Dr. José Luis de Haro Monreal Dra. Sonia Vidal Rodríguez Dr. Miguel Arilla Castilla
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Dr. José Luis de Haro MonrealDr. José Luis de Haro MonrealDra. Sonia Vidal RodríguezDra. Sonia Vidal RodríguezDr. Miguel Arilla Castilla Dr. Miguel Arilla Castilla Dr. Jesús Castaño Lloris Dr. Jesús Castaño Lloris Dr. Eulogio Garate OtaolaDr. Eulogio Garate OtaolaUNIDAD CIRUGÍA DE MANO UNIDAD CIRUGÍA DE MANO ASEPEYO HOSPITAL - COSLADAASEPEYO HOSPITAL - COSLADAMADRID - SPAINMADRID - SPAIN
ARTRODESIS TRAPECIO-METACARPIANA ARTRODESIS TRAPECIO-METACARPIANA EN EL TRATAMIENTO DE LAEN EL TRATAMIENTO DE LARIZARTROSISRIZARTROSIS
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16:10 Arthrodesis of the Trapezium-Metacarpal Joint (TMCJ) in the Treatment ofRizarthrosis S Vidal Rodriguez, MD. Hand Unit - Asepeyo – Coslada (Madrid), Spain
Kevin C. Chung, MD, MS Professor of Surgery University of Michigan Health System
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Dr. José Luis de Haro MonrealDr. José Luis de Haro MonrealDra. Sonia Vidal RodríguezDra. Sonia Vidal RodríguezDr. Miguel Arilla Castilla Dr. Miguel Arilla Castilla Dr. Jesús Castaño Lloris Dr. Jesús Castaño Lloris Dr. Eulogio Garate OtaolaDr. Eulogio Garate OtaolaHAND SURGERY UNIT HAND SURGERY UNIT ASEPEYO HOSPITAL - COSLADAASEPEYO HOSPITAL - COSLADAMADRID - SPAINMADRID - SPAIN
ARTHRODESIS OF THE TRAPEZIUM-ARTHRODESIS OF THE TRAPEZIUM-METACARPAL JOINT (TMCJ) IN THE METACARPAL JOINT (TMCJ) IN THE TREATMENT OF RIZARTHROSIS TREATMENT OF RIZARTHROSIS
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INTRODUCTIONINTRODUCTION
DEGENERACIÓN SUPERFICIE ARTICULAR TMCDEGENERACIÓN SUPERFICIE ARTICULAR TMC
NEOFORMACIÓN ÓSEANEOFORMACIÓN ÓSEA
DÉFICIT FUNCIONALDÉFICIT FUNCIONAL
ELEVADA FRECUENCIAELEVADA FRECUENCIA
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INTRODUCTIONINTRODUCTION
PULGAR : 40% FUNCIÓN DE LA MANOTMC – COMPLEJO OSTEOARTICULAR
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INTRODUCTIONINTRODUCTIONFISIOLOGÍA – BIOMECÁNICA: PINZA – PULGAR –DEDOS LARGOS
INCAPACIDAD SOCIOLABORAL CRÓNICA
REPERCUSIÓN ACTIVIDADES DE LA VIDA DIARIA
PATOLOGÍA FRECUENTE Y CONOCIDA
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INTRODUCTIONINTRODUCTION
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INTRODUCTIONINTRODUCTION
• MUJERES – EDAD POSTMENOPÁUSICA• EDAD MEDIA : 64 años• 33% PREVALENCIA RADIOLÓGICA• Ratio hombre / mujer = 1:10
PROCESO ARTRÓSICO DE MS : MAYOR NÚMERODE PROCESOS QUIRÚRGICOS
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INTRODUCTIONINTRODUCTIONCOLUMNA OSTEOARTICULAR : FLEXIBILIDAD
ESCAFOTRAPEZOIDEA, TRAPECIOMETACARPIANA, METACARPOFALÁNGICA,INTERFALÁNGICA.
FLEXIÓN-EXTENSIÓN 50º-70ºOPOSICIÓN 40-60ºROTACIÓN DEL EJE
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INTRODUCTIONINTRODUCTION
OPOSICIÓN : ANTEPOSICIÓN TMC Y MCF FLEXIÓN : TMC, MCF e IF
PRONACIÓN: TMC, 24º MCF , 7º IF
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INTRODUCTIONINTRODUCTIONARTRODESIS TRAPECIO-METACARPIANA : OPOSICIÓN CORRECTA DEL PULGAR. COMPENSACIÓN RESTO ARTICULACIONES.30-40º ABDUCCIÓN, 30º ANTE-OPOSICIÓN DE 1º META A 2º
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INTRODUCTIONINTRODUCTION
•TYPE I: Sinovitis persistente., mínima artrosis eTYPE I: Sinovitis persistente., mínima artrosis eInestabilidad.Inestabilidad.
•TYPE II: Pinzamiento articularTYPE II: Pinzamiento articular
•TYPE III: Inestabilidad. Osteofito. CrepitaciónTYPE III: Inestabilidad. Osteofito. Crepitación
•TYPE IV: Artrosis otras art. pulgarTYPE IV: Artrosis otras art. pulgar
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INDICACIONES ARTRODESIS TMC
1. PROCESOS DEGENERATIVOS, ARTROSIS TMC.2. PATRÓN HIPERLAXITUD ARTICULAR- SUBLUXACIÓN CRÓNICA3. PROCESO DEGENERATIVO – FX BASE 1º MT – TRAPEZIUM4. PROCESOS DEGENERATIVOS SÍSTÉMICOS - AR
INTRODUCTIONINTRODUCTION
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On this occasion, our aim is to provide a retrospective description of patients diagnosed with rhizarthrosis on whom arthrodesis of the trapezium -metacarpal joint was performed in the period from January 2003 to September 2008. DRESCRIPTION OF THE FIRST DATA COLLECTED.
,.
personal details,
occupation,
diagnostic methods
surgical technique
progression and results
MATERIAL METHODSMATERIAL METHODS
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251 RHIZARTHROSIS280 TRAPEZIUM-METACARPAL ARTHRODESIS29 BILATERALAVERAGE AGE 53.42 yearsPatients were monitored for an average period of 3.61 years.
RESULTSRESULTS
RIGHT LEFT BILATERAL
8141
7129
272
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153 cases involved a high level of functional demandBricklayer, plumber, lorry driver, butcher, housewife,Pianist, waitress 98 involved a low level of functional demand.Paper work.
ACTIVITIES
RESULTSRESULTS
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153 cases involved a high level of functional demand
ACTIVITIES
RESULTSRESULTS
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98 involved a low level of functional demand.Paper work.
RESULTSRESULTS
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197 cases were of degenerative origin, 73 cases involved rhizarthrosis secondary to patterns of chronic dislocation and 10 cases involved post-traumatic conditions.
RESULTSRESULTS
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. MÉTODOS DIAGNÓSTICOS: AP y L X-RAYS de ambas manos , and CLINICAL EXAMINATION for dolor , deformidad, inflamación en la base del pulgar , pérdida de fuerza y limitación de la movilidad
RESULTSRESULTS
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RESULTSRESULTS
TÉCNICA QUIRÚRGICA – MISMO EQUIPO CIRUJANOSTÉCNICA QUIRÚRGICA – MISMO EQUIPO CIRUJANOS
INJERTO ÓSEO AUTÓLOGO - CRESTA ILÍACA CONTRALATERAL.INJERTO ÓSEO AUTÓLOGO - CRESTA ILÍACA CONTRALATERAL.
OSTEOSÍNTESIS CON AGUJAS TIPO KIRSCHNER.OSTEOSÍNTESIS CON AGUJAS TIPO KIRSCHNER.
30-40º ABDUCCIÓN, 30º ANTE-OPOSICIÓN 1º META, 2º META.30-40º ABDUCCIÓN, 30º ANTE-OPOSICIÓN 1º META, 2º META.
INMOVILIZACIÓNINMOVILIZACIÓN
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Bone graftKirschner cross
RESULTSRESULTS
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The planes are dissected the articular capsule is opened up
.an arthrotomy is performed and the surfaces of both joints, the trapezium and the metacarpal, are cleaned. A recess is created for the bone graft.
RESULTSRESULTS
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RESULTSRESULTS
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RESULTSRESULTS
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MISMO PROTOCOLO POSTOPERATORIO.:
• 1 SEMANA: 1º CURA . INMOVILIZACIÓN CON FÉRULA.
• 2 SEMANAS : 2º CURA, RETIRADA DE PUNTOS. YESO DEFINITIVO ANTEBRAQUIAL.
• 40 -70 DÍAS POST-QX : RX CONTROL. SIGNOS DE CONSOLIDACIÓN – RETIRAR YESOY AGUJAS.
RESULTSRESULTS
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67.4 días de evolución : 197 cases the x-ray was satisfactory and we were able to remove the splint and the Kirschner needles. In 83 cases, the splint was applied for a further 10 to 20 days.
.
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. 10-15 sessions RH, an x-ray is performed and the first functional assessment is carried out. UN MES4 MESES6 MESES – VALORACIÓN FUNCIONAL1 AÑO
RESULTSRESULTS
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RESULTSRESULTS 6 MESES : MOVILIDAD DE INTERFALÁNGICA.FLEXIÓN 75-90ºEXTENSIÓN 5-10ºPRONACIÓN 5-10º
100% - 280 CASOS
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MOVILIDAD MCF – 6 MESESFLEXIÓN 60-70ºSUPINACIÓN 5-7ºPRONACIÓN 20º
271 patients had.
RESULTSRESULTS
MOVILIDAD COMPLETA - 271
MOVILIDAD FUNCIONAL - 9 ; disminución de 10-15º de la movilidad completa de MCF
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RESULTSRESULTSCOMPLICATIONS
PSEUDOARTROSIS 0 CASOS
NEURITIS RS NR 3 CASOS
CICATRIZ HIPERTRÓFICA 27 CASOS
ALGODISTROFIA 63 CASOS
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RESULTSRESULTS SATISFACCIÓN GLOBAL 251 PACIENTES 210 - MUY BUENA +++ 30 - BUENA ++ 11 - N/S +/-
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CLINICAL CASECLINICAL CASEMUJER 51 AÑOS, RIZARTROSIS MANO DERECHA . TIENDA TEXTIL – DEPEN.
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CLINICAL CASECLINICAL CASE
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CONCLUSIONS: For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction.
16:10 Arthrodesis of the Trapezium-Metacarpal Joint (TMCJ) in the Treatment ofRizarthrosis Hand Unit - Asepeyo – Coslada (Madrid), Spain
ARTRODESIS TRAPECIO METACARPIANA
RIZARTROSISELIMINAR DOLORMOVILIDAD FUNCIONAL DEL PULGARCONSERVA FUERZAPACIENTES JÓVENESDEMANDA FUNCIONAL A LARGO PLAZO
BRITISH SOCIETY FOR SURGERY OF THE HANDSPRING MEETING22-23 APRIL 2010Education & Research CentreWythenshawe HospitalSouthmoor Road
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MUCHAS GRACIASMUCHAS GRACIASNunca se da tanto como cuando se da la mano
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LIGAMENTOPLASTIAS
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J Hand Surg Am. 2009 Jan;34(1):20-6.Long-term outcomes of trapeziometacarpal
arthrodesis in the management of trapeziometacarpal arthritis.
Rizzo M, Moran SL, Shin AY.Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN MN55905, USA.
LIGAMENTOPLASTIAS