Radius Head Prothesis Surgical Technic

Transcription

1 1. Operation Indication : Radius Head Prothesis Surgical Technic FK radius head modular prothesys Surgical Technique Break of radius head, not reconstuctable break Manson III, IV. Concractura, which inhibit pronation and supination movement, caused by former deformity, or break which is caused by radius head missing. Terrible triad: elbow sprain, break in pieces of radius head, break of processus coronoideus which cause insatbility. 2. Surgery done without blood: (In case of adults it is 300hgmm.) The patient has to back of lay on a normal table. The limb put on arm table which permeable whith Röntgen beam. The limb has to be sterilisation from cuff until the end of fingers ; the isolation has to happen when it is leaved free. 3. Surgical incision direction: The incision starts at the way of epicondylus radilis humeri, above the radius head, 5 7cm along. Don t cut on ventrally from the epicondylus, because the n. radial s drive deep branch could be damaged!! The gentliest way to get to the head of radius is the fascia area, which is located between the anconeus and extensor capri. Useful if you cut slightly slant the ligamentum anularet, so that it makes easier and more secure to sew together them at the reconstruction. 1. Picture Before the Resectio, Hohmann lifter has to be placed around the radius neck. Be careful, and avoid the rough movements; so that around the neck the n.radialis profoundus, its tines which are in the supinator canal, can be saved. Resection cut with oscillation blade, the Radius lenght axle perpendicular direction. (2.Picture) We determine the ideal high of resectio with trial prothesis ( xx). We always have to choose the sortest size. (3.Picture) Oldal 1

2 2. Picture 3. Picture 4. The preparation of implant s location: The opening and rasping of the medullary hollow has to be made by the rasps series ( x) useing them in rising sequances untill we get to the maximal size which is considered to be the tickness of bone (5.6 Picture). The rasp is aslope, this form is match to neck position 10 degree axle's standing. Square is shaped pyramid form the slew against.the rasp end to filing, abducalt stretched thumb's direction. (7 Picture). We do controll the elbow s stabilty, and it s free movement, beside the implant s size by using the trial prothesis. - The instrument is for insertion of trial prothesys (8 Picture). 5. Choosing implant and integration: 5. Picture 6. Picture 7. Picture 8. Picture 1) We have to choose the measured length and size sterilized head, which is packed with poliethylen inlay (9 Picture). 9. Picture 2) We choose the sterlized stem, which going to be placed into the bone hole, the size is same as the latest used rasp s size. (10.Picture) Oldal 2

3 Radius Head Prothesis Surgical Technic 10. Picture 3) Flip togeather by using the special pliers plier ( ) (11 Picture). 11. Picture There is a special instrument on the instrument tray, which is capalble dispart the two components (731 ( ) (12 Picture). 12. Picture 6. The insertation of compiled implant: Before you insert the compiled, modular, modul biarticularis prothesis, you have to check it s free rotation, and the the elbow should be kept in varization ation set-up, and in semiflectal setting; and pay atteintion to the right way of the stem angle, and insert it into the radius (13-15.Picture), (13 and after with the tool stave it in ( ) (731 (16.Picture).

4 13.Picture 14.Picture 15. Picture 16. Picture 7. Functional test: The test has to be done in case of extended and bended elbow too. Controll if the rotation is free or not! Regulary, at the place of head, the capitulum humeri is going to exactly stays afront Picture 17.Picture 18.Picture Oldal 4

5 8. Closing of the operation scission: 19.Picture 20.Picture If it shows luxation tendency, controll it after the lig.anulare suture. If it still shows disjointing tendency, the joint has to be overviewed because the reason could be interopositum in the humero-ulnaris join, or the break of ulna! (21, 22. Picture) 21.Picture 22.Picture Join drainage is 10-12, with Ch Redon drain. Fascia and Subcutan, and after skin suture.(23, 24 Picture) 23.Picture 24.Picture The limb has to be fixed until the scar recovers with a square form upper arm plaster junk or beside enough cooperation it doesn t have to be plastered. Fixation keeps for longer period (maximum 3 weeks), if it is needed because of the wrench tendency, it could cause the restiction of elbow movements. 9. Aftercare: Exercise: Elbow extension and bending, pronatio and supinatio untill the pain border with the help of gymnastics expert, and with helped activ excercises. 10. X-Ray controlls: 1.Intraoperational functional test under picture enhancement picture Oldal 5

6 25.Picture 26.Picture 27.Picture 28.Picture 2. Postoperational close picture. 3. Controll before leaving the hospital. 4. Four weeks before the operation. 5. Four mounths after the operation. 6. Controll per 2 years. Besides the recommended controlls, radiological examine is needed in every case if the patient has complain, or there is a suspicion of prothesis ficama or other complications could happen (unexpected movement restriction, inflectio, pains, which could sign the slack of prothesis). Oldal 6

7 1. Instrument tray Radius Head Rasp S Radius Head Rasp M Radius Head Rasp L Radius Head Rasp XL Radius Head Extractor Forceps Implant Forceps Hammer with Insert Picker Radius Head Trial 21 S Radius Head Trial 21 M Radius Head Trial 21 L Radius Head Trial 21 XL Radius Head Trial 24 S Radius Head Trial 24 M Radius Head Trial 24 L Radius Head Trial 24 XL Radius Head Trial 24 XXL Introducer Radius Head Prothesis Surgical Technic