Operative Techniques: Hand and Wrist Surgery

Pediatric trigger digits

There are two types of pediatric trigger digit procedures: trigger thumb release and trigger finger release. Pediatric trigger thumb release Indications Trigger thumbs are one of the most common hand conditions affecting the pediatric population. They typically present in children…

Capsulotomy for metacarpophalangeal contracture

Indications Metacarpophalangeal (MCP) joint stiffness can usually be prevented or corrected with nonoperative management, such as edema control, splinting, and early joint mobilization. About 90% of patients with MCP contractures are successfully treated nonoperatively. MCP capsulotomy is indicated in motivated…

Capsulotomy for proximal interphalangeal contracture

Indications Proximal interphalangeal (PIP) joint capsulotomy is indicated for patients with decreased range of motion (ROM) and functional limitations who have failed nonoperative management (active joint mobilization, dynamic and/or static splinting, and passive stretching). Patients must understand that recurrence is…

Thumb adductor release

Indications Cerebral palsy patients may develop spastic contracture of thumb adduction and flexion muscles, which causes a characteristic thumb-in-palm deformity ( Fig. 102.1 ). House described four types of thumb-in-palm deformity: Type 1: First ray adduction across the palm from…

Flexor-pronator slide

Indications Indications include established Volkmann ischemic contracture of the flexor-pronator muscles of moderate severity and a sustained functional impairment of the spastic upper extremity (resulting from central nervous system disorders such as cerebral palsy, traumatic brain injury [TBI], or cerebrovascular…

Biceps and brachialis lengthening

Indications One indication is a spastic elbow contracture from upper motor neuron injuries (which are frequently the result of cerebral palsy, stroke, or traumatic brain injury). Any neurologic injury should be stable. In patients with volitional control, flexion contractures of…

Surgical and nonsurgical treatment of dupuytren contracture

Indications It is important to take a patient-centered approach and implement shared decisionmaking when treating patients with Dupuytren disease because indications for intervention vary widely based on patients’ subjective functional limitations and needs. Intervention for Dupuytren disease is most successful…

Ulnar artery to superficial arch bypass with a vein graft

Indications The ulnar artery bypass procedure with a vein graft is used to reconstruct an ulnar artery damaged from occlusion caused by Raynaud phenomenon or repetitive trauma to the hand known as hypothenar hammer syndrome. For Raynaud phenomenon, the indications…