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Surgical treatment of scaphoid fractures with arthroscopic control
The objective of this presentation is not to perform an exhaustive review of the surgical treatment of scaphoid fractures but to try to justify our choice to systematically associate an arthroscopic control in with a percutaneous fixation using a cannulated screw in all non- or minimally displaced scaphoid fractures. Scaphoid fractures are frequent but present unique challenges because of the particular geometry of the bone and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures may lead to non-unions that can progress to carpal collapse and degenerative arthritis of the wrist.
Improvements in diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation even for non-displaced scaphoid fractures that could potentially be treated non-operatively. In our experience, wrist arthroscopy is a useful tool in the management of these fractures not only to assess the quality of reduction but also not to overlook severe carpal ligament injuries, which would be untreated and may lead to chronic and symptomatic carpal instability.
X Martinache
Lecture
7 years ago
187 views
5 likes
0 comments
10:12
Surgical treatment of scaphoid fractures with arthroscopic control
The objective of this presentation is not to perform an exhaustive review of the surgical treatment of scaphoid fractures but to try to justify our choice to systematically associate an arthroscopic control in with a percutaneous fixation using a cannulated screw in all non- or minimally displaced scaphoid fractures. Scaphoid fractures are frequent but present unique challenges because of the particular geometry of the bone and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures may lead to non-unions that can progress to carpal collapse and degenerative arthritis of the wrist.
Improvements in diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation even for non-displaced scaphoid fractures that could potentially be treated non-operatively. In our experience, wrist arthroscopy is a useful tool in the management of these fractures not only to assess the quality of reduction but also not to overlook severe carpal ligament injuries, which would be untreated and may lead to chronic and symptomatic carpal instability.
Arthroscopic reduction of intra-articular distal radius fractures: practical explanations, tips and tricks
The interest of wrist arthroscopy for the treatment of intra-articular fractures of the distal radius has been demonstrated in the literature for several years. This surgical technique requires specific instrumentation,
like a tower traction, small size optics and small tools. Once the stabilization of the wrist has been performed (using K-wires or plates), an arthroscopic control allows to appreciate the reduction of the fracture, and to diagnose and treat ligamentous injuries. Reduction of the fracture is
sometimes not sufficient and can be carried out under arthroscopic control using K-wires as a joystick. This surgical technique needs a learning curve to be able to treat difficult articular fractures of the distal radius. Using arthroscopy, the follow-up of operated articular fractures of the distal radius is easier for the surgeon and the patient.
JM Cognet
Lecture
7 years ago
203 views
1 like
0 comments
13:30
Arthroscopic reduction of intra-articular distal radius fractures: practical explanations, tips and tricks
The interest of wrist arthroscopy for the treatment of intra-articular fractures of the distal radius has been demonstrated in the literature for several years. This surgical technique requires specific instrumentation,
like a tower traction, small size optics and small tools. Once the stabilization of the wrist has been performed (using K-wires or plates), an arthroscopic control allows to appreciate the reduction of the fracture, and to diagnose and treat ligamentous injuries. Reduction of the fracture is
sometimes not sufficient and can be carried out under arthroscopic control using K-wires as a joystick. This surgical technique needs a learning curve to be able to treat difficult articular fractures of the distal radius. Using arthroscopy, the follow-up of operated articular fractures of the distal radius is easier for the surgeon and the patient.
Arthroscopic proximal pole resection, partial scaphoid implant
Proximal pole necrosis of the scaphoid can occur after scaphoid fractures. The replacement of the proximal pole has been tried using many different materials for many years, according to the literature. This technique consists in an arthroscopic debridement of the proximal scaphoid pole, leaving the local ligaments as intact as possible. The proximal pole is substituted by a pyrolitic carbon implant, which has an ovoid shape and fits well into this position. We present the technique and the results of 23 of Prof. Christophe Mathoulin’s patients treated between 1998 and 2007 with 21 good results and only one palmar implant dislocation. Even though good results have been already published in the literature, these results seem closely related to the degree of instability, created by the ligament damage in the scapho-lunate area.

This treatment is therefore a salvage procedure more indicated in elderly people than in young people. On the other hand, it can be a simple and convenient waiting therapy option in other cases.
M Haerle
Lecture
7 years ago
197 views
0 likes
0 comments
07:15
Arthroscopic proximal pole resection, partial scaphoid implant
Proximal pole necrosis of the scaphoid can occur after scaphoid fractures. The replacement of the proximal pole has been tried using many different materials for many years, according to the literature. This technique consists in an arthroscopic debridement of the proximal scaphoid pole, leaving the local ligaments as intact as possible. The proximal pole is substituted by a pyrolitic carbon implant, which has an ovoid shape and fits well into this position. We present the technique and the results of 23 of Prof. Christophe Mathoulin’s patients treated between 1998 and 2007 with 21 good results and only one palmar implant dislocation. Even though good results have been already published in the literature, these results seem closely related to the degree of instability, created by the ligament damage in the scapho-lunate area.

This treatment is therefore a salvage procedure more indicated in elderly people than in young people. On the other hand, it can be a simple and convenient waiting therapy option in other cases.
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
C Mathoulin
Surgical intervention
1 year ago
269 views
4 likes
1 comment
06:03
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
Minimally invasive right superior parathyroidectomy (MIVAP) for symptomatic primary hyperparathyroidism
This video presents the case of a 62 year-old patient with primary hyperparathyroidism characterized by a PTH which is inconsistent with calcium levels. The diagnosis is confirmed by biological findings before searching for the adenoma inducing this hypersecretion. With the use of current precision imaging techniques, in most cases, the adenoma can be identified and managed surgically. In our team, we perform a 99m Tc-MIBI scintigraphy and a CT-scan allowing for a 3D reconstruction according to the IRCAD protocol. This 3D reconstruction shows the relationships between the adenoma, the inferior thyroid artery, the thyroid gland, and the esophagus, making it possible to perform a video-assisted approach using a scar inferior to 2cm.
M Vix, HA Mercoli, S Tzedakis, J Marescaux
Surgical intervention
2 years ago
1096 views
119 likes
1 comment
08:28
Minimally invasive right superior parathyroidectomy (MIVAP) for symptomatic primary hyperparathyroidism
This video presents the case of a 62 year-old patient with primary hyperparathyroidism characterized by a PTH which is inconsistent with calcium levels. The diagnosis is confirmed by biological findings before searching for the adenoma inducing this hypersecretion. With the use of current precision imaging techniques, in most cases, the adenoma can be identified and managed surgically. In our team, we perform a 99m Tc-MIBI scintigraphy and a CT-scan allowing for a 3D reconstruction according to the IRCAD protocol. This 3D reconstruction shows the relationships between the adenoma, the inferior thyroid artery, the thyroid gland, and the esophagus, making it possible to perform a video-assisted approach using a scar inferior to 2cm.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
C Mathoulin, P Liverneaux
Surgical intervention
9 years ago
1155 views
30 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.