September 7, 4:30 - 6:00 PM
Location varies, refer to session details below.
CME Available: The ASSH designates this live activity for a maximum of 1.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
IC15: The Nexus of Military and Civilian Upper Extremity Trauma: Salvage Decisions and Length Preservation
Moderator: Jeffrey B. Friedrich, MD
Location: Plaza B, Hyatt Regency Convention Center
With America’s current involvement in two wars, unfortunately there are a number of servicemen and servicewomen who have suffered significant mangling upper extremity injuries. Mangled upper extremities can also be seen in civilian practices, often as a result of industrial or agricultural trauma. This course will focus on the common factors between these military and civilian injuries, and on how the experiences from these two practice spheres can be used to improve outcome. Military presenters will highlight the challenges faced in treating these injuries, both in theater and at higher echelons of care. Both military and civilian presenters will discuss salvage versus amputation decision-making, followed by strategies to preserve or increase functional amputation length. Finally, the civilian presenters will discuss the prospects of composite tissue transplantation for these patients.
- Analyze pertinent injury and anatomic factors that contribute to decisions regarding limb reconstruction versus amputation following mangling injury.
- Identify reconstructive options for mangled upper extremities that are to be salvaged.
- Describe length preservation strategies, including skeletal and soft tissue modalities, for patients who have undergone upper extremity amputation.
- Identify patients with upper extremity amputations who may be candidates for hand transplantation.
George P. Nanos, MD
Mickey S. Cho, MD
L. Scott Levin, MD, FACS
L. Andrew Koman, MD
IC16: Social Media and Your Practice: How to Connect with and Inform Your Patients and the Public
Moderator: Scott D. Lifchez, MD
Location: Toronto, Hyatt Regency Convention Center
Social Media outlets such as Facebook and Twitter have existed for several years and are regularly used for non-medical online interaction. They allow subscribers to have dynamic interactions with each other through an online platform. Your practice can make use of these social media outlets to better interact with your patients and the public. Many members have concerns that social media outlets will be very time consuming and of low yield to their practice. Faculty of this course will show how to use social media outlets in a manner that emphasizes how to get the most out of these sites while protecting your most precious resource: time. In this instructional course, faculty will demonstrate how to create a Facebook fan page, how to upload content, and how to regulate postings by patients and other site visitors. We will also cover linking your website and Facebook fan page to ASSH.org educational content, and ways to optimize your website such that web search engines will rank your website higher.
- Understand how search engines rank web pages when a term is searched and how to improve Search Engine Optimization.
- Interconnect their practice web site to ASSH.org and patient educational materials contained within ASSH.org.
- Understand how social media outlets can help you marked your practice website and better communicate with patients, their families, and the public.
- Create a Facebook fan page for their practice, import/link to content including videos, and regulate postings to the page.
- Communicate with patients and their families as well as vendors and the Hand Society via Twitter.
Desirae M. McKee, MD
Raymond B. Raven, MD
Adam B. Shafritz, MD
Jonathan Tueting, MD
IC17: Pediatric Elbow and Forearm Trauma: What To Do and When To Do It
Moderator: Donald S. Bae, MD
Location: Columbus AB, Hyatt Regency Convention Center
Through a series of brief didactic lectures and illustrative case presentations, this instructional course will provide an update on the treatment of traumatic elbow and forearm injuries in children. Characteristic pediatric conditions commonly encountered by the practicing hand surgeon will be covered, including supracondylar humerus fracture with vascular injury, Monteggia fracture-dislocations, radial neck fractures and forearm fracture malunion. Skeletal remodeling and limits of non-operative care will be reviewed. Specific focus will be given to the avoidance of common complications and surgical reconstructive strategies.
- Identify characteristic injury patterns of child’s elbow and forearm.
- Understand contemporary treatment algorithms and surgical techniques for traumatic injuries of the pediatric upper limb.
- Identify common complications, strategies for their avoidance and surgical reconstructive options.
Charles A. Goldfarb, MD
Daniel A. Zlotolow, MD
Joshua M. Abzug, MD
IC18: Flexor and Extensor Tendon Injuries, Complex and Complicated, When Things Get Ugly
Moderator: Steve K. Lee, MD
Location: Regency B, Hyatt Regency Convention Center
Tendon injuries continue to be vexing, particularly when there are complex situations where the surgeon must get creative. Complex problems such as distal zone 1 laceration, rupture of tendon repair, chronic zone II injury, major soft tissue loss associated with tendon injury, and late tendon rupture from volar locked plating will be presented in a case-based format with interspersed panel discussions, Q&A and an abundance of photographs and video.
Pulley Management and Tendon Repairs: What to do with the pulleys? How much to retain? Distal zone 1 tendon lacerations. Does the A4 pulley require preservation? What is the role for venting?
Pulley Reconstructive Methods: Case of delayed presentation of zone II FDP & FDS lacerations. What are the options for pulley reconstruction - Weilby vs wrap around vs. other? What are the pros and cons for each pulley reconstruction?
Unique Solutions for Delayed Tendon Reconstruction: Delayed rupture of zone II FDP & FDS repair. Repair vs. graft. Synovial vs. non-synovial graft. Paneva-Holevich Option.
Case Presentations of Tenolysis: indications, timing, complications (to include rupture), rehabilitation, outcomes.
Tendon Injury with Major Overlying Soft Tissue Loss: Case of extensor tendon injury with complex tissue loss. What are coverage options? Pedicle vs free flaps? When should you use tendon rods? Intercalary grafts vs tendon transfers? Tendon Rupture after Volar Locked Plating. Case of FPL rupture after volar plating for distal radius fracture. Review of tendon complications with VLP. How can we avoid tendon ruptures with volar plating? What are options to treat various tendon ruptures? We will present a variety of different ruptures (Ask panel for treatment choices.).
- Describe methods for pulley management and reconstruction.
- Apply unique solutions for secondary tendon reconstruction.
- Summarize indications and timing for tenolysis and recognize possible complications and outcomes.
- Describe methods for treatment of tendon injury with secondary soft tissue loss.
- Identify causes for tendon injury after distal radius plating.
Scott W. Wolfe, MD
Jin Bo Tang, MD
Philip E. Blazar, MD
Aaron Daluiski, MD
IC19: Advances in Management of Shoulder Dysfunction in Patients with Obstetric Brachial Plexus Injury
Moderator: Bassem T Elhassan, MD
Location: Gold Coast, Hyatt Regency Convention Center
Persistent shoulder dysfunction is one of the most common complications affecting the involved upper extremity in patients with obstetric brachial plexus injury. Almost all patients with incomplete recovery of their nerve injury have some degree of shoulder dysfunction which varies from minimal to disabling dysfunction. The purpose of this ICL is to define the anatomic and functional changes in the shoulder and evaluate the outcome of different treatment options in patients with OBPI. These include early non-surgical rehabilitation of the shoulder, soft tissue reconstruction with internal contraction release and tendon transfer or later humeral external rotation osteotomy. In addition, new advances in shoulder reconstruction with bone graft reconstruction of the glenoid and alternative tendon transfers, including lower trapezius transfer, are also discussed.
- Describe the anatomic changes in the shoulder in obstetric brachial plexus injury (OBPI) patients.
- Evaluate the outcome of early non-surgical therapeutic interventions on shoulder function in OBPI.
- Evaluate the outcome of early soft tissue reconstruction on shoulder function in OBPI.
- Evaluate the outcome of humeral rotational osteotomy on shoulder function in OBPI.
- Describe new advances in shoulder reconstruction in patients with OBPI.
Donald S. Bae, MD
Marybeth Ezaki, MD
Peter M. Waters, MD
Scott H. Kozin, MD
IC20: Kienböck’s Disease: A New Understanding
Moderator: Gregory I. Bain, FRACS, PhD
Location: Regency C, Hyatt Regency Convention Center
Historically the treatment of Kienböck’s disease has been based on changes in the morphology and stability of the lunate and carpus as determined by standard radiographs and MRI scans. In recent years it has become clear that the vascular physiology and the cartilage anatomy must also be considered to determine a realistic treatment algorithm. In general, vascular changes play a large role in the earliest stages, at a time long before any bone or cartilage changes occur. Identification and treatment of underlying etiologies in this stage could prevent cartilage and bone collapse and the need for more aggressive treatment. Articular changes on the other hand are most likely to be significant in the middle and late stages of the disease. The significant loss of cartilage from necrotic bone is irreplaceable and must be considered when a treatment options are considered.
Using the bone morphology and alignment as a starting point and by understanding the co-existing healing potential (vascular status) and the cartilage health, it will be possible for future surgeons to:
a) stage or grade in greater detail the vascular, osseous and cartilage changes in Kienböck’s disease.
b) select the stage specific treatment option which is directed towards optimizing outcome.
c) design research protocol?s that can assess these independent variables and their consequences on the various treatment options.
- Understand the multiple etiological factors of Kienböck’s disease.
- Understand the 3 pathological phases of Kienböck’s disease; vascular, osseous and chondral.
- Assess the patient including the vascular, osseous and chondral components of the disease with basic and advanced imaging modalities and arthroscopy.
- Apply an algorithmic treatment approach to Kienböck’s disease; including advanced vascular assessment, traditional radiological osseous staging and joint based factors.
David M. Lichtman, MD
Marc Garcia Elias, MD, PhD
Rainer Schmitt, MD
Peter C. Amadio, MD
IC21: Persistent Pain After Common Procedures: Now What?
Moderator: Kulvinder Sachar, MD
Location: Regency D, Hyatt Regency Convention Center
The purpose of this course is to provide a systematic approach to the evaluation of patients with persisting symptoms following common upper extremity procedures including dorsal carpal ganglion excision, TFCC debridement, carpometacarpal arthoplasty and lateral epicondyle debridement. Our panel will present case examples that emphasize the use of history, physical exam and diagnostic tests to establish a treatment plan for these difficult patients. Upon completion of this course, participants will be able to evaluate patients with ongoing symptoms despite these common procedures. Participants will learn a comprehensive approach to history, physical exam and diagnostics that will allow for a working diagnosis and formulation of a treatment plan. We will emphasize the use of diagnostic modalities such as selective injections and imaging studies combined with focal history and exam to narrow the differential diagnosis. Participants will learn specific treatments for complications of these procedures including revision surgery, alternate surgical options and pain management. Participants will be able to take this systematic approach to these specific procedures and apply it to other common upper extremity procedures.
Typically, dorsal carpal ganglion excision, TFCC debridement, carpometacarpal arthroplasty and lateral epicondyle debridement have good outcomes after surgery. There are, however, patients who receive little improvement from surgical intervention, creating a challenge for the treating physician. Concerns for a differential diagnosis, appropriated intervention and further treatment options persist. Through case examples, this course will provide a systematic and comprehensive approach to the care of theses conditions and will permit application of this approach to other common upper extremity conditions.
- Define a comprehensive and detailed approach to history, physical exam and diagnostics in patients with persistent pain after commonly performed procedures.
- List a differential diagnosis for pain after ganglion excision, TFCC debridement, tennis elbow surgery and CMC arthroplasty
- Recognize common reasons for pain after ganglion excision, TFCC debridement, tennis elbow surgery and CMC arthroplasty
- Apply diagnostic modalities that will help in the diagnosis of pain after these common procedures.
- Apply treatment plans for patients with pain after these common procedures.
David M. Kalainov, MD
Jennifer M. Wolf, MD
Fraser J. Leversedge, MD
IC22: Hand Fractures - Classic Treatment versus Innovative Approaches
Moderator: Michael Bednar, MD
Location: Columbus CD, Hyatt Regency Convention Center
Many hand fractures are treated with techniques that are considered classic, meaning they are technically reproducible and are associated with good outcomes over a prolonged period of time. Occasionally, a new technique surpasses, but does not necessarily replace, an older technique. An example of this is volar locked plating of distal radius fractures. The goal of this ICL is to discuss both classic and innovative ways of treating a number of difficult hand fractures, using the literature and outcome measures, when available, to justify which is better. For fractures at the diaphyseal metaphyseal junction of the metacarpal, the debate will be between pinning, either transversely or intramedullary, or using lag screws versus plating with either nonlocking or locking plates. Comminuted fractures of the proximal phalangeal shaft have the poorest outcomes of any fracture of the hand. Issues for debate here include closed versus open treatment, type of fixation, care of the soft tissues and use of foreign materials to improve tendon gliding. Finally, periarticular fractures of both the MP and PIP joints can lead to stiffness, recurrent subluxation and fragment avascular necrosis. In addition to classic treatment of the fractures, the topics of arthroscopic assisted reduction and autograft, allograft or implant arthroplasty will be discussed.
- Discuss both classic and innovative ways of treating a number of difficult hand fractures.
- Review the literature and outcome measures, when available, to justify which is better.
Richard A. Bernstein, MD
Randip R. Bindra, MD, FRCS
IC23: Nerve Transfers That Work
Moderator: Thomas H. Tung, MD
Location: Columbus EF, Hyatt Regency Convention Center
The purpose of this course is to present and discuss nerve transfer procedures in the upper extremity that have proven functional efficacy. This course will focus on the most consistently reliable transfers, describe technique and discuss functional outcome. Both well established and recently described procedures will be covered. Indications, advantages and limitations, and alternative management of these procedures will also be discussed. The basic principles of nerve transfer surgery will also be reviewed. Procedures will be included for shoulder and elbow function after brachial plexus injuries and the reconstruction of radial, median and ulnar nerve palsies. The relevant anatomy will be reviewed as well as postoperative care and rehabilitation. Teaching strategies will include case presentations, videos and interactive discussion. Surgical tips, critical elements and nuances will be discussed. Controversial points, relevant literature and data, and potential areas for research and investigation will be covered.
- Review basic principles and tenets of nerve transfers.
- Describe indications and technique of nerve transfers in the upper extremity.
- Present functional outcomes of upper extremity nerve transfers.
- Review advantages/limitations of nerve transfers versus tendon transfers.
Jonathan Cheng, MD
Steve K. Lee, MD
J. Megan Patterson, MD
IC24: Joint Denervation: A Safe Approach for Palliative Pain Relief
Moderator: Richard A Berger, MD, PhD
Location: Comiskey, Hyatt Regency Convention Center
Intractable joint pain can cause significant morbidity to patients suffering with joint disease. Many times the patient is either not a candidate for or unwilling to proceed with salvage procedures such as arthrodesis or arthroplasty. Under these circumstances, partial or total denervation of the joint has a predictable value in significantly reducing pain levels while preserving function of the joint. This symposium has been developed to take the learner from the basics of what is currently known about the neural connections of joints, through the classification and function of known mechanoreceptors in joint soft tissues and techniques of safe denervation for palliative pain relief. Both faculty members have significant experience in the basic and clinical sciences, joint innervation and denervation. Both didactic and case-based discussions will be carried out with time dedicated to questions from the learners.
- Describe the normal neural anatomy of joints.
- Define the known function of mechanoreceptors populating joint tissues.
- Understand the principles of the evaluation of patients undergoing possible joint denervations.
- Describe safe surgical approaches for complete and partial denervation of selected joints.
A. Lee Dellon, MD, PhD
Nicolas E. Rose, MD
IC25: Getting the Most Out of Wrist MRI - MRI Bootcamp for Hand Surgeons
Moderator: Kimberly Amrami, MD ▲
Location: Columbus I-L, Hyatt Regency Convention Center
MRI can be a useful tool for hand surgeons, but the quality of image acquisition and interpretation varies widely. This course will allow participants to determine what constitutes a high quality MRI examination of the wrist, what are the appropriate indications for wrist MRI and how to use it to diagnose soft tissue and bony abnormalities in the wrist and hand. Basic MRI techniques will be reviewed with examples of normal and abnormal studies. Advanced techniques such as arthrography, dynamic enhancement and other functionalities will also be included. The emphasis of this course will be on understanding how to use MRI in your practice and how to get the most out of MRI studies of the wrist for your patients.
- Assess wrist MRI for quality, Understand basic MRI principles as applicable to hand surgery.
- Use MRI to assess ligamentous injuries.
- Understand the role of MRI in the diagnosis and treatment of fractures.
- Determine appropriate indications for MRI in the diagnosis of hand and wrist injuries and other pathology.
Michael Ringler, MD
Naveen Murthy, MD
Daniela Binaghi, MD
▲ IC25: Getting the Most Out of Wrist MRI - MRI Bootcamp for Hand Surgeons will include discussion of Gadolinium, an "off-label" or other non-FDA approved, investigational pharmaceutical product manufactured by Multiple.
IC26: Advances in Hand Surgery in Korea
Moderator: Alexander Y. Shin, MD
Location: Buckingham, Hyatt Regency Convention Center
Despite being a small country, hand surgery in Korea is a thriving and advancing specialty. The purpose of this instructional lecture is to highlight four challenges that are seen globally, and the manner in which Korean hand surgeons have met these challenges: congenital hand problems, peripheral nerve problems, hand trauma and microsurgery reconstruction of the hand.
- Understand the advances in congenital hand surgery in Korea and how they have impacted congenital hand surgery globally.
- To understand the challenges of trauma reconstruction of the hand and the advances in care that have occurred in Korea.
- To understand the advances of microsurgery and peripheral nerve surgery in Korea and how they apply to patients globally.
Duke Whan Chung, MD
Kyung-Moo Yang, MD
Jin-Soo Kim, MD
Goo Hyun Baek, MD
Joo-Yup Lee, MD, PhD
IC27: Thumb Reconstruction - State of the Art
Moderator: Neil F. Jones, MD
Location: Plaza A, Hyatt Regency Convention Center
Options for thumb reconstruction after trauma include pollicization, distraction lengthening, the reverse radial forearm osteocutaneous flap and modified great toe or second toe to thumb transfers. Case examples and surgical techniques will be presented. Reconstruction of the congenital hypoplastic or absent thumb usually requires index finger pollicization, but microsurgical toe-to-thumb transfers are increasingly indicated. The surgical technique of index finger pollicization and indications for microsurgical toe transfers for congenital anomalies of the thumb will be described.
- Learn the indications for various techniques of thumb reconstruction.
- See state of the art results of distraction lengthening, osteocutaneous flap reconstruction, index finger pollicization and microsurgical toe-to-thumb transfers in both adults and children.
Paul Smith, MD
Raja Sabapathy, MD
Francisco Del Piñal, MD
IC28: Fixing the Failed PIP Arthroplasty
Moderator: Marco Rizzo, MD
Location: Acapulco, Hyatt Regency Convention Center
Proximal interphalangeal (PIP) arthroplasty remains an important surgical treatment for pain and arthrosis. It is a motion preserving alternative to arthrodesis. Hinged silicone and non-constrained modular implants are utilized. Salvage for failed PIP arthroplasty can be challenging and difficult. Revision arthroplasty, resection arthroplasty and arthrodesis are common options for failed PIP. The aim of this instructional course is to discuss PIP arthroplasty failures and treatment for these often difficult problems.
- Understand indications and technical aspects for arthroplasty of the PIP joint.
- Diagnose and recognize failures of PIP arthroplasty.
- Appreciate treatment options for failed PIP arthroplasty.
- Develop an algorithm for best treatments for failed arthroplasty.
Douglas C. Ross, MD, FRCSC
William P. Cooney, MD
Kurt Pettersson, MD
View faculty disclosures here.