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UdeM PS questions > Main 1 (Fingertip, Tendon injury) > Flashcards

Main 1 (Fingertip, Tendon injury) Flashcards

1
Q

Mallet finger classification name and details

A

Doyle

Type 1: closed injury with or without small fragment avulsion
Type 2: laceration at or proximal to DIP
Type 3: Associated with deep abrasion
Type 4a: peds, transepiphyseal plate fracture
Type 4b: fracture with 20-50% of articular surface
Type 4c: fracture with >50% of articular surface

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2
Q

What to look for in bony mallet x ray (2)

A

% of articular involvement
Presence of volar subluxation (V sign)

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3
Q

Approach to Mallet treatment according to thee classficiations

A

**Type 1: **Non operative, 6 weeks of immobilisation with DIP in extension, K-wire extension splinting if patient is not compliant

Type 2 and 3: Dermatotenodèse

Type 4: K-wire extension splinting

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4
Q

Surgical indication of bony Mallet (3)

A

> 50% articular surface involvement
3mm diasthesis
Volar subluxation of distal phalanx

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5
Q

Surgical approach to bony Mallet

A

Usually CRPP

If big fragment:
- screw
- Bone anchor
- Jugger knot

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6
Q

Pinning method for bony mallet

A

1st K wire in extension bloc (no in fragment), make sure PIP is in slight flexion to prevent swan neck deformity

Longitudinal K wire through distal P3 to base of P2

Remove K wire at 4 weeks, keep splint for 2 weeks

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7
Q

Deformity caused by a chronic mallet, and mechanism of deformity

A

Swan neck deformity

Central slip tension and volar plate laxity

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8
Q

Treatment of chronic Mallet with swan neck deformity

A

Try conservative first with splinting

Fowlers central slip tenotomy (decreases central slip tension)

Oblique retinacular ligament reconstruction (increase DIP extension)

Ténodermodèse avec embrochage

Greffe de palmaris pour recréer extenseur terminal

Arthrodèse

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9
Q

à quoi sert le ligament rétinaculaire transverse et oblique

A

TRL: prevents dorsal subluxation of the lateral band.

ORL: Tightens with extension and extends DIP with PIP extended

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10
Q

Décrire brièvement les 4 étapes de la procédure de Curtis

A
  1. relâchement du TRL et ténolyse des extenserus
  2. sectionnement du TRL
  3. fowler tenotomy
  4. enlever 5mm de cicatrice de la central slip et l’avancer
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11
Q

2 structures à inciser (autre que la peau) dans une ténotomie de Fowler pour corriger un mallet chronique

A

Ligament rétinaculaire transverse
Central slip a/n de son insertion

*principe basé sur le fait que le tendon a guéri avec une certaine élongation

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12
Q

en théorie, à partir de quelle zone d’extenseur faut-t-il faire des core sutures

A

à partir de zone VI

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13
Q

Describe + Elson test

A

Can extend DIP with PIP in full flexion

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14
Q

Treament of chronic PIP subluxation (swan neck) (2)

A

Direct repair volar plate
Volar plate tenodesis using slip of FDS

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15
Q

Treatment of lateral PIP dislocation

A

Closed reduction and buddy tapping with eAROM

If irreducible: lateral band interposition –> operative intervention

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16
Q

Treatment of volar PIP subluxation

A

Reduction
If doubt of central slip: splint in full extension for 6 weeks

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17
Q

Contraindications to primary repair of tendon laceration (3)

A

Gross contamination
Evidence of active infection
Lack of stable soft-tissue coverage
Autre blessure plus importante

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18
Q

quelle est la particularité du FDP de l’index

A

a un ventre musculaire séparé des autres

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19
Q

Reviser le positionnement des poulies A et C

A
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20
Q

Risks associated with shortening FDP tendon more than 1cm + explanation

A

Quadriga effect
Due to common FDP muscle belly
Will cause limited active flexion of uninjured fingers

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21
Q

Explain the Lumbrical plus deformity + 2 conditions hwne it can arise

A

Force of the FDP is transmitted to the lumbricals –> paradoxal extension of IP joint when attempting flexion

Caused by shortening of FDP, usually with finger amputation

Caused by loose tendon graft for flexor tendon repair

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22
Q

Number of strand in flexor repair to allow for early active motion rehab protocol

A

4 strands

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23
Q

Name 5 types of flexion tendon core suture techniques and # of strands each

A

Modified Kessler (2)
Cruciate (4)
Adelaide (4)
Strickland/Indiana (4)
Tsuge (4)

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24
Q

Ideal distance of exit of core suture from tendon laceration

A

7-10mm

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25
% of increased strength when epitendinous suture added to core suture for flexor tendon repair
10-50%
26
4 advantages of adding and epitendinous suture to core suture for flexor tendon repair
Increase strength of repair Minimizes internal tendon collagen exposure Minimizes adhesion formation Promotes glidding
27
Favored tendon tenorraphy technique for tendon transfer
Pulvertaft weave (3 weaves for maximal strength)
28
Indications (2) for repair of flexor tendon injury
FDP >50-60% of tendon laceration
29
Indication for direct tendon repair vs tendon to bone repair for zone 1 FDP injury
>7-10mm from tendon stump: direct repair <7-10mm from tendon stump: tendon to bone repair
30
Techniques (2) for tendon to bone repair for zone 1 FDP injury
Pullout suture with dorsal tie over button Direct fixation to bone with suture anchor
31
Classification for Jersey finger avulsion
Leddy and Packer Type 1: FDP retract into palm, disruption of both vincula Type 2: FDP retracts to level of PIP, held by intact vincula Type 3: FDP avulses with large bony fragment, held by A4 pulley Type 4: Fracture of P3 base + avulsion of the tendon from the bony fragment Type 5: idem à 4 mais fx comminutive
32
Treatment of Jersey finger according to each Leddy and Packer classification
Type 1: Urgent surgical repair <1 week, pull-out vs bone anchor technique Type 2: up to 6 weeks post-injury for repair, pull-out vs bone anchor technique Type 3: ORIF (K-wire or screw fixation) vs pull-out or bone anchor technique Type 4: ORIF + tendon repair
33
Complication fo repairing FDP tendon using FDS tendon
Creates stiffness in uninjured PIP joint
34
What % of A2 and A4 pulley can be released to repair flexor tendon in zone 2
25-50% of A2 100% of A4
35
Reviser les zones de Verdan
36
% de la population qui n'ont pas de FDS-5
ad 20%
37
Tendon retrieval methods (4)
Proximal to distal milking Reverse Esmarch bandage Tendon retriever clamp Proximal incision
38
Flexor zone repair with worse prognosis
Zone 2
39
Important consideration of flexor tendon zone 4 repair
Must repair transverse carpal ligament to prevent bowstringing Step-lengthening to prevent compression of median nerve
40
Immobilisation position after flexor tendon repair
Wrist at 0-30° flexion MCP 45-70° flexion IP near full extension to 15° flexion
41
3 Rehab protocols after flexor tendon repair
Complete immobilization (for children or unreliable adults) Duran: Controlled passive ROM protocol Early active ROM protocol (for 4 strand repairs) Kleinert: PROM dynamique avec bandes élastiques de traction
42
Complications (5) for flexor tendon repair
Decrease ROM Stiffness Tendon bowstringing Quadriga Lumbrical-plus deformity
43
Conditions (3) for tenolysis after flexor tendon repair
>3-6 months since repair Minimum 4-6 weeks of dedicated hand therapy Discrepancy between PROM (full) and AROM (limited)
44
Treatment of joint contracture (3)
Splinting Hand therapy Recalcitrant cases: capsulotomy
45
Indications (3) for flexor tendon reconstruction (vs primary repair)
Segmental tendon loss Delayed presentation with tendon retraction Failed attempt of direct repair
46
Common donors (3) for tendon grafting
Palmaris longus Plantaris Extrinsic 3rd or 4rth toe extensor
47
Indication for 1 stage vs 2 stage tendon graft reconstruction for flexor tendon injury
1 stage if intact tendon sheath and pulley system
48
Explain steps of the first stage of the two stage flexor tendon repair
Excise native tendon Use silicone/Hunter rod: stitch to distal FDP stump, leave proximal end loose in palm or distal forearm
49
Timing for second stage of the two stage flexor tendon repair
8-12 weeks
50
Explain steps of the second stage of the two stage flexor tendon repair
Harvest tendon graft Secure tendon graft to proximal end of silicone rod Pass tendon graft through pseudo-sheath Distal repair with pull-out suture or suture anchor Proximal repair to FDP or FDS
51
Comment ajuster la tension dans une ténorraphie par greffe tendineuse
en suivant la cascade naturelle
52
What is the Paneva-Holevich modifications for the 2 stage FDP reconstruction technique + 1 avantage 1 inconvénient 1 contre-indication
During first stage suture FDS to FDP proximal stump Second stage: use FDS for the tendon graft Advantage: the proximal tenorraphy is healed for the second stage Inconvénient: difficile d'ajuster la tension dans le 2nd stage car ta ténorraphie est distale Contre-indiqué si ton FDS est intacte
53
Tendon transfer option for FDP repair
FDS from uninjured adjacent finger to tendon stump of injured FDP tendon
54
À cbm de temps la ténorraphie est-elle la plus faible? la plus forte?
Plus faible 7-10 jours post op Most strenght: 21-28 jrs Maximal strenght: 6 mois
55
Long-term (3) sequalae of tendon bowstringing
Limited digital flexion Decreased grip strength PIP joint contracture
56
Intra (2) and extrasynovial (1) graft source for pulley reconstruction
Intrasynovial: extensor retinaculum, FDS tendon slip Extrasynovial: PL
57
Indication of extensor tendon repair in zone 2
If only one lateral band lacerated or <50% laceration --> conservative treatment >50% laceration: repair
58
Treatment of zone 3 open versus close central slip injury
Open: central slip must be repaired: primary tendon repair vs bone anchor Closed: splint PIP in full extension for 6 weeks (free MCP and DIP) However if large bone fragment, favor operativ fixation
59
Stages of Chronic Boutonnière deformity, which can be adressed by splinting (Burton classification)
1: Passively correctable deformity (splinting) 2: fixed contracture with contracted lateral bands (splinting) 3: Fixed contracture with joint fibrosis 4: fixed contracture with joint arthritis
60
Operative interventions (3) for chronic boutonnière deformity
Distal Fowler tenotomy Tendon grafting Lateral band mobilization Curtis procedure
61
nommer 4 technique de réparation de boutonnière aigue si perte de substance
greffe tendineusse Snow Aiche V-Y
62
Qu'est-ce qu'une pseudo boutonniere
contracture en flexion de l'IPP suivant une lésion d'hyperextension (ext: entorse, lésion des lig coll) --> cicatrisation de la plaque palmaire et des lig coll
63
Col de cygne: 2 catégories de causes et exemples pour chaque
**Laxité plaque palmaire** * PAR (via érosion pannus) * Laxité ligamentaire généralisée * Trauma **Force d'extension sur l'IPP plus forte que celles de flexion** * MCP subluxation palmaire (PAR) * Mallet finger (dorsalisation lat bands) * Rupture/lacération FDS (ext non opposée) * Contracture des intrinsèques
64
Col de cygne: 3 trouvailles à l'examen physique
-snapping and locking of the fingers -hyperextension of PIP -flexion of DIP
65
tx chirurgical d'un col de cygne
- FDS tenodesis indicated with FDS rupture - spiral oblique retinacular ligament reconstruction - central slip tenotomy (Fowler) - volar plate advancement - Arthrodèse IPD - tx du mallet chronique
66
Classification of sagital band injuries
Type 1: injury without stability Type 2: Injury with tendon subluxation Type 3: Injury with tendon dislocation
67
Treatment of sagital band injury without subluxation
Buddy tapping to adjacent radial digit
68
Treatment of acute (2-3 weeks) vs chronic (>2-3 weeks) sagital band injury with subluxation
Acute: MCP joint splinting for 8 weeks Chronic: repair or reconstruction
69
nommer 3 muscles accessoires / anormaux au extenseurs
Extenseur carpi radialis intermedius (12%) Extenseur medi proprius (10%) Extenseur digitorum brevis manus (3%)
70
2 principales fonctions des bandelettes sagittalles
Prévient hyperextension des MCP Prévient subluxation latérale des tendons extenseurs
71
What are the most important stabilzers of the CMC joint (2)
anterior oblique ligament AND intermetacarpal ligament ## Footnote Source: post-traumaric thumb reconstruction article
72
Lésion de poulie: quel doigt plus atteint (2) et quelle poulie
D4, D3 A2 > A4
73
Meilleure imagerie pour dx une rupture de poulie
IRM
74
Traitement d'une rupture de poulie
Glace Attelle en bague Repos AINS
75
Décrire les deux méthodes de reconstruction de poulie
Encircling: tu prends greffe extrasynoviale et tu fais des loop autour de la phalange a/n de la poulie que tu veux reconstruire A2 : 3 loop, deep to extensor A4 : 2 loop, superficial (sous-cut) Non-encirling: tu weaves ta greffe (intra ou extra synoviale) dans le restant de poulie)
76
In what percentage of the population is the palmaris longus absent (unilat vs bilat)
unilat :15% bilat: 9%

UdeM PS questions (52 decks)

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