MEMORIZE HAND Flashcards
SCAPHOID
- Indications for ORIF scaphoid
- Indications volar approach scaphoid vs dorsal approach
Indications
* 1 Proximal pole fractures
* 2 Displacement >1mm
* 3 Associated carpal instability
* 4 Humpback deformity
* - a Dorsal cortical angle (DCA > 160)
* - b Lateral intrascaphoid angle (LISA > 30)
* - c Height to length ratio (HLR > 0.6)
* 5 Radiolunate angle >15 degrees
* 6 Scapholunate angle > 70 degrees
* 7 Associated perilunate dislocation
* 8 Comminuted fracture
* 9 Unstable vertical or oblique fractures
Volar: distal pole, humpback or if preferred for mid-waist
- a Russe approach = Wagner incision, through FCR subsheath, retract FCR ulnarly, ligate superficial palmar
artery, vertical capsulotomy, ranguer small piece of trapezium for appropriate trajectory, obtain reduction,
retrograde variable threaded cannulated screw
Dorsal: proximal pole or if preferred for mid-waist (contraindicated for humpback)
- b Dorsal midline incision over listers tubercle, incise retinaculum, split third and fourth extensor compartment, T
capsulotomy, dorsal antegrade variable threaded cannulated screw
VISI
- clinical signs of VISI
- VISI management
1Decreased grip strength
2 Tender LT
3 LT shuck = grasp lunate and triquetrum and alternate volar dorsal loads
4 Kleinman’s shear test = same hand position as shuck but lunate is loaded dorsally
5 Compression test = grasp triquetrum and deviate radially and ulnarly
- 1 Nonoperative – splint, injections, and activity modification
- 2 LT repair: Open volar & dorsal approach for acute injuries, suture anchors fixation augmented with k wires and dorsal capsular plication
- 3 LT reconstruction: Distally based slip ECU through bone tunnels triquetrum and lunate from ulnar to radial
- 4 LT Arthrodesis
Adjunctive procedures
+/- Ulnar shortening osteotomy
+/- Midcarpal arthrodesis
+/- PRC
PERILUNATE
- Radiographic signs perilunate
- Reduction maneuver perilunate vs lunate
- mngmnt for irreducible lunate dislocation
PA radiograph
* 1 Intercarpal gapping
* 2 Disruption of Gilulas lines (proximal proximal row, distal proximal row, proximal distal row)
* 3 Loss carpal height (carpal height/third metacarpal ~ 0.5)
* 4 Signet ring sign (from scaphoid flexion)
* 5 Piece of pie sign
Lateral view
* 6 Loss collinearity between radius to capitate
* 7 Spilled teacup sign
Perilunate: Extension traction → flexion → finger pushing on lunate
Lunate: Flexion → traction → extension → finger pushing on lunate
Dual volar dorsal approach
Volar first - Longitudinal incision ulnar to PL (in line with ring finger)
Retract flexor tendons and median nerve laterally
Incise transverse carpal ligament
Identify and reduce lunate and proceed to dorsal approach for fixation
Then dorsal step cut retinaculum 3-4 split, ligament sparing capsulotomy, suture anchor fixation, and cross pin
