Hand Surgery

Question 1

Mention indications for reimplant following amputation

Answer 1

Children, clean wound, thumb amputation

Question 2

Mention absolute & relative CI of reimplant of amputated finger

Answer 2

Abs:
1. Severe underlying medical conditions
2. Psychiatric pts
3. Multilevel injury
4. Inability to stop smoking for 3 m following reimplant
Rel:
1. Multilevel injury
2. Avulsion
3. Severe crush
4. Amputation bet 1st MCP & PIP

Question 3

Mention MC muscle affected by MC cause of shoulder pain

Answer 3

Supraspinatus in rotator cuff tendinitis (painful arc 60-120 in abduction)

Question 4

Describe ttt of stenosing tenovaginitis

Answer 4

Division of constricting fibrous flexor sheath

Question 5

Mention structures affected by De Quervain’s tenosynovitis

Answer 5

Inflammation of tendon sheath of abductor pollices longus & extensor pollices brevis

Question 6

C/P of Dupytren’s contracture

Answer 6

Nodule at the base of righ/little finger: firm irregular tight nodule with strands running to ring or little finger causing flexion deformity at MCP & PIP joints but DIP is free
Early: physiotherapy
Late: surgery subcutaneous fasciotomy or aponeurosis excision +/- capsulotomy & skin graft

Question 7

List principles of tendon repair

Answer 7

1. Extend the wound
2. Atraumatic retrieval of the tendon-with magnification
3. Preserve annular pulleys
4. Gentle tendon retrieval
5. Use strong non-absorbable suture material

Question 8

Mention X ray views required for hand fracture

Answer 8

AP & true lateral of individual finger
Oblique when close to a joint
Pre & post reduction

Question 9

List adv & disadv for early surgery in congenital hand deformities

Answer 9

Adv; full potential for growth, development & patterns of use. Improving scarring. Early incorporation of reconstructed part; reduced physiological affect
Dis; inc technical difficulty, possible inc anesthetic risk

Question 10

Mention CP of pre-axial arrest of hand

Answer 10

Radial club hand: hand is radially deviated, flexed with pronated & shortened forearm
Deficient thumb ray & carpal bones, radial nerves & vessels

Question 11

Mention examples of type II hand anomalies

Answer 11

Syndactyly, trigger thumb, Poland $, campylodactyly (failure of differentiation)

Question 12

Mention the most common type of congenital hand anomaly

Answer 12

Type 3 - duplication

Question 13

With respect congenital hand anomalies, type 4 is…., type 5 is…., type 6 is….

Answer 13

Overgrowth
Undergrowth
Constriction hand syndromes (w/ or w/out distal lymphedema)