WP Chung_OT in Hand and Wrist Surgery_9781975127374

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Operative Techniques in Hand and Wrist Surgery FIRST EDITION Publishes May 2019 SAMPLE CHAPTER PREVIEW

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When you have to be right

Operative Techniques in Hand and Wrist Surgery FIRST EDITION

ISBN Price

978-1-9751-2737-4 £195.00 / €220.00

Part of the best-selling Operative Techniques series, Operative Techniques in Plastic Surgery provides superbly illustrated, authoritative guidance on operative techniques along with a thorough understanding of how to select the best procedure, how to avoid complications and what outcomes to expect. This stand-alone book offers focused, easy-to-follow coverage of the hand and wrist, all taken directly from the larger text. It covers nearly all plastic surgery operations for these specific areas that are in current use, and is ideal for residents and physicians in daily practice.

Features include: Comprehensively covers anesthesia and emergency procedures; hand fractures and dislocations; wrist fractures and carpal instability; rheumatoid arthritis; degenerative disease, nerve conditions; tendon conditions, flaps and microsurgery; congenital hand disorders; tumors; and much more.

Perfect for a quick preoperative review of the steps of a procedure.

Contains thoroughly revised, clinically-focused information, including a new chapter on violence against women and sexual assault.

Each clinical problem is discussed in the same templated format: definition, anatomy, patient history and physical findings, imaging, differential diagnosis, nonoperative management where applicable, surgical management including preoperative planning and approach, step-by-step surgical techniques, pearls and pitfalls, postoperative care, outcomes, complications and references.

Published April 2019 Sample Chapter Preview

When you have to be right

Operative Techniques in Hand and Wrist Surgery

Kevin C. Chung, MD, MS EDITOR-IN-CHIEF EDITOR, HAND AND WRIST Chief of Hand Surgery, Michigan Medicine Director, University of Michigan Comprehensive Hand Center Charles B. G. de Nancrede Professor of Surgery Professor of Plastic Surgery and Orthopaedic Surgery

Assistant Dean for Faculty Affairs Associate Director of Global REACH University of Michigan Medical School Ann Arbor, Michigan

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Contributors

Jason H. Ko, MD Associate Professor Division of Plastic and Reconstructive Surgery Department of Orthopedic Surgery Feinberg School of Medicine Northwestern University Chicago, Illinois Emily Krauss, MD, MSc, FRCSC Clinical Instructor University of British Columbia and the University of Victoria Victoria, British Columbia, Canada Brian I. Labow, MD, FACS, FAAP Associate Professor of Surgery John R. Lien, MD Assistant Professor Department of Orthopaedic Surgery and Section of Plastic Surgery University of Michigan Health System Ann Arbor, Michigan Angelo B. Lipira, MD, MA Assistant Professor of Plastic and Reconstructive Surgery Oregon Health & Science University Portland, Oregon Jacques A. Machol IV, MD Plastic, Hand, and Microsurgery Department of Plastic Surgery Southern California Permanente Medical Group West Los Angeles & Los Angeles Medical Centers Clinical Assistant Professor Division of Plastic Surgery University of Southern California Los Angeles, California Mary Claire Manske, MD Pediatric Hand and Upper Extremity Surgery Department of Orthopaedic Surgery Shriners Hospital for Children Northern California University of California Davis Sacramento, California Harvard Medical School Boston Children’s Hospital Boston, Massachusetts

Kate Elzinga, MD, FRCSC Plastic Surgeon Department of Surgery University of Calgary Calgary, Alberta, Canada John M. Felder, MD Assistant Professor of Surgery Division of Plastic Surgery Washington University in St. Louis St. Louis, Missouri John R. Fowler, MD Assistant Dean for Medical Student Research Assistant Professor, Department of Orthopaedics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Thomas B. Hughes, MD Clinical Associate Professor of Orthopaedic Surgery Orthopaedic Specialists, UPMC School of Medicine Matthew L. Iorio, MD Associate Professor Co-Director of Hand Surgery, & Extremity Microsurgery Associate Program Director Division of Plastic Surgery University of Colorado Hospital Aurora, Colorado Robert A. Kaufmann, MD Associate Professor, Orthopaedics University of Pittsburgh Pittsburgh, Pennsylvania

Sonya Paisley Agnew, MD Assistant Professor Loyola University Medical Center Chicago, Illinois Shoshana W. Ambani, MD Plastic Surgeon Medical Director of Plastic Surgery Henry Ford Allegiance Hospital

Jackson, Michigan Neal C. Chen, MD Assistant Professor Harvard Medical School Interim Chief

Department of Orthopaedic Surgery Hand and Upper Extremity Service Massachusetts General Hospital Boston, Massachusetts Kevin C. Chung, MD, MS Chief of Hand Surgery, Michigan Medicine Director, University of Michigan Comprehensive Hand Center Charles B. G. de Nancrede Professor of Surgery Professor of Plastic Surgery and Orthopaedic Surgery Assistant Dean for Faculty Affairs Associate Director of Global REACH University of Michigan Medical School Ann Arbor, Michigan Rafael J. Diaz-Garcia, MD Attending Surgeon Medical Operations Officer Department of Surgery Allegheny Health Network Clinical Assistant Professor Department of Plastic Surgery University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Kyle R. Eberlin, MD Assistant Professor of Surgery Associate Director, MGH Hand Surgery Fellowship Division of Plastic and Reconstructive Surgery Massachusetts General Hospital

University of Pittsburgh Pittsburgh, Pennsylvania

Grant M. Kleiber, MD Assistant Professor

Department of Plastic Surgery MedStar Georgetown University Hospital Washington, District of Columbia

Harvard Medical School Boston, Massachusetts

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vii

Contributors

Amir H. Taghinia, MD, MPH, MBA Assistant Professor of Surgery Harvard Medical School Staff Surgeon Department of Plastic and Oral Surgery Boston Children’s Hospital Boston, Massachusetts Richard Tosti, MD Hand, Wrist, Elbow, and Microvascular Surgeon Philadelphia Hand to Shoulder Center Assistant Professor of Orthopaedic Surgery Chestnut Hill, Massachusetts Mark A. Vitale, MD, MPH ONS Foundation for Clinical Research and Education, ONS, P.C. Greenwich, Connecticut David Wei, MD Attending Orthopaedic Surgeon Department of Orthopaedic Surgery Greenwich Hospital, Yale-New Haven Health ONS Foundation for Clinical Research and Education, ONS, P.C. Greenwich, Connecticut Thomas Jefferson University King of Prussia, Pennsylvania Joseph Upton, MD Clinical Professor for Surgery Harvard Medical School

Paymon Rahgozar, MD Assistant Professor Division of Plastic and Reconstructive Surgery University of California San Francisco San Francisco, California Patrick Reavey, MD, MS Assistant Professor Section of Plastic and Reconstructive Surgery Department of Surgery Department of Orthopedic Surgery and Rehabilitation University of Chicago Medicine Chicago, Illinois James T. W. Saunders, BSc, MD, FRCSC Division Head of Plastic and Reconstructive Surgery Lions Gate Hospital, North Vancouver Clinical Professor at the University of British Columbia North Vancouver, British Columbia, Canada Ketan Sharma, MD, MPH Resident Physician Barnes-Jewish Hospital Washington University St. Louis St. Louis, Missouri Michael Smith, MD Director of Hand and Upper Extremity Surgery Grandview Medical Center Birmingham, Alabama

Amy M. Moore, MD Assistant Professor of Surgery Chief, Section of Hand Surgery Program Director, Hand, Nerve and Microsurgery Fellowship Washington University School of Medicine St. Louis, Missouri Mark Morris, MD Joseph H. Boyes Hand Surgery Fellow University of Southern California Los Angeles, California Shelley S. Noland, MD Hand & Peripheral Nerve Surgery, Division of Plastic Surgery Assistant Professor, Plastic & Orthopedic Surgery Associate Program Director, Division of Plastic Surgery Mayo Clinic College of Medicine Phoenix, Arizona Donato Perretta, MD Orthopedic Surgery Hand Surgery Private Practice New York Presbyterian—Hudson Valley Hospital

Cortlandt, New York Joseph Pirolo, MD Orthopaedic Surgeon Seattle, Washington

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Contents

12 Hemihamate Arthroplasty for the Proximal Interphalangeal Joint Fracture Dislocation 70 David Wei, Mark A. Vitale, and Amy M. Moore 13 Thumb Carpometacarpal Joint Fusion With Locking Plates 79 John M. Felder and Amy M. Moore SECTION IV WRIST FRACTURES AND CARPAL INSTABILITY 14 Arthroscopic Examination of the Wrist 87 Emily Krauss and Amy M. Moore 15 Ligament Reconstruction for Chronic Scapholunate Dissociation 99 Mark Morris and Kevin C. Chung 16 Lunotriquetral Ligament Reconstruction Using a Slip of the Extensor Carpi Ulnaris Tendon 105 Mark Morris and Kevin C. Chung 17 Fixation of Acute Scaphoid Fractures 113 Ketan Sharma, James T. W. Saunders, and Amy M. Moore 18 Scaphoid Nonunion: Nonvascularized Bone Reconstruction 121 Matthew L. Iorio and Jason H. Ko 19 Scaphoid Fracture Nonunion: Vascularized Bone Reconstruction 128 Matthew L. Iorio and Jason H. Ko 20 Open Reduction and Fixation of Acute Perilunate Fracture Dislocation 137 Grant M. Kleiber and Amy M. Moore 21 Dorsal Capsulodesis for Scapholunate Stabilization With Extensor Carpi Radialis Longus Tenodesis 147 Mark Morris and Kevin C. Chung 22 Proximal Row Carpectomy 153 Patrick Reavey and Amy M. Moore

Contributors vi Preface viii

SECTION I ANESTHESIA AND EMERGENCY PROCEDURES 1 Anesthesia and Emergency Procedures 2 John R. Lien and Kevin C. Chung 2 Fasciotomy for Compartment Syndrome of the Hand and Forearm 8 John R. Lien and Kevin C. Chung 3 Revision Amputation and Shortening of the Digit 14 John R. Lien and Kevin C. Chung 4 Drainage of Septic Flexor Tenosynovitis 19 John R. Lien and Kevin C. Chung SECTION II HAND FRACTURES AND DISLOCATIONS 5 Distal Phalanx Fractures 23 John R. Fowler and Thomas B. Hughes 6 Proximal Phalanx Fractures 28 John R. Fowler 7 Metacarpal Shaft Fractures 35 John R. Fowler and Thomas B. Hughes 8 Open Reduction for Carpometacarpal Joint Dislocation 44 John R. Fowler and Robert A. Kaufmann 9 Reconstruction of Acute and Chronic Ulnar Collateral Ligament Injuries of the Thumb 50 John R. Fowler and Robert A. Kaufmann 10 Closed Reduction and Fixation of Bennett and Rolando Fractures 58 John R. Fowler and Thomas B. Hughes

SECTION III JOINTS 11 Volar Plate Arthroplasty of the Proximal Interphalangeal Joint 64 James T. W. Saunders and Amy M. Moore

SECTION V DISTAL RADIUS FRACTURES 23 Distal Radius Fractures 161 Shoshana W. Ambani and Kevin C. Chung

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Contents

39 Staged Flexor Tendon Grafting and Pulley Reconstruction 313

SECTION VI RHEUMATOID ARTHRITIS 24 Rheumatoid Arthritis of the Hand and Wrist 179 Shoshana W. Ambani and Kevin C. Chung SECTION VII DEGENERATIVE DISEASE 25 Degenerative Disease of the Hand and Wrist 204 Shoshana W. Ambani and Kevin C. Chung

Richard Tosti, Jacques A. Machol IV, and Neal C. Chen

40 Tenolysis of Flexor Tendons 321

Richard Tosti, Jacques A. Machol IV, and Neal C. Chen 41 Acute Repair of Extensor Tendon Injuries in Zones I to VI 326 Michael Smith, Jacques A. Machol IV, and Neal C. Chen 42 Stabilization of Extensor Carpi Ulnaris Tendon Subluxation With Extensor Retinaculum 333 Michael Smith, Jacques A. Machol IV, and Neal C. Chen 43 Trigger Finger Release 338 Donato Perretta, Jacques A. Machol IV, and Neal C. Chen 44 First Dorsal Compartment (de Quervain) Release 341 Donato Perretta, Jacques A. Machol IV, and Neal C. Chen SECTION X FLAPS AND MICROSURGERY 45 Flap Coverage of Fingertip Injuries 344 Kate Elzinga and Kevin C. Chung 46 Flap Coverage of Thumb Defects 353 Kate Elzinga and Kevin C. Chung 47 Reverse Flow Radial Forearm Flap 362 Kate Elzinga and Kevin C. Chung 48 Ulnar Artery Perforator Flap 368 Kate Elzinga and Kevin C. Chung 49 Posterior Interosseous Artery Flap 374 Kate Elzinga and Kevin C. Chung 50 Free Lateral Arm Flap 382 John R. Lien and Kevin C. Chung 51 Pedicled and Free Groin Flap 385 Mark Morris and Kevin C. Chung 52 Free Anterolateral Thigh Flap 392 John R. Lien and Kevin C. Chung 53 Revascularization and Replantation of Digits 395 Mark Morris and Kevin C. Chung 54 Digital Artery Sympathectomy 404 John R. Lien and Kevin C. Chung 55 Ulnar Artery to Superficial Arch Bypass With a Vein Graft for Ulnar Artery Thrombosis 408 Mark Morris and Kevin C. Chung

SECTION VIII NERVE CONDITIONS 26 Carpal Tunnel Release 225 Angelo B. Lipira and Jason H. Ko 27 Ulnar Tunnel Syndrome 234

Mary Claire Manske and Jason H. Ko 28 Cubital Tunnel Syndrome 240 Mary Claire Manske and Jason H. Ko 29 Radial Tunnel Decompression 248 Joseph Pirolo and Jason H. Ko 30 Primary Nerve Repair and Nerve Graft for Traumatic Nerve Injuries 252 Sonya Paisley Agnew and Jason H. Ko 31 Tendon Transfers for Median Nerve Injury 260 Rafael J. Diaz-Garcia and Kevin C. Chung 32 Tendon Transfers for Ulnar Nerve Injury 267 Rafael J. Diaz-Garcia and Kevin C. Chung 33 Tendon Transfers for Radial Nerve Injury 273 Rafael J. Diaz-Garcia and Kevin C. Chung 34 Tendon Transfers for Combined Median and Ulnar Nerve Injury 280 Kate Elzinga and Kevin C. Chung 35 Distal Anterior Interosseous Nerve Transfer to Motor Branch of Ulnar Nerve 291 Shelley S. Noland and Jason H. Ko 36 Nerve Transfers for High Radial Nerve Palsy 296 Shelley S. Noland and Jason H. Ko SECTION IX TENDON CONDITIONS 37 Acute Repair of Flexor Tendon Injuries 302 Jacques A. Machol IV, Neal C. Chen, and Kyle R. Eberlin 38 Repair of Multiple Flexor Tendon Injury at Wrist Zone V (Spaghetti Wrist) 309 Jacques A. Machol IV, Neal C. Chen, and Kyle R. Eberlin

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Contents

56 Second Toe to Thumb Transfer 416 John R. Lien and Kevin C. Chung

67 Second Toe-to-Thumb Transfer for Hypoplastic Thumb 498 Amir H. Taghinia, Brian I. Labow, and Joseph Upton 68 Reconstruction of Amniotic Constriction Bands 507 Amir H. Taghinia 69 Centralization for Radial Longitudinal Deficiency 514 Amir H. Taghinia, Brian I. Labow, and Joseph Upton 70 Excision of Vascular Malformation of the Hand 523 Amir H. Taghinia SECTION XIV TUMORS 71 Lumps and Bumps of the Hand and Wrist 528 Paymon Rahgozar and Kevin C. Chung 72 Excision of Glomus Tumors 535 Paymon Rahgozar and Kevin C. Chung 73 Excision of Hemangioma of the Hand 539 Paymon Rahgozar and Kevin C. Chung 74 Excision of Metacarpal Enchondroma 543 Paymon Rahgozar and Kevin C. Chung 75 Excision of Peripheral Nerve Schwannoma 547 Paymon Rahgozar and Kevin C. Chung 76 Excision of Malignant Skin Tumors 551 Paymon Rahgozar and Kevin C. Chung Index 557

SECTION XI DUPUYTREN DISEASE 57 Dupuytren Contracture 424 John R. Lien and Kevin C. Chung

SECTION XII SPASTIC CONDITIONS 58 Elbow Extension Procedures 434 Paymon Rahgozar and Kevin C. Chung 59 Wrist Extension Procedures 444 Paymon Rahgozar and Kevin C. Chung 60 Finger Extension Procedures 449 Paymon Rahgozar and Kevin C. Chung 61 Lateral Key Pinch Reconstruction 454 Paymon Rahgozar and Kevin C. Chung 62 Grasp Improvement Procedures 458 Paymon Rahgozar and Kevin C. Chung SECTION XIII CONGENITAL HAND DISORDERS 63 Release of Finger Syndactyly Using Dorsal Rectangular Flap 464 Amir H. Taghinia 64 Hypoplastic Thumb Reconstruction 473 Amir H. Taghinia 65 Reconstruction of Radial Polydactyly 482 Amir H. Taghinia 66 Index Finger Pollicization for Hypoplastic Thumb 491

Amir H. Taghinia, Brian I. Labow, and Joseph Upton

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1 Section I: Anesthesia and Emergency Procedures Anesthesia and Emergency Procedures

C H A P T E R

John R. Lien and Kevin C. Chung

DEFINITION

■■ Wrist and digital blocks are essential for patient anesthe- sia in the operating room and during emergency room procedures. ■■ Nerve blocks assist with postoperative pain control. ■■ Wide-awake local anesthesia no tourniquet (WALANT) involves local injection of epinephrine with lidocaine for hemostasis and anesthesia instead of applying a tourniquet and sedation. This technique is useful for minor hand pro- cedures as well as tendon surgery.

ANATOMY

■■ Median nerve ■■

Palmaris longus tendon

At the distal forearm/wrist, the median nerve lies between the palmaris longus (PL) and flexor carpi radialis (FCR) tendons ( FIG 1 ). ■■ The palmar cutaneous branch (PCB) usually passes sub- cutaneously between the FCR and PL tendons.

Flexor carpi ulnaris tendon

Ulnar nerve Ulnar artery

FIG 2 • Ulnar neurovascular bundle anatomy at volar wrist.

■■ Ulnar nerve ■■ At the wrist level, the ulnar nerve is radial and dorsal to the flexor carpi ulnaris (FCU) tendon ( FIG 2 ). ■■ The ulnar artery is adjacent to the radial aspect of the ulnar nerve. ■■ The dorsal cutaneous branch (DCB) originates from the ulnar nerve approximately 5 cm proximal to the ulnar styloid. It crosses from palmar to dorsal near the styloid process. 1 ■■ Superficial branch of the radial nerve ■■ The superficial branch of the radial nerve (SBRN) becomes subcutaneous approximately 9 cm proximal to the radial styloid. 2 ■■ At the radial styloid, there are two to three branches of the SBRN in the subcutaneous tissue ( FIG 3 ). ■■ Digital nerves ■■ Four nerve branches (two palmar, two dorsal) provide sensation to each digit. ■■ The common digital nerves bifurcate to the proper digital nerves at the level of the distal palmar crease.

Palmaris longus tendon

Palmar cutaneous branch

Flexor carpi radialis tendon

Median nerve

FIG 1 • Median nerve anatomy at volar wrist.

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Chapter 1 Anesthesia and Emergency Procedures

Ulnar nerve

Median nerve

Dorsal cutaneous branch of ulnar nerve

Styloid of radius

Superficial radial nerve

FIG 4 • Dorsal hand sensory innervation.

FIG 3 • Superficial branch of the radial nerve anatomy at the radial wrist.

Positioning

■■ Whether the procedure is in the operating room or emergency department, the patient should lie comfort- ably supine to minimize patient movement during the procedure. ■■ Hand table or Mayo stand. Approach Volar subcutaneous approach: This is our preferred tech- nique as it only requires one injection and is shown to be less painful than the transthecal approach. 4 ■■ Dorsal transmetacarpal approach ■■ Transthecal approach ■■ Wrist block ■■ Median nerve ■■ Ulnar nerve ■■ Superficial branch of radial nerve ■■ WALANT ■■ Use 1% lidocaine with 1:100 000 epinephrine ■■ Buffer the lidocaine and epinephrine in a 10:1 ratio with 8.4% sodium bicarbonate ■■ Allow adequate time for the vasoconstrictive effect of epi- nephrine to take effect (25 minutes). 5 ■■ Volume of injection depends on the site of surgery ( FIG 5 ). 6 ■■ Digital block ■■

■■ The dorsal digital nerves of the thumb and small finger extend to the tip of the dorsal digit. ■■ The volar digital nerves supply dorsal sensation distal to the proximal interphalangeal joint in the index, middle, and ring fingers ( FIG 4 ).

SURGICAL MANAGEMENT Preoperative Planning

Materials ■■ Syringe ■■

■■

27-gauge needle ■■ Commonly used local anesthetic agents and additives ●● Lidocaine is commonly used due to its rapid onset (within 2–5 minutes of injection) and medium duration of action (2 hours for digital block). 3 ●● Bupivacaine has a slower onset of action (5–10 minutes) but longer duration of action (12 hours for digital block). 3 ●● Epinephrine additive induces vasoconstriction, which promotes hemostasis, prolongs duration of anesthesia, and reduces the systemic toxicity of the local anesthetic agent. ●● Sodium bicarbonate 8.4% additive buffers the low pH of lidocaine, decreasing injection pain.

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Operative Techniques in Plastic Surgery: Hand and Wrist

1 mL

2 mL

1 mL

2 mL

2 mL 2 mL

2 mL

1 mL

2 mL

10 mL

1 mL

5 mL 5 mL

2 mL

5 mL

2 mL

5 mL

2 mL

10 mL

FIG 5 • Palmar (A) and dorsal (B) hand injection volumes.

■■ Digital Nerve Block Volar Subcutaneous Block T E C H N I Q U E S

sheath (see FIG 5A ). If there is significant resistance to injection, withdraw the needle slightly.

■■ Insert a 27-gauge needle at the distal palmar crease at the level of the A1 pulley ( TECH FIG 1 ). ■■ Inject 3 mL of local anesthetic into the subcutaneous tis- sue. The anesthetic should cause tumescence and flow of anesthetic solution radial and ulnar to the flexor tendon

Dorsal Transmetacarpal Block

■■ Identify the metacarpal head of the digit of interest. ■■ At this level, introduce a 27-gauge needle from the dorsal web space and advance toward the palm ( TECH FIG 2 ).

Flexor tendon

TECH FIG 1 • Middle finger volar subcutaneous block. Note tumescence radial and ulnar to the flexor tendon sheath in A . Note the needle is in the subcutaneous tissue superficial to the flexor tendon sheath in B .

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Chapter 1 Anesthesia and Emergency Procedures

T E C H N I Q U E S

TECH FIG 2 • Dorsal transmetacarpal block.

■ Inject 2 mL of local anesthetic into the radial and ulnar web space to anesthetize each digital nerve. Periodically aspirate the syringe to prevent intravascular injection. Transthecal Digital Block ■■ Palpate the flexor tendon sheath at the palmar digital crease.

■ Insert a 25-gauge needle through the flexor tendon at this level until contact with bone. ■ After bone contact, slowly withdraw the needle with gentle pressure on the syringe ( TECH FIG 3 ). ■ When the needle is withdrawn 1 to 2 mm, anesthetic will enter the sheath. ■ Inject 2 mL of local anesthetic.

Digital nerve

Flexor digitorum profundus tendon Flexor digitorum superficialis tendon

Digital artery

Extensor digitorum tendon

TECH FIG 3 • A. Transthecal digital block. B. Cross-section view.

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Notes:

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