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皮尼亚尔博士与梅奥诊所和香港中文大学骨科部门一起在《手外科杂志》上发表手腕关节镜检查的最新进展

皮尼亚尔博士与梅奥诊所和香港中文大学骨科部门一起在《手外科杂志》上发表手腕关节镜检查的最新进展

29 十二月, 2020

Dry wrist arthroscopy radial sided wrist disorders_01_20201223

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In his new collaborative work for the American edition of the prestigious journal, the role of dry arthroscopy in the approach to pathologies of the radial face of the wrist is addressed

More specifically, the article ‘Dry Wrist Arthroscopy for Radial-Sided Wrist Disorders‘ (Journal of Hand Surgery American Edition, Volume 47, issue 4, p341-353, April, 2020) shows the use of this arthroscopic technique in the approach to distal radius fractures, the execution of radial styloidectomy, the scaphoid fractures and malunions, the perilunate fracture-dislocation and the trapeziometacarpal osteoarthritis.

Dr Piñal developed the technique of dry arthroscopy in 2000 and the results were also published in the Journal of Hand Surgery, in 2007. Since then its use has been expanding, and now it receives a boost by being incorporated by the main universities in the world and recognized as the standard technique.

Placement of the arthroscope
Figure 4. (extracted from ‘Dry Wrist Arthroscopy for Radial-Sided Wrist Disorders’ p344). Placement of the arthroscope in the 3-4 portal can displace a fracture involving the scaphoid facet of the distal radius. By using the 6R portal as working portal, the arthroscope provides a view of the distal radius articular surface without impeding fracture reduction. (Piñal, Francisco D. Atlas of Distal Radius fractures. Thieme NY; 2018:51-72).

The evolution of wrist arthroscopy has been decisive in the diagnosis, prognosis and treatment of bone and ligamentous injuries. The refinement of the process through dry arthroscopy allows the surgeon to face this type of pathology in a minimally invasive way.

The drafting group of this new article is composed, in addition to Dr Piñal, by Drs Sanjeev Kakar, from the department of orthopedic surgery at the Mayo Clinic in Rochester (USA), Marion Burnier and Guillaume Herzberg, from the upper limb orthopedic surgery service at the Edouard Herriot hospital in Lyon (France), Andrea Atzei, from the unit of hand surgery at the GB Rossi polyclinic in Verona (Italy) and P.C. Ho from the Chinese University of Hong Kong.

Midcarpal arthroscopy
Figure 9. (extracted from ‘Dry Wrist Arthroscopy for Radial-Sided Wrist Disorders’ p347). Midcarpal arthroscopy demonstrates evidence of scaphoid nonunion. Note after the debridement, the maintenance of the cartilage shell of the scaphoid.

Pioneer and introducer

The Spanish surgeon Francisco del Piñal was part of the group of pioneer doctors in the arthroscopic approach to wrist injuries. Going one step further, with more than two decades of successful operations, Piñal developed and introduced the dry arthroscopy technique since 2000, allowing surgery without the use of saline solutions during procedures. This absence of fluids significantly improving possibilities and results.

Today, the Piñal dry mode, which enables the combination of complex operations, is the dominant technique in arthroscopic wrist surgery worldwide.

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