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Compartment Syndrome and Volkmann’s Ischemic Contracture

Acknowledgment: The authors gratefully acknowledge the contributions of Dr. Ayan Gulgonen and Dr. Kagan Ozer, who authored the chapter on compartment syndrome in the sixth edition of Green’s Operative Hand Surgery. Compartment Syndrome Acute compartment syndrome (ACS) of the extremity is a diagnosis requiring emergent surgical intervention. ACS is characterized by sustained elevation of tissue pressure within an osseofascial or fascial compartment that exceeds tissue perfusion…

Major Limb Amputations and Prosthetics

Amputation of the upper extremity takes its toll on both the patient and the surgeon. The patient is devastated at the prospect of life with a functional disability and laments the potential loss of the independence we all take for granted. For the surgeon, the toll is much less, but there remain feelings of sympathy and regret, as we wish we had another option. Nonetheless, it…

Digital Amputations

Acknowledgment: We would like to acknowledge the contributions of Dean S. Louis, Mark Bagg, and Peter J. L. Jebson. Traumatic injury is the most common cause of an amputated finger or thumb. In other cases, digital amputation may be necessary because of congenital deformity or acquired pathologic conditions, such as malignant tumors or chronic infection. Sequelae of trauma may also require amputation, such as stiffness, debilitating…

Thumb Reconstruction

“CONCLUSIONS: Much of what has been written in this chapter may soon be outdated.” James Strickland Acknowledgments: The visionary capacity of Dr. Strickland is mesmerizing. In 1982 in the very first edition of this book, he wrote that microsurgery would change the rules on thumb reconstruction. I became fascinated when I read that chapter as a resident, and I still am, having reviewed all the different…

Toe-to-Hand Transplantation

The first report on a toe-to-hand transfer ever done to a human goes back in time to the 19th century when Nicoladoni described staged, pedicled toe-to-hand transfer over a 4-week period. Davis was the first to combine staged transfer with microsurgical anastomosis of the dorsalis pedis artery; however, the credit for the first, one-stage toe transplantation to the thumb actually goes to Yang, who transplanted the…

Vascularized Bone Grafting

Bone grafts have been used since the first decade of the 20th century to fuse joints and repair defects. The desirability of a living bone graft was recognized by several early investigators who used pedicled fibular grafts for tibial defects as early as 1905. The concept of pedicle grafting has been widely applied since that time, using rib, clavicular, iliac crest, scapular, radial, greater and lesser…

Free Flaps to the Hand and Upper Extremity

In contradistinction to a split-thickness or full-thickness skin graft, a flap receives its blood supply independent of the underlying bed on which it is laid. An axial-pattern flap derives its blood supply through an inflow artery and an outflow vein, which is termed the vascular pedicle. When this pedicle of an axial-pattern flap is divided, the flap becomes a free flap. Alternative terms include microsurgical free…

Nonmicrosurgical Coverage of the Upper Extremity

This chapter is dedicated to the memory of Graham Lister, who passed away a few months before this book went to press. Professor Lister was the original author of this chapter in the first edition in 1988 and continued as the single author through the fourth edition when I came on board as his coauthor. Dr. Lister’s original paragraphs on how to raise a flap continue…

The Mangled Upper Extremity

Acknowledgment: We would like to recognize our friend and partner Douglas P. Hanel, MD, who was a coauthor on the sixth edition version of this chapter. His contributions to it, and to hand surgery in general, are innumerable, and we are proud to have him as a partner. Principles Mangling injuries of the hand and upper extremity are devastating injuries that involve multiple critical structures of…

Replantation and Transplantation

No single conceptual development has had as profound an impact on the field of hand surgery as the advent of microsurgical techniques. The ability to microscopically repair blood vessels led to an accelerated phase of discovery and innovation that continues to this day. The availability of microsurgical techniques has expanded the extent and type of injuries that can be considered reconstructible and have made these interventions…

Hand, Wrist, and Forearm Fractures in Children

Hand Fractures Children are not small adults. Although many similar treatment principles and techniques are utilized, a number of special considerations are required in the treatment of hand fractures in skeletally immature patients. Examination of the injured hand can be challenging, particularly in an anxious or nonverbal child. Accurate diagnosis is dependent on clinical history, careful observation, and skilled physical examination. These challenges are compounded by…

Brachial Plexus Birth Injury

Acknowledgments: The authors wish to recognize the work of previous authors, Drs. Robert Leffert, Vincent R. Hentz, Michelle James, and Peter Waters, for their contributions to Green’s Operative Hand Surgery and this chapter. This chapter discusses the diagnosis, treatment, and long-term expected outcomes of infants and children with brachial plexus birth injuries (BPBIs). Because the type and severity of neural injuries are variable, treatment and outcome…

Arthrogryposis

Any child with congenital joint contractures in two or more limbs can be designated as arthrogryposis multiplex congenita (AMC); the term does not specify any certain etiology for the contractures. Arthrogryposis can result from environmental or genetic causes. Amyoplasia, however, the most common form of AMC, is an idiopathic nongenetic disorder with a wide range of levels of severity and anatomic involvement ( Fig. 39.1 ).…

Malformations of the Wrist and Forearm

Acknowledgments: The authors would like to acknowledge Marybeth Ezaki, MD, and Scott Kozin, MD, for providing additional radiographs and photos that have enhanced our chapter. Radial Longitudinal Deficiency ( Case Study 38.1 ) Case Study 38.1 Use of Precentralization Distraction in the Treatment of Radial Longitudinal Deficiency A boy with left type 4 radial deficiency was initially seen at 2 months of age. Stretching and splinting…

Deformities of the Thumb

Acknowledgment: The author would like to acknowledge Brian W. O’Doherty, coordinator of visual media services. His photographic and video excellence was necessary for completion of this chapter. Thumb Hypoplasia Thumb hypoplasia is considered part of radial deficiency even with normal forearm architecture. Hence, associated anomalies need to be considered during the initial evaluation. The workup must include entities such as VACTERL association, thrombocytopenia–absent radius syndrome, Holt-Oram…

Deformities of the Hand and Fingers

Syndactyly Epidemiology Syndactyly, one of the most common congenital abnormalities of the hand, occurs in approximately 1 to 2000 live births. , Syndactyly occurs bilaterally in 50% of cases, with a 2:1 ratio of males compared with females and 10 times more frequently in Caucasian compared with African American patients. In approximately 30% of cases, syndactyly is inheritable as an autosomal dominant trait with variable expressivity…

Embryology of the Upper Extremity

Congenital anomalies affect 1% to 3% of newborns, and approximately 10% of these children have upper extremity abnormalities. , The incidence of congenital anomalies has not changed appreciably over the last decade. Congenital limb anomalies are second only to congenital heart disease in the incidence of birth malformations. Most anomalies occur spontaneously or are inherited. Few malformations are attributed to teratogens. Limb anomalies can be produced…

Tetraplegia

Acknowledgment: The authors wish to recognize the work of previous author Ann E. Van Heest for her contributions to Green’s Operative Hand Surgery and this chapter. Spinal cord injury is devastating to the patient, the family, and his or her friends. In an instance, life has been dramatically downgraded with respect to ambulation, limb usage, bladder/bowel function, and independence. Spinal cord injury has substantial physical, emotional,…

Spasticity: Cerebral Palsy and Traumatic Brain Injury

Acknowledgment: The authors wish to acknowledge and thank Nina Lightdale-Miric, MD. Her efforts in the previous edition of this text provided the foundation for this chapter. The authors would also like to acknowledge Brian W. O’Doherty, coordinator of visual media services. His photographic and video excellence was necessary for the completion of this chapter. Introduction/Etiology Cerebral Palsy Cerebral palsy and traumatic brain injury are upper motor…