Atlas of Hand Surgery Sigurd Pechlaner, M.D. Heribert Hussl, M.D. ie of la. strive Surety UT sarens Laersly robe, Sa Leopold faze averse FFaearich, shia Fridun Kerschbaumer, M.D. u Lasers matic ha edies jatenr Wilco, Goethe Unbrsty Froelfi, Germany Anatomy by Sepp Poisel, M.D. ystaior 1659 lastest rales Thieme Slultgart - New York 2000 Preface Ire macy queres he aahuia -cceised aout techrngues they used erd “renwaded in acne. sirgery prosiced ibe morive-ian far realing “his Aas of Hed Surgure this alas prides an ewig inte cue cichurs sun views sud into exrzcal echniques 2 cxthis pratice which have reolvec in acy yeas of creel experience, 25 3 cecil, many af Ue Wochnigues piecercee lise ate Sex arions fram or “uther davelepreenss Hf well cng origi, erlmigew:. this i the recsorrng. ho}ind the Suthors deesion lo celierately Zo0vs only or t.ee Sechmiqars we Inval acy claim te cceagreliensive 16a tena" the snivwet. Ie atns's <imed primaily a. 3.26 ‘icing avthopudie surgeons ste dea with Loe specitc droniems of ane suige.y. However. alse allews the Senn bis an evervievs 96 arias proven Sue cx prorscaies ead sugges for the Usatmee: of pevifiriouriey and disetee Te rivieal aul ys Speieies tram sungors plastic ani recnliucrive sutgery, emthopedic, auc heunactic srngeryemphasize tar aml sorgery has Decciae 3 Aisle a its ow sgt sity > varieus specialties The tsliive snawledge Cemandec. 9 today's 2230 str ene regulies speetaliszsim slave ae yond the r= ‘risiplingry appraacn I seas 2f Tana Strgers is onzanized eetoncing ta pac Weal eesderatings. Precesung tts mir. secon oF Sauk i an eraocerary macimuie haptes Eat prese™is aMlesafor details, All subseypiel porns of 2h» honk refs Bacto chis chapter. We wuuld like 20 cc Fis ue arsuniy te exarese mr spuvia. Uhanks Re Prot br. Set Poizel for cucceesily arcging Ue gap berween mia: renaye setrinelagy ama clini. soaps A eopter om si ere, sfletissu inal intrest resi een! seren, iis olleee by 9 Secs ten n= rosurgical tern. Hee noal ckapers hans: Ue Srearmes: @ rmpresiins neucopathies ahd leon “rests tollinsed by Cape on Zedon infurrs, cts bi cxvione, al frartares, Aslecian 9: procechies 0. 28 siugiral maragenrant of seleczed tears dhol ana Raparer seunraciure reads ont the wih i I hually a shape. ou sagical mancgement of wfectios $Trsioes vty panei, Eo tis Ee 20 ew nal fuveral roan, ILL be -nced in a revise eerion, A paricar advantage of be Aes ot Hon Surg cs 9 Sutdy lol ic Lizeunsstent curling agrd 10 presen thet dividus: proced ces and fecaniques. Iraneatian. sue!ca “ecniyga. end goscoperative ramagene ae 3a plesun.06 <i estracioms ane. wend. o in crise ipo tex: peserees. ene ls veatrceve agree ‘hoson by ske crther in ite :p.ates cf ensuring ¢'vel= Shou a.esetraig” Gf inferre un vey fact es wen tale 29 maictaintse cana: of -svalabie alas whiter iMusuatians geovide niciediale acess te detc'ed r+- feaen i zetltyramprehsite fern. Some eet ieing sageans my tnd miusca. that che chapters ere at ined stricly by region, Haaeve:, he comprehen elect coatents# sa pernils she mace coryentcrs a S.eseh of neatinginferncation 2 sysduome The scope ef tis toreseond doze ek periois usta Tank all ef oe: co. engrtm wliune advice and aay'iance es accenapeped the cveaLion ofthe Aci of Fol Surges And'we aye thew erwdestancing, Hewyever, se moult 16S tecabe ts upportunily to offer thanksra eels in AE apyropriale unas. Recognizing the ijn a the Times. they wrrduced us ais fasea ing aoe owe fad pevee the way Zor us, Ammocg “hem ste PruPsscis Hane Antes, Rusa! aust, Fol es, ect Bau Jorg Rihler, deat Suck-Granecke, Mbit Lau, Least Rannerlal, Hanao WLasi, Sayre A. Wemise, Henry igs, bersaie O'urien, Gunther iltelphy. were Pleioer, Renard ¥, Butz, Dro Russe, GHs.c8 SaUset eva Ses co, Wales wow, al "al Weyer Goan Tine Verlag linly sapere the nore Wea especialy atalafulsaotit vassal pesenttheatas {ntnwcleburate edition, The viv lrawir gare che 0 1 Ms lakub Gratzer, ne created ten with efeat pat Sal inLalive ermermnccwral yy soemanddissec- Tra rane subjects. The acirvare satane chel> szecial Hanks le Ma, esa P75 shuse shormous zo rent, and sxcerteral alien to dst and clinical sfapiecationinbeirg-g Hh vsiing mecetic: to ts cu ‘ent Tue. fert" nthe fina llase® 92 che Dock. Tag aitcers wish thar the los of lized Surgery ill seach a braaa cpadersrp atl ey hope 2s mer ipkave made aeimir arti i: aricreenlightened Ua.~ mes af tke "men patie.” Vine autlcrs Ve Une las Bea copie for divenssinn ancong thels cullene= an Inocld be ape to Pea any sesponses Leastract ard Fearn fall 1993 Sigaxe Pov Herve Hasel Fri Yerwebauanen v Contents 1 Systematic and Topographic Anatomy Ssystematie Anatoray. Passive Stuetires Ske'eccl Sys r= lagamer pcive Structures topographic Anatomy Kogcenal Topas berearm 2. Sdn and Soft-Tissue Injuries Dra and Pam gf the Wace Laing Finger Thera lupeography cf ke Nerhas ef tne Are Median Kerve Ulnar Verve Rate. Nerve ‘Stassseetona: Anato=ny Skin hnelstans Free Sin Gratis atoms and Types a Sin iat Spla-Thicknsss Sein Gra Pullethicknese Sein eat: Proulecures with Small Leeal Skim Flaps "Plsties fople 7p asi Coacinunts Wamia:e plasty Reverse 7-plastyduLauy sap) ‘vovenlities alma V-V-phasey aia acemn Fup: Pilateral YVplasty vial Pantera Nap: Wola aatvancesient Flan 99 the Thiers seth Fullttavteess $k.a inate CSxial Falcom Flap ulus fvansemen Hsp of che Thun with £4 Yplastyisadal Pal 9 apy Vi, Acborwcement-Fay in the Uther thar the TLas 19 Fingers (ave! Pret Hap: ‘Goss eer Fap ‘karat Pattern Lap? Revesseu Croxs Finger Hae Tantam Pall n Fapi otsal Vascsvar Pecic‘e Flay jAxial vatces Hap) Rotated Adlvancemes. Hap {Ranéem baliern Fup: Hilgenfe c's westevastular land Fag feo the Rorsal Aspnet of the lnk Finger (Antal Pattern Clap Neurovascular Sand E.ap “is the biseal Linge Aspect ef iF Bing Ting {Asal Paster Hap? Lage Pedicted Axial Patteru Skin Flaps vzinal Bap ieacsalFareavon Hae Microsurgial Free Haps Lateral Lppet airs an Innes and Seeandary Changes of tee Finger- ail Anatarny Treatment af Tnjucied tothe Frageirai an Sail Re Treat. of a Subungual Hewaoma Treacicen: et Crash igure tacks Nal Ua Hisaomcea: uf Sevondary Charges i eee Eager url ere Nail Bed Treatmerst ea Spe Fingernall Nall 3e¢ Gat Treataent of Omyehegtypesis Vt n a n 2 22 4 mR “ Contents 3 Microsurgery ‘icrsuryery ofthe Pecipiral Nerves 30 vassal Bate Gatts 8 Shratomy othe Perigherl terves 16 Donor ste Tena artery aod uso: Hee jes Yen % inlets Nerve Dison enrcrmesk: 2% Sree'Tee Tenia e Hislopacolage Changes the het Folic ecim 3 Sune 49 Surges! “eohiges ry sca vocal cues 3 telat Eicon Anastamesis fet pineal Scture a Siar vesce’s 3 Perineuil Sty" 8 Novia Fnd-tonand Anastomosis it Nerve Gat 38 Sieemilar sive verels 104 Eimg.e ob a Heron Cn Us vial sdhtaSie aeastomosi Stal Serve st Hosa arteries 105 Prot eta Side Anastomosis icrovascular Surgery 3 Zuri eth Arerosceci Auseatons 8 changes ane weplaceaion| 8 interned aie Grate ms 4 Compression Neuropathies Compression Neurapathy of tue tedlan Nerve , 112 Camgiessor af ehe raz Meroe a fa Ee 1 nator 113. Sigal Ueaen-ene Opa ety Dinca 112 "Sicueaeous Trapspositon 130 Cine eek 112 commesson ef ee Gna re fr the Wisk CConrgemeson ut is Wan Wecee a the igs (iaaya v3 Gana 3 rend ce sire 116 Poenprss va adlan herve he ipa sadlal Nerve Compression Sypdroines apnmeunnts is. nator Dom: eal ao Tuneton fpuciorruarusecoue WenveSyeicom= 21 Cina eure £Sr Tunnel Spndcome 25 Compression ed te Raia Rone at ts Pein tnt ot the Jail Hunt huete scar ‘iar Nuave Compression Syndrames 6 Septum 138 Auton 126 Pastenurintsruswacs Nee Sndione 1 tut 126 Wareenberss Swrtome mi Giniel wieute 138 5 Tendon Transfers ‘Median Necve Palsy Vunetion ‘Sinica Picture Proximal Median Nerve Psy ‘Surgica, Principle Distal Medion Kev Fay ‘gical Pringle Abdhetar Dit Mun Tansee Transl 9 Hee Flexor git: Ssupscticabs a: Ue Rig inges Umar Nerve Palsy Feri ‘ime: Pirie Proximal Ulnar Rene Paley ital Cheat Merve Paley Surgeal Pinch State Gurieetion ef ce Metacarrst- Ialaigeal jotat with a Zancoll Sansvladess Dy amie Corceetion af Ge Maca ae phalangeal Joint with une Fs" T= thins 158 Dynamic Cactectien W the Welacarn= pphalangzal ‘int wick: the Fatae: tendons 161 rans of che Eno Ince: Mcace Fendon 165 adlal nerve Palsy Prosimal Kadin. Necve Pay Tunction ‘nical Ticeur® ‘Segical 7ncigt" Contents fe GA ig Toelnn Tieesfor stad Rav Netve bay Combined Median and Minar Kerve Palsy Funct osimal Combined Medio. dnl Vina ier Poy Cicueal Piesue Suipical Pincus Discs: Curtin Me i and Lv Metve Pay Latersor Digiti Minin aad estos... 175 Extensor Catpl Racial Fongus Tinklo Teanntin fod ‘Kova: Flexor Carpi ais Veh Syranster 5 Flasor Jegiomia Supertcixis te cla Teanstia 19ss9 Fixation" us raca.cradials Tendo “ra A Gppanens Mssty Laing the Tendon a Ine Cxtenser ‘nes 1s Clini Pete ts Onpacesns Flat “ig the Teaco Surgical Pencpl ivy te Estes Camp kali Biovs Teansterof the Eat ei an 6 Tendon injuries SSeture Matevil and Suture Feximique wes Avulsun, Gong Avuline, osc Rupti Core Suuires rT er -cevrtion af the ecilan Iateal eu sums re Pals ifthe letarmegite Var aed che Pallout ie ‘a istsel aang 2? Moca Kc 8 te 183 ors! nec 205 gee Tencon spe Advegesrvil 8 Fane Ded a8 Sure 1 ce aon f ths Pr sor Tahun 2 Be interlace Sire Pune 188 ‘eel of he Mesaceanphalye!(int =. 263 Talon Repairs Cafe sures = 908 Extensor Tendon Injures tsa Tcadon Stu il Palla Se 4 Astomy ace Tendon Zones 180 yane nd am Irevrmtec uf dees stares is Tera“ if a Bats Teaéen Prec neers By robe srueneneus Goneecion 08 Clanton of $beaneis is vse Tencer: Sate Using Moc ied Tendon iris in dane Dad ane es 13 Kirelnwayr Tecan ais fame a1 Ww larense Tan fj 2 Sefes us the Exe oe Aponcurnis Whesieg 9 re Intentions omeoe 2 ‘Type san MridgcyFotenr Veal Velie Consereative-tcalmont tet Yeu ane fovea Scsleal Trenton! tet eed Acai wll Pullout ie 13 Laisaon of te Foeeeso Ter dons ise ‘onion af he Eten Apoaearosis ha 209 fape 26 ead $e 20 Aachen ith cut Wc im zene nce 36 acces et We Stace tn certo f kseet30r To ie Walinar Fracture: Poca in of the isa tam a0 Interphtatgeal oin yy 1 Tena Sui a Fin saliclton with Rertogiade Them Mm Dat ng Tear ce wy ‘asc Tendo antes in Zoces aT and Zone tt 13 Me ‘los 2c the Bae Aenean Lancet icatnent Ss Tipe fy “99 flor Susere Canservatve treater 189 Hestmect of Pony leales “Rees {pea injries2u he Fxtensor Apomeurets Tipe Teskdor §.ure Yones 12 ane Tid 4 ‘solated Avision, biny Avion, 9-Cesed Supeuris ke Modal Part of Ue Interte ices Lar Couervgtve viealmedc Atlacimant wit Pola. ace Tendon Sutue A = ngers Jamas 2¢ 1, Pet, ane bd Insuitciveey of tke Estenspr pete onl Due co Scaring in ae regvon of ist: imerphalargea join 23 Seay Shreming ey Wesonstruc® die Sceusor Aponsuruss 213 wow ne a5 lsicigecy el te Sedalia he Imermeciate Bom Dus ta Scarring vill Contents Plana. 21s Pax Rrisuliu. ich uf the fateiciesste ‘anes Dp Bare Bp Hand ly Welecting « Tacdlicous Fsp vs Liceiaton of Bia Hence Terns Hesfove Ceutinult Bi Teeson Suture Retensuiuct. af the lae-“wlate rise ane Forearm Harn ita a Teacen 6 ais Zones Dp 5 Faw isl 22) Tacerstion of Hi Heven eraduns Renu uf he Exe asa: Polls Vemscs Tengen Ses Tetakin 2) Zones i" Tera BC 3 vanater oF Be Exeat50¢ Inches Pesroperatine Manageme to Enhacce ‘en 2 Funeria! Kee ation eine, afters Pesnr Vendiea Sule in tne Fleawe Tendon injusies 233 Fingers Pretiainaty S21cats 233 Thumo raionrs ad Tendon Bases Bp Bete Treaty Acute eure 28 Closrd Heres ta the hudon af the blexar Fin 26 Palliis Wangs. youe U1 28 larsratinm ot Lie lends of che Flexor Toms et aes 238 Pot-eis Longa wilh a Sha-t Distal stump. ‘eulsiun oF toe Tendo: ef “he Flour Dig Aarau tuna Peefudus Muscle fg 17 Dist Pane tp? Phalane 226 Sereat of Ui tendon of the Bexor ‘Frachmecc ita Plo Sree 226 Outs Loygus at the Level of the Pranic tun avulsion of te Tendim aie Tiewor hala Digiterur Pradindus ftom fre Distal Suice Flvaacomee ofthe Tension alan with Acécionsl seals cr: Ube Teale Seu veedan from the Bane Franek RF Fame Ps Tees, Fsatign ofthe feulswc Bone Taverali el che exer Poles Were Erngmen: ard Attachment of [ae Tendo i uhe Then: Region Tendon of tne Nil Phalanse pr Tendon Sucure lacerstian ef the Tomlin af Lie eke ‘ore Ye 1 Unncagh Pp 3 Tiigitarsrn Profisrces Muscle iu Zone Dp 1 Pos.opotative Manageme Hance swith a Serr Distal Ser=p ad Functional Rehabs fim ib Advancement in Zore Dp 2 alee a Tlexor Po. eis tonya sun Tord Seiueein Zunes Dp 1 and Scaure Pp 229 treetuec of Bocely IIe ed njuris Bae 39 30 (Civenic Theor andi Laveratis Igolae Larsvation 9 Lae Tend f te Camediate Tenclon tcaft Fiseor Digium Preficeus 230 “Two Stage Tencon Reconstr, Lpeoraciun of Holl Hexor Tenctons 231 Fist and Sersm Stage Teor vere 231 ‘Tecedews m Zor: Dp 1 7_ Fractures and Dislocations General 2A Injuries to the Copsular Ligaments ef the Distal Fingers, Exeludtin Teall of Acute RELIES Tractuves of che D'stal Paaanee Tall Faccuces Conservative “eatin. Retaeval oy tae Fragment Saad rrast.res Consecvative Tisaerent| TinTiacien Basilar acd Arier 97 Prarie ‘Conservative Trras-neh Pin Fiat er Secrw Fsatio the rhein’ iclangert bet Rupture ct the Cillaleral Ligaments ce Volar tne Chmsorvative broweent Combiner 1g ct Rupture ‘Dislacace! Chins ative Treatnent Recows.retions 9° tne Ligesnents Srencces nf the Middle Peale Condglar Fraclutes Consernaive Teatment Pir bivalice Soro fixadian Shel. F acuures ‘cservatee Teatiner Pea Fixation aay Das 24s Ms 2S 251 Contents wire Sutue 272 Sere0 Fina im an Hasunc and Acicular Practzes bia Conservative Teatenent oa Pim Feat 2a Screw Pisalio andl Caneelions Grats. 276 Ingres ta Cae Capsular Tigamen.s ef te Bo na ees alangeal os cad uystuce of the Cullatral Lisieneas ar Conservctvve Veale ar ames: Saute 26 Fhaatior ef te gais 20 Pepuure rete Volar Pate aan Cimecceatve reat 280 Combined Higazaent up. ¢{Mislwertion: =. 289 ‘Coneoreatve “reali 20 Hecorstracton uf Lae Lig?-nonts soso. 28 rast. wlth Prexineal Plans 281 Coteylar Fracteres Conservative Teese Din sain ren Firion, Coufaerd Teettique Shatt Fsacuurs Consersaie Treatinse 2 Din ial iss Sciew bixater 284 Feabiiation with Exel nator 0, 284 beasilar and Acticular Fractures 286 Ganservalive Treatmen: 336 Fie Fexatin 236 Serev? zation 236 Combined Tevtnispie 27 Plate Fisaticn 358 Lajos weshw Capsula Ligaree ofthe Meta carpuphaulayeal Joins of the Fingers, EXIuLg the thus 289 Ruptun: af the Celateral Ligamones 20 Conservative Teatinenn 2a Bexatiov ot 9 Distal Lgatcone Avulsion 290 Fixation of a Prexdmal Ligarmont ul slow 28 Repeure ef ta sian Pate baz Conservative Wrecement 232 upeure of the Callaeral Ligaments me Volar Pave; Dis.ccation af she Metacarpu- phalangeal Jo. cos oitservative Treaisient 292 Reconsturtion of fae Ligatenis. »-» 263 eatinent a Poorly Heaea Injuries Sista imerphalangeal nts Tesuparatle Join Danae Tension Band Arccdesis Proximal interphacangst: nines Instability uf the Collalerl igaonents agama: Receiver setion by Scar keinforcemect Yolar lst ability Supecfiialis Senadev's Lecepavable juins Damage Tein Rand areas Lag-Screw Artaradusis Mavarpophalangeal sof tae Tinges, “bxcing the Tea Tesabycy of fa Cellaaca.isparsent oar neebibity Shurtening die Genta’ Sear” (letacanpals of the Fingers, Excluding the Yhumb snacomy Treactne. of Aue Braceuras Fractures of the Betaca: pals of 30 Fingers, Fxcluding ube Tncab ead Fracires Sees Fearioa Conusvarive Teeatcal Plate Focrien Pip Fuarim ofa Sepavated Hpiphyste ConsorvativeTreatnedl % Pareto Screw E-caion Pin ixaiton Stabilzalot with Ext Fist Basilerand Artcuca Fractures Cocservative “tear mene Frartare Close uke Weracarpal Base, on hated in ta Lite Finger Srrew Foxton late sation bray Avisinn ofa end stated i irs Sovvand ard Fifa Setacarals Sere: Fization Tension Randing Fracture Dis ocatin.f tu hetaenrsal Base ‘with Hany Tigamece avulsion, Museraced 0 che itl Muvaarpal ena.’ Fneeute Disk cation Pan Fixarim ‘Compressis Frarture ofthe Sctacarpal 3ace, Iuscrated us. Thind Metacarpals (Corsinoa Terheque Injuries t che Carpo:setaearpal ei uf oh Fin sets Excluding se The, Irs aed avulslors fhe Capote aca pal lusamenes Canservative Treaseent Eigarsent sui Sete Fheatva uta Rory Ligaen Avasion Teeak- wit 3 Poorly Seale injurios Malinia.ten uf the Fagerstallowing haacarpal or Prusinal Pangea: Face rotation Osczetsr iy Thunb ‘Anatomy ‘Teatmentuffecre inuries Fract rest che Phaanges Injuries“ lke phalangedlJ2:m1 Injuries othe Betararpophalangeal on. ulthe Tura letestui tues Collaczal Ligament... 330 Tyssifrain 1 Vea Co-ateral Ligament Injeres:n ity Th 2H Treamry of Rupture, sion or Bay vets ofthe Whar Cellaeral Ligataent of rrethersb 3H servalive Treauene 3H Spal a9 Inrasubssnace Ruplece sila Ligamecestcure 384 “isan o¢ ar. avulsed Ligament ill a Pulluut Suture thracgh the Bune. ao Fico af a Avu'sed Ligament ‘wt owithauza Uany Avulsion scr ssh a ullaur wire Tecou be Roa. 835 Fxatien ofan avilsed Leary: with Hane sutures via aned Drill o'r= .... 336 Pu Fixarien ofa Distal Bony Lis aulsien 138 Seven Fixation ota Disa’ Bory Liga meae Avision 88 Fin Tixacion ota Pecrdmal By Liga eat sion 238 njucles 0 the Volar Lijit of th Maca Dopalangeal Joint of the Thum Classfcarion offers the volar gamers ol the Mielacarjpageat Joint of ste Thum I:eatinent of 3 Ropu wilson, ur Bony Asin of tne Vols iganiens CConservarive “rear Foxe wl? Pryerual seulsou of te Volar Lensicedinal Lzaieas wt a Potout Sune"Thuctagh Une Bone ¥I Repair of svulsion of Ue vel angie al Ligaen 0.0 the Sis wo getHERLSGEUTE 5s. 243 Reena reat vulshot Ye Tnger~ sese won Ligament ruta tae Sermo ile Ligaceut Suture ae Pin Healiow ra kan AWC son 0: the Fonssesann Ligasnent from the Sesaul itha Leng-cudinal Sess Fractawst se Vnst Betacarpal Husa and heh Prectuies Sa Pacts (ngs vate Trenemea: Pu Fixstion Pea Thacion Vist Metacargal Base Esactures eaeture Close tothe Base, Dista 10 ine sei af the Abd ete: Piss Lous 2B Fingisatca 28 Plate Euation sas race.re Close a the ase, Princinal us tke Insecta atthe Abctucur ol iis Lugs Tin Fistor Place Fain Pract Pislacaron of the First Mtacarpal Base; Benner’ Feacire Dislucaticns 1 Conservanve isan 3 Contents in zation 32 sew Fixzcion 2 Counpressinn Factores Fak Me bal base: Relance's Fracture 383 Tic Ration 353 Date Fixation 354 Mervestirg canvelinn Gea frum he Distal Ragin 355 Ineusies ta the First C-poretaca al ult. | 35 Dislacation 356 anse-vaties Frat 356 garment Sunes 387 Tiezement af Poo-ly Heals injusies 388 Una lascablity ef he Metazarpuphalangeal Jai of che Thur: Reconcrcctiow af dre Lina Colie2a) Uramon Volar asta ry ol the MetLata: jopkcangs Join attr Trem 360 esonecuetias uf igantets for Vols Instalnhny 2a Instabity nf she riot Car aonsetaestpal Js. Resansliuciun of Ligaments ey wrist sis snators 48 Treatmer uf Acute ijuvies 387 lassifcasin 2: Cislocatons aad Fartere Dis o- Fractures athe rise rns Tracures 2 theTapezit™ CCansecvative Treatment suvew Tieation, aagustes af ce Sapheia Casstcatien af oaeceers uf Seuphai ication of Fractures of Seapliuid Treatinent a¢Tractresof tLe suapkuld CConservaive Treat Surgeal Tevarnent Injuries fo cke Carpal Ligamecis ‘Chissiiatiee of arya Inlaid ‘Teatment nf Cara. stability art.al neabiny uf ulnt lslacee Carpal Ligament Injury 05 Chmservalive Feat a Chinn Besluctiun and Pi Cination == 27% Firanon of: stapholaaate lrterns= seas Ligamant Trgqreuolexate inscability CChnserative Teatnert (Crasee eduction, ana Po Fee“ Foualiaa athe Lungtecceral Inter tus ligamesr ae Ccousiex lstability a? Joi Regional Car- bal Ligament ij 319 ‘saphelate Disses 319 ‘Coaservative Trer-r-ent 380 {Closed Redon ara Pin Fixation... 280 Screw Cosatier fake Seaylubunate igamnent 381 Theacon nfire Scaphulunate Ligament ‘with fore Scintes via Aagled Drill oles 382 Contents Souure 9fae Scapliksrae tigr-nent .. 382 aio ase Suto a: the Rrd-nara- phneap'ace game 384 Cums Inseablity of Sever a ena (hae lus auea: Lajay, a6 erhmate islecatian aa ‘Coneereatve creatine. aaa Close: Reduction aad Pia tixatiaa 00. 38 Slaw and Fixatce of the Cezpal lies steal nent ol Pray eal fo aes Pscudaillvosts it che Cazpal Bones Seaplond Iseeartresis, Vole: Appraach in Seapteid Surgery Russo ine Cae Ihursert Sew Fixatiad nde. Mice Fixation Bec. awrHssal Vassicavined Bane Grit Capa testeaily Seaphoicng.e sailing ‘ovsal Saphaihmate Ligeaent econ. Suen anh DDovsal and Woine “igames: Recousa 2 tioa ia seapliol:-ale Dissociation» 4UE Rediesea9.:ulunate Ligament Recon sructiae 4c ‘wrist and untercarpalAiln.-< aC rave acthvudess oe Wise and ual ints 08 #8 Reding and Distal Kadloulnar Joint Avis Theater a ere fies Traghurss of tr Distal Radics Classification ef Facteres of the Dista Haus Treats of Hacccrrs gt che Distal Wadi Cunserezsive Treat nent in Fixation erwulancinns Sere Cisaton Subilization sith External vita las Fixes Trang a Volae Appts a Pic “ise Teroug 9 Basel apical a5 Pics ixation Theingt § Cenckined Volar aral Dursal Appraach a 0 Ce Liste Rethoulne* ibe 51 Sixation of tks Triangular Fibro, Gilage in an Ulnar A sia a “enion Bacuiry oa Rew Avulsiog uF the Trlongele. sbrorarilage in aTice ‘ure af the Lhe: Sisoie wacmect of Potty liselec ajimies Disre Ragial Beton. steotory 13 Cerne a Besa of the Distal Reins 44 Smubvé Kapere AUhracesis ot 22 His x Racioular Joint wl Segmental Une Reeccion 28 ocr Insley of eke Hier gular oes i 43 Fechlaner Secous pees Ustwocimy tthe Uline: ead 40 8 Rheumatoid Disease, Degenerative Changes, Stenosing Tenosynovitis, Avascular Necrasis, Instabilit ies, Wrist Ganglia, and Dupuytren’s Disease Hinges, exctading the Thnmb. Liss inert myer Joives heuer Arthiis 3ad bees ve Ustooe = sl.kis with Heoe-een’s Nodes Arthvedesis Proximal interphalarea fonts ‘Eneumatond Saints Sinai Artveplesty Arhnocests Distal nte-phalangeal aul heal Tote phnageal Joints fie Rhecimatoid @: bi ard eran Betormigy a2 Surglez! Cavrectien a Mw Rowe oni Detorn:igy ‘Mor acarpaaalargeal jana. Rhewwigtace atehricis Swunnevtoany AN wast oeumabsic ArLire and Soya Neck. Dea. mils ann Tnernsie Re ease 45 Recinaculat Recwusitan 40) Fetensor “endons uf Ur Angers, Fung che Ie aS Rupture’ ofthe ix aan We-eors 48 Side to-Side Suuutes. Tenelor Teese, and Tree Tendon Graf Flexor “endons of ch singers, Excluding the Hates Rheuimatoit Stchrtis oF Tenosynoy is Symnvertoany of the Huser Teadocs 7 2eores 3 the Tenor Teeduns ef ke Fm ‘ers, Bsclaeag the Thumb St ‘Snoector-y, Tendan Veaasters, ais! Frue tencan Gets 480 Steruane Tenosynayitis of rigger ingen 482 A Balley Release ata Senatectanny «42 xu Tuma ‘Mecncatpaphaiangea ois: t che Thum Rheuracois Archie aye Bort semis Deterity ‘Syrevecromy Archracesis Betengor Venstors er the Teen Ruptires at Pxransoe Teams Trenstie of sh bens Ine Trem Flexor Torshim the Teen Ruptre iv tae Tension a ine Hest Policia loess hsscle Reranetratine wit Poe Cara Sc Ihe Peisams Lam s Teno Stemming Terisemgett a Tae TEU Tern Sheath Release 1s Qaeesain’s bisrasr Treen Seely Release First Comnemnicaranp en cchris of e Bst Canannelacarsal Iu Ashtiilail Artha.asly oF Ue First Carpumetatarpal oink Hesec in expository Su unuplast vein a Aulus Picked Graet Contents Metaearpals 18 Prapestuns Disease 18 escce-ion wh uhe Paice Aponeurasis 318 wrist ‘ria ils Reeuunalaid avait Senowsctorey a:clunate futbredesis sttsoplasty ‘tevadesis of the wrist jos lus. abiiy, Autti, and Awabeules Scaphot apazio-Trasezoid “Tiscaphe} nuthaodasis Scaphoid-Capitate Acsicodesis ‘ast Ganga Rececoe of tte Doesal Gangcion Recectoe of the Va.ar Gauge bibliography Index xi)