ARTHRODESIS1. 2 3 INDICATIONS Indications for shoulder fusion have diminished over the years because...
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Transcript of ARTHRODESIS1. 2 3 INDICATIONS Indications for shoulder fusion have diminished over the years because...
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ARTHRODESIS 1
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ARTHRODESIS 2
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ARTHRODESIS 3
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.
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ARTHRODESIS 4
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ARTHRODESIS 5
Contraindications
Osteonecrosis.
Charcot arthropathy(nonunion rate is high).
Ipsilateral elbow fusion.
Contralateral shoulder fusion.
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ARTHRODESIS 6
We agree that the position of rotation is the most critical factor in obtaining optimal function.
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ARTHRODESIS 7
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ARTHRODESIS 8
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.
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ARTHRODESIS 9
COMPRESSION TECHNIQUES—EXTERNAL FIXATION
TECHNIQUE 1 (Charnley and Houston)
Used as graft
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ARTHRODESIS 10
5 to 6 weeks
cast 12 weeks
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ARTHRODESIS 11
COMPRESSION TECHNIQUES—INTERNAL FIXATION
TECHNIQUE 1 (Cofield)
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ARTHRODESIS 12TECHNIQUE 1 (Cofield)
45 Degrees
spica cast 12 to 16 weeks
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ARTHRODESIS 13
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.
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ARTHRODESIS 14
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
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ARTHRODESIS 15
TECHNIQUE 3 (Mohammed)
the distal acromion as
avascularized graft
A shoulder spica 8-10
weeks
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ARTHRODESIS 16
TECHNIQUE 4 (AO Group)
Apply
bone grafts
No cast
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ARTHRODESIS 17
TECHNIQUE 5 (Richards et al.)
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
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ARTHRODESIS 18
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ARTHRODESIS 19
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ARTHRODESIS 20
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ARTHRODESIS 21
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.
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ARTHRODESIS 22
TECHNIQUE 1 (Steindler)
AGraft:1.5 x 9 cm
Fitting cast 8 weeks
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ARTHRODESIS 23
TECHNIQUE 2 (Brittain)
Grafts:8 mm x 7.5-10 cm
Fitting cast 8 weeks
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ARTHRODESIS 24
TECHNIQUE 3 (Staples)
Fitting cast 8 weeks
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ARTHRODESIS 25
Technique for fusion in tuberculous arthritis of
elbow .
TECHNIQUE 4(Arafiles)
use the resected epicondylar and
olecranon fragments as bone grafts
a long arm cast for 3
months
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ARTHRODESIS 26
TECHNIQUE 5 (Müller et al.)
The fixator and pins 6 to 8 weeks
a long arm cast until the
arthrodesis is solid
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ARTHRODESIS 27
TECHNIQUE 6 (Spier)
The most common indication was a high-energy, open, infected injury with associated bone loss.
Apply bone graft
The plate and screws 1year only
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ARTHRODESIS 28
ComplicationsComplications of elbow arthrodesis include:• Delayed union.• Nonunion.• Malunion.• Neurovascular injury .• Painful prominent hardware .• Skin breakdown.
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ARTHRODESIS 29
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ARTHRODESIS 30
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ARTHRODESIS 31
Contraindicationsinclude :• 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.
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ARTHRODESIS 32
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).
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ARTHRODESIS 33
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.
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ARTHRODESIS 34
TECHNIQUE 1 (AO Group)
cancellous bone harvested from the
excised bone
A cast (10 to 12 weeks)
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ARTHRODESIS 35
80%
TECHNIQUE 2 (Louis et al.)
Supporting the fusion site with
Kirschner wires or staples.
bone graft is not
necessary .
cast or splint for 12 to 16
weeks
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ARTHRODESIS 36 TECHNIQUE 3 (Haddad and Riordan)
2.5x4cm
If the wrist is unstable,
insert a nonthreaded Kirschner wire
cast or splint for 12 to 16
weeks
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ARTHRODESIS 37 TECHNIQUE 4 (Watson and Vendor)
Place an outer cortical piece of iliac bone graft
Cast 6-8weeks
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ARTHRODESIS 38
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ARTHRODESIS 39
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ARTHRODESIS 40
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.
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ARTHRODESIS 41
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.
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ARTHRODESIS 42
TECHNIQUE (Stern et al.; Segmüller, Modified)
Ball-socket Or Cup-cone
Splint2-3days
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ARTHRODESIS 43
A, Phalangeal osteotomy.
B, Hole for 25- or 26-gauge 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
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ARTHRODESIS 44
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
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ARTHRODESIS 45
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