16231 AAHS Winter 02

A Publication ofthe American

Association forHand Surgery

Winter 2003

use of electrothermal shrinkagein the hand and wrist.

A new segment, “Ask theDoctor” will also be offered. Thiswill allow the participants insmall intimate groups to observea recognized expert performing asimulated surgical procedure.Topics include total wrist/elbowarthroplasty, internal fixation ofdistal radius and hand fractures,percutaneous trigger fingerrelease and arthroscopic fixationof scaphoid fractures. This willgive the opportunity for the par-ticipants to pick the minds of theexperts to learn tips and tricksthey may offer and to expand thediscussion to any topic of handsurgery they desire in theirgroup. This is truly an excitingnew concept and we hope that itwill be well received.

The theme of the meeting willbe “Sports Medicine and HandSurgery.” The opening HandTherapy Specialty Day will focuson the concepts and treatment ofupper extremity sports injuriesfrom the elbow to the hand.Lynn Bassini and Lee Osterman,co-chairs for the Hand Therapyprogram have put together anexcellent meeting, covering awide range of topics in SportsMedicine from the elbow to thehand.

In addition, for those whowant to fine tune or improvetheir computer skills, a computerworkshop will be offered onWednesday, covering such topicsas PowerPoint presentations,publications, M-peg presenta-tions and image management for

continued on page 9

Secrets ofthe Expertsat Meetingin Hawaii

The 33rd Annual Meetingof the AmericanAssociation of HandSurgery will be held at theHyatt Resort in beautiful

Kauai, Hawaii from January 8-11,2003. We hope for an action-packed, timely and informative

meeting. A total of 75papers covering all areasof hand surgery will bepresented. The meetingwas designed so that theparticipants will havetime off in the afternoonsto spend with family inthe beautiful setting ofKauai.

In addition to the mul-tiple papers, there will be 20instructional courses over thefour days of the meeting. A widerange of topics will be covered;from congenital hand deformi-ties, latest updates on wristreconstruction, and vascularizedbone grafts to advances in upperextremity vascular disorders andsoft tissue coverage. In addition,symposiums will cover the latestupdates in new frontiers in wristarthroscopy and the controversial

A M E S S A G E F R O M T H E P R O G R A M C H A I R

WILLIAM GEISSLER, MD

Lookout at Kalalau, Kauai

Ten

The number 10 figures a lotin hand surgery. We have 10fingers, and Paul Brownwrote a classic article, “Lessthan 10” on surgeons who

were successful despite having oneor more fingers amputated. It takes10 years of medical education (ifyou are an orthopedist) to become ahand surgeon. The are 10 structures

in the carpal tunnel. I’m in abit of a ‘late night’ moodtoday, so I thought I’d puttogether a top ten list. Maybeyou have you own top 10ideas for something or anotherrelating to hand surgery—ifyou send them in and I likethem, we can publish them,too. Here goes.

Top 10 Ways to Stay Out ofTrouble Clinically10. Have the patient take responsi-

bility for their own rehabilita-tion. Activity should be a part ofany rehabilitation or treatmentplan. Passive programs do notwork. Plus this way you get apartner in rehabilitation.Probably no need to mention thisto hand surgeons, but I wantedto start out easy.

9. Be sure there is data to supportyour choice. It is surprising howmany things we do that arebased on opinion or anecdote.Recently we learned that arthro-scopic ‘washouts’ were no moreeffective than placebo for arthri-tis treatment. We are pretty surethat carpal tunnel release is apretty good operation, but howabout your favorite wrist liga-ment reconstruction?

8. Consult frequently, and work inteams. Two heads are better than

one. No one knows everything,but together we know a lot. It’seasier to ask for help than to tryand know (and do) it all. Machois for movies.

7. Communicate your diagnosis,expectations, and plans clearlybefore as well as after treat-ment. Study after study hasshown that most malpracticecases have their origin in abreakdown in communication,not poor results.

6. Evaluate the WHOLE patient.Work and outside activities.General health/fitness/nutrition.Social factors and attitudes.Hopefully this goes without say-ing, but it does appear that tosome doctors, their job is to fixhands (or other body parts), notpeople. Ultimately it is moreimportant, as Osler famouslysaid, to know the person whohas the disease than it is to knowthe disease the person has.

5. Be more conservative in com-plex cases. As the number ofinvolved sites and diagnosesincreases, the likelihood of bene-fit from surgery decreases. This Iheard first from Jim Strickland, awise man. I think it’s true, andhas certainly steered me fromtrouble in the past.

4. If faced with a choice of equallyeffective therapies, choose thesimplest. In a way, this is a corol-lary of Strickland’s rule, alsoknow as KISS: keep it simple,surgeon. Don’t make an easy jobhard (my rationale for not doingendoscopic carpal tunnel releases!)

3. Do not falsely label symptomsas disease or injury. This confus-es everyone. It makes doctorsthink they know more than theyreally do, and makes the patientthink there is something that

needs to be fixed. This in turnimplies that something was bro-ken, which then raises the ques-tions of why, whose fault (if it isassociated with work or an acci-dent), etc. Do not medicalize aneveryday ache. This I learnedfirst from Nortin Hadler. I don’tagree with him often, but right isright.

2. Observe more; Do less. It is truethat we learn from mistakes, butit is not necessary that the mis-takes we learn from are our own.Wait for others to report theirlong term results, and don’t buyin to the early hype. There are alot more operations that used tobe done than are done.

And the number one way to stayout of trouble clinically:

Always remember that theneeds of the patient come first.The motto of Mayo Clinic, andthe best tie breaker I know. H

2

F R O M T H E E D I T O R ’ S D E S K

PETER C. AMADIO, MD

Hand SurgeryQuarterly

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Winter2003

PresidentAlan E. Freeland, MD

EditorPeter C. Amadio, MD

Executive DirectorLaura Downes Leeper, CAE

Managing EditorAnne B. Behrens

Hand Surgery Quarterly is a publication ofThe American Association for HandSurgery and is published strictly for themembers of AAHS. This publication isdesigned as a forum for open discussionand debate among the AAHS member-ship. Opinions discussed are those of theauthors or speakers and are not necessarilythe position, posture or stance of theAssociation.

Copyright ©2002, The AmericanAssociation for Hand Surgery. All rightsreserved. No portion of this newslettermay be printed without express writtenpermission from the publisher, 20 N.Michigan Avenue, Suite 700, Chicago, IL60602, 312-236-3307.

The Role ofSports inAmerica,Medicine, andHand Surgery

Humankind’s competitivenature arises fromDarwinian principle, “sur-vival of the fittest.” Itaffects every aspect of our

individual and collective livesevery day. It may range from find-ing enough food and water to sur-vive the day to winning a contract,a contest, a battle, or a war.Sporting and athletic contests pro-vide an excellent and sociallyacceptable outlet for spirited com-petition. They are an art form and acultural activity based upon achiev-ing pinnacles of physical perfor-mance, often with great strategyand intelligence involved. Sportsstand along side of art, music, liter-ature, and science as a venue forexcellence in human expression.

In many ways, sports havebecome the opiate of the masses.Competitive sports are organized atvarious age and skill levels allow-ing almost everyone a chance toplay. We have “Little League” forchildren, “Special Olympics” fordisabled athletes, and the “SeniorGames” for mature citizens.Recreational sports provide enjoy-ment and require the mastery of askill. As a participant or an observ-er (“fan”, a contraction of fanatic),sports provide a physically andmentally healthy respite from therigors of everyday life. Sports pro-mote physical conditioning and fit-ness. Sports may bring us togetherin a venue that promotes humanunderstanding among cultural dif-ferences. Sports have also become a

major commercial entertainmentindustry.

Are there material excesses andmoral deficiencies within athletics?Of course, just like the rest of life.It’s an imperfect world. But rulesapply and ultimately, justice pre-vails. We strive to bridge the gapbetween reality and ideal. This is a“life’s lesson” in itself. In athletics,we learn more about virtues andvice. As in All I Really Needed toKnow I Learned in Kindergarten:Uncommon Thoughts on CommonThings (Robert Fulghum), we learnto “play fair, to share, not hit others,and clean up our own mess.” Welearn about discipline, sacrifice,teamwork, perseverance, tenacity,

honor, sportsmanship, a vision for agoal, and the passion and dedica-tion necessary to achieve it. Thelessons learned on the playingfields, gymnasiums, and courts inyouth may be applied to the chal-lenges of later life. Healthy compe-tition performed with good sports-manship improves us all. It teachesus to try to be the best we can be.Sports have given many an oppor-tunity to rise out of poverty or adisadvantaged life. They do havesocial value.

Vince Lombardi said, “Winningis not the most important thing, it’sthe only thing.” Grantland Ricesaid, “It’s not whether you win or

lose, it’s how you play the game.”Kipling wrote, “Winning and losingare two imposters that should betreated just the same.” MartinaNavratalova said, “People who sayit doesn’t matter whether you winor lose, usually lost.” A sign in myhigh school locker room said, “Aquitter never wins and a winnernever quits.” Each of these viewscontains a message, a grain or moreof truth, an inspiration. But I agreewith John Wooden (They Call MeCoach) who stated that success(“winning”) is “the satisfactionof knowing that you havedone your best.” We value ourstars, but we value our“Rudys” as well. It is better tohave tried and lost than tonever have tried at all.September 11, 2001 will forev-er be etched in each of ourminds as an example of whattrue heroism is all about.

As physicians and sur-geons, we can have many victoriesevery day. We can win as weendeavor to be better spouses, bet-ter parents, better friends, betterphysicians, and better citizens ofour communities. We win when weprovide a kind word or a word ofencouragement to a patient, theirfamily, a student, or resident. Atechnically successful operation is avictory. Restoring a patient to inde-pendent living, gainful employ-ment, the playing field, recreation,child-care, or family and householdresponsibilities is a triumph. Andwhen we fail, we try again.

Throughout history, many of theadvances in the treatment of dis-eases, wounds, and injuries havecome from the battlefield and, morerecently, from our inner cities wherepoverty, ignorance, fear, drugs, andalcohol combine to create a primi-tive and often violent environment.Sports more recently have becomean equally fertile ground for devel-opment in physiology, nutrition,injury prevention, surgical tech-niques, and rehabilitation. 3

F R O M T H E P R E S I D E N T

ALAN E. FREELAND, MD


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Winter2003

continued on page 4

AS PHYSICIANS AND SURGEONS,

WE CAN HAVE MANY VICTORIES

EVERY DAY. WE CAN WIN AS WE

ENDEAVOR TO BE BETTER

SPOUSES, BETTER PARENTS,

BETTER FRIENDS, BETTER

PHYSICIANS, AND BETTER

CITIZENS OF OUR COMMUNITIES.

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Winter2003

Advances in strengthening andconditioning, improved protectiveequipment (headgear, specialtygloves, playing orthoses), magneticresonance imaging (MRI’s), arthro-scopic surgery, and internal fracturefixation have taken their placealong side of modern stadiums,free-agency, corporate sponsorship,and the sports labor movement inushering in the modern era ofsports.

Join us at the 33rd AnnualMeeting in Kauai, Hawaii, fromJanuary 8-11, 2003. There will be arich venue of educational, social,and recreational opportunities. Themeeting will open with our com-bined Hand Therapists andPhysicians Symposium, “Diagnosis,Treatment, Rehabilitation, and theEarly, Safe Return to Play of theHand Injured Athlete” and con-clude with our Guest PresidentialSpeaker, Art Rettig, MD, Indiana-polis Colt Team Physician, address-ing “Hand Injuries in the NFL.”Many aspects of the care providedto athletes extrapolate to improve-ments for the general public aswell. So, “Hang Ten.” Come, con-tribute, and participate in the festivities. H

F R O M T H E P R E S I D E N Tcontinued from page 3

A llen L. Van Beek,MD is in privatepractice inMinneapolis,

MN and teaches Hand,Micro, and PlasticSurgery through thePlastic Surgery trainingprogram at theUniversity ofMinnesota. He com-pleted training pro-grams and attainedcertification in GeneralSurgery, Hand and Microsurgery,and Plastic Surgery. While havingauthored dozens of periodical pub-lications, educational videos, edu-cational CDs, chapters, and cours-es, he feels the most importantthings health care providers do arerelated to their family and themany patients that have entrustedhim with their health care.

As one of the leadership teammembers for the Association, priorexperience as president of the AmSoc Reconst Microsurgery, Am SocPeripheral Nerve, MinnesotaSociety Plastic Surgery, andSouthern Minnesota MedicalSociety have provided insight intothe diversity of membership opin-ions and the complexity of issuesfacing the membership. Dr. VanBeek also serves as the VicePresident for the Plastic SurgeryEducational Foundation and SeniorExaminer for the American Boardof Plastic Surgery.

As 2003-2004 President of theAAHS, his most important goalswill be to continue theAssociation’s excellent tradition ofpairing a learning experience withrecreational fun. Expect the imple-mentation of additional teachingmethods and tools. A second andmore complex goal is to continuethe process of making theAssociation more global and

L E A D E R S H I P P R O F I L E

diverse in its programs,Association affilliationsand membership out-reach. A third goal willbe to explore andestablish potentialmethods of assuringbroad access to special-ty care physicians bymanaged care patientsalong with fair reim-bursement for proce-dures performed byhand surgeons. Dr. Van

Beek believes that professional orga-nizations are essential to assuringthat hand surgeons throughout theworld continue to provide compas-sionate excellence in their care giv-ing.

Commensurate with that belief,he asks members—especiallyyounger members—to volunteer andhelp with AAHS’s educational, com-mittee and board functions. If youare interested in volunteering tohelp, contact Dr. Van Beek at [email protected] or the Association’smanagement office in Chicago athandsurgery.org. H

President-Elect Allen L. Van Beek, MD

7th Annual Day at the Links Golf Tournament

being held in conjunction with the AAHS and ASRM Annual Meetings

Saturday, January 11, 200312:30 pm Departure

Price: $150.00The shotgun tournament will be held at the Poipu Bay Resort Golf Course.

You’ll enjoy stunning ocean vistas from every hole.This Robert Trent Jones, Jr.masterpiece offers an ideal setting from individual players to tournaments.

Tournament fees include lunch, greens fees, cart rental and range balls. Please notethe club is a spikeless facility and metal spikes are not allowed.

Prizes will be awarded to the team with the lowest gross score in addition to thelongest drive, longest putt and closest to the pin.Tournament registration will

officially close on FRIDAY, January 10, 2003 AT 4:00 pm.All pairings should be doneon site in the pro shop. Golfers are encouraged to submit completed foursomes to

the golf pro shop.

To sign up or for more information, call 312-236-3307.

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Winter2003

Program at a Glance

AAHS 33rd AnnualMeetingJanuary 8-11, 2003Hyatt Regency KauaiKoloa, Kauai, HI

Hand Therapy Specialty DayWednesday, January 8, 2003Concepts in the Treatment of UpperExtremity Sports Injury: From the Elbowto Hand6:00–7:30 am Continental Breakfast7:00–7:05 am President’s Welcome

Alan Freeland, MD7:06–7:10 am Program Chair Welcome

William Geissler, MD7:11–7:15 am Hand Therapy Program

Co-Chair WelcomeLynn Bassini, PT, OTLee Osterman, MD

7:15–7:30 am The Epidemiology of Hand,Wrist, Elbow Injury inSportsPeter Amadio, MD

Avulsion Injuries: WhyWon’t It Bend?Moderator: Nash Naam, MD

Flexor DigitorumProfundus Avulsion-Jersey Finger

7:31–7:40 am Diagnosis and TreatmentMukund Patel, MD

7:41–7:50 am RehabilitationLynn Bassini, PT, OT

PIPJ Fracture Dislocations7:51–8:00 am Diagnosis and Treatment

Mark Cohen, MD8:01–8:10 am Rehabilitation

Aviva Wolff, OT

Distal Biceps/TricepsRupture

8:11–8:20 am Diagnosis and TreatmentDean Soteareanos, MD

8:21–8:30 am RehabilitationSue Blackmore, MS, OTR,CHT

8:31–8:44 am Case Presentations &Questions

ArthroscopicManagement of theAthletic WristModerator: Brian Adams, MD

8:45–8:55 am Arif Scaphoid FractureJoe Slade, MD

8:56–9:05 am Arif Distal Radius FractureWill Geissler, MD

9:06–9:15 am Ligament Injuries-Gymnast’s WristRichard Berger, MD

9:16–9:25 am TFCC InjuriesDavid Ruch, MD

9:26–9:35 am RehabilitationTerri Skirven, OTR, CHT orPaul Brach, MS, PT, CHT

10:00–10:15 am Break

Tennis Elbow, Anyone?Moderator: Keith Bengtson,MD

10:15–10:30 am Is There a Scientific Rationalfor the Treatment of ElbowTendonitis?Kevin Plancher, MD

10:31–10:45 am Arthroscopic Treatment ofTennis ElbowMark Cohen, MD

10:46–11:00 am Golfer’s Elbow—MedialEpicondylitisBrian Sennett, MD

11:01–11:15 am Rehabilitation of ElbowTendonitis Stretch or CurlSue Michlovitz, PT, PhD

11:16–11:30 am Is There Light at the End ofthe Radial Tunnel?Lee Dellon, MD

Nerve Injuries in Sports11:31–11:37 am Hand and Wrist: Thumb

Bowler’s/ Cyclist’s PalsyBrian Adams, MD

11:38–11:45 am Nerve Injury about theShoulderJohn Bedenar, MD

11:46–11:55 am Rehabilitation of the InjuredNerveChristine Novak, PT, MS

12:00–1:00 pm Working lunch 12:00–12:14 pm How Your Sport Rates in

Keeping You FitLee Osterman, MD

Decision MakingModerator: Scott Kozin, MD

12:16–12:25 pm Hand Fractures in the LargeSports Medicine PracticeShannon Singletary, MD

12:26–1:00 pm Protective Splinting andHand Gear for the Athlete atAll Levels of PlayPresidential Guest SpeakerArt Rettig, MD

1:01–1:15 pm When Can I Play? Managingthe In-Season InjurySpecialty Casts, Braces,Gloves and TapingRonald Palmer, MDGregory L Gaa, MS, ATC-L,CSCS

1:00–2:15 pm Instructional Courses101 Malalignment Bone and Soft

Tissue TumorsPeter Murray, MD

102 Disorders of the DistalRadioular JointBrian Adams, MD

103 Hand FracturesMark Baratz, MD

104 Management ofRheumatoid Hand andWristAnthony De Santolo, MD

Specific Sports: SpecificInjuriesModerator: Sue Michlovitz,PT, PhD

1:16–1:25 pm Skier’s ThumbMark Baratz, MD

1:26–1:35 pm Boxer’s FractureAlan Freeland, MD

1:36–1:45 pm Baseball Halmate HookNonunionJohn Lubahn, MD

1:45–1:55 pm Mallet FingerTerri Wolfe, OTR, CHT

1:56–2:05 pm Squeaker’s WristRichard Brown, MD

2:05–2:15 pm Hazards of Water Sport—Fish Hooks to Shark BitesBrad Meland, MD

2:16–2:30 pm Questions and Wrap Up2:30–4:30 pm Computer Workshop

(optional)Robert Uhl, MD

Thursday, January 9, 20036:00–7:00 am Coffee

7:00–8:10 am Instructional Courses105 Congenital Hand

Shelia Lindley, MD106 Wrist Reconstruction

Gunter Gorman, MD107 Vascularized Bone Grafts

Allen Bishop, MD108 Advances in Upper

Extremity Soft TissueCoverageWilliam Lineaweaver, MD

109 Updates on Basilar JointArthritisLee Osterman, MD

Concurrent ScientificPaper Session A-1

Hand Fractures8:30–8:36am Locked Percutaneous

Intramedullary Nailing ofMetacarpal and PhalangealFracturesJorge Orbay, MD

8:37–8:43 am Motion Influencing Factorsin Digital FracturesDavid J. Slutsky MD,FRCS(C)

8:44–8:50 am Acute vs DelayedTreatment of Open DistalPhalanx FracturesArshad R. Muzaffar, MD

8:51–8:57 am A New Dynamic SpringDistraction Device in theTreatment of ProximalInterphalangeal JointFracture DislocationJohn LoGiudice, MD

9:05–9:11 am Discussion

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Winter2003

Hand/Wrist Fractures9:12–9:18 am Long-Term Results of

Management of Gun ShotWounds to ProximalInterphalanageal JointsUsing External FixatorC. Balakrishnan, MD

9:19–9:25 am Sports Casting of the UpperExtremity In-Season AthleteRonald E. Palmer, MD

9:26–9:32 am The Management ofComplex Articular Fracturesof the Distal Radius throughthe Volar ApproachJorge Orbay, MD

9:33–9:39 am Palmar Plating for theFracture of the Distal RadiusMasayuki Kamano MD, PhD

9:40–9:46 am Treatment Outcome of theTrimed System forDisplaced Intra-ArticularDistal Radius FracturesKevin Chung MD, MS


Wrist9:54–10:00 am Management of Dorsal

Radiocarpal Ligament TearsDavid J. Slutsky MD,FRCS(C)

10:01–10:07 am A Salvage Operation forKienbock’s Disease withUnsuccessful RadialOsteotomy; Three CaseReports of a VascularizedBone Graft Combined withCapitate Shortening andCapitohamate FusionapitateShorteningRyosuke K. Akinoki MD, PhD

10:08–10:14 am Outcome Assessment ofWrist Denervation—AReview of 84 PatientsMichael Sauerbier MD, PhD

10:15–10:21 am Stability of Scaphoid WaistFractures in Response toForearm and Wrist Rotationand the Role of theRadioscaphocapitateLigamentTimothy R. McAdams, MD

10:22–10:28 am Injury to the Dorsal Branchof the Ulnar Nerve in theArthroscopic Repair ofUlnar Sided TriangularFibrocartilage Tears Usingan Inside-out Technique: ACadaveric StudyTimothy R. McAdams, MD


Concurrent ScientificSession A-2

Tendons8:30–8:36 am Cerebral Reorganization

Following Flexor TendonLesion of the FingersJ. Henk Coert, MD

8:37–8:43 am Biomechanical Analysis ofSwan Neck Tendency in

Program at a GlanceDistal Radius Fixation (spon-sored by Hand Innovations)Jorge Orbay, MDPercutaneous Trigger FingerRelease (sponsored byPharmacocia)Migual Saldana, MD

Scientific Session B

Papers: Elbow11:36–11:42 am Radial-Ulnar Synostosis after

the Two-Incision BicepsRepair: a StandarizedTreatment ProtocolLoannis Sarris, MD, PhD

11:43–11:49 am Reconstruction Essex-LoprestiInjuryGary Kuzma, MD

11:50–11:56 am Steroid Injection vs.Autologous Blood Injection inLateral EpicondylitisMiguel Saldana, MD

11:57 am– Lateral Antebrachial 12:03 pm Cutaneous Nerve Entrapment

at the ElbowNash Naam, MD

12:04–12:10 pm Outcome Following Repair ofDistal Biceps Ruptures Using aSingle Incision Technique andEarly RehabilitationThomas R. Hunt III, MD

12:11–12:17 pm Discussion12:18–12:40 pm Break

12:41–1:10 pm Arthroplasty of the HandRobert Beckenbaugh, MDArnold-Peter Weiss, MD

1:11–1:30 pm International Speaker“History of Hand Surgery inVenezuela”Anthony DeSantola, MD

Friday, January 10, 20036:00–7:00 am Coffee

7:00–8:15 am Instructional Courses110 The Elbow

Mark Cohen, MD 111 New Frontiers in Wrist

ArthroscopyDavid Slutsky, MD

112 Use of ElectrothermalShrinkage in Hand & WristSteven Topper, MD

113 Upper Extremity VascularDisordersNeal Jones, MD

114 Management ofAcute/Chronic Flexor TendonInjuriesScott Kozin, MD

Concurrent Scientific PaperSession C-1

Wrist8:30–8:36 am Capsulodesis for Chronic

Scapholunate DissociationSteven L. Moran, MD

8:37–8:43 am The Outcome of IsolatedLunotriquetral InterosseousLigament Tears Treated byUlnar Shortening OsteotomyM. Ather Mirza, MD

Two-Stage Flexor TendonGraftsShrikant J. Chinchalkar BScOT,OTR, CH

8:44–8:50 am Reduction Flexor Tenoplastyfor Repair of the FlexorTendon Using Large CoreSuture: a BiomechanicalCadaver StudyHoushang Seradge, MD

8:51–8:57 am Improved Technique ofReconstruction of the FingerDistal Extensor Aponeurosisby Dermical BandeletsAlexandru V. Georgescu, Prof

8:58–9:04 am Endoscopic Trigger FingerReleaseTyson Cobb, MD


Carpal Tunnel Syndrome9:12–9:18am Percutaneous Trigger Finger

Release Using a New PushKnifeMichael John Dunn, MD

9:19–9:25 am Scapho-Trapezial Synovitisas a Cause of Prolonged Painafter Carpal Tunnel ReleaseHooman Soltanian, MD

9:26–9:32 am Eleven Year Follow-up of theDistal Single Incision ScopeAssisted Carpal TunnelReleaseM. Ather Mirza, MD

9:33–9:39 am A Meta-Analysis ofRandomized ControlledTrials ComparingEndoscopic and Open CarpalTunnel DecompressionAchilleas Thoma MD, FRCS(C)

9:40–9:46 am Carpal Tunnel Surgery in theElderlyMark F. Hendrickson, MD


Basic Science9:54–10:00 am Wrist Flexor Spasticity

Results in Dramatic MuscleSarcomere LengthsRichard Lieber, PhD

10:00–10:07 am Spastic Muscle Cells AreShorter and Stiffer ThanNormal CellsRichard Lieber, PhD

10:08–10:14 am Effects of Tgf-Beta on FlexorTendon Wound HealingMatthew Klein, MD

10:15–10:21 am Local Application of LowMolecular Heparin in CrushInjuries: an ExperimentalStudy in RatsYu-Hui Yan, MD

10:22–10:28 am Long-Term Outcomes inSurgical Rehabilitation of theUpper Limb in TetraplegiaVincent R. Hentz, MD

10:29–10:35 am Discussion10:29–11:00 am Break

11:00–11:30 am President Invited Speaker“Innovation in HandSurgery”Arnold-Peter Weiss, MD

11:30–12:30 pm Ask the DoctorTotal Elbow Arthroplasty(sponsored by DePuy)William Geissler, MD

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8:44–8:50 am Role of X-Ray, Bone Scan,Arthrogram and Arthroscopyin the Diagnosis of UlnaSided Wrist Pain Due toUlnar Impaction, TfccLesions, or LunotriquetralLigament TearsM. Ather Mirza, MD

8:51–8:57 am A New Method of SurgicallyTreating Midcarpal InstabilityHerbert P. von Schroeder MD,FRCSC

8:58–9:04 am Ten Year Outcome: Treatmentof Scaphoid Instability with-out Fixed DeformityHoushang Seradge, MD


Wrist9:12–9:18 am Lunotriquetral Arthrodesis:

Good Results and LowMorbidityJudson B. Moore, MD

9:19–9:25 am Short-Term Clinical Outcomesof Proximal Row CarpectomyJeffrey A. Nechleba, MD

9:26–9:32 am An Analysis of Symmetry ofDisplacement of the DistalRadioulnar Joint in NormalSubjectsJuli Matsuoka, MD

9:33–9:39 am Electrothermal Shrinkage inInterosseous Ligament TearsWilliam Geissler, MD

9:40–9:46 am Radial Opening WedgeOsteotomy for Kienbock’sDisease: A Long-Term Follow-up StudyMinoru Shibata, MD


9:30–10:30 am Ask the DoctorTotal Wrist Arthroplasty(sponsored by KMI)Brian Adams, MDArthroscopic Fixation ofScaphoid Fractures (sponsored by Acumed)Joe Slade, MDInternal Fixation of HandFractures (sponsored by AO)Mark Cohen, MD

Arthritis9:54–10:00 am Trapeziometacarpal Joint

Renewal with AutogenousEar CartilageWilliam Nickell, MD

10:00–10:07 am Thumb CarpometacarpalArthrodesis withMinicondylar BladeplateFixationDonald P. Condit, MD

10:08–10:14 am An Update on RadiolunateFusion for RadiocarpalArthrosis Due to Malunion ofDistal Radius FractureJaiyoung Ryu, MD

10:15–10:21 am Treatment of the RheumatoidHand-Ulnar Drift (Early andLates Cases)Harilaos T. Sakellarides, MD

10:22–10:28 am Long Term Follow-up ofProximal Row Carpectomyfor Advanced StageKienbock’s Disease: AnAverage 15 Year Follow-upBoyd Christopher Lumsden, MD

Source of Enigmatic UpperExtremity PainWoodward L. Coleman, MD

10:22–10:28 am The Effect of Nerve GrowthFactor Antibody on Long-Term Sensory Function inRat Skin GraftsWilliam G. Williams, MD

10:29–10:35 am Discussion10:35–11:00 am Break

11:00–11:30 am Ancient Greek Coinage:The Stories from Smugglerto Sotheby’sArnold-Peter Weiss, MD

11:30 am– Advances in Management 12:00 pm of Scapholunate Ligament

TearsRichard Berger, MD

12:00–12:10 pm ASSH President AddressDennis Phillip II, MD

12:00–12:40 pm Defend Your PlateJorge Orbay, MD

12:40–1:40 pm President’s BusinessMeetingPresidential Address“Half a Cup”Alan Freeland, MD

1:45–2:30 pm AAHS Board Meeting

Saturday, January 11, 2003AAHS/ASRM/ASPN Combined DayProgram6:30–7:00 am Coffee7:00–5:00 pm Posters Open

7:00–8:00 am Instructional Courses201 Thoracic Outlet

Susan Mackinnon, MDLee Dellon, MD

202 Multi-disciplinary PainManagementJames Campbell, MD

203 Repetitive Making for MajorLimb ReplantationPeter Amadio, MD

204 Decisions Making for MajorLimb ReplantationGabriel Kind, MD

205 Brachial PlexusTBA

8:00–8:15 am Presidents’ WelcomeAlan Freeland, MD (AAHSPresident)Julia K. Terzis, MD, PhD(ASRM President)William Kuzon, MD (ASPNPresident)

8:15–9:30 am Combined Panel: FunctionalRestoration FollowingDevastating InjuriesRod Hentz, MD, David Chuang, MDGu Yu Dong, MD

9:45–10:30 am Presidents’ Invited Lecture“An Eighteen YearExperience of TreatingUpper Extremity Injuries inthe NFL”Art Rettig, MD

10:30–11:15 am Coffee/ Exhibits Break11:15 am– Outstanding Nerve Paper 12:15 pm Presentations


Concurrent Scientific PaperSession C-2

Microvascular8:30–8:36 am Long-Term Outcome

Following Functioning FreeMuscle Transfer in the YoungPediatric PatientArshad R. Muzaffar, MD

8:37–8:43 am Toe Transfer in Hand’sFunctional ImprovementAlexandru V. Georgescu

8:44–8:50 am Functional Recovery after HandTransplantation—Results atThree Year Follow UpWarren C. Breidenbach MD,FRCS(C)

8:51–8:57 am NeuromuscularReconstruction in SevereBrachial Plexus LesionsPietro Giovanoli, MD

8:58–9:04 am Limits of Replantation Surgeryand Alternative Procedures forInjuries of the DistalPhalangesFranz Lassner, MD


Nerve9:12–9:18 am Correction of Internal Rotation

Deformity in Brachial PlexusPalsy with Latissimus andTeres Major Rerouting andLengtheningFiras R. Karmo, MD

9:19–9:25 am The Anatomy of the SensoryCommunication of the Medianand Ulnar Nerves in the PalmSam Biafora, MD

9:26–9:32 am Results of MusculofascialLengthening Technique forSubmuscular Transposition ofthe Ulnar NerveJ. Henk Coert, MD

9:33–9:39 am Functional Outcome ofSurgical Treatment of RadialTunnel Syndrome: Review of213 CasesNash Naam, MD

9:40–9:46 am Treatment of Cubital TunnelSyndrome: Comparisonbetween SimpleDecompression, EndoscopicAssisted Release and AnteriorTranspositionTsu-Min Tsai, MD


Microvascular9:54–10:00 am New Method of Bone Marrow

Transplantation Leads to theExtension of Skin AllograftSurvival across MajorHistocompatibility BarrierMaria Siemionow MD, PhD

10:00–10:07 am Toe Transfer with an In-Conti-nuity Arterio-Venous LoopErin E. Brown MD, PhD,FRCS(C)

10:08–10:14 am Cross Replantation of RightForearm to the Left Side for aCase of Bilateral Amputationof Both Forearms in a TrainAccidentSneh-Sadan Sneh-Sadan, MD

10:15–10:21 am The Superficial Palmar Branchof the Radial Artery as a

AMERICAN ASSOCIATION FOR HAND SURGERY BYLAWS COMMITTEE REPORT

Proposed Bylaws ChangesARTICLE III – MembershipSECTION 12 – ADMISSION TO MEMBERSHIP

The American Association for Hand Surgery will act upon member-ship applications twice a year. The deadlines for receipt of membershipapplications will be May 1 and November 1 of each year or the first work-ing day thereafter. The Membership Committee will then process theapplications and forward their recommended new members ballot to theBoard of Directors and the Active Membership by June 1 and December 1of each year or the first working day thereafter.

Objections to any applicant must be received in writing by theMembership Committee Chair by July 1 or January 1 or the first workingday thereafter. The Membership Committee Chair will forward any andall objections to the Board of Directors for deliberation at their mid-yearor annual meeting. Recommendations may be made by the MembershipCommittee.

The Board of Directors will act upon the membership ballot at theirmid-year meeting and at the first board meeting at the annual meeting.The Board of Directors will decide what action to take regarding appli-cants’ against whom an objection has been filed. There will be no furtherdiscussion of new applicants following the action of the Board ofDirectors.

Applications approved for membership will be referred by ballot tothe Active membership. Active members will be given thirty (30) days tocast their ballot. Newly elected members will be notified in writing oftheir election and their names will be published in the Hand SurgeryQuarterly.

ARTICLE V- Board of Directors

SECTION 1 - COMPOSITIONThe Board of Directors shall consist of seven (7) officers (and the

Treasurer-Elect during his/her year of tenure), the two (2) immediate PastPresidents, the four (4) Directors-At-Large, the Hand Therapy Director, andthe Junior and Senior Affiliate Directors Chair and Vice Chair of the HandTherapy Committee, who will act as Affiliate Directors. The Chair of theHand Surgery Endowment shall serve as a non-voting member participantat the Board of Directors annual meeting and at other meetings of the Boardof Directors at the discretion of the president.

SECTION 8 – Election Rotation

The Vice-President, the Historian, Junior Affiliate Director Vice-Chair ofthe Hand Therapy Committee and two (2) Directors-At-Large shall be elect-ed every year. Of the two directors, one shall be an active member for morethan seven (7) years and the other, not more than seven (7) years. TheSenior Affiliate Director will succeed to the position of Hand TherapyDirector for a one (1) year term. The Secretary and the Treasurer/FinanceCommittee Chair will be elected every three years. The Treasurer-Elect willbe elected in the final year of the Treasurer’s term.

KEY: New Text Deleted Text

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AmericanAssociation forHand Surgery2003 Slate ofCandidates

Officers

President (automatic)Allen Van Beek, MD

President-Elect (automatic)Richard Berger, MD

Vice PresidentSusan Mackinnon, MD

TreasurerN. Bradly Meland, MD

SecretaryRonald Palmer, MD

HistorianA. Lee Osterman, MD

Senior Director At Large Carolyn Kerrigan, MD

Junior Director At LargeShelia Lindley, MD

Junior Affiliate DirectorGail Groth, OTR/L, CHT,MHS

Elected CommitteePositionsNominating CommitteeMiguel Saldana, MDRobert Walton, MD

The USBEvolution

Just when the iMac haslaunched its campaign fortrue plug ‘n’ play technolo-gy, the PC world is rockingwith USB (Universal Serial

Bus). One look at the back of yourcomputer is like an archeologicalexpedition into connectivity stan-dards. Like an old building, thereare relics of the past and presentlike PS/2, serial, parallel, and SCSII/O sub-systems. Standards evolvein the technology world withDarwinian principles respectingspeed above all else, and USBseems to cut muster in this regard.

Early version digital camerastransferred data to the computerthrough the painfully slow serialport. The IEEE 1394 improved mat-ters nicely with 400-Mbps through-

put, but never reached ‘criticalacclaim’ to become a standard PCfeature. Yet, it was easily installedpost-production with a card andcable. USB 2, on the other hand(evolved from USB 1.1) has reachedacclaim and emerged as the PCconnectivity icon. It is small, andspeedy, peaking out at data transferrates north of 480 Mbps. As such, ahuge variety of peripheral manu-facturers now sell hardware withUSB connectivity. (Seehttp://www.usb.org/app/search/products/) “USB is the solu-tion for any PC user who hasever dreamed about aninstant, no-hassle way to con-nect a new digital joystick, ascanner, a set of digital speak-ers, a digital camera, or a PCtelephone to their computer.”

Two additional and mostnoteworthy features of USBare “hot-swapping” and“daisy chaining.” Hot swap-ping permits you to “start” aperipheral simply by plugging it inand to “stop” the device electroni-cally with a mouse click and with-out an annoying, time-consumingre-boot. Daisy chaining means thatmultiple peripherals can ‘hang’ offthe same port. Replication hubs arecheap and easy so that a single USBcomputer port can support multi-ple devices simultaneously. Forexample, a typical digital photo setup might include a direct cameraUSB port, a USB mouse with mem-ory stick drive for downloads, anda mass storage hard drive for back-ups.

Getting your hands around thistechnology is well worth the mini-mal effort for both professional andpersonal use. H

9

T H E D I G I TA L H A N D S U R G E O N

J. DANIEL LABS, MD


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e-mails. I am sure this will be awell received and informativecourse.

Peter Weiss, MD, the KeynoteSpeaker, will talk about innova-tions in hand surgery. Dr. Weiss hasbeen quite instrumental in thedevelopment of a number of med-ical products. We look forward tolearning from his experience inworking with various medicalcompanies in product develop-ment. In addition, Peter is anexpert on coin collecting and willhave an excellent presentation onthe history of hands found oncoins.

Antonio DeSantola will be ourinternational guest speaker and hewill inform us on the developmentof hand surgery in Venezuela. Thisis a very interesting topic, as thehistory and development of handsurgery in South America is quitefascinating.

The meeting will conclude onSaturday with Art Rettig, M.D., theteam physician for the IndianapolisColts. He will deliver thePresidential Address on handinjuries in the NFL. He has over 18years experience in treating upperextremity sports medicine injurieswith the NFL. He will recommendtreating protocols, including safereturn to competition. He will alsodiscuss the interesting role of ateam physician and how it haschanged over the past 18 years.

Please mark your calendars forthe 33rd Annual Meeting in Kauai,Hawaii. This will truly be an excit-ing, comprehensive meeting cover-ing all areas of hand surgery. Inaddition to an informative meetingon the latest topics of hand surgery,there will be ample time for enjoy-ing the beautiful scenery ofHawaii. Please bring your familyand don’t miss it!

I look forward to seeing youthere. H

A N N U A L M E E T I N Gcontinued from page 1

W. P. Andrew Lee, MD, has beenawarded the 2002-2003 SterlingBunnell Traveling Fellowship from theAmerican Society for Surgery of theHand.

Scott Kozin, MD, was elected to theAmerican Society for Surgery of theHand Council as a Member-at-Large.

People in the News is dedicated to recog-nizing the accomplishments of AAHSmembers and their families. Submissionsshould be sent to the AAHS CentralOffice at [email protected], and will beincluded on a space available basis.

P E O P L EI N T H E

N E W S

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M E M B E R S H I P

Active MembersBarakat, NabilFort Knox, KY

Barry, RonaldDetroit, MI

Dowdle, JohnPittsburgh, PA

Imbriglia, JosephWexford, PA

Jemison, D. MarshallMemphis, TN

Jones, JonathanSan Diego, CA

Kassan, MartinAshland, KY

Kasten, StevanSt. Joseph, MI

Kennedy, JamesChattanooga, TN

King, CliffordJanesville, WI

Landis, GeorgeMinneapolis, MN

Nicolaidis, StephenNew York, NY

O’Neil, WilliamLexington, KY

Ortiz, JoseEau Claire, WI

Reubeck, DavidEdina, MN

Roberts, CraigSaratoga Springs, NY

Shin, AlexanderRochester, MN

Tantillo, MichaelBoston, MA

Affiliate MembersJones, AmeliaWarren, MI

Pagonis, JanicePittsburgh, PA

Passig, CiaSpringfield, IL

Samaan, MonaStaten Island, NY

Tung, ThomasChesterfield, MO

Wolff, AvivaSomerset, NJ

InternationalMembersBindra, Randy

Fabris, BetinaBuenos Aires

Candidate MembersBaxbamus, TaizoonSycamore, IL

Cohen, GlennThousand Oaks, CA

Pfalz, HelmutMilwaukee, WI

Salyapongse, NeilSyracuse, NY

Winemiller, MarkRochester, MN

The AAHS Research Grant Awards were establishedto further the purpose of the Association as stated inits Bylaws and to foster creativity and innovation inbasic and/or clinical research in all areas pertinentto hand surgery.

Awards and EligibilityGrants will be made for a one year period to up to three inves-tigators. Grants are available to all AAHS members. One of theinvestigators must be an active or affiliate member of theassociation.

Grant ApplicationApplications may be obtained from:

American Association for Hand Surgery 20 N. Michigan Avenue, Suite 700Chicago, Illinois 60602

Applications (an original plus seven copies) must be receivedby the committee chair no later than Monday, November 3,2003, in order for the judging to be completed in time and therecipients to be announced at the Annual Meeting.

The AAHS and the Research Committee are required by theIRS to document disbursement of grant funds. Award recipi-ents will be required to sign a letter of acceptance and submit aprogress report once each year. The AAHS must be acknowl-edged as the source of funding in any presentation or publica-tion. A final report must be submitted at the completion of thestudy. It is expected that the results of the funded research besubmitted for presentation at an Annual Meeting within twoyears of the receipt of the award.

Funds must be returned to the AAHS if the study is notundertaken within twelve months of the receipt of the award.

Failure to follow these guidelines will disqualify the recipi-ent from any further grant opportunities and from presentingany papers at the AAHS Annual Meeting for a period of threeyears following such default.

Mail Grant Proposals toSaleh M. Shenaq, MDBaylor College of Medicine6560 Fannin Street, Suite 800Houston, TX 77030

2004 Application forResearch GrantsAAHS 2003 Slate of

Candidates for Membership

Dr. Barbieri: Dr. Capo, what do yousee as the most common presenta-tion for a person who requires a DIPjoint fusion?

Dr. Capo: Typically it is an elderlyfemale with painful arthritis in theDIP joints that is causing difficultieswith day-to-day activities. There’s acombination of pain, malalignmentand appearance problems, such asdeviation and nodularity (osteo-phytes, mucous cysts) that bring thepatients to the office.

Dr. Barbieri: How do you differenti-ate between those in which youtreat the mucous cyst alone andthose in which you go ahead andfuse the joint?

Dr. Capo: I think if a mucous cystpresents with arthrosis and pain, afusion is definitely part of the treat-ment regimen. Dr. Capo: I think if amucous cyst presents with arthrosisand pain, a fusion is definitely partof the treatment regimen. The surgi-cal approach in this instance mayhave to be altered to include a rota-tion flap. This depends primarily onthe condition of the skin surround-ing the mucous cyst.

Dr. Barbieri: What’s your typical sur-gical approach when fusing a DIPjoint?

Dr. Capo: My exposure to the dor-sum of the DIP joint is a balloonedout Y incision. The V portion of the

Y looks more like a broad U. Thisallows me to look at the terminaltendon, the DIP joint and the germi-nal matrix because they’re only afew millimeters from each other. I’llflip the skin flap distally and actual-ly sew it to the nail plate to allowme to get a good look at the pathol-ogy.

Dr. Barbieri: How do you treat theextensor tendon?

Dr. Capo: I incise it transversely andflip it back and do whatever workI’m going to do. And I think it isalso important to repair it for softtissue coverage and also to preventany late extensor problems orimbalance.

Dr. Barbieri: Dr. Slater, do you alsouse a Y incision?

Dr. Slater: No. I use a step cut inci-sion with the transverse limb cen-tered dorsally over the DIP flexioncrease and then extend one limbproximally and one limb distally soit’s a step cut. I try to keep the limbthat’s going proximally off of theborder of the hand, that is off theulnar border of the small finger orthe radial border of the index finger.

Dr. Barbieri: How do you treat theextensor tendon with the step cutapproach?

Dr. Slater: I do a transverse divisionof the extensor tendon and flip oneflap proximally and one distally,

and then use thoseflaps for closure fol-lowing the arthrodesis.

Dr. Barbieri: And yourepair that in order tomake sure there’s not aSwan Neck deformitylater?

Dr. Slater: Correct.

Dr. Barbieri: I typicallyutilize a dorsal Happroach for anarthrodesis and splitthe extensor tendonwith the skin incision.I find it gives me thickflaps and I don’t haveproblems with thewound breakingdown. Later, whenrepairing the skin, I perform a ringstitch.

Dr. Neumeister, do you see a lotof wound breakdowns when youoperate around that area of thejoint?

Dr. Neumeister: I haven’t seen thatwith a simple fusion. I have seenthat with a DIP ganglion which hasa very thin skin covering. I don’t seethe purpose of going after the cystwall. The osteophyte is the impor-tant pathology to remove since thatis what initiates the ganglion.

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Small Joint ArthrodesesSmall joint arthrodesis is typically one of the more common procedures performed in the hand. Although a lot of surgeons consid-er fusion a salvage operation, it predictably provides a stable and pain-free joint in situations where mobility is difficult to main-tain. Arthrodesis truly serves as a benchmark against which all other procedures, especially arthroplasty, have to be measured.

Our moderator is Rocco Barbieri, MD, Director, Hand & Microvascular Division, Southern Bone & Joint Specialists,Hattiesburg, MS. Joining him on the panel are hand surgeons John Capo, MD, Assistant Professor; Chief, Hand &Microvascular Surgery, UMDNJ-New Jersey Medical School, Michael Neumeister, MD, FRCSC, FACS, Associate Professor,Program Director Plastic Surgery, Southern Illinois University, Springfield, IL, and Robert R. Slater, Jr., MD,FACS, The Permanente Medical Group, Sacramento, CA, and Assistant Clinical Professor, Hand and UpperExtremity Surgery Division, Department of Orthopaedic Surgery, University of California, Davis, Sacramento,CA, and hand therapist Julie Falla, OTR/L, CHT, Southern Bone & Joint Specialists, Hattiesburg, MS.

SACRIFICING MOTIONOF THE PIP JOINT IN

THE SMALL DIGITSIGNIFICANTLY

IMPAIRS GRIP AND IOFTEN WILL FAVOR

ARTHROPLASTY OVERARTHRODESIS.

ROCCO BARBIERI, MD

continued on page 12

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down the shaft of both the distaland middle phalanges. I use anoscillating saw and make straightcuts that allow an adequate surfacearea for compression.

Dr. Barbieri: How big is that screw?

Dr. Slater: The trailing threads are4.1 millimeter in diameter and theshaft is about 2.5 mm in diameter.So there’s no room for error, but it’sbeautiful because you have verynice, solid compression.

Dr. Neumeister: So it’s a headlessscrew.

Dr. Slater: Yes, it has separatelyrotating proximal and distalthreads.

Dr. Barbieri: I would like to mentiona cadaveric study that demonstrat-ed that the average thickness of theDIP joint is about 3-1/2 millimeters.Occasionally I see that as a bigobstacle with screw fixation, espe-cially in smaller individuals. If youuse a standard Herbert screw, oreven some of the newer headlessscrews, you’ll actually tear up the

sterile and germinal matrix whileplacing the screw across the distalphalanx. This most certainly willcause a nail deformity. Dr.Neumeister, what is your experi-ence?

Dr. Neumeister: Yes, I tend to use thecup and cone and I’ll use the ron-jour instead of power tools for themost part. More importantly,although the cartilage may be wornaway in these arthritic joints, thesubchondral bone must be ron-joured back to good cancellous boneto increase your union rate. I like tohave more of an angle in the ulnarDIP digits than I would the index. Ilike the angle down to around 20degrees of flexion, or possibly even30 degrees for the little finger.

Dr. Barbieri: Do you find that whenyou placing a screw across the DIPjoint into the shaft of the middlephalanx, the cortical bone will havea tendency to extend that fusion soit’s no longer at an angle?

Dr. Neumeister: I use two crossed0.035-inch K wires.

Dr. Barbieri: Dr. Capo, could youexplain how you prepare the jointsurface for a fusion? Do you consid-er using motorized instruments?

Dr. Capo: In the DIP joint, it prettymuch comes out to be a cup andcone. There is not a lot of bone dis-tally if you’re trying to maintain thegerminal matrix. I use a rongeurand try to create a concave cup dis-tally and a convex cone proximally.

Dr. Barbieri: Dr. Slater, could youcomment on your technicalapproach to a DIP fusion? Pleasemention the angle that you typicallyfuse these joints at.

Dr. Slater: For DIP joints, I usuallywill use a cannulated screw. Onethat’s just come out recently forgeneral use, called Twin-Fix, ismade by Stryker-Leibinger(Kalamazoo, MI). Therefore zerodegrees is the only option because itallows one to place a guide wire

A R O U N D T H E TA B L E


Dr. Barbieri: How long do you leavethe K wires in?

Dr. Neumeister: For about six weeks.I don’t wait for the radiographicappearance of fusion. I will likelynot actually see the radiographicevidence of bony union by sixweeks, but clinically, it’s been prettysolid. If the pins are loose before 6weeks, I’ll remove them.

Dr. Barbieri: If they come out a littleearly, do you use a splint to protectthe fusion?

Dr. Neumeister: I have an isolatedsplint for the DIP joint that our ther-apist manufactures to protect it foran extra couple of weeks.

Dr. Barbieri: Ms. Falla, on the topicof post-operative splinting of DIPfusions, could you explain how youapproach someone who comes inwith a DIP fusion?

Ms. Falla: Sometimes it’s quite chal-lenging with hardware sticking outof the finger; however, a volar gut-ter splint can usually be made tosupport the DIP nicely, leaving thenon-involved joints free. Sometimes,patients have a problem with skinbreakdown around the DIP, and inthat case we try to alternatebetween a volar and a dorsal guttersplint.

Dr. Barbieri: Dr. Slater, I often won’tsee bone bridging the area of fusionin the small joints of the hand untilabout ten or twelve weeks. Whenwould you let a person start return-ing to his usual activities followinga DIP fusion?

Dr. Slater: I typically splint the entirehand, leaving the thumb free for thefirst ten days after surgery to keepthe hand quiet and keep the woundin good condition. But after that,splinting just the involved fingerjoint is best. It’s important to protectthat particular joint during theentire ten to twelve weeks. Havingsaid that, when patients are allowedto return to “regular activities”depends a little bit on what thoseparticular activities are.

Dr. Barbieri: Dr. Slater, here inMississippi, we have a lot of chickenplants. How long would you tell theemployer to expect one of the facto-ry workers to be out following asmall joint fusion?

Dr. Slater: If they’re doing highforce, high repetition activities, thenthat’s three months out of work, atleast with that particular hand. Ifthe employer doesn’t have any wayto accommodate patients with therestrictions specified, then that’s thelength of time to expect being out ofwork.

Dr. Barbieri: Dr. Capo, is that alsoyour approach?

Dr. Capo: Yes, I splint the finger ini-tially post-op, for one to two weeksand if I can, I leave as many digitsout as possible. I then will splint thedigit with an isolated splint. Oftenwith these cannulated screws, it isthought that you don’t need tosplint them. But I think it still makesgood sense to put an isolated volarsplint across their DIP joints just toprevent any rotation.

Dr. Barbieri: Dr. Capo, you men-tioned that you often use screw fixa-tion. What do you do in a casewhen you’ve put the screw in and ithas no purchase and there’s still alittle bit of toggle?

Dr. Capo: If intra-op I don’t have fix-ation that’s adequate, I usually willback that screw out and switch to across K wire technique. I’d rathertake the screw out and get somekind of cross fixation with K wiresto provide some initial stability soit’s got a better chance of healing.

Dr. Barbieri: That has been my expe-rience as well. Multiple studies havesupported the notion that thestronger the fixation device—as youmove from K wires to tension bandto screws to plates—the higher thefusion rate. This is providing oneachieves good bone coaptation andadequate stability.

Dr. Slater, can you talk about thePIP joint? When do you decide tofuse the PIP joint vs. performingjoint replacement arthroplasty?

Dr. Slater: Until recently, the optionsfor arthroplasty for the PIP jointhave been fairly limited. Recently,there have been some new devices,but I still think that those are bestreserved for a non-border digit. Inmost cases, an arthrodesis is still thebest option for the PIP joint, espe-cially for the index and small fin-gers.

Dr. Barbieri: Dr. Neumeister, is thatyour approach as well?

Dr. Neumeister: It is forthe most part—for theyoung person, for thelaborer. But I havedone arthroplasties onborder digits insteadof arthrodesis in low-demand patients.

Dr. Barbieri: I wouldconsider replacing thePIP of the small andthe ring fingers whilefusing the index fingerin the appropriate can-didate. Sacrificingmotion of the PIP jointin the small digit sig-nificantly impairs gripand I often will favorarthroplasty overarthrodesis. The indexfinger participates inpinch and the lateralstresses often lead toearly failure when per-forming replacementarthroplasty. Whether Itend to replace or fusethe middle finger PIPjoint often depends onthe condition of the other PIP jointsin the patient.

Dr. Capo, what position do younormally fuse the PIP joints at?

Dr. Capo: The traditional angles thatI have used for PIP joints start withthe index finger at 40 degrees andgo up by 5 degrees to 55 in thesmall. However, when I look back atsome of my results, I think I fusethem perhaps 5 degrees less thanthat because I think it’s important

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YOU HAVE TO MAKESURE THE OSTEOTOMY

CUTS ARE TRUE INTHE AP AND LATERALPLANES TO PREVENT

ANY ROTATIONALDEFORMITY. IT HAS TO

BE RIGHT ON,ESPECIALLY ON THE

MIDDLE DIGITS.

MICHAEL NEUMEISTER, MD

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that they can get their hand into apocket and also lay their hand flatat times.

Dr. Barbieri: And is your surgicalapproach similar to the DIP joint?

Dr. Capo: For a fusion, I’ll split theextensor mechanism right down onthe central slip. Then I’ll actually

elevate it off and ele-vate the collateral lig-aments from bothsides. Next, I willshot-gun the jointinto flexion and thendo my bony work.

Dr. Barbieri: How doyou deal with theextensor tendon atthe end of the opera-tion?

Dr. Capo: I’ll bring itback up, repair itwith a non-absorbable stitch andactually invert thosestitches so they’reagainst the bone.

Dr. Barbieri: Dr.Slater, is yourapproach similar?

Dr. Slater: I also use alongitudinal incision.At the end I’ll use anon-absorbablesuture in a running

fashion to close that central split inthe extensor tendon mechanism sothat rather than having several dif-ferent knots that patients can feel,it’s simply a running suture.

Dr. Barbieri: Dr. Neumeister, how doyou prepare the bone in thesecases? Do you prepare a cup andcone for that bone or do you angleit?

Dr. Neumeister: A lot of times, withthe rheumatoid PIP joint, a cup andcone configuration is almost alreadymade because of the erosion andthe subsequent deformity. I’ll use

A R O U N D T H E TA B L Econtinued from page 13

the cup and cone for these patients.For some of the traumatic arthritisPIP joints, I’ll use beveledosteotomies and then use a tensionband technique. You have to makesure the osteotomy cuts are true inthe AP and lateral planes to preventany rotational deformity. It has to beright on, especially on the middledigits.

Dr. Barbieri: In what circumstanceswould you consider adding a bonegraft to your fusion?

Dr. Neumeister: I don’t usually needbone grafts for the small jointarthrodeses. With more severe trau-ma and bone loss, grafts may berequired. I’ll use the distal radius toget bone graft if I need it.

Dr. Slater: I adopt a similarapproach, except that I would addthat sometimes another good sourceof bone graft would be the proximalulna.

Dr. Barbieri: Dr. Capo, a couple ofauthors have talked about address-ing the volar plate, especially ifthere is significantbone loss. It seemsthe volar plate canget in the way ofactually being ableto adequatelycoapt the bonesurfaces. Haveyou ever encoun-tered this situa-tion?

Dr. Capo: Yes, Ithink it can get inthe way. The col-lateral ligamentscan also be a prob-lem. Usually, I justreflect them, butyou can excisethem. With thevolar plate, I usu-ally reflect it offthe proximal pha-lanx from the dor-sal approach. Thisallows you to doyour bone cutsmore precisely.

You can then deliver both ends ofthe phalanges into the wound andreally make sure your cut is perpen-dicular in the AP plane. I like tomake my cut on the base of themiddle phalanx perpendicular andthen dial in the cut on the head ofthe proximal phalanx and take off alittle at a time to make sure I don’ttake off too much.

Dr. Barbieri: Dr. Slater, whenaddressing a osteoarthritic patientwith end-stage PIP joint involve-ment, what is your fixation tech-nique of choice?

Dr. Slater: In most cases, a cannulat-ed screw is commonly selected as aprimary option. For revisions orcases where you might have morebone loss, then plate fixation with avery low profile plate has provenvery successful.

Dr. Barbieri: Do you use a headlessscrew in this group of cases?

Dr. Slater: I do use a headless screw.There have been a couple that havebeen on the market. The Twin-Fix,

THE DESENSITIZATIONHIERARCHY PROGRAM

SEEMS TO WORKBEST. WE USUALLY

START THEM ON VERYSOFT TEXTURES ANDPROGRESS THEM TO

MORE ROUGHTEXTURES.

JULIE FALLA, OTR/L, CHT

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available from Stryker-Leibinger,allows you to place the implant pre-cisely by first drilling a guide wireinto position and being happy withthat on intra-operative fluoroscopyviews. Then you overdrill the guidewire and implant the fixationdevice.

Dr. Barbieri: Have you ever hadinstances where you’ve been tooclose to the head of the proximalphalanx and propagated a crack thatinterferes with the screw purchase?

Dr. Slater: I’ve seen that beginning todevelop and that might be one casewhere after you’ve done your bonyresection, it’s important to keep thelittle tiny bits of the bone that isresected to pack as graft behind thescrew after it is fully seated.

Dr. Barbieri: Ms. Falla, what is yourpost-op therapy regimen following aPIP fusion, mentioning specificallythe problem of hypersensitivity sec-ondary to prominent hardware or asensitive scar?

Ms. Falla: We put them on a desensi-tization program as soon as theirwound is healed. Tendon glidingwith splint on as well as isolatedROM of non-involved digits is alsovery important in the early post-optherapy regimen.

Dr. Barbieri: In DIP fusion, I’ve had afew patients complain of hypersen-sitivity where a screw has beeninserted retrograde and is buried inthe distal phalanx. How do you tryand help the patient get over thatproblem?

Ms. Falla: The desensitization hierar-chy program seems to work best.We usually start them on very softtextures (cotton ball), and progressthem to more rough textures(uncooked rice, plastic pellets). Weestablish a hypersensitivity baseline,and then set weekly goals for thepatient.

Dr. Barbieri: Do you find this issomething that becomes less sensi-tive with time and with the propertherapy? Or does it necessitate actu-ally taking out the hardware?

Ms. Falla: Usually, it is your heavylaborers that are more sensitive dueto the increased amounts of grip-ping and pinching. Often, they con-tinue to have hypersensitivity. Inthat case, we begin adapting theirwork tools, teaching adaptive meth-ods, and add gel padded tip/fingerprotectors.

Dr. Barbieri: Dr. Neumeister, youtreat people who have traumaticinjury to their PIP joint and requirean arthrodesis by using a plate.What plate do you typically use,and do you often use bone grafts?

Dr. Neumeister: The plates that Ihave used are low profile, a 1.5 mm.

Dr. Barbieri: Does anyone ever useexternal fixation to achieve fusion?

Dr. Neumeister: I’ve used externalfixators when I have had to uselarge segments of corical cancellousbone graft because of loss of bonestock. I will use this technique in astaged procedure to maintain thelength in acute trauma and thencame back later, put the bone graftin there and leave the external fixa-tor in place.

Dr. Barbieri: I found I have usedexternal fixation in a few rareinstances where the soft tissueinjury will not safely permit plateapplication.

Dr. Barbieri: Dr. Neumeister do youhave any tricks for putting on anexternal fixator?

Dr. Neumeister: I’ll use two k-wireson either side of the fracture ordefect and then actually take methylmethacrylate and mold it into what-ever shape that I want.

Dr. Barbieri: After I put in my four Kwires, I’ll pierce the K wires withsuction tubing and actually injectthe cement through the suction tub-ing.

Dr. Neumeister: We’ve done a similarthing with an ET tube.

Dr. Barbieri: Dr. Slater, could youcomment about the time to fusion,

typically with a PIP joint vs. a DIPjoint?

Dr. Slater: I think the time to fusionis actually the same. I would addthat with a PIP joint, because thereis more digit distally, there may beadditional torque on the arthrodesissite. So it’s important to buddy tapethe involved digit with the arthrode-sis to the adjacent digit so thatthere’s less propensity for torque.

Dr. Barbieri: Ms. Falla is that yourexperience? Do younormally buddy tapeit to the adjacent digit?

Ms. Falla: We haveused buddy tape, as itgives them extra sta-bility and they typical-ly do better withregaining their ROM.

Dr. Barbieri: Dr. Capo,do you believe fusionin the thumb IP andMP joints is differentthan in the fingers?

Dr. Capo: I think it is.With the thumb, youreally have to look atthe whole ray of thethumb, and see whatthe state of the CMCjoint is, as well as theadjacent digits. An iso-lated fusion in the IPor MP joint alone isfine. But combinedtogether; fusion ofboth the IP and MPwill put a lot of stresson your CMC joint. You have todecide what the CMC joint is goingto do and decide whether or not anMP joint arthroplasty might be bet-ter.

Dr. Barbieri: Dr. Slater, do you agreewith Dr. Capo’s statement that youwould never fuse the IP and MPjoint together?

Dr. Slater: Never say never, but as ageneral principal it would be pru-dent to explain to the patient that


IF I’M GOING TO FUSE THE MP JOINT, I THINK A TENSION

BAND WIRECONSTRUCT IS MY

PROCEDURE OFCHOICE.

JOHN CAPO, MD

leaving one of those joints mightprovide them a more useful andfunctional thumb with less stress onthe more proximal CMC joint.Alternatively, an arthroplasty ofsome type for the MP joint might beconsidered more seriously in thatsetting because there isn’t anything

available for the IPjoint other thanarthrodesis.

Dr. Neumeister: Dr.Barbieri, I have fusedthe IP and the MPtogether and actuallydone an LRTI recon-struction of the CMCjoint in someonewho had really nomobility but a lot ofpain of the MP jointand instability anddeformity of the IPjoint. This was tomaintain a stable dis-tal post with someproximal motion.

Dr. Barbieri: Didthese patients com-plain about theirfunctional results?

Dr. Neumeister: Notthe functional result.

Dr. Barbieri: Dr.Slater, do you still find screw fixa-tion useful in the IP joint, especiallywith the wider diameter of thebone? Or do you find that in somecircumstances that it’s difficultunless you select the perfect diame-ter screw to really gain a good bite?

Dr. Slater: The most typical scenariowhere you’re actually doing an IPjoint arthrodesis in the thumb is ina case of rheumatoid arthritis, andtherefore the fusion is often com-bined with other procedures. ThenK wire fixation is a great optionbecause rheumatoid bone is softenough and you just need some-16


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thing to hold it for a short timeuntil it heals.

Having said that, screw fixationis still an option, and particularly ifone faced a situation where thebone stock quality was more robust,then headless screw fixation is stilla pretty good option.

Dr. Barbieri: Have you encountereda situation where once you put inthe screw there’s still a little bit oftoggle due to the wider diameter ofbone in the thumb? In this situationwould you add a K wire or changeto a bigger screw or add a secondscrew?

Dr. Slater: I don’t think there’senough room to add a secondscrew. I would remove the screwand use K wire fixation. But someof the newer headless screws arelarge enough that it’s difficult toimagine that you wouldn’t actuallyhave solid fixation.

Dr. Barbieri: I believe fusion in thethumb requires a little more pre-operative planning since the sizeand character of the phalanges inthe thumb seem to differ greatlyamong individuals. I stronglybelieve that anyone who does smalljoint arthrodesis should be comfort-able with all the methods of fusingsmall joints. The specific techniqueutilized often needs to be tailored tothe characteristics of the bone andthe quality of the soft tissue.

How about the thumb MP joint,Dr. Capo? Do you treat that similarto the PIP joint of the fingers? Doyou use a screw? Or do you use atension band type device or plates?

Dr. Capo: If I’m going to fuse the MPjoint, I think a tension band wireconstruct is my procedure of choice.What happens often, if we’re oper-ating on the thumb and it’s arheumatoid patient, is you might bedoing several other procedures onthe hand. In this situation, I thinkcross K wires are adequate if you’retrying to finish your procedureunder one tourniquet time. But mystandard would be tension bandwiring with K wires and a dorsalwire.

Dr. Barbieri: Dr. Neumeister, youmentioned earlier, thumb CMCarthroplasty. When do you consideran arthroplasty vs. an arthrodesisof the thumb CMC joint?

Dr. Neumeister: Most of the arthritisthat I see of the CMC joint of thethumb is in the elderly population.Most of them are woman actuallyand I’ll end up doing arthroplastiesmore often than not. The heavylaborer has traditionally been a per-son who’s a candidate for arthrode-sis because of the stress of that par-ticular joint, and I think that’s avalid indication. I think in the liter-ature, it’s been stated that a poorcandidate for arthrodesis is onewho has an insensate ray or hand.I’m not sure that’s really the case.They fear that it may act like aCharcot joint, but I think if it’sunstable, yet insensate it may be ofbenefit and they don’t go on to fur-ther degeneration.

Dr. Barbieri: In my own experience Ihave fused many joints that wereeither replantations or traumaticinjuries where the fingers were ini-tially insensate and I haven’t runinto the problem of a Charcot jointas of this time. How about you, Dr.Slater? What are your indicationsfor fusing this thumb CMC joint?

Dr. Slater: Indications for fusion ofthat joint are pretty narrow, and aregenerally limited to a youngerpatient who has high demands onthe hands because he or she is amanual laborer. The indications arepretty narrow because for onething, patients don’t like beingunable to flatten the hand com-pletely as we were talking aboutearlier. And even with somebodythat is active with sports or otheractivities, an arthroplasty is usuallythe better option.

Dr. Barbieri: What’s your fixationmethod of choice when fusing thethumb CMC?

Dr. Slater: In most cases, a smallplate and screw fixation works bestbecause it allows solid fixation. Insome cases, one can use a headlessscrew. But rotational control can be

THE MAIN DIFFERENCEIN THE CHILD IS THAT

THE GOAL IS TOPRESERVE THE

EPIPHYSIS AND THEPHYSEAL PLATE, SO

IT’S MORE OF ACHONDRODESIS

ROBERT SLATER, MD

CPT Coding forSmall JointArthrodesisStiles T. Jewett, Jr., MD, FACS

CPT Coding for small jointarthrodesis of the hand isreally quite straight for-ward. One simply needs toanswer the questions: which

digit(s), where (CMC, MP or IP), how(with or without bone graft) andhow many? A total of eleven codesdescribe all of the potential proce-dures for small joint arthrodesis inthe hand. In addition, all the codesinclude the use of fixation ifemployed and, where applicable,the obtaining of a bone graft. Theonly situation in which more thanone code is necessary is in the caseof multiple digits where simple add-on codes are used.

Codes for the thumb are 1. 26820 – Fusion in opposition,with autogenous graft. This codeincludes obtaining the graft. 2. 26841 - Arthrodesis of the car-pometacarpal joint, with or withoutinternal fixation. If a graft is usedthen 26842 applies. This (and allgraft codes) includes obtaining thegraft. Do not code separately as thiswould constitute unbundling.

For the digits other than thethumb, arthrodesis at the carpometacarpal level is coded26843 without bone graft and 26844with graft. For the metacarpalpha-langeal joint use 26850 without and26852 with bone graft.Interphalangeal joint arthrodesis iscoded 26860 without bone graft. Ifmore than one joint is fused, theadd-on code 26861 is used for eachadditional joint. If a bone graft isutilized 26862 applies with 26863used for each additional joint doneemploying a bone graft.

You Code ItPatient with a severe crushinjury undergoes a bone graftprocedure to the thumb toplace it in a position of opposi-tion. In addition, the secondand third metacarpalpha-langeal joints are also fused ina flexed functional position.Bone grafts are not requiredfor the MP joint fusions.

Solution:26280 Fusion in opposition,

thumb, with autogenousgraft (includes obtaininggraft)

26851–51 Arthrodesis,metacarpophalangealjoint, with or withoutinternal fixation

26851–51 “ “

Note the use ofthe –51 modifier(multiple proce-dures) as the add-on codes applyonly to inter-phanalgeal jointprocedures. TheICD-9-CM codesused will dependon the underlyingdiagnosis.

Good luck andgood coding! H 17

C O D I N G C O R N E R

STILES T. JEWETT,JR., MD, FACS


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TABLE 1Digit Location Graft? CodeThumb Fusion in opposition Yes* 26820

Carpometacarpal No 26841“ Yes 26842

Digits Carpometacarpal No 26843(Other than “ Yes 26844Thumb) Metacarpophalangeal No 26850

“ Yes 26852Interphalangeal No 26860

–Each additional No 26861Interphalangeal Yes 26862

–Each additional Yes 26863*code includes obtaining graft

a problem and usually temporarysecondary K wire fixation is used toprevent rotation around the screw.

Dr. Barbieri: Ms. Falla how wouldyou protect the thumb CMCfusion?

Ms. Falla: We fabricate a thumbspica splint allowing IP movement.There’s not a lot of therapyinvolved in the initial phases afterfusion. We teach them an extensivehome program including scar mas-sage, edema control, ROM of non-involved joints and desensitization.Further treatment is delayed until agood union occurs.

Dr. Barbieri: How would you treat apatient who has had a fused thumbCMC joint and then presents witharthritis either at the STT joint orthe MP joint of the thumb?

Dr. Slater: In the STT joint, I tookdown the fusion and did a CMCarthroplasty, which solved bothproblems by removing the trapezi-um and combining that with a liga-ment reconstruction tendon inter-position (LRTI) arthroplasty.

Dr. Barbieri: Did you find that thepatient regained use of the thumbor did the previous period of inac-tivity really inhibit tendon functionand glide?

Dr. Slater: They got rid of their painand that was the primary objective.In terms of the motion of thethumb, it wasn’t much differentthan before but their pain was gone.

Dr. Neumeister: Dr. Barbieri, I wouldalso take it down and do the LRTIto address the scapho-trapezoidjoint. I’ve been happy with just tak-ing a ronjour and removing thearticular surface between thescaphoid and the trapezoid jointthen interposing a small amount oftendon into that gap. That alleviatesthat area of arthritis.

Dr. Barbieri: Do you immobilizethem for any period of time, or doyou use K wires to hold the joint inplace?


Dr. Neumeister: I don’t use K wiresat all, but I do immobilize them ina thumb spica for six weeks. Andthen I get them going with passiveand active range of motion therapy.

Dr. Capo: I think that scapho-trapezoid joint is very important tolook at, both after fusion and ifyou’re going to do an arthroplastyand remove the trapezium. If thatjoint is missed, that can cause per-sistent pain. I address it the sameway and just do a small resectionand interpose some tissue in therebecause that can be easily missedon X-ray and cause significantproblems afterwards.

Dr. Neumeister: Have you ever triedto fuse that joint, the ST joint,instead of the interposition?

Dr. Capo: I have not tried to fuse italone. I’ve done it, obviously, in anSTT fusion. But I haven’t had muchproblem with just resecting it.

Dr. Neumeister: Yes, neither have I. Ithink it works well.

Dr. Capo: Yes, I agree.

Dr. Barbieri: Changing gears slight-ly once again, I would like Dr.Slater to comment on how fusionin a child would differ from fusionin an adult.

Dr. Slater: The main difference inthe child is that the goal is to pre-serve the epiphysis and the physealplate, so it’s more of a chondrode-sis. One must be very delicate anddeliberate in the excision of the car-tilaginous surfaces on either side ofthe joint without damaging thephysis.

Dr. Barbieri: Are your fixation tech-niques similar?

Dr. Slater: I’m more apt to use Kwire fixation rather than leaving anintramedullary device or usingplate fixation, which will be in thepatient for the rest of his or her life.So K wire fixation usually is strongenough and then can be removed

18


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after fusion is accomplished so themetal need not stay in.

Dr. Barbieri: Dr. Neumeister?

Dr. Neumeister: I would agree. Ithink it’s important to preserve thatossification center. K wires wouldbe the treatment of choice.

Dr. Barbieri: On a final note, Ms.Falla, could you comment on howyou protect these children frombreaking down the fusion after it’sbeen surgically stabilized?

19


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H A N D T H E R A P Y P R O F I L E

Jennifer Stephens Chisar, MS, PT, CHTPersonal: I grew up in Swarthmore, PA, outside ofPhiladelphia. As an accomplished musician, Irequested an affiliation in hand therapy as a PT stu-dent, thinking I may be able to continue my associa-tion with the music world by treating musicians withUE problems. I currently live in Pleasant Hill, CA,with my husband, Michael. In my spare time, I playon a co-ed adult recreational soccer team, play bassoon—as my primary instrument—and also playin two English Hand Bell choirs.

Education: B.S. in Physical Therapy from theUniversity of Delaware 1990. M.S. in OrthopedicPhysical Therapy from Hahnemann University 1994.Certified Hand Therapist since 1996.

Employer: Presently the Supervisor of Hand TherapyServices for the John Muir/Mt. Diablo Health Systemin Walnut Creek, CA, and Adjunct AssistantProfessor for the Physical Therapy Program atSamuel Merritt College, instructing courses in grossanatomy and hand therapy. I also presently serve onthe editorial board for the Journal of Hand Therapy,and I am an active contributor to various committeesof the Hand Therapy Certification Commission.

AAHS Involvement: I was accepted as an Affiliatemember of AAHS in 2002 and look forward to con-tributing to the organization wherever my skills andknowledge may be best applied.

Best Part of My Job: I am blessed with an incredibleteam of coworkers who are united in their efforts todeliver the highest quality of care to every patientwho enters our doors. It is rewarding to meetpatients from all walks of life, in what is often a diffi-cult time for them, and guide them through rehabili-tation back to their vocation and avocation. Everyhand and every patient history is different.

MajorAccomplishments:When I began at JohnMuir there was one OTwith limited hand expe-rience in the hand thera-py department. Now weare a formidable depart-ment of 9 therapists thatspans 4 locations. We areknown throughout theSan Francisco Bay Areafor our excellence inupper extremity care.My graduate thesis,“The Reliability of theTekdyne HandDynamometer inNormal Subjects andSubjects FollowingCarpal Tunnel Release”was published in theJournal of Hand Therapyand won the BestScientific Paper Award at the Annual Meeting of theAmer Society of Hand Therapists, Sept 1995.

Clinical Specialties: Complex injuries, wound careand the treatment of performing artists are my areasof special interest.

Greatest Challenge: I enjoy the challenge of problemsolving and collaborating with the treating physicianto generate an individualized treatment approach.

Three Words That Describe Me: Dedicated, com-passionate, a mentor. H

JENNIFER STEPHENS CHISAR,MS, PT, CHT

Ms. Falla: You splint them and youstrap them and you strap them! It isquite difficult with kids, but we docontinue to use thermoplasticsplints if possible. One trick we useis to wrap colored co-ban aroundthe splint (on their arm). This keepsthem from removing the splint soeasily, as with straps. If all else fails,we resort to a long arm cast.

Dr. Barbieri: How about you, Dr.Capo, anything else to add?

Dr. Capo: Immobilization in childrenwith any injury—basically, they geta long arm cast from me. It’s amaz-ing how the little Houdini’s cansquirm out of almost anything. Yes,so for a finger injury, children areput into a long arm cast.

Dr. Barbieri: All right. Well I appreci-ate everyone’s participation on thispanel. Thanks once again for donat-ing your time and expertise. H

www.handsurgery.org20 North Michigan, Suite 700Chicago, IL 60602

Inside This Issue:1 33rd Annual Meeting Preview2 From the Editor’s Desk3 From the President4 Leadership Profile: Allen Van Beek, MD5 2003 Annual Meeting Program at a Glance8 Proposed Bylaws Changes9 The Digital Hand Surgeon

11 Around the Hand Table: Small Joint Arthrodeses

17 Coding Corner19 Hand Therapy Profile

2003January 8–11, 200333rd Annual MeetingHyatt Regency KauaiKoloa, Kauai, HI

February 5–9, 2003American Academy ofOrthopaedic Surgeons –Annual MeetingNew Orleans, LA

April 10–12, 2003Post TraumaticReconstruction of theUpper ExtremityHotel Inter-ContinentalChicago, IL

July 18–20, 2003Mid Year Board ofDirectors MeetingCasa Del MarSanta Monica, CA

September 17–19, 2003American Society for Surgeryof the Hand – 58th AnnualMeetingChicago, IL

2004January 14–17, 200434th Annual MeetingWestin Mission HillsPalm Springs, CA

March 10-14, 2004American Academy ofOrthopaedic Surgeons –Annual MeetingSan Francisco, CA

Spring, 2004Work Related Disorders of theUpper ExtremityWyndham Chicago

American Association for Hand Surgery CalendarJune 11–14, 2004Mid-Year Board of DirectorsMeetingSt. Regis Monarch Beach ResortDana Point, CA

September 9–11, 2004American Society for Surgeryof the Hand – 59th AnnualMeetingNew York, NY

2005January 12–15, 200535th Annual MeetingSanibel Harbor ResortSanibel Island, FL

September 22-24, 2005American Society for Surgeryof the Hand – 60th AnnualMeetingSan Antonio, TX

2006January 11–14, 200636th Annual MeetingLoews Ventana Canyon ResortTucson, AZ

September 7–9, 2006American Society for Surgeryof the Hand – 61st AnnualMeetingWashington, DC

2007January 10–13, 200737th Annual MeetingThe Westin Rio Mar Beach ResortRio Grande, Puerto Rico

2008January 9-12, 200838th Annual MeetingThe Westin Century PlazaHotel & SpaBeverly Hills, CA

For information contact: AAHS Central Office at 312-236-3307 or www.handsurgery.org

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