CHONDORSARCOMA. SHOULDER PROSTHESIS
-
Upload
alberto-bencivenga -
Category
Health & Medicine
-
view
321 -
download
1
description
Transcript of CHONDORSARCOMA. SHOULDER PROSTHESIS
Alberto Bencivenga
MD, DCh, PhD,FCS (ECSA)
Facharzt für Chirurgie (M. Chir.) (Tübingen)Specialista in Chirurgia (M. Chir.) (Florence)
Specialista in Chirurgia addominale (M. Abdominal Surg.) (Florence)Specialista in Urologia (M. Urol.) (Florence)
Professor Emeritus of General Surgery, Somali National UniversityProfessor Emeritus of Orthopaedic Surgery, University of Nairobi
CONSULTANT GENERAL AND TRAUMA SURGEON
TECHNIQUE OF UPPER HUMERUS REPLACEMENT. THE FIRST CASE OF
CHONDROSARCOMA EVER TREATED WITH THIS TECHNIQUE (26.12.1973)
Asha A. age 17.
History of fast growth in the left shoulder during
the previous few months. Irregular and unex-
plained fever episodes most recently.
Clinical aspect
of her lesion
Radiological aspect of the lesion (totally extra-articular).Lungs free.
THE CUSTOM MADE PROSTHESIS
THE OPERATION26.12.1973
DIVISION OF THE DELTOID
THE CAPUT LONGUM OF THE BICEPS
IDENTIFYING THE LEVEL OF THE BONE RESECTION (BELOW THE SO CALLED WAX DROP)
CUTTING THE SHAFT WITH THE OSCILLATING SAW
REMOVAL OF THE SPECIMEN
REAMING OF THE MEDULLARY CANAL TO 9 mm, THE ACTUAL SIZE OF THE PROSTHESIS STEM
DO NOT REAM MORE THAN THE NECESSARY DIAMETER AND THE NECESSARY LENGTH!
SPECIAL REAMER TO SHAPE THE ENTRANCE INTO THE MEDULLARY CANAL TO EXACTLY ACCEPT THE TAPERED
BASE OF THE PROSTHESIS STEM
VERY CAREFUL FINAL REAMING BY HAND, AND UNDER PROTECTION OF THE BONE WITH ONE OR TWO AO
CLAMPS
SECOND SPECIAL REAMER TO FINALISE THE SHAPE OF THE ENTRANCE POINT OF THE
PROSTHESIS STEM
FINISHING THE TAPERING TO THE EXACT SHAPE OF THE PROSTHESIS STEM. AGAIN BY HAND
INSERTING THE PROSTHESIS INTO THE PREPARED CHANNEL WHERE IT SHOULD NOW FIT PERFECTLY
ARTE, NON VI! TAP GENTLY WITH YOUR HAND
SECURING THE ROTATIONAL STABILITY WITH AN AO SMALL-FRAGMENT-SET SCREW THROUGH THE STEM
DRILLING A 2 mm HOLE
MEASURING THE LENGTH OF THE NECESSARY SCREW
TAPPING THE THREAD
INSERTING THE SCREW
THE CAPUT LONGUM OF THE BICEPS WAS PRESERVED AS LONG AS POSSIBLE, NOT ONLY FOR ITS RE-INSERTION, BUT ALSO TO OBTAIN A
STUCTURE WHERE THE GLENO-HUMERAL LIGAMENTS CAN BE SUTURED
The split tendon is threaded through the lower middle hole, inside-out; then, each of the two halves are threaded through the side holes, inside-out, and, after pulling them out, they are sutured according to Bunnel to the main tendon. This will provide reliable soft tissue at both sides of the central holes, where one can suture the capsulo-ligamentous structures for the benefit of an increased joint stability.
SPLITTING THE TENDON END INTO TWO HALVES
THREADING THE TENDON INTO THE CENTRAL HOLE OF THE PROSTHESIS HEAD AND PULLING OUT THE TWO
HALVES THROUGH THE TWO SIDE HOLES
SUTURING THE TWO TENDON HALVES INTO THE MAIN TENDON WITH BUNNEL’S TECHNIQUE
SUTURING THE ARM MUSCLES TO THE PROSTHESIS USING THE AD HOC HOLES IN THE PROSTHESIS SHAFT
SUTURING THE DELTOID MUSCLE
THE INCISION AFTER REMOVING THE INCISION DRAPE
PRIMARY WOUND CLOSURE, LEAVING ONE REDON DRAIN IN EVERY LAYER
SKIN DRESSING
A BACK SLAB WAS USED FOR PATIENT’S CONFORT UNTIL THE WOUND HEALED
THE SPECIMEN WITH AN IRREGULAR JOINT SURFACE, BUT ONE NOT INVADED BY THE NEOPLASM
SECTION TH
SECTION THROUGH THE NEOPLASM
POST-OPERATIVE CHECK X-RAY. NOTE THE EXTREMELY THIN HUMERAL SHAFT, WHICH INITIALLY WOR-RIED US AND ROBERT MATHYS Sen., THE MANU-FACTURER OF THE PRO-STHESIS.NOTE ALSO THE PERFECT JOINT CONGRUENCE.
CHECK X-RAY PICTURE AFTER 8 MONTHS. OBSERVE THE BONE GROWTH FIXING THE STEM BIOLOGICALLY.
11 MONTHS AFTER THE SURGERY. THE NEW FORMED BONE SHELF IS BEGINNING TO PRODUCE A “MEDULLARY”
CANAL!
AFTER 7 YEARS, A SORT OF A MEDULLARY CANAL DEVELOPED AROUND THE PROSTHESIS STEM, WITHIN
THE NEOFORMED BONE SHELF (*)
**
POST-OPERA_TIVE PICTURE
CHECK X-RAY AFTER 7 YEARS AND 4 MONTHS
A STUDY OF THE SCAPULO-HUMERAL JOINT CONGRUENCE
UNDER AXIAL PRESSURE.(PATIENT SUSPENDED ON
PARALLEL BARS).
THANK YOU FOR
YOUR KIND ATTENTION!