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ARTHRODESIS

ARTHRODESIS. DR.MOHAMMAD BASHAR AL BOSHI. SHOULDER ARTHRODESIS. INDICATIONS. Indications for shoulder fusion have diminished over the years because of: the excellent results of shoulder arthroplasty. the near elimination of poliomyelitis and tuberculosis.

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ARTHRODESIS

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  1. ARTHRODESIS DR.MOHAMMAD BASHAR AL BOSHI ARTHRODESIS

  2. SHOULDER ARTHRODESIS ARTHRODESIS

  3. INDICATIONS Indications for shoulder fusion have diminished over the years because of: • the excellent results of shoulder arthroplasty. • the near elimination of poliomyelitis and tuberculosis. • the improved techniques for shoulder stabilization. ARTHRODESIS

  4. ARTHRODESIS

  5. Contraindications • Osteonecrosis. • Charcot arthropathy(nonunion rate is high). • Ipsilateral elbow fusion. • Contralateral shoulder fusion. ARTHRODESIS

  6. We agree that the position of rotation is the most critical factor in obtaining optimal function. ARTHRODESIS

  7. ARTHRODESIS

  8. SURGICAL TECHNIQUES • the limited contact between the glenoid fossa and humeral head can be improved by including the acromion in the fusion mass. • Firm internal fixation usually eliminates the need for bone grafting and external fixation. ARTHRODESIS

  9. Used as graft COMPRESSION TECHNIQUES—EXTERNAL FIXATION • TECHNIQUE 1 (Charnley and Houston) ARTHRODESIS

  10. 5 to 6 weeks cast 12 weeks ARTHRODESIS

  11. COMPRESSION TECHNIQUES—INTERNAL FIXATION • TECHNIQUE 1 (Cofield) ARTHRODESIS

  12. spica cast 12 to 16 weeks 45 Degrees TECHNIQUE 1 (Cofield) ARTHRODESIS

  13. AFTERTREATMENT: • A pelvic band extending from the nipples to the pubic symphysis is applied. • With the elbow flexed 90 degrees, a cylinder cast is applied to the upper extremity. • The extremity is suspended by two wooden struts, or a cock-up wrist splint is used. • At 1 to 2 weeks after surgery, a plastic shoulder spica cast is applied and worn until union is achieved, 12 to 16 weeks after surgery. ARTHRODESIS

  14. TECHNIQUE 2 (Uematsu) Position 20 degrees of abduction, 30 degrees of flexion, and 40 degrees of internal rotatio Used as graft A cast 3 months ARTHRODESIS

  15. the distal acromion as avascularized graft A shoulder spica 8-10 weeks • TECHNIQUE 3 (Mohammed) ARTHRODESIS

  16. Apply bone grafts No cast • TECHNIQUE 4 (AO Group) ARTHRODESIS

  17. 60 D Position 30 degrees of flexion, 30 degrees of abduction, and 30 degrees of internal rotation. Do not osteotomize the acromion A shoulder spica cast 6weeks • TECHNIQUE 5 (Richards et al.) ARTHRODESIS

  18. ARTHRODESIS

  19. ELBOW ARTHRODESIS ARTHRODESIS

  20. ARTHRODESIS

  21. POSITION • For unilateral arthrodesis of the elbow, a position of 90 degrees of flexion is desirable. • Bilateral elbow arthrodesis rarely is indicated because of resultant functional limitations. If indicated, one elbow should be placed in 110 degrees of flexion to permit the patient to reach the mouth and the other should be placed in 65 degrees to aid in personal hygiene. ARTHRODESIS

  22. AGraft:1.5 x 9 cm Fitting cast 8 weeks • TECHNIQUE 1 (Steindler) ARTHRODESIS

  23. Grafts:8 mm x 7.5-10 cm Fitting cast 8 weeks • TECHNIQUE 2 (Brittain) ARTHRODESIS

  24. Fitting cast 8 weeks • TECHNIQUE 3 (Staples) ARTHRODESIS

  25. Technique for fusion in tuberculous arthritis of elbow. use the resected epicondylar and olecranon fragments as bone grafts • TECHNIQUE 4(Arafiles) a long arm cast for 3 months ARTHRODESIS

  26. The fixator and pins 6 to 8 weeks a long arm cast until the arthrodesis is solid • TECHNIQUE 5 (Müller et al.) ARTHRODESIS

  27. The plate and screws 1year only Apply bone graft • TECHNIQUE 6 (Spier) The most common indication was a high-energy, open, infected injury with associated bone loss. ARTHRODESIS

  28. Complications Complications of elbow arthrodesis include: • Delayed union. • Nonunion. • Malunion. • Neurovascular injury . • Painful prominent hardware . • Skin breakdown. ARTHRODESIS

  29. WRIST ARTHRODESIS ARTHRODESIS

  30. ARTHRODESIS

  31. Contraindications include : • An open physis of the distal radius( The distal radial physis close approximately 17 years of age). • After partial destruction of the physis ,the remaining part may be excised to prevent unequal growth. • An elderly patient with a sedentary lifestyle, especially if the nondominant wrist is involved. ARTHRODESIS

  32. POSITION • Usually 10 to 20 degrees of extension (dorsiflexion) with the long axis of the third metacarpal shaft aligned with the long axis of the radial shaft (allow maximum grasping strength). • In general, neutral to 5 degrees of ulnar deviation is preferred. • If bilateral wrist fusions are indicated, the positions of the wrists should be determined by the needs of the patient( The neutral position). ARTHRODESIS

  33. The straight plate is employed when a large intercalary graft is required for a traumatic or tumorous defect. • The short carpal bend is used in small wrists and those in which the proximal row has been resected. • The longer carpal bend is used in large wrists. ARTHRODESIS

  34. TECHNIQUE 1 (AO Group) cancellous bone harvested from the excised bone A cast (10 to 12 weeks) ARTHRODESIS

  35. 80% Supporting the fusion site with Kirschner wires or staples. bone graft is not necessary. cast or splint for 12 to 16 weeks • TECHNIQUE 2 (Louis et al.) ARTHRODESIS

  36. cast or splint for 12 to 16 weeks 2.5x4cm If the wrist is unstable, insert a nonthreaded Kirschner wire • TECHNIQUE 3 (Haddad and Riordan) ARTHRODESIS

  37. Place an outer cortical piece of iliac bone graft Cast 6-8weeks • TECHNIQUE 4 (Watson and Vendor) ARTHRODESIS

  38. ARTHRODESIS

  39. ARTHRODESIS OF FINGER JOINTS ARTHRODESIS

  40. INDICATIONS • Damaged by injury or disease. • Pain. • Deformity. • Instability makes motion a liability rather than an asset. • Arthrodesis is used most often for the proximal interphalangeal joint because motion in this joint is so important. • When the metacarpophalangeal joint is destroyed, if good muscle strength is present, arthroplasty is indicated more often than arthrodesis. ARTHRODESIS

  41. POSITION • The metacarpophalangeal joint should be fixed in 20 to 30 degrees of flexion. • The proximal interphalangeal joints should be fixed from25 degrees of flexion in the index finger to almost 40 degrees in the small finger (less flexion in the radial fingers than in the ulnar fingers). • The distal interphalangeal joints are fixed in 15 to 20 degrees of flexion. ARTHRODESIS

  42. Ball-socket Or Cup-cone Splint2-3days • TECHNIQUE (Stern et al.; Segmüller, Modified) ARTHRODESIS

  43. A, Phalangeal osteotomy. • B, Holefor 25- or 26-gauge stainless steel wire made through middle phalangeal base dorsal to midaxial line. C C, Retrograde insertion of 0.028-or 0.035-inch Kirschner wire into proximal phalanx. • D, Kirschner wire driven into anterior cortex of middle phalanx. • E, Figure-eighttension band created and tightened. • Tension band arthrodesis ARTHRODESIS

  44. A, Anteroposterior and lateral views of crossed Kirschner wires. • B, Anteroposterior and lateral views of interfragmentarywire and longitudinal Kirschner wires. • C, Anteroposterior and lateral views of Herbert screw ARTHRODESIS

  45. THANK YOU ARTHRODESIS

  46. MoKazem.com هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali. This site is not responsible of any mistake may exist in this lecture. Dr. Muayad Kadhim د. مؤيد كاظم

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