Venturing into the overlap between pediatric orthopaedics and hand surgery.

There is an overlap between pediatric orthopaedic surgery and hand surgery. A pediatric orthopaedic surgeon is accustomed to the intricacies of the immature skeleton, whereas a hand surgeon is more familiar with the regional anatomy and finer surgical techniques. Many hand diagnoses and surgical techniques are appropriate for the pediatric orthopaedic surgeon, including straightforward duplicated thumb reconstruction of a trigger thumb.

Update on tendon transfers for peripheral nerve injuries.

Tendon transfer surgery to restore fundamental wrist and hand function is made possible by the redundancy that exists among the actions of our upper-extremity musculature. Potential donors for transfer are those muscles with adequate power to motor the recipient tendon, similar tendon excursion to the recipient, and function in phase with the recipient. Resolution of wound healing, union of fractures, and mobilization of stiff joints are prerequisites for a functioning tendon transfer.

Update of the physiology and biomechanics of tendon transfer surgery.

Tendon transfer surgery has evolved over the past decade. Unique muscle properties have been elucidated in terms of potential force generation, excursion, and metabolic properties. The choice of an appropriate donor muscle is becoming more of a science than an art.