Pedro K. Benejiklian MD David J. Bozentka MD Review of Hand Surgery 2004 Elsevier Philadelphia, PA 275 $72.95

Abstract

This slim text of a scant 275 pages is a concise compilation of information that is a must for those who provide treatment for injuries or diseases of the hand. It is presented as “an enormous value to medical students, residents, fellows, hand therapists, and emergency room surgeons.” Each of the 13 chapters is authored by specialists in the field of hand surgery. Chapter titles include anatomy; tendon; skin and soft-tissue defects, vascular disorders of the hand and upper extremity, nerve; fractures of the hand, wrist, and forearm axis, dislocations/instability; microvascular hand surgery; arthritis, tumors, infection, pediatric hand surgery, and rehabilitation. What one notices immediately about this text is the format. The information is presented in an easy-to-follow, outline format. The first chapter, reviewing anatomy, begins with an introduction to the tissues: osteology, arthrology, nerve, tendon, and ligament. It continues in this same format while detailing the hand, wrist, and forearm. The chapter concludes with a review of the brachial plexus. The remaining chapters follow a similar format while also touching on basic science, anatomy, pathologies, injury, assessment, repair, and rehabilitation. The outlined information in this text moves quickly. For instance, the tendon, reviewed in Chapter 2, begins with a brief, one-paragraph discussion of the collagen fibril makeup, vascular supply, and tendon healing. The extensor system is reviewed, followed by the flexor system, and each is accompanied by detailed diagrammatic representations. Tendonopathies are followed by tendon injuries; both extensor and flexor tendons are delineated by zone of injury. Tidbits of information are frequently included. For instance, the author notes that Zone V open injuries should be suspected to be human bites, and physical examination of the injured flexor tendon reminds the reader that the level of skin laceration does not always correlate with the level of tendon disruption. Types of sutures used in tendon repair and prognostic factors are followed by description of postoperative rehabilitation. Although early motions protocols are not detailed, modified Kleinert, modified Duran, and controlled active motion are touched upon along with drawings of the splinted hand using Kleinert and Duran protocols. The author notes: “a well-trained hand therapist should supervise the rehabilitation program.” Complications, salvage procedures, tendon rupture, and transfers are outlined. The chapter is rounded out with discussion of chronic deformities such as swan-neck, boutonniere, intrinsic and extrinsic tightness, and quadriga. In Chapter 6 fractures are reviewed, beginning with the distal phalanx and moving proximally to the elbow. Special considerations are given for each fracture site as are classification, assessment, and treatment. The reader learns, for instance, that trapezium fractures are “rare but may be seen with CMC joint dislocations and Bennett's fractures of the thumb.” In Chapter 9, the reader can study classification and treatment of tendon ruptures in the carpal region as well as classification and treatment of thumb deformities in rheumatoid arthritis. The chapter on tumors reviews benign and malignant tumors of the skin and bone complete with photographs, radiographs, and micrographs. Dupuytren's disease is described at the end of this chapter. Included throughout the text are numerous photographs, classification tables, diagrams, x-rays, and magnetic resonance imaging photos. Examples of tables include extensor compartments and inflammatory conditions, classification of nerve fibers, and empirical antibiotic recommendations for hand infections. This book includes a hard-to-find diagram of the volar plate accompanied by demonstration of the surgical excision of pathological checkrein bands. Also included is a welcome photograph of the scaphoid illuminating its vascularity. The diagrams will be familiar to the hand specialist, most coming from Green's Operative Hand Surgery as well as the Journal of Hand Surgery. There are even some tips for remembering some of the detail; for instance, C—ceiling for Cleland's ligaments versus G—ground for Grayson's ligaments; and proximal–proximal for A2 pulley positioning and middle–middle for the A4 pulley. Treatment options, both surgical and conservative, are provided for each of the pathologies and injuries reviewed. The therapist may be disappointed, however, in the final chapter, entitled “Rehabilitation.” It is a review of orthoses, prosthetics, and a brief discussion of spasticity as opposed to in-depth rehabilitation techniques or protocols. This text does a very good job of providing a wealth of information in a compact and concise presentation. It moves systematically, providing an overview of the subject material followed by detailed information. It cannot, however, be substituted for complete review and discussion of the systems presented. This may not be the best book for students because the authors assume that the reader already has a working knowledge of the subject matter. This book would make an excellent addition, however, to any therapist's library as a quick reference, and is a must for the therapist preparing for the hand certification examination.