The gamut of treatment for wrist arthritis ranges from motion preserving techniques to complete arthrodesis. 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. Indications for arthroplasty or other salvage techniques for wrist arthritis.
2. Indications for arthrodesis for wrist arthritis.
3. Review selection criteria to optimize outcomes.
4. Identify causes for early complications and late implant loosening.
5. Consider options for revision and salvage of failures.

This course will discuss expert tips and tricks for avoiding complications and achieving good outcomes in phalangeal and metacarpal fractures. Both common fracture patterns as well as complex injury patterns will be discussed. Techniques such as percutaneous pinning, plate fixation, and intramedullary screw fixation will be described, as well as external fixation and cerclage techniques. A case-based format will highlight keys for success and failure and cutting edge surgical techniques will be highlighted.

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

1. Differentiate stable fractures best served with nonoperative care from unstable fractures better suited for operative intervention.
2. Identify how to avoid complications by using improved surgical techniques and tips.
3. Achieve improved results in the management of phalangeal fractures treated both operatively and nonoperatively.

Trauma, infection, and extirpative oncologic surgery can result in skeletal defects of the upper extremity. These represent a reconstructive challenge with a spectrum of solutions available for management of these conditions. This session will employ an expert panel to describe solutions for various skeletal defects. Topics discussed will include: nonvascularized bone graft, Masquelet technique, vascularized bone graft, and engineered osteoconductive scaffolds.

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

1. Identify indications for each of the various techniques for bone gap reconstruction.
2. Become familiar with technical pearls and pitfalls in application of each of these techniques.
3. Discuss outcomes associated with each of these techniques.

Mangling hand injuries are challenging for hand and upper extremity surgeons. Decision-making for these injuries is complex, and it can be challenging to determine when a limb should be salvaged, and when the patient would be better off with prosthetic reconstruction. This session is designed to discuss decision-making, technical strategies, and outcomes for these injuries.

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

1. Identify injury factors that are predictive of successful limb salvage vs. amputation.
2. Plan staged surgical intervention to optimize outcomes of biologic reconstruction.
3. Discuss the important aspects of prosthetic reconstruction and how to optimize utilization and function with upper extremity prosthetics.

MCP and PIP joint arthroplasty have gone through an evolution of materials and designs. There is also some debate, as well as surgeon preference, to surgical approaches for placing these implants; especially when it comes to PIP joint arthroplasty. Outcomes for these patients can be challenging and the primary outcome of pain relief has been fairly reliable with range of motion being much more unpredictable. This course will review the indications and surgical techniques of MCP, PIP and DIP joint arthroplasty, as well as how to optimize outcomes in the small joint arthroplasty patient. Consideration of surface replacement implants, silicone implants and meniscus allograph will be presented. The course will also discuss potential pitfalls and complications, and try to provide pearls for avoiding such situations. The final part of this instructional course lecture will then review what to do when you do run into complications and what salvage options are available. We will discuss the gamut of revision arthroplasty all the way to fusion. Appropriate rehabilitation based on approach and implant will be highlighted.

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

1. Identify surgical indications for small joint arthroplasty.
2. Discuss the volar versus dorsal approaches for implant placement.
3. Recognize the advantages and disadvantages of various implant types.
4. Identify splint and rehab patients following surgery.

Multiple modalities are used in the diagnosis of nerve injury and recovery including electrodiagnostic tests, MRI and ultrasound. This case-based course will review the utility of these different modalities, updates on novel applications, and tips on how to incorporate these into your practice.

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

1. Discuss the current modalities available to the nerve surgeon to image peripheral nerves.
2. Identify the benefits and limitations of current imaging techniques for nerve surgery.
3. Discuss the role of point-of-care ultrasound in the clinic and emergency setting.
4. Utilize electrodiagnostic studies beyond the routine nerve compressions.

Although our understanding of nerve injury, repair and recovery has evolved substantially over the past several decades, elements of our daily practice as nerve surgeons continues to be founded in dogma. This case-based session will explore approaches to common nerve injury scenarios and attempt to separate the science from dogma.

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

1. The evidence for surgical techniques of nerve repair and managing a nerve gap including method of repair and type of nerve graft.
2. The evidence for surgical techniques of neuroma management.
3. The evidence for nerve regeneration including the speed of regeneration and factors contributing to recovery.
4. The evidence for post-operative management including duration of splinting, rehabilitation protocols, and interventions to optimize recovery

Many new nerve transfers have emerged to restore intrinsic hand function. Tendon transfers, however, remain the standard of care for most hand surgeons. This course will provide a review of the nerve and tendon transfers for restoration of intrinsic function with special focus on indications, patient selection, comparative outcomes, and surgical techniques for intrinsic nerve transfers.

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

1. The indications, patient selection, and anticipated outcomes with nerve and tendon transfers for the intrinsic hand.
2. Discuss the surgical technique to perform these nerve transfers.
3. Develop a treatment algorithm for choosing one treatment over the other.

Nerve gaps remain an issue in surgical reconstruction. Different treatments are addressed using fibrin tubes combined with growth factors and mesenchymal stem cells MSC in rodents. Also, a clinical trial using conduits for digital nerve reconstruction will be presented as well as the optimal site to harvest adipose stem cells ASC in humans.

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

1. Discuss Asc, Fibrintubes, and Nerve-Labeling.

Arthroplasty and arthrodesis are mainstays in the treatment of painful arthritis of the hand and wrist, but recently joint denervation has increased exponentially in popularity. Using a case-based approach, this panel of experts will debate the merits of their preferred techniques for the treatment of arthritis involving the wrist, thumb basilar joint and small joints of the hand.

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

1. Identify the indications and contraindications for surgical treatments for arthritis of the hand and wrist.
2. Describe the relevant anatomy and surgical approaches for arthritis of the hand and wrist.
3. Discuss the evidence supporting these techniques.

There are many new therapeutics and techniques being studied to help improve nerve regeneration. This expert panel will review the foundation, basic science and clinical trial updates for innovative techniques such as electrical stimulation, PEG fusion, and advanced nerve repair techniques, as well as explore the barriers to implementing translational research at the bedside.

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

1. Discuss key scientific advances in enhancing peripheral nerve regeneration.
2. Discuss which advances are most likely to translate into clinical use in the next few years.
3. Identify how these new techniques may be used in clinical practice now and in the future to optimize patient outcomes.

The treatment of hand spasticity includes splinting, injections (Botox), tendon lengthening/transfers, as well as neurotomy/nerve transfers. Given the multitude of options available for treatment, it can be challenging to choose the best modality for a given patient. This session will discuss the various options, surgical pearls, and expected outcomes following treatment.

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

1. Learn how to diagnose the different types of hand spasticity.
2. Discuss the treatment options including Botox injections, tendon lengthening/transfers, and nerve surgery.
3. Discuss the surgical pearls when considering tendon lengthening and selective neurotomy for spasticity

This course will discuss the evaluation and management of atraumatic vascular disorders of the hand. The appropriate work up for both vasospastic and vaso-occlusive disorders will be reviewed. Nonoperative treatment modalities including botulinum toxins as well as the role of vascular reconstruction and sympathectomy will be reviewed. Adjunct therapy modalities will be discussed as well.

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

1. Discuss an appropriate work up the atraumatic dysvascular hand.
2. Identify how to utilize botulinum toxins for vasospastic disorders of the hand.
3. Recognize the surgical options for vaso-spastic and vaso-occlusive disorders of the upper limb.
4. Identify the dysvascular limb before and following upper limb procedures.

Anterior Interosseous Nerve palsy (AIN) has traditionally been treated expectantly, without surgical intervention. New imaging techniques, and potential surgical approaches have changed the way that certain hand surgeons treat both traumatic and idiopathic AIN palsy. This ICL will discuss diagnostic workup as well as intervention strategies for this condition.

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

1. Describe the diagnostic workup for traumatic and idiopathic AIN palsy.
2. Discuss the potential surgical interventions and the timing for involvement.
3. Learn the pearls for surgical intervention and decision-making related to decompression alone vs. reconstructive interventions

Advances in surgical techniques and technology have revolutionized amputation care over the past two decades. This session will explore patient selection and surgical techniques aimed at optimizing function of the residual limb and prevention of post amputation pain including targeted muscle reinnervation and regenerative peripheral nerve interfaces. Exciting advances in prosthetic attachment and intuitive control will also be discussed.

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

1. The treatment algorithm for patients with major limb amputation.
2. The surgical techniques available to prevent and treat pain after major limb amputation.
3. Advances in intuitive prosthetic control and osseointegrated prosthetic attachment.

Brachial plexus injuries are devastating injuries to the upper extremity requiring multiple reconstructive surgeries to maximize function. In this panel a case-based approach will be used to get expert opinions on their initial management, timing of surgical intervention, and prioritization of function. The panelists will focus on the benefits and outcomes of both traditional (grafting, distal nerve transfers, free functional muscle) and non-traditional (vascularized nerve grafts, contralateral C7 transfers) treatments as well as the difficult task of pain management in these patients.

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

1. Consider the priorities in upper limb reconstruction after brachial plexus injury.
2. Discuss different techniques for upper extremity reconstruction.
3. Identify different techniques for nerve transfers and their outcomes.
4. Explain the non-surgical and surgical management of pain in BPI.

The management of complex traumatic nerve injures can be daunting and labor intensive depending on multiple factors such as timing of injury, extensive nerve gaps, combined nerve and vascular injuries, or injuries in difficult anatomical locations. Panel members will share their clinical experience and expertise in managing traumatic nerve injuries, highlighting challenges encountered, strategies employed, and outcomes achieved.

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

1. Discuss how to manage traumatic nerve injuries in the acute setting and the pearls and pitfalls of various reconstructive approaches.
2. Discuss strategies for complication prevention, early detection, and effective management to improve patient outcomes.
3. Identify effective rehabilitation protocols, techniques, and approaches that promote optimal nerve regeneration, sensory re-education, and motor relearning.

While mesh repair is a commonly used technique for abdominal hernias, there are potential downsides and complications associated with its use. Functional abdominal wall reconstruction offers advantages over mesh repair such as restoring the integrity as well as the function of the abdominal wall.

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

1. Compare the advantages/disadvantages of functional abdominal wall reconstruction with those of mesh repair.
2. Describe indications for and the various techniques of functional abdominal wall reconstruction as well as common complications and expected outcomes.

Staged reconstruction of a mangled hand or upper extremity involves a planned approach to the surgical management of severe injuries where multiple surgeries are necessary to restore function and improve outcomes. This sequential treatment requires thorough assessment, planning ahead, and the ability to redirect the operative plan when complications arise.

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

1. Discuss the general approach and goals of management of a complex hand/upper extremity injury.
2. Designate possible complications or challenges along the course of treatment and how to avoid or address them.

Trauma or oncologic resection in the extremities can lead to significant challenges for the reconstructive surgeons, where the ultimate outcome may be suboptimal or result in less function than intended. The panel will highlight the teaching points from mistakes made in extremity reconstruction: how plans can be derailed by unexpected events and how reconstructive surgeons can change the course for patients in these challenging situations. From our failures, we can learn to better help others in the future.

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

1. Understand critical decision-making in complex extremity reconstruction.
2. Recognize pitfalls in surgical technique or treatment planning.
3. Develop strategies to troubleshoot complications and effective disclosure to patients.

Nadine Hachach-Haram, a reconstructive plastic surgeon and MedTech entrepreneur, shares her journey, challenges, wins and vision. Nadine also explores the future of surgery, focusing on the pivotal role of healthcare technology in enhancing patient care and health system efficiency. She shows how technology serves as a catalyst to collaboration and smart decision making in the operating room; taking deep dives into the potential of operating room digitization, not only in transforming medical practices but also in inspiring a collective commitment to pushing the boundaries of what is possible through data. Her journey serves as a reminder that drawing inspiration from those around you and building a network united by a shared vision leads to innovation with the power to effect changes, elevate healthcare, and ultimately enhance lives.

This talk will focus on indications, man-machine interfacing and skeletal attachment via osseointegration.

This course will review updates and advancements in the management of brachial plexus birth injuries (BPBI). This expert panel will debate the role of imaging, timing of intervention, and discuss their algorithmic approaches to treatment. They will cover workup and treatments from the pediatric shoulder to elbow and hand while highlighting postoperative therapy to maximize results.

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

1. Discuss the principles and management of brachial plexus birth palsy.
2. Assess BPBI to choose the proper surgical intervention for each patient.
3. Identify tendon and nerve transfers for reconstruction of the pediatric extremity.
4. Discuss the postoperative therapies necessary to maximize surgical outcomes.

Although some nerve compressions are more common than others, where there is a nerve there can be compression. Patients may present with pain and normal electrodiagnostic studies. This expert panel will review diagnosis, surgical treatment, and role of therapy in some of the less-commonly encountered nerve compressions such as in the forearm, thoracic outlet, and tarsal tunnel.

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

1. Understand the classification of nerve injury and anatomy of less common nerve compression syndromes.
2. Develop a diagnostic and treatment approach to patients with nerve pain and normal electrodiagnostic studies as well as less common nerve compression syndromes.
3. Understand the importance of perioperative therapy in managing patients with nerve compression.

Lower extremity nerve injuries remain a challenge for peripheral nerve surgeons due to long distances and less favorable cortical plasticity compared to the upper extremity. This session will discuss new approaches to nerve injuries in the lower extremity including decompression, nerve transfers and muscle/tendon transfers.

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

1. The role of decompression in lower extremity nerve injuries.
2. A surgical approach to nerve reconstruction for injuries at the levels of the thigh and leg.
3. A surgical approach to muscle and tendon transfers in the leg.

There have been recent developments in surgical reconstruction of eye closure after facial palsy that have expanded our treatment options far beyond the gold weight. This panel of experts will discuss these treatments including free functional muscle transfers, muscle grafts, nerve grafts, and nerve transfers.

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

1. Describe additional treatment options for reconstruction of eye closure after facial palsy.
2. Discuss the indications to perform these advanced reconstructive options over traditional treatments.

Reconstructive options for functional sarcoma extremity reconstruction continue to evolve with advancements in surgical techniques, prosthetic technology, and rehabilitative approaches. Management of extremity defects due to sarcoma often must consider the impact of radiation and the possible need for additional oncologic procedures.

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

1. Identify factors that weigh into management of extremity defects from sarcoma resection that differ from traumatic injuries.
2. Describe various techniques or approaches to managing the extremity defects while restoring function and optimizing outcomes.

Basic scientific research is fundamental to advance the field and introduce new concepts to manage nerve injuries. This course is of particular relevance to clinicians and basic scientists working in peripheral nerve and will cover current research topics ranging from nerve reconstruction to pain management therapeutics. Participants will have an opportunity to learn about the latest advances in basic research in the field.

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

1. Learn about the seminal work that provides important insights on the mechanisms and effects on peripheral nerve regeneration and pain.
2. Learn about the new work and animal models to understand peripheral nerve injury, regeneration, and pain.
3. Discuss the new therapeutics being researched for potential use on patients with severe peripheral nerve injury.

The realm of nerve transfer surgery is constantly evolving with new procedures. In this session, the instructors will discuss the indications, surgical techniques, and outcomes for sensory reconstruction in the breast, gender-affirming surgery, genital sensation in low spinal cord injury (TOMAX), and upper extremity function after spinal cord injury.

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

1. Discuss the identification of donor and recipient nerves for sensory neurotization.
2. Discuss the key surgical maneuvers for successful sensory neurotization of the breast and genitalia.
3. Identify the common nerve transfers for upper extremity reconstruction after spinal cord injury.

Reconstruction of facial nerve function is an evolving field with techniques such as nerve transfers, nerve grafts and free functional muscle transfers pushing the boundaries to optimize outcomes for patients. This expert panel will discuss the latest approaches and surgical techniques to restore facial expression as well as postoperative therapy.

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

1. Develop an approach to evaluating patients with facial palsy.
2. Discuss the reconstructive techniques for reanimation of smile and facial expression including nerve transfers, nerve grafts and free functional muscle transfer.
3. Discuss the role of postoperative therapy in optimizing outcomes.