January 23, 2018

Advances in Hand Surgery

By Nicolai B. Baecher, MD

With 29 bones and 34 muscles, the hand is a complex creature – and one designed to move. Thanks to improvements in minimally invasive techniques, small-joint prostheses, skin graft substitutes and suture anchors, we often can quickly restore mobility to surgical patients and prevent stiffness and scarring.

Surgery is a frequent solution for a variety of patients who present with acute traumatic injuries, including severe fractures, nerve and tendon damage and complex upper extremity wounds, and worsening chronic issues such as arthritis or nerve compression (the most common of which is carpal tunnel syndrome).

Arthroscopy has become a successful tool for repairing joint, cartilage and ligament damage in the hand and wrist. Many patients enjoy quicker recoveries, less pain and improved cosmetic results in terms of scarring. Small arthroscopic cameras also allow us to visualize injuries that don’t necessarily appear even on advanced MRI scans, such as partial tears in the scapholunate ligament or TFCC (triangular fibrocartilage complex).

For patients who have suffered burns, infections or traumatic injury, the increasing use of tissue-engineered skin substitutes can avoid the need for skin grafts or flaps from other areas of the body. One effective option is accelular dermal matrixes, often derived from bovine tissue, which provide a three-dimensional scaffold where a patient’s own cells and tissues can grow to fit the intricate shapes of the hands and fingers. This can eliminate or minimize transplant complications such as donor site availability, pain, scarring, slow healing and infection.

While not a new technique, endoscopic carpal tunnel release surgery has become more accepted in recent years. With the endoscope, we can clearly view wrist structures through a smaller incision, allowing many patients to return to work the day after surgery.

Hand and wrist prosthetic joint replacements continue to improve. For some patients, these prosthetics can be a good option instead of traditional joint fusion procedures, allowing for relief of arthritic pain but preserving more motion than may have been possible in the past.

In tendon injuries and ligament repair, modern suture anchors provide for strong and immediate repairs. By increasing the initial strength of our repairs, we are able to get patients moving earlier than before during the critical early healing period, helping some patients avoid long-term casting and immobilization.

The future looks even more promising for hand surgery patients, as we continue to make advances in the development of biological materials and small bone implant innovations.

For now, a holistic, patient-centered approach that combines surgical innovations, time-tested techniques, nonsurgical therapies and injections, along with close communication between all the treatment team members, can benefit many patients – even those who once faced lengthy, painful recovery periods and a permanent loss of mobility.

Nicolai B. Baecher, MD, is a Suffolk-based orthopaedist with Sports Medicine & Orthopaedic Center (SMOC) who specializes in Hand & Upper Extremity Surgery. www.smoc-pt.com