ABPS Surgery of the Hand common mistakes
ABPS Surgery of the Hand · Understand the traps and how to avoid them.
For a nondisplaced scaphoid waist fracture in a young athlete, immediately recommends open reduction and internal fixation without first stating cast immobilization or further imaging for occult fracture.
Anchors on the heuristic that scaphoid fractures in athletes always need surgery and ignores displacement, fracture location, and union risk.
What to do instead
Stratify by displacement (<1 mm), location, and patient factors: cast nondisplaced waist fractures and reserve ORIF for displacement, proximal pole involvement, or delayed union.
Attributes small-finger and ulnar-palm numbness to median nerve compression and plans carpal tunnel release.
Relies on the vague symptom of 'hand numbness' and fails to map median versus ulnar sensory territories.
What to do instead
Map sensory distribution and two-point discrimination, correlate with EMG/NCS, and consider Guyon canal or cubital tunnel when ulnar digits are involved.
Repairs a zone II flexor digitorum profundus laceration with a two-strand core suture and starts immediate unrestricted active flexion.
Recalls that early motion is important but not that motion must be matched to repair strength and patient compliance.
What to do instead
Use a four-strand core suture plus epitendinous repair and a controlled active-motion protocol; modify for concomitant nerve repair or unreliable follow-up.
Treats flexor tenosynovitis with oral antibiotics and splinting and schedules a recheck in 48 hours.
Overweights mild early symptoms and under-recognizes the Kanavel signs as a surgical emergency.
What to do instead
Treat with IV antibiotics and prompt open or percutaneous sheath irrigation; do not delay definitive drainage for imaging when clinical signs are present.
Refuses replantation of a sharply amputated thumb at the proximal phalanx because the patient smokes and the wound is moderately contaminated.
Treats relative contraindications as absolute and underestimates the functional cost of thumb loss.
What to do instead
Attempt thumb replantation whenever technically feasible; smoking and moderate contamination are relative, so cool the part and transfer promptly to a replantation center.
Performs a marginal excision of a dorsal wrist mass presumed to be a ganglion without imaging or biopsy, then discovers a sarcoma.
Anchors on the high base rate of ganglions and skips systematic evaluation of atypical features.
What to do instead
Ask about rapid growth, pain, night pain, and size; obtain MRI before excising atypical masses and refer to a sarcoma center when imaging is indeterminate.
Recommends silicone MCP arthroplasty for a 45-year-old manual laborer with rheumatoid arthritis.
Uses the heuristic 'rheumatoid arthritis equals arthroplasty' and ignores age, demand, and implant survivorship.
What to do instead
Consider synovectomy, tendon rebalancing, or arthrodesis in young high-demand patients; reserve arthroplasty for older low-demand patients with adequate bone stock.
Injects a palmar Dupuytren nodule with corticosteroid and tells the patient the nodule will resolve.
Confuses palmar fibromatosis with an inflammatory condition and overpromises natural history.
What to do instead
Observe asymptomatic nodules; treat functional contracture with fasciectomy or needle aponeurotomy and counsel about recurrence and diathesis.
Plans syndactyly release at 6 months for border digits and 18 months for central digits without examining for Poland, Apert, or other associated anomalies.
Memorizes timing rules but treats syndactyly as an isolated problem rather than a possible syndrome marker.
What to do instead
Perform a full dysmorphology examination, assess for associated anomalies, and coordinate timing and genetic evaluation before surgery.
Reads a normal AP wrist radiograph as excluding perilunate dislocation and discharges the patient without a lateral view.
Forgets that perilunate injury is defined by lateral and carpal-arc relationships, not by the AP view alone.
What to do instead
Obtain a lateral view and traction views when needed; check Gilula arcs and lunate anatomy, and splint or reduce before reimaging.