Digital Trauma

Question 1

Mechanisms of trauma is usually…?

Answer 1

Direct or Indirect

Caused by falling objects or stubbing

Question 2

Most frequent plane injured

Answer 2

Sagittal plane

Question 3

Sagittal plane

Answer 3

Direct
2nd hyper-extension or flexion
Comminuted type

Question 4

2nd most frequent plane injured

Answer 4

Transverse plane

Question 5

Transverse plane

Answer 5

Abduction/Adduction force

Transverse or short oblique fractures

Question 6

Least frequent plane injured

Answer 6

Frontal plane

Question 7

Frontal plane injuries

Answer 7

Associated with rotational, inversion, or eversion injuries

Question 8

Describe clinical presentation of digit fractures

Answer 8

Acute pain

Ecchymosis and edema w/in 2-3 hrs

Question 9

Fractures of proximal phalanges are typically…?

Answer 9

Oblique or comminuted

Question 10

What types of fractures occur in diseased bones?

Answer 10

Transverse pathological fractures

Question 11

For open injuries, do you address soft tissue or the fracture initially?

Answer 11

Soft tissue

Question 12

Explain the Golden Period

Answer 12

Period after the wound is inflicted during which primary intention healing is probable after suturing b/c the body’s defenses can take care of the infection that has been introduced.

Question 13

Golden period time

Answer 13

Less than 6 hours

Question 14

What do you need to rule out with sesamoid fractures?

Answer 14

Rule out bifurcate or bipartite sesamoid. Commonly a sagittal plane/crush injury

Question 15

Predisposing factors to sesamoid fractures

Answer 15

Cavus foot
Metatarsus primus equinus
Sports, flexion
High-heels

Question 16

Sesamoid fracture presentation

Answer 16

Pain is acute or chronic
Edema and ecchymosis
Pain w/ WB or DF

Question 17

If subungual is blackish, then would you assume it was an acute or older injury?

Answer 17

Older injury. The first 24-48 hours will be a bit more symptomatic

Question 18

Separation of nail plate. Posterior nail fold friction injury.

Answer 18

Primary onycholysis

Question 19

Primary onycholysis treatment

Answer 19

Removal of nail plate
Antisepsis
Antibiotics

Question 20

What must you check for with a subungual hematoma, and how should you treat this injury?

Answer 20

Check for fractures and treat as an open fracture

Question 21

Subungual hematoma treatment

Answer 21

X-rays

Remove nail plate if hematoma is greater than 25%

Question 22

Simple nail bed laceration treatment

Answer 22

Antibiotics
Tetanus
Surgical clean and irrigation
Align the root and nail bed
Nail plate may be reused if avulsed

Question 23

Complex nail bed laceration is similar to the simple with what added?

Answer 23

Proximal nail fold defect also

Question 24

Complex nail bed laceration treatment?

Answer 24

Same as simple with the addition of rotational flap

Question 25

Nail bed laceration with phalangeal fracture treatment

Answer 25

Same as complex laceration with reduction of subungual fractures, also removal of bone spicules and nail fragments

Question 26

Explain the 3 zone levels of tissue loss for the nail

Answer 26

1 - distal to phalanx
2 - distal to lunula
3 - proximal to lunula

Question 27

Zone 1 treatment

Answer 27

Granulation

STSG or FTSG

Question 28

Zone 2 treatment

Answer 28

Pedicle flaps

• Atasoy
• Kutler

Question 29

Zone 3 treatment

Answer 29

Primary amputation

Possible preservation of distal interphalangeal of interphalangeal joint