Abos - Hand, Wrist, And Forearm:wrist Instability, Arthritis, And Management:general Concepts

Front 1

What changes occur in the proximal carpal row with radial deviation?

Back 1

Scaphoid, lunate, and triquetrum flex

Front 2

What changes with ulnar deviation?

Back 2

Scaphoid, lunate, and triquetrum extend

Front 3

What should the scapholunate (SL) angle be on a lateral wrist x-ray?

Back 3

<6O degrees and >3O degrees

Front 4

What is the definition of carpal instability dissociative (CID)?

Back 4

Intercarpal ligament (within a given carpal row) disrupted

Front 5

What are the three types of CID?

Back 5

Dorsal intercalated segmental instability (DISI)
Volar intercalated segmental instability (VISI)
Axial instability (carpal collapse)

Front 6

What are the dehnition and mechanism of carpal instability nondissociative (CIND)?

Back 6

Malposition or abnormal movement of the entire proximal or distal carpal row with normal relationships
within the row (for example,
midcarpal instability, SIT instability, distal radius malunion)

Front 7

What is the definition of carpal instability complex (CIC)?

Back 7

Carpal instability within and between carpal rows
Combination of dissociative and nondissociative

Front 8

What is VISI?

Back 8

Volar flexion of the lunate relative to the long axis ofthe radius and capitate

Front 9

What two structures are necessarily disrupted with VISI?

Back 9

Lunotriquetral (LT) ligament
Dorsal radiotriquetral ligament

Front 10

What are four radiographic features consistent with VISI?

Back 10

Broken Gilula’s arc
Radiolunate angle >15 degrees
Capitolunate angle >15 degrees
Scapholunate angle <30 degrees

Front 11

What is the preferred treatment for an acute LT disruption?

Back 11

LT pinning

Front 12

What is the preferred treatment for chronic LT disruption?

Back 12

LT fusion

Front 13

lf the patient has an ulnar positive wrist, and the LT is unstable, what should be done?

Back 13

Ulnar shortening osteotomy with or without LT pinning may be effective in restoring stability because of tightening extrinsic 6 ligaments

Front 14

What is the typical clinical presentation of CIND?

Back 14

Clunking wrist with radial and ulnar deviation

Front 15

What is the characteristic radiographic finding?

Back 15

Sudden shift of proximal carpal row with radial and ulnar deviation
Midcarpal instability

Front 16

What joints can be affected with CIND?

Back 16

Midcarpal
Radiocarpal

Front 17

What is the general treatment approach to midcarpal nondissociative instability?

Back 17

Nonoperative treatment first (immobilization and activity
modification)
Arthroscopic heat shrinkage
capsulodesis
Dorsal wrist ligament repair
reconstruction
If unsuccessful, then fusion across the midcarpal joint

Front 18

What is the most common leading to the development of cause radiocarpal instability?

Back 18

Malunion of distal radius fracture

Front 19

What are the most common causes leading to combined carpal instability?

Back 19

Scaphocapitate syndrome
Periluriate dislocation

Front 20

What is scaphocapitate syndrome?

Back 20

A unique injury: a force causes proximal capitate and scaphoid waist fractures, which can lead to perilunate dislocation

Front 21

What is the treatment of choice for scaphocapitate syndrome?

Back 21

ORIF if displaced fractures or instability

Front 22

What are the four Mayfield stages of perilunate dislocation?

Back 22

I: scapholunate
II: scapholunate, lunocapitate
III: scapholunate, capitolunate, lunotriquetral
IV: volar Iunate dislocation

Front 23

What mechanism reproduced Mayfield stages of perilunate dislocation in a cadaver model? What is the position of the wrist and forearm?

Back 23

Pronation + ulnar deviation on a hyperextended wrist

Front 24

Based on cadaver modeling, what position of the wrist and forearm is required for a perilunate dislocation to result?

Back 24

ORIF followed by 8 to 12 weeks casting

Front 25

What radiographic marker predicts poor outcome after ORIF for perilunate dislocation?

Back 25

Persistent scapholunate gap

Front 26

With what radius/ulna relationship are class II TFCC injuries generally
associated?

Back 26

Ulnar positive

Front 27

What are the five types of Palmer’s class II (degenerative) TFCC injury?

Back 27

A: TFCC wear without perforation or chondromalacia
B: Iunate/ulna chondromalacia
C: TFCC perforation with Iunate chondromalacia
D: Iunate and/or ulnar
chondromalacia, and lunotriquetral ligament perforation
E: TFCC perforation with generalized
arthritic changes involving the
Iunate and ulna, and perforation of the lunatotriquetral ligament

Front 28

In general, what are the initial forms of treatment for class II tears?

Back 28

Immobilization
NSAIDs

Front 29

What is the condition of the TFCC with IIA and IIB tears?

Back 29

TFCC is intact

Front 30

What does operative treatment for IIA, IIB injuries entail?

Back 30

Open ulnar shortening
Arthroscopic evaluation

Front 31

What is the maximum resection allowed for the wafer resection (partial resection of the ulnar dome)?

Back 31

4 mm

Front 32

In IIC injuries, the TFCC is perforated, so operative treatment generally includes what two procedures?

Back 32

Arthroscopic debridement of
perforation and water resection of distal ulna through perforation

Front 33

What is a key contraindication to a wafer procedure?

Back 33

If >2 mm of shortening is required

Front 34

What is the difference between D and E class II injuries?

Back 34

IID: LT ligament disrupted, no VISI
IIE: LT ligament disrupted and VISI and generalized arthritis

Front 35

What operative procedures are appropriate for type IID, IIE degeneration?

Back 35

Arthroscopic debridement of TFCC and LT ligament
Ulnar shortening

Front 36

What is an indirect benefit of ulnar shortening?

Back 36

Lunotriquetral stability improves

Front 37

If the LT articulation remains unstable after ulnar shortening, what is the next
step?

Back 37

Pin across lunate and triquetrum

Front 38

In general, which condition begins the process leading to eventual caput ulnae?

Back 38

DRUJ synovitis
May be caused by such disorders as rheumatoid arthritis

Front 39

What is caput ulnae syndrome?

Back 39

Results from synovitis and stretching of ulnar carpal ligaments
Progresses to dorsal dislocation of the yulna, supination of the carpus, and
subluxation of the extensor carpi ulnaris tendon
If untreated, ulnar translocation can occur

Front 40

In which direction does the ECU sublux?

Back 40

Volar
Ulnar

Front 41

What is the operative treatment for ECU subluxation if nonoperative treatment fails?

Back 41

Extensor retinacular flap used for ECU sheath reconstruction

Front 42

What events classically follow ECU subluxation?

Back 42

Volar ECU subluxation causes loss of ulnar deviation and extension, which radially deviates the wrist and brings the ulnar extensor tendons directly over the distal ulmi
Vaughn—Jackson syndrome develops (attritional extensor tendon rupture)

Front 43

How can Vaughn-Jackson syndrome be clinically differentiated from PIN palsy?

Back 43

Tenodesis test: tendons are intact in PIN palsy

Front 44

What is the preferred surgical treatment for early DRU] synovitis?

Back 44

Synovectomy

Front 45

Once caput ulnae develop, what treatment options are available?

Back 45

Darrach resection of the ulna (stabilized by volar capsule) and ECU relocation with retinacular flap
Suave-Kapandji

Front 46

After Suave-Kapandji, why can pain develop with resisted elbow flexion?

Back 46

Instability of the proximal ulna

Front 47

What operative options are available for DRUj arthritis?

Back 47

Ulnar head resection (hemiresection arthroplasty)
Darrach procedure
Suave-Kapandji
DRUj prosthetic replacement