TRAPEZIECTOMIA E TENOARTROPLASTICA CON ½ FCR “ANNODATO” (relazione SICM 2013)Alberto Mantovani
Relazione al "51° Congresso Nazionale della Società Italiana di Chirurgia della Mano" Rimini 03 - 05 ottobre 2013
RIASSUNTO
Scopo: Lo scopo di questo studio è di presentare e valutare in modo retrospettivo una tecnica di trattamento dell’artrosi trapezio metacarpale (TM) utilizzata dal 1995. Si tratta di un intervento di trapeziectomia, ligamentoplastica e interposizione tendinea con metà del tendine flexor carpi radialis (FCR), che viene prima bloccato in un tunnel osseo nella base del primo metacarpo e poi interposto e più volte annodato nel nuovo spazio scafo metacarpale, fino a colmarlo stabilmente. Dimostriamo inoltre che il muscolo abductor digastricus (ABD.D.) è una costante anatomica utilizzabile per la via chirurgica di accesso al trapezio.
Materiali e metodi: Sono stati valutati 78 pazienti operati dal 1995 al 2012, da 51 a 86 anni, di cui 72 donne e 6 uomini, con un follow up da 1 a 17 anni. Per la valutazione clinica abbiamo usato il Mayo Wrist Score (MWS) “adattato” per il pollice. La distanza scafo metacarpale è stata misurata all’RX di controllo del follow up ed è stata definita: invariata o ridotta di ± ½ confrontandola con l’RX postoperatorio.
Risultati: I risultati clinici con il MWS adattato al pollice sono stati: ottimi in 53 casi, buoni in 15 casi, discreti in 6 casi e negativi in 4 casi: 2 di questi sono stati rioperati dopo 1 e 2 anni rispettivamente, per dolore persistente. Il tempo medio di ripresa funzionale per il lavoro è stato di 2 mesi (range da 1 a 6 mesi) . La distanza scafo metacarpale è risultata costantemente diminuita ma non ha mai superato il valore di – ½ rispetto all’RX post operatorio e senza correlazione con il risultato clinico. Non sono state registrate complicanze.
Discussione: La tecnica descritta è risultata efficace e riproducibile. Associando la stabilizzazione metacarpale mediante plastica legamentosa con metà del tendine FCR e l’interposizione e annodamento dello stesso tendine nel nuovo spazio scafo metacarpale, si può ridurre il tempo di immobilizzazione post operatoria e anticipare il recupero funzionale del pollice. Si tratta di una tenoartroplastica biologica ottenuta solo con strutture del paziente e non richiede perciò costi aggiuntivi di altri materiali. Viene anche segnalato l’interesse chirurgico della via di accesso anteriore al trapezio, sezionando costantemente il tendine del muscolo ABD.D..
This document discusses osteotomies around the hip that are used to treat developmental dysplasia of the hip (DDH). It describes various femoral and pelvic osteotomies, including their objectives, indications, advantages, and disadvantages. For femoral osteotomies, it discusses femoral shortening, derotation, and varus osteotomies. For pelvic osteotomies, it discusses Salter's, Pemberton, Dega, Steel, Sutherland, Tonnis, Ganz, and salvage osteotomies such as Chiari and shelf procedures. The appropriate procedure depends on factors like the patient's age and whether concentric reduction of the hip is possible.
Stage 2 posterior tibial tendon dysfunction is characterized by an elongated and partially torn tendon, resulting in a flexible deformity with increased heel valgus and possible forefoot abduction. Treatment begins conservatively with orthotics but may progress to surgical procedures like flexor digitorum longus transfer, medial displacement calcaneal osteotomy, and lateral column lengthening to restore the arch height and alignment. More advanced cases may require fusion of the talonavicular joint or additional medial column procedures to address deformity in the midfoot. The goal of surgical treatment is to correct all aspects of the flexible deformity through procedures on the hindfoot, midfoot and forefoot.
This document discusses basal joint arthritis of the thumb, also known as trapeziometacarpal arthritis. It covers the ligamentous anatomy, epidemiology, etiology, clinical evaluation, radiographic evaluation, classification systems, treatment options including conservative and surgical management, postoperative care, complications, and cost analysis. The key points are that it is a common source of hand pain, especially in post-menopausal women, and treatment ranges from splinting and injections for mild cases to various surgical procedures like ligament reconstruction and tendon interposition or prosthetic arthroplasty for more advanced stages of arthritis.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing damage. There are two main types: cam impingement from an abnormal femoral head-neck junction; and pincer impingement from acetabular overcoverage. Accurate diagnosis using clinical exams and imaging of the alpha angle and offset ratios is important for determining treatment, which may include hip arthroscopy, osteochondroplasty, or periacetabular osteotomy. FAI is commonly seen in young, active individuals and certain athletic activities increase risk.
Basal joint arthritis, or arthritis of the thumb carpometacarpal joint, is a common condition affecting women in particular. It has multiple treatment options depending on the stage of arthritis. For early stage arthritis with instability, volar ligament reconstruction is recommended. For more advanced arthritis, options include ligament reconstruction with tendon interposition, trapezium excision with tendon interposition, or arthrodesis (fusion) of the joint, with the choice depending on patient age, demands, and severity of arthritis. Surgical treatment aims to relieve pain while maintaining function and stability.
TRAPEZIECTOMIA E TENOARTROPLASTICA CON ½ FCR “ANNODATO” (relazione SICM 2013)Alberto Mantovani
Relazione al "51° Congresso Nazionale della Società Italiana di Chirurgia della Mano" Rimini 03 - 05 ottobre 2013
RIASSUNTO
Scopo: Lo scopo di questo studio è di presentare e valutare in modo retrospettivo una tecnica di trattamento dell’artrosi trapezio metacarpale (TM) utilizzata dal 1995. Si tratta di un intervento di trapeziectomia, ligamentoplastica e interposizione tendinea con metà del tendine flexor carpi radialis (FCR), che viene prima bloccato in un tunnel osseo nella base del primo metacarpo e poi interposto e più volte annodato nel nuovo spazio scafo metacarpale, fino a colmarlo stabilmente. Dimostriamo inoltre che il muscolo abductor digastricus (ABD.D.) è una costante anatomica utilizzabile per la via chirurgica di accesso al trapezio.
Materiali e metodi: Sono stati valutati 78 pazienti operati dal 1995 al 2012, da 51 a 86 anni, di cui 72 donne e 6 uomini, con un follow up da 1 a 17 anni. Per la valutazione clinica abbiamo usato il Mayo Wrist Score (MWS) “adattato” per il pollice. La distanza scafo metacarpale è stata misurata all’RX di controllo del follow up ed è stata definita: invariata o ridotta di ± ½ confrontandola con l’RX postoperatorio.
Risultati: I risultati clinici con il MWS adattato al pollice sono stati: ottimi in 53 casi, buoni in 15 casi, discreti in 6 casi e negativi in 4 casi: 2 di questi sono stati rioperati dopo 1 e 2 anni rispettivamente, per dolore persistente. Il tempo medio di ripresa funzionale per il lavoro è stato di 2 mesi (range da 1 a 6 mesi) . La distanza scafo metacarpale è risultata costantemente diminuita ma non ha mai superato il valore di – ½ rispetto all’RX post operatorio e senza correlazione con il risultato clinico. Non sono state registrate complicanze.
Discussione: La tecnica descritta è risultata efficace e riproducibile. Associando la stabilizzazione metacarpale mediante plastica legamentosa con metà del tendine FCR e l’interposizione e annodamento dello stesso tendine nel nuovo spazio scafo metacarpale, si può ridurre il tempo di immobilizzazione post operatoria e anticipare il recupero funzionale del pollice. Si tratta di una tenoartroplastica biologica ottenuta solo con strutture del paziente e non richiede perciò costi aggiuntivi di altri materiali. Viene anche segnalato l’interesse chirurgico della via di accesso anteriore al trapezio, sezionando costantemente il tendine del muscolo ABD.D..
This document discusses osteotomies around the hip that are used to treat developmental dysplasia of the hip (DDH). It describes various femoral and pelvic osteotomies, including their objectives, indications, advantages, and disadvantages. For femoral osteotomies, it discusses femoral shortening, derotation, and varus osteotomies. For pelvic osteotomies, it discusses Salter's, Pemberton, Dega, Steel, Sutherland, Tonnis, Ganz, and salvage osteotomies such as Chiari and shelf procedures. The appropriate procedure depends on factors like the patient's age and whether concentric reduction of the hip is possible.
Stage 2 posterior tibial tendon dysfunction is characterized by an elongated and partially torn tendon, resulting in a flexible deformity with increased heel valgus and possible forefoot abduction. Treatment begins conservatively with orthotics but may progress to surgical procedures like flexor digitorum longus transfer, medial displacement calcaneal osteotomy, and lateral column lengthening to restore the arch height and alignment. More advanced cases may require fusion of the talonavicular joint or additional medial column procedures to address deformity in the midfoot. The goal of surgical treatment is to correct all aspects of the flexible deformity through procedures on the hindfoot, midfoot and forefoot.
This document discusses basal joint arthritis of the thumb, also known as trapeziometacarpal arthritis. It covers the ligamentous anatomy, epidemiology, etiology, clinical evaluation, radiographic evaluation, classification systems, treatment options including conservative and surgical management, postoperative care, complications, and cost analysis. The key points are that it is a common source of hand pain, especially in post-menopausal women, and treatment ranges from splinting and injections for mild cases to various surgical procedures like ligament reconstruction and tendon interposition or prosthetic arthroplasty for more advanced stages of arthritis.
This document discusses femoro-acetabular impingement (FAI), which occurs when the femoral head and neck abnormally contact the acetabular rim, causing damage. There are two main types: cam impingement from an abnormal femoral head-neck junction; and pincer impingement from acetabular overcoverage. Accurate diagnosis using clinical exams and imaging of the alpha angle and offset ratios is important for determining treatment, which may include hip arthroscopy, osteochondroplasty, or periacetabular osteotomy. FAI is commonly seen in young, active individuals and certain athletic activities increase risk.
Basal joint arthritis, or arthritis of the thumb carpometacarpal joint, is a common condition affecting women in particular. It has multiple treatment options depending on the stage of arthritis. For early stage arthritis with instability, volar ligament reconstruction is recommended. For more advanced arthritis, options include ligament reconstruction with tendon interposition, trapezium excision with tendon interposition, or arthrodesis (fusion) of the joint, with the choice depending on patient age, demands, and severity of arthritis. Surgical treatment aims to relieve pain while maintaining function and stability.
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
This document provides an overview of femoro-acetabular impingement syndrome (FAIS). It defines FAIS as impingement between the proximal femur and acetabulum leading to cartilage injury and pain. There are two main types: cam FAI, caused by a bony thickening at the femoral head-neck junction; and pincer FAI, caused by an anomaly in the acetabular structure. Clinical features include groin pain, decreased range of motion, and late-stage osteoarthritis. Treatment involves both non-operative options like physical therapy as well as surgical options like arthroscopic surgery to resect impingement lesions and repair labral tears.
Claw hand, or intrinsic minus hand, is caused by paralysis of the intrinsic hand muscles due to ulnar nerve injury. This results in hyperextension of the MP joints and flexion of the PIP and DIP joints, impairing hand function. Management involves restoring flexion at the MP joints and extension at the PIP joints through static procedures like capsulotomy or dynamic tendon transfers. Dynamic transfers use expendable donor tendons like the ECRL/ECRB to restore finger flexion and grip strength. Legendary orthopedic surgeon Dr. Paul Brand pioneered many tendon transfer techniques for treating leprosy-related hand deformities and rehabilitating patients.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
The document describes a study evaluating the "Remplissage" arthroscopic technique for treating traumatic shoulder instability accompanied by glenoid bone loss and Hill-Sachs defects. The study involved 28 patients who underwent the Remplissage procedure. Post-operatively, patients showed excellent functional outcomes with no reoccurrences of dislocation, nearly full return to work and sports, and significant improvements in shoulder scoring systems. The conclusion is that Remplissage offers excellent short-term results for addressing shoulder instability with humeral bone loss, despite some loss of external rotation.
This document provides information on ankle arthrodesis. It begins by describing the anatomy of the ankle joint and its biomechanics. It then discusses indications for ankle arthrodesis including various types of arthritis. Conservative management is outlined followed by details of the surgical procedure including patient evaluation, approaches, fixation methods, post-operative care and alternatives to fusion. Specific techniques like transfibular arthrodesis with a fibular strut graft are explained. The goal of ankle arthrodesis is to fuse the ankle joint to relieve pain from arthritis while maintaining alignment and function.
Planovalgus foot, also known as flatfoot, is characterized by a low or absent medial longitudinal arch and hindfoot valgus. The document discusses the anatomy and development of the foot arches, causes of pediatric and adult flatfoot including posterior tibial tendon dysfunction, and treatment options ranging from orthotics to surgery. Surgical procedures discussed include calcaneal osteotomies, tendon lengthening/transfer, and arthrodesis. Complications and special flatfoot conditions like tarsal coalition and congenital vertical talus are also summarized.
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
This document provides an overview of the history and evolution of total hip arthroplasty. It discusses early techniques from the 1820s through developments in the 1920s-1950s that led to modern total hip replacement designs. It then describes pre-operative planning including patient evaluation, x-ray templating, and considerations for implant selection and alignment. Key implant components like the acetabular cup and femoral stem are also summarized.
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
A 32-year-old male presents to the emergency department with right thumb pain after a skiing accident. He fell and landed on his outstretched right hand, pulling his right thumb away from his ski pole. On examination, swelling and tenderness were found over the right thumb. An avulsion of the ulnar collateral ligament, also known as skier's thumb, was diagnosed. Treatment involved splinting the thumb and following up urgently with hand surgery.
The document discusses factors that affect rehabilitation after rotator cuff repair surgery. It covers goals of repair and rehabilitation, current failure rates of repairs, and factors such as surgical approach, fixation method, and tissue quality that influence rehabilitation. Rehabilitation must be tailored based on these surgical and patient-specific factors to optimize repair healing and restore function.
Manuel Mesa. Teoría muscular en la génesis y tratamiento de la coxartrosis....SecretarioSOMUCOT
Este documento presenta información sobre la teoría muscular en la génesis y tratamiento de la coxartrosis, con un enfoque en el papel del músculo glúteo mayor. Describe los signos radiográficos de la coxartrosis, diferentes clasificaciones de la artrosis coxofemoral, y la biomecánica de la cadera. También explora la hipótesis de que la fibrosis del músculo glúteo mayor podría determinar el desarrollo de coxartrosis debido a desequilibrios musculares y alteraciones en la biome
This document discusses multiligament knee injuries, which involve injuries to two or more of the four main knee ligaments. Key points include:
- The incidence is low at 0.02% but many cases go undiagnosed. Injuries are usually due to high-energy trauma like car accidents.
- Associated injuries can include vascular injuries in 5-15% of cases, nerve injuries, and fractures.
- Treatment depends on the specific ligaments injured and stability of the knee. Acute repair or reconstruction is generally preferred but delayed reconstruction is also an option.
- Complications include vascular injuries, nerve injuries, stiffness, and laxity. Proper stabilization, mobilization
This document discusses several types of pelvic osteotomies used to treat developmental dysplasia of the hip. The main osteotomies covered are the Salter single innominate osteotomy, Pemberton acetabuloplasty, Steel triple innominate osteotomy, Chiari medial displacement, and Ganz periacetabular osteotomy. Most pelvic osteotomies require remodeling of the bone and are not as useful in older children over age 8. Careful matching of the procedure to each patient's individual case is needed. The more complex osteotomies have a steep learning curve for surgeons.
The document provides guidance on how to effectively work up and summarize a surgical patient case during a residency interview. It emphasizes knowing the preferred procedures of the interviewing program and being able to describe radiographic findings of flat feet in a systematic way. For a flat foot work up, the assistant should identify deformities in the sagittal, frontal, and transverse planes, then suggest procedures to address each, such as a gastrocnemius recession for sagittal plane correction or a medial calcaneal slide for frontal plane correction. Reading flat foot radiographs involves assessing specific angles on both AP and lateral views that indicate planovalgus deformity severity and type.
Trattamento dell'artrosi trapezio-metacarpale con 1/2 FCR "annodato" (2014)Alberto Mantovani
TRATTAMENTO DELL’ARTROSI TRAPEZIO-METACARPALE
CON TRAPEZIECTOMIA, LIGAMENTOPLASTICA E
INTERPOSIZIONE DI METÀ TENDINE FLEXOR CARPI
RADIALIS “ANNODATO”
Alberto Mantovani, Carmen Girardelli, Michele Trevisan, Daniele Carletti, Marco Cassini
UOC Ortopedia e Traumatologia, ULSS n. 21 Regione Veneto, Ospedale Mater Salutis, Legnago (VR)
supracondylar fracrture of humerus in childrenHardik Pawar
Supracondylar fractures of the humerus are the most common elbow fractures in children. They involve the lower end of the humerus just above the elbow joint. Radiographs are used to classify fractures as non-displaced (Type I), displaced with intact posterior cortex (Type II), or completely displaced (Type III). Treatment depends on the type of fracture and presence of displacement. Undisplaced fractures are treated with splinting while displaced fractures may require closed reduction and casting or pinning. Close monitoring of neurovascular status is important due to risk of injury.
This document provides an overview of femoro-acetabular impingement syndrome (FAIS). It defines FAIS as impingement between the proximal femur and acetabulum leading to cartilage injury and pain. There are two main types: cam FAI, caused by a bony thickening at the femoral head-neck junction; and pincer FAI, caused by an anomaly in the acetabular structure. Clinical features include groin pain, decreased range of motion, and late-stage osteoarthritis. Treatment involves both non-operative options like physical therapy as well as surgical options like arthroscopic surgery to resect impingement lesions and repair labral tears.
Claw hand, or intrinsic minus hand, is caused by paralysis of the intrinsic hand muscles due to ulnar nerve injury. This results in hyperextension of the MP joints and flexion of the PIP and DIP joints, impairing hand function. Management involves restoring flexion at the MP joints and extension at the PIP joints through static procedures like capsulotomy or dynamic tendon transfers. Dynamic transfers use expendable donor tendons like the ECRL/ECRB to restore finger flexion and grip strength. Legendary orthopedic surgeon Dr. Paul Brand pioneered many tendon transfer techniques for treating leprosy-related hand deformities and rehabilitating patients.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
Management of Primary Traumatic Shoulder Instabilitywashingtonortho
This document discusses the management of primary traumatic shoulder instability through a presentation by Dr. J.R. Rudzki. Some key points discussed include:
- Age is a primary risk factor for recurrence, with rates of 100% in patients <10 years old and 79% in patients aged 20-30 years old.
- Surgical stabilization may have better outcomes than conservative treatment for young, active patients based on data from randomized controlled trials.
- For first-time dislocators, arthroscopic Bankart repair reduces the risk of recurrent instability by 76-82% compared to non-operative management.
- Factors like glenoid bone loss, large Hill-Sachs lesions, and capsular
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
The document describes a study evaluating the "Remplissage" arthroscopic technique for treating traumatic shoulder instability accompanied by glenoid bone loss and Hill-Sachs defects. The study involved 28 patients who underwent the Remplissage procedure. Post-operatively, patients showed excellent functional outcomes with no reoccurrences of dislocation, nearly full return to work and sports, and significant improvements in shoulder scoring systems. The conclusion is that Remplissage offers excellent short-term results for addressing shoulder instability with humeral bone loss, despite some loss of external rotation.
This document provides information on ankle arthrodesis. It begins by describing the anatomy of the ankle joint and its biomechanics. It then discusses indications for ankle arthrodesis including various types of arthritis. Conservative management is outlined followed by details of the surgical procedure including patient evaluation, approaches, fixation methods, post-operative care and alternatives to fusion. Specific techniques like transfibular arthrodesis with a fibular strut graft are explained. The goal of ankle arthrodesis is to fuse the ankle joint to relieve pain from arthritis while maintaining alignment and function.
Planovalgus foot, also known as flatfoot, is characterized by a low or absent medial longitudinal arch and hindfoot valgus. The document discusses the anatomy and development of the foot arches, causes of pediatric and adult flatfoot including posterior tibial tendon dysfunction, and treatment options ranging from orthotics to surgery. Surgical procedures discussed include calcaneal osteotomies, tendon lengthening/transfer, and arthrodesis. Complications and special flatfoot conditions like tarsal coalition and congenital vertical talus are also summarized.
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
This document discusses treatment options for bone defects in the glenoid and humeral head that can cause recurrent shoulder instability. It finds that humeral head (Hill-Sachs) defects occur in 65-93% of cases depending on the number of dislocations, while glenoid defects occur in 5-56% of cases. Treatment depends on the size and engagement of the defects. For large Hill-Sachs lesions, options include bone grafting, arthroplasty, or the remplissage procedure. For significant glenoid bone loss over 20-30%, options include soft tissue repair plus bone grafting or procedures like Bristow or Latarjet to add bone to the glenoid. The document advocates
This document provides an overview of the history and evolution of total hip arthroplasty. It discusses early techniques from the 1820s through developments in the 1920s-1950s that led to modern total hip replacement designs. It then describes pre-operative planning including patient evaluation, x-ray templating, and considerations for implant selection and alignment. Key implant components like the acetabular cup and femoral stem are also summarized.
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
A 32-year-old male presents to the emergency department with right thumb pain after a skiing accident. He fell and landed on his outstretched right hand, pulling his right thumb away from his ski pole. On examination, swelling and tenderness were found over the right thumb. An avulsion of the ulnar collateral ligament, also known as skier's thumb, was diagnosed. Treatment involved splinting the thumb and following up urgently with hand surgery.
The document discusses factors that affect rehabilitation after rotator cuff repair surgery. It covers goals of repair and rehabilitation, current failure rates of repairs, and factors such as surgical approach, fixation method, and tissue quality that influence rehabilitation. Rehabilitation must be tailored based on these surgical and patient-specific factors to optimize repair healing and restore function.
Manuel Mesa. Teoría muscular en la génesis y tratamiento de la coxartrosis....SecretarioSOMUCOT
Este documento presenta información sobre la teoría muscular en la génesis y tratamiento de la coxartrosis, con un enfoque en el papel del músculo glúteo mayor. Describe los signos radiográficos de la coxartrosis, diferentes clasificaciones de la artrosis coxofemoral, y la biomecánica de la cadera. También explora la hipótesis de que la fibrosis del músculo glúteo mayor podría determinar el desarrollo de coxartrosis debido a desequilibrios musculares y alteraciones en la biome
This document discusses multiligament knee injuries, which involve injuries to two or more of the four main knee ligaments. Key points include:
- The incidence is low at 0.02% but many cases go undiagnosed. Injuries are usually due to high-energy trauma like car accidents.
- Associated injuries can include vascular injuries in 5-15% of cases, nerve injuries, and fractures.
- Treatment depends on the specific ligaments injured and stability of the knee. Acute repair or reconstruction is generally preferred but delayed reconstruction is also an option.
- Complications include vascular injuries, nerve injuries, stiffness, and laxity. Proper stabilization, mobilization
This document discusses several types of pelvic osteotomies used to treat developmental dysplasia of the hip. The main osteotomies covered are the Salter single innominate osteotomy, Pemberton acetabuloplasty, Steel triple innominate osteotomy, Chiari medial displacement, and Ganz periacetabular osteotomy. Most pelvic osteotomies require remodeling of the bone and are not as useful in older children over age 8. Careful matching of the procedure to each patient's individual case is needed. The more complex osteotomies have a steep learning curve for surgeons.
The document provides guidance on how to effectively work up and summarize a surgical patient case during a residency interview. It emphasizes knowing the preferred procedures of the interviewing program and being able to describe radiographic findings of flat feet in a systematic way. For a flat foot work up, the assistant should identify deformities in the sagittal, frontal, and transverse planes, then suggest procedures to address each, such as a gastrocnemius recession for sagittal plane correction or a medial calcaneal slide for frontal plane correction. Reading flat foot radiographs involves assessing specific angles on both AP and lateral views that indicate planovalgus deformity severity and type.
Trattamento dell'artrosi trapezio-metacarpale con 1/2 FCR "annodato" (2014)Alberto Mantovani
TRATTAMENTO DELL’ARTROSI TRAPEZIO-METACARPALE
CON TRAPEZIECTOMIA, LIGAMENTOPLASTICA E
INTERPOSIZIONE DI METÀ TENDINE FLEXOR CARPI
RADIALIS “ANNODATO”
Alberto Mantovani, Carmen Girardelli, Michele Trevisan, Daniele Carletti, Marco Cassini
UOC Ortopedia e Traumatologia, ULSS n. 21 Regione Veneto, Ospedale Mater Salutis, Legnago (VR)
il dottor Marco Spoliti illustra come curare nel modo migliore con Protesi la fratture di spalla di persone anziane, frattura omero prossimale, protesi inversa
Prolotherapy involves injecting an otherwise non-pharmacological and non-active irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.
Anterior Shoulder Instability Associated With Bony Defects. LATARJET. HovsepianJean Michel Hovsepian
Anterior Shoulder Instability Associated With Bony Defects. The Latarjet procedure has been used commonly for extra-articular treatment of anterior glenohumeral joint
instability. Shoulder Bone Defects. Glenoid Track. Inestabilidad Anterior con Defectos óseos. Latarjet. Material in Spanish.
This document discusses approaches to measuring and treating bone loss in the glenoid and humeral head that can contribute to shoulder instability. It addresses how to measure glenoid and Hill-Sachs lesions using various imaging modalities and arthroscopy. It presents studies examining the amount of glenoid and humeral head bone loss that significantly increases instability risk. The document also introduces the "glenoid track" and "Funky Pizza method" to assess if a Hill-Sachs lesion is engaging or non-engaging. It concludes with an overview of treatment approaches based on the size of glenoid and Hill-Sachs defects.
The document discusses various musculoskeletal injuries including sprains, strains, fractures, and dislocations. Sprains involve ligament tearing and are graded based on severity. Strains refer to muscle-tendon tearing. Fractures are described based on location, pattern, and displacement. Common musculoskeletal imaging modalities are also discussed.
Borsiti, tendiniti, sindrome del tunnel carpale, fibromialgia, artrosi lombare, cervicale, del ginocchio, dei piedi, come rallentare la distruzione delle cartilagini? La diffusione dell’artrite ha ormai raggiunto le dimensioni di un’epidemia. Circa 80 milioni di persone nel mondo soffrono di infiammazioni e dolori cronici alle articolazioni. Come prevenirne la degenerazione? Le risposte in questo articolo.La medicina non ha ancora trovato una cura all’artrite, anzi, si stima che ogni anno 16.000 persone muoiano a causa degli effetti collaterali dei farmaci anti-artrite. L’artrosi è una malattia degenerativa, la più frequente tra le patologie articolari, come si può prevenirne la degenerazione? Quali sono i rimedi naturali più adatti? Come mantenere in buona salute i nostri muscoli, tendini, legamenti e cartilagini? Qual è l’alimentazione consigliata? La medicina quantistica cosa può fare? Come funziona? La Nutripuntura può aiutarci? In questo articolo trovi le risposte a queste domande.
ASPETTI EMATOLOGICI DELLA MALATTIA DI GAUCHER: DALLA DIAGNOSI AL TRATTAMENTOCentroMalattieRareFVG
Slides presentate dai relatori durante il corso avanzato "Aspetti ematologici della malattia di Gaucher: dalla diagnosi al trattamento", che si è tenuto a Udine nei giorni 25 e 26 ottobre 2017.
IL TRATTAMENTO DELL’ARTROSI ISOLATA SCAFO-TRAPEZIO-TRAPEZOIDE CON TENODESI DE...Alberto Mantovani
SUMMARY
The authors report their experience in the treatment of isolated STT arthritis using a novel technique and propose a new clinico-radiological classification for the condition in four stages. In STT arthritis, the joint is rendered unstable due to the rupture of the capitotrapezium and volar scaphotrapezial ligaments. The objective of the operation is to stabilise this joint and, thus, eliminate the pain and the tenosynovitis that occurs due to the instability.
MATERIAL AND METHODOS. The technique involves deepening of the gutter for the flexor carpi radialis in the trapezium, excision of the distal part of the scaphoid and anchorage of the FCR in its fibro-osseous canal.
The hand is immobilised in a plaster for 2-3 weeks depending upon the condition of the tenosynovium and the tendon noted during surgery.
This technique has been utilised in 11 patients between 1995 and 2004 and the results have been reviewed.
RESULTS. Complete and permanent relief of pain was obtained in each of the 11 patients within an average period of 6 months. The follow-up ranged from 1-9 years. There was no loss of range of flexion nor extension as compared to the pre-operative conditions. In fact, we only noted an improvement in the mobility or it remained unchanged.
The scapho-lunate angle, too, was not affected following surgery. The increased angle noted in two patients before surgery, too, remained intact.
CONCLUSIONS. This technique of FCR tenodesis and minimal bony resection of the distal end of the scaphoid is a simple and efficient method that offers consistent results in the treatment of STT arthritis. It probably owes its success to the fact that it tackles the cause of pain i.e. the instability due to the ruptured capitotrapezium and volar scaphotrapezial ligaments.
Presentazione del convegno "ATTIVITA’ FISICA DOPO I 60 ANNI: GLI ESPERTI RISPONDONO" tenutosi presso la palestra Injoy di Thiene (VI) Sabato 12/11/2011.
Sono intervenuti oltre al Dr. Faccin, il Dr. Traina (Rizzoli-Bologna) ortopedico di indubbia fama e
Un utile documento per identificare le patologie e le cause dei nostri dolori quotidiani.
L’artrosi è un fisiologico processo di invecchiamento delle ossa e delle cartilagini che interessa tutte le articolazioni.
Presentazione dell'incontro dedicato all’attività fisica per coloro che hanno più di 60 anni.
Tenutosi persso la palestra Injoy di Thiene (VI) il 12/11/2011.
Un team di esperti hanno esposto alcuni recenti studi sui benefici dell’attività fisica dal punto di vista dell’Allenamento in palestra , Ortopedico e Fisioterapico.
Sono intervenuti:
Dr Traina Francesco ,Medico Chirurgo specialista in Ortopedia,dirigente ospedaliero presso l’Istituto Ortopedico Rizzoli di Bologna. Ricercatore ,ha eseguito attività di ricerca con pubblicazioni su riviste nazionali ed internazionali, ottenendo premi e riconoscimenti negli USA e in tutto il mondo.
Dr Faccin Nicola, laureato in Fisioterapia e sport physioterapist grazie al master di specializzazione patrocinato dal CONI presso l’Università degli studi di Siena
Michela Rigotto , personal trainer presso la palestra injoy di Thiene ed esperta in programmi posturali.
I bite dentali sembrano tutti uguali ma poi se analizzati danno risposte funzionali differenti e talvolta imprevedibili. Una piccola dimostrazione di differenti tipi di comuni bite proposti costruiti in uno stesso soggetto.
Similar to Dr. R.Mele presenta "La chirurgia.mano" (20)
Relazione del Dr Madeyski al 6° Congresso Simcri 2019 ad UdinePaolo Madeyski
Si parla della Ossigenoterapia in Normobarismo negli anni 2017-2018 (Casa di Cura Rizzola 2017-2018) e il razionale della Terapia con ossigenoterapia in normobarismo. Vantaggi per il paziente e per la Sanità Pubblica. Riduzione delle amputazioni maggiori , Importante rapporto vantaggi e svantaggi oltre a nessuna controindicazione
4) Terapia con la cámara local de Dr. Madeyski. Barcelllona 2013Paolo Madeyski
Diapositive proiettate al Congresso internazionale di Barcellona sul Piede diabetico che mostrano la terapia con ossigeno normobarico tramite Ulcosan New o Camera di Madeyski
Cámara de oxigenoterapia normobárica distrectual de madeyskiPaolo Madeyski
Este documento describe el caso clínico de un paciente diabético de 75 años con úlceras en el pie izquierdo. Se aplicó oxigenoterapia normobárica durante 5 semanas. Inicialmente la lesión tenía un área de 11,1 cm2 con tejidos desvitalizados y exudado alto. Tras 31 días de tratamiento, el área aumentó a 18,2 cm2 con mejoría de los tejidos, aumento de la perfusión sanguínea y control del exudado. La TcpO2 también mejoró de 5 a 16 mmHg.
Simcri 2016. Ossigenoterapia Normobarica VS IperbaricaPaolo Madeyski
Differenza tra ossigenoterapia in camera normobarica di Madeyski rispetto alla camera iperbarica nelle lesioni del piede diabetico e delle ulcere arti inferiori
Nuova Medicina Rigenerativa Estetica di Marco Scala
Dr. R.Mele presenta "La chirurgia.mano"
1. ARTROSI E L’ARTRITE DELLE MANI:ARTROSI E L’ARTRITE DELLE MANI:
CAUSE E RIMEDICAUSE E RIMEDI
2. OSTEOARTROSIOSTEOARTROSI
Malattia caratterizzata da fenomeni
degenerativi della cartilagine articolare,
cui si associano processi infiammatori
a carico della membrana sinoviale.
Incide per il 60% sul totale delle malattieIncide per il 60% sul totale delle malattie
reumatichereumatiche
4. Anatomia patologica artrosiAnatomia patologica artrosi
Alterazione delle proprietà di
elasticità e permeabilità
della cartilagine articolare:
• Da lucida ad opaca
• Erosioni e fissurazioni
• Esposizione dell’osso
subcondrale con osteofiti,
sclerosi, pseudocisti,
flogosi sinoviale
Alterazione delle proprietà di
elasticità e permeabilità
della cartilagine articolare:
• Da lucida ad opaca
• Erosioni e fissurazioni
• Esposizione dell’osso
subcondrale con osteofiti,
sclerosi, pseudocisti,
flogosi sinoviale
5. Immagine ARS di un’articolazione normaleImmagine ARS di un’articolazione normale
6. Immagine ARS di articolazione artrosicaImmagine ARS di articolazione artrosica
11. Da sola rappresenta il 10% diDa sola rappresenta il 10% di
tutte le localizzazionitutte le localizzazioni
artrosicheartrosiche
Rizoartrosi
L’articolazione più frequentementeL’articolazione più frequentemente
operata degli arti superiori è quellaoperata degli arti superiori è quella
trapezio-metacarpaletrapezio-metacarpale
12. Maggiore frequenza nel sesso femminile
Età post menopausale
Negli uomini più frequente in età
lavorativa
Rizoartrosi
Viene considerata secondaria a varieViene considerata secondaria a varie
condizioni coinvolgenti sia le strutturecondizioni coinvolgenti sia le strutture
anatomiche interessate sia i numerosianatomiche interessate sia i numerosi
fattori stressantifattori stressanti
13. correlazione fra fattori biomeccanici e
biochimici
Rizoartrosi
prevalenza di alterazioni biochimiche piuttosto che
un semplice e primitivo logorio meccanico della
cartilagine articolare normale.
14. Sempre presente grave diminuzione dei
GAG (glucosaminoglicani), una
perdita di idrossiprolina (Hyp),
diminuzione del condroitin-solfato
(CS) rispetto al Keratan-solfato (KS)
Rizoartrosi
15. ALP
ALP, che si inserisce sul 1° metacarpo, abducendolo e
portandolo in avanti (favorisce la sublussazione)
ALP
Rizoartrosi
16. Joint static compressive forces in
TMJ
• simple pinch with 1 kg
force, 12 kg of force is
applied in TMJ
• strong grasp 120 kg of
compressive forces
may occur in CMCJ
Cooney WP Chao EY Biomechanical analysis of static forces
of the thumb during hand function JBJS 1977; 59A; 27-36
Mele R Principi di anatomia funzionale e biomeccanica dell’arto
superiore. Trattato di Chirurgia della mano Verduci ed. 2007
17. SINTOMATOLOGIA
• Dolore alla base del pollice riferita nell’esecuzione di alcuni
movimenti attivi (prese, pinze) e/o passivi (rotazione, opposizione,
digitopressione)
• Difficoltà crescente nello svolgere attività della vita quotidiana quali
lo svitare tappi di bottiglia o scatolame, girare la maniglia o chiavi
nella toppa, scrivere con una penna sottile o anche abbottonarsi una
maglia
• Nelle fasi più avanzate il dolore è spontaneo ed associato a crepitio
quadri clinici molto compromessi al controllo radiografico hanno unquadri clinici molto compromessi al controllo radiografico hanno un
bassissimo impatto sull’attività del paziente, mentre, in altri casi, stadibassissimo impatto sull’attività del paziente, mentre, in altri casi, stadi
iniziali possono essere estremamente fastidiosi e causa di severiiniziali possono essere estremamente fastidiosi e causa di severi
deficit funzionalideficit funzionali
24. TRAPEZIECTOMIA E PLASTICA IN SOSPENSIONE
Asportazione del trapezio e realizzazione della
“sospensione” del metacarpo attraverso una
plastica tendinea
27. 1 SFERICHE VINCOLATE
NON CEMENTATE
CEMENTATE
ENTRAMBI I TIPI ( ES. ROSELAND,ETC)
2 SFERICHE NON VINCOLATE
3 DI RIVESTIMENTO O ANATOMICHE
TIPOLOGIA DI PROTESI
DE LA
CAFFINIERE
TRIPODAL
34. POST OPERATORIO
• Tutore per quattro settimane
• Rimozione e inizio di esercizi di opposizione
con le altre dita fino al recupero della motilità
residua del primo raggio
• Esercizi di presa con le dita
• Esercizi con la plastilina
• Recupero funzionale nell’arco di alcuni mesi
38. M. DI DE QUERVAINM. DI DE QUERVAIN
definizionedefinizione
Tenosinovite stenosante del primo compartimento
dorsale del polso dove decorrono i tendini del ALP
e EBP
39. Attività ripetitive che richiedono abduzione
del pollice e deviazione ulnare del polso
Frizione sul retinacolo e conseguente
edema e/o restrigimento del canale
osteofibroso
Tendini abberranti nel 1° comp. dorsale
Attività ripetitive che richiedono abduzione
del pollice e deviazione ulnare del polso
Frizione sul retinacolo e conseguente
edema e/o restrigimento del canale
osteofibroso
Tendini abberranti nel 1° comp. dorsale
Tenosinovite di de QuervainTenosinovite di de QuervainTenosinovite di de QuervainTenosinovite di de Quervain
40. DE QUERVAIN clinicaDE QUERVAIN clinica
• Dolore alla superficie dorsale e
radiale del polso
• Aumento del dolore durante la presa
a pinza
• Tumefazione locale, a volte di
consistenza dura
• Test di Finkelstein
41. Finkelstein H: Stenosing tendovaginitis at
the radial styloid process. J Bone Joint
Surg 12: 509-540,1930.
Finkelstein H: Stenosing tendovaginitis at
the radial styloid process. J Bone Joint
Surg 12: 509-540,1930.
TEST DI FINKELSTEINTEST DI FINKELSTEINTEST DI FINKELSTEINTEST DI FINKELSTEIN
ALP
EBP
Pollice all’interno della mano, quindi flettere e ulnarizzare
il polso
43. Tenosinovite di de QuervainTenosinovite di de QuervainTenosinovite di de QuervainTenosinovite di de Quervain
44. Dito a scattoDito a scatto
È la tenovaginite stenosanteÈ la tenovaginite stenosante
delle dita e del pollice.delle dita e del pollice.
Causa comune di dolore allaCausa comune di dolore alla
mano e di disabilità.mano e di disabilità.
La degenerazione del tendineLa degenerazione del tendine
causa un conflitto con lacausa un conflitto con la
puleggia e di conseguenza sipuleggia e di conseguenza si
verifica un blocco nelloverifica un blocco nello
scorrimento durante la flesso-scorrimento durante la flesso-
estensione del ditoestensione del dito
45. Dito a scatto Clinica
Flessione attiva delle dita, quindi
all’estensione il dito affetto si blocca, mentre
gli altri completano il movimento
46. ETIOLOGIA
FATTORI EPIDEMIOLOGICI COMUNI:
• Coesistenza di STC, dita a scatto, De
Quervain, epicondilite e borsite
subacromiale di spalla.
• Attività che richiedono di esercitare una
pressione con il palmo della mano
mentre si esegue una presa di forza o
quando vi sono movimenti ripetuti di
flessione
• Fattori anatomici
(Ottica antero-mediale) A ginocchio esteso è possibile dimostrare i rapporti dell’apice del corpo adiposo di Hoffa con l’articolazione, che se ipertrofico si insinua tra rotula e femore.
Esposizione dell’osso subcondrale della porzione laterale della troclea femorale in un soggetto anziano con evidente iperpressione esterna.