The Wrist: Anatomical and Pathophysiological Approach to Diagnosis and Treatment

ISBN-13: 9783642716249 / Angielski / Miękka / 2011 / 269 str.

Gontran Sennwald; Gontran Sennwald; David Le Vay

Opis

In thc space of ooly a few years, reconstructive surgery of the skeleton of the hand has become a foeus of attention. Thc reason for this has been the advent of principles and techniques of stable internal fixation, tbc unparaJleled advantages of which are particularly evident in the treatment of the complex, multi- structural lesions so typical of injuries of the hand, and also in procedures such as replantation or revascularisatioss. What a striking contrast on the other hand is to be seen in the slow and painful progress made in Dur understanding of the biomechanics of the radiocarpal joint This is most elo- quently ilIustrated by the embryonie state of prosthetic surgery of the wrist, compared with the sophisticatcd advances made in hip and knee surgery. Yet it is undeniable that painful condi- tions involving dysfunctions of the wrist are increasing in number and affect young people in particular; this should spur us on to seek more effective therapeutic solutions.

Spis treści

History.- The Carpus.- The Concept of Stability.- The Radius and the Radio-carpal Joint.- References.- I Anatomical Approach.- A. Bony Anatomy.- B. Ligamentous Anatomy.- Nomenclature.- Classification.- 1. Articular Ligamentous System.- Interosseous Group.- The Palmar V Group.- The Ulnocarpal Complex.- The Dorsal V Group.- Systematic Analysis.- 2. Extra-articular Ligamentous System.- Extensor Retinaculum.- Flexor Retinaculum.- 3. Anatomical Study: Conclusions.- C. Kinematics.- 1. Analysis of the Mobility of the Proximal Row in the Frontal Plane.- Ulnar Deviation.- Radial Deviation.- Neutral Position.- 2. Analysis in the Sagittal Plane.- D. Functional Ligamentous Anatomy.- “Restraining” Ligaments.- “Stabilizing” Ligaments.- “Guiding” Ligaments.- Conclusion.- E. The Concepts of Stability.- History.- Discussion.- Ligamentous Anatomy.- Observation of the Stretched Carpus.- Concept of Stability.- Conclusions.- References.- II Diagnosis of Osteo-ligamentous Lesions of the Carpus.- A. Physical Examination.- B. Radiology.- Routine Projections.- “Dynamic” View.- Arthography.- CT Scanner.- Xerography.- Isotope Scintigraphy.- Costs and Chronology of Radiographical Examinations.- References.- III Hyperextension Injuries of the Wrist: Pathomechanics, Clinical Approach.- A. Pathomechanics.- Pathophysiology of Lesions.- Clinical Cases.- De Quervain’s Fracture-Dislocation.- Conclusions.- References.- B. Clinical Aspects.- 1. Instability of the Carpus and Pseudarthrosis of the Scaphoid.- Case Material.- Type of Operation Related to Cure.- Analysis of Risk Factors.- Analysis of Matti-Russe Procedures with Kirschner Wire Fixation.- Secondary Matti-Russe.- The Problem of Statistical Evaluation.- Conclusions and Consequences.- References.- 2. The Therapeutic Concept of Carpal Instability.- Ligamentoplasties and Partial Arthrodeses.- Anatomical Review.- Systematic Analysis.- Discussion.- Conclusions.- References.- IV Fractures of the Distal Radius.- A. The Specific Problem.- Distribution of Radial Fractures According to Age and Sex.- Current Treatment of Fracture of the Radius.- Tolerance of Malunion.- Analysis of Results.- Subjective Results.- Relationship Between Reduction and Symptoms.- Relationship Between Mobiiity and Symptoms.- Statistical Analysis of Results.- Conclusions.- Discussion.- B. Morphology and Classification of Fractures of the Distal Radius in Relation to the Quality of the Bone: Therapeutic Implications.- Anatomy.- Physiology.- Morphology.- Pathomechanics.- Classification of Fractures and Relation to Treatment.- Special Problems.- C. The Possibilities of Treatment.- Choice of Patients.- Methods of Measurement.- Analysis of Results.- Discussion.- References.- V Operative Techniques and Indications.- A. The Avascular Osteonecroses.- Kienböck’s Disease (Avascular Osteonecrosis of the Lunate).- Avascular Necrosis of the Scaphoid.- References.- B. Pseudarthrosis of the Scaphoid.- Treatment by Inset Cortico-Cancellous Graft.- Osteosynthesis (OS).- Stable OS Without Graft.- Stable OS With Sandwich Graft.- Special Problems.- Conclusions.- C. Recent Fractures of the Scaphoid.- Stable Fractures.- Minimally Stable Fractures Without Lunate Tilt.- Unstable Fractures With Lunate Tilt.- D. Perilunate Dislocations, With or Without Fracture.- Therapeutic Approach.- Special Problems.- Conclusions.- References.- E. Operative Technique for Opening the Carpal Tunnel.- F. Partial Arthrodeses of the Wrist, Arthroplasties and Ligamentous Reconstructions.- Indications.- Technical Problems.- Approaches.- Piso-triquetral Arthrosis.- Skin Incisions.- Conclusions.- Complications.- References.- G. Arthrodeses of the Wrist.- Indications.- Operative Principles.- Operative Technique.- Infections of the Carpus.- Examples.- Remarks.- References.- H. Fractures of the Radius.- Unstable Monoblock Fracture.- Marginal Fracture (Split Epiphyseal Block).- Comminuted Fracture (Multifragmented Epiphyseal Block).- Instability of the Carpus and Fracture of the Distal Radius.- I. Malunion of the Radius.- Intervention Involving the Ulna.- Sauve-Kapandji Technique (1985).- Technique of Oblique Resection Arthroplasty.- Darrach Resection.- Intervention Involving the Distal Radius.- K. Madelung’s Deformity.- References.- Epilogue.