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Ebopras > Fractures/Dislocations > Flashcards

Fractures/Dislocations Flashcards

1
Q

What three structures provided the greatest stability to the proximal interphalangeal (PIP) joint?

A

The three-sided box configuration of the medial and lateral collateral ligaments and the volar plate.

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2
Q

What is the classification of Mallet fractures of the finger?

A

Type 1: closed tendon avulsion with or without fracture
Type 2: laceration with extensor tendon disruption
Type 3: open injury with loss of skin and tendon substance Type 4: physeal fracture in children

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3
Q

What is the treatment of choice for a displaced fracture of the dorsal base of the distal phalanx comprising over 25% of the articular surface?

A

Operative intervention with closed or open reduction and internal fixation.

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4
Q

What is the treatment of choice for a volar base fracture of the distal phalanx with loss of the flexor digitorum profundus insertion?

A

Open reduction and internal fixation.

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5
Q

What is the acceptable angulation for metacarpal shaft fractures (index, middle, ring, and little)?

A
  1. index metacarpal: 10◦ to 15◦
  2. middle metacarpal: 10◦ to 15◦
  3. ring metacarpal: 30◦ to 35◦
  4. small metacarpal: 40◦ to 45◦
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6
Q

What is the most likely direction of angulation of an unstable transverse metacarpal shaft fracture?

A

Apex dorsal angulation due to the volar directed pull of the interosseous muscles.

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7
Q

What are some indications for operative fixation of phalangeal and metacarpal fractures?

A

malrotation
irreducible fractures
intra-articular fractures
open fractures
fractures with bone loss
fractures with associated tendon, vascular or nerve injury r polytrauma patients

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8
Q

How does one assess for malrotation in phalangeal and metacarpal fractures?

A

The hand is assessed with the fingers in extension and flexion. In extension the fingers should be parallel and in flexion they should all point toward the scaphoid tuberosity. Malrotation would present as subtle overlap or scissoring of the fingers.

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9
Q

What is the number 1 complication of operatively treated phalangeal fractures?

A

Digital stiffness.

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10
Q

What is the most likely block to reduction in a complex dorsal dislocation of the metacarpophalangeal joint?

A

Volar plate

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11
Q

What two structures act as a noose around the metacarpal head in an irreducible (complex) dorsal dislocation of the index MCP joint?

A

The flexor tendons (ulnarly) and the lumbricals (radially) maintain a tight encirclement around the narrow neck of the metacarpal preventing reduction.

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12
Q

In a Bennett fracture, what is the deforming force that causes proximal migration of the thumb metacarpal?

A

Abductor pollicis longus.

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13
Q

What is a Stener lesion?

A

A Stener lesion is formed when the distally avulsed ulnar collateral ligament of the thumb metacarpophalangeal
joint comes to lie dorsal to the leading edge of the adductor aponeurosis

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14
Q

What are the most reasonable treatment options for a fracture/dislocation of the PIP joint with a severely comminuted volar base fracture of the middle phalanx involving 40% of the joint surface?

A

Volar plate arthroplasty or Suzuki-type dynamic external fixation/traction.

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15
Q

In volar dislocation of the PIP joint, what commonly associated injury must be examined for?

A

Rupture or avulsion of the extensor tendon central slip

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16
Q

What is the treatment for a fifth metacarpal neck fracture (Boxer fracture) with 40◦ of apex dorsal
angulation?

A

40◦ is the maximal angulation acceptable; however, some would suggest attempted closed reduction to improve angulation and ulnar gutter splinting.

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17
Q

What is the most common carpal bone fractured?

A

Scaphoid fractures account for 80% of all carpal bone fractures.

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18
Q

Describe the anatomy of the major blood supply to the scaphoid.

A

The major blood supply is from branches of the radial artery that enter the dorsal ridge of the scaphoid (distal to the scaphoid waist). This blood supply accounts for 70% to 80% of the total blood supply of the scaphoid and 100% of the blood supply to the proximal pole.

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19
Q

What is snuffbox tenderness?

A

Tenderness on palpation of the anatomic snuffbox (interval between the tendons of the first and third dorsal
compartments distal to the radial styloid), which may indicate fracture of the scaphoid.

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20
Q

What is a scaphoid humpback deformity?

A

The apex dorsal angulation seen with a scaphoid waist nonunion or malunion. The distal scaphoid fragment
angulates volarly and the proximal scaphoid fragment extends with the lunate.

21
Q

What type of carpal instability is seen most commonly with a malunited scaphoid (humpback deformity)?

A

Dorsal intercalated segment instability is visualized on a lateral radiograph as the proximal scaphoid fragment
extends with the lunate.

22
Q

What is the definition of scaphoid fracture displacement or instability?

A

presence of a fracture gap of greater than 1 mm on any radiographic projection r scapholunate angle of greater than 60◦
radiolunate angle of greater than 15◦
intrascaphoid angle of greater than 30◦

23
Q

What is the space of Poirier?

A

A palmar area of inherent capsular weakness between the capitate and lunate, which is torn in perilunate injuries
creating a capsular rent across the midcarpal joint.

24
Q

What is Mayfield’s progressive sequence of perilunate disruption or dislocation?

A

Stage I: disruption of the scapholunate interosseous ligament complex
Stage II: disruption through the space of Poirier and the lunocapitate interval
Stage III: disruption of the lunotriquetral ligament complex and resultant separation of the entire carpus from the
lunate
Stage IV: dislocation of the lunate from its fossa in to the carpal tunnel

25
Q

What is a “lesser arc” injury?

A

This type of injury refers to a purely ligamentous disruption around the lunate.

26
Q

What is a “greater arc” injury?

A

This type of injury refers to disruption around the lunate that involves fractures of some or all of the carpal bones.

27
Q

What is the most common “greater arc” injury?

A

A trans-scaphoid perilunate fracture—dislocation.

28
Q

What is the normal intracarpal angle between the scaphoid and lunate (scapholunate angle)?

A

Between 30◦ and 60◦.

29
Q

What is the most sensitive and specific test for assessment of posttraumatic avascular necrosis of the scaphoid?

A

Magnetic resonance imaging—MRI with gadolinium.

30
Q

What is scaphocapitate syndrome?

A

Fracture of the neck of the capitate with rotation of the proximal fragment in association with a scaphoid waist
fracture.

31
Q

What is carpal instability dissociative?

A

Refers to intrinsic ligament disruptions that occur between carpal bones of the same carpal row (ie, scapholunate
dissociation caused by a scapholunate ligament tear).

32
Q

What is carpal instability nondissociative?

A

Refers to extrinsic ligament disruptions that occur between carpal rows (ie, midcarpal instability).

33
Q

What is Watson scaphoid shift test?

A

The test assesses for scapholunate ligament dissociation. The examiner applies dorsally directed thumb pressure over the patient’s distal scaphoid tubercle. If the SL ligament is torn, pain is elicited when the proximal pole of the scaphoid subluxates dorsally out of the scaphoid fossa of the radius as the patient’s hand is passively moved from ulnar deviation to radial deviation.

34
Q

What is a Terry-Thomas sign?

A

Increased gap between the scaphoid and lunate, greater than 3 mm, indicative of a scapholunate dissociation.

35
Q

On a PA wrist radiograph, what are findings of scapholunate dissociation?

A

Terry-Thomas sign
cortical ring sign
reduced carpal height
triangular shaped lunate r foreshortened scaphoid

36
Q

What are Gilula lines?

A

Gilula et al described three smooth curved lines on a PA projection of the carpus. The first line represents the proximal cortical surfaces of the proximal carpal row. The second line represents the distal cortical surfaces of the proximal carpal row and the third line represents the proximal cortical surfaces of the distal carpal row. A step-off or disruption in any of these lines may indicate carpal malalignment or instability.

37
Q

What radiographic projection would best visualize a hook of hamate fracture?

A

Carpal tunnel profile view.

38
Q

What is the treatment of choice for a symptomatic hook of hamate nonunion?

A

Excision of the hamate hook.

39
Q

What is the “safe” position of immobilization for the hand

A

The “safe” position or the intrinsic-plus position of James is 70◦ of MCP joint flexion and full IP joint extension.

40
Q

What is the Salter–Harris classification of physeal injuries?

A

Salter–Harris classification:
Type I: transverse fracture through the physis
Type II: fracture through the physis with a metaphyseal fragment
Type III: fracture through the physis and in to the epiphysis (intra-articular) Type IV: fracture through the physis, epiphysis, and metaphysis
Type V: crush injury of the physis

41
Q

What radiographic projections would best visualize the position of a screw in the proximal pole of the scaphoid?

A

To best visualize the proximal pole, an ulnar-deviated posteroanterior view and a true lateral radiograph.

42
Q

What is the treatment of choice for a scaphoid fracture that is 1.5 mm displaced?

A

Open reduction and internal fixation with a compression screw.

43
Q

What is an important factor to consider, other than the degree of intra-articular step, when deciding to operate on a bony mallet finger?

A

Distal phalanx subluxation.

44
Q

What is the most likely direction of a CMC dislocation of the thumb?

A

Dorsal.

45
Q

What is the most likely direction of angulation of an unstable transverse proximal phalanx shaft fracture?

A

Proximal phalangeal fractures, typically angulated apex volar.

46
Q

What is the structure at risk when treating a hook of hamate nonunion?

A

Motor branch of the ulnar nerve.

47
Q

Trans-trapezium, trans-hamate peri-pisiform, and peri-hamate trans-triquetrum are all examples of which carpal instability pattern?

A

Longitudinal or axial carpal instability.

48
Q

What is the “Jahss maneuver”?

A

The maneuver used for reduction of metacarpal neck fractures.

Ebopras (32 decks)

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