Exam 3 Hand Ortho Emergencies

Question 1

Metacarpal Fxrs found in what areas? (4)

Answer 1

1) Head
2) Neck
3) Shaft
4) Base

Question 2

Metacarpal Fxrs U caused by what motion?

Answer 2

Direct blow

Smashed

Question 3

Boxer’s Fxr is?

Caused by?

Answer 3

Fxr of 5th metacarpal

Punching

Question 4

Boxer’s Fxr presentation? (3)

Always assess for what?

Answer 4

Significant swelling
Point tender
ROM preserved

Human bite

Question 5

Boxer’s Fxr tx? (3)

Answer 5

If no angulation = ulnar-gutter splint, refer to ortho

If angulation > 35° = reduction

If a/w bite = vigorous wound care, ABX

Question 6

Bennett’s Fxr is?

Tx?

Answer 6

Fxr of thumb metacarpal base
Disrupts carpometacarpal joint at volar base

Reduction + internal fixation

Question 7

Gamekeeper’s Thumb is?

Mechanism of Injury?

Presentation?

Answer 7

Tear in ulnar collateral ligament (UCL) of the MCP joint of the thumb

Ski pole, MVA

Point tender @ base of thumb
UCL > 40° angle
Complete rupture = difficulty pinching

Question 8

Gamekeeper’s Thumb tx?

Answer 8

Thumb Spica splint

Hand Ortho

Question 9

PIP/DIP dislocations U involve?

Mechanism of Injury?

Tx?

Answer 9

Ligament rupture
P fxr

Hyperextension or lateral force

Splint
Hand Ortho

Question 10

Reduction of MCP/PIP/DIP in fingers 2-5?

Answer 10

Longitudinal traction
w/ Hyperext for dorsal dislocation
w/ Hyperflex for volar dislocation

Question 11

Tuft Fxr is?

Tx?

Answer 11

Crush injury to fingertip

Splint
Refer

Question 12

Subungual Hematoma result of?

Tx?

Answer 12

Crushed fingertip
(bleeding under nail)

Evac w/ 18g needle or electrocautery
Dress/splint

Question 13

Subtotal Amputation result of?

Tx?

Answer 13

Crushed fingertip

Clean/Irrigate/Refer
Laceration and Nail bed need repair
Tetanus, ABX, pain meds

Question 14

Complete tip amputation tx?

Answer 14

Tetanus
ABX
Pain meds

Question 15

Compartment Syndrome is?

Answer 15

↑ pressure w/i osteofascial compartment causes ↓ perfusion ->
causes necrosis, limb loss, renal fail

Question 16

Forearm compartments? (4)

Answer 16

1) Superficial volar (flexor)
2) Deep volar (flex digi profundus, flex pollicis long, pronator quad mm/tendons)
3) Dorsal (extensor)
4) Mobile wad of Henry (barchioradialis, ext carpi rad brev/long mm/tendons)

Question 17

Hand compartments? (10 total/5 categories)

Answer 17

1) Dorsal interossei x 4
2) Volar interossei x 3
3) Add pollicis
4) Thenar
5) Hypothenar

Question 18

Compartment Syndrome presentation? (6)

Answer 18

Pain OOP
Pain w/ passive stretch
Parasthesia
Paralysis
Pulselessness
Swollen, hard shiny skin

Question 19

Compartment Syndrome caused by?

Answer 19

Fxr
Crush
Injection
Infection
Drugs

Question 20

High Pressure Injection injury is?

Answer 20

High pressure device (paint/grease guns) inject substance into hand
Type of substance important

Question 21

High Pressure Injection injury presentation?

Tx?

Answer 21

Initial findings scant

URGENT referral to ortho
Hospitalize
Prompt decompress/debridement/irrigation
Long recovery