Hand Injury Quiz Flashcards
Describe this fracture
This is an adequate x-ray of a hand, there are no patient details and no indicators for right or left.
There is a obvious fracture at the base of the proximal phalanx of the thumb.
It appears to be simple, complete and oblique. There is 50% displacement and the fragment appears medially angulated.
It does not appear shortened or rotated
This is in keeping with an avulsion fracture
What is the name given to this fracture?
Which ligament has caused the avulsion?
Skiers/ Game keepers thumb with avulsion
Ulnar collateral ligament
Label the muscles of the thenar eminence
Carpal Tunnel
a) Which nerve is compressed in carpal tunnel syndrome?
b) What sensory distribution is affected?
c) A late sign of carpal tunnel syndrome is wasting of which of these thenar muscles?
d) Why is the sensation over the thenar eminence spared in carpal tunnel syndrome
a) Median nerve
b) Radial 3 and a half finger
c) Abductor Pollicis Brevis
d) Supplied by palmar cutaneous branch of the median nerve which branches before going through the carpal tunnel
a) What fracture is shown below?
b) What are 4 examination test you would expect to be positive in a patient with this x-ray?
a) Scaphoid fracture
b) Provocation tests
- Pain on telescoping the thumb
- Pain on telescoping the index finger
- Tenderness in the snuff box
- Pain over the proximal pole of the scaphoid on palpation and radial deviation
a) When is operative management of a scaphoid fracture required and why?
b) How would you manage a suspected scaphoid fracture with no changes visible on x-ray?
a) Displaced fractures due to risk of AVN
b) Immobilise for 7-10 days an then re x-ray if scaphoid fracture is demonstrated then immobilise for a further 7 weeks
What are the borders of the anatomical snuff box?
Radial – extensor pollicis brevis, abductor pollicis longus
Ulnar – extensor pollicis longus
Proximal – radial styloid
Floor- scaphoid and trapezium
Roof – skin
What lies within the anatomical snuff box?
- Radial artery
- Radial nerve
- Cephalic vein
What are the complications of a fractured scaphoid, shown in this x-ray?
Name 3 other complications of a scaphoid fracture
A SNAC wrist – scaphoid non-union articular collapse
Other complications
- Non union
- post traumatic osteoarthritis
- Avascular necrosis
a) What structure is usually injured in a fight bite?
b) Which bite is worse in terms of infection; Cat, Dog or human?
c) What is the antibiotic of choice following a bite injury? (provided no allergies)
a) Extensor tendons at the MCPJ - bite can penetrate the joint capsule increasing risk of septic arthritis
b) Human bite is worse (only bite worse than a human is a Komodo dragon)
c) Broad spectrum eg. co-amoxiclav
label the muscles of the anterior forearm
True or False
a) Medial epicondylitis is also known as tennis elbow?
b) The flexor digitorum profundus tendon inserts onto the distal phalanges of digits 2-5
c) There is only 1 extensor muscle of digits 2-4.
a) False – it is known as golFers elbow as it the Flexor tendon origin.
b) True
c) False – the main extensor is extensor digitorum, but there is also extensor indices and extensor digiti-mini
A 34 year old man presents following injuring his hand during a rugby match. He presents with pain on the volar surface of his distal middle finger and bruising. When you examine him there is a lump felt at the level of the DIPJ. When you assess his movements he is unable to flex the DIPJ of the middle finger when the movement is isolated.
What is the most likely pathology?
Flexor tenon rupture (middle finger is commonly injured)
Lack of movement at DIPF indicates FDP is injured as this inserts onto the distal phalanx
a) What is the common mechanism of rupturing a flexor tendon?
b) How would you manage a flexor tendon rupture?
c) How would management differ if the injury was caused by attrition in rheumatoid arthritis (usually an extensor tendon)?
a) Opposing force against resisted flexion/griped finger.
b) Surgical repair ➞ splinting (allow repair to heal) and physiotherapy (improve movement)
c) Will likely need a tendon transfer as the ruptured ends are uneven due to being gradually worn down, thus not as amenable to repair.
Describe this x-ray
This is an adequate x-ray of a hand, there are no patient details available.
There is a fracture dislocation of the 1st metacarpal.
There is an oblique fracture at the base of the 1st metacarpal, the fracture is simple, complete, segmental, with complete lateral displacement of the distal fragment.
We only have one view so cannot comment on angulation.
It does not appear shortened or rotated
a) What is a the eponymous name for this fracture?
b) Which ligament causes a fragment of bone to be left behind?
c) Which muscle causes the dislocation.
a) Bennet’s fracture dislocation
b) Anterior oblique ligament
c) Abductor pollicis longus
