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Summer FDTN Exam 4 > Forearm > Flashcards

Forearm Flashcards

1
Q

Unstable forearm fractures include

A

Radial shaft Fx
Ulnar shaft Fx
Galiazzi (radial Fx, carpoulnar dislocation)
Monteggia (ulnar Fx, radial dislocation)

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2
Q

Stable forearm Fx is

A

Nightstick Fx (distal ulnar shaft Fx)

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3
Q

What is the MC distal radial injury

A

Colles Fracture 2/2 FOOSH

Distal radius fracture fragment tilts dorsally (distal part goes upwards)

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4
Q

Other distal radial Fx are

A

Smith’s: oppo of colles, distal radius fracture fragment tilts ventrally (fall on hand inwards)
Barton: Intraarticular Fx w/ carpal dislocation

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5
Q

What XR view is best for diagnosing colles vs smiths

A

Lateral! because you can see the way the bone is oriented

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6
Q

What is a radial torus buckle fracture

A

Fx of distal metaphysis causing buckling of cortex 2/2 compression failure
MC in kids <10
Can cause bone to lose structural integrity and predispose to easy fractures in the future

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7
Q

What is a greenstick Fx

A

complete Fx of tension side of cortex w/ buckling of compression side
AKA bending of the bone! tension side is the outer curve, compression side is the inner curve

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8
Q

How do you treat a Torus buckle fracture

A

Immobilize 4-6 wks until bone can heal

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9
Q

What are the carpal bones

A 
some lovers try positions that they cant handle; 
Scaphoid 
Lunate 
Triquetral
Pisiform 
Trapezium 
Trapezoid 
Capitate 
Hamate
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10
Q

What is the MC fractured carpal bone

A

Scaphoid!
MC 2/2 FOOSH in younger population
Limited blood supply leads to high incidence of nonunion and osteonecrosis

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11
Q

Clinical findings of scaphoid Fx are

A 
Snuffbox pain, ttp 
ROM limitations (limited extension and radial deviation
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12
Q

Why does scaphoid Fx result in limited blood supply

A

Radial artery passes through and provides blood supply (SF palmar branch), but is often damaged in the injury= no blood flow to the area

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13
Q

How do you manage Scaphoid Fx

A

Long arm thumb cast x 6-12 weeks

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14
Q

What imaging do you get with suspected scaphoid Fx

A

1: XR! but it takes 10-14 days for a Fx line to show, so if the 1st XR is negative but you highly suspect Fx, repeat in 10-14 days
2: If 2nd XR is negative for Fx but you still suspect it, get an MRI

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15
Q

What happens to different fractures of phalanges

A

Displaced transverse and oblique Fx: become angulated
Spiral Fx: tend to rotate (ex. you make a fist and the pinky rotates inwards)
Displaces, spiral, comminuted, intra-articular Fx: refer to specialist

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16
Q

Look at slide 31 and know how to associate Fx with it’s picture!

A

Do it

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17
Q

What is the MC Fx of the hand

A

Boxer’s Fx; distal metaphysis of 5th MC

Results from closed fist striking an object

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18
Q

How do you manage Boxer’s fracture

A
  • Ulnar gutter splint if <15 degrees angulated, to cover transverse, oblique, base, and head
  • Surg consult if >15 degrees angulated, intra-articular, comminuted, or spiral
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19
Q

What is DeQuervian’s tenosynovitis

A

Inflammation of the sheath around abductor pollicis longus and extensor pollicis brevis
Sheath thickens and constricts tendon

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20
Q

DeQuervian’s Tenosynovitis will show

A

pain in 1st dorsal extensor compartment (snuff box) worse w/ moving thumb and making a fist
Swelling
crepitus as pt flexes and extends thumb

21
Q

What is Finklestein’s test

A

pain with passive stretching of tendons used to test DeQuervian’s tenosynovitis
Tuck thumb into your fist, and ulnar deviate. this stretches the inflamed tendons over radial styloid causing pain

22
Q

How do you manage DeQuervian’s tenosynovitis

A

NSAIDs
Thumb spica splint
avoid offending activity
steroid injections

23
Q

Difference between DeQuervian’s and a scaphoid fracture

A

Usually, DeQuervian’s is non-traumatic while Scaphoid is traumatic

24
Q

What is Gamekeeper’s thumb

A

Ulnar collateral ligament sprain (1st MCP)
Caused by acute or chronic valgus stress
Will notice pain and swelling localized to ulnar (medial) aspect of thumb

25
Q

Assessing for stability of 1st MCP UCL tear by applying valgus stress can reveal

A

Mild sprain: pain but no laxity
Mod: pain and partial laxity
Complete: pain and significant lacity

26
Q

How do you treat Gamekeeper’s thumb

A

Mild-Mod: brace

Surgical consult if complete tear, or if avulsion Fx involving >25% of articular surface

27
Q

What is Mallet finger

A

Pain and inability to extend at DIP
MC due to trauma to tip of a fully extended finger
Rupture, avulsion, or laceration of extensor tendon at base of distal phalanx

28
Q

How do you treat mallet finger

A

(not emergent, can obs first) 6-8 week splint- must be continuous. If extension is lost at any point, must start over w/ the 6-8 weeks
If full extension is not achieved, consider surgical pinning

29
Q

You need a surgical consult with mallet finger is

A

Failed conservative care
Complete tendon laceration
Fx involves >30% of articular surface

30
Q

The surgical Tx for mallet finger is

A

You basically put a pin through the bone in the finger to keep it firm (Kind of like the penile implant) and then suture a button from the outside of the finger to the inner distal tip

31
Q

What are the tendons of each finger

A

FDP: flexor digitorum profundus
FDS: flexor digitorum superficialis

32
Q

What is Jersey finger

A

Spontaneous (RA) or traumatic (forced extension of flexed finger), usually 4th finger, causing FDP to snap

33
Q

Sx of jersey finger are

A

pain and swelling to palmar DIP
Proximal fullness if tendon retracted
Affected finger is more extended when hand is at rest
Can’t flex affected DIP

34
Q

What should you never do when evaluating jersey finger

A

passively force finger into extension! you will pull the two parts further from each other and exacerbate the situation

35
Q

How do yuo treat jersey finger

A

get an XR to assess for bony avulsion
NEED surgery, pref in 7-10 days!
Splint finger in presenting position while on their way to hand surgeon

36
Q

Complications of jersey finger are

A

fibrosis and scarring of tendon sheath associated with delayed surgery

37
Q

What is trigger finger

A

Nodular thickening of flexor tendon, usually idiopathic (or 2/2 RA and DM)
MC at MP joint
They try to make a fist and get resistance from affected finger, until they finally hear a pop

38
Q

How do you treat trigger finger

A 
Steroid injections (2 max) 
Surgical release if it persists despite injections
39
Q

What is Dupuytren’s contracture

A

Palmar fibromatosis (viking disease bc MC in men >50, northern european)
Nodular thickening and contraction of palmar fascia, usually affecting 4th finger
Does not cause much discomfort
Affects flexion of MCP first, then PIP (travels distally)

40
Q

How do you treat Dupuytren’s contracture

A

Xiaflex injection: inject into contracted cord to break down cartilage. follow with manipulation the next day

41
Q

What are ganglia of wrist and hand (synovial/mucous cysts)

A

cystic swelling overlying a joint or tendon sheath
herniation of synovial tissue from a joint capsule or tendon sheath
MC in 15-40 y/o

42
Q

Where do ganglia of wrist and hand usually occur

A

Dorsum of wrist
Volar radial aspect of wrist
(less commonly over base of finger and DIP)

43
Q

How do you treat ganglia cyst

A

Usually reassurance
If acute, severe Sx: immobilize until size decreases and Sx relieve
+/- needle aspiration (usually need to be repeated)
If continued recurrence, surgical excision

44
Q

How do you treat a mucous cyst

A

If closed: send to wrist and hand specialist 2/2 risk of infection in the joint being high
If open: can drain in office

45
Q

MCC of hand arthritis are

A

OA

secondary DJD

46
Q

OA of hand commonly involves

A

DIP and PIP
causes stiffness and loss of motion of fingers
Herbeden and Bouchard nodes

47
Q

What is a subungal hematoma

A

traumatic and painful blood collection under the nail

If traumatic, need an XR to make sure there is no fracture

48
Q

How do you treat a subungal hematoma

A

If there is an underlying Fx, NO decompression! will cause an open fracture and increase risk of infx
If no Fx: microcautery, 18g needle, or heated paperclip decompression

Summer FDTN Exam 4 (14 decks)

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