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Orthopaedics and Trauma > Hand and wrist > Flashcards

Hand and wrist Flashcards

1
Q

Colles’ fracture

A

Extra-articular

Distal radius

Dorsal displacement

Low-energy

Dinner fork deformity

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2
Q

Barton’s

A

Intra articular

Partial fracture

?Volar displacement

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3
Q

Smith’s

A

Extra-articular

Radial

Volar displacement

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4
Q

Management of wrist fracture

A

Closed reduction

Plaster cast for 5-6 weeks

F/U radiology at 1 and 2 weeks –> malunion/failure of reduction –> consider internal/external fixation

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5
Q

Complications of wrist fracture

A

Malunion –> reduced grip strength + wrist stiffness + pain

Median nerve compression/carpal tunnel syndrome

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6
Q

Features of scaphoid fractures

A

FOOSH

Localised radial-sided carpal pain (anatomical snuffbox)

Difficulty with pronation

Request scaphoid X-ray series +/- MRI

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7
Q

Management of scaphoid fractures

A

Undisplaced –> scaphoid cast + immobilisation for 8-12 weeks

Displaced –> internal fixation with screws

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8
Q

Management of metacarpal and phalangeal fractures

A

Splintage for 2-3 wee with MCP at 90degrees and IPs at full extension, thumb in abduction and opposition

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9
Q

Management of extensor tendon injuries

A

Open –> surgical (suturing, splinting, physio)

Closed–> splinting in extended position

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10
Q

Examination of flexortendons

A
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11
Q

Clinical features of capal tunnel syndrome

A

Paraesthesia + weakness in radial 3.5 fingers

Pain worse at night, may be relieved by shaking hand or running under cold water

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12
Q

Associations of carpal tunnel syndrome

A

Pregnancy

Hypothyroid

Female

Basal thumb arthritis

RA

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13
Q

Management of carpal tunnel

A

Splinting

Steroid/anaesthetic injections

Surgical decompression

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14
Q

Hand nerve examination

A
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15
Q

Pathophysiology of Dupuytren’s

A

Abnormal myofibroblast activity –> thickening + shortening of palmar fascia –> finger flextion

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16
Q

Cliinical features of Dupuytren’s

A

Thickened cords/nodules + fixed flexion of fingers (commonly ring/little MCP)

More aggressive disease: several joints, feet may be affected

17
Q

Associations of Dupuytren’s

A

HIV, alcoholism, diabetes, FHx, men (5th-7th decde), Northern European descent

Leddenhose (in foot) and Peyronie’s (in penis)

18
Q

Features of wrist ganglions

A

Most common hand mass: 70% dorsal

Smooth, fluctatues in size, non-painful, transilluminates

If does not transilluminate suspect bone tumour

19
Q

Pathophysiology of wrist ganglions

A

Herniation of synovial cavity + filling up with mucin

20
Q

Management of wrist ganglions

A

Most resolve spontaneously, high recurrence rate withs surgery/aspiration

21
Q

De Quervain’s tenosynovitis pathophysiology

A

Thickening of extensor retinaculum –> compression of thumb extensor tendons

22
Q

Associations of De Quervain’s tenosynovitis

A

Females post-partum/perimenopause

Overuse –> affects dominant hand

23
Q

Clinical features of De Quervain’s

A

Radial sided wrist pain exacerbated by thumb flexion and ulnar deviation

24
Q

Management of De Quervain’s

A

Rest + splinting

Activity modification, steroid injections

Rarely surgical release

25
Q

Presentation of trigger finger

A

Painful locking of digit (often ring) in full flexion, must be passively extended

Palpable nodule at base of MCP

No thickening of fascia!! (c.f. Dupuytren’s)

Assoc w/ diabetes + RA + amyloid

26
Q

Pathophysiology of trigger finger

A

Fibrocartilage metaplasia –> thickening of A1 pulley system –> prevent free running of flexor tendon

27
Q

Osteo vs rheumatoid arthritis of hand

A

Bony

DIP involvement

Worse with activity

Heberden’s nodules

28
Q

What is a perilunate dislocation?

A

High-energy trauma –> displacement of carpus relative to lunate

High risk of median nerve palsy, compartment syndrome, osteoarthritis

29
Q

Presentation of nodal OA

A

Strong genetic component

Peri-menopausal women

Sequential, additive destruction of hand joints (DIPJs>PIPJs)

Eventually painless hand deformities, increase progression of other joint OA

30
Q

Chauffer’s fracture

A

Radial styloid fracture

31
Q

What is Froment’s sign?

A

Test of ulnar nerve palsy, failure of adductor pollucis

When asked to pinch thumb goes into flexion

32
Q

Roof and base of carpal tunnel

A

Flexor retinaculum

Carpal bones

33
Q

Contents of carpal tunnel

A

9 tendons:

flexor digitorum profundis (4)

Flexor digitorum superficialis (4)

Flexor pollicis longus (1)

Median nerve (-palmar cutaneous branch)

Orthopaedics and Trauma (8 decks)

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