Hand Flashcards
What is a subungual haematoma?
How can this be treated?
Bleed under the nail, causing pain. The nail will eventually fall off but it will grow back.
Leave it alone if the patient can tolerate it or it can be ablated
How are fractures of the 3rd, 4th and 5th metacarpals treated?
Why do fractures of the 3rd and 4th metacarpals have such good stability?
Conservatively
They have strong intermetacarpal ligaments proximally and distally
Fractures at the base of the thumb are common.
Are these intra or extra articular?
Why should they always be fixed?
Intra articular
Any displacement can predispose to OA
Where are boxer’s fracture found?
Which direction will cause more displacement- proximal or distal?
How should these be treated?
How much angulation is accepted without disrupting hand function?
5th metacarpal
Proximal
Strap the digit to its adjacent one and allow early mobilisation
45 degrees
With punching injuries, a ‘fight bite’ can occur. Where can this cause damage?
What can it lead to?
How is it treated?
MCP joint and the extensor tendon
Infection with oral bacteria causing septic arthritis
Always explored and washed out in surgery
What is mallet finger?
What causes it?
Avulsion of the extensor tendon from its insertion into the distal phalanx
Forced flexion of the extended DIP (often from a ball at sport)
What can be seen on examination of mallet finger?
Pain, drooped DIP, inability to extend the DIP, tenderness/bruising
How is mallet finger managed?
Splint for 6 weeks to hold the DIP extended
Fixation if there is a displaced avulsion fracture
How should you treat a PIP joint dislocation?
What can happen if these have a delayed presentation?
Pull it to reduce it and give it a buddy strap
May be impossible to reduce and need fusion
What is a Bennett’s fracture?
A fracture/dislocation at the thumb CMC joint
Where does the flexor digitorum profundis tendon run to?
How do you test its function?
Distal phalanx
Hold the PIP straight and try to bend the DIP
Where does the flexor digitorum superficialis run to?
How do you test its function?
Middle phalanx
Hold the other fingers straight and try to bend the affected finger. There should be bending at the PIP but not the DIP.
Once a repair for extensor tendon damage has been done, what is the next step in management and why?
Splint in extension for 6 weeks because any flexion in this time may cause failure of repair
What is Eschar?
Leathery, inelastic skin which contracts following burns
Penetrating volar hand injuries risk damage to which structures?
Penetrating dorsal hand injuries risk damage to which structures?
Flexor tendons, digital nerves and digital arteries
Extensor tendons
How do you treat a damaged flexor tendon?
Splintage in a flexed position often with elastic traction to allow early extension to prevent stiffness
How are phalangeal fractures usually treated?
If these are displaced or angulated, what is the management?
If they are unstable or intra-articular, what is the management?
Neighbour strapping or splintage
Manipulation under anaesthetic
K-wiring or small screws
What is usually the mechanism of injury for a scaphoid fracture?
What are some clinical signs that this might present with?
FOOSH
Tenderness in the anatomical snuffbox and pain on compressing the thumb metacarpal
What x-ray views are taken if there is suspected scaphoid fracture?
If scaphoid fractures do not show on initial x-rays, when will they be seen?
4 (AP, lateral and 2 oblique)
2 weeks later once the bones ends have been resorbed in fracture healing
If a scaphoid fracture is suspected but there is no radiographic evidence, what is this known as?
What is the management for this?
Clinical scaphoid fracture
The wrist is splinted and further assessment +/- further x-rays are arranged for around 2 weeks later
How are undisplaced scaphoid fractures usualy treated?
Plaster cast for 6-12 weeks
What are the 2 main problems that are fairly common with scaphoid fractures and why?
AVN of the proximal pole: its blood supply comes distally from a branch of the radial artery
Non-union: due to synovial fluid inhibiting fracture healing
How should displcaed scaphoid fractures be treated?
Compression screw sunk into the bone to avoid non-union
What imaging test is most useful to assess whether or not union has occured in a scaphoid fracture?
How are non-unions treated?
CT
Screw fixation and bone grafting
If patients are symptomatic of AVN following a scaphoid fracture, what is often the only treatment?
Partial or total wrist fusion
What type of injury is needed to cause a lunate dislocation?
What direction does the lunate mostly dislocate in?
What is the classic radiograph sign of this?
What nerve can be compressed?
How is this treated?
High energy
Volarly
Split cup sign
Medial nerve
Emergency closed or open reduction with pinning
What causes scapho-lunate dissociation?
What is seen on x-ray in this injury?
If left untreated, what can this cause?
How is it treated?
Rupture of the scapho-lumate ligament
Increased gap between these two bones
Osteoarthritis
Closed reduction and k-wiring (maybe ligament repair also)
What is peri-lunate dislocation?
What type of injury is needed to cause this?
What test will demonstrate this?
What associated injury may be present?
What nerve can be injured?
Dislocation of one of the carpal bones around the lunate
High energy- hyperdorsiflexion
X-ray
Scaphoid or other carpal bone fracture
Median
What is the treatment for a peri-lunate dislocation?
Closed reduction and percutaneous pinning
