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Orthobullets/ FRCSC Canadian Board > Goldenstien Trauma List 6 > Flashcards

Goldenstien Trauma List 6 Flashcards

1
Q

Contraindications to ORIF of scaphoid nonunions (4)

A
  1. Smoker
  2. Older patient
  3. Progressive carpal arthrosis
  4. Chronic non-union
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2
Q

Decision-making factors for treatment of scaphoid nonunions (3)

A
  1. Location of nonunion
  2. Vascularity
  3. Deformity
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3
Q

Radiologic findings of proximal pole AVN in scaphoid nonunions (4)

A
  1. Bone resorption
  2. Cystic changes
  3. Sclerosis
  4. Low signal on T1 and T2 MRI
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4
Q

Complications of surgery for scaphoid nonunions (5)

A
  1. Persistent nonunion
  2. Hardware malpositioning
  3. Stiffness
  4. Chronic pain
  5. Nerve injury
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5
Q

Classification of scaphoid nonunion advanced collapse (4)

A
  1. Stage I: the osteoarthritis is only localized in the distal scaphoid and radial styloid.
  2. Stage II: the osteoarthritis is localized in the entire radioscaphoid joint.
  3. Stage III: the osteoarthritis is localized in the entire radioscaphoid joint with involvement of the capitolunate joint.
  4. Stage IV: the osteoarthritis is located in the entire radiocarpal joint and in the intercarpal joints. It also may involve the distal radio-ulnar joint (DRUJ).
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6
Q

Indications for ORIF of ulnar styloid fractures (4)

A
  1. Open injury
  2. Associated with DRUJ instability
  3. Significant displacement
  4. Large fragment involving the base
  5. Intraarticular fragment
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7
Q

Complications of DRUJ injuries (5)

A
  1. Late instability
  2. Post-traumatic arthritis
  3. Ulnocarpal abutment/impaction
  4. TFCC degeneration
  5. ECU tendon subluxation/dislocation
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8
Q

Stages of perilunar instability (Mayfield) (4)

A
  1. Stage I: Scapholunate ligament tear (scapholunate dissociation)
  2. Stage II: capitolunate ligament tear
  3. Stage III: Lunotriquetral ligament tear (perilunate dislocation)
  4. Stage IV: dorsal radiolunate ligament tear (lunate dislocation)
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9
Q

Sequence of events in progressive perilunar instability (Mayfield) (7)

A
  1. Scaphoid extension
  2. Opening of the space of Poirier
  3. Scaphoid failure
  4. Distal row dissociation
  5. Triquetrum hyperextension
  6. Lunotriquetral ligament failure
  7. Dorsal dislocation of the carpus
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10
Q

Things to look for on XR of perilunate injuries

A
  1. Bones for fracture
  2. Carpal height
  3. Gilula’s lines
  4. Carpal interosseous spaces
  5. Scapholunate and radiolunate angles
  6. Rotatory positions in proximal row
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11
Q

Intrinsic muscle releases for hand compartment syndrome (4)

A
  1. Thenar muscle release
  2. Hypothenar release
  3. Interossei release (2 dorsal incisions)
  4. Carpal tunnel release
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12
Q

Complications of nailbed injuries (8)

A
  1. Hypersensitivity
  2. Cold intolerance
  3. Split nail
  4. Hook nail
  5. Nonadherent nail
  6. Ingrown nail
  7. Ridging
  8. Osteomyelitis
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13
Q

Principles of treatment of fingertip injuries with tissue loss (5)

A
  1. Attempt to maintain length
  2. Prevent joint stiffness/contracture
  3. Preserve nail function if possible
  4. Provide sensate soft tissue to pulp
  5. Enable eventual pain-free use of the finger
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14
Q

Indications for replantation in upper extremity traumatic amputations (5)

A
  1. Thumb (almost any level)
  2. Multiple digit amputations
  3. Metacarpal amputations through the palm
  4. Amputation at the wrist or proximal
  5. Almost anything in a child
  6. Individual digits distal to the FDS insertion (zone I)
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15
Q

Contraindications to replantation (5)

A
  1. Single digit proximal to FDS insertion (zone II)
  2. Multitrauma
  3. Segmental injury/crush/avulsion
  4. Multiple medical comorbidities
  5. Poor rehabilitation potential
  6. Prolonged ischemic time (> 6 hours proximal to the carpus, > 12 warm/24 cold for a digit)
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16
Q

Principles of digit replantation surgical technique (8)

A
  1. Bone shortening and stable fixation
  2. Extensor tendon repair
  3. Flexor tendon repair
  4. Digital artery anastamosis (at least one/digit)
  5. Digital nerve repair
  6. Digital vein anastamosis (2 dorsal/digit)
  7. Skin repair
  8. Fasciotomies as needed
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17
Q

Causes of replantation failure (3)

A
  1. Arterial thrombosis
  2. Venous congestion/thrombosis
  3. Infection
18
Q

Options for surgical treatment of thumb amputations (4)

A
  1. Replantation (#1 choice)
  2. Revision amputation
  3. Toe-to-thumb transfer
  4. Pollicization
19
Q

Classification of ring avulsion injuries (Urbaniak) (3)

A

Type 1: circulation adequate

Type 2A: circulation inadequate, no bone/tendon injury

Type 2B: circulation inadequate, bone/tendon injury

Type 3: complete degloving

20
Q

Principles of digit amputation (6)

A
  1. Preserve functional length
  2. Maintain function and cosmesis
  3. Stable and nontender soft tissue coverage
  4. Preserve sensibility
  5. Avoid symptomatic neuromas
  6. Early mobilization
21
Q

Principles of treatment of high pressure injection injuries (5)

A
  1. Immediate decompression and mechanical debridement
  2. Wide exploration
  3. Leave wounds open
  4. Multiple debridements as needed
  5. Broad spectrum antibiotics
22
Q

Negative prognostic factors in high pressure injection injuries (5)

A
  1. Presentation > 10 hours after injection
  2. Pressure > 7000 psi
  3. Oil-based paint
  4. More material
  5. Injection into digit
23
Q

Classification of extensor tendon injuries (9)

A

Zone I: at the DIP joint

Zone II: over the middle phalanx

Zone III: at the PIP joint

Zone IV: over the proximal phalanx

Zone V: at the MCP joint

Zone VI: over the metacarpal

Zone VII: dorsal wrist

Zone VIII: distal forearm

Zone IX: proximal forearm

24
Q

Classification of mallet finger (zone I extensor tendon injuries) (4)

A

Type I: closed/blunt trauma ± a small chip fracture

Type II: laceration at or proximal to DIP

Type III: deep abrasion with loss of tendon substance

Type IV: physeal fracture in children

25
**Indications for surgical fixation of a mallet finger (4)**
1. **Fracture fragment ≥ 30% of the articular surface** 2. **Displacement \> 2 mm** 3. **Volar subluxation of the distal phalanx** 4. **Occupation prevents splinting**
26
**Complications of mallet fingers (9)**
1. **Persistent deformity/extensor lag** 2. **Secondary swan neck deformity** 3. **Post-traumatic DIP arthritis** 4. **Skin slough** 5. **Nail deformity** 6. **Joint incongruity** 7. **Infection** 8. **Pin failure** 9. **Subluxation**
27
**Causes of boutonniere deformity with zone III extensor tendon injuries (3)**
1. **Central slip rupture** 2. **Triangular ligament injury/attenuation** 3. **Lateral band volar migration**
28
**Indications for surgical treatment of zone III extensor tendon injuries (central slip rupture) (3)**
1. **Avulsion with a bone fragment** 2. **Acute injury with volar subluxation of the lateral bands (traumatic boutonniere)** 3. **Delayed treatment of a missed central slip injury**
29
**Poor prognostic factors for delayed treatment of a central slip rupture (3)**
1. **PIP contracture \> 30°** 2. **Failure to regain full extension preoperatively** 3. **Age \> 45 years**
30
**Classification of flexor tendon laceration (Verdan) (5)**
**Zone I: distal to FDS insertion** **Zone II: within the fibroosseous tunnel (“no man’s land”)** **Zone III: in the palm** **Zone IV: within the carpal tunnel** **Zone V: proximal to the carpal tunnel**
31
**Criteria for successful flexor tendon repair (6)**
1. **Appropriate timing (up to 10 days)** 2. **Appropriate incisions** 3. **Minimal touching of tendon** 4. **Preserve pulleys** 5. **Core and epitendinous suture repair** 6. **Early protected ROM**
32
**Principles of tendon repair (3)**
1. **Strength proportional to the # of strands crossing repair** 2. **Dorsal placement stronger** 3. **Best suture configuration is a 4-strand Kessler with epitendinous repair**
33
**Advantages of adding an epitendinous repair (3)**
1. **Increases strength of repair** 2. **Decreases gap formation at repair site** 3. **Improves tendon gliding by smoothing repair**
34
**Methods to increase the strength of a flexor tendon repair (3)**
1. **Adding an epitenon repair** 2. **More sutures across repair site** 3. **Dorsal sutures**
35
**Classification of flexor digitorum profundus avulsion injuries (“Jersey finger” - Leddy & Packer) (3)**
1. **Type I: retracted into palm, vincula disrupted** 2. **Type II: retracted to A2/3 pulley, vincula intact** 3. **Type III: bony avulsion with retraction to the A4 pulley (DIP)** 4. **Type IIIA: fracture and tendon avulsion**
36
**Principles of rehabilitation of flexor tendon injuries (3)**
1. **Dorsal block splint for 6 weeks (30°wrist flexion, 70° MCP flexion)** 2. **4 weeks of passive PIP/DIP flexion** 3. **Active flexion started at 4 weeks**
37
**Negative prognostic factors following flexor tendon repair (5)**
1. **Crush injury** 2. **Associated fracture** 3. **Skin loss** 4. **Zone II injuries** 5. **Increasing age**
38
**Complications of repair of flexor tendons (3)**
1. **Flexion contracture** 2. **Lumbrical plus finger (IP extension with finger flexion)** 3. **Quadrigia effect**
39
**Indications for flexor tendon reconstruction (5)**
1. **Failed repair** 2. **Stiff digit** 3. **Chronic laceration** 4. **Scarred bed** 5. **Incompetent pulley system**
40
**Requirements for flexor tendon reconstruction (4)**
1. **Supple, mature skin** 2. **Adequate vascularity** 3. **Sensate finger** 4. **Full passive ROM**

Orthobullets/ FRCSC Canadian Board (121 decks)

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