Wrist and Hand

Question 1

Indications for Scaphoid fixation

Answer 1

Unstable fractures:

1. Proximal pole
2. Displaced > 1mm
3. 15 degree humpback deformity
4. Radiolunate angle > 15 (DISI)
5. Intrascaphoid angle > 35
6. Perilunate dislocation fractures
7. Comminuted fractures
8. Vertical or oblique fractures

Non-displaced waist fractures
- Decreased time to union

Question 2

Radial clubhand associations

Answer 2

Thrombocytopaenia Absent Radius (TAR) - (Thumb is usually present)

Fanconi’s anaemia - (Aplastic anaemia, Chromosomal breakage test to screen, Treat with Bone marrow transplant, Autosomal Recessive))

Holt-Oram Syndrome - (Cardiac defects, Autosomal Dominant)

VACTERL - (Vertebral, Anal atresia, Cardiac, TracheoEsophageal fistula, Renal agenesis, Limb)

VATER - (Vertebral, Anal atresia, TracheoEsophageal fistual, Renal agenesis)

Question 3

Principles of Tendon Transfers

Answer 3

Patient 1
Tendon 5
Bed 4
Technique 3
Function 1

Sensible patient

Strong
Sacrificable
Single
Synergistic
Sufficient excursion

Scarless bed
Stable bed
Supple joint
Sensate joint

Straight
Subcutaneous
Secured distally

Single function

Question 4

What are the Components of the TFCC (there are 7)

Answer 4

Articular disc
Meniscus homologue
Dorsal Radio-Ulnar ligament
Volar Radio-Ulnar ligament
Volar Lunate-Ulnar ligament
Volar Triquetral-Ulnar ligament
Ulnar collateral ligament

Question 5

Normal Bands in the hand and the Dupuytrens Cords that they cause

Answer 5

Pre-Tendinous Band (PB)
Spiral Band (SB)
Natatory Ligament (NL)
Lateral Digital Sheet (LDS)
Grayson's Ligament (GL)

Pre-Tendinous Cord (MCPJ flexion)
Central Cord (PIPJ flexion; from PB)
Spiral Cord (PIPJ flexion; from PB, SB, LDS, GL)
Lateral Cord (DIPJ flexion)
Natatory Cord (Webspace; from NL)
Retrovascular Cord (DIPJ flexion)