A National Survey of Hand Surgeons: Understanding the Rural Landscape.

Background: Twenty percent of the US population is described as being rural and may have limited access to hand surgeons, especially on an emergency basis. Little is known about case type, call hours, employment status, and other relevant details of rural hand surgery.

Methods: We surveyed members of the American Society of Surgery for the Hand to begin to describe the problem.

Update on Thumb Basal Joint Arthritis Surgery.

Learning Objectives: After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2.

Secondary Management of Nonnail Perionychial Deformities: Restoring Aesthetic and Functional Subunits.

Delayed finger and thumb tip reconstruction should try to optimally reconstruct perioncyhial aesthetic and functional units by replacing tissue as closely resembling the original loss as possible. Avoid thinking in terms of a "reconstructive ladder" but rather going directly to the reconstructive choice that seems most suited to the task. Some reconstructive choices may seem more attractive because of their simplicity, but may not necessarily give the best functional and aesthetic result.

Targeted Muscle Reinnervation for Symptomatic Neuromas Utilizing the Terminal Anterior Interosseous Nerve.

Sensory nerve trauma at the level of the wrist can lead to debilitating neuromas. Targeted muscle reinnervation (TMR) is an effective therapy for the treatment of neuromas. Here we propose the use of the terminal anterior interosseous nerve (AIN) as a viable recipient for TMR.

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited.

Background: Small joint reconstruction of the hand poses a significant challenge, especially in children where both functional motion and preservation of the epiphysis are desired. Auto-transplantation of whole joints is the only way to reconstruct a functional joint that maintains growth potential. Historically, nonvascularized toe-to-finger joint transfer has been criticized for high rates of avascular necrosis and joint dissolution, while vascularized transfers seemingly resulted in increased durability of the joint space and epiphysis.

Current indications for abdominal-based flaps in hand and forearm reconstruction.

Extensive soft tissue loss or injury of the hand and upper extremity is a challenging reconstructive problem traditionally treated with abdominal-based pedicled flaps. Options for coverage included the groin flap based on the superficial circumflex iliac artery, the Scarpa's fascia flap based on the superficial inferior epigastric artery, and the paraumbilical perforator flap from the deep inferior epigastric artery perforators. Despite the ability to provide consistent and pliable soft tissue coverage with ease of elevation, these flaps have several disadvantages including restriction of mobility, requirement for multiple procedures, bulkiness and patient discomfort.

Recurrent Schwannomatosis of the Hand.

Peripheral nerve sheath tumors (PNSTs) are neoplastic soft tissue masses generated from the abnormal proliferation of Schwann cells. Often, these tumors occur in isolation and are known as schwannomas or neurilemmomas. The presence of multiple schwannomas is known as schwannomatosis.

Reliability of the Dorsal Tangential View in Assessment of Distal Radioulnar Joint Reduction in the Neutral, Pronated, and Supinated Positions in a Cadaver Model.

Purpose: Intraoperative assessment of distal radioulnar joint (DRUJ) alignment is often based on lateral radiographs whose interpretation is dependent upon positioning the forearm in neutral rotation. The dorsal tangential view (DTV) is a near-axial view of the dorsal wrist used in assessing dorsal screw penetration during radius fixation. The purpose of this study was to determine whether the DTV can also reliably assess DRUJ alignment in multiple forearm positions.

Impact of Septated First Dorsal Compartments on Symptomatic de Quervain Disease.

Background: The authors conducted this study to determine whether septation of the first dorsal compartment is more prevalent in de Quervain tenosynovitis, and whether this contributes to failure of corticosteroid injection therapy.

Methods: A retrospective review of 79 consecutive patients (85 wrists) with symptomatic de Quervain tenosynovitis treated with surgical release was performed. The number of corticosteroid injections performed preoperatively and the presence of first dorsal compartment septation determined intraoperatively were recorded.

The Impact of Suture Caliber and Looped Configurations on the Suture-Tendon Interface in Zone II Flexor Tendon Repair.

Purpose: To evaluate the impact of suture caliber and looped configurations on the integrity of 4-strand modified Kessler zone II flexor tendon repairs during progressive cyclic loading.

Methods: Seventy-two flexor digitorum profundus tendons from 18 fresh human cadaver hands were divided into 4 repair groups. Thirty-six matched tendons underwent repair using either a 4-0 looped or 4-0 single-stranded suture, and an additional 36 tendons underwent 3-0 looped or 3-0 single-stranded repairs.

Correlation of the Lateral Wrist Radiograph to Ulnar Variance: A Cadaveric Study.

Purpose: Both positive and negative ulnar variance have been implicated in a variety of wrist disorders. Surgery aims to correct the variance in these pathologic conditions. This necessitates accurate and reproducible measuring tools; however, the most accurate radiographic measurement technique remains unclear.

The Dorsal Aponeurosis of the Thumb.

Purpose: To evaluate the thumb dorsal aponeurosis anatomy. Consideration of structural differences between the fingers and thumb will provide an improved clinical understanding of the thumb dorsal aponeurosis anatomy.

Methods: Ten fresh cadaver hands from 5 patients with an average age of 31.

Finger Injuries in Ball Sports.

Finger injuries are common in athletes playing in professional ball sports. Understanding the intricate anatomy of the digit is necessary to properly diagnose and manage finger injuries. Unrecognized or poorly managed finger injuries can lead to chronic deformities that can affect an athlete's performance.

Soft-Tissue Surgery for Camptodactyly Corrects Skeletal Changes.

Background: This study demonstrates the potential for radiographic and clinical improvement with surgical correction of camptodactyly. Although historically these radiographic changes have been held to be permanent, the authors encourage surgical intervention for digits with severe flexion contracture or progressive radiographic changes before skeletal maturity is reached.

Methods: The authors assessed 18 consecutively operated fingers in nine skeletally immature patients in whom advanced radiographic articular changes had occurred.

Biomechanical evaluation of double-strand (looped) and single-strand polyamide multifilament suture: influence of knot and suture size.

Background: Flexor tendon repair in zone II remains a vexing problem. Repair techniques have been developed to strengthen and optimize the number of core strands crossing a repair. A polyamide looped suture doubles the number of core strands for every needle path.

Vascularized Heterodigital Island Flap for Fingertip and Dorsal Finger Reconstruction.

A heterodigital vascularized island flap can functionally restore large soft tissue defects to the injured fingertip in a single stage. It is optimally used for digits of unequal length so that the donor fingertip is not violated, and the skin island is best taken from the less dominant side of the donor finger. Because it is a transposition flap with a proximal axis of rotation, its transposition arc can also reach the dorsum of an adjacent digit.

Severe camptodactyly: A systematic surgeon and therapist collaboration.

Introduction: Although common, the treatment of camptodactyly is controversial.

Purpose: Our purpose is to delineate a logical stepwise treatment plan based on corresponding components of the pre-operative and intraoperative evaluation of camptodactyly. In addition, describe structure rehabilitation plan utilizing the same stepwise evaluation.

Evaluation of a stepwise surgical approach to camptodactyly.

Background: Camptodactyly is common, but its treatment remains controversial. Multiple deforming forces have been implicated in its pathogenesis. This study evaluates a logical clinical assessment and corresponding stepwise surgical plan.

Closed flexor tendon ruptures.

We review different causes, diagnoses, and treatment options of closed flexor tendon disruptions in the hand. A classification of closed tendon ruptures based on their mechanism includes traumatic tendon avulsion, spontaneous midsubstance rupture, attrition rupture, infiltrative tenosynovial rupture, and iatrogenic. Certain conditions result in tendon disruption inflicted by more than 1 of these etiologies.

Multidigit camptodactyly of the hands and feet: A case study.

A clinical case of a 12-year-old boy who presented with multidigit, nonsyndromal, progressive camptodactyly is discussed. While bilateral little finger camptodactyly is well described, there is no documentation of camptodactyly involving all fingers and many toes as well as both proximal (PIP) and distal interphalangeal (DIP) joints. This patient responded well to surgery, which was performed on four toes and seven fingers, despite having established radiographic changes of camptodactyly in the PIP joints as well as two DIP joints.

Comparison of magnification in primary digital nerve repair: literature review, survey of practice trends, and assessment of 90 cadaveric repairs.

Purpose: To review published clinical outcomes and current practice trends and to assess the quality of cadaveric digital nerve repairs using either loupe or microscopic magnification.

Methods: Published clinical outcomes of digital nerve repair accounting for magnification level were reviewed. Members of the American Society for Surgery of the Hand were surveyed regarding their current surgical practices.

Measurement scales in clinical research of the upper extremity, part 2: outcome measures in studies of the hand/wrist and shoulder/elbow.

Part 1 of this article outlined the basic characteristics of useful clinical measurement instruments and described scales used to measure general health, pain, and patient satisfaction. Part 2 describes the features of some of the scales most commonly used in clinical research in the hand, wrist, elbow, and shoulder.