This MOC-approved course will focus on an update on comprehensive management of metacarpal fractures. The course will cover conservative management of fractures as well as open reduction and fixation techniques. Best available evidence will be presented based on the current literature. Cases will be presented to allow for discussion of treatment options. Lastly, updates on the MOC process for both plastic surgeons and orthopaedic surgeons will be presented.

Objectives: Following this session, participants will be able to:

1. Recognize fracture patterns in metacarpal fractures.
2. Understand the risks and benefits of various techniques of management.
3. Apply best practice standards to the operative and nonoperative management of these injuries.

Course instructors will present their best simple solutions on how to improve results for common flexor and extensor injuries. The panel will discuss the merits of the wide awake flexor tendon repair, early protected movement of zones 3-7 extensor tendon injuries with relative motion and "True active" vs. "place and hold" early protected movement after flexor tendon repair. Results via outcomes data will be presented. Technical pearls and surgical techniques will be described.

Objectives: Following this session, participants will be able to:

1. Understand the multitude of technical considerations involved in a successful tendon repair.
2. Use new concepts in early protected movement after extensor and flexor tendon repair to get better outcomes.
3. Understand the pros and cons of tendon repair using the different techniques.

The treatment of complex trauma in the upper-extremity requires the use of multiple techniques to lead to successful outcomes. This course will discuss the integral roles played by the combination of bony reconstruction, soft-tissue coverage, nerve and tendon repair/reconstruction and rehabilitation of these complex injuries.

Objectives: Following this session, participants will be able to:

1. Identify cases that require the use of multiple techniques in order to restore upper-extremity function.
2. Understand the principles necessary to develop algorithms to address these complicated trauma cases.
3. Understand the interrelation of bony and soft-tissue reconstruction as it applies to complex trauma.
4. Have an understanding of the thought processes in staging reconstruction and developing a long-term rehabilitation program.

Treatment of hand and wrist fractures leads to significant improvement in patient function. At times, however, the initial outcomes do not meet these expectations. This course will discuss common complications seen with fracture care: non-union, stiffness, hardware issues, instability. The lectures will focus on identifying risk factors that lead to these complications as well as provide treatment algorithms to resolve these problems.

Objectives: Following this session, participants will be able to:

1. Identify risk factors that lead to poor outcomes after fracture care.
2. Describe treatment options and salvage for failed internal fixation of the hand and wrist fractures.
3. Detail nerve and tendon complications of internal fixation and strategies for treatment of hand and wrist fractures.
4. Describe indications and techniques for treatment of nonunion/malunion of hand and wrist fractures.

Scapholunate instability is the most common form of carpal instability yet its diagnosis can be difficult, and its successful treatment can be even more complicated. This course will apply the best evidence to help the surgeon make the diagnosis of SL injury through physical exam, MRI and arthroscopy. A review of our current understanding of the anatomy, biomechanics and pathomechanics will be provided followed by the presentation of a treatment algorithm incorporating both open and arthroscopic techniques.

Objectives: Following this session, participants will be able to:

1. Describe the typical injury and biomechanical consequences that define scapholunate injuries.
2. Choose the simplest and most effective conservative and surgical solutions calibrating clinical rationale and evidence.
3. Describe key technical details and expected outcomes for management.

Degeneration of the wrists leads to a significant amount of pain and dysfunction. The use of arthroplasty can restore function and alleviate pain for these patients. However, the track record for some of these arthroplasties has limited their use in the past. This course will review the arthroplasties available for the wrist and discuss when they can best be used. Outcomes and best levels of evidence available will be presented to guide decision making when choosing arthroplasty as a treatment option. There will be a particular focus on technical aspects for optimizing surgical outcomes for each treatment option as well as a detailed review of the post-operative rehabilitation

Objectives: Following this session, participants will be able to:

1. Choose the simplest and most effective reconstructive options calibrating clinical rationale and evidence.
2. Define potential surgical complications and their risk management.
3. Describe key technical details and expected outcomes.
4. Discuss key principles and evidence for post-operative rehabilitation

The focus of this instructional course will be to discuss the basic techniques of targeted muscle reinnervation for the control of upper extremity prosthetic devices. We will examine the indications for targeted muscle reinnervation, the operative techniques to optimize functional outcome, and the various approaches for various amputation levels. We will also examine the role of targeted reinnervation to provide sensory feedback from prosthetic devices. The types of sensory feedback that can be provided with targeted reinnervation, and the benefits of this approach over sensory substitution approaches will be examined. Experts in the field of reconstructive surgery, physical medicine and rehabilitation, and recovery of function following limb loss will participate as panelists. This is sure to be a highly valuable instructional course which will not only discuss the current state-of-the-art but will also look into the future of targeted reinnervation to provide high fidelity motor control and sensory feedback.

Objectives: Following this session, participants will be able to:

1. Learn the indications for targeted reinnervation, eligibility criteria, and operative approaches for targeted reinnervation inpatients sustaining upper extremity amputations.
2. Develop an understanding of use of targeted reinnervation for recording efferent motor action potentials for prosthetic control.
3. Develop an understanding of the use of targeted reinnervation for stimulating afferent sensory action potentials for sensory feedback.
4. Understand the challenges for restoration of function following limb loss and the role of targeted reinnervation to enhance that function.
5. Understand the importance of sensory feedback to optimize functional recovery while using a prosthetic limb.

Chronic pain in joints of the upper and lower extremities represents a major, and often undertreated, cause of morbidity. Several investigators have developed methods of effectively denervating otherwise functional joints, improving and in many cases eliminating pain.

Objectives: Following this session, participants will be able to:

1. Understand the indications and contraindications related to joint denervation.
2. Evaluate the available clinical outcome studies to gauge effectiveness of these treatments.

New imaging modalities offer the surgeon the means to more effectively diagnose nerve injuries than has been available in the past. These noninvasive methods are rapidly moving from investigational to clinical use.

Objectives: Following this session, participants will be able to:

1. Understand the rationale for the use of preoperative imaging in the setting of suspected nerve injury.
2. Critique the available clinical studies in which these technologies are used.

Nerve transfers have revolutionized the management of major nerve injuries. Dr. Mackinnon will discuss her pathway from nerve repair and graft to nerve transfers and use this as an example of how surgical innovation occurs. The nerve transfer technique appears simple, strait forward and "makes sense." However, like most progress in medicine and science the pathway to nerve transfers was anything but smooth and direct. Mackinnon will emphasis the importance of embracing the slow path with multiple false starts and blind alleys punctuated frequently by failure as the only and sure path to important medical innovation. She will remind the younger surgeons just starting their career to expect that the pathway to their surgical passion will be fraught with mistakes, failure but ultimate success and great impact in their own area of surgical passion.

Objectives: Following this session, participants will be able to:

1. Following this session participates will understand that the typical pathway to surgical innovation that involves several factors.
2. Specifically, hard work, failure, a supportive work environment a critical coach and eventually some good luck and serendipity.

Involvement in a medical mission can be a rewarding and educational experience. During this course, speakers will describe their experiences performing medical missions. They will use their experiences to demonstrate how to make a mission successful and rewarding for the patients, staff, and physician’s involved. They will discuss common problems that may interfere with a successful project and how to avoid these problems.

Objectives: Following this session, participants will be able to:

1. Understand the potential rewards of participating in a medical mission from both an educational and humanitarian perspective.
2. Assess the practicality of a proposed mission and understand the forces that will lead to a successful mission.
3. Develop a preliminary availability to plan or participate in a mission with resources for developing that mission.

This course will cover the continuously developing world of social media and its effect on your practice. Common sites such as YouTube, Facebook, and Twitter will be discussed. Issues of privacy that develop as a result of social media involvement will also be addressed. Finally, avoiding common pitfalls will be addressed to make you social media experience a positive one.

Objectives: Following this session, participants will be able to:

1. Understand the most common social media sites such as Twitter, You Tube, and Facebook.
2. Learn how the use of social media sites can benefit your practice.
3. Understand how privacy issues must be addressed when interacting in the social media sphere.
4. Learning how to avoid the common pitfalls when using social media.

Increasing clinical evidence is highlighting the importance of diagnosing and treating proximal forearm compressions. Are we as hand surgeons able to successfully diagnose and treat these conditions? In this course, the panel will discuss anatomy and clinical presentations of forearm nerve compressions including those in the radial tunnel, cubital tunnel, and nerve dysfunction after humerus fracture.

Objectives: Following this session, participants will be able to:

1. Identify compressive neuropathies in the arm, elbow, and forearm.
2. Develop algorithms for the operative and non-operative treatment of these compressive neuropathies.
3. Understand surgical options, approaches, and outcomes for these problems.
4. Understand expected outcomes and complications.

Nerve transfers have revolutionized the care of many kinds of nerve injury, but they are not always successful in restoring the degree of function we seek for our patients. In this course the instructors will discuss their experience with conditions in which nerve reconstructions have failed, necessitating other interventions.

Objectives: Following this session, participants will be able to:

1. Understand reasons why nerve based reconstructions may yield suboptimal results.
2. Examine the options that may be available for improving function beyond nerve based reconstruction.

Acellularized nerve allografts have become widely adopted for bridging nerve gaps. A considerable amount of preclinical and clinical data involving their use has accumulated recently. Instructors will provide a non-biased view of their thoughts surrounding the indications for or against the use of this biomaterial.

Objectives: Following this session, participants will be able to:

1. Understand the basis for the use of nerve allografts.
2. Describe when a nerve allograft may not be preferred.
3. Critically appraise the available data surrounding the use of allografts.

Mutilating hand injuries can be devastating. Furthermore reconstructive options can be limited due to injuries to the contralateral hand and lower extremities. This course will review the use and indications for functional muscle transfer, toe transfers and targeted muscle re-innervation. In addition the use of microsurgery in conjunction with prosthetics will be emphasized to maximize surgical outcomes.

Facial paralysis is a complex and intriguing field in reconstructive surgery. Miraculous improvements can be made to a paralyzed face through the use of microsurgical procedures; however successful outcomes are predicated on a thorough understanding of nerve physiology, anatomy and the techniques involved in functional muscle transfers. Our expert panelists will share their insight and experiences and provide technical tips and tricks on how to provide optimal care to these grateful patients.

The panel will provide an overview of surgical approaches to lymphedema. Special emphasis will be given to indications, preoperative assessment, techniques and pitfalls to consider when performing lymphatic surgery. Major decision points will be discussed, including: When to use lymphaticovenous bypass vs vascularized lymph node transfer, key imaging modalities, the differences in managing primary vs secondary lymphedema, donor and recipient site selection, avoiding donor site morbidity, and combining lymphatic surgery with breast reconstruction.

With the implementation of the ACA, confusion and misunderstanding persists for patients but also for surgeons. How will surgeons deal with the impact of the ACA? How will the ACA affect physician salaries? What are the metrics for productivity and value in this new era? What are some of the strategies that surgeons are employing in this new era? The panel will address issues of cost containment and the new set of rules the ACS is enforcing.

Objectives: Following this session, participants will be able to:

1. To identify the impact of ACA on the physician.
2. To understand how to measure metrics for productivity and value in the new medical era.

The single greatest impediment to neuroscience is the difficulty of getting fine-grained data in and out of the brain. Gradually, however, we are overcoming this barrier. Neural prosthetics in clinical use now restore hearing and vision to patients who've lost those senses, and bring relief to severe Parkinson's sufferers. The next generation of neural prosthetics, in animals, have proven effective in restoring damaged memory formation abilities, in boosting pattern matching abilities, and in facilitating electronic brain-to-brain communication. Recent breakthroughs in brain imaging techniques allow us to observe every neuron in simple animal brains, in real-time, opening the door to new insights never before possible. And computer simulations of brain models are not far behind. We're taking the first steps into a new era of neuroscience, with incredible potential ramifications.

Ramez Naam is a computer scientist and the H.G. Wells and Prometheus Award winning author of four books, including the neuroscience-based science-fiction thriller Nexus. He spent 13 years at Microsoft where he led teams working on web browsing, email, internet search, and artificial intelligence. He serves as Adjunct Faculty at Singularity University at NASA Ames. His work has appeared in or been reviewed in The New York Times, Scientific American, The Atlantic, Slate, NPR, and other prominent outlets. He lives in Seattle.

Welcome to the Bahamas! Gather at the Pyramid on Ripples pool deck to enjoy the sounds and fare of the island while you network and catch up with fellow attendees.

Pediatric nerve injuries require a distinct approach compared with their adult counterparts. In this course, the instructors will discuss their approach to such injuries, highlighting the differences between adult and pediatric situations.

Objectives: Following this session, participants will be able to:

1. Analyze the indications for nerve reconstruction in children.
2. Understand what approaches work well in children.

Nerve transfers have been used in the upper and lower extremities and beyond. The instructors will demonstrate some of the more unusual, yet important applications of nerve transfers throughout the body.

Objectives: Following this session, participants will be able to:

1. Determine the indications for nerve transfers in unusual or novel situations.

Investigators have recently discovered that peripheral nerve injury causes significant changes in the central nervous system. The instructors will highlight some of these changes and explain their importance.

Objectives: Following this session, participants will be able to:

1. Analyze the physiologic basis of changes in the nervous system.
2. Understand the clinical implications of such changes

Chronic neuropathic pain remains one of the greatest unsolved challenges in the treatment of nerve injuries. The instructors will discuss the state of the art in diagnosis and management of such patients.

Objectives: Following this session, participants will be able to:

1. Understand the theories of pain and why they are important to our understanding of this disease.
2. Discuss the most recent advances in clinical management of these patients.

Nerve tumors are relatively common in the clinical practice of many nerve surgeons. This instructional course will cover aspects of the diagnostic workup and management of these tumors.

Objectives: Following this session, participants will be able to:

1. Understand the biological basis of nerve tumors.
2. Gain knowledge for the contemporary clinical management of nerve tumors.

Electrical stimulation has recently emerged as a clinically viable technique to enhance outcomes following treatment of nerve injury. The instructors will discuss the biological rationale for stimulation, and will highlight the clinical studies in which it has been used.

Objectives: Following this session, participants will be able to:

1. Understand the biological basis for electrical stimulation.
2. Evaluate the available clinical data surrounding the use of electrical stimulation.

To determine the outcomes for the patient who have previous failed brachial plexus reconstruction who undergo subsequent muscle and nerve procedures. We will specifically discuss the role of subsequent nerve transfer in patients who have had failed brachial plexus reconstruction as well as the role of tendon transfers and free functioning muscle transfers.

Objectives: Following this session, participants will be able to:

1. To understand the treatment options after failed brachial plexus reconstruction to obtain function.
2. To understand the indications and outcomes of subsequent nerve, tendon and free functioning muscle transfers after failed previous brachial plexus injuries.

The modern day rediscovery of end-to-side neurorraphy was initially met with considerable controversy. Now it is used throughout peripheral nerve surgery for various applications. Professor Viterbo will describe his initial experiences both clinically and in the laboratory with this technique. He will discuss present uses of end-to-side neurorraphy in facial paralysis, olfactory improvement, and impotence.

As the old adage says, we have the world at our fingertips. Touch is the first sense we feel after we are born and the last sense we use before we die. We even feel touch sensation in the womb. For a long time touch has been known to have an important role in the wellbeing of not only human beings but animals as well. For many decades, peripheral nerve surgeons and researches concentrated their efforts on restoring motion to those who lost their ability to move their extremities. Touch restoration took the back seat. Now, as we recognize the importance of touch in dealing with the outside environment, a renewed effort is underway to better understand the physiology of touch and find novel ways to restore touch ability to those deprived of that sense. It is quite challenging to try to restore the sense of touch to a prosthetic limb and to add a graduated sense of the necessary pressure needed for handling different objects. I will also discuss the magical power that touch has in connecting with our world and our loved ones.

Objectives: Following this session, participants will be able to:

1. Analyze the physiology of touch perception and its pathway to our brains.
2. Examine new methods of restoration of the sense of touch.
3. Explore the impact of touch restoration on the lives of our patients.

Past presidents and founding member panelists will engage in a question and answer format discussion of common, controversial and difficult topics within nerve surgery.

Objectives: Following this session, participants will be able to:

1. To evaluate and raise awareness of varying approaches to difficult clinical problems facing peripheral nerve surgeons.

International panelists from around the world will discuss new and different ways of thinking about problems surgeons have while performing different types of nerve surgery.

Objectives: Following this session, participants will be able to:

1. Expose audience members to new methods of managing clinical problems in nerve surgery.