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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
Q

% of increased strength when epitendinous suture added to core suture for flexor tendon repair

A

10-50%

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26
Q

4 advantages of adding and epitendinous suture to core suture for flexor tendon repair

A

Increase strength of repair
Minimizes internal tendon collagen exposure
Minimizes adhesion formation
Promotes glidding

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27
Q

Favored tendon tenorraphy technique for tendon transfer

A

Pulvertaft weave (3 weaves for maximal strength)

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28
Q

Indications (2) for repair of flexor tendon injury

A

FDP
>50-60% of tendon laceration

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29
Q

Indication for direct tendon repair vs tendon to bone repair for zone 1 FDP injury

A

> 7-10mm from tendon stump: direct repair
<7-10mm from tendon stump: tendon to bone repair

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30
Q

Techniques (2) for tendon to bone repair for zone 1 FDP injury

A

Pullout suture with dorsal tie over button

Direct fixation to bone with suture anchor

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31
Q

Classification for Jersey finger avulsion

A

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
Q

Treatment of Jersey finger according to each Leddy and Packer classification

A

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
Q

Complication fo repairing FDP tendon using FDS tendon

A

Creates stiffness in uninjured PIP joint

34
Q

What % of A2 and A4 pulley can be released to repair flexor tendon in zone 2

A

25-50% of A2
100% of A4

35
Q

Reviser les zones de Verdan

36
Q

% de la population qui n’ont pas de FDS-5

37
Q

Tendon retrieval methods (4)

A

Proximal to distal milking
Reverse Esmarch bandage
Tendon retriever clamp
Proximal incision

38
Q

Flexor zone repair with worse prognosis

39
Q

Important consideration of flexor tendon zone 4 repair

A

Must repair transverse carpal ligament to prevent bowstringing

Step-lengthening to prevent compression of median nerve

40
Q

Immobilisation position after flexor tendon repair

A

Wrist at 0-30° flexion
MCP 45-70° flexion
IP near full extension to 15° flexion

41
Q

3 Rehab protocols after flexor tendon repair

A

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
Q

Complications (5) for flexor tendon repair

A

Decrease ROM
Stiffness
Tendon bowstringing Quadriga
Lumbrical-plus deformity

43
Q

Conditions (3) for tenolysis after flexor tendon repair

A

> 3-6 months since repair
Minimum 4-6 weeks of dedicated hand therapy
Discrepancy between PROM (full) and AROM (limited)

44
Q

Treatment of joint contracture (3)

A

Splinting
Hand therapy
Recalcitrant cases: capsulotomy

45
Q

Indications (3) for flexor tendon reconstruction (vs primary repair)

A

Segmental tendon loss
Delayed presentation with tendon retraction
Failed attempt of direct repair

46
Q

Common donors (3) for tendon grafting

A

Palmaris longus
Plantaris
Extrinsic 3rd or 4rth toe extensor

47
Q

Indication for 1 stage vs 2 stage tendon graft reconstruction for flexor tendon injury

A

1 stage if intact tendon sheath and pulley system

48
Q

Explain steps of the first stage of the two stage flexor tendon repair

A

Excise native tendon
Use silicone/Hunter rod: stitch to distal FDP stump, leave proximal end loose in palm or distal forearm

49
Q

Timing for second stage of the two stage flexor tendon repair

A

8-12 weeks

50
Q

Explain steps of the second stage of the two stage flexor tendon repair

A

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
Q

Comment ajuster la tension dans une ténorraphie par greffe tendineuse

A

en suivant la cascade naturelle

52
Q

What is the Paneva-Holevich modifications for the 2 stage FDP reconstruction technique +
1 avantage
1 inconvénient
1 contre-indication

A

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
Q

Tendon transfer option for FDP repair

A

FDS from uninjured adjacent finger to tendon stump of injured FDP tendon

54
Q

À cbm de temps la ténorraphie est-elle la plus faible? la plus forte?

A

Plus faible 7-10 jours post op
Most strenght: 21-28 jrs
Maximal strenght: 6 mois

55
Q

Long-term (3) sequalae of tendon bowstringing

A

Limited digital flexion
Decreased grip strength
PIP joint contracture

56
Q

Intra (2) and extrasynovial (1) graft source for pulley reconstruction

A

Intrasynovial: extensor retinaculum, FDS tendon slip

Extrasynovial: PL

57
Q

Indication of extensor tendon repair in zone 2

A

If only one lateral band lacerated or <50% laceration –> conservative treatment

> 50% laceration: repair

58
Q

Treatment of zone 3 open versus close central slip injury

A

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
Q

Stages of Chronic Boutonnière deformity, which can be adressed by splinting (Burton classification)

A

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
Q

Operative interventions (3) for chronic boutonnière deformity

A

Distal Fowler tenotomy
Tendon grafting
Lateral band mobilization
Curtis procedure

61
Q

nommer 4 technique de réparation de boutonnière aigue si perte de substance

A

greffe tendineusse
Snow
Aiche
V-Y

62
Q

Qu’est-ce qu’une pseudo boutonniere

A

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
Q

Col de cygne: 2 catégories de causes et exemples pour chaque

A

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
Q

Col de cygne: 3 trouvailles à l’examen physique

A

-snapping and locking of the fingers
-hyperextension of PIP
-flexion of DIP

65
Q

tx chirurgical d’un col de cygne

A
  • 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
Q

Classification of sagital band injuries

A

Type 1: injury without stability
Type 2: Injury with tendon subluxation
Type 3: Injury with tendon dislocation

67
Q

Treatment of sagital band injury without subluxation

A

Buddy tapping to adjacent radial digit

68
Q

Treatment of acute (2-3 weeks) vs chronic (>2-3 weeks) sagital band injury with subluxation

A

Acute: MCP joint splinting for 8 weeks

Chronic: repair or reconstruction

69
Q

nommer 3 muscles accessoires / anormaux au extenseurs

A

Extenseur carpi radialis intermedius (12%)
Extenseur medi proprius (10%)
Extenseur digitorum brevis manus (3%)

70
Q

2 principales fonctions des bandelettes sagittalles

A

Prévient hyperextension des MCP
Prévient subluxation latérale des tendons extenseurs

71
Q

What are the most important stabilzers of the CMC joint (2)

A

anterior oblique ligament
AND
intermetacarpal ligament

Source: post-traumaric thumb reconstruction article

72
Q

Lésion de poulie: quel doigt plus atteint (2) et quelle poulie

A

D4, D3
A2 > A4

73
Q

Meilleure imagerie pour dx une rupture de poulie

74
Q

Traitement d’une rupture de poulie

A

Glace
Attelle en bague
Repos
AINS

75
Q

Décrire les deux méthodes de reconstruction de poulie

A

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
Q

In what percentage of the population is the palmaris longus absent (unilat vs bilat)

A

unilat :15%
bilat: 9%

UdeM PS questions (52 decks)

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