Hand MJS

Question 1

Normal anatomical parameters of distal radius

Answer 1

11 degrees volar tilt. 22 degrees inclination. 11mm length

Question 2

what percentage of A2 and A4 can be released without effecting biomechanical function

Answer 2

25%

Question 3

What autologous donor is best for pulley reconstruction

Answer 3

Extensor Retinaculum. You can also used slip of FDS.

Question 4

How long do you wait between surgery in a two stage tendon reconstruction

Answer 4

> 3 months

Question 5

Quadregia

Answer 5

FDP has common muscle belly. If you overtighten one slip it will pull into the palm before the remining digits, weakening the grip strength. Treat with tendon lengthening or reconstruction if hand therapy does not work to loosen the involved digit up.

Question 6

Early active range of motion is not required in which patient population after flexor tendon repair

Answer 6

Pediatrics. You immobilize them in cast for 4 weeks because of their noncompliance and then leave them to do unrestricted movement. Early active ROM rehab not required.

Question 7

Volar approach to scaphoid. What are your landmarks.

Answer 7

FCR and scaphoid tubercle. Hockeystick incision overtop.

Question 8

in your volar approach to the scaphoid you encounter an artery running in the plane. Which is it

Answer 8

Palmar branch of radial artery. You can ligate it.

Question 9

Describe how you harvest cancellous radius bone graft to pack a comminuted scaphoid fracture

Answer 9

Harvesting
Make a 2 cm longitudinal incision proximal to Lister’s tubercle. Retract the tendons of the second compartment radially, and the extensor pollicis longus (EPL) in an ulnar direction. Use a chisel to cut three sides of a small square. Lift the dorsal radial cortex as a flap. After harvesting cancellous bone, replace the “lid”, and suture the periosteum and the skin incision.

Question 10

Indications for dorsal approach to the scaphoid fracture

Answer 10

proximal pole fracture
scaphoid fracture with SL lig injury
scaphoid fracture with distal radius fracture

Question 11

X ray findings in madelungs deformity

Answer 11

Hand displaced volarly and radially. 
Radiographs show:
can see proximal synostosis
characteristic undergrowth of the volar, ulnar corner of the radius
increased radial inclination
increased volar tilt

Question 12

Darrach Procedure

Answer 12

Darrach’s procedure or distal ulna resection is a surgical technique for the surgical removal of the head of ulna. It is performed in cases of radial–ulnar joint pain and instability.[1] The styloid process and muscular attachments are left intact.[2] Weakness and instability can develop after the procedure. It is most appropriate for elderly patients with low physical demands.[3]

Question 13

Sauve Kapandji Procedure

Answer 13

Sauve Kapandji procedure is a procedure which involves removal of about 10 mm of ulna proximal to distal radio ulnar joint and fixing the distal fragment of ulna to radius by means of screw. Sauve Kapandji procedure aims at creating a new joint at the level where ulna is cut and serves two purposes. First , the procedure unloads the ulnar bone so that there is more force is transmitted to the radius instead of the triangular fibrocartilage. Secondly, Sauve Kapandji procedure at the same time provides a distal stabilization.

Question 14

You are doing arthroscopy to assess and SL tear. What portals do you use?

Answer 14

The scapholunate interval is best assessed from the midcarpal portal with the arthroscope in the midcarpal ulnar portal and a probe in the midcarpal radial portal

Question 15

what are the secondary stabilizers of the scaphoid that are still intact during a static reducible SL tear?

Answer 15

secondary scaphoid stabilizers (scaphotrapezial-
trapezoidal, scaphocapitate, and radioscaphocapitate
ligaments).

Question 16

Be careful not in injure this ligament when you are performing a radial styloidectomy

Answer 16

radioscaphocapitate

Question 17

Whats a risk factor for chronic TFCC degeneration

Answer 17

Ulnar positive variance

Question 18

whats the number 1 and 2 affected joints in hand OA

Answer 18

DIP most common. Then CMC

Question 19

What ROM at the wrist can you expect after PRC?

Answer 19

Proximal row carpectomy results in wrist motion that is 50 to 75 percent that of the contralateral
side.

Question 20

What do you need to ensure before you proceed with a PRC

Answer 20

that the capitate and lunate facet of radius are not arthritic.

Question 21

Advantage of PRC of 4CF

Answer 21

One important advantage of proximal row carpectomy
over intercarpal fusion is that it does not
require a lengthy period of immobilization for an
arthrodesis to heal. The procedure has been used
even in young active persons, with good functional
and clinical results.

Question 22

When performing a PRC or a 4CF it is critical to preserve this structure

Answer 22

radioscaphocapitate ligament

Question 23

The wrist subluxes in which direction with Rheumatoid Arthritis

Answer 23

“SUV”

Supination, ulnar deviation and volar deviation

Question 24

Differential for loss of digit extension in the context of rheumatoid arthritis

Answer 24

Differentials for loss of digital extension
PIN neuropathy
extensor tendon rupture
extensor tendon subluxation (torn radial sagittal band)
MCP volar subluxation
trigger finger

Question 25

Name a complication of the darrach procedure

Answer 25

ulnar impingement syndrome

Question 26

Describe the Fowler Procedure

Answer 26

release of the extensor tendon distal to triangular ligament to assist with DIP flexion in the context of a boutanniere deformity.

Question 27

How do you differentiate between CTS, pronator syndrome and AIN syndrome

Answer 27

AIN is motor only.

Pronator syndrome has palmar cutaneous branch involvement.

Question 28

What percentage or Obstetrical brachial plexus injuries with have a spontaneous recovery with no sequelae

Answer 28

92%

Question 29

Name 4 secondary reconstructive operations to restore shoulder/elbow function in a brachial plexus injury that is over a year old

Answer 29

Steindler flexorplasty
upper trapezius transfer
pec major transfer
lat dorsi/teres major re routing

Question 30

Surgical Indications in obstetrical brachial plexus palsy

Answer 30

1. positive horners with flail limb before 3 months
2. Absence of biceps/deltoid by 3-6 months
3. Failure of cookie test by 9 months
4. Failure to progress with respect to active movement scale at 6 month visit.

Question 31

autosomal dominant disorder associated with multiple keratoacanthomas

Answer 31

Muir Torre Syndrome

Question 32

Most common malignant soft tissue sarcoma of the hand

Answer 32

Epitheloid Sarcoma

Question 33

Most common spot for glomus tumours

Answer 33

Under the nail

Question 34

How many days does it take to grow out a nail

Answer 34

100

Question 35

patient presents with ulcerated nodules and abscess that follow lymphatic distribution. What is diagnosis

Answer 35

Sporotrichosis (sporothrix schenkii fungus)

Question 36

factors associated with amniotic band syndrome

Answer 36

prematurity, low birth weight, young mothers, multigravada mothers.
IT DOES NOT HAVE A GENETIC BASIS. ITS SPORADIC