MILANO 11-14 Ottobre 2006 PALAZZO MEZZANOTTE

1. 44° Congresso Nazionaledella Società Italiana di Chirurgia della ManoMalformazioni Congenite Materiali e Nuove Tecnologie 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, Università degli Studi, Genova) MILANO 11-14 Ottobre 2006 PALAZZO MEZZANOTTE

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

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

5. 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

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

7. 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

8. 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 “

9. 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

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

11. TM joint luxation

12. Hand-saw Minimal bone resection Avoiding shortening of the thumb

13. Trapezium cartilage resection Quadrangular space

14. 1,4 or 1,6 mm K wires

15. without going beyond the TS joint!

16. ANY KIND OF IMMOBILIZATION Early motion granted and guided by a taping in painless range for the first 10-12 days

17. K Wires removal after 25 days

19. 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.

20. 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 pseudoarthrodesisin the last 2 years (3 “Z” thumbs)

21. “Z” Thumb

22. - 45 days with K wires- one K wire has a grip on the scaphoid- one K wire does not allow the MF iperextension

23. 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

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

25. thanks for attention