Hand MJS Flashcards
Normal anatomical parameters of distal radius
11 degrees volar tilt. 22 degrees inclination. 11mm length
what percentage of A2 and A4 can be released without effecting biomechanical function
25%
What autologous donor is best for pulley reconstruction
Extensor Retinaculum. You can also used slip of FDS.
How long do you wait between surgery in a two stage tendon reconstruction
> 3 months
Quadregia
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.
Early active range of motion is not required in which patient population after flexor tendon repair
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.
Volar approach to scaphoid. What are your landmarks.
FCR and scaphoid tubercle. Hockeystick incision overtop.
in your volar approach to the scaphoid you encounter an artery running in the plane. Which is it
Palmar branch of radial artery. You can ligate it.
Describe how you harvest cancellous radius bone graft to pack a comminuted scaphoid fracture
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.
Indications for dorsal approach to the scaphoid fracture
proximal pole fracture
scaphoid fracture with SL lig injury
scaphoid fracture with distal radius fracture
X ray findings in madelungs deformity
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
Darrach Procedure
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]
Sauve Kapandji Procedure
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.
You are doing arthroscopy to assess and SL tear. What portals do you use?
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
what are the secondary stabilizers of the scaphoid that are still intact during a static reducible SL tear?
secondary scaphoid stabilizers (scaphotrapezial-
trapezoidal, scaphocapitate, and radioscaphocapitate
ligaments).
Be careful not in injure this ligament when you are performing a radial styloidectomy
radioscaphocapitate
Whats a risk factor for chronic TFCC degeneration
Ulnar positive variance
whats the number 1 and 2 affected joints in hand OA
DIP most common. Then CMC
What ROM at the wrist can you expect after PRC?
Proximal row carpectomy results in wrist motion that is 50 to 75 percent that of the contralateral
side.
What do you need to ensure before you proceed with a PRC
that the capitate and lunate facet of radius are not arthritic.
Advantage of PRC of 4CF
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.
When performing a PRC or a 4CF it is critical to preserve this structure
radioscaphocapitate ligament
The wrist subluxes in which direction with Rheumatoid Arthritis
“SUV”
Supination, ulnar deviation and volar deviation
Differential for loss of digit extension in the context of rheumatoid arthritis
Differentials for loss of digital extension
PIN neuropathy
extensor tendon rupture
extensor tendon subluxation (torn radial sagittal band)
MCP volar subluxation
trigger finger
Name a complication of the darrach procedure
ulnar impingement syndrome
Describe the Fowler Procedure
release of the extensor tendon distal to triangular ligament to assist with DIP flexion in the context of a boutanniere deformity.
How do you differentiate between CTS, pronator syndrome and AIN syndrome
AIN is motor only.
Pronator syndrome has palmar cutaneous branch involvement.
What percentage or Obstetrical brachial plexus injuries with have a spontaneous recovery with no sequelae
92%
Name 4 secondary reconstructive operations to restore shoulder/elbow function in a brachial plexus injury that is over a year old
Steindler flexorplasty
upper trapezius transfer
pec major transfer
lat dorsi/teres major re routing
Surgical Indications in obstetrical brachial plexus palsy
- positive horners with flail limb before 3 months
- Absence of biceps/deltoid by 3-6 months
- Failure of cookie test by 9 months
- Failure to progress with respect to active movement scale at 6 month visit.
autosomal dominant disorder associated with multiple keratoacanthomas
Muir Torre Syndrome
Most common malignant soft tissue sarcoma of the hand
Epitheloid Sarcoma
Most common spot for glomus tumours
Under the nail
How many days does it take to grow out a nail
100
patient presents with ulcerated nodules and abscess that follow lymphatic distribution. What is diagnosis
Sporotrichosis (sporothrix schenkii fungus)
factors associated with amniotic band syndrome
prematurity, low birth weight, young mothers, multigravada mothers.
IT DOES NOT HAVE A GENETIC BASIS. ITS SPORADIC
