Hand Classifications

Question 1

Mayfield

Answer 1

1. Scapholunate
2. • Lunocapitate
3. • Lunotriquetral (peri-lunate)
4. • Volar lunate (ass. w MN injury) (lunate dislocated from fossa - typically volar)

Question 2

SNAC - Radiographic

Answer 2

1. OA of radial styloid (radial side of scaphoid)
2. • Scaphocapitate arthrosis
3. • Periscaphoid OA (lunate and capitate may be ok)

Question 3

SLAC - Watson’s

Answer 3

1. OA of scaphoid and radial styloid
2. OA of scaphoid and entire scaphoid facet of radius
3. Arthritis between capitate and lunate (capitate will move proximally into SL space)

ps the lateral X-ray shows DISI

Question 4

Flexor tendon injury zones 5 +

Answer 4

1. Distal to FDS
2. FDS to distal palmer crease
3. Palm
4. Carpal tunnel
5. Wrist to forearm
   * thumb

Question 5

Seddon classification of peripheral nerve injury

Do you remember all the factors it includes?

Answer 5

1. Neuropraxia
2. Axonotmesis
3. Neurotmesis

Question 6

Dorsal PIP # Dislocation - Hastings - defines treatment

Answer 6

Type I-Stable

- 50%-ORIF, hamate autograft, or volar plate arthroplasty

Question 7

Stages of Duprytren’s

Answer 7

Proliferative stage	
- Hypercellular with large myofibroblast 
-Very vascular 
Involutional stage	
- Dense myofibroblast
-Increase ratio of type III to type I collagen
Residual stage	
- Fibrocytes dominate

Question 8

Kienbocks - Lichtman Classification (try to guess treatment)

Answer 8

1. MRI
2. XR and MRI - Sclerosis
3. A) Lunate collapse, no fixed scaphoid rotation
   B) Lunate collapse, fixed scaphoid rotation
4. Pan lunate OA, intercarpal
   * Don’t forget STT joint, 3b needs PRC or STT fusion

Question 9

Eaton and Littler Classification for CMC OA

Answer 9

1. Joint space widening (pre OA)
2. Narrowing, sclerosis, OP less than 2mm
3. Narrowing, OP >2mm
4. Pan trapezial (with STT!)

Question 10

Trigger Finger (Green)

Answer 10

Grade I Palm pain and tenderness at A-1 pulley
Grade II Catching of digit
Grade III Locking of digit, passively correctable
Grade IV Fixed, locked digit

Question 11

TFCC (2!)

Answer 11

Class 1 - Traumatic TFCC Injuries
1A Central perforation or tear
1B Ulnar avulsion (without ulnar styloid fx)
1C Distal avulsion (origin of UL and UT ligaments)
1D Radial avulsion
Class 2 - Degenerative TFCC Injuries
2A TFCC wear and thinning
2B Lunate and/or ulnar chondromalacia + 2A
2C TFCC perforation + 2B
2D Ligament disruption + 2C
2E Ulnocarpal and DRUJ arthritis + 2D

Question 12

Ledder and Packer Classification for Jersey Finger

Answer 12

Type I FDP tendon retracted to palm. Disruption of the vascular supply. Rx - Prompt surgical treatment
Type II FDP retracts to level of PIP joint Rx: Repair WW
Type III Large avulsion fracture limits retraction to the level of the DIP joint Rx: Repair WW
Type IV Osseous fragment and simultaneous avulsion of the tendon from the fracture fragment (“Double avulsion” with subsequent retraction of the tendon usually into palm) If tendon separated from fracture fragment, first fix fracture via ORIF then reattach tendon as for Type I/II injuries