Faculty Bibliography

Proximal interphalangeal (PIP) joint fracture dislocations are challenging injuries to treat. Multiple and varied treatments have been proposed. We present the use of cerclage wiring as a helpful technique in these challenging scenarios. The technique has the benefit of securing fracture fragments from the volar or dorsal base of middle phalanges or a comminuted fracture involving the entire articular surface. We report on the use of cerclage wires in eight patients (average: 43 years of age). Three patients had volar base fractures, three dorsal base fractures, and two impacted fractures involving the entire articular surface. All fractures healed, and average postoperative PIP active flexion motion arc was 21° to 95° (functional arc of 74°). We believe cerclage wire fixation is an effective and reproducible method to treat intra-articular fractures of middle phalanges, especially comminuted fractures involving the entire articular surface, and should be available to hand surgeons treating these difficult injuries.

PURPOSE: To describe the features of displaced intra-articular fractures confined to the volar rim of the distal radius and compare outcomes after their operative fixation to complete intra-articular and extra-articular fractures treated with operative fixation. METHODS: A total of 627 distal radius fractures were treated over a 6-year period. Twenty-eight patients had volar rim fractures (type 23-B3, as classified by the Orthopaedic Trauma Association [OTA]), all treated with operative reduction and fixation using a volar buttress plate. Clinical outcome information including radiographs, Short Form-36 health survey, and Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at regular postoperative intervals. Patients with volar rim fractures were compared with patients who sustained other types of operatively managed distal radius fractures (OTA types 23-A, 23-B1/B2, and 23-C). RESULTS: The most common type of volar rim fracture consisted of a single large fragment (OTA 23-B3.2; 46%), followed by comminuted fractures (OTA 23-B3.3; 36%). Restoration of radiographic parameters was similar between groups except for an increased volar tilt in volar rim fractures compared with group 23-B1/B2. Active wrist and finger motion improved in all groups except for wrist extension, which was less in the 23-B1/B2 groups. The 23-B1/B2 group had the greatest pain and worst Short Form-36 scores. Disabilities of the Arm, Shoulder, and Hand questionnaire scores were similar and without differences between groups. CONCLUSIONS: Our data suggest that patients with volar rim distal radius fractures can expect a rapid return to function with minimal risk for complications and have outcomes similar to other types of operatively treated distal radius fractures. Further investigation of type 23-B fractures (23-B1/B2) is warranted owing to evidence of diminished outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Hand transplantation is a treatment option for complex injuries that leave patients with structural, functional, and aesthetic deficits that cannot be addressed by other means. It is a form of vascularized composite tissue allotransplantation (CTA). CTA is the highest rung the reconstructive ladder due to its complex technical and immunologic challenges. Despite completion of the first successful hand transplant in 1999, our understanding of hand transplantation is still evolving. Ongoing research is needed to improve functional outcomes and decrease the morbidity associated with long-term immunosuppression. This review will discuss the current protocols for upper extremity donation, transplant receipt, surgical technique, postoperative rehabilitation and immunosuppression, nerve regeneration, functional outcomes, ethical issues, and financial considerations.

Injuries to the finger extensor apparatus are very common and may produce chronic deformity and loss of function. Diagnosis is contingent on an understanding of the complex anatomy of this region as well as the ability to perform a careful physical examination. Immobilization is usually the most effective treatment of acute problems. Surgery is often necessary for chronic conditions, but the results are much less predictably corrective.

Opposition is not grasp but a preposition for grasp that involves 3 components of thumb movements: abduction, flexion, and pronation. Thumb opposition is usually lost with paralysis of the thenar muscles innervated by the median nerve. Many opposition transfers have been described that differ in the donor tendon, route of transfer, and method of attachment to the thumb. No one transfer is applicable for every clinical condition, and each transfer has its advantages and disadvantages. Many factors must be evaluated to decide if surgery is likely to be beneficial and then decide on the optimum treatment

Benign extraosseous cartilage tumours of the hand and wrist comprise soft tissue chondromas, synovial chondromatosis and tenosynovial chrondromatosis. These tumours can significantly affect patients as they are often painful, functionally limiting and cosmetically displeasing. Although each tumour is generally considered to be a distinct entity, they share radiological and histopathological similarities. Occasionally, all three tumours may be seen in the same patient. This is an important consideration because of the risk of recurrence that may not necessarily occur at the same anatomical site but instead extend to different sites, such as a tendon sheath and/or joint

PURPOSE: The radiographic parameters commonly used for evaluating distal radius fractures are radial length, palmar tilt, radial inclination, and articular congruity. Rotation of the distal fragment is not routinely evaluated after distal radius fractures. The purpose of this study was to define the appearance of distal fragment malrotation on conventional radiographs and to correlate varying degrees of malrotation with the corresponding radiographic findings. METHODS: Six distal radiuses from embalmed cadavers were cut and stabilized in 10 degrees, 20 degrees, and 30 degrees of pronated malrotation. Posteroanterior, lateral, and oblique (45 degrees pronated view) radiographs were taken and radiographic measurements were made of radial length, palmar tilt, radial inclination, and rotation. RESULTS: With malrotation, the visible cortical width of the distal fragment mismatched the visible cortical width of the proximal fragment. This was most evident on the oblique view (p < .05) and measured 2.2 mm for 10 degrees of rotation (standard deviation [SD] 0.6), 3.4 mm for 20 degrees of rotation (SD 0.8), and 5.3 mm for 30 degrees of rotation (SD 2.2). CONCLUSIONS: The radiographic parameter of rotation should be considered when evaluating distal radius fracture reduction. Malrotation is best seen on a 45 degrees oblique pronated radiographic view as a mismatch of the cortical width of the distal fragment compared with the cortical width of the proximal fragment. In the absence of radial shortening, a 5.3-mm mismatch is associated with 30 degrees of malrotation and is the upper limit of acceptability