Professional Documents
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Elbow Arthrodesis
General Principles
Indications: manual laborers, TB / infection, compound intraarticular #, failed TEA
Position of fusion 90 best for personal hygiene / 70 for extrapersonal activity
Bilateral rarely required but if doing, place one elbow at 65 and other at 110
Technique (Spier)
Lateral decubitus with tourniquet, Posterior approach protecting ulnar nerve
Triceps split, preserve CFO, CEO, ID and protect Radial nerve proximally (10cm)
Remove synovium and cartilage and square off distal humerus and proximal ulna
Precontour 8-12 hole 3.5mm DCP plate to go around olecranon
Osteotomize radial head to level of bicipital tuberosity (protect PIN)
Fix to ulna and use articulated tensioning device to compress into humerus
LAC until arthrodesis solid (6-12/52)
Wrist Arthrodesis
General Principles
Use the wrist arthrodesis plate (Synthes) with 3.5mm holes proximally and 2.7mm holes distally
Optimal position is with 15 extension and long finger metacarpal lined up with radius
Complications: Ix, hematoma / skin slough, tendon adhesions, non/malunion, DRUJ / CMC OA
Technique (Richards)
Dorsal 3-4 approach with Z-shaped retinacular release for later repair
Osteotomize Listers Tubercle so that plate fits correctly
Capsulotomy and debridement of all intercarpal spaces and distal radius dorsally
5cm sliding bone graft (trough in radius) onto carpals and slotted into 3rd MC (optional)
Fix with plate in position above & protect in cast until fused, close over drains
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