Surgery of Traumatic Hand – Collection of Articles for Residents

by Nicole Phillips, MD

Each article included in the Resident Reader: Traumatic Hand section is appropriate for both initial investigation as well as review; as such, they are likely to benefit residents at every level of training. Details of each study are outlined below:

The authors of Flexor Tendon Repair, Rehabilitation, and Reconstruction present a complete view of all elements of flexor tendon injury and repair, from the initial diagnosis of injury and decision to pursue surgical repair through the postoperative rehabilitation period. This article provides an excellent overview of current trends in flexor tendon repair and a comprehensive reference list that would be of great benefit to anyone interested in further reading on the topic.  One of the authors is an occupational therapist, and a unique strength of this article is the detailed review of postoperative splinting and rehabilitation protocols provided.

In Practical Management of Tendon Disorders of the Hand, Farnebo and Chang present a succinct overview of tendon pathology ranging from common tendinopathies to traumatic injuries. Each of these discussions involves a careful review of the existing literature and condenses the findings of other studies into an overview of diagnosis, treatment options, and published outcomes. Additionally, the authors provide commentary related to their own experience and highlight new developments in the field. Excellent graphics and video content accompany the text.

Best encapsulated by the color flowchart which accompanies the article, Soft-tissue injuries of the fingertip: methods of evaluation and treatment delivers on the promise of the second half of its title: An algorithmic approach. The authors open with a discussion on fingertip anatomy and the elements necessary to conduct a proper evaluation of these commonly-seen injuries. Classification of wounds is discussed and forms the basis for treatment recommendations. The authors take care to highlight patient factors that may influence treatment options, as well as the importance of surgeon experience with different procedures and the ability to achieve reliable results.

The complex anatomy of the extensor system is rendered more accessible in Extensor tendon injuries: acute management and secondary reconstruction. An in-depth discussion of the various components of the extensor system is accompanied by medical illustrations and photographs of cadaver dissections, allowing the reader a comprehensive understanding of the interplay between the various anatomic elements at work. Extensor tendon injuries are then examined by zone. As with the first article reviewed, one of the authors is an occupational therapist, and a useful description of splinting and movement protocols accompanies the discussion on the acute management of injuries.

Emphasizing the goal of restored motion after treatment, the authors of Common Fractures and Dislocations of the Hand examine both the injuries presented as well as the treatment options available. While a broad range of topics is covered, the opening paragraph provides a summation of the basic approach to all fracture-dislocation injuries of the hand. These decision points form the background against which the remainder of the presented material should be considered. The authors carefully present the treatment options and associated long-term follow-up that has been supported by the literature. Supplemental videos support the text.

Chin and Vedder offer a comprehensive examination of metacarpal fractures in their CME article. Anatomy, radiography, and fracture patterns are discussed, as are the management options for specific injuries. Principles of diagnosis and treatment are supported by “before and after” radiographs which accompany the text.

 

All articles discussed can be conveniently found on the Residents’ Gateway homepage in the Traumatic link under the Hand section of the “The Resident Reader: Articles that Will Heighten Your Surgical Skills.”

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