Edward Vincent Craig - Atlas of Orthopedic Surgery: A Guide to Management and Practice (Encyclopedia of Visual Medicine Series)

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An Atlas of ORTHOPEDIC SURGERY

A Guide to Management and Practice

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THE ENCYCLOPEDIA OF VISUAL MEDICINE SERIES

A Guide to Management and Practice

Edward V.Craig, MD
Attending Orthopedic Surgery
The Hospital for Special Surgery
New York, NY, USA

Beth E.Shubin Stein, MD
Assistant Attending Orthopedic Surgery
The Hospital for Special Surgery
New York, NY, USA

LONDON AND NEW YORK

A PARTHENON BOOK

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2004 Taylor & Francis, an imprint of the Taylor & Francis Group

First published in the United Kingdom in 2004
by Taylor & Francis,
an imprint of the Taylor & Francis Group,
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We hope that this Atlas will be useful as a reference guide to the most common disorders of Orthopedic Surgery for the clinician as well as for those who are training for a career in Orthopedics.

The field of Orthopedics is vast and certainly cannot be covered in its entirety in one Atlas. However, we have hopefully succeeded in selecting the most common and most clinically relevant topics. The goal of this Atlas is to illustrate a wide range of orthopedic conditions that are representative of the field and its subspecialties.

We would like to thank the doctors who so graciously contributed both their clinical experience and their library of pictures which were of great assistance in putting together this Atlas:

Dr Michael Vitale, Pediatric Orthopedics; Drs Scott Wolfe and Pamela Sherman, Hand and Wrist; Dr Andrew Elliott, Foot and Ankle; and Dr Andrew Sama, Spine; and Dr Christopher S.Ahmad, Knee and Elbow.

Beth E.Shubin Stein, MD
Edward V.Craig, MD

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Hand surgery is a subspecialty that is frequently an area for additional training beyond the general training in ones primary specialty (e.g. orthopedic surgery or plastic surgery). Most hand problems are seen initially by non-specialists and so it is important for all physicians to have a general knowledge about the field so that they can decide when to refer a patient to a hand surgeon.

The wrist or carpus is the junction of the distal radius and ulna with the hand. The carpal bones include the scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate. The carpal bones are involved in a multitude of articulations. These bones connect the distal radius and ulna to the metacarpals and phalangeal bones of the fingers. A large section of this chapter is devoted to the scaphoid in particular. Of the carpal bones, the scaphoid is the most susceptible to fracture and also to complications after fracture due to its unique blood supply. Carpal stability is increased by its numerous ligamentous connections, and injury to these ligaments often leads to instability and eventual arthritis.

The carpal metacarpal joints connect the wrist to the fingers and are often affected by systemic conditions such as lupus, rheumatoid arthritis and gout. The trapezium-metacarpal joint (the basalar joint of the thumb), in particular, is a common source of pain (more often in women) due to osteoarthritis. This debilitating condition causes tremendous pain and stiffness and can significantly limit the use of the thumb in daily activities such as opening jars, buttoning a shirt and even brushing ones teeth. There are five metacarpal bones that connect to the phalanges. The thumb has only proximal and distal phalanges, whereas the other four fingers are composed of proximal, middle and distal phalanges. The muscles of the forearm cross the wrist and insert as tendons, allowing wrist and finger motion.