The course will cover management of articular and extra-articular fractures of the metacarpals from initial assessment to rehabilitation. Classification, injury patterns and indications for surgery will be discussed. The faculty will use clinical cases to demonstrate surgical approaches, principles and types of fixation and their outcomes and management of complications. Rehabilitation following conservative and operative management will also be discussed.

Objectives: Following this session, the participant will be able to:

1. Identify fracture pattern and formulate a management plan.
2. Discuss surgical approach and type of fixation when required.
3. Recognize complications of treatment and suggest intervention.
4. Explain the principles of splinting and rehabilitation after metacarpal fractures.

This instructional course will cover indications for operating on both acute fractures and established malunions. There will be a discussion of the roles and relative merits of external fixation (alone or augmented), pins and plaster, volar or dorsal plating, fragment specific fixation, and the role of arthroscopic assistance. In addition, there will be a focused section on management of the DRUJ, and a section focused on avoiding and managing complications associated with distal radius fracture management.

Objectives: Following this session, the participant will be able to:

1. Describe the indications for surgical management of acute, subacute, and malunited distal radius fractures.
2. Discuss the pros and cons, and indications for various forms of fixation.
3. Learn the standardized managing associated ulnar sided injuries and the DRUJ. approaches to
4. Discuss the prevention as well as management of complications that can occur when treating distal radius fractures

The course presents a case oriented approach by experienced faculty on the use of total wrist arthroplasty and hemiarthroplasty for the treatment of wrist arthritis using current implant systems. Current opinions and reviews of recent literature will be discussed to gain broader perspective on expected outcomes, with emphasis on optimizing the long term outcomes through proper patient selection and implantation technique. When to consider revision arthroplasty and salvage procedures, including use of current techniques, will also be demonstrated using specific cases.

Objectives: Following this session, the participant will be able to:

1. Review selection criteria to optimize outcomes.
2. Identify causes for early complications and late implant loosening.
3. Consider options for revision and salvage of failures.

This instructional course will review the clinical presentation, radiographic findings and treatments of patients who have failed treatments for phalangeal and metacarpal fractures.

Objectives: Following this session, the participant will be able to:

1. Discuss unique injury patterns associated with metacarpal and phalangeal fractures.
2. Identify different types of management for these injuries and common complications.
3. Review methods for successful treatment of failed management of these injuries.

This course will detail potential complications associated with the diagnosis and management of vascular injury and vasculopathy. Diseases affecting blood vessels including vascular abnormalities caused by degenerative, metabolic and inflammatory conditions, embolic diseases, coagulative disorders.

Objectives: Following this session, the participant will be able to:

1. Understand complications including false aneurysm after trauma
2. Appreciate the potential complications after arterial reconstruction
3. Discuss potential risks of periarterial sympathectomy

High resolution imaging has become an extension of the physical examination of patients with peripheral nerve disorders. This instructional course illustrates the benefits of various imaging modalities used to diagnose and treat a wide variety of conditions, including nerve entrapments, injuries, tumors, and pain syndromes.

Objectives: Following this session, the participant will be able to:

1. Understand the utility of high resolution imaging in one's peripheral nerve practice.
2. Understand the technical and technological advances being made by collaborations by surgeons and clinicians and radiologists and imaging scientists in terms of imaging of peripheral nerve.
3. Understand the potential of high resolution imaging preoperatively, intraoperatively and postoperatively.

This IC will focus on the current management of acute nerve injury. The format will consist of a small didactic component to present key considerations regarding the clinical presentation, pathology and pathophysiology of nerve injury. Majority of the time will entail an interactive session formatted around appropriate cases to allow the panel members to discuss and debate on management decision making and surgical strategies.

Objectives: Following this session, the participant will be able to:

1. Recognize patients presenting with acute nerve injury based on clinical and other criteria.
2. Discuss options for the management of acute peripheral nerve trauma, depending on location, etiology and mechanism.
3. Be aware of which patients require immediate surgery versus those that can be managed in a delayed manner.
4. List surgical options available to manage acute nerve trauma.

Central nervous system injury can result in severe neurological deficit. Recently, peripheral nerve surgeons have devised novel approaches to augment function in these patients. Some of the techniques employed take advantage of nerve transfer surgery, while others utilize neuromodulation such as spinal cord stimulation. An experienced and expert panel have been assembled to present a variety of approaches and foster discussion the audience.

Objectives: Following this session, the participant will be able to:

1. Discuss central nervous system injury in comparison to peripheral nerve injury.
2. Identify patients with possible surgical options to improve neurological function post CNS injury.
3. Examine the current literature concerning augmenting CNS injury recovery.

Panelists will present their complications and provide examples of managing complications arising from nerve reconstruction. The session will serve as a forum for discussion surrounding preventing such complications. Attendees are encouraged to bring their problem cases for discussion as well.

Objectives: Following this session, the participant will be able to:

1. Analyze the common and more unusual complications arising from nerve.
2. Discuss methods of avoiding or addressing complications arising from nerve surgery.

Our panel will consider the basic science of nerve injury from the point of views of 1) the biology of the regenerating nerves and the Schwann cell environment in which the nerves grow and 2) strategies to promote nerve regeneration that have been tested in animal experiments and, in some case, been translated in studies of nerve regeneration in patients. The strategies include brief electrical stimulation proximal to the site of nerve injury, gene therapy to promote expression of neurotrophic factors, conditioning of nerve conduits, use of immunosuppressive agents such as FK506, and exercise.

Objectives: Following this session, the participant will be able to:

1. Discuss the biology of nerve regeneration.
2. Identify current methodologies to enhance functional recovery after nerve injuries.

This course will discuss PIP fracture dislocations and the most common surgical treatments employed for the complex injuries. Emphasis will be placed on the detailed decision making and technical aspects of percutaneous and open treatments of these injuries. Speakers will share the pitfalls that they have encountered as well as their favorite technical tips for success. Interactive case reviews will follow formal presentations and will allow for audience participation.

Objectives: Following this session, the participant will be able to:

1. Recognize those PIP fracture dislocations that are best treated with surgical intervention.
2. Describe PIP injury characteristics that predict failure with open or percutaneous treatment.
3. Develop a logical step-wise approach to treatment PIP fracture dislocations.

The care of the patient with Tetraplegia after Spinal Cord Injury is rewarding both for the patient and the surgeon. Established techniques such as tendon transfers are being supplemented and in some cases supplanted by nerve transfers. Optimizing treatment and minimizing risks requires an understanding of the indications, contraindications, and pitfalls of treatment. Our panel of experts will discuss a case based approach to treatment with emphasis on new techniques.

Objectives: Following this session, the participant will be able to:

1. Understand the role of nerve transfers in tetraplegia.
2. Identify the potential complications of tendon transfers and nerve transfers in tetraplegia.
3. Understand the optimal timing of surgical intervention.
4. Appreciate a global approach to tetraplegia care.

This panel is designed to address the diagnosis and management of patients with neuropathic pain following trauma or iatrogenic nerve injury. This includes pain resulting from neuroma, nerve compression/irritation, partial or complete nerve injury, or soft tissue scarring. The panelists will share their experience with workup including the use of ultrasound and diagnostic nerve blocks, surgical techniques, and management algorithms. Illustrative cases will be presented for discussion.

Objectives: Following this session, the participant will be able to:

1. Review the causes of painful neuropathic conditions following trauma or iatrogenic nerve injury and the associated signs/symptoms.
2. Discuss the utility of ultrasound and diagnostic nerve blocks for evaluation, as well as patient selection for surgery.
3. Incorporate into practice the different treatment options including nerve reconstruction, neurectomy and burying, and flap coverage.

In this course the current management of various entrapment neuropathies will be reviewed and updated. Diagnostic modalities, therapeutic options, indications for surgical intervention, surgical approaches and definitive decompression, management of complications will all be discussed in detail. We expect a lively discussion with the audience members, as there are still important issues that remain controversial in the management of the entrapment neuropathies.

Objectives: Following this session, the participant will be able to:

1. To discuss the important entrapment neuropathies, including natural history, pathophysiology, nonsurgical options for management, indications for surgery and surgical approaches.
2. To evaluate the outcomes of various surgical approaches and their complications.
3. To debate the controversial aspects of specific entrapment neuropathies and their management.

As we strive the provide the best functional restoration following upper extremity injuries, there are many options available to us including nerve transfers and tendon transfers. In this course, we plan to investigate the risks, benefits, complications and possible consequences of the various procedures. We will have some of the world’s experts on this topic as the course instructors including William (Chris) Pederson, Milan Stevanovich, and Steve Moran. They will plan to discuss tendon transfers and nerve transfers for different upper extremity injuries, debate the benefits of each, and share with the audience their “preferred approaches”. We will also have them discuss unknown cases and give them the opportunity to justify their approach to management of that difficult clinical problem. It should be a highly educational and entertaining course.

A decade of change in facial paralysis surgery: What I do now that I didn't 10 years ago.

Update on advances made in surgical treatment of lymphedema.

The AAHS/ASPN/ASRM Combined Panel is focused on reconstructive surgery and the "value" of various reconstructive approaches based on rapidity of recovery, return to work, patient reported outcome measures of satisfaction, and overall cost. Each of the panelists will specifically address controversial areas where there are many reconstructive options and decisions need to be made based on these complex issues. In fact, at times no reconstruction could be perceived as the appropriate intervention. For instance, we will address such difficult issues as, "A comparative effectiveness analysis of leg amputation versus flap reconstruction in the era of value-based practice". It should be a lively, thought provoking, and interesting discussion.

Objectives: Following this session, the participant will be able to:

1. Identify the meaning and importance of "value based practice".
2. Develop a comprehensive understanding of patient reported outcome measures of satisfaction.
3. Articulate cost analysis approaches used by facilities and third party payers as they make decisions regarding surgical interventions.
4. Develop a balanced view of complex reconstruction as it pertains to payers, patients, hospitals, and medical professional from other specialties.

A Comparative Effectiveness Analysis of Leg Amputation versus Flap Reconstruction in the Era of Value-Based Practice
Kevin C. Chung, MD

Economic Cost Benefit of Neurolysis for Tarsal Tunnels Syndrome versus Best Medical Care in Diabetics with Neuropathy
A. Lee Dellon, MD

Building to Last. Breast Reconstruction in the Era of Hightened Cost Control.
David H. Song, MD

Enhancing Intra-operative Decision Making in Brachial Plexus Exploration and Repair, Nerve Transfers, Targeted Muscle Re-innervation and Complicated Revision Surgery using the Checkpoint Nerve Stimulator/Locator

This program will discuss and demonstrate the use of the Checkpoint Nerve Stimulator/Locator in brachial plexus exploration and repair, complex peripheral nerve reconstruction cases, and the latest in nerve transfer indications in spinal cord injury. Additionally, intra-operative nerve assessment and clinical decision-making will be addressed, as well as the application of stimulation for nerve location and mapping in complex exposure cases and targeted muscle re-innervation. Lastly, we will discuss the use of the Checkpoint for prolonged intraoperative stimulation for enhanced nerve regeneration in nerve repair and nerve transfer procedures.
Speakers:
Scott H. Kozin, MD, Chief of Staff Shriners Hospital Philadelphia
Justin Brown, MD, Director of the Neurosurgery Peripheral Nerve Program, University of California San Diego
Jason H. Ko, MD, Assistant Professor of Surgery, Plastic and Orthopaedic Surgery, Northwestern Memorial Hospital
Jovito Angeles, MD, Assistant Professor of Orthopedic Surgery, University of Chicago
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These events are neither supported by nor endorsed by ASPS or ASPN.

This course will review the clinical manifestations of the different peripheral nerve pain syndrome and provide some diagnostic tools to approach these conditions. Surgical management will be discussed and will review the patient selection for these pain conditions.

Objectives: Following this session, the participant will be able to:

1. Discuss clinical manifestations of peripheral nerve pain syndromes.
2. List diagnostic approaches to peripheral nerve syndromes.
3. Describe techniques to manage peripheral nerve syndromes.
4. Apply these diagnostic tools in identifying patients in their own practice suffering from peripheral nerve pain syndromes and offer appropriate surgical management or referral.

This IC will focus on the current management of peripheral nerve sheath tumors and mass lesions. Expert faculty will provide clinical insights, technical nuances and highlight recent developments in the treatment of nerve tumors, including benign and malignant peripheral nerve sheath tumors (MPNST) and other mass lesions involving nerve. The format will consist of slide presentations followed by interactive case discussion around a few select cases to solidify how clinical decisions are made and also to expose the learner to the areas of controversy in the field.

Objectives: Following this session, the participant will be able to:

1. List options for the management of peripheral nerve tumors, MPNSTs and mass lesions involving nerve.
2. Become familiar with indications for surgery of nerve tumors.
3. Be aware of imaging and technical advances pertinent for managing nerve tumors.

This course will review the current state of art and advances in management and evaluation of children with Neonatal Brachial Plexus Palsy. Through didactic and interactive presentations the nerve surgical management (based on current knowledge of pathophysiology, selection of infants for surgery), and outcome evaluation will be presented. Topics will include surgical strategies in various lesion types, nerve grafting versus transfer, the value of using contralateral C7.

Objectives: Following this session, the participant will be able to:

1. Recognize the current state of art and advances in management of Neonatal Brachial Plexus Palsy.
2. Discuss different nerve reconstruction strategies, their advantages and limitations.
3. Recognize the various outcome measures of treatment in Neonatal Brachial Plexus Palsy. Which outcome measures will provide the best reflection of functional outcome and are robust enough for scientific evaluation of treatment strategies.

Surgical reconstruction of injured peripheral nerves will have to be combined with novel therapeutic strategies that enhance the limited degree of recovery following surgical repair. In this course we will highlight progress that has been made in the laboratory with the development of basic neuroscience and translation approaches to promote regeneration of the surgically repaired peripheral nerve. The talks will provide updates on electrical stimulation, rehabilitation and optogenetics, molecular delivery using biomaterials or gene therapy, Schwann cells a delayed nerve repair, and axon fusion using polyethylene glycol.

Objectives: Following this session, the participant will be able to:

1. Electrical stimulation in rat models for peripheral nerve repair and translation to human patients.
2. Optogenetics: can light be used to induce peripheral nerve regeneration?
3. Biomaterials and viral vectors: what is the best way for temporal and spatial delivery of neurotrophic factors?
4. What is axon fusion and can we achieve axon fusion in an injured peripheral nerve?

Our panel will discuss the functional reconstruction of patients with severe muscle or peripheral nerve injuries/lesions with permanent functional deficits. We will consider different patient populations and injury settings, upper and lower extremity reconstruction, timing of surgery, and different muscle options, both local and distant.

Objectives: Following this session, the participant will be able to:

1. Identify appropriate candidates for reconstruction with functional muscle transfer.
2. Discuss a timeline of functional reconstruction in terms of the initial injury and other frequently needed surgical procedures.
3. Be familiar with different options for muscle transfer and the advantages and disadvantages of local versus free muscle transfer, donor site morbidity, and the indications for a staged versus one-stage procedure.

Nerve transfers continue to be an important tool for the restoration of function in a broad variety of clinical settings. The panelists will discuss different approaches, principles, and lessons learned when considering new applications for nerve transfers. Audience input and a lively discussion is anticipated.

Objectives: Following this session, the participant will be able to:

1. Describe the role of nerve transfer techniques for nerve injury.
2. Identify new developments and indications in nerve transfer surgery.

This panel will outline the design and execution of a prospective, randomized, and controlled, double blinded study of lower extremity nerve decompression in patients with painful diabetic neuropathy, including the trials and tribulations of conducting a level one study. The panel will also discuss the difficulties in reaching consensus in the development of an international multi-center study of obstetrical brachial plexus palsy and will focus on Delphi methodology. Participants are invited to bring their own study design problems for discussion.

Objectives: Following this session, the participant will be able to:

1. Describe the process required to complete a randomized blinded controlled trial.
2. Identify key issues to be confronted in the design of a multi-centre data base.