Beruflich Dokumente
Kultur Dokumente
Trs compliqu
Instabilits radio-carpienne Instabilits intra-carpiennes Instabilits mdio-carpiennes Dissociatives, non-dissociatives, adaptatives. Le point commun, une anomalie dans la dynamique du carpe
2 formes: Luxation pure ou fracture luxation Lsions rares Lsions frquemment mconnues (1/3 des cas) Traumatisme haute nergie ou polytraumatisme (adulte jeune de sexe plutt masculin)
Difcults diagnostiques
Clinique peu parlante (normalement trs douloureux) Pas (peu) de dformation visible Radios difciles lire (30 % sont mconnues) - Arcs de Gilula pour la face
Arcs de Gilula
De prol !
Le classement en sous-groupes se fait de prol Luxation antrieure (rarissime) ou postrieure 3 stades selon la vascularisation restante du lunatum
Principes du traitement
Toujours chirurgical Fixer toutes les lsions Le pronostic est la colonne externe Synthse des fractures du scaphode Suture des dchirures scapholunaires
Instabilit scapho-lunaire
Tq L S P
Le couple scapho-lunaire
Du grec ancien !"#$%& skaphos ('carne de navire, (Par extension) vaisseau, navire') avec le sufxe -ode.
Le plus important sur le plan pathologique Fx du scaphode: 0,8 - 4,3 /10000. 2-5% de toutes les
fractures, 11% des fractures de la main et 60% des fractures du carpe
Pathologie du lunatum: ncrose, luxations Instabilits scapho-lunaires Le plus sollicit sur le plan mcanique
Le ligament scapholunaire
Evolution de la crte osseuse qui sparait lespace radio-carpien
Tz C T
S R
ECRB ECRL
Ul
30%
TT S
Tr
dRLT dRT
44%
26%
E + RD
F + UD
Evolution naturelle ?
Plusieurs travaux semblent montrer que la lsion scapholunaire saggrave avec le temps Distension progressive des bres restantes sous la contrainte ? Facteurs favorisants osseux ?
Frederick W. Werner, Walter H. Short, Jason K. Green, Peter J. Evans, Jacquelyn A. Walker. Severity of Scapholunate Instability Is Related to Joint Anatomy and Congruency. J Hand Surg 2007;32A:5560.
Evolution naturelle ?
Plusieurs travaux semblent montrer que la lsion scapholunaire saggrave avec le temps Distension progressive des bres restantes sous la contrainte ? Facteurs favorisants osseux ?
Frederick W. Werner, Walter H. Short, Jason K. Green, Peter J. Evans, Jacquelyn A. Walker. Severity of Scapholunate Instability Is Related to Joint Anatomy and Congruency. J Hand Surg 2007;32A:5560.
Evolution naturelle ?
Sous leffet des contraintes, le scaphode a tendance se subluxer vers larrire
58 The Journal of Hand Surgery / Vol. 32A No. 1 January 2007
Level of Instabilit
ate were monitored using electromagnetic nsors (Fastrak; Polhemus, Colchester, rpal kinematic data were acquired with tous structures intact and after the comoning of the SLIL, the radioscaphocapiligament, and the scaphotrapezium (ST) After ligamentous sectioning, 3 levels of ability were dened (Table 1), minimal, e, or gross, based on visual examinagap between the scaphoid and lunate scaphoid would clunk back into the RS
Evolution naturelle ?
works Corp., Concord, MA) to aid in making bone geometry measurements. Because of how the CT scans were thresholded, the CAD models do not include cartilage. The bony geometry was quantied by examining posteroanterior (PA) and lateral radiographs, and from the CAD models of the bones. The radiographs were taken with the arm in 90 of elbow exion, at neutral forearm rotation, and with the wrist in neutral exion/extension and radioulnar deviation. The beam was centered over the wrist joint at the junction between the proximal carpal row and the distal ra-
aphoid clunk. (A) Lateral view of the scaphoid at 20 of wrist extension with the wrist moving from neutral to th all ligaments intact. (B) Corresponding transverse plane view of the scaphoid shown in (A). (C) Lateral view of phoid with the wrist at 20 extension, but with the SLIL, RSC, and ST ligaments sectioned. The scaphoid has exed, lly, and radially compared to the intact state, and is now on the dorsal rim of the radius. (D) Corresponding w of the scaphoid shown in (C). As the wrist and scaphoid continue to extend, the scaphoid snaps back into the d fossa, approximately 0.04 seconds later in the cadaver wrist motion: (E) lateral view; (F) corresponding transverse
Examen clinique
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Evolution naturelle ?
La dynamique modie du scaphode augmente les pics de contrainte sur une faible surface ce qui gnre une arthrose localise du ple proximal
Evolution naturelle ?
Evolution naturelle ?
Le bloc lunatum-triquetrum bascule en extension (DISI) Le ple proximal du lunatum et la fossette lunarienne restent congruents (pas darthrose)
Continuum de lsions
Au stade de SLAC
STADE 1!
(
STADE 2!
(
STADE 3!
(