Name:
Wrist Arthroscopy with LT Pinning, and ECTR using Disposable Kit
Description:
Wrist Arthroscopy with LT Pinning, and ECTR using Disposable Kit
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/cde3c855-898e-4f59-ad7c-2150af28583d/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H05M36S
Embed URL:
https://stream.cadmore.media/player/cde3c855-898e-4f59-ad7c-2150af28583d
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/cde3c855-898e-4f59-ad7c-2150af28583d/Wrist arthroscopy with LT pinning%2c and ECTR using disposable.mp4?sv=2019-02-02&sr=c&sig=Bf%2B4Jxn447WgsBUm4WRsnkmfKVaMU28ER%2Bmw6DL33kE%3D&st=2024-11-23T09%3A29%3A26Z&se=2024-11-23T11%3A34%3A26Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DR. ALEJANDRO BADIA: We'll be demonstrating here a wrist arthroscopy in a laborer who also had secondary numbness in the hand and we'll be releasing a carpal tunnel as well. If you notice, the joint insufflation quickly led to all of the fluid being introduced into the joint, which is often indicative of significant internal derangement of the wrist. The 3-4 portal is the workhorse for wrist arthroscopy, and that will be the working camera portal, that is between the third and fourth extensive compartments.
DR. ALEJANDRO BADIA: These six are portal or just radial to the 6 extensor compartment will be used to introduce this full radius. Shaver is a 2.9 shaver and quickly demonstrates that there is some disruption along the peripheral TFCC, but there is no loss of the trampoline effect. This effectively tells us that we do not need to do a formal repair. There's a negative liftoff test indicating that the four wheel attachment is intact.
DR. ALEJANDRO BADIA: Therefore, we will address this with radio frequency to tighten the margins and in this case, reduce some of the redundancy of the frayed ligament at the LT interval, which we will fully assess through the midcarpal joint. Notice here we are tightening the peripheral margin of that TFCC articular disk. The critical portal will now be the radial midcarpal portal, which is just distal and a bit more central than the 3 4 portal.
DR. ALEJANDRO BADIA: We dilate this first with a clamp. And the 2.9 millimeter, 30 degree cameras inserted. And we can immediately appreciate that there is a bare spot on the triquetrum. This is often indicative of carpal instability, meaning the extrinsic ligaments were injured. The owner made carpal portal will now be used to help probe. And in this case, we are changing the interval to better assess the scapholunate interval.
DR. ALEJANDRO BADIA: But here we notice it's completely intact. The probe cannot be inserted between the proximal polar scapholunate There is a type 2 fuset to the lunate and we see the significant step off between the triquetrum relative to the lunate. And again, the bare spot, which is a subtle sign of a grade 3 lunal triquetrum ligament injury. Therefore this will be treated with very judicious use of thermal shrinkage, but we will need to further debris the LT interval and now we'll pin it because the debris, that area will bleed once a tourniquet is released.
DR. ALEJANDRO BADIA: And those pins are now cut underneath the skin and they will be removed at approximately 7 to eight weeks post-op where a new LT ligament will essentially form. It's quite a steep angle that we insert and this is done under fluoroscopic guidance with the static image showing good parallel position of both pins. So there is no rotation of the lunate relative to the triquetrum.
DR. ALEJANDRO BADIA: We now will decompress the carpal tunnel. This is an endoscopic technique, but in this case, we will be using an all disposable device. The reason being is that the hope is that many of these patients will have the carpal tunnel released in an office procedure. Much of this will be driven both by insurance and consumer driven.
DR. ALEJANDRO BADIA: Therefore, we are at this point trialing this all disposable system, theTrice medical system, which is the previously known as the segue. This was a metal cannula and now it is a clear plastic. This gives us better visualization and we can see the transverse fibers of the transverse carpal ligaments clearly, we will use this rasp to ensure that there is no interposed nerve segment or tendon and allows us to cut the ligament with a clear visualization.
DR. ALEJANDRO BADIA: It is a retrograde knife. It is quite sharp. We start distally and as you will see we can confirm whether there is a significant enough release. So we need to do that further more distally. There's oftentimes fascia, the most distal part, but being careful to avoid the superficial vascular arch. We also retract the skin right there proximally to ensure we don't cut it.
DR. ALEJANDRO BADIA: The thenar muscles and the palmaris brevis are generally not cut as this will minimize any pillar pain. We now use this 90 degree angled probe to confirm that there is indeed a portion of the transverse carpal ligament, which still needs to be released. That is a critical portion of the procedure. Otherwise the patient can continue to have symptoms due to very focal compression of the medial nerve in the most distal aspect of the carpal canal.
DR. ALEJANDRO BADIA: There, as you saw, the ligament quickly separates once it's completely divided. It's also important to do a release of the antebrachial fascia. However, this is done essentially open with direct visualization. We typically will use a single 4.0 vicryl, rapide absorbable stitch. The patient will be able to bathe and get this wound wet within five to 6 days and the stitch will fall off at that point.
DR. ALEJANDRO BADIA: Notice the range of motion quickly achieved within weeks after pin removal. At that time, we also do a manipulation of the wrist under sedation. And the patient will continue therapy, would focus now on strengthening and gradual incorporation into work and in many cases, sport. This is a minimally invasive surgery that allows both the diagnostic and therapeutic treatment of carpal instability.
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
