Top Banner
sep 2009
80

Wrist sep09

May 26, 2015

Download

Art & Photos

vgtrad

xray wrist carpal instability gilula lines
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Wrist sep09

sep 2009

Page 2: Wrist sep09

Was bedeutet der handsurgeon wissen wollen?

Page 3: Wrist sep09

Xray Measurements

• Carpal height• Ulnar variance• Radial inclination• Radial length• Palmar tilt• Radial shift

Page 4: Wrist sep09

Position

• Neutral PA• Neutral Lat

Page 5: Wrist sep09

Position

• Neutral PA• Neutral Lat

Page 6: Wrist sep09

Position: PA

• Wrist and elbow shoulder height• radius and ulna parallel

Page 7: Wrist sep09

Extensor carpi ulnaris groove

• Radial to mid styloid

Page 8: Wrist sep09

Extensor carpi ulnaris groove

• Radial to mid styloid

Page 9: Wrist sep09

Position: Lateral

• Elbow adducted• Shoulder elbow wrist in 1 plane

Page 10: Wrist sep09

Lateral CCC

• Radius• Lunate• Scaphoid

Page 11: Wrist sep09

Lateral CCC

• Radius• Lunate• Scaphoid

Page 12: Wrist sep09

Lateral CCC

• Scaphoid• Pisiform• Capitate

Page 13: Wrist sep09

Lateral CCC

• Scaphoid• Pisiform• Capitate

Page 14: Wrist sep09

CCC OK!

Page 15: Wrist sep09

Lunate dislocation

Page 16: Wrist sep09

CCC niet OK.

Page 17: Wrist sep09

Shape Lunate

Page 18: Wrist sep09

Scaphoid shape

Ext Uln. deviation

Page 19: Wrist sep09

Scaphoid flex / radial deviation

flexrad deviation

Page 20: Wrist sep09

Scaphoid axis

Page 21: Wrist sep09

Lunate axis

Page 22: Wrist sep09

Capitate axis

Page 23: Wrist sep09

Oblique

trapezo-trapezoid

Page 24: Wrist sep09

Oblique

trapezo-trapezoid

Page 25: Wrist sep09

Carpal height

• Base MC3• Radiocarpal• Collapse

– RA– SL collapse– Lunatomalacie

Page 26: Wrist sep09

Carpal height

• Ratio– MC3 (0.54)– Capitate (1.57)

Page 27: Wrist sep09

Carpal height

• Ratio– MC3 (0.54)– Capitate (1.57)

Page 28: Wrist sep09

Ulnar variance

Page 29: Wrist sep09

Ulnar variance

• Load transfer• Growth disorder• Post trauma

Page 30: Wrist sep09

Ulnar variance

• Association– SL instable– Ulnocarpal impaction– TFCC

• Normal + 3 mmMid

Page 31: Wrist sep09

Radial inclination

• Fracture: – <5° poor outcome

• Madelung steep • Normal 16-28°

Page 32: Wrist sep09

Radial inclination

• Fracture: – <5° poor outcome

• Madelung steep • Normal 16-28°

Mid

Page 33: Wrist sep09

1878 O. W. Madelung: Die spontane Subluxation der Hand nach Vorne.

Page 34: Wrist sep09

Radial length

• Styloid length• Shortening after #• Compare L-R• Normal 10-18 mm

Page 35: Wrist sep09

Radial length

• Styloid length• Shortening after #• Compare L-R• Normal 10-18 mm

Mid

Page 36: Wrist sep09

Palmar tilt

• Volar ligaments• Dorsal bony ridge• Residual deformity

– 200% load ulnocarpal

• Normal 0-22 °

Page 37: Wrist sep09

Palmar tilt

• Volar ligaments• Dorsal bony ridge• Residual deformity

– 200% load ulnocarpal

• Normal 0-22 °

Mid

Page 38: Wrist sep09

Radial shift

• # dislocation• PA• Styloid• Midshaft• Compare L-R

– max 1mm

Page 39: Wrist sep09

Radial shift

• # dislocation• PA• Styloid• Midshaft• Compare L-R

– max 1mm

Width

Mid

Page 40: Wrist sep09
Page 41: Wrist sep09

Wrist conditions

• Carpal instability• Scapholunate Collapse• Ulnar translocation• Ulnocarpal impaction• Radio-Ulnar impingement

Page 42: Wrist sep09

Carpal instability

• SL - scapholunate• LT - lunotriquete• SLT - Combined• Ligaments intact?

Page 43: Wrist sep09

Arc I

LT

Page 44: Wrist sep09

Arc II

SL LT

Page 45: Wrist sep09

Arc III

CH

Page 46: Wrist sep09

DISI

Dorsal intercalated segment instability

Page 47: Wrist sep09

DISI (pathology)

Dorsal ... instabilityLunatum kijkt naar posterior

A A

Page 48: Wrist sep09

VISI

Volar intercalated segment instability

Page 49: Wrist sep09

VISI (variant)

Volar .. instabilityLunatum kijkt naar anterior

A A

Page 50: Wrist sep09

VISI

LT Collapse

Page 51: Wrist sep09

Instability

LT CollapseArc 1 Short ScaphoidParallel

Page 52: Wrist sep09

VISI

Palmar tilt ScaphoidLunate

Page 53: Wrist sep09

VISI

Palmar tilt ScaphoidLunate

Page 54: Wrist sep09

VISI

Palmar tilt ScaphoidLunate

Page 55: Wrist sep09

VISI

SL angle < 30 °

Page 56: Wrist sep09

Scapho lunate advanced collapse

• Progressive• Clinical & Radiological• Narrowing• Sclerosis• Osteophyte• CPPD deposition• Non union

SLAC

Page 57: Wrist sep09

SLAC

• a

Page 58: Wrist sep09

Ulnar translocation

• Clinical & Radiological• Disruption R-C lig.• Instability• Ulnar displacement

– Scaphoid-Styloid– Hamate-Ulna

Page 59: Wrist sep09

Ulnar translocation

Scaphoid-Styloid

Page 60: Wrist sep09

Ulnar translocation

Ulna - Hamate

Page 61: Wrist sep09

Ulnocarpal impaction

• U-L-T Joint degeneration • Compressive forces • Ulna +

Page 62: Wrist sep09

Ulnocarpal impaction

• U-L-T Joint degeneration • Compressive forces • Ulna +

U

T L

Page 63: Wrist sep09

Radio-Ulnar impingement

• ulna -, concave radius, convergence

Page 64: Wrist sep09

TFCC

Intact #

Page 65: Wrist sep09

Cases

Parallel joints OverlapCarpal ArcsShape Fracture

Page 66: Wrist sep09

Case 1

Page 67: Wrist sep09

Case 1

• Lunate not parallel• Arc 1 en 2• Triangular lunate• Dislocated!

Page 68: Wrist sep09

Case 2

Page 69: Wrist sep09

Case 2

TL, HL overlapParallel

R,L,prox S, prox CTriq,H,dist S, dist H, Trap

# H, S

Page 70: Wrist sep09

Case 2

TL, HL overlapParallel

R,L,prox S, prox CTriq,H,dist S, dist H, Trap

# H, STrans scaphoid and capitate perinlunate

#dislocation

Page 71: Wrist sep09

Case 2

Page 72: Wrist sep09

Case 2

Page 73: Wrist sep09

Case 3

Page 74: Wrist sep09

Case 3

LT not parallelArc 1, 2 brokenSL tilted

VISI LT dissociation

Page 75: Wrist sep09

Case 4

Page 76: Wrist sep09

Case 4

All parallelSL wideScaphoid tiltLunate tiltArthrosis RS CL

SLAC (SL tear)

Page 77: Wrist sep09

SLAC (CPPD)

Page 78: Wrist sep09

Approach

CCC and CCCParallel joints OverlapCarpal ArcsShape Fracture

Page 80: Wrist sep09