By Warren C. Hammert MD, Martin I. Boyer MD FRCS(C), David J. Bozentka MD, Ryan Patrick Calfee MD
Published along side the yankee Society for surgical procedure of the Hand (ASSH), the ASSH handbook of Hand Surgery is a pragmatic, entire guide at the analysis and administration of hand difficulties. every one bankruptcy starts with a piece at the anatomy of the quarter in query. info is gifted in easy-to-scan bullet issues, with a variety of lists and algorithms. each one bankruptcy ends with board-type questions and solutions, annotated references, and an inventory of what junior and senior point citizens have to know.
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Extra info for ASSH Manual of Hand Surgery
10A. F. Gilula’s lines are seen on AP or PA views of the wrist. This wrist must be in neutral radial ulnar deviation, and neutral flexion-extension. These lines represent the borders of the carpal bones. Three lines are present: (1) along the proximal margin of scaphoid, lunate, triquetrum; (2) distal margin of scaphoid, lunate, and triquetrum; and (3) proximal margin of capitates and hamate. Disruption in Gilula lines indicates dissociative ligamentous instability (Fig. 11). III. Lateral View of the Hand and Wrist A.
The patient should be instructed prior to needle placement to advise the operator of any paresthesias or “electric shock” sensations in the distribution of the median nerve. If these are encountered, the needle should be repositioned prior to injection of anesthetic so that intraneural injection can be avoided. This technique will provide adequate anesthesia to both the median nerve and the palmar cutaneous branch of the median nerve. 2. A second method to provide anesthesia to the median nerve at the level of the wrist is to perform a carpal tunnel injection of local anesthetic.
These drugs have no effect on prostaglandin metabolism. There is no clear consensus on the use of antiplatelet medication in the perioperative period, in hand surgery. Many practitioners permit continued therapy throughout the perioperative period without experiencing increased intraoperative bleeding or postoperative hematoma. Furthermore, termination of antiplatelet therapy perioperatively should only be done after discussion with the patient and other physicians involved in the patient’s care.