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Plastic Surgery( Grabb)Ali jasim > Hand Fractures > Flashcards

Hand Fractures Flashcards

1
Q

Metacarpal fractures typically assume an apex dorsal deformity,
proximal phalangeal fractures result in an
apex volar deformity

A

T

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2
Q

Rotational deformity may
be subtle, yet clinically significant, and is evaluated through active
range of motion or wrist tenodesis

A

T

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3
Q

5° of metacarpal rotation leads to 1.5 cm of digital overlap

A

T

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4
Q

Three-view (posteroanterior, lateral, oblique) plain radiographs of the hand are mandatory to assess
fracture anatomy

A

T

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5
Q

Definitive fracture treatment is
performed when the wound is clean and stable soft tissue coverage
can be ensured

A

T

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6
Q

all closed hand fractures can be initially managed with
closed reduction and splinting.

A

T

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7
Q

metacarpal and phalangeal fractures are adequately treated by 3 to 4 weeks
of continuous immobilization

A

T

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8
Q

the
duration of immobilization should be as short as possible to allow
fracture healing

A

T

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9
Q

Base fractures assume an
apex dorsal deformity resulting from the pull of the central slip and
the flexion moment imparted by the flexor digitorum superficialis
(FDS) insertion

A

T

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10
Q

Middle phalanx fractures distal to the FDS insertion
assume an apex volar posture because the FDS flexes the shaft and the
extensor mechanism extends the distal fragment

A

T

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11
Q

Indication of surgery in hand fracture

A

■ Articular incongruity
■ Digital malrotation, shortening, or angulation
■ Multiple fractures
■ Open fractures
■ Fractures with soft tissue injury or bone loss

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12
Q

K-wires alone, however, do not provide rigid
fixation or compression across the fracture site

A

T

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13
Q

Additional immobilization may be necessary after putting K-wire

A

T

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14
Q

a single K-wire does not impart rotational stability,

A

T

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15
Q

K-wires
should never cross at the fracture site, as this will lead to distraction
ofthe fracture fragments and limited fracture stability

A

T

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16
Q

Tension band wiring is a modification of K-wire fracture fixation
that increases construct strength

A

T

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17
Q

Compression screws may be used for oblique or spiral fractures
using the lag principle

A

T

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18
Q

Compression screws is ideal when the fracture
length is at least twice the diameter of the bone

A

T

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19
Q

Lag screw fixation
requires drilling a hole in the near cortex that is the same diameter
as the outer diameter of the screw.

A

T

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20
Q

Multiple screws are required to achieve anatomic
reduction and impart axial stability of the construct

A

T

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21
Q

a countersink should
be used to prevent screw head prominence

A

T

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22
Q

interosseous wiring is a technically demanding procedure that provides rigid fixation and fracture site compression.

A

T

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23
Q

Indication of intraosseous wiring ?

A

transverse fractures of the phalanges or metacarpals, in joint arthrodesis, or in digital replantation

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24
Q

Plate fixation provides a highly stable construct for hand fracture
treatment

A

t

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25
Q

Plate fixation commonly used for metacarpal
shaft fractures and for the treatment of nonunion and malunion,
where restoring length and stability are essential

A

T

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26
Q

Plate fixation is
rarely used for phalangeal fractures

A

T

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27
Q

plate fixation in the phalanges frequently leads to tendon scarring and
stiffness

A

T

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28
Q

the extensor tendons overlying the metacarpals
do not sit directly on bone and, as such, are at low risk for adhesions
after plate fixation

A

T

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29
Q

, plate and screw
application requires a relatively large amount of soft tissue dissection
and periosteal stripping

A

T

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30
Q

tenolysis and/or plate removal may be needed after fracture healing

A

T

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31
Q

External fixation fractures with substantial soft tissue injury, marked comminution,
bone loss, and/or contamination

A

T

32
Q

Rarely is external fixation the
definitive solution for hand fracture management

A

T

33
Q

the most common fractures in the hand

A

Distal phalangeal fracture

34
Q

Tuft
fractures most frequently occur in combination with nail bed injuries

A

T

35
Q

The healing of the tuft fracture is very well !!!

A

Tuft fractures often heal with a malunion, but these are rarely symptomatic

36
Q

Articular fractures of the dorsal base of the distal phalanx involve the extensor tendon insertion

A

T

37
Q

managed with distal interphalangeal (DIP)
joint splinting in full extension for 6 weeks

A

T

38
Q

When we should use K-wire fixation for the fracture of the distal phalanx

A

Dorsal block K-wire fixation is recommended for fractures involving more than one-third of
the articular surface or in the setting of volar subluxation of the distal fragment

39
Q

Seymour fracture can lead to osteomyelitis

A

T

40
Q

Phalangeal condylar fractures are classified

A

type I (unicondylar
and nondisplaced), type II (unicondylar and displaced), and type III
(bicondylar).

41
Q

Extreme care must be exercised when performing open repair of
condylar fractures to avoid injury to the vascular supply arising from
the attached collateral ligaments

A

T

42
Q

Phalangeal neck fractures are inherently unstable

A

T

43
Q

majority of these injuries are treated with K-wire fixation

A

T

44
Q

Nondisplaced shaft fractures may be managed with splinting or buddy tape to an adjacent uninjured digit for 3 to 4 weeks

A

T

45
Q

When should do reduction and fixation for phalangeal shaft fracture

A

If malrotated or displaced greater
than 10° to 25° in the sagittal plane or 10° to 15° in the coronal plane,

46
Q

Long oblique and
spiral fractures are treated with interfragmentary screw fixation

A

t

47
Q

The screw diameter should be less than one-third of the length of
the fracture

A

T

48
Q

Nondisplaced phalangeal base fractures are treated with
splint immobilization for 3 to 4 weeks.

A

T

49
Q

Metacarpal head fractures are rare

A

T

50
Q

Computed tomography scan may better visualize the fracture pattern and assist in surgical planning

A

T

51
Q

Nonoperative management is recommended for fractures with less than 25% articular involvement.of MCP

A

T

52
Q

Indication of surgery in metacarpal head fracture

A

fractures with greater articular involvement,
> 1 mm articular incongruity, or collateral ligament instability,

53
Q

Avascular necrosis of the metacarpal head is common

A

F is rare

54
Q

headless screw
fixation is an optimal choice of fixation for metacarpal head fractures

A

T

55
Q

comminuted or associated with joint disruption of MCP joint what are the options

A

best treated by dynamic external fixation or
acute arthroplasty

56
Q

Metacarpal neck (i.e., boxer’s) fractures are common and typically involve the fifth metacarpal

A

T

57
Q

Indication of surgery in Metacatpal neck fracture

A

pseudoclawing excessive shortening, and malrotation
after attempted closed reduction

58
Q

up to 70° in the fifth metacarpal neck angulation accepted

A

t

59
Q

Buried antegrade intramedullary pin application may be
superior because it avoids the extensor mechanism and obviates the
risk for pin tract infection

A

T

60
Q

less angular deformity is
tolerated in the metacarpal shaft

A

T

61
Q

Nondisplaced oblique and spiral
fractures are usually unstable and are often best treated with surgery

A

T

62
Q

If the fracture is
obliquely oriented and the fracture length is at least twice the bone
diameter, lag screws may be the best choice

A

T

63
Q

A disadvantage of Percutaneous pinning of the metacarpal shaft?

A

longer
periods of immobilization and delayed initiation of therapy

64
Q

Extra-articular metacarpal base fractures are managed similarly to
shaft fractures

A

T

65
Q

Given the substantial
mobility of the thumb CMC joint, a relatively large amount of displacement is well tolerated

A

T

66
Q

Reduction is indicated if the distal fragment is flexed greater than 30°Why?

A

this amount of deformity leads to
compensatory thumb MCP joint hyperextension.

67
Q

Bennett fracture represents an oblique intra-articular fracture-dislocation of the thumb metacarpal base.

A

T

68
Q

The metacarpal subluxates proximally, radially, and dorsally ,why?

A

secondary to the pull of the abductor
pollicis longus, extensor pollicis brevis, and adductor pollicis

69
Q

The way of fixation of Bennett fracture

A

place a K-wire across the articular surface perpendicular to the long access of the metacarpal into the second metacarpal base.
additional wire is placed retrograde across
the trapeziometacarpal joint

70
Q

segmental loss management

A

External fixation
soft tissue loss
Bone graft
tendon reconstruction

71
Q

complications are more frequent after phalangeal and open fractures
than with metacarpal fractures

A

T

72
Q

Stiffness with active and passive motion
results from joint contracture, whereas diminished active motion
only is often the result of tendon adhesions

A

T

73
Q

Complication of hand fractures

A

Stiffness
Malunion
Fracture nonunion
Infection
chronic pain

74
Q

Metacarpal fractures lead to an apex dorsal deformity due to
intrinsic muscle pull on the metacarpal head

A

t

75
Q

Proximal phalanx
fractures typically result in an apex volar deformity because the
intrinsic muscles flex the base and the extensor mechanisms
extend the distal shaft.

A

t

76
Q

indications for reduction of a
phalangeal fracture.

A

fractures with greater than
10° to 25° of sagittal plane deformity, 10° to 15° of coronal plane
deformity, shortening of more than 2 to 4 mm, intra-articular
incongruity, multiple open fractures, and fractures with soft tissue injury and/or bone loss.

Plastic Surgery( Grabb)Ali jasim (92 decks)

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