Operative Techniques for the Hand & Wrist

The hand and wrist are used constantly throughout the day making them vulnerable to injury. There are many tendons, ligaments, muscles and nerves that can become problematic in these areas. In many cases the injured area will heal with rest and other non-invasive treatments; however, sometimes surgery may be required. There are several hand and wrist injuries and conditions that often require surgical intervention.

Carpal Tunnel Release

• One of the most common medical conditions associated with the wrist is carpal tunnel syndrome. This condition occurs when the median nerve is compressed or damaged at the wrist. The median nerve travels through the carpal tunnel, which also contains nine tendons. This area can be compressed with inflammation and swelling, or compressed from external pressure like a tight watch. Carpal tunnel surgery is required when nerve compression is severe. To perform a carpal tunnel release, the surgeon makes a small incision in the base of the palm and cuts the transverse carpal ligament -- the 'roof' of the carpal tunnel -- to relieve pressure on the nerve. If scar tissue is present around the median nerve, the doctor can debride the nerve as well.

Wrist Fracture with ORIF

• Wrist fractures commonly occur when a person falls on an outstretched hand. Many times the broken bones can be manipulated back into place and held by a cast until the bone is healed. If the bone breaks into several pieces, surgical intervention may be required. The most common surgery for a wrist fracture is an open-reduction-internal-fixation -- ORIF -- procedure. An incision is made along the forearm typically on the palm side and a plate is applied and held secure with screws. This hardware usually stays in permanently.

Trigger Finger Release

• Trigger finger is a condition that occurs when a nodule forms on a flexor tendon that bends a particular finger. These tendons normally glide through a sheath as the finger bends and straightens; however, the nodule causes the finger to catch as it moves through the sheath. Trigger finger is named after the snapping that occurs when the finger is straightened back out from a bent position. This condition requires surgery when the finger begins to get stuck in a bent position. A small incision is made on the palm side of the hand close to the base of the injured finger. The sheath is then opened to make room for the nodule to pass through as the finger is moved.

Metacarpal Fracture Fixation

• In the hand there are five metacarpal bones in the palm, each corresponding to a particular finger. Metacarpal bones are frequently fractured with high-impact injury. A fracture of the fifth metacarpal is called a "boxer's fracture" because it most commonly occurs after a person punches something. Metacarpal fractures require surgery if they are broken into multiple pieces or are significantly out of place. These fractures can be pinned temporarily with a surgical wire that is drilled into the bone to keep it in place. The opposite end of the wire is outside the skin and the wire is typically removed after a few weeks. More severe metacarpal fractures can require ORIF with plates and screws.