This manual, according to the foreword, is intended to serve as a portable text for the treatment of acute hand injuries. In the preface, the authors state that most books of this type are extremely detailed and heavy in terms of weight and are not easy to use for the evaluation of a complicated hand injury in the middle of the night. However, I am not sure that this book avoids this problem either. There is no doubt that the treating surgeon should know the anatomy of the nerves in the upper extremity, but in an emergency-room setting there is no time to browse through twelve pages on the anatomy and classification of these injuries. Ideally, this chapter would first describe a method of evaluating the patient and making decisions in order to determine the treatment. The discussion of clinical evaluation should have been followed by the two-page description, provided earlier, on the principles and timing of nerve repair. A detailed discussion of nerve-grafting, different types of tendon transfers and their timing, and reflex sympathetic dystrophy is not needed.
The chapter on fractures and dislocations of the hand and injuries of the wrist is well done and will be of practical value in the treatment of various types of acute fractures. The detailed description of ligamentous injuries, carpal instability, and joint dissociations could have been eliminated. The section on distal radial fractures provides the requisite pertinent information.
The chapter on replantation and microsurgery also is well written and provides guidelines for emergency situations and the rationale for the decision-making process. The chapter on the treatment of mutilating hand injuries begins well but would have been more informative if the authors had discussed, as in the first part of the chapter, the principles underlying the salvage procedure for each digit. The chapter on acute hand injuries in children is also well written and provides useful information.
Unfortunately, the authors seem to have fallen into the same trap as those who have written other large textbooks. Although this manual has some major strengths, I hope that it will be revised at regular intervals and that the authors will keep in mind that the contents must reflect the title and purpose of the book.
Leela Rangaswamy, M.D.
Deputy Editor
The Journal of Bone and Joint Surgery
Needham, Massachusetts