JBJS essential surgical techniques · 2012
Elbow Resection for Deep Infection After Total Elbow Arthroplasty: Surgical Technique.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sanchez Sotelo Joaquin, Zarkadas Peter, Throckmorton Thomas, Morrey Bernard F
Аннотация
INTRODUCTION: Deep infection at the site of a total elbow arthroplasty is best managed with definitive removal of the components with resection arthroplasty in selected patients.
STEP 1 SKIN INCISION AND FLAP MANAGEMENT: Use a previous skin incision when possible, keep the subcutaneous flaps as thick as possible, and avoid inadvertent iatrogenic injury to the ulnar nerve.
STEP 2 IDENTIFY ULNAR AND RADIAL NERVES: The location of the ulnar nerve may be unpredictable, and the radial nerve may be at risk in two different locations.
STEP 3 DEAL WITH EXTENSOR MECHANISM: Access the implants through windows on the medial and lateral aspects of the triceps; whenever possible, consider an extended olecranon osteotomy when the ulnar component and cement are well fixed.
STEP 4 REMOVE HUMERAL COMPONENT AND CEMENT: Removal of all retained cement after removal of the humeral component is critical.
STEP 5 REMOVE ULNAR COMPONENT AND CEMENT: The ulna is much more delicate and fragile than the humerus and is prone to iatrogenic fracture.
STEP 6 OBTAIN SAMPLES FOR CULTURES AND PATHOLOGICAL ANALYSIS: Send three separate samples for culture when there was at least one preoperative positive culture, and five samples when there were no positive preoperative cultures.
STEP 7 PREPARE AND INSERT SPACER: Use the nozzles of cement guns to create cylinders of cement to be inserted in the ulna and humerus.
STEP 8 CLOSE: For patients with compromised soft tissues, we often consult with a plastic surgeon prior to surgery to contemplate improved coverage with rotation or free flaps at the time of the resection arthroplasty.
STEP 9 POSTOPERATIVE IMMOBILIZATION AND CARE: Early motion in an articulated brace may be allowed with a "stable" resection; unstable resections with substantial bone loss are best protected longer with no motion and may require a static brace.
RESULTS: We recently reviewed the Mayo Clinic experience with resection arthroplasty for the treatment of infection after total elbow replacement.
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
STEP 1 SKIN INCISION AND FLAP MANAGEMENT: Use a previous skin incision when possible, keep the subcutaneous flaps as thick as possible, and avoid inadvertent iatrogenic injury to the ulnar nerve.
STEP 2 IDENTIFY ULNAR AND RADIAL NERVES: The location of the ulnar nerve may be unpredictable, and the radial nerve may be at risk in two different locations.
STEP 3 DEAL WITH EXTENSOR MECHANISM: Access the implants through windows on the medial and lateral aspects of the triceps; whenever possible, consider an extended olecranon osteotomy when the ulnar component and cement are well fixed.
STEP 4 REMOVE HUMERAL COMPONENT AND CEMENT: Removal of all retained cement after removal of the humeral component is critical.
STEP 5 REMOVE ULNAR COMPONENT AND CEMENT: The ulna is much more delicate and fragile than the humerus and is prone to iatrogenic fracture.
STEP 6 OBTAIN SAMPLES FOR CULTURES AND PATHOLOGICAL ANALYSIS: Send three separate samples for culture when there was at least one preoperative positive culture, and five samples when there were no positive preoperative cultures.
STEP 7 PREPARE AND INSERT SPACER: Use the nozzles of cement guns to create cylinders of cement to be inserted in the ulna and humerus.
STEP 8 CLOSE: For patients with compromised soft tissues, we often consult with a plastic surgeon prior to surgery to contemplate improved coverage with rotation or free flaps at the time of the resection arthroplasty.
STEP 9 POSTOPERATIVE IMMOBILIZATION AND CARE: Early motion in an articulated brace may be allowed with a "stable" resection; unstable resections with substantial bone loss are best protected longer with no motion and may require a static brace.
RESULTS: We recently reviewed the Mayo Clinic experience with resection arthroplasty for the treatment of infection after total elbow replacement.
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.