surgery - PLASTICS hand trauma Flashcards

Question

definitive mx for amputated digit?

Answer 1

Finger replantation avoid smoking + hand therapy

Answer 2

Thumb at any level – the thumb provides 40-50% of hand function Multiple digits – preference to prioritise thumb and middle finger in order to achieve pinch grip Mid-palmar amputation Single digit distal to FDS insertion (Flexor Zone 1) Any amputation in a child

Answer 3

Contraindications for performing the procedure includes those with a mangled or severe crush injury, any segmental amputated, or prolonged ischaemic time (>24hrs).

Answer 4

The main complication to consideration in finger replantation is replantation failure, most commonly due to either arterial thrombosis or venous insufficiency. Other complications that can occur include infection, stiffness, altered sensation, or bone malunion.

Answer 5

result from a traumatic injury, such as a laceration to the volar hand surface, and therefore can occur with concurrent neurovascular injury.

Answer 6

VERDAN"S ZONES

Answer 7

Flexor Digitorium Profundus (FDP) Flexor Digitorium Superficialis (FDS) Flexor Pollicis Longus (FPL) Flexor Carpi Radialis (FCR) Flexor Carpi Ulnaris (FCU).

Answer 8

come from two sources, direct vascular perfusion and diffusion through synovial sheaths.

Answer 9

via use of a series of pulleys. Digits 1-4 contain 5 annular pulleys*, labelled A1 to A5, and cruciate pulleys, labelled C1 to C4 (Figure 2). The thumb contains two annular pulleys and one interposed oblique pulley.

Answer 10

inability to flex their finger(s) inability to move that joint weakness or pain on resisted movement.

Answer 11

Passively extend the patients wrist whilst asking them to relax their upper limb fully and this will allow assessment of the tenodesis effect; maintenance of digit extension at the proximal interphalangeal joint (PIPJ) or distal interphalangeal joint (DIPJ) with wrist extension indicates a fault with the flexor tendon.

Answer 12

plain film radiograph

Answer 13

all jewellery must be removed and any wound present irrigated to reduce any gross contamination tetanus booster + antibiotics Keep the hand elevated to reduce swelling. exploration +/- tendon repair and washout in theatre, before being closed and placed in a splint. flexor tendon repair or reconstruction

Answer 14

tendon adhesions, bowstringing, re-rupture, joint contracture, swan-neck deformities, and trigger finger

Answer 15

boxer's fracture bennett's fracture rolando fracture

Answer 16

a fracture of the 5th metacarpal neck, which typically occurs from a clenched fist striking a hard surface (such as a wall);

Answer 17

these are typically very stable fractures and can be managed with a period of buddy taping and then full mobilisation

Answer 18

an intra-articular fracture of the 1st metacarpal base, with a palmar and ulnar fragment

Answer 19

typically requires reduction and surgical fixation.

Answer 20

an intra-articular fracture of the 1st metacarpal base, with a Y or T configuration.

Answer 21

requires reduction and surgical fixation.

Answer 22

traumatic injury pain and swelling reduced range of motion

Answer 23

A metacarpal fracture with significant rotational deformity is a common indication for surgical intervention. Rotational deformity is evaluated by asking the patient to make a fist. In a normal hand, the fingertips will point towards the scaphoid tubercle. In a metacarpal fracture, the finger may be rotated internally or externally, with the fingertip no longer pointing towards the scaphoid tubercle. In severe cases, the fingertips may overlap; this is referred to as “scissoring” of the digits

Answer 24

plain film radiograph CT

Answer 25

remove jewellery pain relief elevate hand in high-arm sling to reduce swelling immobilise 3-4wks with buddy taping, ulnar gutter or solar resting splint repeat radiograph after 1 wk

Answer 26

rotational deformity, intra-articular involvement, significant volar angulation, significant shortening, or an unstable fracture pattern

Answer 27

Closed reduction and percutaneous fixation with K-wires – the fracture is reduced and then held in place with temporary wires, which are removed in 3-4 weeks’ time Open reduction and internal fixation – an incision is made in the skin and the fracture is reduced under direct vision; metal screws or plates are then used to hold the fracture in the correct place

Answer 28

an occur through crush, axial loading, torsional, or hyperflexion* mechanisms. Sports injuries and machinery accidents are the most common causes of phalangeal injuries, especially in younger patients, with falls being the more common cause in older patients.

Answer 29

trauma localised pain reduced function may be obvious defrost with tenderness +/- reduced movement concomitant joint subluxation, joint ligament injury, or tendon avulsion (mainly in mallet injuries), or nail bed injuries (in distal phalangeal fractures).

Answer 30

plain film radiograph CT MRI

Answer 31

adequate bony alignment and stabilisation, with early mobilisation displaced fracture should be reduced in A+E

Answer 32

open reduction with internal fixation (ORIF) or closed reduction percutaneous pinning (CRPP) using K-wires.

Answer 33

unstable, open, or comminuted that have concomitant associated soft tissue injury, or significant angulation or shortening will often require an operation too.

Answer 34

stiffness due to prolonged immobilisation malunion or non-union UNCOMMON metalwork infection, pain, scarring, and tendon adhesions.

Answer 35

can be either at the PIPJ (more common), DIPJ (often associated with tendon avulsion), or the MCPJ, more common in the dorsal direction secondary to a hyperextension injury

Answer 36

plain film radiograph

Answer 37

closed reduction and splinting/buddy-taping if closed not possible, joint will be opened and reduced in theatre + temp K-wires

Answer 38

Crush injuries from doors, machinery, and heavy equipment are the most frequent presentation.

Answer 39

Nail bed injuries are most commonly caused by crush injuries. Crushing trauma to the nail bed can cause compression of the nail, nail bed, or bony surface. Damage to a specific region of the nail bed can give characteristic changes during regrowth to the nail for example, a scar in the germinal or sterile matrix can result in a split or absent nail.

Answer 40

subungual haematoma nail bed laceration nail bed avulsion

Answer 41

A subungual haematoma forms when blood collects between the nail and nail bed (Fig. 2). The colour of the haematoma can change from red/purple to brown/black giving it a bruise-like appearance. The formation of a subungual haematoma is often related to heavy impact such as a door crush injury or a heavy weight falling on the finger.

Answer 42

Compression of the nail bed between the distal phalanx and nail can result in a simple or complex laceration. A nail bed laceration is usually present with an intact nail and a subungual haematoma greater than 50% of the nail surface area. Sharp objects like knives can penetrate the nail if they land with sufficient force resulting in a nailbed laceration.

Answer 43

A nail bed avulsion is when the nail and part of the nail bed are pulled away from the rest of the finger. This is usually caused by higher energy injuries with traction and crushing forces. Avulsion injuries most commonly occur in the ring finger and are often associated with other injuries, such as distal phalanx fractures and dislocations.

Answer 44

pain following ep of trauma soft tissue swelling or lacerations

Answer 45

clinical palin film radiograph to rule out fractures, dislocations, and foreign bodies.

Answer 46

simple nail bed injuries may be managed conservatively, often with a short course of prophylactic oral antibiotics. require removal of the nail plate, nail bed repair, and splinting of the eponychial fold. The nail plate is carefully separated from the underlying sterile and germinal matrix soft tissue and soaked in betadine solution.

Answer 47

Nail bed repairs are undertaken usually with a 6-0 absorbable suture, such as Vicryl Rapide. The removed nail plate may then be trimmed and used to splint eponychial fold to facilitate growth of the new nail plate.