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Semester 4 PM Exam 4 > Surgical Wrist and Hand > Flashcards

Surgical Wrist and Hand Flashcards

1
Q

Fractures and Dislocations - what is usually most important

A

Soft tissue injury is usually more important - esp. in the hand
Bone injury must be stabilized in order to adequately treat the soft tissue injury

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2
Q

Fracture treatment goals

A

Obtain and maintain fracture reduction

Early motion

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3
Q

Bone/Joint Injury - stages of healing

A
  1. Heal w/o infection (first 2 weeks)
  2. Fracture healing (up to 6 weeks)
  3. Regain function/mobility (6-12 wks) – ROM and Strength
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4
Q

Volar Locking Plate - advantage

A

able to start early ROM

Studies show now advantage over casting though

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5
Q

Most common carpal bone to fracture

A

Scaphoid and then triquetrum

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6
Q

Fracture of base of thumb metacarpal - what to do

A

Requires surgery

Predisposes to arthritis

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7
Q

Someone comes in with finger sprain and bruising, what do you do

A

Refer for x-ray

Bruising may indicate a fracture

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8
Q

Hand dislocations - named by

A

the direction of the displacement of the distal segment

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9
Q

Complications with hand dislocations

A

Stiffness, arthritis

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10
Q

Mechanism of injury for hand dislocation

A

hyperextension with axial load

Jammed finger

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11
Q

Thumb MP joint injury - acute vs. chronic

A

Acute - can repair for 3 weeks, but after 3 weeks is chronic and needs reconstruction

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12
Q

Finger Fracture Therapy - pins are removed when and what can be done with therapy

A

3-4 wks
A/AA ROM
Splint for rest

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13
Q

Finger fracture - when discontinue splint

A

6 wks when fx heals - can do PROM then too

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14
Q

Open Dorsal Fracture/Dislocation PIP joint

A 
Digital block
Washout
Closed reduction
Splint
Early protected motion
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15
Q

Types of arthritis -

A

Post traumatic arthritis (Malalignment - Lose cartilage)
OA (Lose cartilage - malalignment)
RA (Synovitis - malalignment and lose cartilage)

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16
Q

Scaphoid nonunion can lead to what

A

Post traumatic arthritis

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17
Q

RA typical deformities

A 
Caput Ulnae
MP volar subluxation
Ulnar drift of fingers
Swan neck deformity
Thumb boutonniere deformity
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18
Q

Problems in arthritis - what are they complaining of

A 
Pain
Stiffness
Weakness
Functional disability
Social and emotional disability
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19
Q

Therapy for arthritis

A 
Modalities
Splints 
Adaptive tools
ROM ex. 
Strengthening
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20
Q

Surgical options for arthritic of wrist

A 
Arthroscopy
Excision bone
Interposition arthroplasty
Limited fusions
Total wrist fusion
Implant arthroplasty
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21
Q

Soft tissue problems - define by

A

Tissue group

  • nerve
  • mm and tendon
  • blood vessel
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22
Q

Nerve compression syndromes - what do they all have in common

A 
Pain at compression site
Radiation of pain
Numbness
Grip weakness
mm weakness
Activity related sx
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23
Q

Carpal tunnel - nerve is compressed by

A

Small space
Tenosynovitis
Position narrows space
Fracture hematoma

24
Q

CTS - More common in who

A

2/3 females

mostly over 40

25
Q

S/S CTS

A

Dec/altered sensation in thumb, index, middle, and ring
Pain in wrist that radiates prox
Night pain and numbness
Aggravated by activity, worse in certain positions

26
Q

Exam findings in CTS

A

Dec median n. distribution sensation
Weak grip
Thenar atrophy or weakness
Pos Tinels (percussion), Phalens (position), Durkans (pressure)

27
Q

What other pathologies are common with CTS

A

Diabetes Mellitus
Hypothyroidism
Positive family hx
Obesity, smoking, poor aerobic fitness

28
Q

Nonsurgical tx for CTS

A

Wrist splint - 3 to 6 wks
Relative rest
Cortisone injection
(into carpal tunnel 80% benefit - good for dx)

29
Q

Thenar atrophy sometimes need

A

mm transfers to restore function
Abd dig min
Palmaris longus
Ext Indicis proprius

30
Q

Goal with CTS surgery

A

Remove pressure from Median nerve

Cut transverse carpal tunnel ligament

31
Q

DeQuervains Syndrome

A

Stenosing ext tenosynovitis of 1st dorsal compartment

32
Q

Stenosing flexor tenosynovitis

A

Trigger finger, trigger thumb

33
Q

Common feature of tendon entrapment is what

A

Tenderness of compartment

34
Q

Tendon entrapment syndrome - early treatment

A

Activity modifications
Splints
Anti inflammatory meds
Cortisone injection into tendon sheath

35
Q

Trigger finger vs. Dupuytrens disease

A

Trigger finger = clicks, catches, painful to fully extend

Dupuy: No pain, unable to fully extend

36
Q

Dupuytrens Dx

A

Palmar Fibromas
Flexion contractures
Loss of ext. even passively
No loss of flexion

37
Q

Treatment for Dupuy

A

Collagenase injections
Fasciotomy
Fasceiectomy

38
Q

Newest nonsurgical tx for Dupuytrens

A

Xiaflex (collagenase clostridium)

39
Q

Needle Aponeurotomy - pros and cons

A

For D. cont
Pro - in office and local anesthetic use
Con - recurrence, nerve injury, skin tear, bumps remain)

40
Q

Subtotal palmar fasciotomy - therapy

A

early ROM, night time splinting 6 months

41
Q

Pros and cons to subtotal palmar fasciotomy

A

Pro - bumps gone, safer for PIP and DIP

Con - need surgical anesthetic, recurrence, neurovascular injury, healing time

42
Q

Ganglion cysts can relate to

A

Intra-articular pathology

SL ligament instability, TFCC tears, arthritis

43
Q

Complications after infection

A

STIFFNESS

usually due to - swelling, tendon adhesion, joint contracture

44
Q

Problems causing dysvascular fingers

A

Clotted vessels
Raynauds
Pseudoaneurysms

45
Q

Flexor and Extensor tendon repairs - what is important

A

zone of injury

Need to protect repair for 12 weeks post op

46
Q

Problems with flexor and extensor tendon repairs

A

Adhesions, rupture, contracture

47
Q

Critcial pulleys

A

A4

A2

48
Q

What is essential with extensor tendon repairs

A

correct length is essential!

49
Q

Micro-surgery would be to what

A

Nerve and BVs

50
Q

Post op microsurgery to nerve and BVs

A

Immobilize as necessary in safe position
Move joints ASAP
Usually 3 wks post op immob for arterial repairs to prevent vessel spasm

51
Q

Replantation indications

A

Any part in a child
Thumb
Multiple digits
Sharp lacerations

52
Q

Relative contraindications for replantation

A

Gorss contamination
Aculsion or crush injury
Single digit
Comorbidities that preclude surgery

53
Q

All thumb amputations should be evaluated for

A

reconstruction

54
Q

Single digit replantation is feasible but

A

not always the best option

55
Q

Function after replantation is always

A

less than normal!

cold intolerance, stiffness, numbess are 100% likely

Semester 4 PM Exam 4 (10 decks)

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