HAND AND UPPER EXTREMITY SPLINTING: PRINCIPLES & METHODS,

11830 Westline Industrial Drive St. Louis, Missouri 63146 HAND AND UPPER EXTREMITY ISBN 0-8016-7522-7 SPLINTING: PRINCIPLES & METHODS, THIRD EDITION Copyright © 2005 Mosby, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.” Previous editions copyrighted 1981, 1987 International Standard Book Number 0-8016-7522-7 Publishing Director: Linda Duncan Managing Editor: Kathy Falk Developmental Editor: Melissa Kuster Deutsch Editorial Assistant: Colin Odell Publishing Services Manager: Melissa Lastarria Project Manager: Joy Moore Design Manager: Gail Morey Hudson Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 To our unsung heroes— our families E.E.F. K.S.G. C.A.P. J.R.J. FM.qxd 7/20/04 4:19PM Pagevii Contributors Joni Armstrong, OTR, CHT Hand Therapist, Consultant, North Country Peak Performance Bemidji, Minnesota University of North Dakota School of Medicine and Health Sciences Grand Forks, North Dakota Judith Bell Krotoski, OTR, CHT, FAOTA; CAPTAIN, USPHS (Ret.) Private Teaching and Consulting, Hand Therapy Research Baton Rouge, Louisiana Former Chief Hand and OT/Clinical Research Therapist USPHS National Hansen’s Disease Programs Baton Rouge, Louisiana Alexander D. Mih, MD Hand Surgeon, The Indiana Hand Center Indianapolis, Indiana James W. Strickland, MD Clinical Professor, Indiana University School of Medicine Indianapolis, Indiana Past President, American Academy of Orthopaedic Surgeons Past President, American Society for Surgery of the Hand vii FM.qxd 7/20/04 4:19PM Pageix Foreword to First Edition he emergence of hand surgery as a specialty and the advances in the science and art of hand surgery since World War II have been truly phe- nomenal. Societies for surgery of the hand have attracted some of the most skillful and dedicated sur-geons and have served as a forum for discussion and criticism, new concepts, and the testing and trial of competing ideas. At first, this exciting advance in hand surgery was not accompanied by a parallel advance in techniques of conservative and nonoperative management of the hand. Not only has this led to a tendency to operate on patients who might have been better treated con-servatively, but many patients who have rightly and properly been operated on have failed to obtain the best results of their surgery because of inadequate or poorly planned preoperative and postoperative management. It is encouraging to note that just in the last decade interest has surged in what is being called “hand rehabilitation.” This term is used to cover the whole range of conservative management of the hand. It rep-resents an area in which the surgeon and therapist work closely together, with each bringing their special experience and expertise to the common problem. Hand rehabilitation centers are multiplying, and a new group, the Society of Hand Therapists, has been formed in association with the American Society for Surgery of the Hand to bring together those physical therapists and occupational therapists who specialize in the hand. Pioneers in the new movement are Elaine Fess, Karan Gettle, and James Strickland, and their work has concentrated on the neglected field of hand splint-ing. Little research has been done on the actual effect of externally applied forces on joints and tissues of the hand. Experienced surgeons and therapists have developed an intuitive “feel” for what can be accom-plished, but there is little in the literature to assist the young surgeon in what to prescribe or to help a young therapist know the hazards that can turn a good pre-scription into a harmful application. In this situation, Elaine Fess, Karan Gettle, and James Strickland have put their own experience down on paper and made it available to all of us. It is obvious that they have a great deal of experience. It is also clear that they have gone far beyond the “cookbook” stage of previ-ous splinting manuals. They have researched and studied their subject thoroughly, and we are fortunate indeed to have the result of that study presented so clearly and illustrated so well. What pleases me most about this book is that it deals first with principles and only then with specific design. It begins with an emphasis on anatomy and topography and then with mechanical principles; after chapters on principles of design and fit and construc-tion, the authors discuss specific splints. In addition, there is a good chapter on specific problems and how to handle them. It is a measure of how far we still have to go in the science of splinting that the authors do not feel able to recommend actual specific forces by numbers to use in dynamic splints. My own feeling is that the boundary between art and science is numbers. Even in hand surgery we are not yet able to say that a spe-cific tendon should be attached with a tension of 200 grams, so why should we expect a therapist to fix a rubber band at a specific level of tension? One day we will take these extra steps toward precision. When data are available, Elaine Fess, Karan Gettle, and James Strickland will be the first to put it into their next book. They have jumped into a clear position of leadership with this book. I am sure they will stay ahead of each new advance as it comes along. Paul W. Brand, F.R.C.S.* Clinical Professor of Surgery and Orthopaedics Louisiana State University; Chief, Rehabilitation Branch United States Public Health Service Hospital Carville, Louisiana *Deceased. ix ... - tailieumienphi.vn