Hand_Scenario

Question 1

Hand_Scenario

Answer 1

1. History
   
   1. Age/Sex
   2. O nset
   3. P osition
   4. Q uality/Quantity
   5. R adiation
   6. S ymptoms associated
      
      1. Neurologic
      2. Mechanical
      3. Constitutional
      4. Local
   7. T iming
   8. AA
   9. PSHX, PMHX, Meds, Allergies
   10. Family Hx, Social Hx (EtOH, tobacco)
   11. Handedness, Occupation, Sports
   12. ADLs
   13. ROS
2. Physical Exam
   
   1. Look
      
      1. Gait
      2. S welling
      3. E rythema
      4. A trophy
      5. D eformity
      6. S kin changes
   2. Feel
   3. Move
   4. NV Exam
   5. Special Tests
3. Imaging
   
   1. Xrays, other modalities
4. Diagnosis or DDx
   
   1. Implications (AVN risk, infection, etc.)
5. Acute Rx and work-up
   
   1. Reduce/splint/traction, ER tests/consults, admit, further imaging, plan OR for trauma
6. Treatment plan
   
   1. Goals
   2. Non-operative Rx
      
      1. Indications
      2. options
   3. Operative Rx
      
      1. Indications
      2. Options
   4. Consent
      
      1. Outcome
      2. Risks
         
         1. immediate
         2. late
   5. Pre-op
      
      1. labs (x-match), tests (ECK, CXR), old OR reports, consults
   6. Post the case
      
      1. patient, surgery, implants, adjuncts (teams, consultants, special equipment), table, flouro, monitoring
7. Technique
   
   1. Position, ABX
   2. Incision, approach, fixation
8. Post-op
   
   1. NV exam, compartment check
   2. Xrays
   3. Immobilization
   4. Weight Bearing Status, Physio
9. Disposition and Follow-up
   
   1. F/U plan
10. Complications
    
    1. List potential complications
    2. Prevention
    3. Treatment