The Injured Hand

A specialist in hand surgery will not be available at all hospitals for some years. In the meantime, the fate of the patient will continue to rest in the hands of the surgeon who first treats him. It is essential, therefore, that both the novice and the accomplished surgeon have a sound grasp of the diagnostic and therapeutic fundamentals of hand surgery. The material in this book is presented in a clear, practical manner by a general surgeon who has successfully practiced hand surgery; the result is an especially useful and rewarding book. Many acute situations in hand surgery are not as complicated as they appear to be, whereas other problems can be handled only after much study and experience. Based on his experience with over 7000 general and emergency opera tions yearly at the Ludwigshafen Surgical Clinic and after years of inten sive work in the field of hand surgery, my medical chief, Dr. H. R. Mittelbach, has taken the time and trouble to write this handbook for general and clinical practice. For the practicing surgeon and especially the resident, the most important aspects of the treatment of hand injuries have been presented in a clear, concise manner. The didactic excellence of the material, its novel format, and the simple yet forceful drawings that obviate lengthy text descriptions enable the reader to become quickly oriented. However, the book is more thanjust a "cookbook" for quick reference.

Functional Anatomy and Diagnostics in Hand Surgery.- I. Functional Anatomy of the Hand.- II. Diagnosis in Hand Surgery.- Conservative and Operative Phases of Hand Surgery.- I. Conservative Phase of Acute Hand Surgery.- II. Conservative Phase of Reconstructive Hand Surgery.- III. Vocational Rehabilitation.- Surgery of the Hand.- I. Bloodless Field.- II. Instruments.- III. Adequate Access.- IV. Atraumatic Tissue Handling.- Anesthesia in Hand Surgery.- I. Technique of Block Anesthesia.- II. Treatment of Toxic Reactions to Local Anesthesia.- III. Treatment of Allergic Reactions to Local Anesthesia.- Care of Open Hand Injuries.- I. Correct Procedure before the Operation.- II. Immediate Care, "Delayed Primary Care," or "Emergency with Delayed Operation"?.- III. Severe Combined Injuries: Global Primary Care or Staged Reconstruction?.- IV. Correct Procedure during the Operation.- V. Correct Postoperative Procedure.- Amputations.- I. Care of the Skin.- II. Care of the Bones.- III. Care of the Tendons.- IV. Care of the Neurovascular Bundles.- V. Thumb Amputations.- VI. Amputation at the Middle Phalanx of the Long Fingers.- VII. Amputation at the Basal Phalanx of the Long Fingers.- VIII. Exarticulation of One or More Fingers.- IX. Carpometacarpal Amputation.- X. Exarticulation at the Wrist and Forearm Amputations.- XI. Replantation of Severed Members.- Fingertip Injuries.- I. Subungual Hematoma.- II. Loss of the Nail.- III. Nail Deformities.- IV. Fractures of the Distal Phalanx.- V. Fingertip Hematoma in the Child.- VI. Defect Wounds.- VII. Extensor Tendon Injuries of the Distal Phalanx.- VIII. Injury of the Deep Flexor Tendon in the Fingertip Region.- IX. Traumatic Epithelial Cyst.- Soft Tissue Injuries of the Dorsal Side: Injuries of the Wrist Extensors, Long Finger Extensor Tendons, and Dorsal Aponeurosis of the Fingers.- I. Wrist Extensors.- II. Division of the Long Finger Extensors Central to the Tendinous Junctions.- III. Division of the Extensor Tendons in the Region of the Metacarpophalangeal Joint.- IV. Division of the Dorsal Aponeurosis in the Region of the Proximal and Middle Phalanges.- V. Extensor Tendon Injuries with Accompanying Bone Injuries.- Soft Tissue Injuries of the Volar Side: Injuries of the Long Finger Flexor Tendons, Wrist Flexors, and Median and Ulnar Nerves.- I. Flexor Tendon Surgery.- II. Neurosurgery.- III. Position of the Beginner, the Experienced Surgeon, and the Specialist in the Treatment of Flexor Tendon and Nerve Injuries of the Hand.- IV. Treatment Tactics for Routine Practice.- V. Operative Techniques.- Capsular Ligament Injuries of the Finger Joints.- I. Anatomy.- II. Pathology.- III. Diagnosis.- IV. Treatment.- Fractures of the Phalanges and Metacarpus.- I. Diagnosis.- II. Reduction.- III. Immobilization.- IV. Surveillance.- V. Exercise.- VI. Care of the Fresh Fracture.- VII. Repair of Malunited Finger and Metacarpal Fractures, Pseudarthrosis, and Tendon Blocks after Fractures.- Fractures and Dislocations of the Carpal Bones.- I. General.- II. Special X-ray Diagnostics.- III. Treatment.- Thumb Injuries.- I. Amputation.- II. Fractures of the Thumb.- III. Thumb Joint Injuries.- IV. Division of the Long Extensor Tendon of the Thumb.- V. Division of the Long Flexor Tendon of the Thumb.- VI. Cicatricial Adduction Contracture of the Thumb.- VII. Thumb Reconstruction.- Compressive Nerve Injuries of the Hand.- I. Localization of the Compression Injury.- II. Diagnosis.- III. Indications.- IV. Therapy.- V. Postoperative Care.- Transfer Operations for Irreparable Nerve Damage.- I. General Indications.- II. Contraindications.- III. Techniques.- IV. Limits.- Severe Crush Injuries of the Hand.- I. Severe Open Crush Injury.- II. Severe Closed Crush Injury.- Foreign Bodies in the Hand.- I. Diagnosis.- II. Indications and Contraindications to the Operative Removal of Foreign Bodies.- III. Therapy.- Infections of the Hand.- I. Pyogenic Infection.- II. Primary Phlegmonous Infection.- III. Differential Diagnosis.-