These may be related to locoregional anesthesia technique (see Chap. 6.4) or directly to the surgery [18]. The literature most often reports extreme cases (i.e., excising a nerve instead of a tendon [19]). However, arthroscopic maneuvers on the proximal interphalangeal (IP) joints or on the wrist are at high risk of nerve injury [20, 21]. Only experience, anatomical knowledge, and care can prevent these complications.

Long regarded as a risk factor for infection, this complication does not seem to have any impact [22, 23]. Recent publications confirm that it is a very relative contraindication, which has also been the experience of hand surgeons [24], although surgery may increase a preexisting lymphedema [25].

The true incidence of these lesions is impossible to assess because – thanks to the presence of double vascular axes – they have almost no effect. They can be detected only during surgery, although this is rare because of the use of a tourniquet. They usually occur during the installation of the material. Prevention is by experience, anatomical knowledge, and careful and rigorous technique [26, 27].

These include tenosynovitis or tendon rupture and can occur in 7 % of osteosyn­theses, especially of the wrist. They are usually due to conflict with the material [26, 28]. Prevention requires experience and a rigorous osteosynthesis technique. The need to remove the material will be assessed by the surgeon. If the risk of tendon abrasion is important due to protruding pins or a cumbersome plate, material removal should be proposed. However, compact and low profile material, such as screws, can be left in place. The athlete is no exception to these rules, and material removal should be proposed based on these criteria.

These complications are discussed in specific chapters.

These complications may occur in up to 8 % of osteosyntheses (Fig. 10.2). They are promoted by early and poorly controlled mobilization. However, they do not necessarily result in failure or nonunion if detected early and the mobilization is modified [29].

According to a recent meta-analysis, these complications can affect up to 19 % of grafts [30]. They include nerve damage, hematoma, fracture, and infection of the donor site. The most common complication is pain [31]. Different harvesting sites have their peculiarities: for moderate amounts of grafts, the distal radius and the olecranon are useful at the cost of a risk of fracture with mechanical consequences (Fig. 10.3). The iliac crest allows for harvesting larger amounts of grafts without functional consequences in case of fracture but should be performed under general anesthesia.

The name of this disease is, in itself, subject to debate: algodystrophy, Sudeck’s syndrome, reflex sympathetic dystrophy, shoulder-hand syndrome, etc. It is a general complication of trauma, and is not related to the treatment, whether surgical or not. There are many different symptoms that can occur concurrently, to variable degrees: pain, significant edema greatly exceeding the traumatized area, erythrosis, hyperhidrosis, and stiffness. The diagnosis is mainly clinical, and the use of scintigraphy is not systematic. The treatment proposals are as varied as they are controversial. However, there are validated, preventive measures:

Only a few curative treatments seem to be validated in the literature:

In any case, this condition is problematic, both in its understanding and in its treatment, and treatment by a specialized team should be the rule whenever possible.

This can cause swelling, pain, or ischemia and nerve damage. The signs are pain, a sensation of constriction, venous stasis with a bluish appearance of the skin (sometimes difficult to differentiate from a hematoma), paresthesias, or an ischemic appearance distal to the dressing. In case of doubt, redressing should be proposed. The dressing should meet the usual rules: comfort, cleanliness, and flexibility. Its renewal remains at the discretion of the practitioner.

Cast compression (Fig. 10.4) is a devastating complication, with a poorly assessed frequency. It can progress into a Volkmann syndrome, a neurological compression or pressure sores. These complications can be prevented by rigorous technique and regular monitoring, particularly to assess severe pain and dysesthesia [34]. The monitoring instructions must be given to the patient. The type of trauma (crushing, high energy) must be considered in the risk-benefit analysis.

The hand surgeon must often administer local anesthesia, and this implies low but non-negligible risks:

Informed consent is now a legal requirement and a necessity in the surgeon-patient relationship, especially in a specialty such as hand surgery with such a high functional risk. This consent requires a detailed and fair explanation of the benefits and potential risks of the surgery and allows the patient to participate in the treatment decision. It leads to the patient signing a consent document (Box 10.2).