DR.MOHAMMAD BASHAR AL BOSHI

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ARTHRODESIS
DR.MOHAMMAD BASHAR AL BOSHI
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SHOULDER ARTHRODESIS
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INDICATIONS

• Indications for shoulder fusion have diminished
  over the years because of
• the excellent results of shoulder arthroplasty.
• the near elimination of poliomyelitis and
  tuberculosis.
• the improved techniques for shoulder
• stabilization.

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Contraindications

• Osteonecrosis.
• Charcot arthropathy(nonunion rate is high).
• Ipsilateral elbow fusion.
• Contralateral shoulder fusion.

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• We agree that the position of rotation is the
  most critical factor in obtaining optimal
  function.

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SURGICAL TECHNIQUES

• the limited contact between the glenoid fossa and
  humeral head can be improved by including the
  acromion in the fusion mass.
• Firm internal fixation usually eliminates the
  need for bone grafting and external fixation.

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Used as graft
COMPRESSION TECHNIQUESEXTERNAL FIXATION

• TECHNIQUE 1 (Charnley and Houston)

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5 to 6 weeks
cast 12 weeks
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COMPRESSION TECHNIQUESINTERNAL FIXATION

• TECHNIQUE 1 (Cofield)

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spica cast 12 to 16 weeks
45 Degrees
TECHNIQUE 1 (Cofield)
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• AFTERTREATMENT
• A pelvic band extending from the nipples to the
  pubic symphysis is applied.
• With the elbow flexed 90 degrees, a cylinder
  cast is applied to the upper extremity.
• The extremity is suspended by two wooden struts,
  or a cock-up wrist splint is used.
• At 1 to 2 weeks after surgery, a plastic
  shoulder spica cast is applied and worn until
  union is achieved, 12 to 16 weeks after surgery.

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• TECHNIQUE 2 (Uematsu)

Position 20 degrees of abduction, 30 degrees of
flexion, and 40 degrees of internal rotatio
Used as graft
A cast 3 months
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the distal acromion as avascularized graft
A shoulder spica 8-10 weeks

• TECHNIQUE 3 (Mohammed)

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Apply bone grafts
No cast

• TECHNIQUE 4 (AO Group)

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60 D
Position 30 degrees of flexion, 30 degrees of
abduction, and 30 degrees of internal rotation.
Do not osteotomize the acromion
A shoulder spica cast 6weeks

• TECHNIQUE 5 (Richards et al.)

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ELBOW ARTHRODESIS
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POSITION

• For unilateral arthrodesis of the elbow, a
  position of 90 degrees of flexion is desirable.
• Bilateral elbow arthrodesis rarely is indicated
  because of resultant functional limitations. If
  indicated, one elbow should be placed in 110
  degrees of flexion to permit the patient to reach
  the mouth and the other should be
• placed in 65 degrees to aid in personal
  hygiene.

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AGraft1.5 x 9 cm
Fitting cast 8 weeks

• TECHNIQUE 1 (Steindler)

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Grafts8 mm x 7.5-10 cm
Fitting cast 8 weeks

• TECHNIQUE 2 (Brittain)

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Fitting cast 8 weeks

• TECHNIQUE 3 (Staples)

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Technique for fusion in tuberculous arthritis of
elbow.
use the resected epicondylar and olecranon
fragments as bone grafts

• TECHNIQUE 4(Arafiles)

a long arm cast for 3 months
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The fixator and pins 6 to 8 weeks
a long arm cast until the arthrodesis is solid

• TECHNIQUE 5 (Müller et al.)

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The plate and screws 1year only
Apply bone graft

• TECHNIQUE 6 (Spier)

The most common indication was a high-energy,
open, infected injury with associated bone loss.
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Complications

• Complications of elbow arthrodesis
• include
• Delayed union.
• Nonunion.
• Malunion.
• Neurovascular injury .
• Painful prominent hardware .
• Skin breakdown.

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WRIST ARTHRODESIS
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Contraindications

• include
• An open physis of the distal radius( The distal
  radial physis close approximately 17 years of
  age).
• After partial destruction of the physis ,the
  remaining part may be excised to prevent unequal
  growth.
• An elderly patient with a sedentary lifestyle,
  especially if the nondominant wrist is involved.

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POSITION

• Usually 10 to 20 degrees of extension
  (dorsiflexion) with the long axis of the third
  metacarpal shaft aligned with the long axis of
  the radial shaft (allow maximum grasping
  strength).
• In general, neutral to 5 degrees of ulnar
  deviation is preferred.
• If bilateral wrist fusions are indicated, the
  positions of the wrists should be determined by
  the needs of the patient( The neutral position).

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• The straight plate is employed when a large
  intercalary graft is required for a traumatic or
  tumorous defect.

• The short carpal bend is used in small wrists
  and those in which the proximal row has been
  resected.

• The longer carpal bend is used in large wrists.

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• TECHNIQUE 1 (AO Group)

cancellous bone harvested from the excised bone
A cast (10 to 12 weeks)
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Supporting the fusion site with Kirschner wires
or staples. bone graft is not necessary.
cast or splint for 12 to 16 weeks

• TECHNIQUE 2 (Louis et al.)

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cast or splint for 12 to 16 weeks
2.5x4cm
If the wrist is unstable, insert a nonthreaded
Kirschner wire

• TECHNIQUE 3 (Haddad and Riordan)

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Place an outer cortical piece of iliac bone graft
Cast 6-8weeks

• TECHNIQUE 4 (Watson and Vendor)

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ARTHRODESIS OF FINGER JOINTS
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INDICATIONS

• Damaged by injury or disease.
• Pain.
• Deformity.
• Instability makes motion a liability rather than
  an asset.
• Arthrodesis is used most often for the proximal
  interphalangeal joint because motion in this
  joint is so important.
• When the metacarpophalangeal joint is destroyed,
  if good muscle strength is present,
• arthroplasty is indicated more often than
  arthrodesis.

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POSITION

• The metacarpophalangeal joint should be fixed in
  20 to 30 degrees of flexion.
• The proximal interphalangeal joints should be
  fixed from 25 degrees of flexion in the index
  finger to almost 40 degrees in the small finger
  (less flexion in the radial fingers than in the
  ulnar fingers).
• The distal interphalangeal joints are fixed in 15
  to 20 degrees of flexion.

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Ball-socket Or Cup-cone
Splint2-3days

• TECHNIQUE (Stern et al. Segmüller, Modified)

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• A, Phalangeal osteotomy.
• B, Hole for 25- or 26-gauge stainless steel
  wire made through middle phalangeal base dorsal
  to midaxial line. C C,
  Retrograde insertion of 0.028-or 0.035-inch
  Kirschner wire into proximal phalanx.
• D, Kirschner wire driven into anterior cortex
  of middle phalanx.
• E, Figure-eight tension band created and
  tightened.

• Tension band arthrodesis

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• A, Anteroposterior and lateral views of crossed
  Kirschner wires.
• B, Anteroposterior and lateral views of
  interfragmentary wire and longitudinal
  Kirschner wires.
• C, Anteroposterior and lateral views of Herbert
  screw

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THANK YOU
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  department of orthopedics in Damascus hospital,
  under the supervision of Dr. Bashar Mirali.
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Dr. Muayad Kadhim