Instabilidade e Artrose do punho e Mão. Ressecção 1ªfiada do carpo / Prótese total do punho....

8/6/2019 Instabilidade e Artrose do punho e Mo. Resseco 1fiada do carpo / Prtese total do punho. Julio Andr

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Jlio AndrCuria, 23 de Abril

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Instabilidade e Artrose do punho e MoResseco 1 fiada do carpo / Prtese total do punho


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Resseco 1 fiada do carpo

V. Prtese total do punho

HOSPITAL GARCIA DE ORTA E.P.E.HOSPITAL GARCIA DE ORTA E.P.E.

ServiServio de Ortopedia Traumatologiao de Ortopedia Traumatologia

Director Dr. Craveiro LopesDirector Dr. Craveiro Lopes

Unidade de Cirurgia

da mo e membro superiorHospital Garcia de Orta Almada

Jlio AndrFernando CruzM Jos Maio


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Pain relief

Improved movement (30/30)

Strength

Durable (young people)

Surgical treatment aims degenerative arthritis of Wrist


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Surgical motion-sparing procedures

Partial Arthrodesis

intercarpal arthrodesis

radioscaphoid Arthrodesis

radioscapholunate Arthrodesis

Proximal row carpectomy

Total wrist arthroplasty


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Used successfully to treat arthritis of the wrist since 1939

Stamm

Removal of the scaphoide, lunate and triquetrum turns a

complex link joint into a simple hinge.

Roux 1992

Proximal row carpectomy


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dorsal longitudinal incision 7-8 cm

retinaculum overlying 3 dorsal compartment Extensor pollicis longus retracted radially

Extensor carpi radialis brevis retracted radially

dorsal capsule longitudinally incised

Proximal row carpectomy - surgical technique


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removal of carpal bones

scaphoide lunate - piramidal

radial styloidectomy and temporary pinning

plaster splint (10 extension) 3 weeks

plaster splint (neutral) 3 weeks



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Proximal row carpectomy - advantages

Technical ease

Preservation of motion

Satisfactory strength

Pain relief

Patient satisfaction.


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Proximal row carpectomy - disadvantages

Loss of carpal height

Incongruent joint

Potencial degenerative arthritis of the radiocapitate


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Proximal row carpectomy - indications

Scapholunate advanced collapse (SLAC)

Scaphoid nonunion with SLAC

Kienbck disease

Chronic perilunate dislocations

Failed lunate prosthesis.


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Proximal row carpectomy - contraindications

Rheumatoid Arthritis (75% poor results)

Failed lunate prosthesis (unpredictable)

Capitolunate arthritis


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Proximal row carpectomy - results

Pain relief

Improved movement > 60%

Improvement in daily activities > 90% Probability of survival 10 years: 80-100%


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Themistocles Gluck . ivory - 1890

Swanson . spacers - 1960

Meuli Wrist arthropasty .. 2 components - 1970



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Original design of the Mennon/KMI Wrist which recreates

radial inclination of the proximal component.



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The Guepar Wrist from France employs an ellipsoid articulating design to

stabilize lateral motion.



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The uncemented Biax Wrist has a ball-and-socket design.



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The New Meuli Wrist minimizes bone resection and intrinsically

conforms to the centers of rotation.



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Total wrist arthroplasty- surgical technique

dorsal midline longitudinal incision

retinaculum incision 3 /4 compartment


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Destot, from P. Ledoux


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radial and carpal components are fixed (un/cemented)

immobilisation .. 3 weeks

rehabilitation programme


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Total wrist arthroplasty - advantages

Pain relief

Stability

Improved movementProfession

Daily activities


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Total wrist arthroplasty - disadvantages

High failure rate

Low predictable

High rate revisions


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Although arthrodesis continues to be a mainstay of therapy

Total wrist arthroplasty - indications

Bilateral rheumatoid involvement


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Total wrist arthroplasty - contraindications

Loss of innervation

Lack of active extension

Local infection

Poor bone stock

Need for weight-bearing through the joint (crutches)


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Total wrist arthroplasty - results

Pain relief

Improved movement 40

Improvement in daily activities > 80%

Probability of survival 9 years 70%


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Concluses


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Jlio AndrCuria, 23 de Abril

Painel 3

Instabilidade e Artrose do punho e MoResseco 1 fiada do carpo / Prtese total do punho

Instabilidade e Artrose do punho e Mão. Ressecção 1ªfiada do carpo / Prótese total do punho....

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