Digital Distortions
What deformity is the most reliable physical examination finding indicating an unstable phalanx fracture requiring reduction rather than simple splinting.
malrotation
What is the major advantage of intramedullary headless compression screws in proximal phalanx fractures.
minimal tendon disruption permitting early motion?
What deformity develops when a central slip injury is missed.
boutonniere deformity
What clinical finding is more important than radiographic angulation when deciding on surgery.
rotational deformity
A reduced PIP fracture-dislocation requiring more than what degree of flexion to remain reduced is generally considered unstable
30 degrees
What flexor tendon inserts onto the middle phalanx
FDS
This complication is increased when plates are placed dorsally instead of laterally.
extensor tendon adhesions
What percentage of articular involvement generally predicts an unstable dorsal fracture-dislocation.
40-50%
A closed proximal phalanx fracture with 25° angulation and rotational deformity should generally receive this treatment
Reduction with operative stabilization
Closed mallet finger injuries are generally treated with uninterrupted splinting for approximately this duration.
8 weeks
Forced extension of a flexed DIP joint produces this tendon injury
Jersey finger
These fractures benefit most from lag screw fixation rather than K-wires.
long oblique fractures
What soft tissue structure most commonly blocks reduction in a complex MCP dislocation
volar plate
This physical examination maneuver is essential for detecting rotational malalignment.
Having the patient flex the fingers into a fist and assessing for digital scissoring
A 9-year-old has an open physeal fracture of the distal phalanx with the nail plate lying superficial to the eponychial fold.
Appropriate treatment includes
A. Splint only
B. Buddy taping
C. Nail removal, irrigation, reduction, nail-bed repair if indicated, antibiotics
D. Observation
E. DIP fusion
C. Nail removal, irrigation, reduction, nail-bed repair if indicated, antibiotics
This is an open Salter-Harris I/II fracture until proven otherwise.
What two forces create the apex solar deformity seen in proximal phalanx shaft fractures?
Interossei (flexing the proximal fragment) and the extensor mechanism (extending the distal fragment)
Crossed K-wires should ideally avoid violating this structure
PIPJ
What is a hemihamate arthroplasty and what is it used for?
Reconstruction of the volar lip using a dorsal distal hamate osteochondral graft.
What radiographic sign indicates articular step-off
loss of congruent subchondral arc
The greatest risk of transarticular pinning across the PIP joint is this postoperative complication.
joint stiffness
These muscles produce ulnar deviation of the index and radial deviation of the small finger after proximal phalanx fractures.
interossei
What fixation method is often preferred for unstable neck fractures in children
crossed k-wires
What ligament provides the primary restraint against hyperextension at the PIP joint
volar plate
Normal digital alignment places all fingertips toward this landmark during flexion
scaphoid tubercle
Loss of what amount of proximal phalanx length may produce approximately 12° of extensor lag