Green's Operative Hand Surgery, 6th Edition

Cover......Page 1
Front Matter......Page 2
Copyright......Page 3
Contributors......Page 4
Foreword for the 6th Edition......Page 9
Preface......Page 10
Acknowledgments......Page 11
Record Keeping......Page 12
Doppler Examination......Page 14
Radiographs......Page 15
Injections......Page 16
Arteriography......Page 17
Operative Game Plan......Page 18
Skin Preparation......Page 19
Perioperative Antibiotics......Page 20
Cuff Size and Design......Page 21
? Author’s Preferred Method of Tourniquet Use......Page 23
Forearm Tourniquets......Page 24
Surgical Instruments......Page 25
Radiation Exposure to the Surgeon......Page 28
Postoperative Care......Page 30
Tourniquet......Page 32
Aggravating a Preexisting Nerve Injury......Page 34
Pregnant Patients......Page 35
Historical Techniques......Page 36
Interscalene Block......Page 37
Infraclavicular Block......Page 38
Axillary Block......Page 39
Wrist Block......Page 40
Digital Block......Page 41
? Authors’ Preferred Method of Treatment: Regional Anesthesia......Page 43
Management (Figure 2.14)......Page 44
References......Page 45
Types of Infections......Page 48
Patient Evaluation......Page 49
Treatment Principles......Page 50
Operative Methods......Page 51
? Authors’ Preferred Method of Treatment......Page 53
Postoperative Management and Expectations......Page 54
Postoperative Management and Expectations......Page 55
Clinical Presentation and Evaluation......Page 56
Operative Treatment......Page 57
Volar Incision......Page 58
Postoperative Management and Expectations......Page 59
? Pertinent Anatomy......Page 60
Closed Tendon Sheath Irrigation......Page 61
? Authors’ Preferred Methods of Treatment......Page 62
Postoperative Management and Expectations......Page 63
Open Treatment......Page 64
Thenar Space......Page 65
Midpalmar Space......Page 66
Dorsal Longitudinal Approach.......Page 67
Hypothenar Space......Page 68
Interdigital Web Space (Collar-Button Abscess)......Page 69
Parona’s Space......Page 70
Postoperative Management and Expectations......Page 71
Clinical Presentation and Patient Evaluation......Page 72
Proximal Interphalangeal Joint......Page 73
Postoperative Management and Expectations......Page 74
? Anatomic Site......Page 76
Treatment......Page 77
Animal Bites......Page 78
Marine Organisms......Page 79
Human Bites......Page 80
Prosthetic/Implant Infections......Page 81
Shooter’s Abscesses: Infections Caused by Parenteral Drug Abuse......Page 82
Herpetic Whitlow (Herpes Simplex Virus Infection of the Fingers)......Page 83
Diabetic Hand Infections......Page 84
Necrotizing Soft Tissue Infections and Gas Gangrene......Page 85
Cutaneous Anthrax Infections......Page 87
Mimickers of Infection......Page 88
References......Page 89
Diagnosis......Page 92
Guidelines for Specimen Collection and Handling......Page 94
Additional Evaluation......Page 95
Anthrax......Page 96
Treatment......Page 97
Microbiology......Page 98
Diagnosis......Page 99
Diagnosis......Page 100
Classification......Page 101
Diagnosis......Page 102
Diagnosis......Page 103
Etiology......Page 104
Clinical Findings......Page 105
Treatment......Page 106
Clinical Findings......Page 107
Treatment......Page 108
Mucormycosis......Page 109
Diagnosis......Page 110
Treatment......Page 111
Clinical Pathology......Page 112
Anesthetic Skin Patch......Page 113
Thickened Nerves......Page 114
Skin Lesions......Page 115
Technique......Page 116
Technique of Fine-Needle Nerve Aspiration......Page 117
Relief of Pain......Page 118
Lucio’s Reaction......Page 119
Treatment......Page 120
Compression Neuropathy......Page 121
Treatment......Page 122
Treatment of Deformities......Page 123
Rehabilitation......Page 124
Mycobacterial Infections (Tuberculous and Nontuberulous)......Page 125
Diagnosis......Page 126
Diagnosis......Page 127
Diagnosis......Page 128
Diagnosis......Page 129
Treatment......Page 130
Tuberculous Osteomyelitis of the Hand in Adults......Page 131
Antituberculous Drugs and Multidrug Therapy Regimens......Page 132
Regimens......Page 133
Clinical Findings......Page 134
Diagnosis......Page 135
Onchocerciasis (Onchocercosis, Filarial Infection)......Page 136
Etiology and Epidemiology......Page 137
Cellular Immune Responses......Page 138
Bacillary Angiomatosis......Page 139
Warts......Page 140
Keratolytic Therapy......Page 141
Human Orf (Farmyard Pox, Milker’s Nodule, Ecthyma Contagiosum, Contagious Pustular Dermatitis)......Page 142
Differential Diagnosis......Page 143
References......Page 144
Basic Science......Page 147
? Pertinent Anatomy......Page 148
Pathoanatomy......Page 150
Historical Review......Page 152
Preparations for Surgery......Page 153
? Author’s Preferred Treatment Method......Page 158
Postoperative Management and Expectations......Page 161
References......Page 162
Juncturae Tendinae......Page 165
Extensor Digitorum Communis Insertion......Page 166
Extension of the Finger......Page 167
Testing the Anatomic Integrity of the Central Slip: Elson’s Test......Page 168
Oblique Retinacular Ligament......Page 169
Biomechanics of Finger Extension......Page 170
? Author’s Preferred Treatment......Page 171
Postoperative Management......Page 172
Outcomes......Page 173
Acute Mallet Finger Injury (Zone 1: Distal Interphalangeal Joint Level)......Page 174
Nonoperative Treatment......Page 175
Operative Treatment......Page 176
Type IV (Mallet Fractures)......Page 177
Technique of Skin Imbrication......Page 178
Technique of Spiral Oblique Retinacular Ligament Reconstruction......Page 179
? Author’s Preferred Treatment of Chronic Mallet Injury......Page 180
Zone 3 (Proximal Interphalangeal Joint) Injuries......Page 181
? Author’s Preferred Method of Treatment of Zone 3 Injuries......Page 182
Chronic Zone 3 Closed Injuries (Chronic Boutonnière)......Page 183
? Author’s Preferred Method: Curtis’ Staged Reconstruction......Page 184
Closed Sagittal Band Rupture......Page 186
Finger Zone 6 Injuries at Metacarpal Level......Page 189
Chronic Injuries and Ruptures in Zone 7......Page 190
Zone 9: Proximal Forearm Injuries......Page 191
References......Page 192
Musculoskeletal......Page 195
? Anatomy......Page 197
Preoperative Considerations......Page 198
Flexor Digitorum Profundus Avulsion......Page 199
Core Sutures......Page 200
Role of Postoperative Passive Motion Rehabilitation......Page 201
? Author’s Preferred Method: Zone 1 Tendon to Bone Repair......Page 202
? Author’s Preferred Method: Primary Tendon Repair in Zones 1 and 2......Page 204
? Author’s Preferred Method: Postoperative Rehabilitation of Zone 1 and 2 Repairs......Page 207
Complications......Page 210
References......Page 211
Flexor Tendon Reconstruction......Page 213
Preoperative Evaluation......Page 214
? Authors’ Preferred Technique: Tenolysis......Page 215
Expectations......Page 216
Indications......Page 217
Pull-out Sutures—“Around the Bone”......Page 218
Proximal Juncture......Page 219
Single-Stage Grafting Technique......Page 220
Proximal Juncture Technique......Page 221
Long-term Graft Integrity......Page 222
Single-Stage Grafting Technique with Intact Flexor Digitorum Superficialis Tendon (Zone I Injuries)......Page 223
Expectations......Page 224
Historical Review......Page 225
? Authors’ Preferred Technique......Page 226
Postoperative Care......Page 227
Technique......Page 228
Tissue Response to Silicone Implant......Page 229
Staged Tendon Reconstruction in the Thumb......Page 230
Other Options in Flexor Pollicis Longus Disruption......Page 231
Expectations......Page 232
Technique of Plantaris Tendon Harvest......Page 234
Technique of Long Toe Extensor Harvest......Page 235
Technique of Toe Flexor Harvest......Page 236
Pulley Reconstruction Using Free Tendon Graft......Page 237
Pulley Reconstruction Using Artificial Materials......Page 238
Indications......Page 239
Quadrigia......Page 240
Late Flexion Deformity......Page 241
References......Page 242
8 Fractures of the Metacarpals and Phalanges......Page 245
Metacarpal Head Fractures......Page 246
Metacarpal Neck Fractures......Page 247
Closed Reduction of Metacarpal Neck Fractures......Page 248
? Authors’ Preferred Method of Treatment......Page 249
Closed Reduction and Plaster Immobilization......Page 251
Closed Reduction and Percutaneous Pinning......Page 252
Kirschner Pins......Page 253
Cerclage and Interosseous Wiring......Page 254
Intramedullary Fixation......Page 255
Interfragmentary Compression Screws......Page 256
? Authors’ Preferred Method of Treatment......Page 257
Segmental Metacarpal Loss......Page 259
Fracture-Dislocations of the Small Finger Carpometacarpal Joint......Page 260
? Authors’ Preferred Method of Treatment......Page 261
Dorsal Angulation......Page 262
Osteomyelitis......Page 263
Fractures of the Distal Phalanx......Page 264
Fractures of the Middle and Proximal Phalanges......Page 265
Condylar Fractures......Page 266
Dorsal, Volar, or Lateral Base Fractures......Page 267
? Authors’ Preferred Method of Treatment: Articular Fractures......Page 268
Shaft Fractures......Page 273
External Fixation......Page 274
Surgical Approaches......Page 275
Open Reduction with Pin Fixation......Page 276
Intramedullary Fixation......Page 277
? Authors’ Preferred Method of Treatment: Phalangeal Shaft Fractures......Page 278
Spiral and Oblique Fractures......Page 279
Displaced: Unstable and Comminuted......Page 280
Expected Outcomes: Phalangeal Shaft Fractures......Page 281
Base Fractures of the Proximal Phalanx......Page 282
Malunion......Page 283
Shortening......Page 284
Nonunion......Page 285
Proximal Interphalangeal Joint Extensor Lag......Page 286
Role of Antibiotics......Page 287
Intra-articular Fractures and Avulsions......Page 288
Articular Fractures of Thumb Metacarpal Base: Bennett’s Fracture......Page 289
? Authors’ Preferred Method of Treatment......Page 290
Complications......Page 291
Rolando’s Fracture......Page 292
References......Page 293
Clinical Evaluation......Page 297
Acute Dorsal Proximal Interphalangeal Dislocations......Page 298
Volar Proximal Interphalangeal Dislocations......Page 299
Unstable Fracture-Dislocation......Page 300
Extension Block Splinting......Page 301
Dynamic Skeletal Traction......Page 302
Technique of Proximal Interphalangeal Joint Volar Plate Arthroplasty......Page 303
Distal Interphalangeal Joint Stiffness......Page 305
Technique for Dynamic Skeletal Traction......Page 306
Expected Results.......Page 309
Technique for Hemihamate Reconstruction......Page 310
Postoperative Protocol.......Page 312
Chronic Proximal Interphalangeal Joint Fracture-Dislocations......Page 313
Postoperative Management......Page 314
? Authors’ Preferred Method of Treatment......Page 315
Finger Distal Interphalangeal and Thumb Interphalangeal Joints......Page 316
? Anatomy......Page 317
Preoperative Evaluation......Page 318
? Authors’ Preferred Method of Treatment......Page 319
Isolated Radial Collateral Ligament Ruptures of the Metacarpophalangeal Joints......Page 320
? Anatomy......Page 321
Stener Lesion......Page 322
Treatment......Page 323
Technique of Open Repair of Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament......Page 324
Preoperative Evaluation......Page 326
? Authors’ Preferred Method of Treatment......Page 327
Preoperative Evaluation......Page 329
? Authors’ Preferred Method of Treatment......Page 330
Preoperative Evaluation......Page 331
? Authors’ Preferred Method of Treatment......Page 332
Historical Review......Page 333
? Authors’ Preferred Method of Treatment......Page 334
Postoperative Management and Expectations......Page 335
References......Page 336
Subungual Hematoma......Page 339
Nail Bed Repair......Page 340
Nail Bed Defect......Page 342
Fracture......Page 343
Amputation......Page 344
Postoperative Management......Page 346
Nonadherence......Page 347
Absence......Page 348
Nail Spikes, Cysts, and Cornified Nail Bed......Page 349
Hyponychial Deformities......Page 350
Pincer Nail......Page 351
Bacterial......Page 352
Pyogenic Granuloma......Page 353
Verruca Vulgaris......Page 354
Glomus Tumor......Page 355
Malignant Tumors......Page 356
References......Page 358
Metacarpophalangeal Joint......Page 360
Proximal Interphalangeal Joint......Page 361
The Interossei and Hypothenars (Richard J. Smith, M.D.)......Page 364
The Lumbricals......Page 365
Extrinsic Extensors......Page 366
Examination and Etiology of the Stiff Joint......Page 367
Nonoperative Treatment of the Metacarpophalangeal Joint......Page 369
Nonoperative Treatment of Proximal Interphalangeal Joint Contractures......Page 370
? Authors’ Preferred Method—Metacarpophalangeal Joint (Extension Contractures), Operative Treatment......Page 371
Surgical Mid-lateral Approach......Page 373
External Fixation Devices......Page 374
Extension Contractures—Proximal Interphalangeal Joint......Page 375
Technique of Distal Intrinsic Release......Page 377
Late Post-traumatic Interosseous Contracture of the Metacarpophalangeal and Proximal Interphalangeal Joints......Page 378
Arthroplasty for the Stiff Joint (Nonrheumatoid)......Page 379
Surface Replacement Arthroplasty......Page 380
Surgical Technique......Page 381
Proximal Interphalangeal Joint Arthroplasty......Page 382
Dorsal Approach......Page 384
Implantation......Page 386
Distal Interphalangeal Joint Arthroplasty......Page 389
Swanson Double-Stemmed Implant for the Distal Interphalangeal Joint......Page 390
References......Page 391
Historical Review......Page 394
Surgical Technique......Page 395
Surgical Technique......Page 396
Silicone Implant Arthroplasty......Page 397
Alternative Exposures......Page 398
Pyrolytic Carbon Proximal Interphalangeal Joint Arthroplasty......Page 399
Distal Interphalangeal Joint Arthroplasty......Page 400
Techniques of Finger Joint Arthrodesis......Page 401
Complications of Arthrodesis of Small Joints of the Hand......Page 405
Proximal Interphalangeal Joint Arthrodesis......Page 406
? AuthorS’ Preferred Treatment......Page 407
? AuthorS’ Preferred Method......Page 408
References......Page 410
Physical Examination......Page 412
Stage II......Page 413
Pathoanatomy......Page 414
Nonoperative Treatment......Page 415
Surgical Considerations......Page 416
Technique......Page 417
Complete Trapeziectomy with Flexor Carpi Radialis Ligament Reconstruction Only (No Interposition)......Page 418
Technique......Page 419
Partial Trapeziectomy with Tendon Interposition Only (No Ligament Reconstruction)......Page 420
Technique......Page 421
Technique......Page 422
Trapeziometacarpal Arthrodesis......Page 423
Arthroscopy of the Thumb Basal Joint......Page 424
Volar Ligament Reconstruction......Page 425
Stage IV Disease......Page 426
Acknowledgments......Page 427
References......Page 430
14 Arthroplasty and Arthrodesis of the Wrist......Page 432
Radiographic Evaluation......Page 433
Indications......Page 434
Technique for Radiolunate Fusion......Page 435
? Author’s Preferred Method of Radiolunate Arthrodesis......Page 438
Net Analysis of the Literature......Page 439
? Author’s Preferred Method of Scaphocapitate Arthrodesis......Page 442
? Author’s Preferred Method of Treatment......Page 443
Complications......Page 444
Pitfalls......Page 445
? Author’s Preferred Method of Scaphotrapeziotrapezoid Fusion......Page 446
What Patients Should Be Told......Page 447
Postoperative Management (Kirschner Wire Fixation)......Page 448
Total Wrist Arthrodesis......Page 449
Plates, Wires, and Staples......Page 450
? Author’s Preferred Method of Total Wrist Arthrodesis......Page 451
Wrist Arthrodesis after Failed Total Wrist Arthroplasty......Page 452
Technique for Wrist Fusion (Method of the AO Hand Study Group)......Page 453
Postoperative Management......Page 455
What Patients Should Be Told......Page 456
History of Total Wrist Arthroplasty90,91......Page 457
Surgical Technique (Universal II Implant)......Page 458
Centralization of the Extensor Tendons......Page 460
Other Prostheses......Page 461
References......Page 464
Ligamentous Anatomy......Page 467
Extrinsic Carpal Ligaments......Page 468
Midcarpal Ligaments......Page 469
Carpal Kinematics......Page 470
Stabilizing Mechanisms of the Wrist......Page 471
Stabilizing Mechanism of the Radiocarpal Joint......Page 472
Pathomechanics of Carpal Ligament Injuries......Page 473
Clinical Examination......Page 474
Additional Views......Page 475
Measurement of Carpal Bone Alignment......Page 476
Ulnar Variance......Page 477
Computed Tomography......Page 478
Cineradiography or Fluoroscopy with Videotape......Page 479
Arthrography......Page 480
Classification......Page 481
Pattern......Page 482
Pathomechanics of Scapholunate Dissociation......Page 483
Stage IV: Complete Scapholunate Ligament Injury, Nonrepairable, Reducible Rotary Subluxation of the Scaphoid......Page 484
Scaphoid Shift Test......Page 485
Cineradiography......Page 486
Percutaneous Kirschner Wire Fixation of the Scapholunate Joint......Page 487
Open Reduction, Internal Fixation, and Repair of the Dorsal Scapholunate Ligament......Page 488
Stage III: Complete Scapholunate Ligament Injury, Nonrepairable, Normally Aligned Scaphoid......Page 489
Bone-Ligament-Bone Grafts......Page 490
Tendon Reconstruction of the Scapholunate Ligaments......Page 491
Scaphoid-Lunate-Capitate Arthrodesis......Page 493
Stage VI: Complete Scapholunate Ligament Injury with Irreducible Malalignment and Cartilage Degeneration)......Page 494
Total Wrist Arthrodesis......Page 495
Pathomechanics of Lunate Triquetrum Dissociation......Page 496
Clinical Forms of Lunate Triquetrum Dissociation......Page 497
Clinical Examination......Page 498
Radiographic Examination......Page 499
Acute Lunate Triquetrum Injury without Carpal Collapse......Page 500
Chronic Lunate Triquetrum Injury without Carpal Collapse......Page 501
Chronic Perilunate Instability (Scapholunate plus Lunate Triquetrum Instability)......Page 502
Carpal Instability Secondary to Scaphoid Fracture......Page 503
Ulnar Translocation......Page 504
Pure Radiocarpal Dislocation......Page 505
Pathomechanics of Midcarpal Instability......Page 506
Diagnosis of Midcarpal Instability......Page 507
Forced Radial Deviation Test......Page 508
Anterior Midcarpal Instability......Page 509
Combined Radiocarpal-Midcarpal Instability......Page 510
Carpal Instability Adaptive......Page 511
Closed Reduction and Cast Immobilization......Page 512
Open Reduction, Internal Fixation, and Ligament Repair......Page 514
Author’s Preferred Method of Treatment: Perilunate Dislocations......Page 515
Dorsal Perilunate Fracture-Dislocations (Greater Arc Injuries)......Page 516
Open Reduction and Internal Fixation......Page 517
Transtriquetrum Perilunate Fracture-Dislocations......Page 518
Axial Fracture-Dislocations......Page 519
Dislocation of the Scaphoid......Page 521
References......Page 522
? Anatomy and Biomechanics......Page 525
Physical Examination......Page 529
Radiography......Page 530
Magnetic Resonance Imaging......Page 531
Triangular Fibrocartilage Complex Lesions......Page 532
Class 1B Tear......Page 533
Class 1D Tear......Page 535
? Author’s Preferred Technique: Open Triangular Fibrocartilage Complex Repair for Class 1B Tear......Page 536
Acute Distal Radioulnar Joint Instability......Page 537
Triangular Fibrocartilage Complex Repair (Class 1B Injury)......Page 538
Ulnar Styloid Fractures and Nonunions......Page 539
Evaluation......Page 540
Treatment......Page 541
? Author’s Preferred Technique: Chronic Distal Radioulnar Joint Instability......Page 542
Outcome......Page 543
Distal Radius and Forearm Malunions......Page 544
Evaluation......Page 546
Partial Distal Ulnar Resection (Wafer Procedure)......Page 547
? Author’s Preferred Technique: Ulnar-Shortening Osteotomy......Page 548
Hemiresection-Interposition Arthroplasty......Page 549
? Author’s Preferred Technique: Hemiresection-Interposition Arthroplasty......Page 550
? Author’s Preferred Technique: Sauvé-Kapandji Procedure......Page 551
Distal Ulnar Resection (Darrach Procedure)......Page 552
? Author’s Preferred Technique: Distal Ulnar Resection......Page 553
? Author’s Preferred Technique: Stabilization of Resected Distal Ulna......Page 554
Failed Distal Ulnar Resection......Page 555
Distal Ulnar Head Implant Arthroplasty......Page 556
Outcome......Page 557
Volar Capsulectomy......Page 558
Extensor Carpi Ulnaris Tenosynovitis and Subluxation......Page 559
Extensor Carpi Ulnaris Tendon Stabilization......Page 560
References......Page 561
The Rationale for Modern Treatment......Page 563
? Pertinent Anatomy......Page 565
? Radiographic Pathoanatomy......Page 566
Recognition of Fracture Patterns......Page 568
Lunate Load, Die Punch, or Medial Cuneiform Fracture......Page 570
Columnar Classification......Page 571
Classification of Associated Injuries to the Distal Radioulnar Joint......Page 576
Fracture Stability......Page 578
Closed Reduction......Page 579
Technique of Closed Reduction......Page 580
Percutaneous Pin Fixation......Page 581
External Fixation......Page 584
Technique of External Fixation......Page 585
Augmented External Fixation......Page 586
Technique: Arthroscopic Reduction and Percutaneous Fixation......Page 593
Additional Soft Tissue Injuries......Page 594
Open Reduction and Internal Fixation......Page 595
“Universal” Dorsal Approach to the Distal Radius......Page 597
Technique of Volar Plate Fixation......Page 599
Fragment-Specific Fixation......Page 604
Surgical Approach to the Volar Ulnar Fragment......Page 605
Technique of Distraction Plating......Page 608
The Ulnar Column......Page 609
Treatment Options for Distal Radioulnar Joint Lesions......Page 612
? Author’s Preferred Treatment: Ulnar Column Instability......Page 614
Evidence-Based Decision Making......Page 615
Minimizing Hand and Shoulder Stiffness......Page 618
Type II—Shear Fractures......Page 619
Type III—Compression Fractures of the Joint Surface......Page 622
Three- and Four-Part Injuries......Page 623
Associated Injuries......Page 624
Outcome and Patient Expectations......Page 626
Complications......Page 627
Technique of Extra-articular Radial Osteotomy......Page 628
Technique: Dorsal Approach for Osteotomy of Malunited Distal Radius Fractures......Page 629
Technique: Volar Approach for Osteotomy of a Malunited Distal Radius Fracture......Page 631
Watson’s Trapezoidal Osteotomy......Page 632
Malunited Smith’s Fractures......Page 633
Intra-articular Osteotomies......Page 634
Distal Radioulnar Joint Procedures......Page 635
References......Page 637
Bony and Ligamentous Anatomy......Page 641
Vascular Anatomy......Page 643
Biomechanics of Scaphoid Fractures and Implications of Nonunion......Page 644
Scaphoid Fracture Classification and Implications for Treatment......Page 645
Distal Pole Fractures......Page 646
Managing Scaphoid Fractures in Athletes......Page 647
Screws......Page 648
Mechanics of Fracture Fixation......Page 649
Open Dorsal Fixation of Scaphoid Fractures......Page 650
Volar Percutaneous Scaphoid Fixation......Page 651
? Authors’ Preferred Technique: Volar Percutaneous Scaphoid Screw Fixation......Page 652
Dorsal Percutaneous Scaphoid Fixation......Page 653
Step 2: Dorsal Guide Wire Placement in a Reduced Scaphoid Fracture......Page 654
Step 4: Screw Implantation......Page 655
Surgical Techniques......Page 656
? Authors’ Preferred Technique: Arthroscopy-Assisted Dorsal Percutaneous Scaphoid Fixation......Page 657
? Authors’ Preferred Technique: Arthroscopy-Assisted Internal Fixation of Combined Scaphoid and Distal Radius Fractures......Page 659
Open and Arthroscopic Treatment......Page 660
Complications of Scaphoid Fracture Treatment......Page 661
Use of Fluoroscopy and Surgical Navigation to Reduce Screw Malposition......Page 662
Scaphoid Fracture in Children......Page 663
Scaphoid Nonunions Without Substantial Bone Loss: Grades I to III......Page 664
Bone Grafting and Fixation of a Correctly Aligned Scaphoid Nonunion......Page 665
Matti-Russe Surgical Technique......Page 666
Open Dorsal Technique for Scaphoid Nonunions......Page 667
Arthroscopy and Percutaneous Dorsal Capsular Release.......Page 668
Percutaneous Bone Grafting of Nonunions.......Page 669
? Authors’ Preferred Technique: Arthroscopic Reduction, Grafting, and Internal Fixation of Scaphoid Nonunions (Geissler Technique)......Page 670
Technique: Anterior Wedge Grafting......Page 674
Vascularized Bone Grafting for Treatment of Scaphoid Avascular Necrosis......Page 675
Technique for Surgical Preparation of the 1,2 ICSRA Graft......Page 677
Vascularized Medial Femoral Condyle Grafting......Page 678
Treatment of Scaphoid Malunion......Page 679
Intercarpal Fusion......Page 680
Preiser’s Disease......Page 681
Fractures of the Triquetrum......Page 682
Treatment......Page 683
Radiographic Features and Treatment......Page 684
Treatment......Page 686
Avascular Necrosis of the Capitate......Page 687
Clinical and Radiographic Presentation......Page 688
Postoperative Care......Page 689
Body of the Hamate......Page 690
Fractures of the Pisiform......Page 691
Fractures of the Trapezoid......Page 692
Treatment......Page 693
Blood Supply......Page 694
Kienbock’s Disease......Page 695
Etiology......Page 696
Staging......Page 697
Stage I, II, or IIIA with Ulnar-Negative Variance......Page 698
radial-shortening osteotomy.......Page 699
technique based on the fourth and fifth extensor compartment arteries.......Page 700
technique for vascularized bone graft from the radius.......Page 701
Technique: Radial Osteotomy.......Page 703
Stage IIIB......Page 704
Stage IV......Page 705
References......Page 706
6R and 6U Portals......Page 710
Volar Portals......Page 711
Distal Radioulnar Joint Portals......Page 712
Standard Portals......Page 713
Chondroplasty and Loose Body Removal......Page 714
? Author’s Preferred Method of Treatment: Kienbock’s Disease......Page 715
Volar Ganglionectomy......Page 717
Indications......Page 718
Treatment of Interosseous Ligament Injuries......Page 719
LTIL Injury......Page 720
Arthroscopy-Assisted Percutaneous Kirschner Wire Fixation......Page 721
Thermal Shrinkage......Page 722
? Author’s Preferred Method of Treatment: Interosseous Ligament Injuries......Page 723
? Author’s Preferred Method of Treatment: Extrinsic Ligament Injuries......Page 724
Technique of DRCL Repair......Page 725
Nonsurgical......Page 726
Mechanism and Classification......Page 727
Indications......Page 728
Class IB Tears......Page 729
Technique of Radial-Sided Repair......Page 730
Class IB Tears......Page 731
? Author’s Preferred Method of Treatment: Degenerative TFCC Lesions......Page 732
Contraindications......Page 733
Treatment20......Page 734
Three-Part Fractures......Page 735
Four-Part Fractures......Page 736
Treatment......Page 737
Hemiresection Trapezial Arthroplasty......Page 738
Complications of Wrist Arthroscopy......Page 739
References......Page 740
Radiographic Examination......Page 743
? Anatomy......Page 744
Column Concept......Page 745
Bicolumnar Fractures......Page 747
Extra-articular Intracapsular Fractures......Page 748
Trochlea......Page 749
Other Articular Patterns......Page 750
Historical Review......Page 752
Fractures in Elderly Adults......Page 753
Total Elbow Replacement......Page 755
Operative Exposures......Page 756
Paratricipital Approach......Page 757
Triceps-Splitting Approach......Page 758
Triceps-Reflecting Anconeus Pedicle Approach......Page 760
Lateral Approach......Page 762
Implant Biomechanics......Page 765
Bicolumnar Fractures in an Active Patient with Healthy Bone......Page 767
Simple Supracondylar Involvement......Page 768
Fixation of Osteotomy......Page 769
Unicolumnar Fractures......Page 771
Complex Capitellar Fractures and Articular Fracture Variants......Page 772
Postoperative Care......Page 773
Expectations......Page 774
Nonunion of Olecranon Osteotomy......Page 775
Ulnar Neuropathy......Page 776
Stiffness and Heterotopic Ossification......Page 777
References......Page 778
Imaging......Page 781
Associated Injuries......Page 783
? Anatomy and Biomechanics......Page 786
Treatment Options......Page 788
Nonoperative Management......Page 789
Open Reduction and Internal Fixation......Page 790
Arthroplasty of the Radial Head......Page 791
Surgical Approach......Page 792
Fragment Excision......Page 793
Open Reduction and Internal Fixation......Page 796
Implant Arthroplasty of the Radial Head......Page 800
Open Reduction and Internal Fixation......Page 804
Primary Resection of the Radial Head......Page 806
Postoperative Protocol......Page 807
Osteoarthritis......Page 808
Stiffness and Heterotopic Bone......Page 811
Axial Instability......Page 812
References......Page 814
Coronoid Process......Page 818
Radial Head......Page 819
Anatomy of Elbow Stability......Page 820
Olecranon Fracture-Dislocations......Page 821
Historical Review......Page 823
Excision and Triceps Advancement......Page 824
Tension Band Wiring......Page 825
Standard Techniques......Page 826
Monteggia Fractures......Page 828
Displaced Fractures with Comminution and/or Dislocation of the Elbow......Page 829
Infection......Page 830
Stiffness/Heterotopic Ossification......Page 831
References......Page 832
General Evaluation and Preoperative Considerations......Page 834
? Pertinent Anatomy......Page 835
Anterior Approach......Page 836
Technique: Anterior Approach to the Radial Shaft......Page 837
Posterior Approach for Radial Shaft Fixation......Page 838
Fixation of Galeazzi-Type Fracture-Dislocations......Page 839
Alternative Fixation Methods for Fractures of the Radial Shaft: Intramedullary Rods and External Fixation......Page 841
? Authors’ Preferred Method of Treatment......Page 842
Preoperative Planning......Page 843
Postoperative Management and Expectations......Page 845
? Pertinent Anatomy The ulna is the stable unit of the forearm. Although there may be modest counter-rotation of the ulna that is caused largely by plastic deformation of the bone, the radius rotates about the essentially stationary ulna to allow a functi......Page 846
Direct Ulnar Approach for Distal and Midshaft Ulnar Fixation......Page 847
? Authors’ Preferred Method of Treatment—Direct Ulnar Approach for Plate Fixation of Distal and Midshaft Ulna Fractures......Page 848
? Authors’ Preferred Method of Treatment—Anterior Approach for Radial Shaft Fixation and Direct Ulnar Approach for Ulnar Shaft Fixation......Page 849
Postoperative Management and Expectations......Page 850
Removal of Hardware from the Radius and Ulna......Page 851
Preoperative Evaluation......Page 852
Rotational or Angular Osteotomies for Malunion of the Radius or Ulna......Page 853
Postoperative Management and Expectations......Page 854
Radioulnar Synostosis......Page 855
? Authors’ Preferred Method of Treatment Preoperative planning includes radiographic and clinical assessment of the wrist and elbow. Any damage to the proximal or distal articular relationships of the forearm should be appreciated, and the impact of resto......Page 856
? Pertinent Anatomy......Page 858
Prevention of Longitudinal Instability of the Forearm......Page 859
One-Bone Forearm......Page 860
Interosseous Ligament Reconstruction......Page 861
Postoperative Expectations......Page 862
References......Page 863
Musculotendinous Components......Page 866
Acute Injury......Page 867
Dislocation with Radial Head Fracture......Page 868
Posterior Olecranon Fracture-Dislocation or Monteggia Lesion......Page 869
Varus Posteromedial Rotational Injury......Page 870
Acute Injuries (Less than 2 Weeks)......Page 871
Examination under Anesthesia......Page 872
Technique: Open Reduction and Internal Fixation......Page 873
Operative Management......Page 874
? Authors’ Preffered Technique......Page 875
Olecranon Fracture-Dislocations......Page 876
Operative Technique......Page 877
Reconstruction......Page 878
Expected Outcomes......Page 879
References......Page 880
Mechanism of Dislocation......Page 883
Clinical Findings and History of Chronic Elbow Instability......Page 884
Physical Examination......Page 885
Imaging of the Unstable Elbow......Page 886
Role of the Lateral Collateral Ligament Complex......Page 887
Coronoid Tip Fractures......Page 888
Anteromedial Coronoid Fractures......Page 889
Posterolateral Rotatory Instability......Page 891
Tardy Posterolateral Rotatory Instability Secondary to Cubitus Varus......Page 892
Valgus Instability......Page 893
Technique of Posterolateral Ligament Reconstruction......Page 894
Postoperative Management and Expectations......Page 896
References......Page 897
Causes and Prevention of the Stiff and Contracted Elbow......Page 899
Duration of Contracture and Timing of Operative Release......Page 900
What Degree of Motion Is Necessary?......Page 901
Imaging the Stiff Elbow......Page 903
Classifying the Contracture and Matching the Operative Plan......Page 904
Open Release......Page 905
Anterior Capsular Exposure......Page 906
Flexor-Pronator Muscle Origin......Page 907
Ulnar Nerve Transposition......Page 908
The First 24 Hours......Page 909
Hinged Fixation after Contracture Release......Page 910
Distraction (Interposition) Arthroplasty......Page 911
Adjuvant Therapy for Heterotopic Ossification......Page 912
Turnbuckle Splint (for Extension or Flexion).......Page 913
Continuous Passive Motion (or “Slow intermittent Passive Positioning”) Device......Page 914
Joint Infection......Page 915
Soft Tissue Deficiencies or Wound Necrosis......Page 916
References......Page 917
Etiology, Associations, and Pathophysiology......Page 919
Diagnosis......Page 920
Treatment of Medial and Lateral Epicondylitis......Page 921
Surgical Treatment for Medial Epicondylitis......Page 922
Treatment of Elbow Epicondylitis......Page 923
Arthroscopic Technique......Page 924
Surgical Treatment for Medial Epicondylitis......Page 925
Treatment......Page 927
? Anatomic Considerations......Page 928
Complications......Page 929
Treatment of Acute Complete Biceps Ruptures......Page 930
Two-Incision Repair......Page 931
Postoperative Treatment Protocol......Page 932
Triceps Avulsions and Rupture......Page 934
Repair of Complete Avulsion Injuries......Page 935
References......Page 937
Biomechanics of Throwing......Page 941
Physical Examination......Page 943
Imaging......Page 944
Historical Perspective......Page 945
? Authors’ Preffered Technique......Page 946
Anterior Compartment Arthroscopy and Pathology in the Throwing Athlete......Page 947
Posterior Compartment Arthroscopy and Pathology in the Throwing Athlete......Page 948
Posteromedial and Posterior Olecranon......Page 949
Postoperative Management......Page 950
Outcomes......Page 951
References......Page 952
Post-Traumatic Arthritis......Page 955
Primary Osteoarthritis......Page 956
Hemophilic Arthropathy......Page 957
Historical Review......Page 959
? Authors’ Preferred Method......Page 960
Complications......Page 963
Mechanical Failure......Page 964
Mortality......Page 966
References......Page 968
Double Crush......Page 970
Systemic Conditions and Personal Factors......Page 971
Use of Provocation Tests......Page 972
Shoulder and Scapular Movement Examination......Page 975
Two-Point Discrimination......Page 976
Nerve Conduction Studies......Page 977
? Anatomy......Page 978
Operative Treatment......Page 979
Chow Two-Portal Endoscopic Technique......Page 981
? Authors’ Preferred Technique: Open Carpal Tunnel Release We prefer the classic open carpal tunnel release with intravenous regional anesthesia (Bier block) for the treatment of carpal tunnel syndrome. General anesthesia is rarely indicated. Axillary blo......Page 982
Postoperative Care......Page 983
? Anatomy......Page 984
? Authors’ Preferred Technique......Page 985
Postoperative Care......Page 986
? Anatomy......Page 987
Cubital Tunnel Syndrome......Page 988
? Anatomy......Page 989
Operative Treatment......Page 990
Medial Epicondylectomy......Page 991
Subcutaneous Anterior Transposition......Page 992
Submuscular Transposition......Page 993
Postoperative Care......Page 994
? Anatomy......Page 996
Postoperative Care......Page 997
? Anatomy......Page 998
Anterior (Modified Henry) Approach......Page 999
? Authors’ Preferred Technique......Page 1000
Operative Technique......Page 1001
Revision Surgery......Page 1002
Revision Surgery......Page 1003
Median Nerve Compression in the Proximal Forearm......Page 1004
References......Page 1005
Arterial Thoracic Outlet Syndrome......Page 1008
Electrically Negative Neurogenic Thoracic Outlet Syndrome......Page 1009
Anatomy......Page 1010
Costoclavicular Triangle.......Page 1011
Clinical Findings......Page 1012
Upper Limb Tension Test......Page 1013
Radiologic Evaluation......Page 1017
Nonoperative Treatment......Page 1018
? AuthorS’ Preferred Method of Treatment: Neurogenic Thoracic Outlet Syndrome......Page 1019
Results......Page 1023
Recurrent Symptoms After Surgical Treatment......Page 1024
References......Page 1025
Indications......Page 1028
Axonal Transport......Page 1029
Functional Segregation......Page 1030
Wallerian Degeneration......Page 1031
Classification of Nerve Injuries......Page 1032
The Tinel Sign......Page 1033
Neurologic Examination......Page 1035
Electrodiagnosis......Page 1036
The Lesion in Continuity......Page 1037
The Consultation and Operative Record......Page 1038
Apparatus and Instruments......Page 1039
Direct Suture or Graft?......Page 1041
Delayed Suture......Page 1042
Use of Fibrin Clot Glue in Suturing......Page 1043
Choice of Graft......Page 1044
Entubulation......Page 1047
Nerve Transfer......Page 1048
Assessment of Recovery of Function......Page 1049
Cause of the Injury......Page 1050
The Median and Ulnar Nerves......Page 1051
Digital Nerves......Page 1052
The Radial Nerve......Page 1053
Nerve Injuries in Children......Page 1054
Rehabilitation......Page 1055
Pathophysiology......Page 1056
Treatment......Page 1057
General Principles......Page 1058
Repair of the Damaged Nerve......Page 1059
Silastic Cap.......Page 1060
Without Excision of the Neuroma.......Page 1061
Translocation of Nerve into Muscle.......Page 1063
References......Page 1064
? Anatomy......Page 1068
Nonoperative Treatment......Page 1069
Nerve Repair and Graft versus Tendon Transfers......Page 1070
One Tendon—One Function......Page 1071
Timing of Tendon Transfers......Page 1072
Historical Review......Page 1073
Flexor Carpi Ulnaris Transfer......Page 1074
Postoperative Management......Page 1076
Absence of the Palmaris Longus......Page 1077
Superficialis Transfer (Boyes)......Page 1078
? Author’s Preferred Method of Treatment......Page 1079
Expected Outcomes......Page 1080
Radial Nerve Palsy Associated with Fractures of the Humerus......Page 1081
Nerve Exploration at 6 to 8 Weeks if No Return......Page 1082
? Author’s Preferred Method of Treatment......Page 1083
References......Page 1084
The Deficit and the Deformity......Page 1086
Prevention and Preoperative Treatment of Contractures......Page 1087
Selection of Motor for Transfer......Page 1088
Results......Page 1089
Four Standard Opponensplasties......Page 1090
Superficialis Tendon Harvest.......Page 1091
Royle-Thompson Opponensplasty.......Page 1092
Technique.......Page 1093
Results.......Page 1094
Results.......Page 1095
Technique.......Page 1096
Technique.......Page 1097
Tendon Transfers (“Compromise Opponensplasty”) for Severe Nerve Deficits......Page 1098
Technique.......Page 1099
Alternative Flexor Pollicis Longus Opponensplasties......Page 1100
Technique.......Page 1101
Mennen’s Technique.......Page 1102
Postoperative Management of Opponensplasty......Page 1103
High Median Nerve Palsy......Page 1104
Restoration of Thumb Opposition......Page 1105
Complications......Page 1106
Expectations and Patient Counseling......Page 1107
Patterns of Paralysis......Page 1108
Ulnar Claw Hand and Its Management......Page 1109
Static Techniques......Page 1110
Palmar Capsulodesis of the Metacarpophalangeal Joint (Zancolli’s Technique)......Page 1111
Results.......Page 1112
Parkes Static Tenodesis......Page 1113
Insertions for Dynamic Transfers......Page 1114
Modified Stiles-Bunnell Procedure......Page 1115
Results......Page 1116
Results.......Page 1117
Flexor Route Transfer of the Extensor Carpi Radialis Longus......Page 1118
Restoration of Thumb-Index Key Pinch and Tip Pinch......Page 1119
Results.......Page 1120
Flexor Digitorum Superficialis as Motor......Page 1121
Palmaris Longus to First Dorsal Interosseous......Page 1122
Extensor Digiti Minimi Transfer......Page 1123
Restoration of Ring and Little Finger Flexion and Strength......Page 1124
? Author’s Preferred Method of Treatment: Isolated Ulnar Nerve Palsy......Page 1125
Combined Median and Ulnar Nerve Palsies......Page 1127
References......Page 1128
Elbow......Page 1131
Grasp and Release......Page 1132
Preoperative Therapy and Other Modalities......Page 1133
Voluntary Hand Use......Page 1135
Timing of Surgical Procedures......Page 1136
Technique......Page 1137
Technique......Page 1138
Technique......Page 1139
Technique......Page 1140
Technique......Page 1142
Technique......Page 1143
Operative Procedures......Page 1144
Technique......Page 1145
Contraindication......Page 1146
Technique......Page 1147
? Author’s Preferred Method of Treatment......Page 1148
Operative Procedures......Page 1149
Indication......Page 1150
Technique......Page 1151
? Author’s Preferred Method of Treatment......Page 1152
Operative Procedures......Page 1153
Technique......Page 1154
Technique......Page 1156
Technique......Page 1157
Technique......Page 1158
Indication......Page 1159
Indication......Page 1160
Technique......Page 1161
References......Page 1162
Role of Reconstructive Surgery......Page 1165
Stroke......Page 1166
Motor Impairment......Page 1167
Prognosis......Page 1168
Acute Injury......Page 1169
Physiologic Recovery......Page 1170
Heterotopic Ossification......Page 1171
Complex Regional Pain Syndrome......Page 1172
Active and Passive Function......Page 1173
Phenol Blocks......Page 1174
Wrist and Finger Flexor Spasticity......Page 1175
Thumb-in-Palm Deformity......Page 1176
Clinical Evaluation of Motor Control......Page 1177
Laboratory Assessment of Motor Control......Page 1178
Trauma......Page 1179
Inferior Subluxation......Page 1180
? Authors’ Preferred Method: Biceps Suspension Procedure......Page 1181
Spastic Adduction–Internal Rotation......Page 1182
Technique of Shoulder Muscle Release......Page 1183
Technique of Selective Shoulder Muscle Lengthening......Page 1184
Elbow with a Significant Static Deformity......Page 1185
Technique of Elbow Release: Elbow Without Volitional Control......Page 1186
Spasticity......Page 1187
Technique of Biceps Rerouting......Page 1188
Spastic Flexion......Page 1189
Spastic Extension......Page 1190
Trauma......Page 1191
Spastic Clenched Fist......Page 1192
Technique of Superficialis to Profundus Tendon Transfer......Page 1193
Spastic Thumb-in-Palm Deformity......Page 1194
Technique of Thenar Muscle Slide......Page 1195
Technique of Ulnar Motor Neurectomy......Page 1196
Intrinsic-Minus Deformities......Page 1197
References......Page 1198
Preoperative Work-Up......Page 1200
Indications and Contraindications for Operative Intervention......Page 1202
Tendon Transfer......Page 1204
Biceps to Triceps Tendon Transfer......Page 1205
Posterior Deltoid to Triceps Tendon Transfer......Page 1207
Group 0......Page 1208
Brachioradialis to Extensor Carpi Radialis Brevis Tendon Transfer......Page 1209
Passive Key Pinch Reconstruction......Page 1210
Groups 2 and 3......Page 1211
Carpometacarpal Fusion......Page 1213
Split Flexor Pollicis Longus Transfer......Page 1214
Extensor Digitorum Communis Tenodesis......Page 1216
Pronator Teres to Flexor Pollicis Longus Tendon Transfer......Page 1217
Groups 6 and 7......Page 1218
? Author’s Preferred Method of Treatment......Page 1219
Digital Clawing......Page 1220
Surgical Technique: Lasso Procedure......Page 1221
Functional Electrical Stimulation......Page 1222
References......Page 1223
Classification of Nerve Injury......Page 1226
Traction Injury......Page 1227
Gunshot Wound Injury......Page 1228
C5-7 Injury......Page 1229
Physical Examination......Page 1230
Imaging Evaluation......Page 1232
Contraindications to Surgery......Page 1233
Informed Consent......Page 1234
Surgical Approaches to the Brachial Plexus......Page 1235
Supraclavicular Exploration......Page 1236
Infraclavicular Exploration......Page 1237
Choline Acetyltransferase Activity......Page 1238
Pan-plexal Injury......Page 1239
Indications......Page 1240
Other Nerve Graft Options......Page 1241
Coaptation......Page 1242
? Surgical Anatomy......Page 1243
Suprascapular Nerve Neurotization......Page 1244
Operative Procedure.......Page 1245
Expected Outcomes......Page 1246
Ulnar Nerve Fascicular Transfer to the Biceps Motor Branch......Page 1247
? Surgical Anatomy......Page 1248
Contraindications......Page 1249
Complications......Page 1250
Intercostal Nerve Dissection......Page 1252
Neurotization of the Musculocutaneous Nerve......Page 1253
Postoperative Care Specific to Intercostal to Musculocutaneous Nerve Transfer......Page 1254
Contralateral C7 Nerve Dissection and Transfer......Page 1255
Complications......Page 1256
Phrenic Nerve.......Page 1257
Shoulder and Elbow......Page 1258
Gracilis Harvest......Page 1259
Rationale for the Surgical Approach......Page 1260
Operative Technique......Page 1261
Postoperative Protocol......Page 1263
Single-Stage Free Functioning Muscle Transfer for Prehension......Page 1264
Shoulder Reconstruction in Adult Patients with Brachial Plexus Injury......Page 1265
Tendon Transfer for Reconstruction of Shoulder Function......Page 1266
Upper Trapezius Transfer......Page 1267
? Authors’ Preferred Procedure......Page 1268
Shoulder Arthrodesis......Page 1269
? Authors’ Preferred Method: Glenohumeral Arthrodesis......Page 1270
Late Reconstruction of Elbow Function......Page 1271
Operative Procedure......Page 1272
Expected Outcomes......Page 1273
Latissimus Dorsi Transfer......Page 1274
Bipolar Transplantation......Page 1275
Complete Bipolar Transplantation of the Pectoralis Major......Page 1276
Indication......Page 1278
Expected Outcomes......Page 1279
References......Page 1280
Proximal-Distal Limb Development......Page 1284
Anterior-Posterior Limb Development......Page 1285
Genes and Molecular Abnormalities......Page 1286
Systemic Considerations......Page 1288
References......Page 1289
Management......Page 1291
Commissure Reconstruction......Page 1293
Separation and Resurfacing of the Digits......Page 1294
Paronychial Fold......Page 1297
? Management—Authors’ Preferred Technique......Page 1298
Acrosyndactyly......Page 1299
Apert’s Syndrome......Page 1300
Dystrophic Epidermolysis Bullosa......Page 1303
Classification and Treatment......Page 1304
Surgical Technique......Page 1305
Treatment......Page 1306
Treatment......Page 1308
Epidemiology......Page 1309
Pathology......Page 1310
Management......Page 1311
? Authors’ Preferred Technique......Page 1312
Central Hand Deficiencies......Page 1314
Clinical Features......Page 1316
Removal of Transverse Bones......Page 1317
Release of the First Web Space and Closure of the Cleft......Page 1318
Management of the Absent Thumb Deformity......Page 1321
Surgical Management of the Feet......Page 1322
Etiology......Page 1325
Classification......Page 1326
Constriction Ring......Page 1327
Clinical Features......Page 1328
Anatomy......Page 1329
Treatment of the Oligodactylic (Few Fingers) Type (Type 4)......Page 1330
Free Phalangeal Transfer......Page 1331
Harvesting the Graft......Page 1332
Complications......Page 1333
The Hand with No Digits......Page 1334
Contraindications......Page 1336
Osteosynthesis......Page 1338
Nerve Repairs......Page 1339
Results......Page 1340
Epidemiology......Page 1341
Management......Page 1342
? AUthors’ Preferred Technique......Page 1344
Anatomy......Page 1345
? AUthors’ Preferred Technique......Page 1346
Macrodactyly......Page 1347
Etiology and Anatomy......Page 1349
Management......Page 1350
Reducing the Digit......Page 1351
? Authors’ Preferred Technique......Page 1354
References......Page 1355
Narrow Thumb-Index Web Space......Page 1358
Ulnar Collateral Ligament Insufficiency......Page 1359
Absence of Intrinsic Thenar Muscles......Page 1360
Surgical Procedure for Type II or IIIA Thumb Hypoplasia......Page 1361
Pollicization for Type IIIB, IV, and V Hypoplasia......Page 1363
Complications......Page 1368
Clinical Features......Page 1370
Type I and II Split Thumbs......Page 1371
Types III and IV Split Thumbs......Page 1372
Type VII Split Thumb......Page 1375
Complications......Page 1379
Triphalangeal Thumb......Page 1381
Management Considerations......Page 1382
Thumb-Index Web Space......Page 1383
Incidence and Etiology......Page 1384
Surgical Technique......Page 1385
Clasped Thumb......Page 1386
Treatment......Page 1387
References......Page 1388
Types of Operations......Page 1391
Centralization......Page 1392
Ulnar Lengthening......Page 1393
Expected Outcomes......Page 1395
Preoperative Evaluation......Page 1396
Thumb Reconstruction (Deepening of the First Web, Opponensplasty, Pollicization)......Page 1397
? Authors’ Preferred Method of Treatment......Page 1398
Preoperative Evaluation......Page 1399
Radial Opening Wedge Osteotomy......Page 1400
? Authors’ Preferred Technique......Page 1402
? Authors’ Preferred Technique......Page 1403
Preoperative Evaluation......Page 1404
Radial Head Resection......Page 1405
? Authors’ Preferred Method of Treatment......Page 1406
Preoperative Evaluation......Page 1407
Derotation Osteotomy......Page 1408
Postoperative Management and Expectations......Page 1410
Types of Operations......Page 1411
Postoperative Management and Expectations......Page 1414
Preoperative Evaluation......Page 1415
Types of Operations......Page 1416
Postoperative Management and Expectations......Page 1417
References......Page 1418
Shoulder and Elbow......Page 1421
Forearm and Wrist......Page 1425
Thumb and Fingers......Page 1427
Pathophysiology......Page 1429
Indications......Page 1431
Deeper Dissection......Page 1432
Tendon Transfer......Page 1433
Postoperative Care......Page 1434
Outcome......Page 1435
The Contracted Clasped Thumb......Page 1437
Goals and Timing......Page 1438
Skin Envelope......Page 1439
Intrinsic Muscle Contracture—Release of the Thenar Muscle Origin......Page 1440
Treatment of Metacarpophalangeal Joint Flexion Contracture......Page 1441
References......Page 1442
? Pertinent Anatomy......Page 1444
Preoperative Evaluation......Page 1445
Natural History......Page 1449
Microsurgery......Page 1450
Surgical Technique: Microsurgery......Page 1453
Postoperative Management: Microsurgery......Page 1456
Preoperative Evaluation: Shoulder......Page 1457
Historical Review: Shoulder......Page 1458
Operations: Shoulder......Page 1459
? Author’s Preferred Treatment......Page 1461
Postoperative Management......Page 1462
Forearm......Page 1463
References......Page 1464
Applications in the Upper Extremity (Indications)......Page 1467
Contraindications and Family Counseling......Page 1468
Two-Staged Lengthening Techniques......Page 1469
Distraction Osteogenesis (Callotasis)......Page 1470
Complications of Callotasis......Page 1471
Forearm......Page 1472
Radial Deficiency......Page 1473
Choice of Device......Page 1478
Nonvascularized Fibula Graft......Page 1479
Skin Incision......Page 1480
Osteotomy......Page 1481
The Lengthening Process......Page 1482
Complications......Page 1483
References......Page 1484
Epidemiology......Page 1487
Preoperative Evaluation......Page 1488
? Pertinent Anatomy......Page 1489
? Author’s Preferred Method of Treatment......Page 1490
Physeal Fractures......Page 1491
? Author’s Preferred Method of Treatment......Page 1492
Phalangeal Neck Fractures......Page 1493
Physeal Fractures......Page 1496
? Author’s Preferred Method of Treatment......Page 1497
? Author’s Preferred Method of Treatment......Page 1498
Metacarpal Neck Fractures......Page 1499
Metacarpal Base Fractures......Page 1500
? Author’s Preferred Method of Treatment......Page 1501
Base of Thumb Metacarpal Fractures......Page 1502
Epidemiology......Page 1503
Preoperative Evaluation......Page 1504
Soft Tissue Structures......Page 1505
Scaphoid Fractures......Page 1506
? Author’s Preferred Method of Treatment......Page 1507
Pisiform Fractures......Page 1508
Bicortical Metaphyseal Fractures......Page 1509
? Author’s Preferred Method of Treatment......Page 1513
? Author’s Preferred Method of Treatment......Page 1515
Epidemiology......Page 1519
Preoperative Evaluation......Page 1520
Historical Review......Page 1522
Complete Fractures......Page 1523
? Author’s Preferred Method of Treatment......Page 1526
Open Fractures......Page 1527
Monteggia’s Fracture-Dislocations......Page 1528
Postoperative Expectations and Management......Page 1529
References......Page 1530
Loupes......Page 1534
Operating Microscope......Page 1535
Arm, Table, and Chair Positioning......Page 1536
Essential Features......Page 1537
Dilators......Page 1538
Background......Page 1539
Accessory Instruments......Page 1540
Laboratory......Page 1541
Essentials for a Patent Anastomosis......Page 1542
End-to-End Anastomosis Technique......Page 1543
Patency Test......Page 1548
Vessel Characteristics, Access, and Size Discrepancy......Page 1549
? Author’s Preferred Technique: Back Wall–First Technique (One-Way-Up Technique)......Page 1550
End-to-Side Technique......Page 1551
Sleeve and Cuffing Techniques......Page 1553
Mechanical Devices......Page 1554
Revision of the Failed Anastomosis......Page 1555
Vein Grafts......Page 1556
Maintaining Flow......Page 1557
Postoperative Measures......Page 1558
Monitoring Techniques......Page 1559
Organizing a Microsurgical Service......Page 1560
Dextran......Page 1561
Fibrinolytic Agents......Page 1562
References......Page 1563
Patient Selection......Page 1566
Instruments......Page 1570
Who Should Perform Replantations?......Page 1571
Initial Surgical Management......Page 1572
Technique and Sequence of Surgery......Page 1573
Bone Shortening and Fixation......Page 1574
Flexor Tendon Repair......Page 1575
Arterial Repair......Page 1576
Vein Repair......Page 1577
Routine Postoperative Precautions......Page 1578
Major Limb Replantation......Page 1579
References......Page 1580
Principles......Page 1583
Mechanisms and Pathophysiology of Injury......Page 1584
Initial Evaluation......Page 1585
Examination......Page 1586
Amputation/Skeletal Contribution......Page 1589
Joints......Page 1590
Soft Tissue Coverage and Nerves......Page 1591
Emergency Treatment......Page 1592
Débridement/Wound Excision......Page 1593
Skeletal/Joint Reconstruction......Page 1596
Tendon Repair/Reconstruction......Page 1599
Vascular Repair/Reconstruction......Page 1602
Soft Tissue Coverage......Page 1605
Fingers, Hand, and Wrist......Page 1608
Elbow and Arm......Page 1614
Secondary Procedures......Page 1619
Expected Outcomes......Page 1622
References......Page 1623
Histology of Skin......Page 1625
Response to Injury......Page 1626
Timing of Grafting......Page 1627
Types of Grafts......Page 1628
Choice of Donor Sites......Page 1629
Freehand Grafts......Page 1630
Padgett Electric Dermatome......Page 1631
Davol Dermatome......Page 1632
Mesh Grafting......Page 1633
Preparation of a Meshed Graft......Page 1634
Full-Thickness Grafts......Page 1635
Technique for Obtaining a Full-Thickness Graft......Page 1636
Use of Negative Pressure Wound Therapy......Page 1638
Filling the Defect with the Graft......Page 1639
Care of the Donor Site......Page 1640
Outpatient Surgery......Page 1641
Random-Pattern Flaps......Page 1642
Axial-Pattern Flaps......Page 1643
Raising a Flap......Page 1644
Local Flaps......Page 1645
Type I—Transposition Leaving a Secondary Defect Requiring Skin Coverage......Page 1646
Type II—Transposition with Direct Closure of the Secondary Defect......Page 1647
“Z”-Plasty......Page 1648
Four-Flap “Z”-Plasty......Page 1649
Axial Pattern......Page 1650
The Kite Flap (First Dorsal Metacarpal Artery)......Page 1652
The Second Dorsal Metacarpal Artery Flap......Page 1653
Rotation Flaps......Page 1654
Advancement Flaps......Page 1655
“V-Y” Advancement......Page 1656
Random-Pattern Regional Flaps......Page 1657
Cross-Finger Flap......Page 1658
Innervated Cross-Finger Flap......Page 1661
Division of Random Regional Flaps......Page 1662
Neurovascular Island Flap......Page 1663
Fasciocutaneous Flap......Page 1668
Radial Artery Forearm Flap......Page 1669
Reversed Posterior Interosseous Artery Flap......Page 1673
Musculocutaneous Flap......Page 1675
Latissimus Dorsi Flap......Page 1676
Distant Flaps......Page 1678
Groin Flap......Page 1679
? Authors’ Preferred Methods of Treatment—Defects of the Hand and Forearm......Page 1684
Chemotherapeutic Extravasation Skin Loss......Page 1686
Flap Failure......Page 1687
Salvage of a Failing Flap......Page 1688
Preoperative Evaluation......Page 1689
Surgical Technique......Page 1690
Surgical Technique......Page 1692
Surgical Technique......Page 1693
Anconeus......Page 1694
Surgical Technique......Page 1695
Free Tissue Transfer......Page 1696
References......Page 1697
Contraindications......Page 1701
Muscle Flap......Page 1702
Venous Flaps......Page 1703
Angiography......Page 1704
Wound Débridement......Page 1705
Recipient Vessels......Page 1706
Dissecting the Pedicle......Page 1707
Capillary Refill......Page 1708
Other Monitoring Techniques......Page 1709
Leeches......Page 1710
Infection......Page 1711
Operative Technique......Page 1712
Radial Forearm Flap......Page 1715
Operative Technique......Page 1716
Anatomy......Page 1718
Operative Technique......Page 1719
Operative Technique......Page 1720
Operative Technique......Page 1722
Operative Technique......Page 1724
“Tailored” Latissimus Dorsi Musculocutaneous Flap or Thoracodorsal Artery Perforator Flap......Page 1725
Anatomy......Page 1726
Anatomy......Page 1727
Operative Technique......Page 1728
Operative Technique......Page 1729
Sensory Flaps from the First Web Space of the Foot......Page 1730
Operative Technique......Page 1731
Soft Tissue Defects......Page 1733
References......Page 1734
Applied Muscle Physiology......Page 1737
Pertinent Anatomy......Page 1739
Harvesting Technique......Page 1740
Preoperative Planning......Page 1741
Revascularization......Page 1743
Flap Coverage......Page 1744
Postoperative Management and Expectations......Page 1745
Preoperative Evaluation......Page 1746
Muscle Transfer......Page 1747
Surgical Exposure and Harvesting......Page 1748
Postoperative Management and Expectations......Page 1749
Preoperative Evaluation......Page 1750
Postoperative Management and Expectations......Page 1751
Cortical Plasticity and Motor Relearning......Page 1752
References......Page 1753
Biology of Vascularized Bone Grafts......Page 1755
Physeal Arrest......Page 1756
Clavicle......Page 1757
Donor Site......Page 1758
Free Flap......Page 1759
Osteocutaneous Flap......Page 1761
Anatomy......Page 1762
Medial Femoral Condyle Periosteal or Corticoperiosteal Flap......Page 1763
Humerus......Page 1764
Buoy Flap......Page 1765
Fibula......Page 1766
Tumor......Page 1767
Trauma......Page 1768
Secondary Bone Graft for Delayed Union......Page 1769
Stress Fracture......Page 1770
Kienbock’s Disease......Page 1771
Anatomy......Page 1772
Distal Anastomoses......Page 1774
Graft Placement......Page 1775
Fifth Plus Fourth ECA Graft......Page 1777
Arteriovenous Bundle with Iliac Crest Graft......Page 1778
Scaphoid......Page 1779
Conclusion......Page 1780
References......Page 1783
General Considerations......Page 1786
Primary Versus Secondary Toe-to-Hand Transplantation......Page 1787
Single-Finger Amputation......Page 1788
Reconstruction of Multiple-Digit Proximal Amputation......Page 1789
Congenital Absence of Digits......Page 1791
Anatomy for Toe Dissection......Page 1792
Indications......Page 1794
? Authors’ Preferred Method of Treatment......Page 1797
? Authors’ Preferred Method of Treatment......Page 1799
Indications......Page 1801
Indications......Page 1802
Indications......Page 1803
Flap Design and Elevation......Page 1804
Indications......Page 1805
Indications......Page 1806
? Authors’ Preferred Method of Treatment......Page 1807
Tendon and Pulley Preparation......Page 1808
Tendon Repair......Page 1809
Vascular Anastomoses......Page 1810
Secondary Procedures......Page 1811
Motor Rehabilitation......Page 1812
Conclusion......Page 1813
References......Page 1814
Historical Review......Page 1817
Thumb Reconstruction after Partial or Complete Traumatic Loss......Page 1818
Acceptable Length with Poor Soft Tissue Coverage......Page 1819
Palmar Advancement Flap with Proximal Releasing Incision......Page 1820
Heterodigital Flap Reconstruction......Page 1822
Cross-Finger Flap to the Thumb......Page 1823
Radial-Innervated Cross-Finger Flap......Page 1825
Dual Innervated Cross-Finger Flap......Page 1828
Neurovascular Island Pedicle Flap......Page 1830
Subtotal Amputation with Questionable Remaining Length......Page 1834
Four-Flap “Z”-Plasty of the Thumb Web......Page 1835
Phalangization of the First Metacarpal with Dorsal Rotational Flap Coverage......Page 1838
Regional and Distant Flaps......Page 1840
First Web Space Deepening with Cross-Arm Flap Coverage......Page 1841
Osteoplastic Reconstruction......Page 1843
Stage 1......Page 1844
Stage 2......Page 1846
Composite Radial Forearm Island Flap......Page 1848
Pollicization of an Index or Long Finger Stump......Page 1852
Total Loss with Destruction of the Basal Joint......Page 1856
References......Page 1858
56 Amputations......Page 1861
Split-Thickness Grafting......Page 1862
Digital Tip Amputations with Exposed Bone......Page 1863
Atasoy-Kleinert Volar “V-Y” Flap......Page 1864
Volar Flap Advancement......Page 1865
Cross-Finger Pedicle Flap......Page 1867
Island Flaps......Page 1868
Through the Distal Interphalangeal Joint......Page 1869
Amputation through the Proximal Phalanx......Page 1870
Ray Amputations......Page 1871
Index Ray Amputation......Page 1873
? Authors’ Preferred Method of Treatment: Index Ray Amputation......Page 1874
Long Finger Ray Amputation with Transposition of the Index Finger (Carroll18)......Page 1875
Long Finger Ray Amputation without Transposition......Page 1877
Ring Finger Ray Amputation with Transposition of the Fifth Metacarpal......Page 1878
? Authors’ Preferred Method of Treatment: Long Finger Ray and Ring Finger Ray Amputation......Page 1880
Multiple Digit Amputations......Page 1881
Amputations through the Carpus......Page 1884
? Authors’ Preferred Method of Treatment: Wrist Disarticulation......Page 1885
Transradial Amputations......Page 1886
Krukenberg’s Procedure......Page 1887
Transhumeral Amputations......Page 1888
Amputation of the Arm at the Level of the Pectoralis Major......Page 1889
Shoulder Disarticulation......Page 1890
Forequarter Amputation......Page 1891
Anterior Approach (Berger)......Page 1892
Posterior Approach (Littlewood)......Page 1894
Radical Forequarter Amputation......Page 1896
Tikhor-Linberg Procedure (Resection of the Shoulder Girdle with Preservation of the Arm)......Page 1897
Terminal Devices.......Page 1898
Sockets and Liners.......Page 1899
Phantom Limb Sensation......Page 1900
References......Page 1901
Pertinent History......Page 1904
Diagnosis......Page 1905
Acute Stage......Page 1908
Intermediate Stage......Page 1911
Postoperative Management and Expectations......Page 1912
Preoperative Evaluation......Page 1913
Types of Operations......Page 1914
Muscle Slide Procedure......Page 1915
Functional Muscle Transfer......Page 1916
Management of Nerve Lesions......Page 1917
Holden Type II......Page 1918
References......Page 1921
Spiders......Page 1924
Snakes......Page 1925
Cnidarians (Jellyfish, Portuguese Man-O’-War, Anemones, Corals)......Page 1927
Venomous Fish......Page 1928
References......Page 1931
Historical Review......Page 1933
Pain Mediators/Receptor Control......Page 1935
Acute Versus Chronic Pain......Page 1936
Psychological Problems Mimicking Complex Regional Pain Syndrome......Page 1937
Symptoms and Signs......Page 1938
Mechanical Nociceptive Focus......Page 1939
Bone Scan (Scintigraphy)......Page 1940
Regulation of Microvascular Flow......Page 1941
Diagnostic Regional and Sympathetic Blockade......Page 1942
Thermography......Page 1944
Pharmacologic Interventions......Page 1945
Adrenergic Compounds......Page 1946
Calcium Channel Blockers......Page 1949
Free Radical Scavengers......Page 1950
Percutaneous Neural or Ganglionic Blockade......Page 1951
Level of Evidence for Treatment of Complex Regional Pain Syndrome......Page 1952
A Multidisciplinary Team Approach......Page 1953
Expected Outcomes of Drug Therapy......Page 1954
Summary of the Role of Sympathectomy......Page 1955
Surgical Technique for the Management of Injury to the Superficial Branch of the Radial Nerve Complicated by Complex Regional Pain Syndrome......Page 1956
? Authors’ Preferred Method of Treatment: Revision of Carpal Tunnel Surgery......Page 1958
Operative Technique......Page 1959
References......Page 1960
Dysfunctional Postures......Page 1963
Recognizing Factitious Illness and Avoiding Mistaken Diagnoses......Page 1964
Management of Patients with Factitious Disorders......Page 1965
References......Page 1966
Surgical Considerations in the Arthritic Patient......Page 1967
Staging Hand Surgery......Page 1968
Psoriatic Arthritis......Page 1970
Systemic Lupus Erythematosus......Page 1971
Wrist Deformity......Page 1972
? Authors’ Preferred Method of Treatment......Page 1973
Digital Deformity......Page 1974
The Metacarpophalangeal Joint......Page 1975
Rheumatoid Nodulosis......Page 1976
? Anatomy of the Tendons and Tendon Sheath......Page 1977
? Authors’ Preferred Method of Treatment: Dorsal Tenosynovectomy......Page 1978
Flexor Tenosynovitis in the Wrist......Page 1980
? Authors’ Preferred Method of Treatment: Flexor Tenosynovectomy......Page 1981
? Authors’ Preferred Method of Treatment: Digital Tenosynovectomy......Page 1983
Extensor Tendon Ruptures......Page 1984
Flexor Tendon Ruptures......Page 1985
? Authors’ Preferred Method of Treatment......Page 1986
Ring and Small Finger Ruptures......Page 1987
Rupture of More Than Three Extensor Tendons......Page 1988
Tendon Transfers in Patients with Fused Wrists......Page 1990
Operative Technique......Page 1991
Rupture of Both Superficial and Deep Finger Flexor Tendons......Page 1992
Operative Treatment of Rheumatoid Radiocarpal and Radioulnar Joint Deformities......Page 1993
Distal Ulnar Excision and Reconstruction of the Distal Radioulnar Joint Complex......Page 1994
Operative Technique: Distal Ulnar Excision and Reconstruction of the Distal Radioulnar Joint......Page 1995
Operative Technique: Extensor Carpi Radialis Longus Transfer......Page 1998
Choice of Operation for the Rheumatoid Wrist......Page 1999
Operative Technique: Partial Wrist Arthrodesis......Page 2000
Two-Pin Modification of Feldon......Page 2001
Complications of Wrist Fusion......Page 2002
Synovectomy......Page 2003
Metacarpophalangeal Joint Synovectomy......Page 2004
Crossed Intrinsic Transfer......Page 2005
Metacarpophalangeal Joint Arthroplasty in Rheumatoid Arthritis......Page 2006
Contraindications......Page 2007
Flexible Implant Arthroplasty......Page 2008
Technical Points......Page 2011
Complications......Page 2012
Outcomes......Page 2013
Operative Technique......Page 2014
Distal Interphalangeal Joint Fusion......Page 2015
Operative Technique for Fusion of the Distal Interphalangeal Joint with a Screw......Page 2017
Type II: Proximal Interphalangeal Joint Flexion Limited in Certain Positions......Page 2018
Lateral Band Mobilization......Page 2019
Flexor Tenosynovitis Associated with Proximal Interphalangeal Joint Stiffness......Page 2020
Type IV: Stiff Proximal Interphalangeal Joints with Poor Radiographic Appearance......Page 2021
Indications......Page 2022
Surgical Approaches......Page 2023
Volar Approach.......Page 2024
Outcomes......Page 2025
Boutonnière Deformity......Page 2026
Extensor Tenotomy......Page 2027
Stage III: Severe Boutonnière Deformity......Page 2028
Proximal Interphalangeal Joint Fusion......Page 2029
Type I Thumb Deformity (Boutonnière Deformity)......Page 2030
Indications for Operative Treatment......Page 2031
Indications for Operative Treatment......Page 2032
Indications for Operative Treatment: Severe Joint Destruction and Arthritis Mutilans......Page 2033
Metacarpophalangeal Joint Synovectomy with Reconstruction of the Extensor Mechanism......Page 2034
Arthrodesis of the Interphalangeal and Metacarpophalangeal Joints Without Severe Deformity or Bone Loss.......Page 2035
Arthrodesis for Arthritis Mutilans.......Page 2036
References......Page 2037
Gout......Page 2040
Calcific Tendinitis......Page 2041
Amyloid Deposition......Page 2042
Causative Factors......Page 2043
Nonoperative Management......Page 2044
Technique of Corticosteroid Injection.......Page 2045
Topographic Anatomy and Skin Incisions.......Page 2046
Operative Technique of Open Trigger Digit Release.......Page 2048
Complications......Page 2049
Congenital Trigger Thumb......Page 2050
de Quervain’s Disease......Page 2052
Technique of Injection.......Page 2053
Pertinent Anatomy.......Page 2054
? Author’s Preferred Method......Page 2055
Intersection Syndrome......Page 2056
Extensor Pollicis Longus......Page 2057
Flexor Carpi Radialis Tendinitis......Page 2058
References......Page 2059
Pathophysiology......Page 2062
Initial Evaluation and Management......Page 2063
Classification of Burns......Page 2064
Escharotomy......Page 2065
Splinting......Page 2066
Local Wound Care......Page 2067
Excision and Grafting......Page 2069
Graft Loss......Page 2071
Prevention......Page 2072
Nail Bed Deformities......Page 2073
Web Space Syndactyly/ Interdigital Contractures......Page 2074
Digital Flexion Contracture......Page 2075
Amputation Deformity......Page 2077
Heterotopic Ossification......Page 2078
Reconstructive Tools......Page 2079
Anterolateral Thigh Flaps......Page 2080
Properties of Electricity and Pathophysiology......Page 2081
General Management......Page 2082
Surgical Management......Page 2083
Management......Page 2085
Hydrofluoric Acid......Page 2086
Pathophysiology......Page 2087
Treatment......Page 2088
Rehabilitation......Page 2089
References......Page 2090
General Principles......Page 2094
Tumor Excision......Page 2095
Cutaneous Horn......Page 2096
Verruca Vulgaris......Page 2097
Pyogenic Granuloma......Page 2098
Distal Digital Keratoacanthoma......Page 2099
Common Acquired Nevi......Page 2100
Congenital Nevi......Page 2101
Arsenic Keratosis......Page 2102
Atypical Nevus (Atypical Mole)......Page 2103
Types of Melanoma......Page 2104
Treatment......Page 2105
Lymph Node Dissection......Page 2106
Squamous Cell Carcinoma......Page 2107
Basal Cell Carcinoma......Page 2108
Treatment......Page 2109
Sweat Gland Tumors......Page 2110
References......Page 2111
Classification and Staging of Tumors......Page 2114
Histologic Grade and Surgical Staging......Page 2115
Plain Radiographs......Page 2116
Biopsy......Page 2117
Excisional Biopsy......Page 2118
Malignant Tumors......Page 2119
Middle Phalanx......Page 2120
Finger Metacarpals......Page 2121
Wrist and Distal Forearm......Page 2122
Clinical Characteristics......Page 2123
? Anatomy......Page 2126
Pathogenesis......Page 2127
Clinical Characteristics......Page 2128
Operative Technique......Page 2129
Dorsal Wrist Syndrome and Impingement......Page 2131
Operative Technique......Page 2132
Operative Technique......Page 2133
Operative Technique......Page 2134
Operative Technique......Page 2135
Postoperative Care......Page 2136
First Extensor Compartment (Dorsal Retinacular) Ganglion......Page 2137
Foreign Body Lesions......Page 2139
Lipomas......Page 2140
Schwannomas (Neurilemomas)......Page 2141
Digital Fibroma of Infancy......Page 2142
Juvenile Aponeurotic Fibroma......Page 2143
Staging......Page 2144
Operative Treatment......Page 2145
Epithelioid Sarcoma......Page 2146
Liposarcoma......Page 2147
Malignant Peripheral Nerve Sheath Tumor (Neurofibrosarcoma/Malignant Schwannoma)......Page 2148
Enchondroma......Page 2149
? Author’s Preferred Method of Treatment......Page 2150
Periosteal Chondroma......Page 2151
Osteoid Osteoma......Page 2152
Unicameral Bone Cyst......Page 2153
Giant Cell Tumor of Bone......Page 2154
? Author’s Preferred Method of Treatment......Page 2156
Osteogenic Sarcoma......Page 2157
? Author’s Preferred Method of Treatment......Page 2158
Metastatic Tumors......Page 2159
Acknowledgment......Page 2161
References......Page 2162
History......Page 2169
Physical Examination......Page 2170
Ultrasound......Page 2171
Digital Plethysmography (Pulse Volume Recordings)......Page 2172
Laser Doppler Fluxmetry......Page 2173
Isolated Cold Stress Testing......Page 2174
Vital Capillaroscopy......Page 2175
Magnetic Resonance and Computed Tomographic Angiography......Page 2176
Contrast-Enhanced Angiography......Page 2177
? Authors’ Preferred Approach......Page 2178
Arterial Anatomy......Page 2179
Microvascular Beds......Page 2180
Control Mechanisms......Page 2181
History......Page 2182
Natural History After Acute Arterial Injury......Page 2183
Isolated Noncritical (Radial/Ulnar) Arterial Laceration......Page 2184
Exposure......Page 2185
Reversed Interposition Grafting......Page 2186
Bypass Grafting......Page 2187
Temporary Shunting......Page 2188
Management and Surgical Treatment......Page 2189
Management and Surgical Options......Page 2190
History and Physical Examination......Page 2191
Types of Operations and Treatment......Page 2192
Radial Artery Thrombosis......Page 2193
Embolectomy......Page 2194
Reversed Interposition Vein Grafting......Page 2195
Salvage Procedures (Omental Transfer)......Page 2197
Reconstruction......Page 2198
Clinical Findings and Natural History......Page 2199
Diagnosis......Page 2200
? Authors’ Preferred Method of Treatment......Page 2201
Preoperative Evaluation......Page 2202
? Anatomy and Pathophysiology......Page 2203
Pharmacologic Management......Page 2204
Technique for Peripheral/Periarterial Sympathectomy.......Page 2205
Surgical Technique.......Page 2206
Postoperative Management and Expectations......Page 2207
Palliative Options......Page 2208
Management......Page 2209
References......Page 2210
A......Page 2213
B......Page 2217
C......Page 2221
D......Page 2226
E......Page 2228
F......Page 2231
G......Page 2235
H......Page 2236
I......Page 2238
K......Page 2240
L......Page 2241
M......Page 2242
N......Page 2246
O......Page 2248
P......Page 2249
R......Page 2253
S......Page 2257
T......Page 2263
U......Page 2268
V......Page 2269
W......Page 2270
Z......Page 2272