Operative Techniques in Hand, Wrist, and Forearm Surgery contains the chapters on the hand, wrist, and forearm from Sam W. Wiesel's Operative. Techniques. operative techniques in hand wrist and forearm surgery as you such as. By searching the title, books in PDF, EPUB, and Mobi Format. Click Download or. operative techniques in orthopaedic surgical oncology 1e format pdf mb in hand wrist and forearm surgery 1e format pdf mb download link http shst.
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The authors describe the techniques available, as well as giving a step-by-step guide as to how these can be executed, with clear illustrations.
A DVD containing 14 surgical videos accompanies the book. The breadth of topics covered in this book is impressive. Within each of the broad sections coverage is given to a comprehensive range of topics going from the most basic through to current controversies and advanced techniques.
For example, within the primary knee arthroplasty section the book starts with chapters describing how to do the medial parapatellar approach and then the lateral approach. Chapters then progress through other approaches, biomechanics and bearing surfaces, component design, cemented versus uncemented TKA, patellar resurfacing, pain management, unicondylar arthroplasty and patient factors. This general scheme is carried through each of the sections with wide coverage of both basic and specialized topics.
The list of contributing authors is extensive and includes many eminent surgeons within the field of knee surgery. They are almost all from the United States, so inevitably this book does present a very American perspective with much of the evidence quoted coming from the American literature.
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As an overall package this book is unique. It is superbly written and presented and provides a very clear overall view of the surgical techniques of all aspects of knee reconstruction. In my view it is a book that should have a place in the library of any surgeon with an interest in knee surgery or any orthopaedic trainee aiming towards this.
It contains approximately chapters which are divided into different pathological entities and anatomical regions. A large number of distinguished authors have contributed and the aim of the book is to provide a step-by-step operative guide supported by relevant basic sciences and anatomy. The book covers both elective and traumatic conditions of bone and soft tissues in the hand and wrist.
The chapters follow a common structure, defining and classifying conditions, exploring the appropriate anatomy, the presenting complaints and physical findings, investigations, differential diagnoses and management, both non-operative and surgical. Where things differ from standard texts is that the surgical treatment is then discussed and illustrated, often with intra-operative photographs.
It provides step-by-step instructions on how to perform the operations with clear post-operative instructions. Median nerve deficits Indications In high-level injuries of the median nerve both extrinsic and intrinsic muscles of the forearm and hand, as well as the sensation on the volar-radial part of the hand, are affected and need restoration. In low-level injuries thumb, opposition and sensation in the 1st, 2nd, 3rd, and radial half of the 4th fingers are addressed for reconstruction.
The most common donor is the radial nerve and its branches to the supinator and ECRB. In case of isolated injuries to the anterior interosseous nerve AIN , intra-median nerve transfers have been described using intact branches of the median nerve which are redirected.
Motor nerve transfers Thumb opposition When available the AIN branch to the pronator quadratus is isolated and transferred to the motor branch of the thenar muscles [Figure 2]. The donor and recipient match well in size, but transfer requires a nerve graft which leads to the inevitable loss of some of the regenerating axons. In high-level injuries, ulnar nerve to median third lumbrical motor branch [ 39 ] or radial nerve to median motor branch to the extensor digiti minimi and extensor carpi ulnaris via interposition graft have been described, but results are uncertain and thus common tendon transfers might be considered instead.
Distal median nerve deficit. Transfer of the terminal branch of the anterior interosseous nerve to the motor branch to the thenar muscles, using an interpositional graft. AIN: Anterior interosseous nerve Schematic description A carpal tunnel incision is made to expose the median nerve and its motor branch at the level of the wrist.
The latter is gently isolated proximally as far as its fibers can be distinguished. The AIN and its branch to the pronator quadratus are then isolated with intramuscular dissection in order to obtain the maximal possible length. A nerve graft is usually necessary for a tension-free closure.
Although the number of axons matches well, the need for a nerve graft downgrades the level of outgrowth and, therefore, the actual potential for re-innervation. Pronator function The pronator teres function can be impaired in high median nerve injuries or secondary to an isolated deficit.
All surgical-related specialities (Anesthesiology, Neurosurgery, etc)
In case of isolated PT deficiency, an intra-median nerve transfer is planned using one of the branches to the FDS[ 40 ] sutured to the PT motor branch. Two main problems are faced: first, the lack of flexion in the thumb, index and the long fingers, and second, the loss of pronation. If there is a significant discrepancy in size, the branch to the supinator can also be included. In this case the AIN needs to be traced proximally in order to reach comfortably the motor branch to the supinator.
Operative techniques in orthopaedic surgery
High median nerve deficit. Transfer of the motor branch to extensor carpi radialis brevis to the anterior interosseous nerve. A lazy-S incision is made over the volar aspect of the mid-forearm, and the lacertus fibrosus is divided.
The tendon of the superficial part of the PT is lengthened to allow the muscle to be retracted, and the median nerve exposed. The AIN lies on the radial side of the median nerve and does not always course as a distinct fascicle.
A longitudinal vessel often demarcates it from the rest of the median nerve. Once isolated, it should be traced proximally to obtain enough length for a tension-free suture. The motor branch to the ECRB is then identified under the brachioradialis muscle, coursing close to the sensory branch of the radial nerve.
This is followed as distal as possible and then rotated toward the AIN. In case of a size mismatch, the radial nerve is isolated proximally in order to include the motor branch to the supinator, which in turn will reach the AIN if appropriate proximal dissection is completed. In lower brachial plexus injuries where both the median and ulnar nerve have been compromised, the AIN can be reinnervated by using the branch to brachialis muscle[ 43 ] or the branch to the brachioradialis muscle,[ 44 ] after both the donor and recipient are isolated for the necessary length at the elbow or a slightly proximal level.
Sensory nerve transfers Priority is given to the ulnar side of the thumb and the radial side of the index finger in order to re-establish functional pinch and grip.
Several donors can be considered depending upon their availability. The first choice includes the digital nerves to the fourth web space, innervated by the ulnar nerve[ 15 ] [Figure 4].
Operative Techniques in Hand, Wrist, and Forearm Surgery
An alternative is the dorsal sensory branch from the radial nerve to the thumb. Figure 4.
Sensory median nerve deficit. Transfer of the sensory branches from the ulnar nerve to the fourth web space to the sensory branches of the first web space Schematic description A carpal tunnel incision is made and prolonged distally in a zig-zag fashion toward both the first and the fourth interdigital spaces.
Deep to the superficial arterial arch and the digital arteries, the common digital nerves to the ulnar side of the ring finger and the radial side of the little finger are isolated, traced proximally, and divided as distally as possible.
The digital nerves to the first web space are then identified and isolated proximally in order to obtain enough length to be sutured to the donor nerves. The remainder of the sensory median nerve can then be divided proximally and coupled in an end-to-side fashion to the ulnar digital nerve of the 5th finger in order to restore protective sensation.
Ulnar nerve deficits Indications High-level nerve injuries lead to the loss of both grip and pinch strength in the hand, and sensation in the little finger and the ulnar side of the ring finger. Even following an early repair it is difficult to obtain a functional re-innervation of the intrinsic musculature, a fact which caused some authors to question the utility of surgical intervention at the site of lesion. Alternatively, the median nerve can provide motor and sensory branches in the forearm and hand that compensate for the ulnar nerve deficiency.
Motor If the median nerve is intact, the distal part of the AIN can re-innervate the distal motor component of the ulnar nerve [Figures 5 - 7 ]. Brown et al. Recently, Sukegawa et al.
The motor component of the ulnar nerve can be reached through a Taleisnik incision[ 58 ] which extends from the interthenar region proximal to the distal forearm. Once the point of divergence is identified, the motor nerve is followed proximally by blunt dissection. As reported by Sukegawa et al. Sharp dissection is then required for an average of 19 mm.
A longitudinal vascular bundle usually separates the motor from the sensory part of the ulnar nerve.The chapters are mostly well illustrated with clinical intra-operative photographs, although some rely on illustrations. Traumatic brachial plexus injuries.
Written by experts from leading institutions around the world, this superbly illustrated volume focuses on mastery of operative techniques and also provides a thorough understanding of how to select the best procedure, how to avoid complications, and what outcomes to expect.
In cases in which surgical exploration is difficult secondary to a previous extensive injury, distal nerve transfer, will shorten the time to re-innervation and avoid nerve repair in a highly fibrotic bed. Based on a thorough understanding of the functional anatomy of the hand and wrist, the surgeon is able to choose the surgical approach to the hand and wrist with care to correctly expose the underlying anatomical structures.
Chapters then progress through other approaches, biomechanics and bearing surfaces, component design, cemented versus uncemented TKA, patellar resurfacing, pain management, unicondylar arthroplasty and patient factors. Figure 1. Battiston and Lanzetta[ 53 ] described the use of the palmar sensory branch of the median nerve to the sensory component of the ulnar nerve.
Each clinical problem is discussed in the same format: