A new technique of wrist arthroscopy to visualise instability J. Huracek*, J. Chomiak º, H. Troeger* *Department for surgery of the hand and the peripheral nerve, University Hospital Basel, Switzerland °Clinic for orthopaedic surgery Bulovka, Prague, Czech Republic

wrist arthroscopy and instability great extent of positioning ligamentotaxis / palpation no palmar approach no pro- / suppination no operation in succession technique on wrist technique on shoulder / knee

wrist arthroscopy and instability horizontal position no distraction intraarticular pression up to150 mm Hg hypomochlion move instead of draw

wrist arthroscopy and instability prospective study of 30 patients –arthroscopy without distraction, followed by –conventional arthroscopy with 3 kg traction standardised protocol –diagnostic sensitivity –quality of surgical procedures –complications

wrist arthroscopy and instability diagnoses involved 19 injuries, 11 degenerative diseases 11 times therapeutic surgery 2 discus suture, 9 discus debridèment mean age 37,1 years; follow-up 10,2 weeks

wrist arthroscopy and instability results with / without distraction: –same sensitivity (except for instability) –same specifity –surgical procedures not hindered –no complications (CTS) followed-up till today : –30 prospectively, 117 retrospectively

wrist arthroscopy and instability arthroscopy of intercarpal space MCU

wrist arthroscopy and instability arthroscopy of radiocarpal space total SL - rupture

wrist arthroscopy and instability arthroscopy of radiocarpal space total SL - rupture with pathological RU-duction

less extent (positioning, fluoroscopy) technically more difficult dynamical assessment of ligamentous instability direct proceed to open surgery (arthrotomy, distal radius fracture) the Basel technique of wrist arthroscopy

outlook intra-articular assessment before standard OP new, combined arthroscopic-open procedures assessment of acute trauma