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implant arthroplasty, even with formal collateral ligament reconstruction and prolonged splinting during rehabilitation ( Fig. 2 ). Arthrodesis should therefore be considered carefully, especially in the radial digits, if the lateral deformation of the PIP
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variable and differently evaluated. The main points of debate are related to the surgical technique, radiological analysis, post-operative rehabilitation and assessment of clinical results. Surgical technique PIP joint surgery may be performed by a
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arthroplasty. Postoperative results have been reported to be similar to those following primary trapeziectomy ( 25 , 26 ). Disadvantages Technically demanding procedure Replacement of the CMC-1 joint is a technically demanding procedure with a
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. • To help early identification of treatment methods with poor results, in order to minimise post-operative complications and improve care. • To improve pre- and post-operative information to patients and increase patient participation in surgical
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when systemic sedation is considered too risky ( 23 ). Being awake and alert, the patient can gain insight into his condition and therapy, which will help in postoperative rehabilitation ( 24 ). Local anesthesia: the numbness is administered only
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transfer 21 and in the future new rehabilitation methods may further improve outcome. Post-operative care There is still a debate about the rule of early active mobilisation after microsurgical nerve repair and reconstruction. Early
Hand Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Faculty of Life Sciences and Medicine, King’s College London, London, UK
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, details of surgical procedure given) 10 7. Description of postoperative rehabilitation Not described 0 Described 5 Part B: Scores may be given for each section 1. Outcome criteria Outcome measures
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, meticulous skin dissection to preserve skin survival and prevent postoperative necrosis may be improved with microsurgical techniques. Not only may microscopically assisted fasciectomy, named with the neologism ‘microfasciectomy’, decrease complications and
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of surgery is an important step, which is influenced by concurrent bony lesions or soft tissue lesions. Post-operative rehabilitation starts two weeks after discharge from the hospital with guided passive and active range-of-motion exercises
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, 9 , 10 Intercarpal arthrodesis requires up to six weeks of wrist immobilisation in either a cast or a plastic splint before initiation of the rehabilitation period. Assessment of bone healing can be difficult, and only a CT-scan at this time can
