Hand surgery

Question 1

Hand surgery for trauma

Answer 1

• For fractures that are extra-articular: no rotational deformity accepted, must operate to restore normal alignment
• Bennetts fracture: intra-articular fracture at the base of the first metacarpal
• No man’s land: lacerations to the flexor tendon sheath (from MCP to insertion of FDS on middle phalanx) leads to high probability to scar tissue formation

Question 2

Classic signs of tendon sheath infection

Answer 2

• Diffuse swelling of the finger
• Tenderness along the flexor sheath
• Finger held in slightly flexes position
• Excruciating pain w/ passive extension of finger

Question 3

Wartenburg’s syndrome vs wartenburg’s sign

Answer 3

• Wartenburg’s syndrome: lesion to the superficial radial nerve
• Wartenburg’s sign: lesion to the ulnar causes 5th phalanx to constitutively abduct

Question 4

Allen’s test

Answer 4

• Tests the presence of collateral circulation in the hand
• Occlude the radial and ulnar arteries at the wrist
• When one side is released all fingers should regain color
• Test again and release the other artery to confirm the same result