Hand Clinics RSS feed: Current Issue. Hand Clinics updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in hand surgery and is presented under the direction of an experienced guest editor. Note that subscribers to the Hand Clinics can subscribe to this Atlas at a reduced rate.http://www.hand.theclinics.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Hand Clinics0749-0712261February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.hand.theclinics.com/article/PIIS0749071209001206/abstract?rss=yesContents10.1016/S0749-0712(09)00120-6Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3vviihttp://www.hand.theclinics.com/article/PIIS0749071209001218/abstract?rss=yesForthcoming Issues10.1016/S0749-0712(09)00121-8Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3viiiviiihttp://www.hand.theclinics.com/article/PIIS0749071209001085/abstract?rss=yesIt is an honor to act as guest editor for this edition of Hand Clinics of North America. I currently practice in Ottawa, Ontario—home to the largest skating rink in the world. For the months of January to March, the Rideau Canal is transformed into an 8-kilometer skating rink for people to enjoy or even skate to work! Unfortunately, experienced and beginner skaters alike commonly have falls on this amazing but sometimes treacherous rink. Our volume of radius fractures, scaphoid fractures, and other wrist injuries dramatically goes up during these months. As I am sure many other orthopedic surgeons have experienced, the increased population, increased life expectancy, and increased general activity level have all translated into a great demand on physicians that deal with these problems. In Canada, the shortage of orthopedic specialists can compound this problem. Correct treatment can have a great impact on the patient and on society in terms of health care costs.PrefaceSteven Papp10.1016/j.hcl.2009.08.016Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3ixixhttp://www.hand.theclinics.com/article/PIIS0749071209001012/abstract?rss=yesAppreciation and knowledge of anatomy as it relates to surgical approaches is critical for planning treatment of traumatic wrist injuries. This article discusses the pertinent anatomy and some of the more commonly used approaches to wrist trauma.Wrist Anatomy and Surgical ApproachesRoy Cardoso, Robert M. Szabo10.1016/j.hcl.2009.08.009Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3119http://www.hand.theclinics.com/article/PIIS0749071209001024/abstract?rss=yesPhysical examination of the wrist requires knowledge of wrist anatomy and pathology to make a diagnosis or narrow the differential diagnosis. Symptoms are provoked by palpation and signs are produced by manipulation. Negative findings elsewhere in the wrist are important. Final diagnosis may require diagnostic imaging. By having all three methods of assessment agree one is assured of correct diagnosis. The physical examination of the wrist is not unlike that of other joints, in that a systematic approach includes observation, range of motion, palpation, and special tests.Physical Examination of the WristDarryl Young, Steven Papp, Alan Giachino10.1016/j.hcl.2009.08.010Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-32136http://www.hand.theclinics.com/article/PIIS074907120900095X/abstract?rss=yesDistal radius fractures are common injuries. Multiple classification systems have highlighted the evolution of the understanding of distal radius fractures. Understanding the classifications of distal radius fractures is important in identifying the important aspects that affect their outcome. Surgical indications of distal radius fractures can be divided into the following categories: patient factors, fracture reduction, fracture stability, and the presence of associated injuries.Distal Radius Fractures—Classification of Treatment and Indications for SurgeryAsif M. Ilyas, Jesse B. Jupiter10.1016/j.hcl.2009.08.003Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-33742http://www.hand.theclinics.com/article/PIIS0749071209001048/abstract?rss=yesNonoperative treatment of distal radial fractures by reduction and immobilization remains the most common treatment, based on the incidence of appropriate fracture types, as seen in many epidemiological studies in the literature. In this article, the indications, technique, predictors of failure, outcomes, and complications are reviewed. A variety of treatment options have been proposed for distal radial fractures that are predicted, or subsequently identified, to be too unstable for nonoperative management. Percutaneous pinning is an effective option for select fractures. The authors also review the indications, described techniques, complications and outcomes associated with this treatment option.Distal Radius Fractures: Nonoperative and Percutaneous Pinning Treatment OptionsWade Gofton, Allan Liew10.1016/j.hcl.2009.08.012Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-34353http://www.hand.theclinics.com/article/PIIS0749071209001000/abstract?rss=yesFractures of the distal radius are the most common fractures that occur in patients between ages 15 and 75 years. Many methods for treating displaced distal radius fractures are available. All forms of treatment involve obtaining fracture reduction, which may then be maintained by casting, functional bracing, external fixation, percutaneous pinning, internal fixation, or a combination of these methods. This article discusses the indications and technique of fracture treatment with external fixation and, when required, adjuvant percutaneous pins.External Fixation of Distal Radius FracturesJubin B. Payandeh, Michael D. McKee10.1016/j.hcl.2009.08.008Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-35560http://www.hand.theclinics.com/article/PIIS0749071209000948/abstract?rss=yesNo area of fracture management has had such a recent explosion of new treatment modalities as distal radius plating. This explosion has largely been implant- and industry-driven, with little evidence-based research guiding the way. A perceived difficulty with commonly used modalities by the orthopedic community has been enough to drive an entire new set of options for distal radius fixation. A drift from dorsal to volar plating has occurred that has been unexamined by randomized research. Segment specific fixation has been a new mindset that has resulted in a novel plate line and has caused other manufacturers to redesign their product lines. Other novel approaches for proposed problems include locking plates, nail-plate combinations, and others. This article outlines some of these options with a literature opinion and a clarification from the authors. A treatment plan for common fractures of the distal radius is also outlined.Plating for Distal Radius FracturesPaul A. Martineau, Gregory K. Berry, Edward J. Harvey10.1016/j.hcl.2009.08.002Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-36169http://www.hand.theclinics.com/article/PIIS074907120900105X/abstract?rss=yesDistal radius malunions are a common cause of patient morbidity. This review of the literature surrounding distal radius malunion covers the demographics, pathologic anatomy, and indications for surgery, surgical techniques, and salvage options. Particular emphasis is placed on subject areas that have not been reviewed as extensively in previous articles, including: intra-articular malunion, computer-assisted techniques, bone graft alternatives, and volar fixed-angle plate osteosynthesis.Management of Post-Traumatic Malunion of Fractures of the Distal RadiusBradley E. Slagel, Suriya Luenam, David R. Pichora10.1016/j.hcl.2009.08.013Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-37184http://www.hand.theclinics.com/article/PIIS0749071209000973/abstract?rss=yesFractures occur at the distal end of the radius more frequently than at any other location. The reported complication rates of distal radius fractures in the literature vary from 6% to 80%. Complications may occur from the fracture or its treatment. This article reviews complications caused by distal radius fractures and their treatment. Complications are divided chronologically into immediate, early (less than 6 weeks), and late (greater than 6 weeks).Complications of Distal Radius FracturesRobert G. Turner, Kenneth J. Faber, George S. Athwal10.1016/j.hcl.2009.08.005Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-38596http://www.hand.theclinics.com/article/PIIS0749071209000997/abstract?rss=yesScaphoid fractures are a common problem encountered in clinical practice. This manuscript provides an algorithm for the diagnosis, evaluation, and treatment of acute scaphoid fractures.Acute Scaphoid FracturesJulie E. Adams, Scott P. Steinmann10.1016/j.hcl.2009.08.007Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-397103http://www.hand.theclinics.com/article/PIIS0749071209001036/abstract?rss=yesScaphoid nonunions can exist with or without avascular necrosis of the proximal pole, and waist fractures may have an associated humpback deformity. CT best shows the deformity and bone loss, whereas MRI will show avascular necrosis. Operative treatment should be directed at correcting the deformity with open reduction and internal fixation and bone grafting. Vascularized bone grafts should be used in cases of avascular necrosis.Management of Scaphoid NonunionsThanapong Waitayawinyu, H. James Pfaeffle, Wren V. McCallister, Nicholas M. Nemechek, Thomas E. Trumble10.1016/j.hcl.2009.08.011Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3105117http://www.hand.theclinics.com/article/PIIS0749071209001061/abstract?rss=yesCarpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.Carpal Bone FracturesSteven Papp10.1016/j.hcl.2009.08.014Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3119127http://www.hand.theclinics.com/article/PIIS0749071209000985/abstract?rss=yesScapholunate instability is the most common form of carpal instability. Pain produced by this condition is caused by the wrist's inability to sustain physiologic loads because of an injury to the linkage between the scaphoid and lunate. The term scapholunate instability may describe a wide spectrum of clinical conditions ranging from mild wrist dysfunction and partial ligamentous tear to debilitating pain with associated rupture of the scapholunate interosseus ligament complex. This article reviews the pathophysiology of scapholunate instability and its identification and treatment.The Diagnosis and Treatment of Scapholunate InstabilityJennifer Manuel, Steven L. Moran10.1016/j.hcl.2009.08.006Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3129144http://www.hand.theclinics.com/article/PIIS0749071209000961/abstract?rss=yesPerilunate injuries are complex injuries of the bony and ligamentous structures of the wrist. They require operative management with careful restoration of carpal alignment and open reduction and internal fixation of associated fractures. Even with optimal treatment, mild to moderate dysfunction affects most patients.Perilunate InjuriesDavid J. Sauder, George S. Athwal, Kenneth J. Faber, James H. Roth10.1016/j.hcl.2009.08.004Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3145154http://www.hand.theclinics.com/article/PIIS0749071209001073/abstract?rss=yesTraumatic injuries of the distal radioulnar joint (DRUJ) may give rise to complex wrist pathologies. Substantial ongoing disability can arise should these injuries go unrecognized resulting in sub-optimal treatment and lack of appropriate rehabilitation. Injuries of the DRUJ may occur in isolation but more commonly are found with a fracture of the radius. These challenging DRUJ injuries may be simple or complex (irreducible or severe instability), acute or chronic. An adequate knowledge of the stabilizers of the DRUJ is essential in understanding treatment options. Traumatic instability of the DRUJ is reviewed and the anatomy and stabilizing factors are discussed. An algorithm to guide selection of treatment options in complex cases is presented.Traumatic Injuries of the Distal Radioulnar JointJonathan S. Mulford, Terry S. Axelrod10.1016/j.hcl.2009.08.015Hand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3155163http://www.hand.theclinics.com/article/PIIS074907120900122X/abstract?rss=yesIndex10.1016/S0749-0712(09)00122-XHand Clinics 26, 1 (2010)2010-02-01Hand Clinics2010-02-01261S0749-0712(09)X0005-3165168