Copyright â Springer-2015
Evaluation of Vascular Disorders of the Upper Limb
Causes of Injury to Blood Vessels
Compressive Injury to Blood Vessels
Acute Occlusive Conditions Affecting Vessels
Systemic Processes Causing Vessel Injury
Connective Tissue Disease
Nerve Anatomy and Microanatomy
Blood Supply and Surgical Anatomy
Physiology of Peripheral Nerves Following Injury
Morphology of Peripheral Nerves Following Injury
How Does the Response of Denervated Schwann Cells to Reinnervation Relate to Time?
Protection of Motor Neurons and Sensory Neurons Following Injury
Clinical Assessment of the Injured Nerve
Assessment of Sensory Function
Assessment of Motor Function
Nerve Recovery After Direct Repair Following Division
Principles of Nerve Repair
Surgical Technique for Nerve Repair
Post-operative Care and Complications
Results of End to End Neurosynthesis
Management of a Nerve gap
Principles of Nerve Grafting
Surgical Technique of Nerve Grafting
Vascularised Nerve Grafts and Allografts
End to Side Neurosynthesis
Investigations After Nerve Injury
3: Injury: Tendons – Flexor
Technique of Repair (See Appendix)
Management of the Tendon Sheath
Post-operative Management
Classification of Injuries
Appendix: Fine Detail of the Technique of Primary Flexor Tendon Repair
Specialisation in Flexor Tendon Surgery and Rehabilitation
4: Injuries: Tendon – Extensor
Closed Rupture of the Central Slip (Boutonnière Injury)
Classification of Extensor Tendon Injuries
Principles of Surgical Treatment for Open Injuries
Open Zone 1 Injuries (Distal Interphalangeal Joint)
Open Zone 2 Injuries (Middle Phalanx)
Open Zone 3 Injuries (Proximal Interphalangeal Joint)
Open Zone 4 Injuries (Proximal Phalanx)
Open Zone 5 Injuries (Metacarpophalangeal Joint)
Open Zone 6 Injuries (Metacarpal)
Open Zone 7 Injuries (Wrist)
Open Zone 8 (Distal Forearm)
Open Zone 9 (Proximal Forearm)
Rehabilitation and Results
5: General Principles of Skin Cover and Flaps to the Elbow, Forearm, Wrist and Hand
Trauma – General Principles
Trauma – Specific Considerations
Escharotomy in the Burnt Hand and Upper Limb
Wound Debridment, Judging Tissue Viability and Assessing Tissue Degloving
Cosmesis of the Primary and Secondary Defects
Specific Wound Closure Techniques
Perforator Fascio-Cutaneous Flaps
Proximally Based Fascio-Cutaneous Flaps
Distally Based Fascio-Cutaneous Flaps
Adipo Fascial Turnover Flaps
Inferiorly Based Abdominal Flaps
Micro Vascular Free Flap Transfers
Skin and Fasciocutaneous Free Flaps
Free Innervated Muscle Flaps
When Multiple Flaps Are Needed
How to Make the Decision on the Choice of Flap?
6: Soft Tissue Cover of the Hand
Part 1. Non-flap Based Approaches to Soft Tissue Cover
Healing by Secondary Intention
Part 2. Flap Cover of the Digits
Functional Considerations
Soft Tissue Cover of the Fingertips (Index to Little)
Bilateral Lateral VY Flaps (Kutler and Segmuller Flaps)
Homodigital Triangular Advancement Island Flaps (Venkatswami)
Soft Tissue Cover of Defects Proximal to the Fingertip
Turnover Adipofascial Flap
Microvascular Toenail Transfer
Defects of Dorsal Middle Phalanx
Homodigital Adipofascial Turnover Flap (Merle Flap)
Defects of Dorsal Proximal Phalanx
Dorsal Metacarpal Artery Perforator Flaps (Quaba Flap)
Outcomes of Fingertip Reconstruction
Level III Evidence – Retrospective Comparative Reviews
Level IV Evidence – Non-comparative Case Series
Algorithm for Management (Flow Chart 6.1)
Palmar Advancement Flaps (Moberg flap)
Heterodigital Neurovascular Island Flaps (Littler/Buchler Flaps)
First Dorsal Metacarpal Artery Flap (FDMCA/Foucher Flap)
Toe Pulp and Variations (Great Toe Pulp, Tibial Neurocutaneous Flap, Toe Wraparound)
Outcomes in Distal Thumb Reconstruction
Level III Evidence – Retrospective Comparative Reviews
Level IV Evidence – Non-comparative Case Series
Part 4: Small Free Flaps in Digital and Webspace Reconstruction
Free Posterior Interosseus Flap
First Webspace Free Flap/Dorsalis Pedis Free Flap
7: Distal Interphalangeal Joint and Fractures of the Distal Phalanx
Anatomy of the Distal Phalanx
Presentation, Investigation and Treatment Options
Fractures of the Distal Phalanx
Fractures of the Tuft of the Distal Phalanx
Fractures of the Shaft of the Distal Phalanx
Intra-articular Fractures of the Distal Phalanx
Jersey Finger, or Flexor Digitorum Profundus (FDP) Tendon Avulsions
Amputations of the Fingertip
Surgical Techniques and Rehabilitation
To Remove the Nail or Not?
Bony Mallet Finger Fixation Techniques
Complications of Treatment
8: Proximal Interphalangeal Joint Injuries
Presentation, Investigation and Treatment Options
Volar Plate and Collateral Ligament Injuries
Extra-articular Fractures
Intra-articular Fractures
Base of Middle Phalanx Injuries
Dorsal Fracture Subluxation
Volar Plate Bony Avulsion From the Volar Base of the Middle Phalanx
Surgical Techniques and Rehabilitation
Outcome Including Literature Review
9: Fractures of the Proximal Phalanx and Those Involving the Metacarpo-Phalangeal Joint
Problems and Particular Challenges
Fractures Around the Metacarpophalageal Joint
10: Injury-Fractures-Carpo-Metacarpal Joint and Metacarpal
Treatment Options and Outcomes
Base Fractures and Carpometacarpal Fracture-Dislocations
Thumb Metacarpal Fractures
Extra-articular Base Fractures
Intra-articular Base Fractures and Carpometacarpal Fracture-Dislocations
Pure Trapeziometacarpal Joint Dislocation
Post-traumatic Osteoarthritis
Conclusions and Personal Views
11: Fractures of Carpal Bones Other than the Scaphoid
12: Acute Scaphoid Fractures
Classification of Scaphoid Fractures
Assessment of Fracture Union
Open – Dorsal Approach (Fig. 12.3)
Outcome of Acute Scaphoid Fractures
13: Fractures of the Distal Radius and Distal Radioulnar Joint
Extra Articular Fractures
Intra Articular Fractures
Fractures of the Distal Ulna
14: Hand Injuries in Children
Fingertip and Nail Bed Injury
Distal Radius and Ulna Fractures
Complex and Mutilating Hand Injuries
15: Acute Thumb and Finger Instability
The Distal Digital Joint (DIPJ of the Fingers and IPJ of the Thumb)
Anatomy and Clinical Implications
The Distal Interphalangeal Joint (DIPJ) of the Fingers
The Thumb Inter Phalangeal Joint (IPJ)
Clinical Features and Diagnosis
Clinical Features and Diagnosis
Collateral Ligament Injury
Clinical Features, Diagnosis and Treatment
Joint Dislocation: Dorsal
Clinical Features and Diagnosis
The Proximal Interphalangeal Joint: (PIPJ)
Anatomy and Clinical Implications
Bony Architecture and Angles in the Hand
The Proximal Interphalangeal Joint (PIPJ) of the Fingers
Epidemiology and Pathomechanics
Clinical Features and Diagnosis
Outcomes, Personal Views and Conclusions
Injuries to the Pip Joint
Collateral Ligament Ruptures
Clinical Features and Diagnosis
Epidemiology and Pathomechanics
Conclusions/Personal View
Open Dorsal Capsular Injuries
Epidemiology and Pathomechanics
Clinical Features and Diagnosis
Outcomes, Personal Views and Conclusions
Volar Dislocation of the PIPJ
Clinical Features and Diagnosis
Epidemiology and Pathomechanics
The Thumb Metacarpophalangeal Joint: (MCPJ)
Anatomy and Clinical Implications
The Metacarpophalangeal Joint (MCPJ) of the Thumb
Dorsal Capsular Injuries (Volar Dislocations)
Clinical Features and Diagnosis
Volar Plate Injuries (Dorsal Dislocations)
Clinical Features and Diagnosis
Ulnar Collateral Ligament Tear of the Thumb: Metacarpo-Phalangeal Joint
Clinical Features and Diagnosis
Radial Collateral Ligament Tear of the Thumb: Metacarpo-Phalangeal Joint
Clinical Features and Diagnosis
The Metacarpophalangeal Joint of the Fingers (MCPJ)
Anatomy and Clinical Implications
The Metacarpophalangeal Joint (MCPJ) of the Fingers
Extensor Retinacular System
Dorsal Metacarpo-Phalangeal Dislocations
Clinical Features and Diagnosis
Volar Metacarpo-Phalangeal Dislocations
Lateral Metacarpo-Phalangeal Dislocations
Clinical Features and Diagnosis
Sagittal Band Disruptions
Clinical Features and Diagnosis
The Carpometacarpal Joint of the Fingers (CMCJ)
Anatomy and Clinical Implications
The Carpometacarpal Joint (CMCJ) of the Fingers
Dorsal Carpometacarpal Dislocations
Clinical Features and Diagnosis
Pathology, Mechanism and Classification
The Thumb Carpometacarpal Joint: (CMCJ)
Anatomy and Clinical Implications
The Carpometacarpal Joint (CMCJ) of the Thumb
First Carpometacarpal (Dorsal) Dislocations
Clinical Features and Diagnosis
16: Acute Carpal Instability
Presentation, Investigation and Treatment Options
Classification of Carpal Instability
Surgical Techniques and Rehabilitation Including Results
Technique of Open Reduction and Repair
Isolated Scapholunate Dissociation
Isolated Lunotriquetral Dissociation
17: Acute DRUJ Instability
Aetiology of Acute Instability
TFCC Repair (Class 1B Injury)
Ulnar Styloid Fracture Repair
18: Massive Upper Limb Trauma
Assessment of the Patient with the Massively Injured Upper Extremity
Pain Relief: The Concept of ‘On Arrival Block’
Assessment of the Massively Injured Upper Extremity
To Salvage or Not to Salvage?
Debridement of the Massively Injured Upper Extremity
Reconstruction of the Massively Injured Upper Extremity
Revascularization Considerations
Skeletal Fixation Considerations
Repair of Functional Units
Total Primary Reconstruction Versus Staged Reconstruction
Provision of Soft Tissue Cover
Pyogenic Flexor Tenosynovitis
Radial and Ulnar Bursae and Space of Parona Infections
Midpalmar (or Deep Palmar) Space
Mycobacterium Tuberculosis (TB)
Tuberculous Osteomyelitis
Tuberculous Tenosynovitis
Non-tuberculous Mycobacterial Infections
Leprosy (Mycobacterium leprae)
Cutaneous Fungal Infections
Deep or Systemic Fungal Infections
Subcutaneous Fungal Infections
20: Pain Management in Disorders of the Hand
Progression of Acute Pain to Chronic Pain
Pre-emptive and Preventive Analgesia
Management: Patient Information and Education
Management: Pharmacotherapy
Simple (Non Opioid) Analgesics
Management: Interventional Procedures
Local Anaesthetic Blockade
Persistent (Chronic) Pain
Management: Non-pharmacological
Management: Pharmacotherapy
Simple (Non Opioid) Analgesics
Management: Patient Information and Education
Management: Pharmacotherapy
Management: Interventional Procedures
Management: Physical and Vocational Rehabilitation
Complex Regional Pain Syndrome (CRPS)
Management: Patient Information and Education
Management: Pharmacotherapy
Management: Interventional Procedures
Management: Psychological Intervention
Management: Physical and Vocational Rehabilitation
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