Levels of structure and care

HAND SURGERY – Recommended levels of structure and care in Sweden

Summary of the structural and organizational plan agreed upon at the Swedish Society for Surgery of the Hand’s annual meeting, November 27, 1996, and accepted by the Swedish Society for Orthopedic Surgery, January 1997.

 

HAND SURGERY                                               ORTHOPEDIC SURGERY

 

Cerebral palsy                                                         -

 

Tetraplegia                                                               -

 

Nerves                                                                     Nerves

 - brachial plexus injuries                                             - isolated digital nerve injury finger

 - nerve stem injuries                                                   - simple nerve entrapments, i.e. CTS

 - injuries in palm/fingers of particular

    difficulty

 - reconstructions after peripheral nerve injury

 - advanced/difficult nerve entrapments

 - complications after entrapment surgery

 

Flexor tendons                                                       Flexor tendons

- injuries zone I-II                                                     - isolated injuries proximal to tendon sheath level

 - combined injuries with nerve/vessel

    injuries and/or skin defects

 - tendon reconstructions on all levels

 

Extensor tendons                                                   Extensor tendons

- difficult injuries, i.e. tendon injuries                          - simple tendon injuries

    on PIP-joint level

 - tendon reconstructions on all levels

 

Bone/joints                                                             Bone/joints

 - multiple dislocated fractures                                  - isolated metacarpal/phalangeal fr.

 - complex intraarticular fractures                              - ligaments injuries thumb

 - complex carpal fractures                                       - total wrist and finger joint arthrodesis

 - carpal ligament injuries/dislocations                        - interposition arthroplasty CMC I

 - reconstructive bone/joint surgery

 

Skin                                                                        Skin

 - large defects                                                            - limited defects

 - smaller defects requiring flap surgery                        - simple scar corrections

 - deep burn injuries

 

Rheumatoid arthritis                                               Rheumatoid arthritis

 - complex volar tenosynovectomies                             - limited volar tenosynovectomies

 - Boutonnière/swan-neck deformities                          - dorsal tenosynovectomies

 - large grip reconstructions, including                           - limited arthrosynovectomy

    arthroplasties                                                           - wrist/finger joint arthrodesis

 

Infections                                                                 Infections

 - occult or therapy resistant infections                           - pyogenic flexor tenosynovitis

    in bone/soft tissue                                                      - pyogenic arthritis

 - chronic infections

 

Pressure injection injuries                                     -

 

Dupuytren’s contracture                                        Dupuytren’s contracture

 - complex contractures                                               - simple contractures

 - several fingers involved

 - recurring contractures

 

Congenital deformities

 

Tumors                                                                     Tumors

 - malignant tumors                                                       - joint ganglion

 - giant cell tumors                                                        - tendon sheath ganglion

 - occult tumors                                                             - pyogenic granuloma

                                                                                     - mucous cysts

                                                                                     - benign small tumors