injuries and conditions

Question 1

scaphoid fx

Answer 1

most common (70%) of all carpal fx.
MOI: FOOSH.
4-6 months in cast, tends toward delayed/nonunion particularly in ages >40. Commonly requires ORIF/ vascularized bone graft to heal.
Fx of proximal 1/3rd can disrupt blood supply from radial art which enters in at distal side of waste.
Preiser’s.

Question 2

triquetral fx

Answer 2

2nd most common carp fx, most freq a dorsal cortical fx.
MOI: forced hyperflexion or avulsion
palpate by radial deviation.
nondisplaced-> cast immobilization 4-6weeks.
displaced might require ORIF.

Question 3

lunate fx

Answer 3

3rd most common carpal fx
MOI: repetitive trauma-> microtears. or direct traumatic blow.
common symptoms: pain on central dorsal wrist, loss of motion at wrist. diminished grip strength.
Kienbocks.

Question 4

hook of hamate fx

Answer 4

common in baseball and softball.

possible complication: damage to terminal branch of ulnar nerve

Question 5

Boxer’s fx

Answer 5

fx of neck of 5th metacarpal

Question 6

Bennet’s fx

Answer 6

intra-articular fx involving the 1st carpometacarpal joint of thumb. Most freq of all thumb fxs.
“palmar beak fragment”

Question 7

mallet finger

Answer 7

rupture of extensor tendon at distal phalanx, with/without bony avulsion)
DIP joint splinted at 0 degrees.
May produce swan neck deformity.

Question 8

Boutonniere deformity

Answer 8

rupture of central slip of extensor tendon.
MCP hyperextension, PIP flexion, DIP hyperextension.
PIP is splinted at 0 degrees.

Question 9

Dupuytrens contracture.

Answer 9

idiopathic flexion contracture of finger flexion tendon. Tx: surgical debridement or release

Question 10

most commonly affected with contusions

Answer 10

radius

Question 11

wrist tenosynovitis

Answer 11

DeQuervain’s disease, involving abductor pollicis longus and extensor pollicis brevis
Finkelstein’s test (not particularly sensitive)

Question 12

ganglion of wrist

Answer 12

herniation to synovial sheath. not typically removed unless symptomatic. surgery not 100% effective.

Question 13

Colles fx

Answer 13

DISTAL radius displaced posteriorly.

“extension fx of radius.” think right hand make C at wrist.

Question 14

Smith Fx.

Answer 14

DISTAL radius displaced anteriorly. flexion fx of radius. opposite of Colles.

Question 15

Lunate dislocation

Answer 15

most common carpal dislocation.
very subtle
Special test, Murphy’s sign.
Kienbock’s

Question 16

scapholunate dissociation.

Answer 16

+when gap is >2-3 mm between scaphoid and lunate

scapholunate ligament is the most important lig at wrist. MOI: FOOSH/direct blow to hyperext wrist.

Question 17

Carpal tunnel syndrome

Answer 17

most common repetitive motion injury. 10 structures involved that reside in tunnel: median nerve, flexor pollicis longus, flexor digitorum profundus (4), flexor digitorum superficialis(4)