Highlights of Hand - Proximal phalanges

The content has been revised by Aida Garcia and Fabio Suarez with Simon Lambert as executive editor.

Visit the module entry page here!

The hand – our best work, communication, and expression tool – requires a detailed study of the anatomy to apply all the surgical techniques described. The main goal of treating hand injuries is to recover its pinch and grip function. To achieve this, the management of soft tissues is essential to avoid fibrosis and/or stiffness.

The hand, complementing visual expression and language as our means of communication and as the tool through which we interact with the environment, comprises simple, repeating units combined as a system of sensate levers bringing the palmar sensory receptors of the fingers into optimal relation with the object of the visual attention.

The hand also functions as a load bearing platform: during power grip (involving the whole hand), and pincer or tripod grip (involving mainly the radial column of the hand) the intracarpal relationships change, guided and limited by the intercarpal ligaments, to distribute the resultant load to the radius and ulna at the distal forearm. This adjustment brings the carpal bones into an energy-efficient interosseous-stable state of ‘close-packing’, permitting load-transfer with minimal effort from the brachio-(meta)carpal muscles.

This edition of the hand module addresses the challenges of internal fixation of the fractures and associated ligament injuries of the hand that often result in decrements – of sensibility or activity – caused by malalignments and instabilities.

New information is offered about current trends including the utility of adjunctive arthroscopic management of some injuries, intramedullary fixation methods, and updated rehabilitation programs.

The main differences to the first edition are:

• Update of plating procedures to VA locking plates
• Management of metacarpophalangeal joint dislocation

Pages on the following topics have been added:

• Nonoperative treatment to most of the fracture types
• K-wire fixation to most of the fracture types
• Intramedullary screw fixation to transverse fractures
• External fixation to multifragmentary shaft fractures

Several approach and procedure videos have been added:

• Dorsal approach to the proximal phalanx
• Dorsal approaches to the proximal interphalangeal joint
• Midaxial (lateral) approach to the proximal phalanx
• Volar approach to the metacarpophalangeal joint
• Mini external fixator
• Bicondylar fracture fixation using a 1.5 mm variable angle locking phalangeal head plate

Read all release notes and the table of contents here.