Hand Wrist

Question 1

Carpal Instability

Answer 1

Carpal instability dissociative
Carpal instability non-dissociative
1.Palmar CIND-Visi
Common, Rx R/L or 4c fusion
2.Dorsal CIND - Disi
Uncommon, lig laxity, 4cfusion(?)
3.Combined
Lig laxity, soft tissue imbrication
4.Adaptive
Secondary to DR malunion - osteotomy

Question 2

DRUJ arthritis options

Answer 2

Low demand:
Darrach (head resection)

High demand:
TFCC intact–> hemiresection+tissue I’position
TFCC not intact–> sauvé-kapandji

Ulnar stump instability:

1. ECU slip (prox based) & FCU slip (dist based) tenodesis
2. Scheker arthroplasty (useful for salvage)

Question 3

Anatomical components of palmar fascia (7)

Answer 3

Ulnar aponeurosis
Palmar aponeurosis
Radial aponeurosis
Transverse ligament of PA
Natatory ligaments
Commissural fibres
Septae of Legueu & Jevara

Question 4

Anatomical components of TFCC (6)

Answer 4

1. Dorsal radio ulnar lig
2. Volar radio ulnar lig
3. Ulnocarpal ligaments
4. Articular disc
5. Meniscal homologue
6. ECU sheath

Question 5

Scapholunate instability (arthroscopic)

Answer 5

Geissler

1. Attenuation only (viewed from MC portal)
2. Attenuation + minimal step/gap
3. Step/ gap can accommodate a/s probe
4. Gap can accommodate 2.7mm scope