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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1238_Библиотеки_им_академика_М_И_Перельмана.pdf
Section VII.3 The Carpometacarpal Joint: Finger Carpometacarpal Joint Injuries . . . . . . . . . . . . . . . . . . . . . . . . .211
Chapter 70 Closed Reduction and Internal Fixation of Reverse Bennett’s Fractures . . . . . . . . . . . . . . . . . . . . . . .212
Chapter 71 Open Reduction and Internal Fixation of Ring and Small Fracture-Dislocations . . . . . . . . . . . . . . . .215
Section VII.4 The Carpometacarpal Joint: Finger Carpometacarpal Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
Chapter 72 Arthrodesis of Ring and Small Carpometacarpal Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .218
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221
■ x CONTENTS
Foreword
In Wrist Surgery: Tricks of the Trade, four seasoned hand
surgeons provide technical insight into the application of
a variety of surgical procedures for the treatment of wrist
disorders. The beauty of this text lies in the uniform outline for each chapter (indications, technique, pearls and
pitfalls, alternatives, postoperative care, and suggested
readings), liberal use of high-quality illustrations to supplement the text, and the concise nature of each chapter.
The text focuses on the major problem areas that the
orthopaedic hand surgeon faces on a daily basis. These
include individual chapters regarding the surgical management of distal radius fractures and reconstruction; the
distal radioulnar joint, including instability, management
of abutment, and arthroplasty; scaphoid fractures, both
acute and nonunions; degenerative conditions of the
carpus; Kienböck disease; and disorders of the thumb
trapeziometacarpal joint.
There are no black and white answers for the
management of many of the domains outlined above.
For example, in the section on scapholunate ligament
disruption, the reader is presented with the spectrum
of procedures to manage this difficult problem. Because
of the succinct nature of each chapter, a surgeon, in
short order, can read all the chapters on a topic, such as
on scapholunate ligament reconstruction, and decide
which procedure best addresses the problem of their
particular patient.
The liberal use of illustrations and pitfalls and pearls
helps to demystify the described procedures. The format
highlights the nuances of each procedure, permitting
even experienced surgeons to improve their care.
When I first started reading the book, I thought the
intended audience should be hand fellows. Upon completion, however, it was clear that the book has something for everyone. For the resident, surgical approaches
and anatomy will be beneficial, and for the attending
physician, pearls and pitfalls will prove invaluable.
We are indebted to these authors for a pithy, wellillustrated text that will facilitate our surgical decisionmaking and management of wrist disorders.
Peter J. Stern, M.D.
Normal S. and Elizabeth C. A. Hill Professor
and Chairman
Department of Orthopaedic Surgery
University of Cincinnati College of Medicine
Cincinnati, Ohio
xi ■
Preface
The wrist positions the hand for tasks that require the
precision of a surgeon, the force of a fighter, and the
explosive velocity of a pitcher. Wrist dysfunction arises
from congenital differences, trauma, and aging. For
many wrist problems we have solutions; for some,
particularly wrist instability, we have procedures that
moderate but rarely cure the associated pain. With over
70 years of combined practical experience, we have
learned what procedures work. In this text, we describe
a variety of approaches to treating wrist dysfunction that
we have found successful. Most surgeons are visual
learners who rely on images of anatomy, surgical
approaches, and techniques. For this reason have constructed a book where each of 72 wrist operations is
presented with an outline of indications, technique, postoperative care, and alternative techniques. Liberally illustrated with line drawings, the book is designed to be a
resource for all practicing surgeons, residents, and fellows
who need a quick reference when treating the ailing
wrist.
Mark E. Baratz, M.D.
xiii ■
Acknowledgments
I would like to acknowledge the considerable contributions of Jodie Fowler, Kim Avolio,
Lorenda Layne, and Eric Mullins, M.D.
Mark E. Baratz
I would like to acknowledge my hand fellow Ryan Beekman, M.D., for his invaluable
assistance.
Melvin P. Rosenwasser
xv ■
Section I
Overview of Distal
Radius Fractures
1
Closed Reduction and Percutaneous Pin Fixation of Distal Radius Fractures
Indications
• Dorsally angulated fracture with palmar cortex that is
not comminuted
• Indications for surgery are based on radiographic
parameters. The indications vary with the patient’s
age and the demands to be placed on the wrist.
Consider surgery for:
1. Dorsal angulation beyond neutral
2. Shortening 4 mm
■ Pearl
Check for acute carpal tunnel in all patients with a distal
radius fracture. If the patient has numbness and abnormal two-point discrimination, consider carpal tunnel
release.
Technique
• Close reduce fracture. Check reduction with intraoperative radiograph.
• If fracture reduced:
1. Create 1 to 2 cm incision centered over the radial
aspect of the radial styloid (Fig. 1–1).
2. Identify and protect sensory nerves. Expose the
radial styloid dorsal to the tendons of the first
extensor compartment (Fig. 1–2).
3. Insert two or more 0.062 in. wires across fracture
fragments (
over fragments that will be pinned via a dorsal
approach. Retract and protect the extensor tendons.
Fig. 1–3A,B).
Make a small incision
Figure 1–1
Figure 1–2
■ 2 SECTION I OVERVIEW OF DISTAL RADIUS FRACTURES
A
Figure 1–3
B
• If fracture not reduced after attempted closed reduction:
1. Use fluoroscopy to localize the fracture on a lateral
projection.
2. On AP projection localize two points along the
fracture line: one beneath the scaphoid(S) fossa,
the second beneath the lunate(L) fossa. Make two
1 cm incisions at these points.
3. Spread through incisions to dorsal cortex with
curved hemostat.
4. Insert, without power assist, 0.062 in. wires into
the fracture site to, but not through, the palmar
cortex. Verify position with fluoroscopy (Fig. 1–4).
5. Place wire driver on wire and move driver distally
until pin is 45 degrees to the long axis of the
radius (Fig. 1–5). Check reduction with fluo-
Figure 1–4
Figure 1–5
CHAPTER 1 REDUCTION AND FIXATION OF DISTAL RADIUS FRACTURES 3 ■