ASHT Hand Trauma

Question 1

what does artery compromise look like?

Answer 1

pale or white “dusky”, cold feeling, slow capillary refill

Question 2

what does vein compromise look like?

Answer 2

blue or purple in color, edema, rapid capillary refill

Question 3

what are steps of manual edema mobilization?

Answer 3

Use in healthy lymph system in fibroplastic stage (unlike MLD with unhealthy lymph system) Steps: diaphragmatic breathing, clear exercises (proximal AROM), light skin traction, massage axillary and elbow lymph nodes, “flow exercises” clear AROM

Question 4

4Ps of compartment syndrome

Answer 4

Pain Paresthesias Pallor Pulselessness

Question 5

What is normal vs. critical pressure of compartments?

Answer 5

Normal 8-10 mmHg, critical >30mmHg

Question 6

what is tensile strength of a wound?

Answer 6

Increases from day 5-30 By week 3 15-20%, healed wound 80%

Question 7

STSG

Answer 7

viable in 3-5 days, Low primary High secondary contracture

Question 8

FTSG

Answer 8

Viable in 5-7 days, High primary low secondary contracture

Question 9

Reasons for skin graft failure

Answer 9

Hematoma, infection, improper immobilization

Question 10

Local Flaps

Answer 10

tissue adjacent to wound repositioned to cover defect, blood supply from dermal layer

Question 11

Pedicle Flaps

Answer 11

skin and sensate tissue detached from donor site, reattached to recipient site, second surgery required to separate

Question 12

Free tissue transfer

Answer 12

1 surgical procedure: free groin flap, scapular flap, lateral arm flap, latissimus flap. used to cover large defects. nerves and muscles can also be harvested

Question 13

Moberg Advancement flap

Answer 13

nail intact, thumb tip, pulls IP into flexion. Basically just move skin distally.

Question 14

VY advancement flap

Answer 14

nail intact, for finger tip coverage, incision is a V but when stitched looks like a Y

Question 15

3 types of pedicle flaps

Answer 15

Thenar, Cross finger, Groin

Question 16

Common deformities post-burn

Answer 16

1. thumb webspace contracture (dorsal or thenar burn)
2. PIP joint flexion contracture (from central slip damage or dorsal hand burn)
3. Boutonniere deformity (central slip or prolonged PIP flexion posture)
4. Swan neck (EDC adherence or intrinsic tightness)
5. Claw hand
6. Burn syndactyly
7. Palmar cupping

Question 17

Types of prosthesis

Answer 17

1. no prosthesis
2. passive
3. body power
4. external power
5. hybrid
6. activity specific (sports, military)

Question 18

Types of CRPS: sympathetically independent Pain

Answer 18

occuring in the initial onset of syndrome, more amenable

Question 19

Types of CRPS: Sympathetically Maintained Pain

Answer 19

occurs after a period of time “a symptoms of CRPS but not a clinical entity”

Question 20

CRPS criteria

Answer 20

1. inciting noxious event or immobilization
2. continuing pain, allodynia, or hyperalgesia
3. edema, changes in blood flow, or abnormal sudomotor activity (vascular/sympathetic ie. sweating changes, asymmetry)
4. exclusing other condition which would cause symptoms

Question 21

Complex tendon/muscle reconstruction

Answer 21

with replant or if both systems lacerated. protect FLEXORS over EXTENSORS

Question 22

Types of Orthosis

Answer 22

1. Immobilization orthosis
2. Mobilization orthosis
   A. dynamic
   b. static progressive
   c. serial static

Question 23

Modified Weeks Test

Answer 23

After heat/preconditioning degrees of improvement vs. orthosis.
20=No orthosis
15=static
10=dynamic
0-5=static progressive

Question 24

11 essential hand functions

Answer 24

8 grasps:
1. cylindrical
2. power
3. spherical
4. hook
5. lateral
6. tripod
7. tip pinch
8. lateral pinch

3 Mobile essential functions:
1. rotation
2. shifting
3. translation

Question 25

who is appropriate for replantation?

Answer 25

1. thumb 2. multiple digits 3. metacarpal amputations 4. children 5. wrist or forearm level amputations 6. digit tips DISTAL to FDS insertion

Question 26

what is the rationale for Early Protective Motion ?

Answer 26

differential glide of tendons - joint movement to decrease stiffness, protect hand from composite motion which may disrupt repairs, give enough tendon gliding without tension to prevent adhesions. Balance between flexors and extensors for minimal tension on repairs, proportional ROM, tenodesis mostly wrist/MP. Indications: digital replant, stable fixation, clean injury

Question 27

Early Protective Motion Phases

Answer 27

1. 4-14 days post op controlled active tenodesis 2. 7-14 days post-op passive hook fist 3. 14 days post-op active hook fist place and hold>active, add active gliding, usolated FDS, strengthen lumbricals and interossei in intrinisc + position. 4-5 weeks post-op begin gradual wrist extension past neutral wtih digits flexed, 4-6 weeks post-op begin full composite flexion and extension. then add NMES, passive stretch, blocking light function