Hand & Upper Limb

Question 1

Most common carpal coalition

Answer 1

Lunotriquetral

Question 2

Carpal bone ossification sequence

Answer 2

• capitate (3-4 mths)
• hamate
• triquetrum
• lunate
• scaphoid (4-5 yrs)
• trapezium
• trapezoid
• pisiform (6-8 yrs)

CAP (kid) –> SCAHPOID (skateboarder) –> PISS OFF (oldest)

Question 3

Most common type of pre-axial polydactyly

Answer 3

Type IV = duplicated proximal phalanx

2nd most common = Type II (duplicated distal phalanx)

Question 4

Pollex abductus

Answer 4

Abnormal connection between EPL and FPL

= band of tendon from FPL to EPL

= eliminates active flexion and extension of the thumb IP joint

= abduction of affected digit + abscence of IP joint crease

Question 5

Polydactyly demographics & inheritance

Answer 5

Pre-axial = whites > blacks

most commonly sporadic

Post-axial = blacks > whites

autosomal dominant

Question 6

Radial longitudinal deficiency - top points

Answer 6

• 50% bilateral
• most commonly right side when unilateral
• 80% thumb & index finger hypoplasia
• Associated with
  
  • TAR (thrombocytopenia-absent radius)
  • Fanconi’s anemia
  • Holt Oram (congential heart dx)
  • VACTERL
  • Craniofacial abnormalities
• Tests to order
  
  • CBC
  • Renal US
  • Echo

Question 7

VACTERL

Answer 7

• vertebral anomalies
• anal anomalies
• cardiac anomalies
• tracheo-esophageal fistula
• renal anomalies
• limb anomalies (*radial deficiency)

Question 8

Radial longitudinal deficiency - Bayne Classification

Answer 8

• Type 1: short distal radius
• Type 2: hypoplastic radius (deficiency both ends of radius)
• Type 3: partial abscence of radius (central or distal)
• Type 4: complete abscence of radius (most common*)

Question 9

Radial longitudinal deficiency - surgical options/considerations

Answer 9

• Operate at 6-12 mths age
• Centralization = ulna aligned with 3rd MC
• Radialization = ulna aligned with 2nd MC (overcorrection)
• GOALS
  
  • optimize UE length
  • straighten the forearm axis
  • reconstruct/ablate the thumb
  • pollicize the index finger

Question 10

Ulnar Clubhand - Associated Anomalies

Answer 10

SF REST

• syndactyly
• fibular hemimelia
• radial head dislocation
• elbow instability
• synostosis
• thumb duplication/hypoplasia

Question 11

Thumb Hypoplasia

Answer 11

• Often bilateral
• Blauth type V most common (complete abscence)
• Type V treatment = index pollicization
  
  • new position of index = 120 pronation, 40 abduction, 15 extension