Management of Complications in Common Hand and Wrist Procedures: Fessh Instructional Course Book 2021

Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021
Title Page
Copyright
Contents
Preface
Contributors
Section 1 Tendon Surgery
1 Management of Complications of Flexor Tendon Surgery
1.1 Management of Flexor Tendon Adhesions
1.1.1 Definition/Problem: Current Understanding of the Biology of Adhesion Formation
1.1.2 Treatment
1.1.3 Rehabilitation
1.1.4 Tips and Tricks
1.1.5 Conclusions
1.2 Bowstringing
1.2.1 Definition/Problem
1.2.2 Treatment
1.2.3 Rehabilitation
1.2.4 Tips and Tricks
1.2.5 Conclusion
1.3 Rupture
1.3.1 The Problem
1.3.2 Management of Patient with Rupture Presenting Early after Tendon Repair
1.3.3 Rehabilitation
1.3.4 Tips and Tricks
1.3.5 Conclusion
1.4 Infection after Flexor Tendon Repair
1.4.1 The Problem
1.4.2 Management
1.4.3 Rehabilitation
1.4.4 Tips and Tricks
1.5 Take-Home Message
2 Management of Complications of Extensor Tendon Surgery
2.1 Introduction
2.2 Complications after Extensor Tendon Lesion Zone 1 and Zone 2
2.3 Complications after Extensor Tendon Lesion Zone 3 and Zone 4
2.4 Complications after Extensor Tendon Lesion Zone 5 and Zone 6
2.4.1 Tethering of the Tendons: Tenolysis
2.4.2 Tethering of the Nerves
2.4.3 Punch Injury: Risk of Infection
2.4.4 Sagittal Band Lesion
2.5 Complications after Extensor Tendon Lesion Zone 7–Zone 9
2.5.1 Zone 7
2.5.2 Zone 9
2.6 Complication of the Thumb Extensor Tendons
2.7 Take-Home Message
3 Treatment of Complications after Surgical Management of Tenosynovitis
3.1 Introduction
3.2 Nerve Injury
3.2.1 A1 Pulley Release
3.2.2 First Extensor Compartment Release
3.3 Bowstringing and Subluxation
3.3.1 A1 Pulley Release
3.3.2 First Extensor Compartment Release
3.4 Infection
3.5 Recurrence of the Triggering
3.5.1 A1 Pulley Release
3.5.2 First Extensor Compartment Release
3.6 Percutaneous Trigger FingerRelease
3.7 Discussion
3.8 Take-Home Message
Section 2 Nerve Surgery
4 Management of Complications in Sensory Nerve Surgery
4.1 No Recovery or Incomplete Sensory Recovery
4.1.1 Definition
4.1.2 Treatment
4.1.3 Rehabilitation
4.2 Neuropathy
4.3 Hyperalgesia/Hyperesthesia
4.4 Cold Intolerance
4.5 Painful Neuropathies
4.5.1 Definition
4.5.2 Diagnosis
4.5.3 Principles of Treatment
4.6 Rehabilitation—Sensory Desensitization
4.7 Take-Home Message
5 Management of Complications of Surgery of the Median, Ulnar, and Radial Nerves in the Forearm
5.1 Introduction
5.2 Optimizing the Nerve Repair
5.3 Normal Recovery
5.3.1 Timing of Normal Recovery
5.4 Problems with Recovery
5.4.1 Neuropathic Pain
5.4.2 Scar
5.4.3 Neuroma Formation
5.4.4 Surgical Management of Symptomatic Neuromas
5.5 Sensory Recovery
5.5.1 Sensory Nerve Transfer
5.6 Motor Recovery
5.6.1 Motor Nerve Transfer
5.6.2 Tendon Transfers for Paralysis Reconstruction
5.7 Distal Entrapment Following Proximal Repair
5.8 Follow-Up after Nerve Repair and Clinical Decision-Making
5.9 Management of Nerve Specific Problems
5.9.1 Median Nerve
5.9.2 Ulnar Nerve
5.9.3 Radial Nerve
5.9.4 Combined Nerve Injury
5.10 Failed Salvage Surgery
5.11 Take-Home Message
6 Management of Complications of Nerve Decompression Surgery
6.1 Part A: Complications of Carpal Tunnel Release
6.1.1 Introduction
6.1.2 Intraoperative Complications
6.1.3 Postoperative Complications
6.2 Part B: Complications and Failure of Cubital Tunnel Surgery
6.2.1 Introduction
6.2.2 Surgery for Ulnar Neuropathy: Different Procedures and Potential Complications
6.2.3 Persistence or Recurrence of CuTS despite Previous Surgery
6.2.4 Prevention and Management of Complications; Tips and Tricks
6.2.5 Conclusions
Section 3 Bone Surgery: Fracture
7 Management of Finger Fracture Complications
7.1 Finger Stiffness
7.1.1 Evaluation of the Stiff Finger
7.1.2 Treatment of the Stiff Finger
7.2 Malunion
7.2.1 Treatment of Malunions
7.3 Nonunion
7.3.1 Treatment of Nonunions
7.4 Take-Home Message
8 Management of Complications in Carpal Fractures (Malunion, Nonunion)
8.1 Introduction
8.2 Uncommon Carpal Fractures
8.3 Scaphoid Fractures
8.3.1 (Patho-)Physiology of Fracture Healing in the Scaphoid
8.3.2 Complications in Fracture Healing
8.3.3 Surgical Interventions for Complication in the Healing Process
8.3.4 Types of Bone Grafts
8.3.5 Other Options for Proximal Pole Replacement
8.3.6 Treatment Algorithm for Scaphoid Nonunion
8.4 Osteosynthesis Devices
8.5 The Role of Arthroscopic Techniques
8.6 Take-Home Messages
9 Management of Complications of Scaphoid Fracture Fixation
9.1 Introduction
9.2 Hardware Complications
9.2.1 Tips and Tricks
9.3 Scaphoid Nonunion
9.3.1 Risk Factors
9.3.2 Treatment
9.3.3 Tips and Tricks
9.4 Recalcitrant Scaphoid Nonunion
9.4.1 Tips and Tricks
9.5 Scaphoid Malunion
9.5.1 Tips and Tricks
9.6 Miscellaneous Complications
9.6.1 Nerve/Tendon Lesions/Infection
9.7 Take-Home Message
10 Management of Complications in Lunate Facet Fracture Fixation
10.1 Definition and Problem
10.2 Anatomy of the Fracture
10.3 Treatment: Management of Volar Rim Fractures
10.3.1 Surgical Approach
10.3.2 Fixation Techniques
10.4 Arthroscopy
10.5 Lunate Facet Fractures: The Tip of the Iceberg
10.6 Rehabilitation
10.7 Salvage
10.8 Tips and Tricks
10.9 Take-Home Message
11 Management of Complications Following Open Reduction and Plate Fixation of Distal Radius Fractures
11.1 Complications Related to the Surgical Approach
11.1.1 Neuromas due to the Volar Approach
11.1.2 Posterior Interosseous Nerve and Tendon Problems due to the Dorsal Approach
11.2 Complications Related to the Quality of Reduction
11.2.1 Posterior Anterior View
11.2.2 Lateral View
11.3 Complications due to Plate and Screw Position
11.3.1 Volar Plating
11.4 Complications due to Infections
11.5 Take-Home Message
12 Management of Distal Radius Malunion
12.1 Part A: Planning: From Educated Guess toward Computer-Assisted Correction Osteotomies; Pitfalls and Complications
12.1.1 Introduction
12.1.2 Diagnostics
12.1.3 Treatment
12.1.4 Navigation and Fixation
12.1.5 Take-Home Message
12.2 Part B: Practical Guideline: Malunion of Distal Radius
12.2.1 Timing: Early versus Late
12.2.2 How to Do It
12.2.3 How to Deal with the Gap?
12.2.4 Ulna Shortening Osteotomy
12.2.5 Outcome
12.2.6 Complications
12.2.7 Rehabilitation
12.2.8 Tips and Tricks
12.2.9 Take-Home Message
Section 4 Bone Surgery: Arthritis
13 Treatment of Complications after Surgery for Finger Joint Arthritis
13.1 Introduction
13.2 Complications in PIP and DIP Arthroplasty: Review of the Literature
13.3 Indication for Revision Surgery of Finger Arthroplasty
13.3.1 Implant Fracture or Loosening
13.3.2 Implant Malalignment
13.3.3 Other Causes of Revision
13.4 Solutions for Failed Finger Arthroplasty
13.4.1 Soft Tissue Revisions
13.5 Implant-Related Revisions
13.5.1 Silicone Implants
13.5.2 Two-Component Implants
13.6 Joint Fusion for Failed Implant Arthroplasty
13.7 Complications of PIP and DIP Fusion
13.8 Indication for Revision Surgery for Failed Finger Joint Fusion
13.9 Solutions for Failed Finger Joint Fusion
13.10 Take-Home Message
14 Management of Complications of Thumb CMC Surgery: Trapeziectomy, Arthrodesis, and Total Joint Arthroplasty
14.1 Introduction
14.2 Injury to Sensory Nerve Branches
14.3 Trapeziectomy with and without Ligamentoplasty
14.3.1 Incomplete Trapeziectomy
14.3.2 Scaphotrapezoid Arthritis
14.3.3 Problematic Subsidence of the Thumb Metacarpal
14.4 Trapeziometacarpal Arthrodesis
14.4.1 Nonunion
14.4.2 Hardware-Related Problems
14.4.3 Malpositioning and Reduced Mobility
14.4.4 STT Arthritis
14.5 Thumb Carpometacarpal Joint Arthroplasty
14.5.1 Total Joint Arthroplasty
14.5.2 Pyrocarbon Interposition Arthroplasty
14.6 Arthroscopy
14.7 Take-Home Message
15 Treatment of Complications of Midcarpal Joints Arthritis
15.1 Introduction
15.2 Complications
15.2.1 Infection
15.2.2 Hardware-Associated Problems
15.2.3 Malalignment
15.2.4 Nonunion
15.2.5 Secondary OA
15.2.6 Prosthesis/Spacer
15.2.7 Pain/CRPS
15.3 Stiffness
15.3.1 Causes of Stiffness
15.3.2 Treatment of Stiffness
15.4 Take-Home Message
16 Management of Complications after Salvage Procedures of the Radiocarpal and Distal Radioulnar Joint
16.1 Radiocarpal and Total Wrist Arthrodesis
16.1.1 Definition of the Problem
16.1.2 Treatment of Complications: Nonunion and Hardware Problems
16.1.3 Rehabilitation
16.1.4 Tips and Tricks
16.2 Total and Interpositional Wrist Replacement
16.2.1 Definition of the Problem
16.2.2 Treatment of Complications
16.2.3 Rehabilitation
16.2.4 Tips and Tricks
16.3 The Distal Radioulnar Joint
16.3.1 Definition of the Problem
16.3.2 Treatment of Complications
16.3.3 Tips and Tricks
16.4 Take-Home Message
Section 5 Ligament Surgery
17 Management of Complications of Ligament Repair of Thumb and Finger Joints
17.1 Introduction
17.2 Indications for Surgery
17.2.1 Short-Term Complications and Their Treatment
17.2.2 Mid-Term Complications and Their Treatment
17.2.3 Long-Term Complications and Their Treatment
17.3 Operative Technique
17.3.1 Preferred Method of Secondary Ligament Reconstruction of the Radial/Ulnar Collateral Ligament of the Thumb MCP Joint
17.4 Foreign Body Material
17.5 Joint Specific Issues
17.6 Take-Home Message
17.7 Diagnostic Pearls
17.8 Technical Tips
18 Treatment of Complications after Scapholunate Ligament Repair
18.1 Complication versus Mistake
18.2 Treatment of Complications after Scapholunate Ligament Repair
18.2.1 Loss of Scapholunate Reduction
18.2.2 Loss of Carpal Reduction
18.2.3 Stiffness
18.2.4 Tendon Complications
18.2.5 Bony Problems
18.2.6 Nerve Complications
18.2.7 Infection
18.3 Take-Home Message
19 Management of Complications Following Surgery to the Triangular Fibrocartilage Complex
19.1 Introduction
19.1.1 Definition and Causes of Complications Following TFCC Repair and Reconstruction
19.2 Clinical Assessment
19.2.1 History and Examination
19.2.2 Investigations
19.2.3 Arthroscopy
19.3 General Overview of Complications Following TFCC Repair and Reconstruction
19.3.1 Complications Following Repair of Superficial Tears
19.3.2 Complications Following Repair of Foveal Fibers
19.4 Addressing Bony Morphology
19.4.1 Acute- on Chronic- with Positive Ulnar Variance
19.5 Avoiding Problems with TFCC Tears: Challenging Scenarios
19.5.1 Missed TFCC Tear with Distal Radius Fixation
19.5.2 The Chronic TFCC Tear with DRUJ Instability
19.5.3 The Chronic TFCC Tear with DRUJ Arthritis
19.6 Algorithm
19.7 Take-Home Message
Section 6 Soft-Tissue Surgery
20 Complications Following Treatment of Dupuytren’s Disease and Their Management
20.1 Introduction
20.2 General Overview of Complications of Fasciectomy
20.2.1 Specific Complications of Limited Fasciectomy (LF)
20.2.2 Specific Complications of Segmental Fasciectomy (SF)
20.2.3 Specific Complications of Dermofasciectomy (DF)
20.3 General Complications of Fasciotomy
20.3.1 Specific Complications of Percutaneous Needle Fasciotomy (PNF)
20.3.2 Specific Complications of Open Fasciotomy (OF)
20.4 Complications of Treatment with Collagenase (CCH)
20.5 Complications after Treatment with Radiotherapy (RTX)
20.6 Complications of Local Treatment
20.7 Complications of Systemic Treatment
20.8 Take-Home Message
21 Management of Complications in the Treatment of Fingertip Injuries
21.1 Introduction
21.2 Nail Deformities
21.3 Painful Neuroma
21.4 Infection
21.5 Cold Intolerance and Fingertip Hypotrophy
21.6 Authors’ Own Experience and Preferred Technique
21.6.1 Nail Deformities
21.6.2 Painful Neuroma
21.6.3 Infection
21.6.4 Fingertip Hypotrophy
21.7 Take-Home Message
Section 7 Rehabilitation: How to Prevent and Manage Complications by Hand Therapy
22 Flexor Tendon Repair in Zone 2: Prevention and Management of Complications by Hand Therapy
22.1 Wound Healing—A Paradigm Shift
22.2 Complications
22.2.1 Adhesions versus Ruptures
22.2.2 Bowstringing
22.3 Prevention of Complications
22.3.1 Early Active Motion
22.4 Effective Exercising—Tips and Tricks to Improve Outcomes
22.4.1 Move from the DIP and Not from the PIP
22.4.2 Make Sure the “Right” Tendon Is Moving
22.4.3 Postoperative Exercise—Keep It Simple, Functional, and Relatable
22.4.4 Patient-Centered versus Protocol-Driven Care
22.5 Take-Home Message
23 Peripheral Nerve Surgery: Prevention and Management of Complications by Hand Therapy
23.1 Introduction
23.2 Complications
23.2.1 Edema
23.2.2 Pain
23.2.3 Muscle Strength Loss
23.2.4 Contractures and Shortening (E.g., Muscle Tightness)
23.2.5 Sensory Loss
23.2.6 Autonomic Nerve Function Loss
23.2.7 Psychological Stress
23.3 Future
23.4 Take-Home Message
24 Bone and Joint Surgery: Prevention and Management of Complications by Hand Therapy
24.1 Part A: Hand Therapy: Prevention and Management of Complications in Bone and Joint Fractures
24.1.1 General Principles
24.1.2 Complications
24.1.3 Conclusions
24.1.4 Take-Home Message
24.2 Part B: Rehabilitation after Joint Arthroplasties in the Hand
24.2.1 General principles
24.2.2 Complications
24.2.3 Conclusions
24.2.4 Take-Home Message
Section 8 CRPS
25 Debunking Complex Regional Pain Syndrome/Sudeck/Reflex Sympathetic Dystrophy
25.1 Introduction
25.2 The Weakness of the CRPS Concept
25.3 The Series
25.3.1 Flare Reaction
25.3.2 Causalgia
25.3.3 Dystonic-Psychogenic Hand
25.3.4 Misdiagnosis–Bad Doctoring
25.3.5 Irritative Carpal Tunnel Syndrome (ICTS)
25.4 Discussion
25.5 Take-Home Message
Section 9 Social Issues
26 Managing Expectations/Factitious Disorders
26.1 How to Set the Right Patient Expectations before Surgery
26.2 Importance of Patient Expectations with Relationship to Outcome and Unhappiness/Litigation
26.3 Role of the Therapist in Preoperative Counseling
26.4 Factitious Disorders: Definition and Classification
26.4.1 Self-Mutilation
26.4.2 Factitious Edema
26.4.3 Dystonic Posturing
26.4.4 Diagnosis of FD
26.4.5 Management of FD
26.5 Take-Home Message
27 Informed Consent/How to Prevent Medicolegal Issues
27.1 Informed Consent
27.1.1 Background
27.1.2 Elements of Informed Consent
27.1.3 Consent in Children
27.1.4 Financial Consent
27.1.5 Exceptions to Informed Consent
27.1.6 Refusing Consent for Treatment
27.1.7 Documentation
27.2 How to Prevent Medicolegal Issues
27.2.1 Nature of Malpractice Claims
27.2.2 Preventing Medicolegal Issues
28 Complications: What They Do to the Surgeon
28.1 Introduction
28.2 Complications and Errors
28.2.1 What Is a Complication?
28.2.2 The Chance of a Complication
28.2.3 When Is a Complication a Non-negligent Error and When Is It Negligence?
28.3 Avoiding Complications and Consequences
28.3.1 The Competence of a Surgeon
28.3.2 How Can a Surgeon Avoid Complications?
28.3.3 Consent
28.4 What to Do If a Complication Happens
28.4.1 Admit to Yourself a Complication Has Happened
28.4.2 Tell the Patient That a Complication Has Happened
28.4.3 How to Deal with a Natural Complication
28.4.4 How to Deal with an Error
28.5 Effects of Complications on the Surgeon
28.5.1 The Second Victim
28.5.2 Emotional Toil
28.5.3 Risk of Depression and Burnout
28.6 Coping Strategies
28.6.1 Emotional Strategies
28.6.2 Risk Aversion
28.6.3 Institutional Culture
28.6.4 Recovery
28.6.5 Resilience
28.6.6 Summary
29 Complications: What They Do to the Patient
29.1 Introduction
29.2 Trust
29.3 Inconvenience
29.4 Expense
29.5 Functionality
Index