[Diagnostic arthroscopy of the wrist in adults and children with subsequent single-stage surgical procedures].
BACKGROUND
Wrist arthroscopy today still faces the problem of being much to often diagnostic only. In addition, if the diagnosis requires a larger operation to follow, it can rarely be performed in the same session. Above all the special positioning makes a second session necessary. A new technique of wrist arthroscopy established in the University Clinic of Basel, Switzerland, allows a conventional positioning and thus a secondary surgical procedure in the same session. In a prospective clinical two-centre study, we aim to answer questions about general feasibility and possible complications due to the multiple compartment anatomy in adults and children.


METHODS
In the two centres, University Clinic for Hand Surgery Basel, Switzerland and Orthopaedic Clinic IPVZ Hospital Bulovka, Czech Republic, we perform the new technique of wrist arthroscopy without distraction. Conventional 2.4 mm arthroscope and the III/IV, VI/R and MCU--approaches were used in adult patients (n = 147) and children (n = 10). High pressures up to 150 mm Hg of Ringer's lactate solution replaced the traction, but leaving the wrist freely movable and in a comfortable horizontal position. If indicated by the diagnostic arthroscopy, an open operation on the wrist was performed immediately. A standardised regimen of previously arranged clinical controls was followed.


RESULTS
Out of 157 wrist arthroscopies performed in the two clinics, 32 had an arthrotomy or another surgical procedure to follow in the same session. The mean duration of the diagnostic arthroscopy was 34 minutes. There were no arthroscopy related complications. Also in children, the arthroscopy gave the sufficient information about wrist anatomy and it was possible to continue with the surgical procedure in the same session.


CONCLUSIONS
According the literature reports, the arthrotomy does not follow the wrist arthroscopy using distraction, because the complicated positioning of the extremity. Wrist arthroscopy without distraction is a new technique, previously published by first author, and enables arthrotomy of the wrist in the same session, and was not previously published. Also arthroscopy of the wrist in the childhood was not published up to now.


CONCLUSIONS
In our study we have proven the feasibility of an arthrotomy or another surgical procedure to follow an arthroscopy on the wrist, all despite the special anatomical situation and the high intraarticular fluid pressure. We conclude the overall cost to be reduced and the patient's comfort improved. The method of the wrist arthroscopy without distraction can be used also in the childhood.
Hurácek
J
J
Univerzitní klinika chirurgie ruky a periferních nervů, Kantonální nemocnice, Basilej.
Chomiak
J
J
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014955:Wrist Joint / Q000473:pathology* / Q000601:surgery*
Diagnostická artroskopie zápĕstí u dospĕlých a dĕtí s následným chirurgickým zákrokem provedeným v jedné dobĕ.