Hand Surgery-1판

6. Flexor Tendon Reconstruction (Zone 2)
6.1 Description
6.2 Key Principles
6.3 Single-Stage Flexor Tendon Reconstruction
6.3.1 Indications
6.3.2 Contraindications
6.3.3 Special Instructions, Position, and Anesthesia
6.3.4 Surgical Technique
6.3.5 Postoperative Course
6.3.6 Complications
6.4 Two-Stage Flexor Tendon Reconstruction
6.4.1 Indications
6.4.2 Contraindications
6.4.3 Surgical Technique
6.4.4 Special Instructions, Position, and Anesthesia
6.4.5 Tips, Pearls, and Lessons Learned
6.4.6 Postoperative Course
6.4.7 Bailout, Rescue, and Salvage Procedures
6.4.8 Pitfalls
6.5 Pulley Reconstruction
6.5.1 Indications
6.5.2 Surgical Technique
6.5.3 Pitfalls
6.5.4 Postoperative Care
6.6 Flexor Tenolysis
6.6.1 Indications
6.6.2 Surgical Technique
6.6.3 Postoperative Care
Suggested Readings

7. Radial Nerve Palsy Tendon Transfers
7.1 Description
7.2 Key Principles
7.3 Expectations
7.4 Indications
7.5 Contraindications
7.6 Special Considerations
7.7 Special Instructions, Positioning, and Anesthesia
7.8 Tips, Pearls, and Lessons Learned
7.8.1 PT Donor
7.8.2 FCU Donor
7.8.3 FCR Donor
7.8.4 FDS Donor
7.8.5 PL Donor
7.8.6 ECRB Recipient
7.8.7 EDC Recipient
7.8.8 EPL Recipient
7.8.9 Postoperative Care
7.9 Difficulties Encountered
7.9.1 Contractures
7.9.2 Tensioning
7.10 Key Procedural Steps
7.10.1 Number of Incisions
7.10.2 Tendon Preparation
7.10.3 Weaving
7.10.4 Tensioning
7.10.5 Dangers
7.10.6 Postoperative Care
7.11 Bailout, Rescue, and Salvage Procedures
References

8. Low Median Nerve Palsy Tendon Transfers
8.1 Description
8.2 Key Principles
8.2.1 General Principles of Tendon Transfers
8.2.2 Considerations Specific to Low Median Nerve Palsy Tendon Transfers
8.3 Expectations
8.4 Indications
8.5 Contraindications
8.6 Special Considerations
8.7 Special Instructions, Positioning, and Anesthesia
8.8 Tips, Pearls, and Lessons Learned
8.8.1 EIP Transfer
8.8.2 PL (Camitz) Transfer
8.8.3 FDS Transfer
8.8.4 ADM (Huber) Transfer
8.9 Difficulties Encountered
8.10 Key Procedural Steps
8.10.1 EIP Transfer
8.10.2 PL (Camitz) Transfer
8.10.3 FDS Transfer
8.10.4 ADM (Huber) Transfer
8.11 Bailout, Rescue, and Salvage Procedures
8.12 Pitfalls
References

9. Tendon Transfers for Low Ulnar Nerve Palsy
9.1 Key Principles
9.2 Expectations
9.3 Indications
9.4 Contraindications
9.5 Special Considerations
9.6 Special Instructions, Positioning, and Anesthesia
9.7 Tips, Pearls, and Lessons Learned
9.7.1 Correction of Clawing
9.7.2 Loss of Pinch Strength
9.8 Difficulties Encountered
9.9 Bailout, Rescue, and Salvage Procedures
References

10. Extensor Indicis Proprius Tendon Transfer for Rupture of the Extensor Pollicis Longus Tendon
10.1 Description
10.2 Key Principles
10.3 Expectations
10.4 Indications
10.5 Contraindications
10.6 Special Considerations
10.7 Special Instructions, Positioning, Anesthesia
10.8 Tips, Pearls, and Lessons Learned
10.9 Difficulties Encountered
10.10 Key Procedural Steps
10.11 Bailout, Rescue, and Salvage Procedures
10.12 Pitfalls
Suggested Readings

11. Extensor Indicis Proprius to Extensor Digitorum Comminus Tendon Transfer
11.1 Description
11.2 Key Principles
11.3 Expectations
11.4 Indications
11.5 Contraindications
11.6 Special Considerations
11.7 Special Instructions, Positioning, and Anesthesia
11.8 Tips, Pearls, and Lessons Learned
11.9 Difficulties Encountered
11.10 Key Procedural Steps
11.11 Bailout, Rescue, and Salvage Procedures

12. Superficialis Transfer for Rupture of the Flexor Pollicis Longus Tendon
12.1 Preoperative Work-up
12.1.1 Indications and Contraindications
12.2 Surgical Technique
12.3 Postoperative Management
12.4 Complications
12.5 Summary/Functional Outcomes
References


Part III: Tendinopathies
13. Trigger Finger/Thumb Release
13.1 Description
13.2 Key Principles
13.3 Expectations
13.4 Indications
13.5 Contraindications
13.6 Special Considerations
13.7 Special Instructions, Positioning, and Anesthesia
13.8 Tips, Pearls, and Lessons Learned
13.9 Difficulties Encountered
13.10 Key Procedure Steps
13.11 Bailout, Rescue, and Salvage Procedures
Suggested Readings

14. DeQuervain Tenosynovitis
14.1 Introduction
14.2 Evaluation
14.2.1 Patient History
14.2.2 Physical Examination
14.2.3 Imagine
14.2.4 Differential Diagnosis
14.3 Nonoperative Treatment
14.4 Treatment Surgical
14.4.1 Indications
14.4.2 Principles
14.4.3 Technique
14.4.4 Rehabilitation
14.4.5 Complications
14.4.6 Outcome
14.4.7 Tips
Suggested Readings

15. Extensor Carpi Ulnaris Tenosynovectomy/Instability
15.1 Anatomy
15.2 Mechanism of Injury
15.3 Evaluation and Exam
15.4 Treatment
15.5 Surgical Approach
15.6 Tenosynovitis
15.7 Instability
References

16. Intersection Syndrome
16.1 History
16.2 Epidemiology
16.3 Pathoanatomy
16.4 Clinical Presentation
16.5 Differential Diagnosis
16.6 Radiographic Features
16.6.1 Ultrasound
16.6.2 Magnetic Resonance Imaging
16.7 Nonoperative Management
16.8 Surgery
16.8.1 Positioning
16.8.2 Surgical Technique
16.8.3 Postoperative Care
16.8.4 Pitfalls
References

17. Lateral Epicondylar Debridement
17.1 Background
17.2 Nonoperative Treatment
17.2.1 Author's Preferred Method for Nonoperative Treatment
17.3 Differential Diagnosis
17.4 Surgical Indications
17.5 Surgical Techniques
17.5.1 Arthroscopic Debridement
17.5.2 Author's Preferred Technique: Open Release and Debridement
17.5.3 Postoperative Rehabilitation
17.6 Potential Complications and Pitfalls
17.7 Pearls, Tips, and Lessons Learned
17.7.1 Surface Anatomy
17.7.2 Positioning
17.7.3 Lateral Collateral Ligament and Joint Capsule
17.7.4 Radial Nerve and Branches
17.7.5 Vascular Considerations for the Capitellum
17.7.6 Rehabilitation
17.8 Conclusion
References

18. Medial Epicondylar Debridement
18.1 Background
18.2 Pathophysiology
18.3 Evaluation
18.4 Surgical Treatment
18.5 Ulnar Neuropathy
References


Part IV: Nerve Repair/Reconstruction
19. Nerve Repair in the Hand
19.1 Description
19.2 Key Principles
19.3 Indications
19.4 Contraindications
19.5 Special Considerations
19.6 Special Instructions, Positioning, and Anesthesia
19.7 Tips, Pearls, and Lessons Learned
19.7.1 Primary Nerve Repair
19.7.2 Nerve Reconstruction
19.8 Difficulties Encountered
19.9 Key Procedural Steps
19.10 Bailout, Rescue, and Salvage Procedures
References

20. Peripheral Nerve Injury and Repair using Autograft or Allograft
20.1 Background
20.2 Nerve Anatomy
20.3 Pathophysiology
20.4 Injury Classification
20.5 Repair Methods
20.5.1 Direct Repair
20.5.2 Autograft
20.5.3 Allograft
References
Suggested Readings

21. Nerve Conduits for Nerve Repair/Reconstruction
21.1 Description
21.2 Key Principles
21.3 Nerve Conduit Characteristics
21.3.1 Advantages of Nerve Conduits
21.3.2 Materials for Nerve Conduits
21.4 Indications
21.5 Contraindications
21.6 Surgical Technique
21.6.1 Preparation of Nerve Ends
21.6.2 Suturing of Nerve Ends
21.6.3 Final Surgical Considerations
21.7 Postoperative Rehabilitation
21.8 Special Considerations
21.8.1 Precautions
21.8.2 Complications
References

22. Oberlin Transfer
22.1 Description
22.2 Key Principles
22.3 Expectations
22.4 Indications
22.5 Contraindications
22.6 Special Considerations
22.7 Special Instructions, Positioning, and Anesthesia
22.8 Tips, Pearls, and Lessons Learned
22.9 Difficulties Encountered
22.10 Key Procedural Steps
22.11 Bailout, Rescue, and Salvage Procedures
References


Part V: Nerve Compression
23. Open Carpal Tunnel Release
23.1 Description
23.2 Key Principles
23.3 Expectations
23.4 Indications
23.5 Contraindications
23.6 Instructions, Positioning, and Anesthesia
23.7 Tips, Pearls, and Pitfalls
23.7.1 Incision Marking
23.7.2 Tissue Handling
23.7.3 Surgeon Positioning
23.8 Difficulties Encountered
23.9 Key Procedural Steps
23.10 Postoperative Management
References

24. Endoscopic Carpal Tunnel Release
24.1 Description
24.2 Key Principles
24.3 Expectations
24.4 Indications
24.5 Contraindications
24.6 Special Considerations
24.7 Special Instructions, Positioning, and Anesthesia
24.8 Tips, Pearls, and Lessons Learned
24.9 Difficulties Encountered
24.10 Key Procedural Steps
24.11 Bailout, Rescue, and Salvage Procedures
References

25. Proximal Median Nerve Compression
25.1 Anatomy
25.1.1 Anomalous Anatomy
25.2 Pathophysiology
25.3 Diagnosis
25.3.1 Clinical Exam
25.3.2 Testing
25.4 Treatment
25.4.1 Nonoperative Management
25.4.2 Surgical Decompression
25.4.3 Surgical Technique
25.4.4 Postop Protocol
25.4.5 Potential pitfalls
References

26. Open Ulnar Nerve Decompression at the Wrist
26.1 Description
26.2 Key Principles
26.3 Expectations
26.4 Indications and Contraindications
26.5 Special Considerations
26.6 Special Instructions, Positioning, and Anesthesia
26.7 Key Procedural Steps
26.8 Tips, Pearls, and Lessons Learned
26.9 Difficulties Encountered
26.10 Bailout, Rescue, and Salvage Options
References

27. Endoscopic Ulnar Nerve Decompression
27.1 Introduction
27.2 Description
27.3 Outcome
27.4 Goals
27.5 Indications and Contraindications
27.5.1 Indications
27.5.2 Contraindications
27.5.3 Alternate Procedures
27.6 Operative Detail
27.6.1 Preparation—Planning/Special Equipment
27.6.2 Technique/Key Steps
27.6.3 Risks/What to Avoid
27.6.4 Salvage
27.6.5 Tips/Pearls
27.7 Postoperative
27.7.1 Postoperative Care
27.7.2 Complications
References

28. Open Ulnar Nerve Decompression/Subcutaneous Transposition at the Elbow
28.1 Description
28.2 Outcome
28.3 Indications
28.4 Positioning and Anesthesia
28.5 Operative Techniques
28.5.1 Open In Situ Ulnar Nerve Decompression
28.5.2 Subcutaneous Ulnar Nerve Transposition and Z-Lengthening of the Flexor-Pronator Mass
28.5.3 Key Procedural Steps: Pearls, Pitfalls, and Lessons Learned
28.6 Postoperative Rehabilitation
28.7 Complications
28.8 Failed Ulnar Nerve Decompression at the Elbow
References

29. Submuscular Ulnar Nerve Transposition
29.1 Key Principles
29.2 Expectations
29.3 Clinical Findings and Indications
29.4 Contraindications and Considerations
29.5 Special Instructions, Positioning, and Anesthesia
29.6 Tips, Pearls, and Lessons Learned
29.7 Difficulties Encountered
29.8 Key Procedural Steps
29.8.1 Approach
29.8.2 Decompression
29.8.3 Transposition
29.8.4 Complications
References

30. Partial Wrist Denervation for Chronic Wrist Pain
30.1 Introduction
30.2 Key Principles
30.3 Expectations
30.4 Indications
30.5 Contraindications
30.6 Anatomy
30.6.1 Anterior Interosseous Nerve
30.6.2 Posterior Interosseous Nerve
30.7 Presurgical Diagnostic Testing
30.7.1 Imaging
30.7.2 Injections
30.8 Surgical Procedure
30.8.1 Dorsal Approach
30.8.2 Volar Henry Approach
30.8.3 Volar Ulnar Approach
30.9 Pitfalls
References


Part VI: Hand Fractures
31. Distal Phalanx Fractures: Percutaneous Pinning and Open Reduction Internal Fixation
31.1 Description
31.2 Key Principles
31.3 Expectations
31.4 Operative Indications
31.4.1 Seymour Fractures
31.4.2 Mallet Fractures
31.4.3 Open Fractures
31.4.4 Unstable Fractures with Nail Plate Loss
31.5 Contraindications
31.6 Special Considerations
31.6.1 Open Fractures
31.6.2 Associated Nailbed Injury
31.7 Special Instructions, Positioning, and Anesthesia
31.8 Tips, Pearls, and Lessons Learned
31.8.1 Mallet Fracture
31.8.2 Suture Anchor Fixation
31.8.3 ORIF with a Compression Screw
31.8.4 Seymour Fracture
31.8.5 Shaft Fracture
31.9 Key Procedural Steps
31.9.1 Seymour Fracture
31.9.2 Mallet Fracture
31.10 Difficulties Encountered, Bailouts, and Pitfalls
References

32. Middle/Proximal Phalanx (Pinning)
32.1 Description
32.2 Key Principles
32.3 Expectations
32.4 Indications
32.5 Contraindications
32.6 Special Considerations
32.7 Special Instructions, Positioning, and Anesthesia
32.8 Individual Fractures Discussing Tips, Key Procedural Steps, and Expected Outcomes
32.8.1 Extra-Articular Fractures
32.8.2 Intra-Articular Fractures
32.9 Bailout, Rescue, and Salvage Procedures
32.10 Pitfalls
References

33. Middle/Proximal Phalanx (Open Reduction and Internal Fixation)
33.1 Introduction
33.2 Goals
33.3 Indications
33.4 Contraindications
33.5 Alternate Procedures
33.6 Operative Detail
33.6.1 Preparation: Planning/Special Equipment
33.6.2 Approach
33.6.3 Reduction
33.6.4 Open Reduction and Lag Screw Fixation
33.6.5 Open Reduction and Plate Fixation
33.6.6 Risks/What to Avoid
33.7 Salvage
33.7.1 Corrective Osteotomy
33.7.2 Fusion
33.8 Tips/Pearls
33.9 Postoperative
33.10 Postoperative Care
33.11 Complications
References
Suggested Readings

34. Fixation of Uni and Bicondylar Phalangeal Fractures
34.1 Description
34.2 Key Principles
34.3 Expectations
34.4 Indications
34.5 Contraindications
34.6 Special Considerations
34.7 Special Instructions, Positioning, and Anesthesia
34.8 Tips, Pearls, and Lessons Learned
34.9 Difficulties Encountered
34.10 Key Procedural Steps
34.10.1 Closed Reduction and Percutaneous K-wire Fixation
34.10.2 ORIF through Midlateral Approach
34.10.3 Osteochondral Graft Reconstruction through Volar Approach (Shotgun)
34.10.4 Dorsal Approach
34.11 Bailout, Rescue, and Salvage Procedures
References

35. Bony Mallet Fixation
35.1 Description
35.2 Key Principles
35.3 Expectations
35.4 Indications
35.5 Contraindications
35.6 Special Considerations
35.7 Special Instructions, Positioning, and Anesthesia
35.8 Tips, Pearls, and Lessons Learned
35.8.1 Percutaneous Fixation
35.8.2 Internal Fixation
35.9 Difficulties Encountered
35.10 Key Procedural Steps
35.11 Bailout, Salvage, and Rescue Procedures
Suggested Readings

36. Proximal Interphalangeal Joint Fracture-Dislocation
36.1 Description
36.2 Key Principles
36.3 Expectations
36.4 Indications
36.5 Contraindications
36.6 Special Considerations
36.7 Special Instructions, Positioning, and Anesthesia
36.8 Tips, Pearls, and Lessons Learned
36.9 Difficulties Encountered
36.10 Key Procedural Steps
36.10.1 Extension Block Pinning
36.10.2 Dynamic External Fixation
36.10.3 Open Reduction and Internal Fixation
36.10.4 Volar Plate Arthroplasty
36.10.5 Hemi-Hamate Arthroplasty
36.11 Bailout, Rescue, and Salvage Procedures
Suggested Readings

37. Metacarpals (Pinning)
37.1 Overview
37.2 Indications
37.2.1 For Operative Fixation
37.2.2 For Pinning over Internal Fixation
37.2.3 Contraindications (Indications for Plating)
37.3 Preparation
37.3.1 Diagnostic Studies
37.3.2 Equipment and Hardware
37.3.3 Anesthesia
37.3.4 Assistants
37.4 Approach to Specific Fracture Patterns
37.4.1 Bennett Fracture Dislocation
37.4.2 Metacarpal Neck Fracture (Boxer Fracture)
37.4.3 Comminuted Fractures
37.5 Postoperative Care
37.5.1 Splinting
37.5.2 Antibiotics
37.5.3 Pin Removal
37.6 Complications
37.6.1 Infection
37.6.2 Pin Instability
37.6.3 Stiffness
References

38. Metacarpal Fracture Open Reduction and Internal Fixation (ORIF)
38.1 Description
38.2 Key Principles
38.3 Expectations
38.3.1 Metacarpal Head Fractures
38.3.2 Metacarpal Neck Fractures
38.3.3 Metacarpal Shaft Fractures
38.4 Indications
38.4.1 General Indications
38.4.2 Metacarpal Neck fractures
38.4.3 Metacarpal Shaft Fractures
38.5 Contraindications
38.6 Special Considerations
38.7 Special Instruments, Positioning, and Anesthesia
38.7.1 Patient Positioning
38.7.2 Anesthesia
38.8 Tips, Pearls, and Lessons Learned
38.9 Difficulties Encountered
38.10 Key Procedural Steps
38.11 Bailouts, Rescue, and Salvage Procedure
Suggested Readings

39. Limited-Open Retrograde Intramedullary Headless Screw Fixation of Metacarpal Fractures
39.1 Description
39.2 Key Principles
39.3 Outcomes
39.4 Indications
39.5 Contraindications
39.6 Special Considerations
39.7 Key Procedural Steps
39.8 Postoperative Rehabilitation
39.9 Tips, Pearls, and Lessons Learned
References

40. First Metacarpal Base Fractures (Bennett and Rolando Fractures)
40.1 Description
40.2 Key Principles
40.3 Expectations
40.4 Indications
40.5 Contraindications
40.6 Special Considerations
40.7 Special Instructions, Positioning, and Anesthesia
40.8 Tips, Pearls, and Lessons Learned
40.8.1 Closed Reduction and Percutaneous Pinning
40.8.2 Open Reduction Internal Fixation with Interfragmentary Screw
40.8.3 Open Reduction Internal Fixation with A Plate
40.8.4 Arthroscopic Assisted Reduction
40.9 Difficulties Encountered
40.10 Key Procedural Steps During Open Reduction and Internal Fixation (ORIF)
40.11 Bailout, Rescue, and Salvage Procedures
Suggested Readings


Part VII: Wrist Fractures
41. Scaphoid Pinning/ORIF
41.1 Description
41.2 Key Principles
41.3 Expectations
41.4 Indications
41.5 Contraindications
41.6 Special Considerations
41.7 Operative Treatment
41.7.1 Special Instructions, Positioning, and Anesthesia
41.7.2 Tips, Pearls, and Lessons Learned
41.7.3 Difficulties Encountered
41.7.4 Pitfalls
41.8 Key Procedural Steps
41.8.1 Volar Open
41.8.2 Dorsal
41.9 Bailout, Rescue, and Salvage Procedures
References

42. Percutaneous/Kapandji Pinning
42.1 Key Principles
42.2 Expectations
42.3 Indications
42.4 Contraindications
42.5 Special Considerations
42.6 Special Instructions, Positioning, and Anesthesia
42.7 Tips, Pearls, and Lessons Learned
42.7.1 To Incise or Not to Incise Skin
42.7.2 Pinning Sequence
42.8 Postoperative Management
42.9 Difficulties Encountered
42.10 Key Procedural Steps
42.10.1 If Anatomic Reduction Is Achieved by Closed Manipulation
42.10.2 If Anatomic Reduction Is Not Achieved by Closed Manipulation
42.11 Bailout, Rescue, and Salvage Procedures

43. Distal Radius: Volar Approach
43.1 Description
43.2 Key Principles
43.3 Advantages
43.4 Indications
43.5 Contraindications
43.6 Considerations
43.7 Requirements, Positioning, and Anesthesia
43.8 Approach
43.8.1 Henry Approach
43.8.2 The Trans-FCR
43.8.3 The Volar-Extensile Approach
43.8.4 Modifications
43.9 Pitfalls
43.10 Bailout and Salvage Procedures
References
Suggested Readings

44. Dorsal Approach to Distal Radius
44.1 Introduction
44.2 Indications
44.3 Surgical Technique
44.3.1 Case 1
44.3.2 Case 2
44.3.3 Case 3
44.3.4 Case 4
44.3.5 Case 5
44.4 Results
44.5 Tips and Tricks
44.6 Conclusion
References

45. Bridge Plating of Distal Radius Fractures
45.1 Description
45.2 Anatomy
45.2.1 Bones
45.2.2 Biomechanics
45.2.3 Radiographic Parameters
45.2.4 Extensor Compartments
45.3 Definition
45.4 Indications
45.5 Key Principles
45.6 Contraindications
45.7 Special Considerations
45.8 Biomechanical Stability
45.9 Surgical Management
45.9.1 Planning, Positioning, and Anesthesia
45.9.2 Closed Reduction
45.9.3 Surgical Approach/Plate Placement
45.9.4 Plate Fixation
45.9.5 Postoperative Care
45.10 Pitfalls
References
Suggested Readings

46. External Fixation of Distal Radius Fractures
46.1 Description
46.2 Key Principles
46.3 Expectations
46.4 Indications
46.5 Contraindications
46.6 Special Considerations
46.7 Surgical Management
46.7.1 Planning, Positioning, and Anesthesia
46.8 Tips and Pearls
46.9 Key Procedural Steps
46.10 Pitfalls
References


Part VIII: Bone Reconstruction
47. Phalangeal Osteotomies
47.1 Description
47.2 Key Principles
47.3 Expectations
47.4 Indications
47.5 Contraindications
47.6 Special Considerations
47.7 Special Instructions, Positioning, and Anesthesia
47.8 Tips, Pearls, and Lessons Learned
47.8.1 Preoperative Planning
47.8.2 Osteotomy Location and Type
47.8.3 Approach
47.8.4 Tenolysis and Capsulectomy
47.8.5 Articular Malunions
47.8.6 Types of Fixation
47.9 Difficulties Encountered
47.10 Key Procedural Steps
47.11 Bailout, Rescue, and Salvage Procedures
47.12 Pitfalls
References

48. Corrective Osteotomy of Metacarpal Malunion
48.1 Description
48.2 Key Principles
48.2.1 Treat the Patient, Not the Radiograph
48.2.2 Diagnose Before Initiating Treatment
48.2.3 Measure Twice, Cut Once
48.3 Expectations
48.4 Indications
48.5 Contraindications
48.6 Special Considerations
48.6.1 Hardware Selection
48.6.2 Bone Graft Selection
48.7 Positioning, Anesthesia
48.8 Tips, Pearls, and Lessons Learned
48.9 Challenges/Pitfalls
48.10 Key Procedural Steps
48.10.1 Exposure
48.10.2 Deangulation Osteotomy
48.10.3 Derotation Osteotomy
48.10.4 Postoperative Care
48.11 Pitfalls
References

49. Scaphoid Nonunion: Medial Femoral Condyle Vascularized Bone Graft
49.1 Description
49.2 Key Principles
49.3 Indications
49.4 Contraindications
49.5 Special Considerations
49.5.1 Avascular Necrosis
49.5.2 Preoperative Imaging
49.6 Key Procedural Steps
49.6.1 Anesthesia and Positioning
49.6.2 Volar Wrist Surgical Technique
49.6.3 Flap Harvest Surgical Technique
49.6.4 Graft Fixation
49.6.5 Microvascular Anastomosis
49.7 Difficulties Encountered
49.8 Complications
49.9 Postoperative Care
49.9.1 Knee
49.9.2 Wrist
49.10 Donor Site Postoperative Morbidity
References

50. Scaphoid Nonunion-ORIF and Bone Graft for Humpback Deformity
50.1 Key Principles
50.2 Expectations
50.3 Indications
50.4 Contraindications
50.5 Special Considerations
50.6 Special Instructions, Positioning, and Anesthesia
50.7 Tips, Pearls, and Lessons Learned
50.7.1 Reduction of the Lunate Prior to Scaphoid Correction
50.7.2 Graft Procurement and Placement
50.7.3 Immobilization after Surgery
50.8 Difficulties Encountered
50.9 Key Procedural Steps
50.10 Bailout, Rescue, and Salvage Procedures
References

51. Capitate Shortening Osteotomy
51.1 Introduction
51.2 Indications
51.3 Contraindications
51.4 Operative Technique
51.5 Operative Technique Alternatives
51.6 Outcomes
51.7 Complications
References

52. Distal Radius Osteotomy for Malunion (Volar Approach)
52.1 Overview
52.2 Basic Anatomy
52.3 Key Principles
52.4 Indications and Contraindications
52.4.1 Indications
52.4.2 Contraindications
52.4.3 Timing
52.5 Anesthesia
52.6 Caveats, Pearls, and Lessons Learned
52.6.1 Preoperative Assessment
52.6.2 History
52.6.3 Physical Examination
52.6.4 Imaging
52.6.5 Volar Approach
52.6.6 Key Operative Steps
52.6.7 Special Considerations
52.6.8 Difficulties and Complications

53. Distal Radius Osteotomy for Malunion: Dorsal Approach
53.1 Introduction
53.2 Key Principles
53.3 Outcomes
53.4 Special Considerations
53.5 Indications and Contraindications
53.5.1 Indications
53.5.2 Contraindications
53.6 Special Instructions, Positioning, and Anesthesia
53.6.1 Patient Positioning
53.6.2 Anesthesia
53.7 Preoperative Planning
53.8 Operative Details
53.8.1 Preparation—Planning/Special Equipment
53.8.2 Procedures
53.8.3 Approaches
53.8.4 Technique/Key Steps
53.8.5 Risks/What to avoid
53.8.6 Salvage
53.8.7 Tips/Pearls
53.9 Considerations
53.10 Postoperative Care
53.11 Complications
References


Part IX: Arthritis
54. Distal Interphalangeal Joint Arthrodesis
54.1 Description
54.2 Key Principles
54.3 Expectations
54.4 Indications
54.5 Contraindications
54.6 Special Considerations
54.6.1 Special Instructions, Positioning, and Anesthesia
54.7 Tips, Pearls, and Lessons Learned
54.7.1 Headless Compression Screw
54.7.2 Kirschner Wires
54.7.3 90 x 90 Wires/Wires and Pins
54.7.4 Bone Loss
54.7.5 Failure of Fixation
54.7.6 Failure of Union
54.8 Difficulties Encountered
54.9 Key Procedural Steps
54.10 Bailout, Rescue, and Salvage Procedures
Suggested Readings

55. Thumb Basal Joint Arthroplasty: Trapeziectomy
55.1 Description
55.2 Key Principles
55.3 Expectations
55.4 Indications
55.5 Relative Contraindications
55.6 Special Considerations
55.7 Special Instructions, Positioning, and Anesthesia
55.8 Tips, Pearls, and Lessons Learned
55.9 Key Procedural Steps
55.10 Salvage Procedures
Suggested Readings

56. Ligament Reconstruction Tendon Interposition (LRTI)
56.1 Description
56.2 Key Principles
56.3 Expectations
56.4 Indications
56.5 Contraindications
56.6 Special considerations
56.7 Special Instructions, Positioning, Anesthesia
56.8 Tips, Pearls, and Lessons Learned
56.8.1 Approach
56.8.2 Trapeziectomy
56.8.3 Inspection of Scaphotrapeziotrapezoid (STT) Joint and Partial Trapeziectomy
56.8.4 Tunnel Placement
56.8.5 Harvesting FCR
56.8.6 Passing FCR
56.8.7 Securing MC Suspension
56.8.8 Capsular Closure
56.9 Bailout, Rescue, and Salvage Procedures
56.9.1 FCR Transection
56.9.2 Tunnel Fracture
References

57. Total Wrist Arthrodesis
57.1 Description
57.2 Key Principles
57.3 Expectations
57.4 Indications
57.5 Contraindications
57.6 Special Considerations
57.7 Special Instructions, Positioning, and Anesthesia
57.8 Tips, Pearls, and Lessons Learned
57.9 Difficulties Encountered
57.10 Key Procedural Steps
57.11 Bailout, Rescue, and Salvage Procedures
57.12 Pitfalls
References

58. Proximal Row Carpectomy
58.1 Description
58.2 Key Principles
58.3 Indications
58.4 Contraindications
58.5 Special Considerations
58.6 Special Instructions, Positioning, Anesthesia
58.7 Tips, Pearls, and Lessons Learned
58.8 Key Procedural Steps
58.9 Bailout, Rescue, and Salvage Procedures
References

59. Scaphoidectomy and Four-Corner Fusion
59.1 Description
59.2 Key Principles
59.3 Expectations
59.4 Indications
59.5 Contraindications
59.6 Special Considerations
59.7 Positioning and Anesthesia
59.8 Tips, Pearls, and Lessons Learned
59.8.1 Approach
59.8.2 Arthrotomy
59.8.3 Scaphoidectomy
59.8.4 Styloidectomy
59.8.5 Graft
59.8.6 Alignment
59.9 Difficulties Encountered
59.9.1 Approach
59.9.2 Scaphoidectomy
59.9.3 Ensuring Fusion
59.10 Key Procedural Steps
59.11 Bailout, Rescue, and Salvage Procedures
References

60. Partial Distal Ulna Resection (Wafer, Hemiresection)
60.1 Wafer Procedure
60.1.1 Description
60.1.2 Key Principles
60.1.3 Expectations
60.1.4 Indications
60.1.5 Contraindications
60.1.6 Special Considerations
60.1.7 Special Instructions, Positioning, and Anesthesia
60.1.8 Tips, Pearls, and Lessons Learned
60.1.9 Difficulties Encountered
60.1.10 Key Procedural Steps
60.1.11 Bailout, Rescue, and Salvage Procedures
60.2 Ulnar Hemiresection Arthroplasty
60.2.1 Description
60.2.2 Key Principles
60.2.3 Expectations
60.2.4 Indications
60.2.5 Contraindications
60.2.6 Special Considerations
60.2.7 Special Instructions, Positioning, and Anesthesia
60.2.8 Tips, Pearls, and Lessons Learned
60.2.9 Difficulties Encountered
60.2.10 Key Procedural Steps
60.2.11 Bailout, Rescue, and Salvage Procedures
60.3 Acknowledgments
References

61. Complete Distal Ulna Excision (Darrach)
61.1 Description
61.2 Indications
61.3 Contraindications
61.4 Pertinent Anatomy
61.5 Clinical History and Physical Examination
61.6 Imaging
61.7 Nonoperative Management
61.8 Positioning and Anesthesia
61.9 Surgical Procedure
61.9.1 Approach
61.9.2 Osteotomy
61.9.3 Closure and Stabilization
61.10 Postoperative Management
61.11 Functional Outcomes
61.12 Radioulnar Convergence/Stump Instability and Salvage
61.13 Pearls and Pitfalls
References


Part X: Instability
62. Finger (PIP/DIP) Collateral Ligament Repair
62.1 Description
62.2 Anatomy
62.3 Evaluation
62.4 Key Principles
62.5 Expectations
62.6 Indications for Surgery
62.6.1 Contraindications
62.6.2 Postoperative Care
62.7 Pearls
References

63. Finger Metacarpophalangeal Joint Collateral Ligament Repair
63.1 Description
63.2 Anatomy/Physiology
63.3 Examination
63.4 Clinical Aspects
63.5 Ligament Injury Grades/Classification
63.5.1 Grade 1
63.5.2 Grade 2
63.5.3 Grade 3
63.5.4 Fractures
63.6 Location of Ligament Injury
63.7 Radiographic Studies
63.8 Conservative Treatment
63.9 Indications for Surgical Treatment
63.10 Contraindications to Surgery
63.11 Positioning and Anesthesia
63.12 Surgical Techniques
63.12.1 Acute Injuries
63.12.2 Chronic Injuries
63.12.3 Small Displaced Avulsion Fractures
63.12.4 Larger Displaced Fractures
63.13 Postoperative Treatment
63.14 Outcomes
63.15 Pitfalls
References

64. Thumb Metacarpophalangeal Joint Collateral Ligament Repair
64.1 Description
64.1.1 Anatomy/Physiology
64.2 Key Principles
64.3 Expectations
64.4 Indications
64.5 Contraindications
64.6 Special Considerations
64.7 Special Instructions, Positioning, and Anesthesia
64.8 Tips, Pearls, and Lessons Learned
64.9 Difficulties Encountered
64.10 Key Procedural Steps (UCL Repair)
64.11 Bailout, Rescue, and Salvage Procedures
64.12 Pitfalls
References

65. Thumb Metacarpophalangeal Joint Collateral Ligament Reconstruction
65.1 Description
65.2 Relevant Anatomy
65.3 Clinical Presentation
65.3.1 History
65.3.2 Physical Examination
65.3.3 Radiographic Evaluation
65.4 Indications
65.5 Contraindications
65.6 Surgical Technique of UCL Reconstruction: Key Procedural Steps
65.6.1 Setup
65.6.2 Exposure
65.6.3 Bone Tunnel Preparation
65.6.4 Tendon Harvest
65.6.5 Tendon Graft Passage and Tensioning
65.6.6 Other Fixation Techniques
65.6.7 Closure
65.7 Pitfalls
65.8 Rehabilitation
65.8.1 Phase I: 0-6 weeks
65.8.2 Phase II: 6-12 weeks
65.8.3 Phase III: > 12 weeks
References

66. Scapholunate Ligament Repair
66.1 Description and Diagnosis
66.2 Indications
66.3 Outcomes
66.3.1 Expectations
66.3.2 Special Considerations
66.4 Surgical Technique for Scapholunate Ligament Repair with Capsulodesis Augmentation
66.4.1 Special Instructions and Positioning
66.4.2 Diagnostic Arthroscopy
66.4.3 Exposure
66.4.4 Reducing the SL Interval
66.4.5 Repair of the Ligament
66.4.6 Capsulodesis
66.5 Postoperative Care
66.6 Pitfalls
References

67. Scapholunate Capsulodesis
67.1 Introduction
67.2 Anatomy
67.3 Pathophysiology, Nonoperative Treatment, and Natural History
67.4 Clinical and Imaging Evaluation
67.5 Operative Treatment
67.5.1 General Concepts
67.5.2 Blatt Capsulodesis (Historical Perspective)
67.5.3 Alternatives
67.6 Indications
67.7 Contraindications
67.8 Special Considerations
67.9 Special Instructions, Positioning, and Anesthesia
67.10 Tips, Pearls, and Lessons Learned
67.11 Key Procedural Steps
67.11.1 Postoperative Course
67.12 Bailout, Rescue, and Salvage Procedures
References
Suggested Reading

68. Scapholunate Ligament Reconstruction (Brunelli Types)
68.1 Description
68.2 Key Principles
68.3 Expectations
68.4 Indications
68.5 Contraindications
68.6 Special Considerations
68.7 Special Instructions, Positioning, and Anesthesia
68.8 Tips, Pearls, and Lessons Learned
68.9 Difficulties Encountered
68.10 Key Procedural Steps
68.10.1 Volar Approach and Graft Harvest
68.10.2 Dorsal Approach
68.10.3 Tunnel Placement
68.10.4 Graft Placement
68.10.5 Reduction and Fixation
68.10.6 Postoperative Course
68.11 Bailout, Rescue, and Salvage Procedures
References

69. Distal Radioulnar Ligament Repair/Reconstruction
69.1 Description
69.2 Key Principles
69.3 Expectations
69.4 Indications
69.5 Contraindications
69.6 Special Considerations
69.7 Special Instructions, Positioning, and Anesthesia
69.8 Tips, Pearls, and Lessons Learned
69.8.1 TFCC Repair
69.8.2 Ligament Reconstruction
69.9 Difficulties Encountered
69.10 Key Procedural Steps
69.11 Bailout, Rescue, and Salvage Procedures
69.12 Outcomes
69.13 Pitfalls
Suggested Readings


Part XI: Skin
70. Split Thickness Skin Graft
70.1 Introduction
70.1.1 Indications
70.1.2 Alternatives
70.2 Surgical Technique
70.2.1 Preparation—Planning and Special Equipment
70.2.2 Technique
70.2.3 Salvage
70.3 Postoperative Care
70.4 Complication
References
Suggested Readings


71. Full Thickness Skin Graft
71.1 Description
71.2 Key Principles
71.3 Expectations
71.4 Indications
71.5 Contraindications
71.6 Technique, Positioning, and Anesthesia
71.7 Postoperative Care
71.8 Tips, Pearls, and Lessons Learned
71.9 Complications
References

72. V–Y Advancement Flap
72.1 Expectations
72.2 Indications
72.3 Contraindications
72.4 Special Instructions, Positioning, and Anesthesia
72.5 Tips, Pearls, and Lessons
72.6 Difficulties Encountered
References

73. Volar Advancement Flaps—Moberg
73.1 Description
73.2 Key Principles
73.3 Expectations
73.4 Indications
73.4.1 Moberg Advancement Flap Indications
73.4.2 V–Y Advancement Flap Indications
73.5 Contraindications
73.5.1 Moberg Advancement Flap Contraindications
73.5.2 V-Y Advancement Flap Contraindications
73.6 Vascular Considerations
73.7 Special Instructions, Positioning, and Anesthesia
73.8 Key Procedural Steps
73.8.1 Moberg Advancement Flap Technique
73.8.2 V-Y Advancement Flap Technique
73.9 Technical Difficulties
73.10 Procedural Modifications
73.10.1 Moberg Modifications
73.10.2 V-Y Modifications
73.11 Expected Outcomes
73.12 Complications
References

74. Cross Finger (and Reverse) Flap
74.1 Description
74.2 Key Principles
74.3 Expectations
74.4 Indications
74.4.1 Cross-Finger Flap
74.4.2 Reverse Cross-Finger Flap
74.5 Contraindications
74.5.1 Both Cross-Finger and Reverse Flaps
74.6 Special Considerations
74.7 Special Instructions, Positioning, and Anesthesia
74.8 Tips, Pearls, and Lessons Learned
74.9 Difficulties and Complications Encountered
74.10 Key Procedural Steps
74.10.1 Cross-Finger Flap
74.10.2 Reverse Cross-Finger Flap
74.11 Bailout, Rescue, and Salvage Procedures
References

75. Thenar Flap
75.1 Description
75.2 Key Principles
75.3 Expectations
75.4 Indications
75.5 Contraindications
75.6 Special Considerations
75.7 Special Instructions, Positioning, and Anesthesia
75.8 Tips, Pearls, and Lessons Learned
75.9 Difficulties Encountered
75.10 Key Procedural Steps
75.10.1 Stage 1
75.10.2 Stage 2
75.11 Bailout, Rescue, and Salvage Procedures
75.12 Pitfalls
References

76. Axial Flag Flap and First Dorsal Metacarpal Artery Flap (Kite Flap)
76.1 Description
76.2 Key Principles
76.3 Expectations
76.4 Indications
76.5 Contraindications
76.6 Special Considerations
76.7 Special Instructions, Positioning, and Anesthesia
76.8 Tips, Pearls, and Lessons Learned
76.8.1 Pedicle Dissection
76.8.2 Flap Sizing
76.8.3 Closure
76.9 Difficulties Encountered
76.10 Key Procedural Steps
76.11 Bailout, Rescue, and Salvage Procedures
Suggested Readings

77. Z-plasty
77.1 Introduction
77.1.1 History
77.1.2 Classification
77.2 Technique
77.3 Modifications
77.4 Postoperative Care
References
Suggested Readings

78. Radial Forearm Flap
78.1 Description
78.2 Key Principles
78.3 Expectations
78.4 Indications
78.5 Contraindications
78.6 Special Considerations
78.7 Special Instructions, Positioning, and Anesthesia
78.8 Tips, Pearls, and Lessons Learned
78.8.1 Radial Artery Perforator Location
78.8.2 Composite Flap
78.8.3 Tunneling a Pedicled Flap Under a Skin Bridge
78.9 Difficulties Encountered
78.10 Key Procedural Steps
78.10.1 Anatomy
78.10.2 Antegrade Fasciocutaneous Pedicled Flap and Free Flap
78.10.3 Retrograde (Reverse) Fasciocutaneous Pedicled Flap
78.10.4 Radial Artery Sparing Perforator-based Pedicled Flap
78.10.5 Adipofascial Flap
78.10.6 Osteocutaneous Flap
78.10.7 Other Flap Considerations
78.11 Bailout, Rescue, and Salvage Procedures
78.12 Pitfalls
References
Suggested Reading


Part XII: Dupuvtren's Disease
79. Needle Aponeurotomy for Dupuytren's Disease
79.1 Key Principles
79.2 Indications
79.3 Contraindications
79.4 Procedure
79.5 Technical Tip/Pearl
79.5.1 Breaking the Cord
79.5.2 Complications
Suggested Readings

80. Subtotal Fasciectomy for Dupuytren's Disease
80.1 Key Principles
80.2 Indications
80.3 Contraindications
80.3.1 Relative Contraindication
80.4 Procedure
80.4.1 Skin Incision
80.4.2 Subtotal Fasciectomy
80.4.3 Contracture Release
80.4.4 Recurrence and Complications
References


Part XIII: Arthroscopy
81. Thumb CMC and MCP Joint Arthroscopy
81.1 Indications
81.2 Contraindications
81.3 Procedural Setup
81.3.1 Establishing Portals
81.4 Diagnostic Arthroscopy
81.5 Arthroscopic-Assisted Synovectomy
81.6 Joint Capsular Shrinkage
81.7 Joint Surface Resection
81.8 First Metacarpal Intra-Articular Fracture Reduction
81.9 Septic Arthritis
81.10 MCP Joint Arthroscopy
References

82. Diagnostic Wrist Arthroscopy
82.1 Key Principles
82.2 Expectations
82.3 Indications
82.4 Contraindications
82.5 Special Considerations
82.6 Special Instructions, Positioning, and Anesthesia
82.6.1 Tips, Pearls, and Lessons Learned
82.6.2 Portal Placement
82.6.3 Radiocarpal Joint
82.6.4 Midcarpal Joint
82.7 Difficulties Encountered
82.8 Key Procedural Steps
82.9 Bailout, Rescue, and Salvage Procedures
References

83. Arthroscopic Triangular Fibrocartilage Complex/Ligament Debridement
83.1 Description
83.2 Key Principles
83.3 Expectations
83.4 Indications
83.5 Contraindications
83.6 Special Considerations
83.7 Special Instructions, Positioning, and Anesthesia
83.8 Tips, Pearls, and Lessons Learned
83.9 Key Procedural Steps
83.10 Bailout, Rescue, and Salvage Procedures
References

84. TFCC Outside-ln Repair
84.1 Introduction
84.2 Key Principles
84.3 Description
84.4 Special Considerations
84.5 Indications and Contraindications
84.6 Procedures
84.7 Special Instructions, Positioning, and Anesthesia
84.8 Key Steps
84.9 Postoperative Care
84.10 Tips/Pearls
84.11 Pearls and Pitfalls
References


Part XIV: Infection
85. Paronychia
85.1 Description
85.2 Anatomy
85.3 Pathophysiology
85.4 Pathogens
85.5 Risk Factors
85.6 Differential Diagnosis
85.7 Diagnosis
85.7.1 Acute Paronychia
85.7.2 Chronic Paronychia
85.7.3 Studies
85.8 Treatment
85.8.1 Acute Infection
85.8.2 Antibiotics
85.8.3 Chronic Infection
85.9 Pitfalls
References

86. Felon
86.1 Description
86.2 Anatomy
86.3 Pathophysiology
86.4 Pathogens
86.5 Risk Factors
86.6 Differential Diagnosis
86.7 Diagnosis
86.8 Treatment
86.8.1 Overview
86.8.2 Antibiotics
86.8.3 Felon Surgery
References

87. Flexor Tenosynovitis
87.1 Description
87.2 History
87.3 Differential
87.4 Work-up
87.4.1 Physical Exam
87.4.2 Laboratory Findings
87.4.3 Radiology
87.5 Treatment
87.5.1 Anesthesia
87.5.2 Surgical Technique
87.5.3 Postoperative Care
87.6 Antibiotic Management
87.7 Inpatient versus Outpatient Treatment
87.8 Expectations
87.9 Pitfalls
Suggested Readings

88. Septic Joint
88.1 Introduction
88.2 Clinical Presentation
88.3 Diagnosis
88.3.1 Physical Examination
88.3.2 Differential Diagnosis
88.3.3 Laboratory and Diagnostic Testing
88.4 Surgical Treatment
88.4.1 Septic Distal Interphalangeal Joint
88.4.2 Septic Proximal Interphalangeal Joint
88.4.3 Septic Metacarpophalangeal Joint
88.4.4 SepticWrist Joint
88.5 Postsurgical Care
88.5.1 SurgicalWound Management
88.5.2 Antibiotic Therapy
88.6 Septic Joint Sequelae
References

Index