wire
made through middle
phalangeal base dorsal to
midaxial line.
C
C, Retrograde insertion of
0.028-or 0.035-inch Kirschner
wire into proximal phalanx.
D, Kirschner wire driven
into anterior cortex of middle
phalanx.
E, Figure-eight tension
band created and tightened.
Tension band
arthrodesis
ARTHRODESIS
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A, Anteroposterior
and lateral views of
crossed Kirschner
wires.
B, Anteroposterior
and lateral views of
interfragmentary
wire and longitudinal
Kirschner wires.
C, Anteroposterior
and lateral views of
Herbert screw
ARTHRODESIS
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ARTHRODESIS
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• This lecture is one of a series of lectures were prepared and
presented by residents in the department of orthopedics in
Damascus hospital, under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may exist in this
lecture.
Dr. Muayad Kadhim
‫ مؤيد كاظم‬.‫د‬