Name:
Wrist Arthroscopy With LT Pinning and Open Ulnar Shortening Osteotomy
Description:
Wrist Arthroscopy With LT Pinning and Open Ulnar Shortening Osteotomy
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/0ce0dcc9-7f69-4b77-aac9-8d2200facffa/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H05M31S
Embed URL:
https://stream.cadmore.media/player/0ce0dcc9-7f69-4b77-aac9-8d2200facffa
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/0ce0dcc9-7f69-4b77-aac9-8d2200facffa/Wrist arthroscopy with LT pinning%2c and open ulna shortening .mp4?sv=2019-02-02&sr=c&sig=tZQbIElMOU65fMEk7Ppu585uh2sC6ZjGItodv%2BPY0CM%3D&st=2024-11-22T04%3A03%3A19Z&se=2024-11-22T06%3A08%3A19Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ALEJANDRO BADIA: In this middle aged female will be planning an arthroscopy to determine the extent of ulnar impaction and proceed with shortening osteotomy if indicated. We see there is marked ulnar positive variance in this plain X-ray, would impaction that is seen already on the lunate. Wrist arthroscopy will be done to confirm this but to also address the issues, namely whether there is a TFCC tear or not.
ALEJANDRO BADIA: As we insufflate the joint, we can see the entire contents of the syringe are emptied into the joint suggesting their significant internal derangement. This is done through the 3-4 portal. This is a 2.7 millimeter, 30 degree scope, which we will use, and we will first determine the extent of pathology in the radial carpal joint.
ALEJANDRO BADIA: To do synovectomy and better visualize, we will create a portal in the 6R interval, now inserting a 2.9 millimeter full radius shaver, noting already signs of ulnar impaction on the lunate. Radio frequency will be used to help complete the synovectomy and address the capsule. We now go to the midcarpal joint to rule out any carpal instability, seeing all four carpal bones at this corner
ALEJANDRO BADIA: and we'll then make the ulnar mid carpal portal to introduce full radius shaver and determine if there is any carpal instability. We immediately see the bare spot on the triquetrum, which is a subtle sign of lunar triquetral instability. We will now confirm this by inserting a small joint hook probe, we can easily place it between the two carpal bones, noting the step off of the joint.
ALEJANDRO BADIA: This is essentially a grade 3 lunar triquetral ligament tear. Radial frequency will now be used to tighten and address the central TFCC tear typically see what ulnar impaction. We already determined we will need to pin the LT interval that is done by taking traction off of the wrist and then using a .045 k-wire to pass through the triquetrum into the lunate, checking pin position in AP and lateral views. As we move the wire, we confirm that the carpal bones move as a unit.
ALEJANDRO BADIA: That pin is cut underneath the skin and we now place a second wire parallel to avoid any rotation motion. Again, final fluoroscopy pictures are taken. Now, we will proceed with ulnar shortening in order to alter the underlying anatomy that caused the problem to begin with using a volar incision. This is a much smaller incision than the plate even affords, and we can always lengthen it as needed. We pass underneath the flexor carpi ulnaris and identify the volar cortex of the distal ulnar shaft.
ALEJANDRO BADIA: In this case, we will use a compression plate, but we will not use the special ulnar shortening osteotomy jigs. Part of the reason is cost and in this particular patient, we are essentially doing this freehand hence the video. We lock in the plate distally and now we'll place a screw. This is the Intellisense. [DRILLING STARTS] The first please.
ALEJANDRO BADIA: 11.4 drill, please. So that second beep is the far cortex being penetrated and the Intellisense technology tells us the screw length. We will now remove the plate. Once the plate is removed, we will then make the cut. This is an oblique cut, removing approximately 3 to 4 millimeter wedge of bone. We do this obliquely because there's more surface area for bony healing.
ALEJANDRO BADIA: There's that wedge removed. Now reapply the plate with the distal screws. Once that plate is well secured, we will then pull on the plate proximally and that will close down the gap. Essentially the same thing that is done with one of the jigs, which is another alternate technique. There you see on my left hand, I'm pulling on a plate and my first assistant, Kate Samuels, is placing that screw,
ALEJANDRO BADIA: and now we'll close down the gap, which we will check momentarily. The remainder of the screws are applied. This is the most proximal screw. We will flex the wrist in order to be able to translate the skin sufficiently. There is no need for very large incisions because that simply creates more soft tissue trauma and healing issues.
ALEJANDRO BADIA: And now the most distal of the screws. We do use a compression lag, oblique screw and you will see that they're closing down the gap. You see good position to the plate and you see the k-wires in position if you notice there was also now an ulnar neutral, slightly negative variant, so we corrected the ulnar positive variance.
ALEJANDRO BADIA: Subcutaneous closure is done with several 3-0 vicryl sutures. This takes tension off of the skin edges, but we will close the skin also with absorbable stitches, in this case, vicryl rapide. There is after the pins were removed at eight weeks and we see already healing at the osteotomy site. Arthroscopy gives us the indication for what will be done in surgery, planning pre operatively the ulnar shortening osteotomy due to the clinical and radiographic findings.
ALEJANDRO BADIA: This is done under regional block anesthesia as an outpatient procedure and tends to be a very successful surgery as we are altering the anatomy in the patient's best interest. Thank you for your attention.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
