Current Practice in Hand Surgery

1st Edition - January 20, 2025
Editors: Jin Bo Tang, David Elliot, Roy Meals
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 1 0 9 7 2 - 0
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 1 0 1 8 - 4

Offering authoritative advice, technical tips, and personal approaches from renowned experts in hand surgery worldwide, Current Practice in Hand Surgery is a uniquely glob… Read more

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Offering authoritative advice, technical tips, and personal approaches from renowned experts in hand surgery worldwide, Current Practice in Hand Surgery is a uniquely global, practical resource to help guide clinical practice. In print and on video, key opinion leaders in the field cover everything from infection, compartment syndrome, and joint stiffness to hand fractures and dislocation to reconstruction and replantation of hands and digits—including particularly challenging disorders and future research directions.

Current Practice in Hand Surgery
Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
From the editor: How to use this book
Commentaries
Dedication
About the book cover
Video contents: Videos cited in the chapters
Video contents: E resources of lectures and surgical methods
List of Tables
List of Illustrations
PART I. General Hand Surgery Approaches
1. Modern clinical settings and approaches
Introduction
Hand surgery setting in Saint John, Canada (Donald Lalonde)
General settings
Operating hand cases in three settings
Layout and workflow of the minor procedure room area
Equipment in our minor procedure room
Hand surgery setting in Leuven University hospitals, belgium (Ilse Degreef)
General settings
Subspecialization
Outpatient setting
Surgery planning
Operative setting
Postoperative flow
Hand surgery setting in Nantong University hospital, China (Jin Bo Tang)
The size of the department of hand surgery
Specialized hand surgery operating facility adjacent to one inpatient ward
An efficient wide-awake surgical room
The goals are efficient treatment of the patients and almost no waiting time for surgeons
Presurgical discussion of operative cases
Hospital settings and basic science laboratories of the department
Hand surgery units in the United Kingdom (David Elliot)
Specialization, education and other settings
References
2. Infection, compartment syndrome, and joint stiffness
Introduction
Infection (Ilse Degreef)
Incidence
Risk factors
Prevention
Clinical presentation
Differential diagnosis
Management
Specific hand and finger infections
Infection of the upper extremity
Postoperative infections in hand surgery
Compartment syndrome (Jin Bo Tang)
Etiologies and pathology
Clinical presentation
Diagnosis
Treatment
In-depth advice: What compartment syndrome do we often see nowadays?
Joint stiffness (Ilse Degreef)
Etiology
Clinical presentation
Treatment planning
Treatment options
Prevention
Unsolved problems and current status
In-depth advice: How to better assess and treat finger joint stiffness (David Elliot)
The role of edema
The role of extensor tendon and collateral ligament tightening
Clinical evaluation
Incidence of extensor tethering
Prevention
Treatment
In-depth advice: How to deal with each joint in a stiff finger (David Elliot)
Contracture of dorsal capsule and ligaments of the MCP joint
Contracture of the PIP joint
Contracture of the DIP joint
Further knowledge: Open trauma, gunshot wounds, burns, foreign bodies, and high-pressure injection injuries of the hand and upper extremity (Jin Bo Tang)
General principles and treatment methods for open wounds
Gunshot wound
Burns
Electrical and chemical burns
Foreign bodies
High-pressure injection injuries
Amputation and prosthetics
References
PART II. Fractures and Dislocations
3. Hand fractures and dislocations
Introduction
Phalangeal fractures
Distal phalangeal fractures
Middle and proximal phalangeal fractures
Fractures of the thumb
Metacarpal fractures
Fractures of the second to fifth metacarpal
Fractures of the first metacarpal
Articular fractures and dislocation
Fractures and dislocation of DIP joint
Fractures and dislocation of PIP joint
Fractures and dislocations of the MP joint
Fractures and dislocations of the CMC joint
Complications of hand fractures
Joint dislocations and ligament injuries
Dislocations of DIP joint and IP joint in the thumb
Dislocations and ligament injuries of the PIP joint
Dislocations and ligament injuries of MP joint in the finger
Injuries of the MP joint in the thumb
UCL injury of the MP joint of the thumb
RCL injury of the MP joint of the thumb
Dislocations of the second to the fifth CMC joint
Dislocations of the thumb CMC joint
Fractures and dislocations in an open wound
Fracture and dislocation in children
Current status and unsolved problems
In-depth advice: Updated views in treating finger fractures (Donald Lalonde)
Percutaneous k-wire fixation, early protected movement, and field sterility
K-wires can be removed 2 weeks after surgery when fractures are clinically healed
In-depth analysis: Dogmas relevant to hand fractures revised (Jin Bo Tang)
Safe position for hand immobilization
Starting motion therapy within a week after surgery can be delayed to week 2 or 3 in most patients
Short splints can be used in many more patients
Deciding surgery on metacarpal neck and shaft fractures according to hand function
In-depth advice: How to take a simpler approach and use easier methods in treating hand fractures (Jin Bo Tang)
References
4. Late problems after bone and joint trauma
Introduction
Fracture malunion and bony defects (Carlos Henrique Fernandes)
Malunion
Bone defect
Arthroplasty (Michel Ernest H. Boeckstyns)
Types of implants
Indications
Surgical techniques
Outcomes
Current status and remarks
The author’s experience and preferred method
Finger arthrodesis (Shu Guo Xing)
Indications
Preoperative assessment
Key surgical considerations
Postoperative care
Complications and treatment
Specific consideration in DIP arthrodesis
Specific considerations for PIP arthrodesis
Specific consideration for MCP arthrodesis
Current status and unsolved problems
In-depth advice: Treatment of traumatic soft tissue contracture of finger joints (Martin Richter)
Simple periarticular versus complex contractures
Prevention and conservative treatment
Stepwise surgical release
How to perform rehabilitation postsurgery
References
5. Distal radius fractures
Introduction
Essential knowledge
Anatomical points
Clinical presentation, diagnosis, and essential treatment
Treatment strategies and methods
Nonoperative treatment
Closed reduction percutaneous pinning
Volar plate fixation
Arthroscopic management
Complications
Malunion and arthritis
Tendon rupture
Other early or late complications
Treatment of malunion
Indications for surgery
Surgical methods
Often discussed topics
Percutaneous pinning versus plating: Indication and selection (rozental and bain)
Treatment of associated soft tissue injuries: Timing and techniques (nakamura and arora)
Unsolved problems and future perspectives
References
6. Fractures of the elbow and forearm
Introduction
Terrible triad injuries of the elbow
Anatomy and pathoanatomy
Clinical presentation and assessment
Radiographic assessment
Treatment
Prognosis
The essex-lopresti injury
Anatomy
Biomechanics and pathophysiology
Clinical presentation and assessment
Radiographic assessment
Intraoperative assessment
Chronic instability
Treatment
Radial head fractures
Anatomy
Function and pathophysiology
Clinical presentation and assessment
Radiographic assessment
Treatment
Fractures of the proximal ulna
Diagnosis
Classification
Nonoperative treatment
Operative treatment
Pearls and pitfalls
Postoperative care
Outcomes
Both bone forearm and galeazzi fractures
Anatomy and biomechanics
Clinical presentation and evaluation
Treatment
The “transitional” lesion
Galeazzi equivalents
Outcomes
Often encountered dislocations
Radial head dislocation (subluxation) in children
Elbow dislocation
Unsolved problems
References
PART III. Wrist and Distal Radioulnar Joint
7. Evolution and current methods of arthroscopic wrist surgery
History of wrist arthroscopy; excisional operations to repair and reconstruction
Arthroscopic bone grafting in scaphoid nonunion (Pak-Cheong Ho)
The technique
Clinical outcomes
Arthroscopic transosseous repair of the avulsed TFCC at the fovea (Toshiyasu Nakamura)
The technique
Clinical outcomes
Arthroscopic reconstruction of the TFCC (Andrea Atzei)
The technique
Clinical outcomes
Arthroscopic SL ligament reconstruction (Fernando Corella)
Indications
The technique
Postoperative rehabilitation
Clinical outcomes
Arthroscopic lunotriquetral ligament reconstruction (Jan-Ragnar Haugstvedt)
The technique
Clinical outcomes
Current status, challenges, and future of wrist arthroscopy
Further information
References
8. Acute scaphoid fractures
Introduction
Epidemiology
Anatomical location of the fracture
Blood supply
The distal pole, waist, and proximal pole of the scaphoid
Common sites of the fracture, displacements, and consequences
Causes, clinical presentations, and diagnosis
Clinical presentations
Radiographs
Suspected scaphoid fracture: Treatment
Non-displaced scaphoid fractures: Treatment
Displaced scaphoid fracture: Clinical keys
Implications of scaphoid fracture displacement
Diagnosis of fracture union
Treatment goals
Proximal pole fractures: A difficult fracture type
Treatment methods
Wrist immobilization (eg, cast): Indications and methods
Indications and roles of surgical fixation
Methods of internal fixation
Surgical approaches
Complications and outcomes
Scaphoid fractures in children or athletes, and Preiser’s disease
Unsolved problems and future perspectives
In-depth advice
References
9. Scaphoid nonunion or malunion and wrist arthritis: Unsolved problems
Introduction
Scaphoid nonunion
Definition and incidence
Classification
Clinical presentation and diagnosis
Treatment
Bone grafting sources and methods: Nonvascularized
Bone grafting sources and methods: Vascularized
The value of an arthroscopically assisted approach
Proximal pole replacement
Postoperative care for the above procedures
Clinical difficulties, tips, and unsolved problems
Scaphoid malunion
Clinical presentation and radiographic evaluation
Treatment
Wrist arthritis
Treatment strategies
Surgical methods
Clinical difficulties and tips
Unsolved problems and current questions
In-depth advice (Rohit Arora and Gernot Schmidle)
In-depth advice (Ruby Grewal)
Scaphoid nonunions: Role of vascularized graft
SNAC wrists: Arthritis and salvage surgery
References
10. Carpal instability: Current techniques
Introduction
Essential knowledge
Current concepts
Anatomy
Clinical presentation and diagnosis
Clinical presentations
Classification
Diagnosis (history, examination, and imaging)
Imaging
Treatment plans and methods
Treatment plan and guidelines
Treatment of SL dissociation
Treatment of lunotriquetral (LTq) dissociation
Treatment of carpal instability nondissociative CIND
Postoperative rehabilitation
After scapholunate surgery
After lunotriquetral surgery
Current status and unsolved problems
References
11. Distal radioulnar joint instability
Introduction
Anatomy and biomechanics
Classification of TFCC disorders
Clinical presentations and examination
History
Clinical examination
Specific tests for distal radioulnar joint instability
Medical imaging
Arthroscopy
Treatment of DRUJ instability
Nonoperative treatment
Operative management
Chronic DRUJ instability with arthritis
Alternative reconstructions or salvage procedures
Unsolved problems and controversies
References
12. Treatment of Kienböck disease: A major unsolved problem
Introduction
Basic science (Gregory Bain, Simon Maclean)
Etiology
Osseous
Vascular
Putting it all together
Clinical presentation
The three phenotypes of Kienböck’s disease
The dynamic aspect of Kienböck’s disease
Natural history (Sanjeev Kakar)
Amalgamated classification system and precision treatment algorithm (David M. Lichtman, William Pientka, and Gregory Bain)
Clinical management strategies (Gregory Bain, Simon Maclean)
Roles of imaging
Strategies
Osteotomies about the wrist (Gregory Bain, Simon Maclean)
Single-cut, single-screw capitate shortening osteotomy
Single-cut, single-screw radial shortening osteotomy
Arthroscopic assessment and treatment of Kienböck’s disease (Gregory Bain, Simon Maclean)
Bain and Begg articular classification
Arthroscopic reconstruction in Kienböck’s disease (Pak-Cheong Ho)
Local and free bone grafts in Kienböck’s disease (Rou Wan, Grzegorz J. Kwiecien, Steve Moran)
Indications
Outcomes of vascularized bone grafts
Proximal lunate resurfacing
Lunate replacement
Summary of vascularized grafts
Motion-preserving procedures in Kienboöck’s disease (Simon Maclean, Gregory Bain)
Proximal row carpectomy
Scaphocapitate arthrodesis
Radioscapholunate fusion
Current status and future perspectives (Gregory Bain)
Current status
New developments
Future perspectives
References
13. Carpal dislocations
Introduction
Perilunate dislocations
Basics and classifications
Diagnosis
Treatment
Aftercare
Prognosis
Radiocarpal dislocation
Classifications
Diagnosis
Treatment and prognosis
Ulnar translation
Mechanism and classifications
Diagnosis
Treatment
Prognosis
Axial carpal dislocation
Mechanism and classifications
Diagnosis and treatment
Prognosis
Midcarpal dislocation
Mechanism
Diagnosis
Treatment and prognosis
Isolated carpal bone dislocations
References
14. Other carpal fractures and carpal disorders
Introduction
Essential knowledge
Anatomy
Trauma mechanism
Clinical presentation and diagnosis
Symptoms and signs
Plain radiographs
Planning for operative/conservative management
Treatment methods and different approaches
Lunate fractures
Triquetrum fractures
Pisiform fractures
Trapezium fractures
Trapezoid fractures
Capitate fractures
Hamate fractures
References
PART IV. Tendons and Nerves
15. Primary flexor tendon repair
Introduction
Anatony, biomechanics and tendon healing
Anatomical points
Biomechanics of tendon gliding and repairs
Tendon healing, gliding, and remodeling
Clinical presentation and diagnosis
Methods of primary repair
Timing of direct repair
Indications and contraindications
Surgical techniques
FPL injuries
Injuries in children
Partial tendon lacerations
Closed rupture of the flexor tendons and pulleys
Postoperative care
Outcomes, prognosis, and complications
Variants of treatment methods and outcomes documented from different institutes
Tenolysis
Further considerations of zone 1 and 2 repair: Current status and needs
In-depth advice
Further information (David Elliot, Koji Moriya, and Huey Tien)
References
16. Secondary flexor tendon surgery
Introduction
Timing, requirements, and contraindications
Avoiding secondary surgery
Timing and requirements of secondary surgery
Contraindications
Indications and methods of each procedure
Tenolysis
Tendon grafting: One-stage
Staged reconstruction
Technical details in tendon grafting
Shared tendon reconstruction
Paneva-holevich technique
Vascularized tendon reconstruction
Amputation of the digit
Bowstringing and pulley reconstruction
Tendon bowstringing
Indications for surgery and surgical options
Skin deficiency and replacement
Reconstruction of the FPL tendon
Outcomes
Current status and unsolved problems
In-depth advice: How to deal with a gapped tendon, pulleys, and other tissues in tenolysis (David Elliot)
References
17. Extensor tendon repair and reconstruction
Introduction
Anatomical features and zones
Features
Tendon structures
Anatomical zones
Zones 1 and 2 (mallet finger)
Causes and types
Clinical presentation
Nonsurgical treatment
Operative treatment
Complications
Outcomes
Treatment of acute complex injury
Secondary surgery
Zones 3 and 4
Clinical presentation
Nonsurgical treatment
Surgical treatment
Outcomes
Treatment of delayed presentation
Treatment of complex dorsal injuries
Outcomes
Secondary surgery
Outcomes
Zones 5 (sagittal band or tendon injury)
Radial sagittal band injury
EDC tendon laceration
Outcomes
Punch injury
Zone 6
Secondary surgery
Zones 7, 8, and 9
Traumatic laceration
ECU subluxation
Special considerations for open injuries in the forearm (Zone 9)
Secondary surgery
The thumb extensors
Anatomy
Treatment of acute injury
Postoperative care
Outcomes
Functional evaluation and criteria
Rehabilitation
Current status and unsolved problems (Jin Bo Tang)
In-depth advice: Tenolysis after extensor tendon repairs in the fingers (David Elliot)
In-depth advice: Changes in treatment of acute and secondary extensor tendon problems (Jin Bo Tang)
References
18. Entrapment neuropathies of the up per extremity: Current practice
Introduction
Entrapment neuropathies in the wrist, forearm, and elbow
Carpal tunnel syndrome
Ulnar nerve compression at the wrist (guyon canal syndrome or ulnar tunnel syndrome)
Median nerve compression in the forearm
Radial nerve compression in the forearm (radial tunnel syndrome)
Cubital tunnel syndrome
Entrapment of the superficial branch of the radial nerve (wartenberg’s syndrome)
Nerve compression in the upper arm
Radial nerve entrapment in the distal part of the upper arm
Radial nerve compression in the proximal upper arm (triangular interval syndrome)
Axillary nerve entrapment
Musculocutaneous nerve compression
Suprascapular and dorsal scapular nerve compression
In-depth advice: Neuritis versus external compression of the nerve
In-depth analysis: Double crush (double compression) (Jin Bo Tang)
In-depth analysis: Different patient populations (Jin Bo Tang)
Further information (Donald Lalonde, and Leila Harhaus)
Further information: Extended readings (Jin Bo Tang)
References
19. Nerve repair and reconstruction: Updated methods
Introduction
Acute peripheral nerve injuries (lacerations)
Etiology, incidence, and pathophysiology
Anatomical points
Evaluation
Clinical presentation of different nerve injuries
Timing of direct repair and graft reconstruction
Repair of incomplete nerve lacerations and neuroma-in-continuity
Late peripheral nerve injury and failed primary repair
Late direct repair (repair 6 months or more after laceration)
Nerve transfers versus tendon transfer
Evaluation and outcomes of surgery in different nerves
Early recovery
Motor function
Sensory function
Whole nerve function
Patient-reported outcome measures (PROM)
Outcomes for individual nerves
Unsolved problems and ongoing investigations
In-depth advice: Values and my preferred tendon transfers (Leila Harhaus)
Values of tendon transfers
Indications for tendon transfers
Reconstruction for ulnar nerve palsy
Reconstruction for median nerve palsy
In-depth advice (Jin Bo Tang)
Tension-free repair can be replaced with “repair under normal tension”
Outcomes of digital nerve repair and cross-innervation of the normal digital nerve
Interpretation of effectiveness of one intervention after multiple measures
References
20. Traumatic adult pan-brachial plexus injuries: Current methods and variations
Introduction
Essential knowledge
Anatomy
Clinical presentation
Examination and diagnosis
Investigations
Neurodiagnostic studies
Chest radiographs and sniff test
Computed tomography myelography or magnetic resonance imaging
Angiography
Treatment
Timing of surgery
Priorities of reconstruction and setting patient expectations
Modern principles and methods of management
Variations in treatment algorithms
Mayo clinic team approach to surgical reconstruction
Measuring outcomes
Future needs
References
21. Tendon transfers after nerve injuries to the arm and forearm
Introduction
Principles and general guidelines
Correction of muscle-joint contracture
Adequate strength
Muscle architecture and amplitude of motion
Line of pull
One tendon, one function and exceptions
Synergism
Expendable donor
Stress-relaxation of the donor muscle before attachment
Correct tendon-to-tendon suture
Timing of tendon transfer
Establish your own “toolbox” of tendon transfers
Get involved in postoperative training
Radial nerve palsy
The clinical pattern of radial nerve palsy
Common tendon transfers in radial nerve palsy
Rationale for choice of procedures
Our preferred choices and techniques
Median nerve palsy
Clinical presentation of high median nerve palsy and goals
Treatment methods: After high median nerve injury
Authors’ preferred choice
Ulnar nerve palsy
Clinical presentation of low ulnar nerve palsy
Clinical presentation of high ulnar nerve palsy
Treatment methods: For lower and high ulnar nerve palsy
Surgical technique to correct the little finger abduction deformity
Treatment methods: For high ulnar nerve palsy
Combined ulnar and median nerve injury
Types of combined nerve palsies and treatments
Our techniques to restore thumb-index key pinch
The role of nerve transfer
In-depth advice: Addressing claw hand deformity after ulnar nerve injury
Outcomes and challenges
Outcome measurements and best clinical practice
Rehabilitation resources
Interesting developments
General comments and unsolved problems
Further information: Tendon transfers for traumatic tendon defects and setting suture tension
References
PART V. Soft-Tissue Coverage and Microsurgery
22. Soft-tissue cover of the thumb and fingers
Introduction
Treatment goals and functional impacts
Anatomy and injury types
Anatomical considerations
Types of injuries
Treatment of thumb or finger tip defects and amputations
Decision making on repair options: Self-regeneration, replantation, or repair surgery
Commonly used local flap transfers for the distal finger
Commonly used local flap transfers for the thumb tip
Treatment of the nail and nail bed injuries
Treatment of defects of the middle and proximal phalangeal segments of the fingers
Volar aspect of the fingers
Dorsum of the fingers
Skin substitutes
Secondary problems and surgery
Outcome evaluation
Current status and unsolved problems
In-depth advice: Technical keys in venous flaps
In-depth analysis: Less-invasive approaches in digital cover (Jin Bo Tang)
References
23. Flap coverage for the hand and upper extremity
Introduction
General principles of method selections
Choice of different methods
Single or staged reconstruction for complex multiple structural defects
Treatment methods
Healing by self-regeneration
Skin grafts
Dermal substitutes
Timing of tissue transfers
The use of VAC
Flaps
Flap from the thorax
Local flaps from the forearm
Perforator flaps from upper extremity
Flaps from other parts of the body
Fascial flaps
Venous flaps
Concept of flow-through flaps
Preoperative planning: From the elbow to the hand
Losses of substance for the elbow region
Loss of substance in the forearm
Loss of skin in the dorsum of the hand
Large substance losses of the dorsum of the hand
Palmar side of the hand
First web space
Current status and unsolved problems
Postoperative care and dealing with crisis
Postoperative care
Inpatient monitoring and crisis exploration
In-depth advice (Chao Chen)
Which flaps are commonly used and which ones are not
Technical keys to ensure success for some of flaps that we often use
Some key technical points in several flaps
Use of VAC versus early coverage by flaps: How to make a choice
References
24. Replantation of digits and hands: Current indications and dealing with difficult patients
Introduction
Key anatomical points
Indication and contraindications
Time limit and preservation of amputated parts
Initial clinical examination and decision-making
Surgical settings
Methods, sequences, and keys of surgery in each area
Very distal digital replantation
Single digital replantation
Common technical keys for single- or multi-digit replantations
Multi-digit replantation
Thumb replantation
Transmetacarpal replantation
Hand and distal forearm replantation
Pediatric replantation
Hand degloving injuries
Very difficult and particular cases
Replanting digits with crush or avulsion injuries
Replanting a hand with soft tissue defects
Replanting digits served at multiple levels
Postoperative treatment
Splinting and dressing changes
General treatment immediately after surgery
Early complications
Vascular crisis in the first few days after replantation
Clinical presentation
Indication and methods for exploration
Rehabilitation following replantation
Secondary surgeries
Tendon transfer for avulsed thumb replantation
Treatment of bone malunion
Functional evaluation and outcomes
Disagreements, unsolved problems, and future efforts
Further information: Incomplete amputation
Further information: Techniques for complex cases (Jin Bo Tang)
Structure-by-structure method versus digit-by-digit method
Digital replantation with local tissue defects
Extremely challenging digital replantation
Simultaneous severance at the digit and palm
Recent methods to help reduce operating time
References
25. Reconstruction of the hand and digits
Introduction
Thumb and finger reconstruction (Francisco del Piñal)
The thumb (Francisco del Piñal)
Basic anatomy
Choice by level of amputation
Coverage issues
Short muscles
The fingers (Francisco del Piñal)
Associated soft tissue losses (Francisco del Piñal)
Closing pearls (Francisco del Piñal)
Reconstruction of the thumb (Roberto Adani)
Distal third amputations
Middle-third amputations
Proximal-third amputations
Metacarpal and metacarpal-like hands (Yu-Te Lin)
Double second-toe or combined second- and third-toe transfers (Yu-Te Lin)
Claw-toe deformity (Yu-Te Lin)
References
26. Management of a mutilated hand
Introduction
Classifications
Scores and classifications used to decide between salvage and amputation
The first steps
Setting the goals and treatment
Debridement
How far to go on day 1?
Timing of soft tissue cover
Types of soft tissue cover
Management of composite defects
Management of degloving injuries
Secondary procedures
Measuring outcomes
Methods
Factors determining outcomes
Unsolved problems and current status
References
PART VI. Other Difficult Disorders
27. Dupuytren disease
Introduction
Epidemiology and risk factors (Dominic Furniss, Osaid Alser)
Prevalence
Risk factors
Clinically relevant anatomy (Martin Langer, David Warwick)
Fibrous skeleton of the palm
Fibrous skeleton at the border between the palm and the fingers
Fibrous skeleton of the fingers
Clinical presentation (Ilse Degreef)
Major findings and progression
Different contractures
Disease diathesis
Associations
Examination tools and differential diagnosis
Pathologic and molecular changes (Ilse Degreef)
Evaluation of outcomes (David Hunter-Smith, Elisa Jonatan)
Goniometry
Patient-reported outcome measures (PROMs)
Specific hand PROMs
Dupuytren’s specific PROMs
Recommendations
Treatment of the mild form of DD
Fasciectomy (Hitoshi Hirata and Michiro Yamamoto)
Indications
Surgical setting
Surgical techniques
Postoperative treatment
Prognosis
Radiotherapy (Richard Shaffer, Jarad Martin)
Radiotherapy for early progressive DD
Emerging practice in the postoperative setting
Toxicity
Techniques
Collagenase (Gary M. Pess)
Injection procedure
Advantages, side effects, and complications
Outcomes
Controversies
Dermofasciectomy (David Warwick)
Indications and techniques
Complications
Percutaneous needle fasciotomy (Joakim Stromberg)
Indications and contraindications
Technique
Complications
Results
Hand therapy (Vera Beckmann-Fries, Sarah G. Ewald, Janine Hareau)
Scar treatment and edema reduction
Exercises
Hand use and loading
Splinting postintervention
Further information: Genetic and cellular advances (Dominic Furniss)
Genetic perspectives
Cell biology perspectives
Summary (Adam Stoneham, David Warwick)
The past and current status
Unsolved problems
References
28. Trapeziometacarpal osteoarthritis: Current approaches and unsolved problems
Introduction
Anatomical points
Evolution of treatment
Classification and clinical presentation
Classification
Clinical presentations and diagnosis
Treatment strategies and decision-making
Common surgical methods and outcomes
Trapeziectomy: Evidence-based surgical choice
Evidence reported on “simple trapeziectomy” versus trapeziectomy with tendon adjunct
Surgical technique of “simple” trapeziectomy
Postoperative care after “simple” trapeziectomy
Revision and salvage of failed trapeziectomy
Joint prostheses
Implants and surgical outcomes
Comparison of joint prostheses versus trapeziectomy with or without tendon adjunct
Reoperation of failed prostheses
Other surgical methods
Interposition of foreign materials
Mini tightrope suspension
Partial trapeziectomy
Arthroscopic procedures
Extension osteotomy at the base of the first metacarpal
Trapeziometacarpal arthrodesis
Denervation
Revision surgery
Overall conclusions, debates, and unsolved problems
In-depth analysis
Choices of treatment methods
Summary of authors’ analysis
References
29. Congenital hand disorders: Differences in strategies and treatment
Introduction
Incidence, etiologies, and classification (Steven Hovius)
The first consultation, observation, physical examination, anesthesia, and timing (Marybeth Ezaki)
Syndactyly (Michael Tonkin)
Classification
Surgical methods
Comments and alternatives in treating syndactyly
Radial polydactyly (Gill Smith)
Definition
Classification
Clinical treatment
Surgical methods and technical tips
Triphalangeal thumb (Steven Hovius)
Definition and etiology
Clinical presentation
Treatment
Outcomes
Current status and our suggestions
Comments and alternatives on radial polydactyly and triphalangeal thumb
Thumb hypoplasia (Michael Tonkin)
Classification
Grading system
Clinical assessment
Surgical techniques
Comments and alternatives in treating thumb hypoplasia
Symbrachydactyly (Grainne Bourke)
Classification
Associations
Treatment
Unsolved problems of symbrachydactyly
Cleft hand (Wee Lam and Stéphane Guero)
Pathogenesis (Wee Lam)
Principles of treatment (Stéphane Guero)
Comments and alternatives
Radial longitudinal deficiency (Steven Hovius)
Definition
Treatment
Overall outcomes of treatment: Function, participation, and activity
Comments and alternatives
Arthrogryposis (Scott Oishi)
Definition
Treatment
Comments and alternatives
Overgrowth conditions (Scott Oishi)
Medical treatment
Treatment of specific conditions
Summary points
Conclusions (Steven Hovius and Michael Tonkin)
References
30. Rheumatoid arthritis, tendinopathies, and other connective tissue diseases
Introduction
Rheumatoid arthritis (Ilse Degreef)
Typical deformities of the hands in RA
Surgical goals
Surgical methods
Typical hand surgical procedures in RA
Complications and surgical risks
Medication policy in perioperative period
Tendinopathies in the flexor and extensor tendons (Jin Bo Tang)
Trigger fingers (including trigger thumbs)
de Quervain’s disease
In-depth advice: Tips to avoid complications of trigger fingers and de Quervain’s disease
Intersection syndrome
Tennis elbow and other tendinopathies around the elbow (Ilse Degreef)
Epicondylitis
Distal biceps tendinosis
Triceps insertion tendinopathy
Contracture of the muscles of the ulnar fingers (Jin Bo Tang)
Causes
Clinical findings and diagnosis
Surgical treatment
Gout
Causes and clinical presentation
Treatment
Other connective tissue diseases
Rare heritable disorders
Systemic autoimmune diseases
A few rare conditions
Linburg-Comstock syndrome
Mauclaire’s disease
Preiser’s disease
References
31. Chronic vascular disorders of the hand
Introduction
Essential knowledge
Anatomy and pathophysiology
Etiology
Patient history
Clinical presentation
Imaging
Raynaud disease and raynaud phenomenon
Clinical presentation
Diagnosis
Treatment
Collagen vascular disease
Clinical presentation
Diagnosis
Treatment
Ulnar artery thrombosis (Hypothenar hammer syndrome)
Clinical presentation
Diagnosis, treatment, and outcomes
Radial artery thrombosis or occlusion
Clinical presentation
Diagnosis and treatment
Hand-arm vibration syndrome
Clinical presentation
Diagnosis
Treatment
Arteriovenous fistula and ischemic steal syndrome
Clinical presentation
Diagnosis
Treatment
Aneurysmal disease
Clinical presentation
Treatment
Arteriosclerosis
Vascular anomalies
Clinical presentation
Diagnostic tools, treatment, and surgical planning
Surgical methods and outcomes
Unsolved problems and future investigations
References
32. Enhancing hand control in tetraplegia
Introduction
Essential clinical findings and strategies
Clinical presentations
Surgical options, therapy, and combined treatment approaches
Current diagnosis and treatment
Improved diagnostics in planning nerve transfer surgery
Nerve transfers
Algorithms for choice of surgery: Tendon transfers versus nerve transfers
Targeted tendon transfer after successful nerve transfer
Restoring intrinsic balance
Spasticity in spinal cord injury
Clinical findings
Treatment methods
Current research and investigation
Research and development of neuroprostheses and neuromodulation devices
Challenges and future research priorities and trends
References
33. Improving hand function after cerebral palsy, stroke, or brain damage
Introduction
Clinical classification (Caroline Leclercq)
Pathologic development of muscle spasticity (Eva Ponten)
Clinical presentation and evaluation (Caroline Leclercq)
Evaluation of resting posture of the upper limb
Evaluation of spasticity
Muscle contracture
Joint deformity
Motor assessment
Sensory examination
Functional assessment
General preoperative assessment
Imaging and electromyography
Botulinum toxin injection for clinical evaluation
Evidence for clinical strategies (Shai Luria)
Clinical decision-making and surgical strategies (Caroline Leclercq)
Classic treatment methods (Caroline Leclercq)
Botulinum toxin
Surgical methods
Contraindications for surgery
Hyperselective neurectomy (Caroline Leclercq)
Indications and contraindications
Surgical techniques
Postoperative care
Outcomes
Surgery of the spastic shoulders (Nadine Sturbois-Nachef)
Surgical goals
Surgical methods
Our strategies
The spastic elbow (Paolo Panciera)
Clinical decision-making
Surgical methods
Heterotopic ossifications
Our preferred surgical strategies
Treatment outcomes
The spastic wrist (Camillo Fulchignoni and Marco Passiatore)
Causes of deformity
Surgical methods
Our surgical strategies
Outcomes
The spastic fingers (Nadine Sturbois-Nachef)
Goals of surgery
Surgical methods
Our surgical strategies
The spastic thumb (Caroline Leclercq)
Surgical methods
Our surgical strategies
Unsolved problems and the future
References
34. Tumors of the hand and upper extremity
Introduction
Clinical diagnosis
Clinical presentation
Clinical examination and diagnosis
Surgical resection
Benign tumors (Andrzej Zyluk)
Benign soft-tissue tumors
Benign bone tumors
Locally aggressive bone tumors
Malignant tumors (Massimo Ceruso)
General information
Malignant soft-tissue tumors
Malignant bone tumors
Melanoma and keratinocyte skin cancer (Erik T. Walbeehm)
Types, treatment guidelines and surgeries
Basal cell carcinoma
Cutaneous squamous cell carcinoma
Melanoma
Metastatic tumors of the hand (Christian Dumontier)
References
35. Neuropathic pain of the upper extremity
Introduction
Clinical assessment
Clinical description
Clinical examination and imaging tools
Treatment options
Nonsurgical treatment
Surgical treatments
Surgical methods for divided nerves and end neuromas
Treatment goals
Different sites (zones) of nerve relocation
Preoperative assessment
Zone I (digital nerves)
Zone II
Zone III
Outcomes, failure, and recurrence
Surgical methods for painful nerves in continuity
Pathologies and treatment goals
Nerve grafting of smaller painful nerves in continuity
Nerve grafting of large painful nerves in continuity
Tenoneurolysis and vein wrapping of smaller painful nerves in continuity
Tenoneurolysis and vascularized fat wrapping of smaller painful nerves in continuity
Tenoneurolysis and free fat grafting of smaller painful nerves in continuity
Tenoneurolysis and local muscle flap wrapping of small or major painful nerves
Division and relocation of smaller painful nerves in continuity
Tenoneurolysis and autologous tissue wrap of painful major nerves
Tenoneurolysis and vascularized fascial flap wrapping of painful major nerves
Postoperative management
Failure to relieve pain by local surgery
Nonsurgical alternatives for relief of peripheral nerve pain
New developments in treatment
New nonsurgical treatment
New surgical treatment
Current status and unsolved problems
Further knowledge: How to deal with hypersensitivity (David Elliot)
Distal hypersensitivity
As a component of end neuroma pain
Over an intact and painful large nerve
Developing in a nerve territory without sensation
On the thumb
In the forearm
In the hypothenar eminence
References
36. Topics with major uncertainties, including birth palsy and thoracic outlet syndrome
Introduction
Brachial plexus birth palsy (Gürsel Leblebicioğlu)
Etiology and incidence
Pathological anatomy
Clinical presentation
Attention to other proximal pathological changes
Clinical diagnosis
Differential diagnosis
Determination of pathological changes during surgery
Clinical observation
Timing and indications for surgery
Surgery versus nonsurgery
Surgical methods
Prognosis and outcomes
My personal experience
Future and unsolved problems
In-depth advice
In-depth analysis (Tim Hems)
Further information: Current approaches to this disorder in my unit (Tim Hems)
Thoracic outlet syndrome (Gürsel Leblebicioğlu and Jörg Bahm)
Etiology
Clinical presentation
Clinical examination
Differential diagnosis
Other examinations
Treatment
Outcomes
Controversies and unsolved problems
In-depth advice (Gürsel Leblebicioğlu)
Complex regional pain syndrome and neuropathic pain (Jörg Bahm)
Pathophysiology
Clinical presentation
Criteria of clinical diagnosis
Treatment
Surgery to relieve CRPS or neuropathic pain
In-depth advice: My own experience (Jörg Bahm)
Prognosis and future research
References
Index

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Jin Bo Tang