Steven Beldner

Surgical management of the hand in scleroderma.

Disabling deformity of the hand is a hallmark feature of the person afflicted with scleroderma. However, existing literature provides little guidance to operative treatment for the wide spectrum of hand derangement. Although arthrodesis is generally recommended for severe flexion contractures of the interphalangeal joints, other surgical procedures such as arthroplasty, excision of painful calcinosis, and digital sympathectomy have been employed sparingly, undoubtedly due to potentially hazardous soft tissue conditions. Based on experience with 70 scleroderma patients requiring 272 hand operations, this article provides further insight as to the role of surgical treatment for the scleroderma hand. The favorable results in this relatively large series of cases support the efficacy of precisely timed and skillfully executed surgery in the alleviation of pain, prevention of tissue loss, preservation of function, and improvement in aesthetics. For the ischemic tissues of the scleroderma hand the prerequisite for uncomplicated surgery is a tension-free wound, often requiring judicious skeletal shortening and healing by secondary intention.

Disabling Hand Injuries in Boxing: Boxer's Knuckle and Traumatic Carpal Boss

This article describes the treatment of the two most debilitating hand-related boxing injuries: boxers knuckle and traumatic carpal boss. Recognition of the normal anatomy as well as the predictable pathology facilitates an accurate diagnosis and precision surgery. For boxers knuckle, direct repair of the disrupted extensor hood, without the need for tendon augmentation, has been consistently employed; for traumatic carpal boss, arthrodesis of the destabilized carpometacarpal joints has been the preferred method of treatment. Precisely executed operative treatment of both injuries has resulted in a favorable outcome, as in the vast majority of cases the boxers have experienced relief of pain, restoration of function, and an unrestricted return to competition.

Arthrodesis of the Metacarpophalangeal and Interphalangeal Joints of the Hand: Current Concepts.

Metacarpophalangeal arthrodesis and interphalangeal arthrodesis are excellent tools in the surgeon’s armamentarium to restore function of the disabled hand. Typical indications for these procedures are pain, deformity, and/or stiffness. Arthrodesis is generally considered a salvage procedure to be used when other reconstructive procedures, such as arthroplasty, are not possible or would be associated with a high rate of complication or failure. To determine the most functional position for arthrodesis in each patient, the surgeon should preoperatively evaluate the compromised joint in the context of the disease process, determine the initial cause of the joint pathology, and assess the condition of the surrounding joints. Current methods of achieving fusion of metacarpophalangeal and interphalangeal joints include options for incisions, bone preparation techniques, and surgical implants; each has advantages and associated risks.

The Double Thenar Flap: A Technique to Reconstruct 2 Fingertip Amputations Simultaneously

Fingertip injuries are a common problem. There may be pulp loss and exposed bone. Various techniques have been described to reconstruct function as well as aesthetics; yet it is still unclear which treatment options should be chosen for each specific injury. Evidence-based treatment strategies are limited because there are no prospective randomized clinical trials evaluating one method with another. Fingertip injuries are usually variable in their presentation, and therefore treatment decisions are often dictated by the knowledge and expertise of the treating physician combined with the patients unique injury. With exposed bone and major distal soft tissue loss, many reconstructive techniques have been well-described including local advancement flaps, thenar flaps, and cross-finger flaps. There is scarce literature discussing surgical options when multiple fingers are involved. This report details a novel technique used to reconstruct 2 simultaneously injured fingers using the double thenar flap.

Erratum to: 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures (Arch Orthop Trauma Surg, (2016), 136, (771-778), 10.1007/s00402-016-2438-4)

Wint, John M. Erickson, John McAuliffe, John T. Capo, John Taras, Jose A. Ortiz, Julie Adams, Karl-Josef Prommersberger, Kevin M. Rumball, Kyle D. Bickel, Lior Paz, Lisa Lattanza, Louis Catalano III, M. Jason Palmer, Marc J. Richard, Marco Rizzo, Maurizio Calcagni, Maximillian Soong, Megan M. Wood, Michael Baskies, Michael Behrman, Michael Darowish, Michael Nancollas, Michael W. Grafe, Michael W. Kessler, Miguel A. Pirela-Cruz, M. P. Bekerom, Naquira Escobar Luis Felipe, Nathan Hoekzema, Oleg M. Semenkin, Patrick W. Owens, Philip Blazar, Ralph M Costanzo, Ramon de Bedout, Renato M. Fricker, Richard L. Hutchison, Richard S. Gilbert, Rick Papandrea, Robert R. Slater, Robert R. L. Gray, Ryan Klinefelter, Ryan P. Calfee, Sander Spruijt, Sanjeev Kakar, Saul Kaplan, Seth Dodds, Stephen A. Kennedy, Steven Beldner, T. Apard, Taizoon Baxamusa, Thomas G. Stackhouse, Todd Siff, W. Arnnold Batson, Warren C. Hammert. Erratum to: Arch Orthop Trauma Surg (2016) 136:771–778 DOI 10.1007/s00402-016-2438-4