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Musculoskeletal > Forearm, wrist and hand orthopaedics and trauma > Flashcards

Forearm, wrist and hand orthopaedics and trauma Flashcards

1
Q

What is the name given to a fracture of the radius with dislocation of the ulna at the distal radioulnar joint?

A

Galeazzi fracture dislocation

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2
Q

What is a Monteggia fracture dislocation?

A

A fracture of the ulna occurs with dislocation of the radial head at the elbow

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3
Q

What is the management for a Monteggia fracture dislocation and why?

A

ORIF, even in children

Manipulation alone has a high recurrence rate

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4
Q

What is Dupuytren’s contracture?

A

A proliferative connective tissue disorder where the specialized palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressingto contractures at the MCP and PIP joints

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5
Q

What is the pathology involved in Dupuytren’s contracture?

A

Proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1)

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6
Q

What proportion of cases of Dupuytren’s contracture are bilateral?

A

50%

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7
Q

Which fingers are most commonly involved in Dupuytren’s contracture?

A

Ring and little fingers

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8
Q

Which gender is more affected by Dupuytren’s contracture?

A

Males 10:1

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9
Q

What can cause Dupuytren’s?

A

Familial - autosomal dominant inheritance

Alcoholic disease

A side effect of phenytoin therapy

Common in diabetics

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10
Q

What other fibromatosis is Dupuytren’s associated with?

A

Peyronie’s disease, which affects the penis

Plantar fibromatosis affecting the feet (Ledderhose disease)

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11
Q

When is surgical treatment for Dupuytren’s disease offered?

A

If contractures are interfering with function

Up to 30° of contracture can be tolerated at the MCP joint and but the PIPJ readily stiffens and any contracture here is usually an indication for surgery

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12
Q

What surgical management is avaliable for Dupuytren’s contracture?

A

Removal of all diseased tissue (fasciectomy)

Division of cords (fasciotomy)

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13
Q

What causes trigger finger?

A

Tendonitis of a flexor tendon to a digit can result in nodular enlargement of the affected tendon, and can get stuck in a fascial pulley, holding the finger in a ‘trigger’ position

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14
Q

What fascial pulley is usually involved in trigger finger?

A

A1

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15
Q

What will relieve the symptoms of trigger finger in most patients?

A

Injection of steroid around the tendon

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16
Q

Which site of the hands is very common for development of OA in post-menopausal women?

A

Distal interphalangeal joints

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17
Q

Which metocarpal joint is commonly affected by OA, especially in women?

A

1st - base of thumb

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18
Q

Which joints in the hands tend to be spared by RA?

A

DIP joints

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19
Q

What are the three stages of RA in the hands?

A

Synovitis and tenosynovitis

Erosions of the joints – inflammatory pannus denudes the joints of articular cartilage

Joint instability and tendon rupture – patients can progress to subluxation and chronic tenosynovitis predisposes to extensor tendon ruptures

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20
Q

What are the deformities of the hands seen in RA?

A

Volar MCPJ subluxation

Ulnar deviation

Swan neck deformity

Boutonniere deformity

Z-shaped thumb

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21
Q

What is a swan neck deformity?

A

Hyperextension at PIPJ with flexion of DIPJ

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22
Q

What is Boutonniere’s deformity?

A

Flexion at PIPJ with hyperextension of DIPJ

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23
Q

Which procedure may prevent tendon rupture in the hands in RA?

A

Tenosynovectomy (excision of synovial tendon sheath)

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24
Q

What procedure may be required for distal radio-ulnar joint RA?

A

Resection of the distal ulna

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25
Q

What are ganglion cysts?

A

Mucinous filled cysts found adjacent to a tendon or synovial joint, commonly found in the hand or wrist

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26
Q

What are the most common soft tissue swellings of the hand?

A

Ganglion cysts

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27
Q

Where are giant cell tumours of the tendon sheath found?

A

They are usually on the palmar surface of the hand

Common around the PIP joint of the index and middle fingers

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28
Q

Where can giant cell tumours of the tendon sheath spread locally?

A

They can envelop the digital artery or nerve and erode into bone

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29
Q

What is the significance of the radius and ulna being connected proximally and distally by strong ligaments around the proximal and distal radio‐ulnar joints in relation to fractures?

A

The forearm acts as a ring where if one bone is fractures, there is usually a fracture or dislocation involving the other bone

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30
Q

What is a nightstick fracture?

A

A fracture of the ulnar shaft

31
Q

How might a Nightstick fracture occur?

A

Direct blow to the ulna

32
Q

What associated injury must be checked for in Nightstick fracture?

A

Monteggia - dislocation of radial head with the ulnar fracture

33
Q

What treatment is used for a fracture of both bones of the forearm?

A

Usually requires ORIF with plates and screws

Anatomical reduction required to preserve function

34
Q

How can minimally angulated fractures of both bones of the forearm in children be treated?

A

Plaster only

35
Q

What is a Colles fracture?

A

An extra‐articular fracture of the distal radius with dorsal displacement

36
Q

What other fracture may be associated with a Colles fracture?

A

Associated fracture of the ulnar styloid

37
Q

How might minimally angulated/displaced Colles fractures be treated?

A

Splintage

38
Q

How is a Colles fracture with any angulation past neutral treated?

A

Manipulation and held in a plaster cast

Percutaneous wires or ORIF with plate & screws may be preferred if fracture is particularly unstable

39
Q

What complications can arise from a Colles fracture?

A

Median nerve compression from stretch of the nerve or a bleed into the carpal tunnel

Rupture of the Extensor Pollicis Longus tendon

40
Q

What is Smith’s fracture?

A

A volarly displaced or angulated extra‐articular fracture of the distal radius

41
Q

How does Smith’s fracture usually occur?

A

Falling onto the back of a flexed wrist

42
Q

What is the treatment for Smith’s fractures?

A

ORIF with plate and screws

43
Q

What are Barton’s fractures?

A

Intra‐articular fractures of the distal radius involving the dorsal or volar rim, where the carpal bones of the wrist joint sublux with the displaced rim fragment

44
Q

How can Barton’s fractures be classified?

A

Volar Barton’s fractures (an intra-articular Smith’s fracture)

Dorsal Barton’s fracture (an intra-articular Colles’ fracture)

45
Q

How do scaphoid fractures usually occur?

A

Fall onto outstretched hand

46
Q

What are the signs of a scaphoid fracture?

A

Tenderness in anatomical snuffbox

Pain on compressing (telescoping) the thumb metacarpal

47
Q

How is an accurate image of the scaphoid taken?

A

4 different Xrays are taken

AP, lateral and two oblique views

48
Q

What should be done if scaphoid fracture suspected but not shown on Xray?

A

Splint the wrist

Further clinical assessment

Repeat Xrays after 2 weeks

49
Q

What are the complications of a scaphoid fracture?

A

Non-union

AVN of proximal pole (its blood supply comes distally)

50
Q

How are displaced scaphoid fractures treated?

A

Fixed with a special compression screw sunk into the bone to avoid non‐union

51
Q

How are scaphoid non-unions treated?

A

Screw fixation and bone grafting

52
Q

What is a peri-lunate dislocation?

A

Dislocation of one of the carpal bones around the lunate

53
Q

How does a peri-lunate dislocation usually occur?

A

High energy wrist injury resulting from hyperdorsiflexion

54
Q

What will Xrays show in peri-lunate fracture?

A

A loss of alignment of the capitate and lunate with the concave lunate fossa being empty

55
Q

What is the treatment for peri-lunate dislocation?

A

Emergency treatment is required with closed reduction and percutaneous pinning or open reduction if closed reduction is not possible

56
Q

What does lunate dislocation show on Xray?

A

“Spilt cup” sign of the lunate which is usually tilted volarly and empty like a split tea cup

57
Q

How does scapho-lunate dissociation occur?

A

Rupture of the scapho-lunate ligament

58
Q

What happens if scapho-lunate dissociation is left untreated?

A

Abnormal forces are placed upon the wrist and carpus and osteoarthritis ensues

59
Q

How is scapho-lunate dissociation treated?

A

Closed reduction and k‐wiring with or without scapholunate ligament repair

60
Q

What structures are put at risk in a penetrating injury of the volar aspect of the hand?

A

Flexor tendons

Digital nerves

Digital arteries

61
Q

What structures are put at risk with penetrating injuries to the dorsum of the hand?

A

Extensor tendons

62
Q

What extensor tendon injuries in the hand are treated and how?

A

More than 50% division

Surgical repair with splintage in extension for 6 weeks

63
Q

What is mallet finger?

A

Avulsion of the extensor tendon from its insertion into the terminal phalanx and is caused by forced flexion of the extended DIPJ

64
Q

How does mallet finger present?

A

Pain

Drooped finger

Inability to extend the DIPJ

65
Q

What is the treatment for mallet finger?

A

A mallet splint holding the DIPJ extended which should be worn continuously for a minimum of 4 weeks

66
Q

Which metacarpal fractures are treated conservatively?

A

3rd, 4th and 5th

67
Q

How do fractures of the 5th metacarpal tend to occur?

A

A punching injury

68
Q

What degree of flexion in a 5th metacarpal injury can be tolerated without affecting function?

A

45 degrees

69
Q

Displacement of the 5th metacarpal in which plane should be fixed to avoid functional issues?

A

Rotational deformity

70
Q

How are metacarpal fractures treated conservatively?

A

Neighbour strapping of the affected digit to the adjacent finger and early motion to maintain function

71
Q

What treatment should be given in a fight-bite associated with metacarpal fracture?

A

Surgical washout of the wound to avoid septic arthritis

72
Q

How are most phalangeal fractures managed?

A

Neighbour strapping

Splintage

73
Q

How might intra-articular phalangeal fractures be fixed?

A

K-wires or small screws

74
Q

How are significantly displaced or angulated phalangeal fractures managed?

A

Manipulation under anaesthetic

Musculoskeletal (19 decks)

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