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Wrist sep09
- 1. sep 2009
- 2. Was bedeutet der handsurgeon wissen wollen?
- 3. Xray Measurements • Carpal height • Ulnar variance • Radial inclination • Radial length • Palmar tilt • Radial shift
- 4. Position • Neutral PA • Neutral Lat
- 5. Position • Neutral PA • Neutral Lat
- 6. Position: PA • Wrist and elbow shoulder height • radius and ulna parallel
- 7. Extensor carpi ulnaris groove • Radial to mid styloid
- 8. Extensor carpi ulnaris groove • Radial to mid styloid
- 9. Position: Lateral • Elbow adducted • Shoulder elbow wrist in 1 plane
- 10. Lateral CCC • Radius • Lunate • Scaphoid
- 11. Lateral CCC • Radius • Lunate • Scaphoid
- 12. Lateral CCC • Scaphoid • Pisiform • Capitate
- 13. Lateral CCC • Scaphoid • Pisiform • Capitate
- 14. CCC OK!
- 16. CCC niet OK.
- 17. Shape Lunate
- 18. Scaphoid shape Ext Uln. deviation
- 19. Scaphoid flex / radial deviation rad deviation flex
- 20. Scaphoid axis
- 21. Lunate axis
- 22. Capitate axis
- 25. Carpal height • Base MC3 • Radiocarpal • Collapse – RA – SL collapse – Lunatomalacie
- 26. Carpal height • Ratio – MC3 (0.54) – Capitate (1.57)
- 27. Carpal height • Ratio – MC3 (0.54) – Capitate (1.57)
- 28. Ulnar variance
- 29. Ulnar variance • Load transfer • Growth disorder • Post trauma
- 30. Ulnar variance • Association – SL instable – Ulnocarpal impaction – TFCC • Normal + 3 mm Mid
- 31. Radial inclination • Fracture: – <5° poor outcome • Madelung steep • Normal 16-28°
- 32. Radial inclination • Fracture: – <5° poor outcome • Madelung steep • Normal 16-28° Mid
- 33. 1878 O. W. Madelung: Die spontane Subluxation der Hand nach Vorne.
- 34. Radial length • Styloid length • Shortening after # • Compare L-R • Normal 10-18 mm
- 35. Radial length • Styloid length • Shortening after # • Compare L-R • Normal 10-18 mm Mid
- 36. Palmar tilt • Volar ligaments • Dorsal bony ridge • Residual deformity – 200% load ulnocarpal • Normal 0-22 °
- 37. Palmar tilt • Volar ligaments • Dorsal bony ridge • Residual deformity – 200% load ulnocarpal • Normal 0-22 ° Mid
- 38. Radial shift • # dislocation • PA • Styloid • Midshaft • Compare L-R – max 1mm
- 39. Radial shift • # dislocation • PA Width • Styloid • Midshaft • Compare L-R – max 1mm Mid
- 41. Wrist conditions • Carpal instability • Scapholunate Collapse • Ulnar translocation • Ulnocarpal impaction • Radio-Ulnar impingement
- 42. Carpal instability • SL - scapholunate • LT - lunotriquete • SLT - Combined • Ligaments intact?
- 43. Arc I LT
- 44. Arc II SL LT
- 45. Arc III CH
- 46. DISI Dorsal intercalated segment instability
- 47. DISI (pathology) Dorsal ... instability Lunatum kijkt naar posterior A A
- 48. VISI Volar intercalated segment instability
- 49. VISI (variant) Volar .. instability Lunatum kijkt naar anterior A A
- 50. VISI LT Collapse
- 51. Instability LT Collapse Arc 1 Short Scaphoid Parallel
- 52. VISI Palmar tilt Scaphoid Lunate
- 53. VISI Palmar tilt Scaphoid Lunate
- 54. VISI Palmar tilt Scaphoid Lunate
- 55. VISI SL angle < 30 °
- 56. Scapho lunate advanced collapse • Progressive • Clinical & Radiological • Narrowing • Sclerosis • Osteophyte SLAC • CPPD deposition • Non union
- 57. SLAC •a
- 58. Ulnar translocation • Clinical & Radiological • Disruption R-C lig. • Instability • Ulnar displacement – Scaphoid-Styloid – Hamate-Ulna
- 59. Ulnar translocation Scaphoid-Styloid
- 60. Ulnar translocation Ulna - Hamate
- 61. Ulnocarpal impaction • U-L-T Joint degeneration • Compressive forces • Ulna +
- 62. Ulnocarpal impaction • U-L-T Joint degeneration • Compressive forces • Ulna + T L U
- 63. Radio-Ulnar impingement • ulna -, concave radius, convergence
- 64. TFCC Intact #
- 66. Case 1
- 67. Case 1 • Lunate not parallel • Arc 1 en 2 • Triangular lunate • Dislocated!
- 68. Case 2
- 69. Case 2 TL, HL overlap Parallel R,L,prox S, prox C Triq,H,dist S, dist H, Trap # H, S
- 70. Case 2 TL, HL overlap Parallel R,L,prox S, prox C Triq,H,dist S, dist H, Trap # H, S Trans scaphoid and capitate perinlunate # dislocation
- 71. Case 2
- 72. Case 2
- 73. Case 3
- 74. Case 3 LT not parallel Arc 1, 2 broken SL tilted VISI LT dissociation
- 75. Case 4
- 76. Case 4 All parallel SL wide Scaphoid tilt Lunate tilt Arthrosis RS CL SLAC (SL tear)
- 77. SLAC (CPPD)
- 78. Approach CCC and CCC Parallel joints Overlap Carpal Arcs Shape Fracture