"Hand surgery requires precision, in-depth expertise, and versatility in order to perform a wide variety of operations on fractures, tendon and nerve conditions, soft tissue injuries, rheumatoid deformities, and congenital defects. Hand Surgery: Tricks of the Trade by renowned Rothman Orthopaedic Institute hand surgeon Pedro K. Beredjiklian and an impressive group of contributors provides a clear roadmap on how to perform common hand surgery procedures. Concise step-by-step text enables readers to quickly read through, review, and understand the most salient points for each approach. Organized into 14 major sections and 88 chapters, this book encompasses the entire spectrum of orthopedic surgery procedures on the tendons, nerves, bones, and joints of the hand. The text starts with two sections focused on tendon repair and reconstruction. Subsequent sections detail open and endoscopic release and decompression techniques for nerve conditions, fixation and plating of hand and wrist fractures, osteotomy for bone reconstruction, arthroplasty for arthritis, and ligament repair for instability. The last four sections discuss plastic surgery procedures, including the use of diverse skin grafts and flaps, Dupuytren's disease, arthroscopy, and infections"--.

• Hand Surgery: Tricks of the Trade
• Title Page
• Copyright
• Dedication
• Contents
• Foreword
• Preface
• Contributors
• Part I: Tendon Injuries
  • 1 Extensor Tendon Repair (Zone 1, 3, 5)
    • 1.1 Key Principles
    • 1.2 Anatomy
    • 1.3 Repair Indications and Contraindications
    • 1.4 Anesthesia
    • 1.5 Caveats, Pearls, and Lessons Learned (Extensor Zone 1, 3, 5)
      • 1.5.1 Zone 1: Terminal Tendon Injuries(Mallet Finger)
      • 1.5.2 Zone 3: Central Slip Injuries
      • 1.5.3 Zone 5: MCP Joint Injuries
    • Suggested Readings
  • 2 Extensor Tendon Repair (Zones 2, 4, 6–9)
    • 2.1 Introduction
    • 2.2 Evaluation
    • 2.3 Treatment
      • 2.3.1 General Treatment Guidelines
      • 2.3.2 Repair Techniques
      • 2.3.3 Zone 2 (Proximal Phalanx (Pinning) Phalanx) Injuries
      • 2.3.4 Zone 4 (Proximal Phalanx) Injuries
      • 2.3.5 Zone 6 (Metacarpal) Injuries
      • 2.3.6 Zone 7 (Carpus) Injuries
      • 2.3.7 Zone 8 (Distal Forearm) Injuries
      • 2.3.8 Zone 9 (Proximal Forearm) Injuries
    • 2.4 Complications
    • 2.5 Rehabilitation
    • References
    • Suggested Readings
  • 3 Flexor Tendon Repair (Zone 1)
    • 3.1 Description
    • 3.2 Key Principles
    • 3.3 Indications
    • 3.4 Contraindications
    • 3.5 Special Considerations
    • 3.6 Special Instructions, Positioning, and Anesthesia
    • 3.7 Tips, Pearls, and Lessons Learned
    • 3.8 Difficulties Encountered
      • 3.8.1 Distal Stump
      • 3.8.2 Distal Phalanx Fractures
    • 3.9 Key Procedural Steps
      • 3.9.1 Initial Approach
      • 3.9.2 Tendon-to-Tendon Repair
      • 3.9.3 Tendon to Bone
      • 3.9.4 Bone to Bone
    • 3.10 Bailout, Rescue, and Salvage Procedures
    • References
  • 4 Flexor Tendon Repair (Zone 2)
    • 4.1 Description
    • 4.2 Key Principles
    • 4.3 Expectations
    • 4.4 Indications
    • 4.5 Contraindications
    • 4.6 Special Considerations
    • 4.7 Special Instructions, Positioning, and Anesthesia
    • 4.8 Tips, Pearls, and Lessons Learned
    • 4.9 Key Procedural Steps
    • 4.10 Postoperative Care
    • 4.11 Complications
    • References
  • 5 Flexor Tendon Injuries (Zone 3–5)
    • 5.1 Description
    • 5.2 Classification
    • 5.3 Key Principles
    • 5.4 Expectations
    • 5.5 Indications
    • 5.6 Contraindications
    • 5.7 Diagnosis
    • 5.8 Timing of Repair
    • 5.9 Key Procedural Steps
    • 5.10 Rehabilitation
    • 5.11 Complications
    • 5.12 Special Considerations
      • 5.12.1 Wide-Awake Flexor Tendon Repair
      • 5.12.2 Primary Repair with Intercalary Defects
    • 5.13 Pearls
    • References
• Part II: Tendon Reconstruction
  • 6 Flexor Tendon Reconstruction (Zone 2)
    • 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 Communis 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 Imaging
      • 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 (▶Fig. 18.2)
    • 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 and 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 (▶Fig. 38.4, ▶Fig. 38.5, ▶Fig. 38.6)
    • 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 VolarWrist 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 toScaphoid Correction
      • 50.7.2 Graft Procurement and Placement
      • 50.7.3 Immobilization after Surgery
    • 50.8 Difficulties Encountered
    • 50.9 Key Procedural Steps (▶Fig. 50.6)
    • 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 Distal Radioulnar Joint (DRUJ)
      • 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 × 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) Jointand 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
    • 57.5 Contraindications
    • 57.4 Indications
    • 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 Repairwith 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 Reading
  • 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 (▶Fig. 76.2)
    • 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 Undera 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 Readings
• Part XII: Dupuytren’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 DiagnosticWrist 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 Positioning and Wrist Distraction
      • 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 TFCC/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-In 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 Surgical Wound Management
      • 88.5.2 Antibiotic Therapy
    • 88.6 Septic Joint Sequelae
    • References
• Index