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73 Cards in this Set
- Front
- Back
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Indications for operative treatment of distal radius fractures?
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- >5mm short
- >15 deg dorsal tilt - articular diplacement >2mm - metaphyseal comminution |
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Associated injuries with distal radius fx's?
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50 % incidence intercarpal ligament and TFCC injuries
*watch SL interval *consider TFCC w shortening >5mm, persistent pain |
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Meta-analysis and outcomes of internal v extyernal fixation distal radius fx's?
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No difference between int and ext fixation
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Bone scan to Dx scaphoid fx?
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need >72 hours
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MRI to Dx scaphoid fx?
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only need 24 hours
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surgical indications for scaphoid fx?
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>1mm displacement
RL > 15 degrees prox pole fractures transcaphoid perilunate distal radius fx's |
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given a list, what does not contribute to development of scaphoid fx nonunion?
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distal pole location
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Scaphoid nonunion surg if no collapse?
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percutaneous screw fixation
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Scaphoid nonunion surg if no prox pose osteonecrosis?
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palmar placed structureal autograft and rigid internal fixation.
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Scaphoid fx nonunion surg if collapse and porximal pole AVN?
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Vascularized radial bone graft and rigid internal fixation.
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Hamate hook Dx, Rx?
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Dx: CT scan
Rx: excision |
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DISI cause?
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dorsal capsular fibers are torn, then when scaphoid flexes the lunate and triquetrum extend
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When remove nail and repair nailbed in distal phalanx fx hand?
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if >50% subungual hematoma
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Bennet's fx?
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intra-articular avulsion fx of volar oblique ligament
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Rolando's fx?
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if significantly comminuted, treat with external fixation.
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Thumb stabilizers taught in flexion?
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Collateral ligament
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Thumb stabilizers taught in extension?
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Accessory collateral
palmar plate |
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Stener Lesion?
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Adductor aponeuroses is placed inside of collateral ligament, which then cannot heal properly
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Dx complete tear UCL thumb on stress testing?
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>30 deg radial deviation
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Indication to repair acute/complete w/o Stener lesion?
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lax in extension and flexion.
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Hand flexor tendons dorsal blood supply?
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Vincula
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Hand flexor tendons volar blood supply?
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Peritenon
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Pulleys to preserve in Zone II?
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A-2 and A-4 pulleys
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Boutonierre Rx?
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Splint PIP, move DIP.
Surg acute: repair displaced bone fragments Surg chronic? Central slip reconstruction |
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Radial sagittal band injuries: acute/young?
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splint MP in extension, PIP free.
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EPL rupture post radius fx?
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Can't do primary repair.
intercalary graft EIP to EPL transfer |
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Peripheral nerve Neuropraxia Rx?
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Ischemic...3 mo's observe
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Peripheral n Rx for Axontemisis?
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epineurum intact...?
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Peripheral n Rx for neurotmeisis
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fix in 10-14 days
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indications for correction of malunion of distal radius fx"?
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loss of radial height 4-5 mm>;
loss of radial inclination 10 degree dorsal tilt 15 degrees, |
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TFCC type IC?
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Ulnar avulsion, arthroscopic or open repair
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TFCC type ID?
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radial detachment, debride and repair only if DRUJ unstable
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Chronic TFCC Ulnar (-) or neutral Rx?
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Debride
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Chronic TFCC Ulnar (+) Rx?
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Shorten
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Chronic TFCC unstable DRUJ Rx?
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ligament weave vs shorten
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Basal joint arthritis stage I: def and Rx?
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Stage I: instability withour arthritis.
Rx: ant oblique ligament reconstruction, dorsal closing wedge osteotomy, arthroscopy and capsular shrinkage |
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Basal joint arthritis stage II and III Rx?
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trapeziectomy and suspension arthroplasty,
interposition arthroplasty, CMC fusion in younger and manual laborer |
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Thumb MPJ DJD Rx?
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fuse 0-15 degrees
CMC and IPJ also diseased: consider arthroplasty (rare; maybe in RA) |
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Finger MPJ arthritis Rx?
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uncontstrained "pyrocarbon" (typo?). silicone is constrained and ahs high fx rate, pt satisfaction <50%
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Finger PIPJ Rx?
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arthroplasty long, ring, and small.
fusion in index |
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Finger DIPJ Rx?
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arthrodes at 0-20 degrees
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Median nerve compression sites?
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-IM Septum
-lacertus fibrosus -pronator teres -FDS arch -carpal tunnel |
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most sensitive test for detecting CTS early disease?
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2 pt Semmes-Weinstein
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Durkham's test?
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compress median nerve at carpal tunnel, reproduces symptoms
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Neg EMG/NCV and CTR?
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up to 20% of clinical CTS w normal EMG/NCV respond to CTR
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Diff open v endo CTR?
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earlier RTW for endo
no long term diffs **no diff complications no benefit to internal neurolysis or flexor tenosynovectomy |
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Most predictable benefit CTR?
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Relief of night pain.
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Most common reason for persistent carpal tunnle symptoms after carpal tunnel release?
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Incomplete release, most commonly missed distally
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Most common complication of CTR?
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Pillar Pain
-po week 4 50% -po 1 year 10% -usually lasts 3 months -**no diff open v endo |
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CTS recurrence?
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8-13%
inc risk w diabetes, RA, amyloidosis, hypothyroidism, vibratory tools |
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Anterior Interosseous Nerve compression Dx?
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ulnar head of PT:
-no sensory findings -radial FDP, FPL, PQ weakness most are neuritic (parsonage-Turner) and can be partial Watch minimum 3 months |
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Pronator syndrome diff from CTS?
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100x less common
numbness palm less night pain Tinel's at forearm pain w pronation and elbow extension Weight-lifters |
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Pronator syndrome Rx?
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release ligament of Struthers, lacertus fibrosus, split head of PT, arcade of FDS
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Martin-Gruber anastomosis?
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ulnar nerve carries Median/AIN components
15% |
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Riche-Cannieu?
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median nerve carries ulnar motor fibers
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Recurrent motor branch median nerve?
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high division
transligamentous 17% ulnar sided extraligamentous 66% |
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Ulnar nerve compression sites?
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-arcade of Struthers
-cubital tunnel -Guyon's canal FCU, ulnar FDP, ulnar paraesthesia |
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Radial tunnel syndrome Causes?
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fibrous bands
brachioradialis origin radial recurrent vessels ECRB Acrade of Froshe (leading edge of supinator) |
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Wartenberg's Disease?
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superficial branch of radial nerve. (eg handcuffs)
sensory loss to dorsal thumb, 1st dorsal webspace -*surgery no better than conservative care in relieving symptoms |
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Low median nerve palsey Dx and Rx?
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loss of thumb opposition
-transfer to APB -EIP transfer -FDS (IV) |
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Median nerve palsey, high Dx/Rx?
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-loss of thumb opposition
-loss of thumb IP flexion -Loss of index/long finger flexion index/long FDP-->ring/small FDP BR-->FPL |
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Low ulnar nerve palsey Dx/Rx?
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loss of IV/V lumbricals causes claw
loss of intrinsic muscles: weak pinch -pinch: ECRB/FDS(RF)-->Add Pollicis -Claw correction: transfer to lateral bands |
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High ulnar nerve palsey Dx/Rx?
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loss of RF/SF lumbricals
loss of RF/SF flexion (no claw) - if median nerve intact: side-to-side II/IIIFDP-->IV/V FDP |
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Modified Jones?
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Wrist ext: PT-->ECRB
Thumb ext: PL-->EPL finger extension: -->FCR/FCU --> EDC |
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the most common tumor of the hand is?
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dorsal carpal ganglin
(distal edge of scaphoid ligament) |
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second most common tumor of the hand?
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GCT of tendon sheath, most common location is DIP
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Glomus tumor?
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subungual
pinpoint tenderness bluish hue |
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most common bony tumor of the hand?
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enchondroma
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Ollier's disease?
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multiple enchondromas
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Mafucci's syndrome?
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hemangiomas and multiple enchondromas
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epitheliod sarcoma?
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young adults
painless mass that then ulcerates Rx with wide local or radical excision |
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synovial cell sarcoma?
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2nd to 4th decades
may be confused w ganglion dorsum of hand near joints xrays w calcification -->wideor radical excisions with radiotherapy |
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metastatic carcinoma to the hand?
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most common is bronchogenic lung CA
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