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A new technique of wrist arthroscopy to visualise instability
J. Huracek*, J. Chomiak º, H. Troeger*
* Department for surgery of the hand and the peripheral nerve, University Hospital Basel, Switzerland
° Clinic for orthopaedic surgery “Bulovka”, Prague, Czech Republic
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wrist arthroscopy and instability
• great extent of positioning• ligamentotaxis / palpation• no palmar approach• no pro- / suppination• no operation in succession
• technique on wrist• technique on shoulder / knee
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wrist arthroscopy and instability
• horizontal position• no distraction• intraarticular pression up to150 mm Hg• hypomochlion• move instead of draw
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wrist arthroscopy and instability
• prospective study of 30 patients– arthroscopy without distraction, followed by– conventional arthroscopy with 3 kg traction
• standardised protocol– diagnostic sensitivity– quality of surgical procedures– complications
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wrist arthroscopy and instability
• diagnoses involved19 injuries, 11 degenerative diseases
• 11 times therapeutic surgery2 discus suture, 9 discus debridèment
• mean age 37,1 years; follow-up 10,2 weeks
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wrist arthroscopy and instability
• results with / without distraction:– same sensitivity (except for instability)– same specifity– surgical procedures not hindered– no complications (CTS)
• followed-up till today :– 30 prospectively, 117 retrospectively
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wrist arthroscopy and instability
arthroscopy of intercarpal space
MCU
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wrist arthroscopy and instability
arthroscopy of radiocarpal space
total SL - rupture
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wrist arthroscopy and instability
arthroscopy of radiocarpal space
total SL - rupture withpathological RU-duction
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• less extent (positioning, fluoroscopy)
• technically more difficult• dynamical assessment of ligamentous instability• direct proceed to open surgery (arthrotomy, distal radius
fracture)
the “Basel” technique of wrist arthroscopy
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outlook
• intra-articular assessment before standard OP• new, combined arthroscopic-open procedures• assessment of acute trauma
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