ARTHRODESIS 1

ARTHRODESIS 2

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.

ARTHRODESIS 4

ARTHRODESIS 5

Contraindications

Osteonecrosis.

Charcot arthropathy(nonunion rate is high).

Ipsilateral elbow fusion.

Contralateral shoulder fusion.

ARTHRODESIS 6

We agree that the position of rotation is the most critical factor in obtaining optimal function.

ARTHRODESIS 7

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.

ARTHRODESIS 9

COMPRESSION TECHNIQUES—EXTERNAL FIXATION

TECHNIQUE 1 (Charnley and Houston)

Used as graft

ARTHRODESIS 10

5 to 6 weeks

cast 12 weeks

ARTHRODESIS 11

COMPRESSION TECHNIQUES—INTERNAL FIXATION

TECHNIQUE 1 (Cofield)

ARTHRODESIS 12TECHNIQUE 1 (Cofield)

45 Degrees

spica cast 12 to 16 weeks

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.

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

ARTHRODESIS 15

TECHNIQUE 3 (Mohammed)

the distal acromion as

avascularized graft

A shoulder spica 8-10

weeks

ARTHRODESIS 16

TECHNIQUE 4 (AO Group)

Apply

bone grafts

No cast

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

ARTHRODESIS 18

ARTHRODESIS 19

ARTHRODESIS 20

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.

ARTHRODESIS 22

TECHNIQUE 1 (Steindler)

AGraft:1.5 x 9 cm

Fitting cast 8 weeks

ARTHRODESIS 23

TECHNIQUE 2 (Brittain)

Grafts:8 mm x 7.5-10 cm

Fitting cast 8 weeks

ARTHRODESIS 24

TECHNIQUE 3 (Staples)

Fitting cast 8 weeks

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

ARTHRODESIS 26

TECHNIQUE 5 (Müller et al.)

The fixator and pins 6 to 8 weeks

a long arm cast until the

arthrodesis is solid

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

ARTHRODESIS 28

ComplicationsComplications of elbow arthrodesis include:• Delayed union.• Nonunion.• Malunion.• Neurovascular injury .• Painful prominent hardware .• Skin breakdown.

ARTHRODESIS 29

ARTHRODESIS 30

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.

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).

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.

ARTHRODESIS 34

TECHNIQUE 1 (AO Group)

cancellous bone harvested from the

excised bone

A cast (10 to 12 weeks)

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

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

ARTHRODESIS 37 TECHNIQUE 4 (Watson and Vendor)

Place an outer cortical piece of iliac bone graft

Cast 6-8weeks

ARTHRODESIS 38

ARTHRODESIS 39

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.

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.

ARTHRODESIS 42

TECHNIQUE (Stern et al.; Segmüller, Modified)

Ball-socket Or Cup-cone

Splint2-3days

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

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

ARTHRODESIS 45

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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.

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كاظم. مؤيد Dr. Muayad Kadhimد