General
Phalangeal Fx
Metacarpal Fx
Dislocations
Thumb Injury
100
Name the splint
Ulnar gutter
100
What is #1 complication of operatively treated phalangeal fractures?
Digital stiffness
100
What is Jahss maneuver?
Maneuver used for reduction of MC neck fractures by flexing the MP and PIP joints to 90 degrees, and using the proximal phalanx to push up the metacarpal head
100
What 3 structures provide greatest stability to PIP joint?
Medial and lateral collateral ligament and the volar plate
100
In Bennett fracture, what is the deforming force that causes proximal migration of the thumb metacarpal?
Abductor pollicis longus
200
What is toxic dose of lidocaine 1% with or w/o epinephrine (in mg/kg)?
- 1% Lidocaine: > 4mg/kg
- 1% Lidocaine with epinephrine (1:100,000): > 7mg/kg
200
What is an appropriate management of this Seymour fracture?
Open reduction, debridement of the fracture site, repair of associated nail bed laceration, and possible Kirschner wire fixation of the fracture across the DIP joint.
200
What is the treatment of 5th MC neck fx with 40 degrees of apex dorsal angulation?
Acceptable angulation
(OR closed reduction and ulnar gutter splint to achieve better angulation)
200
Inability to obtain reduction of closed dorsal PIP J dislocation is often related to what?
Volar plate
200
How is Bennett's fracture reduced?
With longitudinal traction, palmar abduction, and pronation
300
Describe the fracture
Displaced, dorsally angulated transverse fractures of the metacarpal shafts of the ring and small fingers.
300
What is the long-term complication of untreated "mallet finger" (Describe it)?
Swan-neck deformity (DIP flexion and PIP hyperextension
300
What is the acceptable angulation for metacarpal shaft fracture of middle finger?
10-15 degrees
300
What two structures can lead to irreducible complex dorsal dislocation of index MCP joint?
Lumbricals (radially) and flexor tendons (ulnary)
300
How do you test for integrity of the UCL?
by applying valgus (radially directed) stress to the MCP joint
400
What is the appropriate Salter-Harris fracture classification of this fracture?
Type IV (through epiphysis, growth plate, and metaphysis)
400
Identify this type of injury? What type is it (I-IV) And what is the appropriate treatment?
- Jersey finger (avulsion of FDP tendon from its insertion point),
- Type IV (Large avulsion fracture limits FDP retraction to the level of the DIP joint – caught on A4 pulley).
- ORIF
400
Name three different operative techniques to fix metacarpal shaft fracture
- CRPP
- Open reduction with lag screw
- Open reduction with dorsal plating
400
What are some reasonable treatment options for fracture/dislocation of PIP joint with severely comminuted volar base fracture of the middle phalanx involving 40% of joint surface?
Dynamic external fixation
Volar plate arthroplasty
Hemi-hamate graft
400
What is Stener lesion?
formed when the distally avulsed UCL of thumb MCP J comes to lie dorsal to the leading edge of the adductor aponeurosis
500
What is the safe position or intrinsic plus position of the hand?
Wrist extended 20-30 degrees, MP joints flexed 70-90 degrees, and IP joints in full extension
500
What is an important factor to consider, other than the degree of intra-articular step, when deciding to operate on a bony mallet finger?
Distal phalanx subluxation
500
Indications for operative fixation of metacarpal fractures? Name 5
- Malrotation
- Irreducible fractures
- Intra-articular fractures
- Open fractures
- Fractures with bone loss
- Fractures associated with tendon, vascular or nerve injury
- Multiple hand or wrist fractures
- Polytrauma patients
- Reconstruction
500
Dorsal extension block splinting is indicated for what PIP J fractures/dislocations?
- the maximum percentage of middle phalanx joint avulsion that is acceptable for closed reduction is approximately 30% to 40%
- no more than 30 degrees of flexion can be accepted to maintain reduction.
500
What indicates a complete UCL tear on physical exam?
Complete UCL tear likely if radial deviation of thumb at the MCP joint (flexed or extended) > 35 degrees or 10-15 degrees more compared to the opposite thumb