Surgeon Updates News on Hand SurgeryFractures, arthritis, nerve injuries, and tumors are just a few of the problems hand surgeons treat. In this review article, Dr. P. C. Amadio from the Mayo Clinic reports on the latest news in hand surgery.
Fractures of the scaphoid bone in the wrist that don't heal may be helped by vascularized bone grafts. These bone grafts have their own blood supply to help keep them alive longer while the body builds its own bone around them. Pins work better than screws to hold the graft in place.
The best treatment for radial wrist fractures is still unclear. Internal fixation with pins, plates, or screws for fractures has fewer complications but no difference in terms of final results. A newer treatment for distal radial fractures using volar locking plates allows earlier wrist movement. Studies are underway comparing this treatment to other treatment options.
Bone fusion called arthrodesis for severe wrist arthritis is usually done with wires, staples, or screws. A newer method may not pan out. Circular plates used to fuse the wrist have a much higher nonunion rate (26 per cent compared to three per cent for other methods of fixation).
Joint replacement using silicone versus the newer prolytic carbon is also under investigation. More work is needed to improve the results of these operations.
Ruptured or torn tendons are repaired using sutures. Newer methods using tissue-engineering methods may speed healing. Rehab is essential to good results from this procedure.
Retraining the hand or a finger after nerve injury can be challenging. The patient must use the injured area and avoid using uninjured areas. Recent results from Sweden show that applying a topical numbing cream on the normal skin can help improve perception of touch, pressure, and feeling in the injured area.
The authors offer similar updates on carpal tunnel syndrome, cosmetic surgery, and bone tumors. More shoulder and elbow surgeries have also been reported. Microsurgery with the aid of improved technology has made it possible to attach fingers traumatically amputated.
Peter C. Amadio, MD: What's New in Hand Surgery. In The Journal of Bone and Joint Surgery. February 2007. Vol. 89-A. No. 2. Pp. 460-465.
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