Faculty Bibliography

Fractures and nonunions of the scaphoid are common and can present specific challenges for both diagnosis and treatment. We review the anatomy, cause, presentation, and various treatment options that may be considered by the surgeon, with a concentration on newer techniques.

Traditionally, complex wrist injuries were identified and characterized on the basis of observation of bony injury and presumption of soft tissue embarrassment, followed by employment of a classification scheme or cumbersome nomenclature. The extent of tissue compromise was often underestimated, leading to undertreatment and inferior results. This paper encourages physicians to think more mechanistically about the pattern of injury by relying on the concept of "transverse" force transmission to identify the global extent of wrist trauma. By employing a basic understanding of the components of the wrist "system" and superimposing the flow of energy through it, one can better grasp these complex topics. The standard "greater arc" and "lesser arc" injuries are explained in this context. Another recognizable injury pattern in the transverse instability spectrum, that of the "inferior arc," is introduced, along with clues for its identification. The large fragment and small fragment fracture variants of the inferior arc injury are emphasized, and their significance is described. Basic evaluation and treatment recommendations for inferior arc injuries are offered.

The limited-incision carpal tunnel release provides an effective, reliable, and safe method for decompression of the median nerve at the wrist. The technique minimizes risk of complication through the design of the instruments and the conceptual approach to the anatomy and surgical exposure. This method combines the reduced postoperative pain and quicker recovery of the ECTR technique with the safety and lower operative expense of the conventional open technique.

The limited incision carpal tunnel release provides an effective, reliable, and safe method for decompression of the median nerve at the wrist. The technique described above minimizes risk of complication through the design of the instruments and conceptual approach to the anatomy and surgical exposure. This method combines the reduced postoperative pain and quicker recovery of the ECTR technique with the safety and lower operative expense of the conventional open technique.