Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Flexor Tendon Injuries

Flexor tendon injuries in the hand are common and surgically challenging. Verdan and Michon sent shock waves through the scientific community in the 1960s when they recommended primary repair, which to this day remains the standard treatment for these injuries. Kleinert then improved functional outcomes by proposing early protected mobilization. Prior to this, however, in the 1930s, Sterling Bunnell had taken the position that primary repair…

Finger and Hand Soft Tissue Defects

Small Finger and Hand Soft Tissue Defects Small soft tissue defects affecting the digits are common. The method of coverage should be carefully selected and based on the following criteria: the topography of the defect, the affected finger, the associated injuries of the injured finger and neighboring fingers. The requirements of postoperative rehabilitation, functional requirements, age and sex of the patient are also important factors in…

Revascularization

The diagnosis of a finger devascularization, single or multiple, should be made upon admission of the patient because it defines the degree of urgency. Revascularization consists of restoring arterial inflow and venous return. It is undertaken once the skeleton has been stabilized. Osteosynthesis, by restoring the length, defines the need for and length of potential grafts. The reconstruction strategy, however, must be fully defined before the…

Metacarpal and Phalangeal Fractures

With metacarpal and phalangeal skeletal fractures, early mobilization remains the most effective way to counter edema, joint stiffness and tendon-periosteum adhesions. Early mobilization can, however, only be undertaken following reduction and stabilization of the fracture. The average time off work due to a fracture of the proximal phalanx is 4.3 to 8.4 weeks according to Barton. This variability is due to different fracture patterns and the…

Dislocations and Fracture-Dislocations of the Carpometacarpal Joints of the Fingers and Thumb

The carpometacarpal (CMC) joints of the long fingers have not received the same level of interest as their equivalent in the thumb. Yet they deserve special attention because their only similarity to the trapeziometacarpal (TMC) joint is their anatomic position in the hand. The differences in injury patterns are significant. Whereas fractures are more common for the thumb column (Bennett and Rolando fractures), dislocations predominate for…

Sprains and Dislocations of the Fingers

Sprains and dislocations of the fingers are common and mainly concern the proximal interphalangeal (PIP) joints of the long fingers, the metacarpophalangeal (MCP) joint of the thumb, and more rarely the MCP joints of the long fingers. These conditions require detailed clinical and radiographic assessment, which should be performed under local anesthesia. These injuries, in the absence of instability, can often be treated conservatively. Unfortunately, splinting…

Injury Assessment and Operative Strategy

Injuries of the hand are common and account for 30% of work-related accidents and also a significant percentage of household and leisure accidents. There are 400,000 people with work-related hand injuries every year in France, but evaluating the total number of hand injuries is more difficult. The figure probably lies around 1.4 million, 620,000 of which are serious and require specialized treatment. The annual cost of…

Instrumentation and Technical Equipment

The practice of hand surgery requires appropriate instrumentation. The instruments used should be adapted in size to the tissue structures themselves, and the instruments should have an ergonomic handle for precision and comfort. Handles should be short because this surgery is performed in a superficial plane. Here we will only describe the necessary instruments in common hand surgery procedures; instrumentation for osteosynthesis and instruments for microsurgery…

Emergency Microsurgery of the Upper Extremity

Introduction Severe upper extremity and hand injuries have significant morbidity and economic impact. Recovery may be long and complicated, placing the patient and his or her livelihood at risk. Significant improvements in the surgical outcomes of mutilating upper extremity injuries have been the result of not only the wide dissemination of microsurgical techniques but also the maturing of surgical strategies. Management now focuses on reconstruction of…

Ultrasound-Guided Regional Anesthesia of the Upper Limb

Introduction Upper extremity surgery, whether elective or emergency, can be done under regional anesthesia in the vast majority of cases. Used alone or as a supplement to general anesthesia, regional anesthesia allows for lower opiate consumption, less postoperative nausea and vomiting and better pain control. This chapter explains how regional anesthesia is used in the upper limb. We will emphasize the important anatomic landmarks to administer…

Collagenase

You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here