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Functional Anatomy and Principles of Upper Extremity Surgery
Every hand case rests on the same foundation: knowing which joints need mobility, which need stability, and how to run an acute hand with a trauma-first mindset. Get this layer right, and every chapter after it makes sense.
In this episode of Plastics in Practice, we cover the foundational anatomy and operative principles of the upper extremity: how the thumb, finger, and wrist joints differ in their tolerance for stiffness and instability; the classic deformities (swan-neck, boutonniere, DISI, VISI) and the ligaments that produce them; the acute hand workup from "life over limb" through ER reduction; how to image and describe fractures in anatomic terms rather than eponyms; intrinsic plus splinting; safe tourniquet use; Bruner incisions; and why elevation is the single most important postoperative instruction you'll ever give.
Key takeaways:
- MCP joints have low tolerance for stiffness; the DIP tolerates it well - stability matters more there than motion.
- Volar plate disruption at the PIP causes swan-neck; central slip rupture causes boutonniere - opposite mechanisms, opposite deformities.
- Scapholunate ligament tear leads to DISI; lunotriquetral tear leads to VISI. The lunate follows the ligament that's still intact.
- Tourniquet time should be 90 to 120 minutes max to avoid ischemic reperfusion injury; pressure about 100 mmHg above systolic.
- Splint in the intrinsic plus position: wrist in slight extension, MCPs flexed, IPs extended.
- Routine soft-tissue cases under 2 hours: postop antibiotics show no clear benefit. Open fractures and bony work: 24 hours of perioperative IV coverage.
- Bruner zigzag incisions across the volar finger and palm prevent contracture; never cross flexion creases perpendicularly.
This content is for educational purposes only and is not medical advice.
Full episodes available now:
Instagram: https://www.instagram.com/plasticsinpractice/
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z
Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216
YouTube: https://youtube.com/@plasticsinpractice
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
Free Study Guides: https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
#PlasticSurgery #Residency #HandSurgery #UpperExtremity #SurgicalEducation #PlasticsInPractice #HandAnatomy #BoardReview
View all episodes
By Plastics in PracticeEvery hand case rests on the same foundation: knowing which joints need mobility, which need stability, and how to run an acute hand with a trauma-first mindset. Get this layer right, and every chapter after it makes sense.
In this episode of Plastics in Practice, we cover the foundational anatomy and operative principles of the upper extremity: how the thumb, finger, and wrist joints differ in their tolerance for stiffness and instability; the classic deformities (swan-neck, boutonniere, DISI, VISI) and the ligaments that produce them; the acute hand workup from "life over limb" through ER reduction; how to image and describe fractures in anatomic terms rather than eponyms; intrinsic plus splinting; safe tourniquet use; Bruner incisions; and why elevation is the single most important postoperative instruction you'll ever give.
Key takeaways:
- MCP joints have low tolerance for stiffness; the DIP tolerates it well - stability matters more there than motion.
- Volar plate disruption at the PIP causes swan-neck; central slip rupture causes boutonniere - opposite mechanisms, opposite deformities.
- Scapholunate ligament tear leads to DISI; lunotriquetral tear leads to VISI. The lunate follows the ligament that's still intact.
- Tourniquet time should be 90 to 120 minutes max to avoid ischemic reperfusion injury; pressure about 100 mmHg above systolic.
- Splint in the intrinsic plus position: wrist in slight extension, MCPs flexed, IPs extended.
- Routine soft-tissue cases under 2 hours: postop antibiotics show no clear benefit. Open fractures and bony work: 24 hours of perioperative IV coverage.
- Bruner zigzag incisions across the volar finger and palm prevent contracture; never cross flexion creases perpendicularly.
This content is for educational purposes only and is not medical advice.
Full episodes available now:
Instagram: https://www.instagram.com/plasticsinpractice/
Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z
Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216
YouTube: https://youtube.com/@plasticsinpractice
Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/
Free Study Guides: https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ
#PlasticSurgery #Residency #HandSurgery #UpperExtremity #SurgicalEducation #PlasticsInPractice #HandAnatomy #BoardReview