The Pediatric Upper Extremity

31 Pages·2014·0.24 MB·English

The Pediatric Upper Extremity

(cid:129)
Joshua M. Abzug Scott H. Kozin
Dan A. Zlotolow
Editors
The Pediatric Upper
Extremity
With1116Figuresand449Tables
Editors
JoshuaM.Abzug
UniversityofMarylandSchoolofMedicine
Baltimore,MD,USA
ScottH.Kozin
ShrinersHospitalsforChildren
Philadelphia,PA,USA
DanA.Zlotolow
ShrinersHospitalsforChildren
Philadelphia,PA,USA
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To the children and adolescents all over the world who have
differences and/or injuries that involve their upperextremity
Joshua M. Abzug
TomymentorsinhandsurgeryattheMayoClinic,manyofwhom
have become friends and are critical in my professional and
personal life. Their influence has compelled me to provide the
highest-qualitycaretomypatientsandhasguidedmetoachieve
success in my career as a physician and as a person
Scott H. Kozin
Tomycoeditorsfortheirtirelesseffortsonthisprojectandallof
theauthorsfortheirongoing,enduring contributions tothecare
of the pediatric hand
Dan A. Zlotolow

Foreword
Itisparadoxicalthatfocusonthechild’shandcameratherlateinthespecialty
of Hand Surgery. Treatment methods for the adult hand and upper limb
initiallydevelopedfollowingsurgicalexperienceinadultsduringtheSecond
World War. The reverse was true in adult orthopedics; the children came
first. Orthopedics as a specialty prospered when First World War soldiers
were treated by English orthopedic surgeons using methods developed
in dedicated crippled children’s hospitals before the war. Some First World
War soldiers even returned to crippled children’s units in England for
convalescence.
Furthermore,untilrecentlyinwell-respectedchildren’sorthopediccenters
treatinglargenumbersofchildrenwithhandanomalies,therewaslittleinterest
in these cases among pediatric orthopedists. The care of children’s hand
problems in these centers was relegated to what I call hobbyists. A hand
surgeonortwoinaparticularcommunitywouldvolunteertospendadayor
twoeachmonthtorunahandclinicinpediatricorthopedichospitals.Evenin
standardHandSurgerytexts,withfewexceptions,pediatricupperlimbprob-
lemsinchildrenweretreatedasanafterthought.Inarealsense,thepediatric
handwasthelastoftheareasinHandSurgerytobefullyexploredbysurgeons
whohaddedicatedtheirpracticetochildren.
This began to change at the end of the twentieth century as pediatric
orthopedic hospitals finally had the foresight to establish a hand surgery
servicewithfull-timehandsurgeonsandhandtherapists.Thesepioneermen
andwomenwerewillingtolimittheircareersexclusivelytothetreatmentof
children. This changed the face of Pediatric Hand Surgery, and training
programsforsurgeonsinchildren’shandsurgerymethodswereestablished.
Theeditorsofthisworkareamongthemostdistinguishedofthisnewgroup
of pediatric hand surgeons. They and others like them have taken the
treatmentofchildren’shandstoawholenewlevel.Today,full-timepediatric
hand surgeons are spreading throughout North America and around
theworld.
Kozin,Zlotolow,andAbzughavealsoenlistedotherwell-respectedsurgi-
calcolleagueswithuniqueandextensiveexperienceinspecificproblemareas
to contribute to this textbook. Because of this, the final product lays out the
current state of our art in this new and specialized field, Pediatric Hand
Surgery,asubspecialtythathasfinallycomeintoitsown.
vii
viii Foreword
Surgeons-in-training as well as the experienced hand surgeon will find
The Pediatric Upper Extremity a thorough, up-to-date, and useful reference
in their management of these problems. This title is destined to assume a
leadingplaceinHandSurgerylibrariesaroundtheworld.
Dallas,Texas,USA PeterR.Carter
August2014
Preface
PediatricUpperExtremitySurgeryisemergingasastandalone subspecialty,
that combines the anatomic and disease specific knowledge of hand surgery
withtheuniquephysiologyofthegrowingchild.Theworldwideexpertisein
allfacetsofPediatricUpperExtremitySurgeryhasgrownexponentiallyover
the past few decades. This has been fueled in large part by the dedication,
innovation, and cooperation of the authors that contributed to this title and
thosethatcamebeforethem.
This book is the first of its kind—an entire work dedicated to Pediatric
Upper Extremity Surgery. The book is divided into various sections to
coverthegamutofpediatricupperextremitysurgery,includingembryology,
physical examination, imaging, anesthesia, therapy, outcome measurements,
congenital differences, nerve injuries, brachial plexus palsies, spinal cord
injury, neuromuscular disorders, trauma, infection, tumor, compartmentsyn-
dromes,burns,skinlesions,vasculardisorders,rheumatologicdiagnoses,and
sportsinjuries.Wovenintoeachsectionarechaptersthatprovidethenecessary
detail for the diagnosis and treatment of the pediatric upper extremity.
Operative techniques are detailed in tabular form and highlighted by photo-
graphstomaximizethereader'sbenefit.Pearlsandpitfallsarediscussedbythe
expertstooptimizepatientcare.
Wehopethattheaccumulatedwisdomofthesepageswillhelptoenhance
current practice and stimulate others to advance the field of pediatric upper
extremitysurgery.
August2014 JoshuaM.Abzug
ScottH.Kozin
DanA.Zlotolow
ix