hand wrist trauma management

🛠️ Reconstructive Hand & Wrist Surgery Reconstructive hand and wrist surgery is a specialized area of orthopedic and plastic surgery focused on restoring function, appearance, and strength to the hand, fingers, and wrist after injury, disease, deformity, or congenital abnormalities. The complexity of the hand—with its bones, tendons, ligaments, nerves, and blood vessels—requires precise, often microsurgical techniques. ✅ Indications for Reconstructive Surgery 1. Trauma Fractures, dislocations Tendon or nerve lacerations Crush or avulsion injuries Amputations and replantations 2. Degenerative Diseases Osteoarthritis (OA) Rheumatoid arthritis (RA) Ligament instability (e.g., scapholunate) Collapsing wrist (e.g., SLAC/SNAC wrist) 3. Congenital Deformities Syndactyly, polydactyly, thumb hypoplasia Radial club hand 4. Tumors or Masses Ganglion cysts Bone or soft tissue tumors 5. Nerve Compression Carpal tunnel syndrome Cubital tunnel syndrome 6. Functional Loss Brachial plexus injury Stroke or cerebral palsy-related deformities Dupuytren’s contracture 🧰 Common Surgical Procedures 🔹 Fracture Fixation Plates, screws, or pins for metacarpal, phalangeal, or distal radius fractures Realignment to restore motion and grip strength 🔹 Tendon Repair or Transfer Flexor/extensor tendon repairs Tendon transfers for nerve palsies (e.g., radial nerve palsy → wrist drop correction) 🔹 Nerve Surgery Nerve grafts or conduits for traumatic injuries Microsurgical repair for sharp lacerations Nerve decompression (e.g., carpal tunnel release) 🔹 Joint Reconstruction or Fusion Arthroplasty (joint replacement) for small joints (e.g., MCP, PIP) Arthrodesis (fusion) for pain relief and stability Used in advanced arthritis or instability 🔹 Ligament and Soft Tissue Repair TFCC repair (Triangular Fibrocartilage Complex) Scapholunate ligament reconstruction Wrist stabilization for chronic instability 🔹 Flap Surgery / Free Tissue Transfer Soft tissue reconstruction using local or free flaps Microsurgical techniques for complex wounds 🔹 Amputation & Prosthetic Integration Revision of traumatic amputations Preparing the limb for functional prosthetics (e.g., myoelectric) 🧪 Advanced & Emerging Techniques 3D-printed bone and joint implants Arthroscopic wrist surgery (minimally invasive) Biologic injections (e.g., PRP, stem cells) Robotic-assisted microsurgery (experimental) 🧑‍⚕️ Multidisciplinary Approach Hand surgeons (plastic or orthopedic) Therapists for post-op rehabilitation Pain management specialists Rheumatologists or neurologists if underlying systemic disease 🎯 Goals of Reconstructive Surgery Restore mobility, strength, and coordination Minimize pain, stiffness, and deformity Improve independence and quality of life Optimize cosmetic appearance when possible