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M&M's Technique : Four Corner Arthrodesis with Fusion Restricted to the Center, Scaphoid Graft, and Dorsal Circular Plates
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April 2, 2012
This technique was described by Mathoulin&Mantovani (M&M's) on the European JHS 2010, as an easier ...
read more ↘ way to perform a 4 bone fusion using a dorsal circular plate.
The main idea is to perform first the DISI deformity correction, while all the joints are intact, and temporary fix it with K wires. Then a central ressection is performed with a BUR in a way to promote a bone bridging between the 4 bones restricted only on the center of the construction. As the fusion site is not so big, the healthy part of the distal pole of the scaphoid is enough to fill the space, and a rigid fixation with dorsal circular plate is applied in order to promote a prompt mobilization protocol.
Technical details are also the double capsule approach, avoiding a complete injury on the lunate dorsal capsular attachments, which may avoid a vascular supply deficit to this bone, once 30% of population may present an incomplete pattern of lunate vascularity without volar vascular supply to this bone. Another technical pearl is ressecting the scaphoid bone as one piece and not piecemeal as commonly described. For this we may use a combined volar mini-incision over the scaphoid tubercle attachments. With a single piece of the scaphoid is possible to ressect more properly the cartilage and subchondral bone and obtain a better piece of good quality sponjous bone graft.
The goals of this technique is to make the procedure faster and easier than the conventional approach, and promote quicker recovery of the patients using internal rigid fixation. The clinical results obtained are good, contrary on the first series using dorsal circular plates with non acceptable rates of nonunion and other complications.
↖ read less
read more ↘ way to perform a 4 bone fusion using a dorsal circular plate.
The main idea is to perform first the DISI deformity correction, while all the joints are intact, and temporary fix it with K wires. Then a central ressection is performed with a BUR in a way to promote a bone bridging between the 4 bones restricted only on the center of the construction. As the fusion site is not so big, the healthy part of the distal pole of the scaphoid is enough to fill the space, and a rigid fixation with dorsal circular plate is applied in order to promote a prompt mobilization protocol.
Technical details are also the double capsule approach, avoiding a complete injury on the lunate dorsal capsular attachments, which may avoid a vascular supply deficit to this bone, once 30% of population may present an incomplete pattern of lunate vascularity without volar vascular supply to this bone. Another technical pearl is ressecting the scaphoid bone as one piece and not piecemeal as commonly described. For this we may use a combined volar mini-incision over the scaphoid tubercle attachments. With a single piece of the scaphoid is possible to ressect more properly the cartilage and subchondral bone and obtain a better piece of good quality sponjous bone graft.
The goals of this technique is to make the procedure faster and easier than the conventional approach, and promote quicker recovery of the patients using internal rigid fixation. The clinical results obtained are good, contrary on the first series using dorsal circular plates with non acceptable rates of nonunion and other complications.
↖ read less
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