Abos - Hand, Wrist, And Forearm:fracture & Dislocations Of The Hand & Digits:metacarpophalangeal And Interphalangeal Joints

Front 1

Does the ulnar collateral ligament (UCL) generally avulse proximally or distally?

Back 1

Distally

Front 2

What two clinical findings are suggestive of thumb UCL ligament injury?

Back 2

Over 45 degrees opening on stress of UCL
Over 15 degrees of side-to-side difference

Front 3

How is the accessory UCL tested in isolation?

Back 3

Stress in full extension

Front 4

How is the proper UCL tested in isolation?

Back 4

Stress in 30 degrees of flexion

Front 5

What is a Stener lesion?

Back 5

The distal edge of the ulnar collateral ligament displaces superficial and proximal to the adductor aponeurosis.
It becomes lodged between the adductor pollicis aponeurosis and its normal position. It is clinically significant because it will have persistent instability due
to lack of healing. It is an indication for surgery.

Front 6

What structure is interposed in a Stener lesion and prevents the UCL from healing?

Back 6

Adductor pollicis aponeurosis

Front 7

The greatest MCP wear occurs with what hand motion?

Back 7

Grasping

Front 8

What is the optimal position for thumb MP joint arthrodesis in flexion, pronation, and abduction?

Back 8

10 degrees flexion
10 degrees pronation
O degrees abduction

Front 9

What is the preferred treatment for simple (partial) tear?

Back 9

Buddy tape to adjacent digit for 3 weeks

Front 10

What is the preferred treatment for complete tear?

Back 10

Buddy tape to adjacent digit for 6 weeks

Front 11

Operative intervention is indicated for what situation? Why?

Back 11

Complete tear of radial collateral ligament (RCL) of index PIP joint
Surgery restores stability in pinch

Front 12

What is the most likely diagnosis in a patient with acute loss of active and passive MCP motion but with a PIP that remains mobile?

Back 12

Catching and locking of the collateral ligament on an osteophyte

Front 13

What is the preferred initial treatment if reducible?

Back 13

Reduce and observe

Front 14

What is the preferred treatment if irreducible?

Back 14

Surgical excision of the causeof collateral ligament catching (e.g., osteophyte, joint debridement)

Front 15

Interposition of what structure may result in an incomplete reduction?

Back 15

Volar plate

Front 16

With dorsal dislocations, does the volar plate generally avulse proximally
or distally?

Back 16

Distally

Front 17

What is the treatment if a stable reduction is achieved?

Back 17

Early active motion

Front 18

What if the reduction remains unstable?

Back 18

Extension block splint

Front 19

If untreated, what long-term complication may develop?

Back 19

Swan-neck deformity, PIP
hyperextension

Front 20

With a volar dislocation, the head of the phalanx is often entrapped between what two structures?

Back 20

Lateral band
Central slip (straight volar dislocation central slip only)

Front 21

How can the intrinsics best be relaxed to facilitate reduction?

Back 21

Flex finger at MP joint

Front 22

What structure is commonly injured with a volar dislocation? What is the resultant deformity?

Back 22

Central slip commonly injured (also in rotatory dislocation)
Acute boutonniere deformity

Front 23

What is the preferred treatment if fracture fragments are nondisplaced?

Back 23

Extension block splint

Front 24

What is the preferred treatment if fracture fragments are displaced and
comminuted?

Back 24

Traction device

Front 25

What is the preferred treatment if fracture is a single displaced fragment?

Back 25

ORIF if >25% but <40% articular surface involved

Front 26

What is the salvage procedure if treatments are unsuccessful?

Back 26

Volar plate arthroplasty

Front 27

With what pathologic process is a mucous cyst associated?

Back 27

Arthritic DIP joint

Front 28

What is the natural history of mucous cysts?

Back 28

20 to 60% spontaneously resolve

Front 29

What is the indication for operative treatment of a mucous cyst?

Back 29

Persistent drainage due to increased risk of infection

Front 30

In general, what is the preferred treatment for posttraumatic arthrosis of PIP and DIP joints?

Back 30

Fusion

Front 31

What type of fixation is generally best for IP joint fusion? What is the preferred position?

Back 31

Screws are best for DIP joints, can use Kirschner (K) wires or screws for PIP joint
DIP joint 0 to 5 degrees, PIP (index = 40, middle = 45, long = 50, small = 55)

Front 32

Volar plate at PIP
UCL (thumb MCP)
MCL at the elbow

Back 32

Distal
Distal
Distal