دانلود رایگان مقاله شرایط ساده بدن جهت آرتروسکوپی انگشت پا

Abstract

Toe arthroscopy has historically had limited applications but is beginning to emerge as a viable treatment option for select toe pathologies, and continues to have expanding indications as technology and techniques improve. Toe arthroscopy has used a multitude of distraction techniques to perform the procedures but all have had limited success. Thus, we propose a simple toe arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of an assistant, external weights, or any reprocessed sterile equipment.

Discussion

Using our simple toe distraction setup may decrease surgical setup times, reduce overall costs, and minimize the burden on central sterilization and operative equipment as well as decreasing essential personnel. The surgical setup time is decreased when the ancillary room for complete joint exposure (Fig 4). The arthroscope and arthroscopic tools are then inserted in the standard nick-and-spread technique. The senior author (K.D.M.) prefers to use a short 30
2.7-mm high defi- nition camera, a 2.9-mm shaver, and a 1.4-mm cautery. Initially, a dorsal synovectomy is performed to create visualization; next a complete articular examination is completed (Fig 5). The working and viewing portals are exchanged as needed for adequate visualization and instrumentation. Small to moderate dorsal cheilectomys (Fig 6) can be performed as well as debridement and microfracture of osteochondral defects (Fig 4) using standard small joint instruments. If, during the procedure, visualization is not adequate because of tight spacing, the external positioning arm is gently pulled in line with the lower extremity for additional distraction. This can provide a larger space for placement of the arthroscope and tools. If an angle needs to be obtained for visualization, the external positioning arm allows for varus or valgus stress to be applied or flexion/ extension depending on the angle needed. The trimano external positioning arm is a single cylinder that allows for easy access to all quadrants of the MTPJ; it also makes incorporation of fluoroscopy positioning much easier, thus limiting radiation exposure to not only the patient but also the medical personnel in the operating room. (Video 1 details our technique.)