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 Operative complications can have a major impact on patients and surgeons. While most textbooks list them, few provide in-depth discussion on prevention, repercussions, and methods to resolve them. Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021 , edited by renowned hand surgeons Brigitte van der Heijden, Jan-Ragnar Haugstvedt, and Henk Coert, features contributions from an impressive group of international hand surgery experts. This book provides in-depth, illustrated coverage on the prevention and management of complications that can occur during common hand and wrist approaches. It also provides insights on how meticulously performed hand therapy can help alleviate postsurgical problems, on the complex regional pain syndrome (CRPS), and on critical social issues. Key Highlights Firsthand clinical pearls, evidence-based interventions, and expert opinion for preventing and resolving complications from distinguished hand surgery experts The history of the catch-all term CRPS, why continued use of this term is a disservice to patients and medical progress, and an evidence-based argument on why it should be removed from the armamentarium and eventually the literature Managing expectations of patients with factitious disorders, the role of informed consent in preventing medicolegal issues, and the impact of complications on surgeons and patients This unique and insightful resource will be invaluable in the practice of plastic, orthopaedic, and trauma surgeons specializing in hand and wrist surgery. This book includes complimentary access to a digital copy on (https://medone.thieme.com) https://medone.thieme.com. 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 **__Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021__** Operative complications can have a major impact on patients and surgeons. While most textbooks list them, few provide in-depth discussion on prevention, repercussions, and methods to resolve them. Management of Complications in Common Hand and Wrist Procedures: FESSH Instructional Course Book 2021, edited by renowned hand surgeons Brigitte van der Heijden, Jan-Ragnar Haugstvedt, and Henk Coert, features contributions from an impressive group of international hand surgery experts. This book provides in-depth, illustrated coverage on the prevention and management of complications that can occur during common hand and wrist approaches. It also provides insights on how meticulously performed hand therapy can help alleviate postsurgical problems, on the complex regional pain syndrome (CRPS), and on critical social issues. **Key Highlights*** Firsthand clinical pearls, evidence-based interventions, and expert opinion for preventing and resolving complications from distinguished hand surgery experts * The history of the catch-all term CRPS, why continued use of this term is a disservice to patients and medical progress, and an evidence-based argument on why it should be removed from the armamentarium and eventually the literature * Managing expectations of patients with factitious disorders, the role of informed consent in preventing medicolegal issues, and the impact of complications on surgeons and patients This unique and insightful resource will be invaluable in the practice of plastic, orthopaedic, and trauma surgeons specializing in hand and wrist surgery. This book includes complimentary access to a digital copy on [https://medone.thieme.com.](https://medone.thieme.com)