wrist

Biopsy Anatomical Approach

Region specific approaches

 

Theory

- want to traverse one muscle / one compartment

- keep away from NV bundle

- as a rule perform open biopsy through compartment the tumour is in

- this is the compartment that will require surgical removal in wide excision

- direct approach without going through muscle if possible i.e. tibia, distal ulna

 

Lower Limb

 

Thigh

 

Multiple Hereditary Exostosis

AKA

 

Diaphyseal Aclasis / Multiple Osteochondromas

 

Definition

 

Heritable skeletal dysplasia

 

Epidemiology

 

AD with variable penetrance (96%)

 

Malignant Transformation

 

Incidence of malignant transformation much higher 

- 10% overall

- 1 % / year

 

Chondrosarcoma (CS) > Osteosarcoma (OS)

 

Upper Limb

Indications for Surgery

 

Upper limb surgery is mainly in spastic hemiplegia

- many of the CP' s have sensory neglect for affected limbs   

- won't use limb post surgery anyway

 

Surgical indications

- a reasonable level of IQ (>70)

- spastic not athetoid 

- voluntary grasp and release

SNAC

Definition

 

Scaphoid non union advanced collapse

 

Diagnosis

 

Xray / CT

- non union of scaphoid

- radio-scaphoid OA

 

SNAC Wrist APSNAC Wrist CT

 

Operative Options

 

Distal Radius Fracture

Epidemiology

 

2 groups

 

1.  Elderly

- low velocity injury

- osteoporotic

- need to start bisphosphonates

 

2.  Young patients

- high velocity injury

 

Anatomy

 

Distal Radius Angles

- radial volar tilt 11°

- radial inclination  22°

- radius is 11 mm longer than ulna 

- ulna variance 2mm positive on average

 

Rheumatoid Wrist

EpidemiologyRheumatoid Wrist

 

Extremely common

- 90% by 10 years have wrist problems

 

Principles

 

Landsmeer 1961

- treat wrist at same time as treat fingers or will recur

 

Frequently combine procedures

- synovectomy

- tendon transfer

- ulna procedure