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About the Authors
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Dr. Andrew J. Weiland is an attending orthopedic surgeon at the
Hospital for Special Surgery. He is currently professor of Orthopedic
Surgery and professor of Surgery (Plastic) at the Weill Medical
College of Cornell University in New York. Dr. Weiland is the past
president of the American Society for Reconstructive Microsurgery
(1991), the American Society for Surgery of the Hand (1995), the
American Orthopaedic Association (1998-1999), and the American
Board of Orthopaedic Surgery (1998-1999), and treasurer of the
American Academy of Orthopaedic Surgeons (2000-2003).
Dr. Rachel S. Rohde is a board certified attending orthopedic
surgeon at William Beaumont Hospital in Royal Oak, Michigan.
She completed her bachelor of science at the University of Michigan
with highest distinction, following which she earned her doctorate of medicine from Harvard Medical School and Massachusetts
Institute of Technology Division of Health Sciences and Technology.
She trained in orthopedic surgery at the University of Pittsburgh
and then completed fellowship training in hand and microvascular
surgery at the Hospital for Special Surgery in New York City.
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Preface
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Orthopedic conditions are among the most commonly evaluated
complaints in the emergent and urgent care settings, as well as in
primary care. In 2003, these musculoskeletal complaints accounted
for the second highest number of physician visits in the United
States. Many are acute problems involving the hand or wrist, an
area of complex anatomy and function. Often, patients are evaluated
by health care providers who might not have had the exposure or
training to assess and manage certain complaints appropriately with
confidence.
This book is written for physicians, physician assistants, nurse
practitioners, resident physicians, and students who provide care
in emergency room, urgent care, and primary practice settings, as
well as for orthopedic surgeons who are not hand specialists. It is
intended to be a concise, basic reference for the non-hand specialist
to aid in the initial management of acute hand complaints. Although
there is no text that can substitute for the advice of an experienced
hand specialist, we hope that the following chapters will offer some
guidance until that is available.
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Foreword
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Acute Management of Hand Injuries is designed as an easy-to-use,
quick reference guide for physicians treating acute hand and wrist
conditions. The emergency room physician, primary care physician,
student, nurse, physician’s assistant and others who have not had formal hand surgery training will find this convenient, clearly written,
and well-illustrated text a valuable asset. As an addition to its logical
approach to the evaluation, the initial exam, and the definitive treatment of acute conditions, the authors provide some very innovative
and attractive features that enhance the text’s value. In a group of
well-constructed appendices, the authors describe common techniques such as the performance of digital blocks and the fabrication
and application of commonly needed splints. Others describe currently recommended antibiotic treatment for felons, paronychia, and
suppurative flexor tenosynovitis, and reference checks for tetanus
and rabies immunization. Another useful feature is the frequent use
of illustrative cases that demonstrate, for instance, the key to effective evaluation of the patient with a wrist injury, with anatomical
snuffbox tenderness, and with suspected scaphoid fracture. Located
at the end of each chapter is a short list of well-selected and timely
references on the subject.
The authors are to be congratulated on delivering such an effective guide to the principles and practice of emergency hand and
wrist diagnosis and treatment. The book will prove to be an invaluable addition to the libraries, and to the pockets, of those who are
on the front line, where initial management is so critical to the final
outcome.
Richard H. Gelberman, MD
Professor and Chairman
Department of Orthopedic Surgery
Washington University School of Medicine
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Introduction
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This book is written and organized for use by health care providers who provide care for patients with urgent hand and wrist
complaints in the emergency room, urgent care, and other practice
settings.
The first chapter is an introduction to evaluating these conditions,
including detailed pictures illustrating a hand examination. The
chapters that follow are divided into sections detailing the mechanisms of injury, evaluation, initial treatment, definitive treatment,
and potential problems encountered in the most common hand complaints. At the end of each section, we suggest readings that we think
are appropriate for further education regarding each subject.
Appendices illustrate techniques such as splinting, administering digital anesthesia, and removing tight rings as well as provide
quick references regarding orthopedic abbreviations and tetanus
protocols.
This text is not intended to replace appropriate supervision by, or
consultation of, providers with more experience treating hand and
wrist injuries, but rather to serve as a quick reference to guide acute
care and early, appropriate referral for definitive management.
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Section I
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Assessment of Acute Hand
Injury Patients:
The Basics
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