Greens Operative Hand Surgery Free Download Pdf: Learn from the Experts in Hand Surgery

The new fourth edition builds upon this foundation and clearly carries it into the next generation of hand surgery. Many of the legendary hand surgeons who have contributed to this text in past editions continue to lend their ever more mature experience to some of the more complex and difficult areas, yet often now in conjunction with younger, bright, and talented hand surgeons as co-authors. Nearly half of the contributors are new and their contributions, along with those of the original contributors, result in a text that benefits from decades of experience, updated with the newest advances and approaches, all in clear perspective.

Greens Operative Hand Surgery Free Download Pdf

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Highlights the latest advances and approaches, such as wide-awake local anesthesia no tourniquet (WALANT) hand surgery, nerve transfer techniques, tendon transfer and tendon avulsion repairs, skin grafting techniques, and more.

The Journal of Hand Surgery Global Online (JHS GO) is an open access companion title to Journal of Hand Surgery. It is a clinically-oriented, peer-reviewed, international forum for the latest techniques and advances in hand and upper extremity surgery. Published quarterly, it features original articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include clinical and basic science studies and systematic reviews along with brief communications, case reports, review articles, surgical technique articles, policy papers and guidelines, and letters to the editor.

During open surgery, it is possible to inspect directly the cartilage and look for concomitant ligament and chondral lesions. The most important dorsal component of the SLL is the one that can most often be directly repaired. There are no ideal open treatment options in the subacute setting for the volar part of the SL, as an open volar approach requires incision through the important secondary ligament stabilisers. A longitudinal dorsal incision centred over the SL interval is used. The dorsal retinaculum is divided along the third compartment and the fourth compartment is subperiosteally reflected ulnarly. The wrist joint is exposed through a longitudinal capsular incision or with a ligament-sparing technique according to Berger and Bishop.37 The dorsal and proximal membranous portion of the SLL is evaluated. Once reduced anatomically, percutaneous pin fixation from the scaphoid into the lunate and from the scaphoid into the capitate is performed. This pinning technique has been shown to be the strongest method.38 The ligament is then repaired using free needles, sutures, osteosutures and/or bone anchor sutures, depending on the type of injury. In some cases, it is easier to place the sutures into the ligament prior to the final reduction and then simply tie them all once the SL joint has been reduced and stabilised. A straight direct repair with sutures or suture anchors has remained a reliable technique in the acute setting, but the open technique is limited to the correction of the dorsal part of the SLL. Biomechanical research has previously indicated that only the dorsal SLL needs to be repaired to achieve relatively normal carpal kinematics in cadavers, but this has subsequently been the subject of debate in recent studies.1,28

Various tendon reconstruction techniques for the SL have been described in the past and the techniques have evolved considerably. In 1995, Brunelli and Brunelli27 suggested the use of a strip of the FCR tendon to adjust both the distal and proximal parts of the scaphoid instability with rotatory subluxation. The strip of FCR is passed through a transverse hole drilled across the distal scaphoid to the dorsal part of the scaphoid neck and then anchored to the ulnar part of the distal radius. The three-ligament tenodesis (3LT) technique (Fig. 7) is a further developed and modified technique and appears to be an improvement. Using this technique, the FCR tendon is used to augment the palmar-distal connections of the scaphoid (which enhances and replicates the scapho-trapezio-trapezoid (STT) ligaments), the dorsal SLL is reconstructed and the ulnar translation of the lunate is reduced (which enhances the dorsal radiotriquetral (RTq) ligament).29 A distally based strip of the FCR tendon, approximately 8 cm long and 3 mm wide, is harvested and passed through a drill tunnel from the palmar tuberosity of the scaphoid to the point of insertion of the dorsal SLL. The lunate should be easy to reduce, otherwise this technique is not recommended. A channel over the reduced dorsum of the lunate is carved with a rongeur and an anchor suture is placed in the cancellous bone. The FCR strip is then tightened through a slip in the RTq ligament and sutured once again to itself under tension. Kirschner-wire fixation between the scaphoid and lunate and scaphoid-capitate should remain in place for eight weeks. This 3LT technique has shown promising results, with significant improvements in pain and improved alignment but reduced movement and grip strength. In general, modified Brunelli ligament reconstruction and tenodesis using tendon grafts produce satisfactory results when it comes to correcting reducible chronic SL instability in wrists without pre-operative notable osteoarthritis. This repair technique achieves a relatively pain-free wrist, with acceptable grip strength and normal SL distance, but with loss in the arc of movement and sometimes a loss of long-lasting correction of the SL angle. Garcia-Elias et al29 reported a series of 3LT repairs involving 38 patients with a follow-up of approximately four years, in which they found that 75% of the patients returned to their normal occupational/vocational activities and experienced significant pain relief at rest. The patients regained approximately 75% of flexion and extension movement on average compared with the non-injured contralateral side. The average grip strength was 65% relative to the contralateral side. A recurrence of carpal collapse and DISI occurred in only 5% of the patients.

In cadaveric and clinical studies, the strength of bone-ligament-bone grafts43 has been shown to be similar to that of the normal ligament. More commonly used grafts are bone-retinaculum-bone, second or third metacarpal-carpal-bone or hamate-capitate grafts, with or without screw augmentation. There is some lack of long-term results for this type of surgery, which makes it difficult for hand surgeons to determine its appropriate use. Early results have indicated that this method could play a role in the treatment of SL dissociation in the future,43 but the consolidation of the graft in this compromised area is difficult and this technique still needs further research. Van Kampen et al44 state that they have abandoned the technique of bone-ligament-bone graft for SL injury for other less technically demanding procedures.44

The surgical management of the degenerative wrist due to SLAC is still a challenging choice among several different surgical options. Total wrist fusion historically provides predictable pain relief at the cost of a complete loss of movement and shock absorption. The complication rate in total wrist fusion is also relatively high (approximately 15%). In the event of a SLAC wrist (SLAC I to IV is explained in Table 2), only some kind of salvage operation can be recommended. Wrist denervation can only be used selectively. In SLAC I, a radial styloidectomy may relieve the pain and postpone further surgery. In SLAC II, the most used options are proximal row carpectomy (PRC) or four-corner fusion (4CF) (Fig. 8). In the short-term, these two operations produce similar results with pain relief and a ROM of flexion 30 to 40, extension 30 to 40 and 75% maintained grip force.46 In SLAC III (mid-carpal arthritis), the only alternative is 4CF or perhaps PRC plus resurfacing of the proximal part of the capitate with resurfacing capitate pyrocarbon implant. In older patients, with a low ROM pre-operatively and a round and blunt-shaped capitate, PRC can be recommended. In patients younger than 35 years or with a pointed, peaked and narrow capitate, 4CF can be recommended. Some scepticism is, however, in order in terms of the long-term viability of a joint with a completely mis-matched articular surface between the capitate and the lunate fossa of the radius. Long-term radio-capitate degeneration after more than ten years of follow-up is, however, often asymptomatic and generally only present in about 10% to 20% of patients after PRC. However, several other studies have reported a significantly larger number of patients with secondary arthritic changes after PRC, although most are symptom-free. There is a lack of well-conducted studies, but Mulford et al46 reported and confirmed in a systematic review that both 4CF and PRC produce a clear improvement in pain and subjective outcome measurements for patients with symptomatic SLAC wrists. PRC can perhaps provide a better post-operative ROM, with less risk of the potential complications specific to 4CF (10% more complications occurring; such as nonunion, hardware problems and dorsal impingement). This systematic review reported that the risk of subsequent osteoarthritis, albeit most often asymptomatic, is significantly higher after PRC. Subjective outcomes and quality of life, pain relief, ROM and grip strength appear to be similar in both groups.

Advanced hand deformity results in functional impairment including loss of fine motor manipulation [7, 8, 10]. Treatments are aimed at delaying deformities or contracture with therapy; improving function with surgery, delaying recurrence with splinting and meticulous skin care, recurrence is inevitable [7, 8, 11].

CPG priorities for those living with EB and their carers were established at the 2017 DEBRA U.K. annual general meeting. Individuals were asked what they wanted from hand surgery and therapy; and to share experiences of what had and had not worked with skin grafting, dressing changes, removal of wires and long-term splinting. They were also asked to identify and add any new or key issues. This information provided qualitative and quantitative data for initial panel discussion. 2ff7e9595c