Name: InternalBrace™ Suspensionplasty
Uploaded: 2019-12-16T00:00:00Z
Channel: Arthrex
Description: Andrew S. Greenberg, MD (Great Neck, NY), presents clinical findings and his technique for treating CMC arthritis by performing CMC suspensionplasty with Internal Brace™ ligament augmentation.

<p>Andrew S. Greenberg, MD (Great Neck, NY), presents clinical findings and his technique for treating CMC arthritis by performing CMC suspensionplasty with <em>Internal</em>Brace™ ligament augmentation.</p>

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VID1-000660-en-US | A | InternalBrace™ Suspensionplasty

Andrew S. Greenberg

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InternalBrace™ Suspensionplasty

So the way my journey was in fellowship, we literally just did trapeziectomy. And then I kind of gravitated towards doing an LRT and then the TightRope, you know, Geoff Yow, I've been friends with him for a while and, you know, he was doing TightRope and the TightRope was pretty awesome for me. We've ended here doing this trapeziectomy with a SwiveLock internal brace. And initially I was taking a strip of APL just like Steve Lee was doing. But again, it goes back to the debate. Is is a two millimeter slice of a dead tissue going to become alive one day? I really, really, really don't think so. So this is just an example of a patient and this is kind of what it is. All right. So doing a median nerve block. So really kind of minimal sedation kind of bear with me through this. This has got to be way actually to. Maybe we can speed this up a little bit. You guys don't need to know how to do a block. So I do a dorsal approach. I create the interval between the APL and EPB. And that's where I kind of make my incision. I always kind of find the radial artery, just because it always seems to be where I want it to be. Broad based capsulotomy. Because the key to this is going to be your capsule repair, right? If you're going based on your forming scar tissue in your first CMC joint, you really need to make sure that you can actually repair it. I used to take a saw and chop that trapezium up, and this was by far the longest part of the procedure. But now the mcglamery elevator. This is phenomenal. This is not a major invention. The podiatrist has been using this forever, but the mcglamery elevator. I have not had to take a saw to a trapezium. And I have not taken more than ten minutes to get a trapezium out in full with no breaks. Since using this you can scoop it around. It's relatively. There is a little learning curve to this but the trapezium comes out and then you're empty. Your FCR is unharmed should you need anything for a bailout. Now, the key here is this is your guidewire for the SwiveLock. Initially we're doing this down the center, and we kind of moved it now radially. I go on the border of the mid portion of the axis of the first metacarpal at the most radial border. All right. And I enter it. I'm using LabralTape with this not SutureTape because why not use a bigger suture to create a suspension. And you know, I'm not shoving graft in there so I can maximize the amount of suture. I go from the first to the second, and there's different modifications now that we can. We're kind of playing around with it and talking about doing. But there you're looking right at your second metacarpal. I enter I do use a fluoro, which you don't see here. I just want to make sure that I'm not popping out the top. I want to make sure I'm centered the metacarpals a little soft. And this is, you know, we should pause this for one second here because the tension for this is really, really different when you're when you're tensioning this, you want to prevent impingement. So when you're doing a TightRope, the way you'll do it is you'll kind of call up or what I'll do is I'll ball up a bunch of blue towels or whatever towels you have, and I'll have the patient. I'll kind of fold the thumb around it. And that way I know I'm not impinging my first and my second. And I know at that point I can hold it out to length and I'm not going to over distract. And you kind of create that that Centerline of the the hand using floral for this. It's totally different for this. You want to bring the thumb into a deduction and you actually don't want to over tension. Because if you over tension, your LabralTape bridge is actually going to be longer. Right? Because you're now you're creating it to how far you're going. So now you're longer. So then when you let go, it actually subsides more. So you really want to put it at the exact height that you want, which by the way, will obscure your SwiveLock hole. So get your SwiveLock hole, enter the fork tip in there, and then have your assistant hold it perfectly so then you can create tension on the SwiveLock. And then here it is empty. And then just cut away the rest. Now I know some modifications, some are taking a little strip of CRx starting in the second and then bringing that strip over, kind of creating a dynamic sling onto the side. So I'm still using a strip of APL and you can really do whatever you want, because again, that's the beauty of using this InternalBrace technique. You're just bracing whatever your poison is. And then so here's kind of the way you're tensioning it. If you want to use a graft, this is how you can do it. Again, if you're going to use a graft with a SwiveLock, it really shouldn't be bigger than two millimeters. You just run into trouble. You'll you'll you'll. Your anchor won't sit. You'll pull it out. You'll get frustrated. You want to make this as easy as possible for yourself so that you do it this way. So what I will do is I do a forearm based thumb spica splint for 4 to 6 weeks. They can take it off to shower, and they can do gentle active motion in the shower with no power grip and no strengthening. And at week four, I start a hand therapy with active range of motion. At week six, we begin about 50% strengthening 50 to 75% strengthening with discontinuing the splint. But I will give them a hand base at that point. If my patients are not, they're not splitting atoms. These people, I mean, they'll take their brand new hand and start like opening jars and and you can hurt things. And at 12 weeks full activity. And this is that patient. Thank you.

InternalBrace™ Suspensionplasty

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