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368 Cards in this Set
- Front
- Back
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nerve compression
Froshe Arcade of Struthers Ligament of Struthers Osborne |
Froshe = Radial
Archade of Struthers = Median Ligament of Struthers = Ulnar Osborne = Ulnar |
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Collar button Abcess via ?
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lumbrical canal or
palmar fascia |
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juvenile rheumatoid arthritis
deformity |
wrist = flexion
carpo/metacarpal = ulnar dev. loss of flexion IP & MPjoints radial deviation of MP |
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Subungual melanoma
survival |
66%
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Upper extremity embryologic development tissue
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Apical Ectrodermal Ridge
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SLAC wrist
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I radio - scaphoid
II radio - mid carpal III radio - mid carpal IV pan carpal |
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thumb hypoplasia
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I small
II small, unstable,thenar cone decrease or absent III short, web space contracture, absent thenar cone, global instability IV absent |
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camptodactyly
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small finger
not progressive after puberty mild = splint severe = surgery |
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Syndactyly
age for surgery inheritance sex distribution |
surgery = 12 - 18 mo.
inherited = 10 - 40% M>F |
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Scaphoid fracture healing
nondisplased displaced 1 mm best rx |
nondisplaced = 90% unite (10-14 wks)
displaced 1 mm = 50% rx = vascularized bone graft |
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rx of chronic paranechia
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epinechial marsupialization
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rheumatoid swan neck deformity
etiology |
tight intrisics
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rx of sagital band rupture
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splint 2 weeks
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Moberg transfer for thumb pinch
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FDP tenodesis
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Reiters Syndrome
(psoriatic arthritis) |
HIV
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oncomysosis rx
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terbinafine
intraconazole |
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trigger finger release in
rheumatoid arthritis |
contraindicated
further agrivates ulnar drift |
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structures causing failure of reduction of mp joint dislocation
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lumbrical
flxr tendon volar plate |
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"clench fist"
treatment |
botox
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sensory fiber function
vibration pain (burn) pain(sharp) moving 2pd static 2pd |
vib = pacinian
burn = C fibers sharp = A fibers mov 2pd = meisner's stat 2pd = merkel cell |
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arthrogryposis
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present at birth
nonprogressive |
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ectrodactyly
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partial or complete absence of fingers
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glomus tumor
%recurrance %multiple |
recur = 20%
multiple = 25% |
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C5-6 tetraplegia - correction of forearm suppination
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redirect biceps through interosseous membrane
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frostbite
bone scan result |
normal = observation
abnormal = amputate pip and vascular tissue cover |
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Rx of rupture ring and small finger extensors in rheumatoid arthritis
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Darrach procedure
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Moberg flap
maximun defect size |
2 x 2 cm
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structure preventing reduction of volar pip dislocation
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condyles of prox phalynx pass through the ext tendon
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genetic transmission of congenital amputation
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0%
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Rx camptodactyly
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release abnormal lumbrical
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delta phalynx
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longitudinally bracketed epiphysis
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brachioradialis flap
coverage artery |
antecubital fossa
recurrent radial artery |
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blood supply for osteocutaneous radial forearm flap
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fasciocutaneous perforators from radial artery
bet. brachiorad. and fcr |
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Rx electrical burn
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0.9% NaCl
Mannitol NaHCO3 |
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how long post injury can a boutinairre still be treated by splinting
|
6 wks
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nerve repair
first sensory return |
pain
nerve growth = 1mm/day |
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Rx osteogenic sarcoma
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radical exc.
radio Rx chemo Rx |
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Rx frostbite
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anti inflammitory Rx
decreases thrombuxane B2 decreases protoglandi F |
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margin of excision merkel cell ca
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3 cm
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type III dislocation pip
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communited fracture
Rx = volar plate arthroplasty` |
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etiol of mp flxn in dupuytren.s
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pretendinous cord
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first carpal bone to ossify
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capitate
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most common cause of pip contracture in dupuytren's
|
central cord
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lobster claw hand - inheritence
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autosomal domninent
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dorsal dislocation mp joint
reduction technique |
wrist flexion and pressure on proximal phalynx (not distraction)
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structures blocking reduction of mp dislocation
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lumbrical, fdp, volar plate
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giant cell tumor of bone
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vascular
multinucleated giant cells |
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test for radial tunnel syndrome
|
selective local anesthetic
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most common nerve palsy in brachial touniquet
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radial
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timing of tendon transfer in radial palsy
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no return in 6 months
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volkman's (mild)
most com. nerve involved most com. muscle |
median
fdp and fpl |
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radial forearm flap - bone
|
10 -12 cm
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brachial plexus birth injury
prognosis based on time to recovery of deltoid and biceps function |
2 months = complete recovery
6 months = no recovery |
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posterior interosseous flap
what muscle taken when incorporating bone |
epl
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lateral arm flap
sensory nerve |
posterior brachial cutaneous nerve
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lateral arm flap
bone length |
10 cm
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lateral arm flap
artery |
posterior radial collateral
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spastic cerebral palsy, clenched fist with poor sensability and palm masseration (2pd 10mm)
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transfer fds to fdp
lengthens the flexors |
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stab wound injuring ant tib artery,
most likely area aneathesia |
first webspace
deep peroneal nerve |
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innervation dorsum of foot
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superficial peroneal nerve
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innervation lateral foot
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sural nerve
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innervation medial foot
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saphneous nerve
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HFl burn
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copious irrigation water or saline
topical or injected Calcium Gluconate |
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mid palmar space
|
bounded
flx tendons, metacarpals,interosseous fascia, septum from 3rd mc to fdp sheath and hypothenar em. |
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volar dislocation of middle phalynx
what structure is interposed in the joint |
extensor tendon
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artery for toe to hand transfer
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1st dorsal metatarsal artery from the dorsalis pedis
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SLAC wrist
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scapholunate advanced collapse
Rx = four corner arthrodesis |
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most common organism in hand infection
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staph aureus
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lumbrical plus deformity
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paradoxal extension of the pip joint on attempted flexion
(occurs with dip amputations and with excessively long tendon grafts) |
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camptodactytly
loss of flexion less that 30 degrees |
observation
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kanavel's signs
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fusiform swelling
flex posture pain on passive extension pain over the digital theca |
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devascularized long finger following repalntation
best functional result |
ray amputation
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Rx for venous congested reverse radial forearm flap
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anastomsis of outflow vein
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most important factor in success of replantation
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mechanism of injury
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split nail deformity
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full thickness nail grafting from the toe
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dorsal dislocation of the mp joint
structure preventing reduction |
lumbrical
volar plate flexor digitorum profundus |
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posterior interosseous flap with vascularized bone
which muscle supplies the bone |
EPL
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incomplete simple syndactyly
age of repair |
12 - 18 months
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pincer or trumpet nail deformity
Rx |
lateral elevation of nail and dermal grafting
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dupuytren's diathesis
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knuckle pads
plantar fascial nodules peyronie's more agressive, earlier onset, more often bilateral and more often radial |
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compartment syndrome (hand intrinsics)
Rx |
two dorsal incisions over the index and ring m/c
hypothenar and thenar cone decompression from mid axial incicions no palmar incisions |
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electrical burn of hand and forearm
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requires fasciotomy
(not escarotomy alone) |
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congenital constricting bands of extremities
Rx |
excision of the bands and z-plasty
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painful nail plate and sensativity to cold
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glomus tumor
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radial palsy
tendon transfer |
p.t. - ecrb
fcu - edc pl - epl |
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painful ulcerations, calcium deposits in soft tissue,
ischemia, flexion contractures, ip joint erosion, entrapment neuroapathy |
scleroderma
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crest syndrome
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calcinosis
reynaud's esophageal envolvemsnt sclerodactyly telangiectasia |
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pain in hand with activity,
paresthesia involving palm " " radial digits |
pronator syndrome
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dorsal dislocation pip joint
Rx |
irreducible = fdp or volar
plate open rx = partial division of A3 pulley |
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burn hand
pip joint active flexion lag with mp flexion intact |
read question carefully
if the question reads "burn hand" and not fingers then rx = tendon release central slip |
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traumatic amputation of all fingers
order of repair |
structure by structure beginning with bone
(not finger by finger) |
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inablity to flex the dip joint of index finger with normal sensability
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anterior interosseous syndrome
(pronator syndrome = sensability changes) |
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digit migration
at which level |
metacarpal base
(more cancellous bone for union) |
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ray amputation of the index finger
|
20% loss of key pinch and
power grip 50% loss of suppiantion and pronation strength better cosmesis |
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disi
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dorsal intercalated segment instability
rx = operative repair (early) |
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fracture scaphoid with displacement
rx |
orif (herbert scew or compression screw)
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circumflex scapular artery
triangular space |
long head triceps
teres major teres minor |
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nondisplaced scaphoid fracture
thumb spica for ____ weeks |
10 - 14
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inability to flex the pip joint following dip amputation
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lumbrical plus deformity
rx = release of the lumbrical |
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rheumatoid arthritis
flexor tendon most likely to rupture |
fpl
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pain and crepitus 4 cm proximal to dorsal wrist crease after strenous activity
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intersection syndrome
(between 1st and 2nd cmpt) |
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intersection syndrome
RX |
injection cortisone and splint
surgery = release 2nd dor cmpt + synovectomy when conservative rx fails |
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12 cm tibia defect
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contra lateral free fibular flap
(20 cm available) |
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sudden loss of flexion 5 weeks after repair
Rx |
explore and repeat repair
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thumb volar pad amputation
2x2 cm |
moberg vlap
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most sensative of kanavel's signs
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passive extension
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venous congestion of replant
immediate Rx |
remove dressings
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pan-trapezial arthritis
failing medical rx |
trapeziectomy and tendon interposition
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delayed infection of tibial fracture
initial rx |
debride bone
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congenital trigger thumb
Rx age dx resolution |
rx = tenovaginotomy A1
age = usually not recognized till 6 mo. 30% resolve by age 3 |
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first dorsal metacarpal flap
artery location |
1st dor met art located within fascia of 1st dorsal interosseous
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game keeper's thumb
structure interposing between ulnar collateral ligament and proximal phalynx |
adductor pollicus
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effort induced carpal tunnel syndrome
etiology |
lumbrical
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fanconi syndrome
|
radial club hand
autosomal dom thumb hypoplasia |
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VATER syndrome
|
v = vertebral anom
a = anal anom t = trach anom e = esoph anom r = renal anom |
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dupuytren's contracture
pip joint |
natatory ligament = NOT involved
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thumb-in-palm deformity
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spasticity adductor, fpl
skin contracture dec mobility mp joint NOT flaccidity ext mech. |
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finger tip amp with tendon exposed
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flap
thenar vs cross finger (inj may preclude one) |
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fixed flxn deformity at ip joint thumb in 4 y.o.
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dongenital trigger
release A1 |
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absolute contranindication to replantation
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life threatening condition
all others are relative contrindications |
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complete ring finger avulsion
rx |
complete amputation
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contrast extravasation associated with compartment syndrome
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volumes greated than 100 cc
(dx - pain on extension confirm with compartment pressures) |
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football tackle with immediate loss of dip flsx
zone of injury |
zone I
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surgical release of pip with resultant finger tip necrosis
cause |
stretching of dig arteries
(answer to the question but not in real life, would not happen with intact dorsal skin) |
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dupuytren's
rx with collagenase |
relieves mp contracture
not pip contracture |
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tibial defects
|
prox 1/3 = gastrocnemius
mid 1/3 = soleus |
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herpetic whitlow
rx |
dry dressings
(said that topical acyclovir is of limited benefit, don't know why they don't mention systemic acyclovir) |
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dupuytren's spiral cord = spiral band +
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grason's ligament
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terminal branch of posterior interosseous nerve
passes beneath |
epl
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thumb defect 2x3 cm
|
kite flap
(moberg limited to 1.5 cm) |
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type IIIb hypoplastic thumb
rx |
ablation and index migration
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wassel type IV
muscle transfer |
ablation of radial digit requires transfer of APB
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C5 tetraplegia
most imp muscle reconstructive function |
elbow extension
(ability of patient to transfer) |
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a-v malformation
rx |
when excising do so widely
"local" excision = high recurrence |
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nonsmoker with ulnar digit ischemia
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ulnar hammer syndrome
(buerger's(thromoangiitis obliterans) usually in smokers) |
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ulnar nerve elbow
structure causing compression |
osborne's ligament
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infection index finger drains to which space
|
thenar space
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painful digit ischemia (reynaud's or scleroderma) failed medical rx =
|
conservative ammputation
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most definative test of osteomylitis
|
bone biopsy and culture
|
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ulnar collat lig instability mp thumb
structure interposing between lig and insertion |
adductor pol
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crush injury arm with pain on passive finger extension
|
fasciotomy
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tibial defect - 9 cm
rx |
free fibular flap
(6 cm or less usually traditional bone graft) |
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advantage of wrist disarticulation vs forearm amp.
|
preserve pronation/suppination
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stellate laceration sterile matrix
rx |
repair matrix and replace nail plate
(test answer - not in my patients) |
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arthrodesis angles pip joints
|
index = 40
long = 45 ring = 50 small = 55 |
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arthrodesis angles mp joints
|
thumb= 15
index = 25 long = 30 ring = 35 small = 40 |
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medial antebrachial cutaneous nerve graft
located next to |
basilic vein
|
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compartment syndrome hand intrinsics
minimum # incisions |
4
thenar, hypothenar, two dorsal |
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if replanting complete ring avulsion
best chance for success |
use ulnar dig a. from long finger
|
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ray amp ring finger
structure to suture to close the gap |
deep intermetacarpal ligament
|
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limited pronation/suppination wrist in rheumatoid arthritis
rx |
Darrach
(ulnar head resection) |
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neonate complete absence thumb
|
assoc with hematopoetic disorders
+spinal,cardiovasc,renal,gi,trisomy18,apert, carpenter |
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basilar thumb joint arthritis
|
not assoc. with rupture epl
|
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extremity amputation and nerve repairs
|
when possibel shorten the extremity to perform primary nerve repair
|
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flexor tendon repair strength related to
|
number of strands crossing the repair
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six strand flx t. repair
post op management |
best = early active motion
(test answer) |
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ulnar nerve at wrist
motor fasicle located |
ulnar and dorsal
|
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3 y.o. with finger tip amp.
best rx |
replant the amp segment as composite graft
(when available) |
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mallet finger with >30% joint surface
rx |
closed reduction with k wire
orif also acceptable |
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limited flexion of adjacent digits post advancement repair of profundus tendon
|
quadragia effect
|
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TAM (total active motion) of digits =
|
total flexion - extension lag
|
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glomus tumor
rx |
simple excsion
|
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congenital band amputation of all fingers
rx |
toe transfer
|
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moberg flap
contains |
both digital arteries
both digital nerves |
|
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following amputation of distal phalynx
paradoxical extension of pip joint on attemnpted flexion |
lumbrical plus deformity
|
|
|
exposed dialysis gortex in antecubital fossa
best flap artery |
radial recurrent
(brachioradialis flap) |
|
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arm amputaion at humerus level
1st rx |
arterial shunting
(answer for major limb amputations, otherwise bone fixation is first) |
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dupuytren's nodule
rx |
observation
|
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|
delta phalynx
also called |
longitudinally bracketed epiphysis
|
|
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severe pain, swelling, and discoloration 1 month post minor injury to hand =
|
reflex sympathetic dystrophy
|
|
|
most effective method of clearing bone adherent bacteria in open wound
|
surgical soap
|
|
|
pain over mobile wad and pain with resisted long finger extension and suppination =
|
radial tunnel syndrome
|
|
|
pacinian corpuscles
|
vibration
|
|
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syndactyly
associated with what other anomalies |
usually none
(usually an isolated finding) |
|
|
acute closed boutonnier deformity
how long delay and still splint |
10-21 days
|
|
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pronator syndrome
sensability change |
fingers + palm
|
|
|
delta phalynx
deformity? |
clinodactyly
|
|
|
Volkman's contracture
most common finding |
fibrosis of flexor muscles
|
|
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moberg flap
|
1-1.5 cm
|
|
|
healing wound foot
pressures and O2 levels |
ankle and great toe pressure
>40mmHg transcutaneous O2 > 30 torr |
|
|
trans-scaphoid perilunate dislocation
Rx |
carpal tunnel release
relocate lunate repair volar raciocarpal lig. |
|
|
sensation return post graft or flap
|
ftsg > stsg
|
|
|
rice bodies in tenosynovitis
|
acid fast organism
|
|
|
finger tip amputation with volar to dorsal angulation
Rx |
atasoy klinert flap
(test answer) |
|
|
dupuytren's contracture
indication for surgery |
mp =/>30 degrees
pip any contracture (15 deg.) |
|
|
volar wrist ganglion
Rx |
excision = lowest recurrence rate
|
|
|
touniquet time > 2 hours
|
release for 20 minutes then re-inflate (5min / 30 min of
inflation) |
|
|
dorsal finger injury with loss of epitenon
Rx |
flap coverage - reverse radial forearm
(test answer) |
|
|
exposed nerve
Rx |
flap cover
|
|
|
normal scapholunate angle
|
30-60 degrees
|
|
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ulnar hammer syndrome
Rx |
resection and vein graft
|
|
|
holt-oram syndrome
|
cardiac plus upper extremity syndrome anomalies
|
|
|
chronic schapholunate dissoc. with pain and radioschaphoid arthritis
Rx |
prox. row carpectomy
|
|
|
trapeziectomy
implant vs tendon interposition |
no diff in pain relief
do diff in post op strength |
|
|
valium and pregency
|
risk to the fetus exists
|
|
|
compartment syndrome in the hand
|
pain on passive adduction and abduction of fingers
|
|
|
absent epl function
Rx |
ext ind proprius transfer
|
|
|
1:1000 of 1% providone-iodine
|
non toxic and effective antimicrobial
|
|
|
amputation and warm ischemia
|
with muscle < 8 hrs.
without muscle 10 - 12 hrs. |
|
|
comminuted frx pip joint
acute Rx |
dynamic traction
|
|
|
traumatic nail plate deformity
Rx |
sterile matrix graft
(test answer) |
|
|
electrical burn upper extremity
Rx |
fasciotomy
|
|
|
rsd (crps - complex regional pain syndrome)
Dx test |
three phase bone scan
(diffuse periarticular activity) |
|
|
palmar numbness and carpal tunnel syndrome
|
no correlation
(palmar sensory cutaneous nerve enters the palm before the carpal tunnel) |
|
|
which flexor tendo zone laceration has the best prognosis
|
Zone 5
|
|
|
thumb mp joint ulnar collateral ligament fracture
Rx |
orif
|
|
|
thumb mp joint ulnar collateral ligament fracture
what structure interposes between the fragments |
adductor apponeurosis
|
|
|
thumb mp joint ulnar collateral ligament fracture
indications for repair |
30 degrees of radial deviation instability
|
|
|
rheumatoid arthritis in all upper extremity joints
sequence of repair |
proximal to distal
elbow-wrist-mp joints |
|
|
rapid onset of psoriatic arthritis or reiter's syndrome
|
hiv
nail pitting, pain, stiffness,and swelling joints |
|
|
subungual melanoma with mri suggesting possible extension along nv pedicle
Rx |
interphalyngeal amputation
(ignore mri with initial rx) |
|
|
fixed pip joint contracture
rx |
they want capsulectomy
(does not work, continue p.t. for a long, long, long time) |
|
|
diabetic foot amputations
ankle-brachial indices for wound healing |
0.70 or greater is acceptable for expected wound healing
|
|
|
congenital band syndrome with normal thumb and absent fingers
Rx |
toe to hand transfer
|
|
|
widened scapholunate joint space =
|
scapholunate dissociation pattern or disi (dorsal intercolated segment instability)
|
|
|
irreducible volar pip dislocation
Rx |
open
repair of lateral band and central slip of the extensor mechanism |
|
|
absent (weak) extension of fingers and thumb with sensory deficiet =
|
posterior interosseous syndrome
|
|
|
pip joint contracture without trauma
|
camptodactyly
|
|
|
ischemic fingers
Dx Rx |
arteriogram
if occluded radial or ulnar artery = bypass |
|
|
total absence of radius
Rx |
centralization of the ulna
(dx = radial club hand) |
|
|
oblique fracture with comminution proximal phalynx thumb
type of fixation |
lag screw and plate
|
|
|
the most important prerequisite for success of tendon transfers
|
full supple passive motion of the joints
|
|
|
nail bed (sterile matrix) injuries
Rx |
test answer = remove nail plate and repair
(not my answer) |
|
|
exposed achilles tendon repair
(soft tissue loss) Rx |
free flap
|
|
|
circumferential burn of extremity with vascular compromise
Rx |
escarotomies
|
|
|
test for intrinsic tightness
(bunnell test) |
extend mp joint and have patient attempt flexion of pip joint
|
|
|
moberg procedure for tetraplegia
|
thumb for adduction
tenodesis fpl to radius (plus release of annular ligaments) tenodesis epl to radius arthrodesis ip joint |
|
|
% of people with a palmaris longus
|
71 - 85%
|
|
|
brachial-ankle index indicating ischemia
|
0.7 or less
(look out for this because would need bypass before ftt) |
|
|
wassel type VII deformity
|
radial member of duplicated thumb is triphalyngeal
|
|
|
wassel deformities
Rx |
for the test almost always will be presented with an ulnar dominent duplicate
the radial member is removed and the radial side of the remaining member is reconstructed (collateral lig., abductor tendon etc.) |
|
|
distal phalynx mass with nail grooving
Dx |
mucous cyst
(nail grooving resolves with removal of cyst) |
|
|
SLAC wrist
Rx |
Scapho Lunate Advanced Collapse
schaphoidectomy plus "four corner" arthrodesis |
|
|
tendon transfers
if you do not recognize the choices |
look at what will be "given up" with each transfer and eliminate the ones that would be inappropriate sacrifices
|
|
|
ring avulsions
|
incomplete should attempt salvage
complete = amputation (poss. attempt in the very young) |
|
|
most appropriate nerve graft for digital nerve
|
test answer = posterior interosseous
(some would use the sural) |
|
|
pain on resisted suppination
Dx |
radial tunnel syndrome
|
|
|
chronic paranechia
first step = |
biopsy
"close association between chronic paranehia and scc) |
|
|
exposed tendon or joint
Rx |
flap cover (if large ftt. this is better than thick)
|
|
|
pain relief in severe rheumatoid arthritis wrist
|
arthrodesis
|
|
|
white phosphorus burns
|
Rx = water lavage
copper sulfate used to identify areas of residual phosphorus |
|
|
phenol burns
|
topical glycerol, propyleneor polyethylene glycol
|
|
|
smooth walled lytic lesion in phylanx
|
enchondroma
|
|
|
most common cause of pathologic fractures age 10 - 30 yrs
|
enchondroma
|
|
|
reynaud's - which is more effective
cervical sympathectomy or periarterial sympathectomy |
periarterial sympathectomy
|
|
|
one of the relative "contraindications" to replantation
|
single digit proximal to fds insertion
|
|
|
radial aplasia or hypoplasia
need to evaluate for |
bleeding
is associated with several syndromes TAR (thrombocutopenia-absent radius) and Fanconi anemia |
|
|
dupuytren's
most common complication of surgery |
recurrence of cord
(reported as 20-25%) |
|
|
profundus distal phalynx fracture avulsion
Rx |
orif
|
|
|
avulsion of sterile matrix
Rx |
great toe sterile matrix graft
(test answer) |
|
|
post burn exposed tendons with no flap donor sites available
Rx |
Integra
(i would stsg) |
|
|
tourniquet inflation pressure
|
75 - 100 mmhg above systolic pressure
|
|
|
recommended repurfusion time with brachial tourniquet
|
5 minutes/30 minutes of tourniquet time
|
|
|
most important factor in the successful outcome for trapeziectomy and interposition arthroplasty
|
post op splinting (4-6 wks)
|
|
|
renal transplant and digit tenosynovitis
risk |
amputation
(75-100%) |
|
|
condylar fracture proximal phalynx
stability? |
inherently unstable
requires orif |
|
|
post op ischemia of digit blocked with lidocaine and epinephrine
Rx |
Phentolamine
reverses eipnephrine indused aterial spasm in avg 1 hour 25 minutes |
|
|
last function to return post ulnar nerve repair at elbow
|
adduction thumb
last muscle innervated |
|
|
pip fusion results in what effect to the hand
|
quadriga effect
|
|
|
pip joint dislocation
pip joint dislocation with bone fragment Rx |
same - dorsal (extension) blocking splint
|
|
|
finger tip ulceration in scleroderma
Rx |
local wound care
conservative debreidment of bone when exposed |
|
|
tibial bone defect requiring free fibular transfer
|
6-8 cm or greater
|
|
|
best test for muscle damage post electrical burn
|
mri
|
|
|
pantrapezial arthritis
Rx |
splint and cortisone injection (initially)
|
|
|
most appropriate graft for syndactyly release
|
ftsg (grows with the child)
|
|
|
moberg flap thumb defect
size? |
1.5cm
|
|
|
radial and ulnar bursas are connected through
|
Parona's space
|
|
|
hand weakness and normal sensability
|
canal of Guyon (ulnar nerve)
|
|
|
radial bone harvest site in radial forearm flap
|
radial aspect between brachioradialisis and pronator teres
|
|
|
finger tip sensativity to cold
|
glomus tumor
|
|
|
replantation of digit
cold ischemia warm ischemia |
reports of 54 hour of cold and 42 hours of warm ischemia
|
|
|
best predictor of outcome for surgery in cerebral palsy
|
level of voluntary control
|
|
|
dupuytren's
origin of following cords pretendinous cord lateral cord natatory cord |
predendinous band
lateral digital sheath natatory band |
|
|
dupuytren's
spiral cord |
pretendenous band
spiral band lateral digital sheath grayson's ligament |
|
|
dupuytren's
what ligaments are not affected by dupuytren's |
cleland's
landsmeer's deep transverse ligament |
|
|
dupuytren's
what causes mp contracture |
pretendinous cord
|
|
|
dupuytren's
what causes pip contracture |
spiral cord,
lateral cord central cord |
|
|
dupuytren's
what causes adduction contracture |
natatory cord
|
|
|
dupuytren's
what causes neurovascular displacement |
spiral cord
|
|
|
myofibroblasts are found in
cord nodule |
cord = no
nodule = yes |
|
|
dupuytren's
is the dip joint involved |
uncommonly
|
|
|
dupuytren's diathesis
def: |
aggressive form of dupuytren's
assoc with palmar, plantar nodules and peronies (ventral penile nodule) |
|
|
which of below are associated with dupuytren's
diabetes anti-convulsive therapy alcoholism HIV infection tobacco consumption |
all
|
|
|
dupuytren's
Luck's classification |
1.proliferative
2.involutional 3.residual |
|
|
dupuytren's
what causes contracture |
myofibroblasts in the nodules
|
|
|
dupuytren's
"suggested etiology" |
local ischemia and free radical production
|
|
|
dupuytren's
indication for surgery |
mp 30 degrees
pip 15 degrees (any contracture) |
|
|
Amnionic band and heredity
|
none
|
|
|
fixed flexion of fingers post compartment syndrome with normal joints
Rx |
tendon lengthening
|
|
|
free muscle transfer and volkman's contracture
|
reserved for severe cases,
needs nerve grafting |
|
|
muscle slide and volkman's
|
reserved for mild cases
|
|
|
Rx cat bite
|
Amoxicillin and clavulanate
|
|
|
advantage of joint repalcement to jont fusion (wrist)
|
mobility
|
|
|
advantage of fusion to joint replacement wrist
|
strength and stability
|
|
|
talepes equinovaris
Rx when skin deficeit is anticipated |
tissur expander
(club foot) |
|
|
dorsal dislocation of pip joint without major fracture fragment (<20%)
|
dorsal blocking splint
|
|
|
volar thumb defect with tendon exposure = soft tissue cover
|
flag flap (1st dorsal metacarpal artery flap)
|
|
|
tarsal tunnel syndrome
what nerve |
medial plantar nerve (innervates flex dig brevis)
|
|
|
amnionic bands
assoc cause = |
oligohydramnious
|
|
|
Rx of ulnar hammer syndrome
|
resection of thrombus containing artery
(most would then reconstruct the artery) |
|
|
avulasion of heel
innervated flap reconstruction |
mendial plantar flap
medial plantar a. & medial plantar n. |
|
|
Rx trigger finger in rheumatoid arthritis
|
synovectomy +/- slip of superficialis tendon
|
|
|
test answer for vascualar evaluation of lower extremity in patient with renal insufficiency
|
color-flow doppler
(most would say mra) |
|
|
effectiveness of diuretics in unilateral extremity lymphedema
|
none
|
|
|
which artery does the reverse sural flap receive its major contrib.
|
peroneal
|
|
|
in dorsal perilunate dislocations what ligament is most likely to be intact
|
radiolunate
|
|
|
instability of mp joint with radial pressure = what injury
|
raidal collateral ligament
|
|
|
artery supply for
free fibula soleus |
peroneal
poplilteal |
|
|
with proximal arm ulnar injury
surgery that is most likely to return intrinsic function |
nerve transfer of distal anterior interosseous to motor ulnar at wrist
|
|
|
relation of anemia to wound healing
|
none, even severe
(as long as normal circulation is maintained) |
|
|
single digit replantation in zone II
|
yes in children, no in adults
|
|
|
sudden loss of extensor function in rheumatoid arth. with normal tenodesis effect
|
posterior interosseous syndrome
|
|
|
anterior lateral thigh flap = portion of which muscle
|
vastus lateralis
|
|
|
best test to dtm site of viability for frostbite
|
tech-99 bone scan
|
|
|
temp of water for rewarming of frostbite
|
40 - 42 deg celcius
|
|
|
`high pressure injection of finger
Rx? |
debriedement
|
|
|
recurrence post surretage of enchondroma
|
10%
(never saw a recurrence) |
|
|
organism causing crepitus
|
strep pyogenes
clostridia |
|
|
return sensate skin to finger volar pad
|
toe pulp free flap
|
|
|
staged excision of skin and sq tissue in lower extremity lymphedema
|
some do it ?????
|
|
|
Rx necess to be avail for Rx of malig hyperthermia
|
dantrolene
|
|
|
Rx of chronic post traumatic finger nail deformity
|
split thickness gft from great toe steril matrix
(good luck) |
|
|
most limiting factor in replantation
|
mechanism of injury
(avulsion = worst) |
|
|
brachial plexopathy in newborn
delay before surgery |
6 months
|
|
|
nerve for
plantar flexion plantar sensation |
tibial
|
|
|
initial step in eval of suspected malignant mass hand
|
incisional bx (though inc.that can easily be incorporated into final resection)
|
|
|
simple syndactyly = what type of anomaly
|
failur of differentiation
|
|
|
complete simple syndactyly of all digits
release 1st ? |
border digits first
|
|
|
fracture proximal fibula inability to dorsiflex and evert = ?
|
deep peroneal
|
|
|
can one charge for internal neurolysis of median nerve in addition to carpal tunnel release
|
yes (with opreating room microscope)
|
|
|
toe pressure of what = ischemia
|
<30mm Hg
|
|
|
most common carpal fracture
|
schaphoid
|
|
|
second most common carpal fracture
|
triquetrium
|
|
|
rapid progressive contracture of fingers with development of knuckle pads
|
dupuytren's diathesis
|
|
|
most signif. finding indicating lower ext. amp.
|
absent plantar sens
posterior tibial nerve |
|
|
single gunshot wound to upper arm with radial pulsy
Rx |
observation, no recovery in 6 months = exploration
|
|
|
local nerve ischemis prevents what nerve function
|
membrane depolarization
|
|
|
portion of what muscle is harvested with free fib. flap
|
flex hallicus longus
|
|
|
cause of delayed enfection post osteocutaneous flap closure of chronic osteomylitis wound
|
failure of adequate debriedment
|
|
|
significant dupuytren's contracture of mp and pip joint - long term results of surgery
|
mp = good
pip = poor |
|
|
appropriate rx for transplant patient with skin lesion
|
Bx
|
|
|
1 cm digital nerve gap
Rx |
polyglycolic acid conduit
(supposedly better than nerve grafts) |
|
|
flap to cover infected fem distal artery prosthetic bypass when profunda is occluded
|
satorius
|
|
|
laxity in MP joint thumb suggesting complet collateral lig injury
|
30 degrees (or 15 deg. greater than the contrtalateral side)
indcates ORIF |
|
|
mycobacterium marinum
Rx |
Rifampin
|
|
|
Rx of brachydactyly
|
distraction of ulnar digits
(test answer - more complex than that) |
|
|
closure of exposed FPL thumb
|
flag flap (first dorsal metacarpal artery flap)
|
|
|
closed reduction of bennet's fracture requires traction, dorsal pressure on dorsum of thumb base and ?
|
palmar abduction and pronation of thumb
|
|
|
Sunderland classification of nerve injury
|
I neuropraxia
II axonotomesis complete V neurotomesis |
|
|
rheumatoid tendon rupture
most appropriate repair |
tendon transfer
|
|
|
mycobacterium marinum culture characteristics
|
very difficult to grow, take a long time, require specific temperatures
|
|
|
primary benefit of silastic replacement arthroplasty
|
pain relief
|
|
|
tourniquet itmes > 120 minutes
|
deflate and reinflate
|
|
|
dorsal dislocation mp thumb
Rx |
closed reduction
|
|
|
thumb reconstruction with amputation at mp joint
|
toe transfer
suggested ipsilateral great toe |
|
|
multiple digit amputation with thumb not replantalble
|
move a finger to thumb
|
|
|
macrodacytly
Rx |
epiphysiodesis and debulking
only works for those with single epiphysis |
|
|
axillary block with tournequet pain = failure to block which nerve
|
musculcutaneous
|
|
|
thumb in palm syndrome
|
(cerebral palsy) ischemic contracture adductor therefore release of adduvtor is Rx
|
|
|
Rx of Pincer nail deformit
|
elevate and graft beneath the sterile matri
transverse curve to nail |
|
|
fusion of pip joint results in
|
quadregia effect (if fdp is intact)
|
|
|
fracture of long bone that does not involve the epiphysis
|
extra -octave fracture
(who cares) |
|
|
Rx of pip joint contractures and ulcers in scleroderma (systemic sclerosis)
|
arthrodesis of joints in slight flexion
|
|
|
basal thumb joint arthritis results in what intial structural weakness
|
volar beak ligament
|
|
|
weakness to dorsiflexion of foot and numbness to lateral leg post knee dislocation = injury
|
common peroneal nerve
|
|
|
wound defect on extremity post fasciectomy
Rx |
STSG
(extremity is swollen gft contracture will help) |
|
|
child with severe hand anomaly who uses the hand normally
surgery ? |
none
boy is this a dumb question |
|
|
adipofascial turndown flap
|
some sort of a small dorsal finger flap that can be turned down to cover tendons. then should be skin grafted. never saw one
|
