Dry arthroscopic 4-corner arthrodesis and other refinements to stay within a tourniquet time

Abstract

4-corner arthrodesis is a widely implanted procedure to treat degenerated joints in the wrist such as SLAC and SNAC stage II and III. Arthroscopy in combination with headless cannulated screws, permits reproducing the same intervention with the advantages of a minimally invasive surgery. This technique has already been published in the past supported by the early experience in this new exciting field. The purpose of this paper is to present new technical refinements collected over the years in order to speed up the surgery while obtaining optimum results. In this paper we also present extreme scenarios solved by combining the scope with cannulated screws.

Zusammenfassung

Die mediokarpale Teilversteifung unter Resektion des Skaphoids ist eine gut etablierte Behandlung degenerativer Veränderungen des Handgelenkes beim karpalen Kollaps Stadium II und III bei SLAC- und SNAC-wrist. Die Kombination von Arthroskopie und Verwendung von kanülierten kopflosen Schrauben macht es möglich, den Eingriff minimal invasiv durchzuführen. Hierüber wurde bereits in der Vergangenheit berichtet. In dieser Arbeit präsentieren wir über Jahre entwickelte Verfeinerungen der Operationstechnik, deren Ziel es ist, die Operationszeit zu verkürzen und die Ergebnisse zu optimieren. Zugleich stellen wir an extremen Fallbeispielen dar, welche Möglichkeiten die Kombination von Arthroskopie mit kanülierten Schrauben bietet.

Key words

Dry arthroscopy - 4-Corner arthrodesis - partial wrist arthrodesis - total wrist arthrodesis

Schlüsselwörter

Trockene Arthroskopie - 4-Corner-Arthrodese - Handgelenksteilversteifung - Handgelenksvollversteifung

Publication History

Received: 02 August 2020

Accepted: 11 August 2020

Article published online:
29 September 2020

• Literature

• 1 del Piñal F, García-Bernal FJ, Pisani D. et al. Dry arthroscopy of the wrist: Surgical technique. J Hand Surg Am 2007; 32: 119-123
• 2 del Piñal F. Dry arthroscopy and its applications. Hand Clin 2011; 27: 335-345
• 3 del Piñal F, Klausmeyer M, Thams C. et al. Early experience with (dry) arthroscopic 4-corner arthrodesis: From a 4-hour operation to a tourniquet time. J Hand Surg Am 2012; 37: 2389-2399
• 4 del Piñal F, Tandioy-Delgado F. (Dry) arthroscopic partial wrist arthrodesis: Tips and tricks. Handchir Mikrochir Plast Chir 2014; 46: 300-306
• 5 del Piñal F, García-Bernal FJ, Delgado J. et al. Correction of malunited intra-articular distal radius fractures with an inside-out osteotomy technique. J Hand Surg Am 2006; 31: 1029-1034
• 6 del Piñal F. Arthroscopy: Some Dos and Don’ts. In del Piñal F. (ed.) Arthroscopic management of distal radius fractures. New York: Thieme; 2018: 51-72
• 7 Mühldorfer-Fodor M, Ha HP, Hohendorff B. et al. Results after radioscapholunate arthrodesis with or without resection of the distal scaphoid pole. J Hand Surg Am 2012; 37: 2233-2239
• 8 del Piñal F, Moraleda E, Rúas JS. et al. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am 2015; 40: 692-700
• 9 Ho PC. Arthroscopic partial wrist fusion. Tech Hand Up Extrem Surg 2008; 12: 242-265
• 10 Nagy L, Büchler U. AO-wrist arthrodesis: with and without arthrodesis of the third carpometacarpal joint. J Hand Surg Am 2002; 27: 940-947