You can see that you have solved the scissoring problem by watching your patient take the fingers through a full range of active motion before you close the skin.

Patients see the reduction of their bone on fluoroscopy. They watch themselves achieve a full range of flexion and extension of their fingers during the surgery. They remember this and know that this will be achievable if they stick with therapy and exercise after the surgery.

You and your hand therapist can educate wide awake patients during the operation to instill the importance of postoperative therapy into patients’ consciousness.

Patients can practice postoperative movement in a pain-free state during surgery.

You can check the stability of the bone fixation with full flexion and extension during the surgery. This helps you to decide whether or not to allow early protected movement after surgery.

All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.

See Chapter 1, Atlas, for illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.

Local anesthesia for a Bennett fracture is the same as for a trapeziectomy (see Chapter 27). You flood the radial side of the hand with 40 ml of buffered lidocaine with epinephrine, as shown in Clip 42-1.

The local anesthetic for fracture dislocations of the fourth and fifth metacarpal bases is 40 ml of buffered lidocaine and epinephrine flooding the ulnar side of the distal wrist and base of the hand, as shown in Clip 42-2.