The Use of Patient-Specific Implants for the Treatment of Upper Extremity Fractures
In this article, we discuss the use of three-dimensional (3-D) printed patient-specific implants in the management of upper extremity fractures. Traditional fracture fixation methods involve the use of standard-sized implants, which may not adequately address the needs of every patient, particularly those who have complications related to fracture nonunion or malunion and those who have significant bone loss. The benefits and limitations of this technology are also discussed, along with considerations for implementation in clinical practice. Overall, the use of 3-D printed patient-specific implants holds promise for improv...
Source: Hand Clinics - August 20, 2023 Category: Orthopaedics Authors: Sneha R. Rao, Gregory F. Pereira, Marc J. Richard Source Type: research
Strategies for Perioperative Optimization in Upper Extremity Fracture Care
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed. (Source: Hand Clinics)
Source: Hand Clinics - August 12, 2023 Category: Orthopaedics Authors: Thompson Zhuang, Robin N. Kamal Source Type: research
Novel Tools to Approach and Measure Outcomes in Patients with Fractures
Upper extremity fractures are prevalent and pose a great burden to patients and society. In the US alone, the annual incidence of upper extremity fractures is 67.6 fractures per 10,000 persons. While the majority of patients with upper extremity fractures demonstrate satisfactory outcomes when treated appropriately (the details of which are discussed in prior articles), the importance of follow-up and outcome measurement cannot be understated. Outcome measurement allows for accountability and improvement in clinical outcomes and research. The purpose of this article is to describe recent advances in methods and tools for a...
Source: Hand Clinics - August 1, 2023 Category: Orthopaedics Authors: Edgar Garcia-Lopez, Ryan Halvorson, Lauren Shapiro Source Type: research
Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes. (Source: Hand Clinics)
Source: Hand Clinics - July 21, 2023 Category: Orthopaedics Authors: Gabrielle Anne Bui, Jerry I. Huang Source Type: research
Minimally Invasive Techniques for Treatment of Metacarpal and Phalanx Fractures
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes. (Source: Hand Clinics)
Source: Hand Clinics - July 21, 2023 Category: Orthopaedics Authors: Gabrielle Anne Bui, Jerry I. Huang Source Type: research
Vascularized Medial Femoral Condyle Flap Reconstruction for Osseous Defects of the Hand and Wrist
Vascularized bone flaps from the descending genicular artery system are versatile and effective for the use of recalcitrant nonunions from the tubular bones of the hand to the long bones of the upper extremity. Familiarity with the vascular pedicle, various techniques of harvest and inset, and skin paddle harvest and application are essential for the reconstructive surgeon. (Source: Hand Clinics)
Source: Hand Clinics - July 18, 2023 Category: Orthopaedics Authors: James P. Higgins Source Type: research
Proximal Interphalangeal Joint Arthroplasty for Fracture
Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period. They provide viable alternatives to arthrodesis, osteotomy and amputation in the appropriate patient. (Source: Hand Clinics)
Source: Hand Clinics - July 18, 2023 Category: Orthopaedics Authors: Jeremy E. Raducha, Arnold-Peter C. Weiss Source Type: research
InternalBrace for Intercarpal Ligament Reconstruction
Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic injuries with predynamic or dynamic instability, the ideal surgical approach remains unclear. In January 2020 the authors started enrolling patients with predynamic and dynamic instability in an Institutional Review Board –approved prospective study, aimed at meticulously studying outcomes using the all-dorsal InternalBrace reconstruction technique. The all-dorsal technique described herein is straightforward, efficient, and easy to learn, with early outcomes e...
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Brian W. Starr, Kevin C. Chung Source Type: research
Wrist Arthritis and Arthrodesis
This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications. (Source: Hand Clinics)
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Anthony LoGiudice, Hisham Awan Source Type: research
Wrist and Distal Radioulnar Joint Arthroplasty
Traditional management of wrist arthritis consists of proximal row carpectomy, partial carpal fusions, or, in the event of pancarpal arthritis, total wrist fusion. Although proximal row carpectomy and partial wrist fusions preserve some motion at the wrist while relieving pain symptoms, the quality of results obtained from these procedures is not predictable or optimal in many instances. Management of hip, knee, ankle, and shoulder joints has evolved from arthrodesis to arthroplasty. The wrist joint is following the same pattern of evolution with the advent of reliable designs. (Source: Hand Clinics)
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Amit Gupta, Luis Scheker Source Type: research
Infection Management for the Hand Surgeon
Infections of the upper extremity can be challenging to diagnose and treat because of the complex anatomy and range of offending pathogens. Early recognition of infections that require an emergent surgical intervention, such as necrotizing fasciitis and septic joints, is imperative for good clinical outcomes. In addition, prompt diagnosis and intervention for deep closed space infections, such as deep abscesses or flexor tenosynovitis, is necessary to avoid chronic pain and dysfunction. Complicating factors such as underlying osteomyelitis, atypical pathogens, and immunocompromised states of patients should always be consi...
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Victor King, Nisha Crouser, Amy Speeckaert, Reena Bhatt Source Type: research
Challenges in Nerve Repair and Reconstruction
Peripheral nerve injuries may substantially impair a patient ’s function and quality of life. Despite appropriate treatment, outcomes often remain poor. Direct repair remains the standard of care when repair is possible without excessive tension. For larger nerve defects, nerve autografting is the gold standard. However, a considerable challenge is donor si te morbidity. Processed nerve allografts and conduits are other options, but evidence supporting their use is limited to smaller nerves and shorter gaps. Nerve transfer is another technique that has seen increasing popularity. The future of care may include novel biol...
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: James S. Lin, Sonu A. Jain Source Type: research
Preface
We have all had the case that made us think, caused us to question, and forced us to try new techniques unexpectedly. We are able to navigate these situations based on our experiences and our adherence to principles. Given the ever-evolving state of hand surgery, we thought it would be important to have an issue of Hand Clinics devoted to challenging and complex conditions of the hand. (Source: Hand Clinics)
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Sonu A. Jain Source Type: research
Managing Difficult Problems in Hand Surgery: Challenges, Complications, and Revisions
HAND CLINICS (Source: Hand Clinics)
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Authors: Sonu A. Jain Source Type: research
Copyright
ELSEVIER (Source: Hand Clinics)
Source: Hand Clinics - July 14, 2023 Category: Orthopaedics Source Type: research
