<iframe align="bottom" frameborder="0" height="1200" longdesc="Five image The Wrist and Hand image Dorsal Approach to the Wrist Applied Surgical Anatomy of the Dorsal Approach to the Wrist Volar Approach to the Distal Radius Volar Approach to the Carpal Tunnel and Wrist Volar Approach to the Ulnar Nerve Applied Surgical Anatomy of the Volar Aspect of the Wrist Volar Approach to the Flexor Tendons Midlateral Approach to the Flexor Sheaths, Proximal and Middle Phalanges Dorsal Approach to Phalanges and Interphalangeal Joints Applied Surgical Anatomy of the Finger Flexor Tendons Vascular Supply of the Tendons Volar Approach to the Scaphoid Dorsolateral Approach to the Scaphoid Drainage of Pus in the Hand Optimum Operative Conditions Drainage of Paronychia Drainage of a Pulp Space Infection (Felon) Web Space Infection Anatomy of the Web Space of the Fingers Anatomy of the Web Space of the Thumb Adductor Pollicis Muscle First Dorsal Interosseous Muscle Arteries Tendon Sheath Infection Deep Palmar Space Infection Drainage of the Medial (Midpalmar) Space Drainage of the Lateral (Thenar) Space Applied Surgical Anatomy of the Deep Palmar Space Lateral Space (Thenar Space) Medial Space (Midpalmar Space) Drainage of the Radial Bursa Drainage of the Ulnar Bursa Anatomy of the Hand Palm Dorsum of the Hand Eighteen approaches to the wrist and hand are described in this chapter: Two to the wrist, two to neural structures crossing the wrist, two to the flexor tendons, two to the scaphoid, one to the phalanges and interphalangeal joints, and nine approaches required for the drainage of sepsis in the hand. The dorsal approach to the wrist joint is used mainly for treating rheumatoid arthritis, open reduction and internal fixation of distal radial fractures and surgery on the bones of the carpus; the volar approach to the wrist is used for fixation of distal radial fractures. The volar approach to the carpal tunnel is used primarily for exploring the carpal tunnel and its enclosed structures but can also be used for fracture fixation. The applied anatomy of each approach is considered separately in this chapter. The volar approach to the flexor tendons is used most often in hand trauma. It also provides excellent exposure of the digital nerves and vessels. The midlateral approach is useful in the treatment of injuries to the digital neurovascular bundles and also phalangeal fractures. A discussion of the applied anatomy of the finger flexor tendons follows the description of these two approaches in this chapter. Dorsal and volar approaches to the scaphoid are outlined together, with a brief description of the blood supply of that bone. Infection within the hand is a common clinical problem. Although early diagnosis and the use of intravenous antibiotics have reduced the number of cases of hand sepsis requiring surgery surgical intervention is still necessary in many cases to avoid permanent disability. The methods of drainage used for these conditions are described together, with an introduction to the general principles of drainage in the hand. Of all the infections of the hand that require surgery, paronychia and felons are by far the most common. Throughout this book, we have related anatomy to surgical approaches. In the hand, however, the majority of wounds encountered arise from trauma, not from planned incisions. A brief review of the overall anatomy of the hand is vital to explain the damage that may be caused by a particular injury. Although clinical findings are the key to the accurate diagnosis of tissue trauma, knowledge of the underlying anatomy is crucial in bringing to light all possibilities and minimizing the risk that a significant injury will be overlooked. For example, arterial hemorrhage from a digital artery in a finger nearly always is associated with damage to a digital nerve, because the nerve lies volar to the severed artery. Arterial hemorrhage in a finger should alert the surgeon to the possibility of nerve injury, which often appears clinically as a change in the quality of sensation rather than as complete anesthesia, and can be overlooked in a brief examination. Therefore, this chapter ends with a section on the topographic anatomy of the hand. This information is presented in one section rather than on an approach-by-approach basis to provide a clear and integrated picture of hand anatomy. Dorsal Approach to the Wrist The dorsal approach provides excellent exposure of all the extensor tendons that pass over the dorsal surface of the wrist. It also allows access to the dorsal aspect of the wrist itself, the dorsal aspect of the carpus, and the dorsal surface of the proximal ends of the middle metacarpals. Its uses include the following: 1. Synovectomy and repair of the extensor tendons in cases of rheumatoidarthritis; dorsal stabilization of the wrist1,2 2. Wrist fusion3 3. Excision of the lower end of the radius for benign or malignant…
