Faculty Bibliography

Severe compressive trauma to the hand presents with multiple soft-tissue and osseous manifestations that often appear unrelated, leading to underrecognition and potential undertreatment of the complex injuries. Approaching the crushed hand with a logical and systematic diagnostic plan allows surgeons to recognize the location and severity of the injury portfolio and direct comprehensive treatment. Both for emphasis and for the purpose of describing the hydraulic mechanism of tissue failure, the term exploded hand syndrome is proposed. The exploded hand connotes the compendium of clinical findings that include skin failure at the webspaces or glabrous border, atypical (usually longitudinal) fracture patterns of the tubular bones, and axial carpal dissociations. These are accompanied by extensive compromise of the interosseous musculature that is extruded or may exhibit evolving compartment syndrome. Understanding the trauma mechanism and patterns of injury in the exploded hand will maximize awareness and guide surgical reconstruction and rehabilitation.

Severe degeneration in the wrist of a rheumatoid patient remains a troublesome problem to handle. Concomitant upper extremity arthrosis, bilateral occurrence of wrist disease, and the need to maintain function for weight bearing and fine motor skills all factor into the surgeon's and patient's decision for surgical intervention. Total wrist arthrodesis with plate fixation remains an excellent choice for pain relief and for maintenance of the functional sphere provided by the upper extremity. Plate fixation adds the benefits of a decreased risk for complications and greater ease of wrist positioning for the surgeon. Other procedures, such as the Nalebuff and Feldon modified technique of intramedullary pinning, may be advantageous, however, in the case of a rheumatoid patient whose soft tissue envelope could lead to complications with plate fixation. © 2005 Elsevier Inc. All rights reserved.

Purpose of review: Replacement of the fractured radial head and neck with metallic implants has experienced a renaissance. Clinically and biomechanically, this form of treatment has been demonstrated to yield acceptable range of motion, stability, and durability. The current status of radial head replacement and the future direction of clinical and scientific development are reviewed to update the student of sophisticated elbow surgery and assist in surgical decision making. Recent findings: An expanding clinical experience with more anatomic, modular implants has now been reported in the literature. Material science and laboratory kinematic analysis of the implants are assisting the surgeon in determining optimal morphology and placement of the prosthesis. Although at times conflicting, recent contributions have begun to better define the roles of resection, fixation, and replacement of the fractured radial head. Advances have been made in both technology and technique in regard to employing radial head implant arthroplasty. Summary: Radial head implant arthroplasty has emerged as not only an acceptable but in some reports a superior alternative to simple resection or even osteosynthesis. Despite greater coverage and scrutiny, questions and challenges face the elbow surgeon when considering whether or how to employ a radial head implant. Outcomes will be maximized by selecting the right implant designs and employing them in the proper circumstances. © 2005 Lippincott Williams & Wilkins.