Stable Fixation of the Hand and Wrist

In the past, conservative (or nonoperative) treatment of fractures of the hand has been the rule and severe and multiple fractures usually did not receive surgical atten tion. There are probably several reasons why this is so. Rarely did these fractures threaten life; they usually healed rapidly; and after immobilization, hand pain usually subsided. At the same time, intraarticular fractures frequently were unstable and often displaced and attempts to correct deformity were considered difficult to achieve. As a result, the ultimate joint motion in many cases was limited. It can fairly be said that decisions and techniques regarding internal fixation of small joints and bones were not known to most surgeons. Although the history of internal fixation is not extensive, there have been some exciting events. In the 16th century gold plates were used to repair cleft palates. Later, the Chinese employed wire loop sutures to correct difficult fractures. In the 18th century silver cerclage wires were used to achieve fixation and promote early bone healing. Although these fracture treatments occasionally proved successful, more frequently they did not and they never enjoyed wide acceptance. Doctors Alan Free land, Michael Jabaley, and James Hughes have described this history of bone fixation in a manner that is both colorful and educational and they have managed to extract the essential features that lend continuity to the story of the development of internal fixation.

History and basic Science.- 1 History.- 2 Bone Healing.- 3 The AO/ ASIF Principles: Fracture (Cast) Disease.- 4 Precision Implants and Instrumentation.- 5 The Lag Screw.- 6 Plates.- 7 Tension Band Wires.- 8 External Fixation.- 9 Indications for Stable Fixation.- Fracture Repair.- 10 Bennett's Fracture.- 11 Vertical Trapezial Fractures.- 12 Rolando's Fracture.- 13 Reverse Bennett's Fracture.- 14 Dorsal Oblique Hamate Fracture.- 15 Other Metacarpal Base Fractures.- 16 Transverse and Short Oblique Metacarpal Shaft Fractures.- 17 Oblique and Spiral Metacarpal Shaft Fractures.- 19 Intraarticular Metacarpal Head Fractures.- 20 Multiple Metacarpal Fractures.- 21 Scaphoid Fractures.- 22 Marginal Fractures at the Base of the Proximal Phalanx.- 23 Intraarticular Split Fractures of the Base of the Proximal Phalanx.- 24 Transverse and Short Oblique Phalangeal Fractures.- 25 Oblique and Spiral Phalangeal Shaft Fractures.- 26 Spiral Oblique Phalangeal Fractures with Butterfly Fragments.- 27 Unicondylar Phalangeal Fractures.- 28 Bicondylar Fractures of the Proximal Phalanx.- 29 Fractures of the Volar Margin of the Middle Phalanx Associated with Unstable Dorsal Proximal Interphalangeal Joint Dislocation.- 30 Volar Fracture-Dislocation of the Proximal Interphalangeal Joint.- 31 Intraarticular Fractures of the Dorsal Lip of the Distal Phalanx.- 32 Large Displaced Fracture of the Volar Lip of the Distal Phalanx Associated with Flexor Digitorum Profundus Rupture.- 33 Colles' Fractures.- 34 Smith's Fractures.- 35 Volar Radiocarpal Fracture-Dislocation (Volar Barton's Fracture).- 36 Radial Styloid Fractures.- 37 Polyfractures in the Hand.- 38 Poly traumatized Patient.- 39 Open Fractures.- 40 Children's Fractures.- Reconstruction.- 41 Delayed Union, Nonunion, and Pseudoarthrosis.- 42 Wrist Arthrodesis.- 43 Distal Radioulnar Arthrodesis.- 44 Limited Intercarpal Arthrodesis.- 45 Thumb Trapeziometacarpal Joint Arthrodesis.- 46 Other Carpometacarpal Arthrodeses.- 47 Intermetacarpal Bone Block for Arthrodesis Between the Thumb and Index Finger Metacarpals to Maintain Palmar Abduction of the Thumb.- 48 Thumb Metacarpophalangeal Joint Arthrodesis.- 49 Index Metacarpophalangeal Joint Arthrodesis.- 50 Proximal Interphalangeal Joint Arthrodesis.- 51 Thumb Interphalangeal Joint Arthrodesis.- 52 Finger Distal Interphalangeal Joint Arthrodesis.- 53 Corrective Osteotomy-Distal Radius.- 54 Corrective Osteotomy-Metacarpal.- 55 Corrective Osteotomy-Phalangeal.- 56 Corrective Osteotomy-Kienbock's Disease.- 57 Osteotomy for Thumb Metacarpal Lengthening.- 58 Ray Transposition.- 59 Rotational Osteotomy at the Base of the Fifth Metacarpal.- 60 Reconstruction in Children.- 61 Lag Screw Fixation of a Hunter Rod for Two- Stage Tendon Reconstruction.- 62 Lag Screw Fixation for Steindler Flexorplasty.- 63 Internal Fixation to Maintain Thumb-Web Space Release.- 64 Epilogue.