A new technique of wrist arthroscopy to visualise instability

J. Huracek*, J. Chomiak º, H. Troeger*

* Department for surgery of the hand and the peripheral nerve, University Hospital Basel, Switzerland

° Clinic for orthopaedic surgery “Bulovka”, Prague, Czech Republic

wrist arthroscopy and instability

• great extent of positioning• ligamentotaxis / palpation• no palmar approach• no pro- / suppination• no operation in succession

• technique on wrist• technique on shoulder / knee

wrist arthroscopy and instability

• horizontal position• no distraction• intraarticular pression up to150 mm Hg• hypomochlion• move instead of draw

wrist arthroscopy and instability

• prospective study of 30 patients– arthroscopy without distraction, followed by– conventional arthroscopy with 3 kg traction

• standardised protocol– diagnostic sensitivity– quality of surgical procedures– complications

wrist arthroscopy and instability

• diagnoses involved19 injuries, 11 degenerative diseases

• 11 times therapeutic surgery2 discus suture, 9 discus debridèment

• mean age 37,1 years; follow-up 10,2 weeks

wrist arthroscopy and instability

• results with / without distraction:– same sensitivity (except for instability)– same specifity– surgical procedures not hindered– no complications (CTS)

• followed-up till today :– 30 prospectively, 117 retrospectively

wrist arthroscopy and instability

arthroscopy of intercarpal space

MCU

wrist arthroscopy and instability

arthroscopy of radiocarpal space

total SL - rupture

wrist arthroscopy and instability

arthroscopy of radiocarpal space

total SL - rupture withpathological RU-duction

• less extent (positioning, fluoroscopy)

• technically more difficult• dynamical assessment of ligamentous instability• direct proceed to open surgery (arthrotomy, distal radius

fracture)

the “Basel” technique of wrist arthroscopy

outlook

• intra-articular assessment before standard OP• new, combined arthroscopic-open procedures• assessment of acute trauma