44° Congresso Nazionale della Societ à Italiana di Chirurgia della Mano Malformazioni Congenite Materiali e Nuove Tecnologie MILANO Ottobre 2006 PALAZZO MEZZANOTTE MILANO Ottobre 2006 PALAZZO MEZZANOTTE New Surgical Technique About Thumb ’ Osteoarthrosis Autori: M. Rubino*, A. Civani**, G. De Montis**, L. Biglieni**, M. Moretti*, S. Bardella*. (*I Div. Ortopedia, Osp. S. Martino, Genova; **Clin. Ortopedica, Universit à degli Studi, Genova) New Surgical Technique About Thumb ’ Osteoarthrosis Autori: M. Rubino*, A. Civani**, G. De Montis**, L. Biglieni**, M. Moretti*, S. Bardella*. (*I Div. Ortopedia, Osp. S. Martino, Genova; **Clin. Ortopedica, Universit à degli Studi, Genova)

Rhizoarthrosis Classification: Dell Eaton Brunelli Rhizoarthrosis Classification: Dell Eaton Brunelli Clinical Relieves pain functional loss in pinching TM instability (Grinding test +) pain functional loss in pinching TM instability (Grinding test +) Surgical indications

- Prosthesis of TM - Arthrodesis - Tendon arthroplasty - Arthroscopic technique Variants of technique

Arthrodesis disadvantages -TS joint overload particularly unuseful in young patients - Inability in adduction of the thumb - Metacarpal head relief when the hand leans on flat surface -TS joint overload particularly unuseful in young patients - Inability in adduction of the thumb - Metacarpal head relief when the hand leans on flat surface

Tendon arthroplasty CRF Tendinitis in 40% to 60% until 7-8 months after surgery Reflex sympathetic dystrophy in prone subjects CRF Tendinitis in 40% to 60% until 7-8 months after surgery Reflex sympathetic dystrophy in prone subjects

Need of a new technique failed attempts of TM arthrodesis bony segments mobility in presence of implants pain and functional limitation good recovery by removal implant leaving articular surfaces decorticated and covered by a coat of fibrous tissue that restore integrally the TM joint function

Innovative idea: The search of a surgical technique that aims to obtain immediately the conditions before described and not as secondary to a failed attempt of arthrodesis For these reasons we have named this technique “ PSEUDOARTHRODESIS “ Innovative idea: The search of a surgical technique that aims to obtain immediately the conditions before described and not as secondary to a failed attempt of arthrodesis For these reasons we have named this technique “ PSEUDOARTHRODESIS “

Pseudoarthrodesis - removing by hand-saw cartilage of trapezium and basis of the first metacarpal -Temporary blocking with K wires ( 25 days) strictly without going beyond the TS joint -motion immediately granted and guided by a taping in painless range until the stitches removal - removing by hand-saw cartilage of trapezium and basis of the first metacarpal -Temporary blocking with K wires ( 25 days) strictly without going beyond the TS joint -motion immediately granted and guided by a taping in painless range until the stitches removal

Dorsal - radial approach Paying attention to the radial nerve sensitive branches

TM joint luxation

Hand-saw Minimal bone resection Avoiding shortening of the thumb

Trapezium cartilage resection Quadrangular space

1,4 or 1,6 mm K wires

without going beyond the TS joint!

ANY KIND OF IMMOBILIZATION Early motion granted and guided by a taping in painless range for the first days ANY KIND OF IMMOBILIZATION Early motion granted and guided by a taping in painless range for the first days

K Wires removal after 25 days

We have been using this technique for two years (at the beginning alternated with Weilby-Ceruso technique) During the last year we managed all rhizhoarthrosis with this new technique, as results completely satisfy us We have been using this technique for two years (at the beginning alternated with Weilby-Ceruso technique) During the last year we managed all rhizhoarthrosis with this new technique, as results completely satisfy us Association with trapezium scaphoidal arthrosis Weilby-Ceruso. Association with trapezium scaphoidal arthrosis Weilby-Ceruso.

Cases 81 cases: 32 arthrodesis failed ( 24 with cambre, 8 with plates and screw of 2 o 2.7 mm ) in the last 13 years 49 rhizoarthrosis managed with pseudoarthrodesis in the last 2 years (3 “Z” thumbs) Cases 81 cases: 32 arthrodesis failed ( 24 with cambre, 8 with plates and screw of 2 o 2.7 mm ) in the last 13 years 49 rhizoarthrosis managed with pseudoarthrodesis in the last 2 years (3 “Z” thumbs)

“Z” Thumb “Z” Thumb

- 45 days with K wires - one K wire has a grip on the scaphoid - one K wire does not allow the MF iperextension

Results - Pain: immediately absent without motion; until the second-third month durring strong pinching - Strength in pinch: equal or superior than the other side between the second and fourth month -Fisiological range of motion : optimal within the second month in hard patients too - Results lasting in time Results - Pain: immediately absent without motion; until the second-third month durring strong pinching - Strength in pinch: equal or superior than the other side between the second and fourth month -Fisiological range of motion : optimal within the second month in hard patients too - Results lasting in time

- Simple - Economic - Easy post-surgical management - Changeable in according to the case by position of K wires, time of immobilization, use of taping - Simple - Economic - Easy post-surgical management - Changeable in according to the case by position of K wires, time of immobilization, use of taping Conclusions Technique: