POSTER ABSTRACTS - ISAKOS

faster rehabilitation, so we think it’s an interesting
alternative to the techniques actually in use.
E-poster #206
Microsurgical Dissection of the Carpal Tunnel
in Respect to Neurovascular Structures At Risk
During Endoscopic Carpal Tunnel Release
Harilaos S. Vasiliadis, Ioannina, GREECE,
Presenter
Anastasios V Tokis, Anatoli- Ioannina, GREECE
Nikolaos V. Kordalis, Ioannina, GREECE
Alexandros E. Beris, Ioannina, GREECE
Anastasios Georgoulis, Ioannina, GREECE
Department of Orthopaedics, University of
Ioannina, Ioannina, GREECE
Introduction: The aim of the study was to
investigate the anatomy of the carpal tunnel in
respect to the related neurovascular structures
and to better understand the procedure of
Endoscopic Carpal Tunnel Release.
Material and methods: 10 fresh frozen cadaveric
hands were used for the study. Dissection of the
palmar aspect of the hand was performed using
magnifying loopes, an operative microscope and
microsurgical instruments. All anatomic
components were photographed and dimensions
were recorded using a micrometer. The distance
from the radial aspect of os pisiformis to other
very important structures, the distance between
the entry and exit portals and the main structures
usually injured was measured. Topography of the
transverse ligament and possible adhesions to the
tendons and median nerve were described.
Results: The mean distance from radial aspect of
os pisiformis to radial border of the Guyon's canal
was 10,7mm (9-12mm) and to ulnar edge of the
palmaris longus tendon was 16,2mm (12-22mm).
The mean distance from the exit portal to the
superficial palmar arch and ulnar artery were
8,8mm (5-15) and 6,2mm (4,6-9) respectively. The
mean distance from the distal edge of the
transverse ligament to the thenar branch of the
median nerve was 2,7mm (0-4,1). The mean length
of the transverse ligament was 31,6mm (25-34,5).
In 9 hands we identified the palmaris longus
tendon. In 7 hands we found adhesions between
the transverse ligament and the sheath.
Discussion: The area beneath the palmaris longus
tendon is the safest place for the entry portal and
the only guarantee for not introducing the
obdurator in the Guyon's canal (distance from os
pisiformis more than 12mm). Identification of the
distal border and not working more than 5mm
further from it is very essential. Synovial
adhesions can usually cover the transverse
ligament and they need to be removed for clear
endoscopic identification of the transverse fibres
before cutting the ligament.
E-poster #207
Arthroscopy for Snapping Elbow Due to
Congenital Radial Head Dislocation: A Case
Report
Yoshiaki Kurihara, Soka City, Saitama JAPAN,
Presenter
Takeshi Muneta, Tokyo, JAPAN
Soka City Hospital, Soka City, Saitama, JAPAN
There have been few reports on elbow arthroscopy
for congenital radial head dislocation, though
some reports have been available in regard to
snapping elbows due to synovial plicae. We
report a case of adult bilateral snapping elbows
with bilateral congenital radial head dislocation,
which required a surgical procedure.
The patient was a 37-year-old woman who had
been aware of the popping of her elbows since her
childhood but ignored the symptom with no signs
of disability in evidence. A few years ago, after
contusion of her left elbow, she had pains in both
elbows while popping in motion at work and
visited our hospital. Physical examination
revealed anterior dislocation of the bilateral radial
heads in extension and their lateral shift in
flexion. Snapping with pains occurred at about 90
degrees of flexion in both elbows. X-ray and 3D-CT
of her left elbow showed a dome-shaped radial
head and mild displasia of humeral capitulum.
MRI showed a relaxed and displaced annular
ligament. Conservative treatments like motion
control or joint injection were not effective and
surgical treatment for the left elbow was required.
With elbow arthroscopy, it was observed that
there was no intercalation and that snapping
occurred between the humeral capitulum and the
radial head, accompanied by articular
cartilaginous damage. The snapping and pains
disappeared after excision of the radial head by
means of additional small incision. Arthroscopic
excision was considered to be possible if
important structures, such as the nerves and the
vessels, were guarded.