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Ortho > chapter 33 - injuries of the hand > Flashcards

chapter 33 - injuries of the hand Flashcards

1
Q

what is a subungual haematoma

A

haematoma under the nail

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2
Q

what causes a subungual haematoma

A

crushing of the terminal phalanx

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3
Q

how do you treat a subungual haematoma

A

Heat a needle in a flame until the tip is red hot and then perforate the nail in one or two places - this allows the haematoma to drain and the tension is relieved

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4
Q

what is a mallet finger? ie what is injured

A

disruption of the long extensor insertion to the base of the terminal phalanx, with or without a small fragment of bone

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5
Q

when does a mallet finger occur? example?

A

occurs when an outstretched finger is suddenly and forcibly flexed - eg: cricket ball strikes finger

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6
Q

how does a mallet finger present clinically? which 3 fingers does it usually affect?

A

the patient cannot extend the terminal phalanx - commonly middle, ring and little fingers

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7
Q

with a mallet finger, what would you find on xray?

A

a flexion deformity of the terminal phalanx or the small detached fragment of bone may be seen

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8
Q

how do you treat a mallet finger? and for how long?

A
  1. a mallet finger splint to keep the terminal joint extended and allowing the proximal joints to be free to move - strapped in place for 6-8 weeks
  2. open cases - surgical repair
  3. Work men: if a splint cannot be used then a Kirschner wire is used in situ to keep the terminal joint extended - left in for 6 weeks
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9
Q

what is another name for the dis insertion of the flexor digitorum profundus FDP ( sport related)

A

rugby jersey injury

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10
Q

how does the FDP avulsion occur?

A

the finger is forcibly extended while tightly gripping the jersey - such as in a tackle situation

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11
Q

which finger is commonly affected in a FDP avulsion

A

the ring finger

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12
Q

how do you treat an FDP avulsion considering the time frame

A

< 96 hours: operative re attachment of avulsed tendon

> 96 hours: no treatment or athrodesis of DIP joint

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13
Q

what is a boutonniere injury?

A

disinsertion of the central slip of the extensor tendon from the base of the middle phalanx

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14
Q

when should you suspect a boutonniere injury

A

after an injury when there is swelling and a flexion deformity of the PIP joint

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15
Q

how does a boutonniere injury present clinically?

A

flexed PIPJ and extended DIPJ

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16
Q

what is the button hole effect?

A

it occurs when the lateral bands of the extensor tendon slip volarly and cause a true boutinniere deformity

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17
Q

what is the early and late treatment for a boutonniere injury

A

early: splint for 4 weeks with PIP fully extended and DIP joint free
late: difficult treatment, results of surgery unpredictable and disability is often the outcome

18
Q

how does the base of the phalanx usually dislocate

A

base of the phalanx dislocated dorsally

19
Q

how do you treat a dislocation

A
  1. reduce under general or local anaesthesia and then splint to allow the torn capsule and collateral ligaments to heal
20
Q

what do you do if you cannot reduce the dislocation?

A

open reduction is performed DO NOT continue to violently try and reduce it

21
Q

what could cause an obstruction in a dislocation

A

capsule
volar plate
interposition of flexor tendon

22
Q

what do you call an acute tear of the ulnar collateral ligament of the thumb?

A

skiers thumb

23
Q

what is a game keepers thumb

A

chronic form of ligament laxity of the ulnar collateral ligament of the thumb

24
Q

what happens with chronic stress on the ulnar collateral ligament?

A

the pt cannot apply a pinch or key grip

25
Q

name two situations in which an extensor pollicis lngus tendon may rupture

A

rheumatoid disease

late complication of colles fracture

26
Q

how does an extensor pollicus longus tendon rupture present clinically?

A

pt cannot extend the IP joint of the thumb

reduced extension of MCP joint

27
Q

how do you treat an extensor pollicis longus tendon rupture?

A

tendon transfer to replace the lost motor function

28
Q

how do you treat a crush injury to the finger tip in children and adults?

A

children: if bone is not exposed - apply a vaseline gauze dressing
adults: immediate split skin graft
workmen: nibble away bone + do primary flap repair = full or partial amputation of the tip of the terminal phalanx
if bone exposed: bone nibbled back and a split skin graft applied

29
Q

what happens to the skin in a crush injury with avulsion of the nail base?

A

the skin is split laterally and or medially from the nail fold

30
Q

how do you treat a crush injury with avulsion of the nail base?

A

place the nail back underneath the nail fold and keep it in position with a double right angled suture

31
Q

treatment of fracture of the terminal phalanx

A

focus on the soft tissue injury
grossly displaced fractures: kirschner wire can be used to maintain reduction, improve stability and hasten soft tissue healing
child: displacement is dorsal at the epiphyses and must be replaced, the nail seperates from the nail fold and needs to be stitched in place

32
Q

treatment of fractures of the middle and proximal phalanges

A

stable(85%): buddy strapping - finger strapped to adjacent finger and joints are left free
unstable(15%): reduction, fixation, immediate mobilisation

33
Q

how does a fractured proximal phalanx involving the epiphysis present?

A

little or index finger stands out at an angle

34
Q

treatment of a fractured proximal phalanx involving the epiphysis

A

reduce by closed manipulation, buddy strap, mobilise

35
Q

what is another name for a fractured metacarpal neck?and why?

A

boxers fracture - occurs when fist hits a hard object like a jaw

36
Q

which metacarpal is most commonly fractured in a boxers fracture?

A

5th MC neck

37
Q

treatment of boxers fracture?

A
  1. crepe bandage hand and wrist and may add buddy strapping, leave mcp joints free and focus on mobilisation
  2. if angulation excessive -closed reduction and percutaneous K wires inserted under x ray control
38
Q

fractured metacarpal shaft treatment

A
  1. crepe bandage and early mobilisation

2. if displaced and unstable need reduction and percutaneous k wire fixation

39
Q

what is a bennetts fracture?

A

fracture- dislocation at the base of the thumb metacarpal. the joint capsule is ruptured and the metacarpal base displaced laterally

40
Q

treatment of bennetts fracture

A

closed or open reduction
+ kirschner wires
+ POP cast for 6 weeks

Ortho (41 decks)

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