100 Hand Cases
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100
Hand
Cases
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100 Hand
Cases
Martin I. Boyer, MD, FRCS(C)
Carol B. and Jerome T. Loeb Professor of Orthopedic Surgery,
Co-Chief, Hand and Wrist Service,
Washington University School of Medicine,
St. Louis, Missouri
James Chang, MD, FACS
The Johnson & Johnson Distinguished Professor of Surgery
and Orthopedic Surgery,
Chief, Division of Plastic and Reconstructive Surgery,
Stanford University School of Medicine,
Stanford, California
2016
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CRC Press
Taylor & Francis Group
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© 2016 by Taylor & Francis Group, LLC
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To those we teach
and from whom we learn:
Our fellows, residents, and medical students
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EXECUTIVE EDITOR Sue Hodgson
SENIOR PROJECT EDITING MANAGER Carolyn Reich
SENIOR DEVELOPMENTAL EDITOR Megan Fennell
GRAPHICS MANAGER Brett Stone
DIRECTOR OF ILLUSTRATION AND DESIGN Brenda Bunch
BOOK DESIGN Jayne Jones
PROJECT MANAGER Kelly Mabie
MANUSCRIPT EDITOR Rebecca Sweeney
PRODUCTIONIST Debra Clark
PROOFREADER Linda Maulin
INDEXER Matthew White
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Preface
Over the course of the past 15 years at our respective institutions—Washington University and Stanford
University—we have had the honor and pleasure of training hundreds of medical students, residents
(both orthopedic and plastic), and hand fellows. We have found that teaching hand surgery is best done
while standing in front of a patient, while looking at a radiograph, or while settling in at the operating
table. The education is personal and is focused on that specific hand problem.
The scope of hand and upper extremity surgery—from the shoulder to the fingertip and from skin to
bone—can be overwhelming. However, we have realized that many themes repeat; the same hand prob-
lems present over and over. We decided that most of the core principles in hand surgery can be presented
in 100 illustrative case examples. This book, 100 Hand Cases, attempts to cover these key principles of
hand surgery with straightforward treatment of classic hand problems.
This book will be an easy read. Only one photo per chapter is shown on purpose, and the presentation
and treatment of each problem are concise. It is exactly what we discuss with our students, residents,
and fellows in several focused minutes at the bedside or operating table. This book is designed for the
learner to have an overview of the entire spectrum of hand surgery and to become familiar and com
fortable with the most common hand problems. Key articles are listed for those who wish to delve
deeper.
Special thanks to Julia Roeder Chang and Angela Sotelo for your wonderful transcription, editing, and
organization.
We hope this book will give surgeons of every level confidence in treating the myriad clinical presenta-
tions that make up the extraordinary field of hand surgery.
Martin I. Boyer
James Chang
vii
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Contents
PART I Amputations/Fingertip Injuries
1 Replantation 3
2 Hand Near Amputation 6
3 Mutilated Arm Injury 8
4 Thumb Pulp Defect 10
5 Fingertip Defect 12
6 Total Thumb Reconstruction 14
PART II Anesthesia and Pain Management
7 Complex Regional Pain Syndrome 19
8 Radial Sensory Neuritis 21
PART III Arthritis
9 Thumb Carpometacarpal Joint Osteoarthritis 25
10 Scaphotrapeziotrapezoid Joint Osteoarthritis 27
11 Metacarpophalangeal Joint Osteoarthritis 29
12 Proximal Interphalangeal and Distal Interphalangeal Joint Osteoarthritis 31
13 Scapholunate Advanced Collapse Wrist Arthritis 33
14 Metacarpophalangeal Joint Rheumatoid Arthritis 35
15 Pisotriquetral Joint Osteoarthritis 37
16 Posttraumatic Wrist Arthritis 39
17 Ulnar Impaction Syndrome 41
ix
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x Contents
PART IV Burns
18 Thermal Burn 45
19 Delayed Burn Reconstruction 47
PART V Compartment Syndromes
20 Compartment Syndrome 51
21 Acute Carpal Tunnel Syndrome 53
PART VI Congenital Conditions
22 Thumb Polydactyly 57
23 Thumb Hypoplasia 59
24 Syndactyly 61
25 Epidermolysis Bullosa 63
26 Constriction Band Syndrome 65
27 Cleft Hand 67
28 Apert Hand 69
29 Pediatric Trigger Thumb 72
PART VII Contractures
30 Spastic Hand and Wrist Contracture 77
31 Stiff Finger in Extension 79
32 Stiff Finger in Flexion 81
33 Camptodactyly 83
34 First Web Contracture 85
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Contents xi
PART VIII Dupuytren Contracture
35 Dupuytren Contracture 89
36 Recurrent Dupuytren Contracture 92
PART IX Fractures/Dislocations/Nonunions/Malunions
37 Radial Head Fracture 97
38 Both-Bone Forearm Fracture 99
39 Volar Dislocation of the Distal Radioulnar Joint 101
40 Essex-Lopresti Injury 103
41 Distal Radius (Colles) Fracture 105
42 Distal Radius Fracture (Smith) 107
43 Distal Radius Fracture Malunion 109
44 Transscaphoid Perilunate Fracture Dislocation 111
45 Multiple Metacarpal Fractures 113
46 Phalanx Fracture 115
47 Proximal Interphalangeal Joint Fracture Dislocation (Dorsal) 117
48 Metacarpophalangeal Dislocation 119
49 Proximal Interphalangeal Dislocation 121
50 Scaphoid Fracture 123
51 Scaphoid Nonunion 125
52 Gunshot Wound to the Hand 127
53 Hook of Hamate Fracture 129
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xii Contents
PART X Infections/Bites
54 Human Bite Injury 133
55 Cat Bite 135
56 Paronychia 137
57 Herpetic Whitlow 139
58 Flexor Tenosynovitis 141
59 Osteomyelitis 143
60 Necrotizing Fasciitis 145
61 Chronic Olecranon Bursitis 147
PART XI Infections/Extravasations
62 Dorsal Hand Extravasation 151
63 Paint-Gun Injection Injury 153
PART XII Instability
64 Ulnar Collateral Ligament Tear of the Thumb Metacarpophalangeal Joint 157
65 Scapholunate Ligament Tear 159
66 Sagittal Band Rupture 161
PART XIII Osteonecrosis
67 Kienböck Disease 165
PART XIV Peripheral Nerve
68 Carpal Tunnel Syndrome 169
69 Cubital Tunnel Syndrome 172
70 Guyon Tunnel Mass 174
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Contents xiii
71 Radial Tunnel Syndrome 176
72 Forearm Laceration 178
73 Radial Nerve Palsy 180
74 Median Nerve Palsy 182
75 Ulnar Nerve Palsy 184
76 High Median and Ulnar Nerve Palsy 187
77 Adult Brachial Plexus Injury 189
78 Gunshot Wound to the Axilla 192
PART XV Soft Tissue Defects
79 Exposed Flexor Tendon 197
PART XVI Tendon: Atraumatic Conditions (Tenosynovitis)
80 Trigger Finger 201
81 de Quervain Tenosynovitis 203
82 Lateral Epicondylitis 205
PART XVII Tendon: Traumatic
83 Extensor Tendon Laceration 209
84 Zone II Flexor Tendon Injury 211
85 Spaghetti Wrist 213
86 Swan-Neck Deformity 215
87 Boutonnière Deformity 217
88 Mallet Finger 219
89 Flexor Tendon Avulsion 221
90 Flexor Tendon Adhesions 223
91 Staged Flexor Tendon Reconstruction 225
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xiv Contents
PART XVIII Tumors
92 Mucous Cyst 231
93 Dorsal Wrist Ganglion 233
94 Glomus Tumor 235
95 Hemangioma 237
96 Squamous Cell Carcinoma 239
97 Melanoma 241
98 Schwannoma 243
PART XIX Vascular Conditions
99 Hypothenar Hammer Syndrome 247
100 Scleroderma 249
Index 251
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