Treatment - orthnorth.org.uk€¦ · Treatment Alan Middleton Consultant Orthopaedic Surgeon North...
Transcript of Treatment - orthnorth.org.uk€¦ · Treatment Alan Middleton Consultant Orthopaedic Surgeon North...
Treatment
Alan MiddletonConsultant Orthopaedic Surgeon
North Tees Hospital29 April 2013
Monday, 29 April 2013
Non Surgical
Analgesia
NSAIDs
Intra - articular injections
Physio / Splints
Monday, 29 April 2013
Fingers
Most effective for pain relief = fusion
Problems with non union
Function affected distal to proximal
Monday, 29 April 2013
Soft Tissue Procedures
Cheilectomy
Volar Plate Arthroplasty
Monday, 29 April 2013
Arthroplasty
Relies on soft tissues
ROM usually does not improve
Good for pain relief
Long term promising
Monday, 29 April 2013
Types
Silastic - not good for high demand
Metal - poly - metal
Rotating platform
Pyrocarbon
Monday, 29 April 2013
Thumb Base
Options:
- Remove (Trapeziectomy +/- LRTI)- Fuse (no STT involvement, accelerates OA at adjacent joints)- Replace (Huge topic.... )
Monday, 29 April 2013
Trapeziectomy
Gold Standard, but not brilliant
Weakness
Long recovery
LRTI vs pinning vs nothing
ST & MC/MC not addressed
Monday, 29 April 2013
Fusion
Different fixation types
Non union & reoperation up to 40%
Younger patients where grip needed
Monday, 29 April 2013
Arthroplasty
Complex joint morphology & biomechanics
Main problem is soft tissue
Constraints do not work
?spacers
Monday, 29 April 2013
Monday, 29 April 2013
Wrist
Wrist fusion best
Better tolerated than believed
Non union - need meticulous preperation
Tendon problems
3rd CMCJ or not?
Monday, 29 April 2013
Wrist Arthroplasty
Developing field
Concepts around replicating normal movements
1 articulation to replace 2 .....
Traditionally not for OA, but recent results promising
Monday, 29 April 2013
Monday, 29 April 2013
DRUJ
Excision
Problem with instability & impingement
Good for Rheumatoid
Monday, 29 April 2013
Monday, 29 April 2013
Arthroplasty
Hemi: - consider bearing surface
Total - needs to be constrained
Monday, 29 April 2013
Monday, 29 April 2013
Monday, 29 April 2013
Monday, 29 April 2013