Adobe Systems Vyskočil R., Rouchal M., Ryba L., Vališ P., Nýdrle M., Filipovič M., Ortopedická klinika FN Brno Přednosta: Prof. MUDr. Martin Repko Ph.D. Adobe Systems 03072413s DSC_0181 Adobe Systems Adobe Systems ̶Knee ̶Shoulder ̶Wrist ̶Elbow ̶Hip ̶Para-articular spaces / Achilles tendon, carpal tunnel – CTD / Adobe Systems monitor ̶ ̶ ̶ PC ̶ light source ̶ processor of the camera DSC_0137 DSC_0189 Adobe Systems Pump ̶ ̶ Shaver DSC_0141 DSC_0159 DSC_0142 DSC_0154 Adobe Systems optics 30° DSC_0162 DSC_0164 Adobe Systems DSC_0166 Adobe Systems Instruments TwinFix TwinFix katalog Dotahovač uzlu Adobe Systems Turniquet ̶ ̶Ischemisation of the leg „bloodless“ procedure ̶250 Torr / Systolic BP + 100 / ̶Maximum 90 min ̶ ̶Knee, ankle, foot ASC DSC_0139 DSC_0160 Adobe Systems Preparation ̶Knee scope ̶ ̶Supine position ̶Thigh holder ̶Turniquet ̶ ̶ DSC_0168 Adobe Systems DSC_0172 DSC_0176 Adobe Systems DSC_0174 Adobe Systems Basic 2 portals ̶For Optics – AL ̶Instruments – AM ̶ DSC_0183 Adobe Systems DSC_0185 Adobe Systems DSC_0188 surgeon anesthetist Adobe Systems Upper limb Shoulder Indication: Degeneration Trauma, post – traumatic pathology Infection - lavage Tumour - biopsy Adobe Systems Most common diagnosis of shoulder Arthroscopy: ̶Repeated shoulder dislocations – „Bankart“ lesion venral labrum tear ̶Slap lesion Superior – „ superior labrum antero-posterior“ upper labrum tear ̶Rotator cuff pathology – tear, rupture ̶Pathology of SA space – „Shoulder Impingement“ ̶Osteoarthritis, degeneration slap2 Adobe Systems slap2 Adobe Systems position on the table 1.lateral decubitus traction of operated limb 2. „beach chair“ position Poloha pacienta Adobe Systems Přístupy Adobe Systems Porty Adobe Systems Ventral defect of the labrum – Bankart lesion ventral shoulder dislocation Labrum destroyed / Hill Sachs lesion of the head Adobe Systems Restored labrum + capsule and fixed with anchors 6 12 Adobe Systems Post op X ray 13 14 Adobe Systems Post op fixation ̶Labrum reconstruction - Dessault orthosis for 6/52 ̶ ̶SAD /decompression/ - scarf bandage, intensive RHB ̶ ̶Rotator cuff suture - Abduction splint for 6/52 – 3/12 001 Adobe Systems Open surgery Mini-invasive approach ̶Rotator cuff repair/suture / m. supraspinatus, infaspinatus, teres minor, subscapularis / ̶Open Resection of distal /lateral/ end of the clavicle / Stewart operation / Adobe Systems Wrist Smaller optics and instruments No pump and turniquet ̶Pathology of TFCC / triangular fibrocartilage complex / ̶Scapho-lunate dissociation ̶ Adobe Systems ̶Wrist instability ̶Partial excisions of the wrist ̶Distal ulna/radius ostetomy ̶Pseudoarthrosis ossis scaphoidei ̶CTD carpal tunnel decompresion ̶Artrodesis of the wrist and fingertips ̶Synovectomy open surgery... Adobe Systems Lower Extremity Hip ̶Post-traumatic /degenerative arthrosis ̶Coxitis – debridement + lavage ̶Foreign bodies removal ̶Labral reconstruction ̶FAI – Femoro-acetabular impingement repair Adobe Systems Knee ̶ ̶Acute trauma: haemarthros Instability – rpt ACL/PCL ̶Infection / gonitis - lavage ̶Osteoarthritis - debridement ̶Meniscus repair/resection, LCA/PCL reconstruction, plica resection, chondral defects, foreign bodies removal, patellar release,…. ̶ ̶ ASgenus klin Adobe Systems Adobe Systems Adobe Systems Adobe Systems Adobe Systems Chondral defects ̶Mosaicplasty osteochondral blocs taken from non-bearing zone ̶Autologous chondrocytes transplantation taken healthy parts of cartilage – multiplication after 6 weeks open implantation on the carriers – scaffolds to the defect ̶Allogeneic chondrocytes transplantation ( USA ) mozaika1 Adobe Systems Adobe Systems ̶Mosaicplasty 016 022 Adobe Systems ̶Autologous chondrocytes transplantation - chondrograft F:\2012_chrupavka_koleno\Farkašová_Hana_1970\DSC_0172.JPG F:\2012_chrupavka_koleno\Farkašová_Hana_1970\DSC_0174.JPG Adobe Systems Adobe Systems ATC – Ankle Arthroscopy ̶ ̶Acute injury ̶Degeneration necrosis ostechondritis dissecans chondral defects Adobe Systems Osteochondrosis dissecans / OCHD / mrprop5 mrprop4 rtg01prop Adobe Systems OCHD necrotic bone – debridement, use chondrograft healthy bone – fixation back with the screw Medial Malleolus ostetomy 0059 0062 Adobe Systems 0075 0078 Chondrograft fixation Screw fixation of medial malleolus Adobe Systems 0058 0077 before after Adobe Systems Thank you for your attention Adobe Systems