Upper Extremity

Question 0

Where do distal humerus ORIF typically fail?

Answer 0

Supercondylar level

Question 1

What flap is used to cover deficits over posterior elbow?

Answer 1

Reverse radial forearm flap

Question 2

How should posterior incision cross elbow? (Midline, medial or lateral)

Answer 2

Medial to olecrenon, because lateral skin flap is more vascular

Question 3

Three approaches for intra articular distal humerus fracture?

Answer 3

Bryan-Murray
triceps split
olecrenon osteotomy

Question 4

Which posterior approach allows for the most intra articular visualization?

Answer 4

Olecrenon osteotomy (>50%)

Question 5

When would you not want to do olecrenon osteotomy? (What patient population)

Answer 5

Patient who may need a TEA (relative contraindications)

Question 6

When doing Olecrenon osteotomy, what are operative considerations?

Answer 6

Consider pre-drilling (put plate on, drill holes, take plate off)
Landmark bare area
Chevron cut
Rough finish (don’t cut all the way through with saw)
Medial and lateral windows using paratricipital approach
Identify and protect collateral ligaments
Cut almost all the way through before breaking roughly to facilitate interdigitation

Question 7

What is bare area?

Answer 7

Area deficient of cartilage at intraarticular base of coronoid, landmark for olecrenon osteotomy

Question 8

When fixing olecrenon with tension band wires, what is ideal shape/position of wires in relation to fracture?

Answer 8

Should cross at fracture (or osteotomy site), distance from k wires to fracture should be the same as distance from fracture to exit holes.

Question 9

The triceps has three heads but only two insertions, which heads coalesce distally?

Answer 9

Medial and lateral

Question 10

Name some principals of parallel plating for distal humerus fractures, with respect to screws.

Answer 10

As many screws as possible
Try and get a screw from both plates through every fragment
Interdigitate screws
Compress sequentially alternating medial and lateral
Every screw should go through plate

Question 11

2004 study by Kamineni et al., DHF with TEA replacement, what was the issue with the TEA?

Answer 11

Better over first 2 years, but TEA has increased issues after 2 years including periprosthetic fractures and need for revisions.

Question 12

McKee et al 2008, study of TEA vs ORIF for DHF, what was main finding?

Answer 12

TEA in patients over 65 have better DASH for 2 years.

Question 13

What is SLAC?

Answer 13

Scapholunate advanced collapse

Question 14

What is SNAC?

Answer 14

scaphoid nonunion advanced collapse

Question 15

With radial deviation the scaphoid —— .

Answer 15

Flexes

Question 16

With ulnar deviation the scaphoid ——.

Answer 16

Extends

Question 17

Contribution to wrist rom.

• —- occurs at radio carpal joint.
• —– occurs at mid carpal joint.

Answer 17

60%

40%

Question 18

Madelungs deformity is of what bone?

Answer 18

Distal radius

Question 19

Someone had a proximal row carpectomy ten years ago, comes in with slowly worsening wrist pain, what is diagnosis?

Answer 19

Arthritis between lunate surface of capitate and distal radius

Question 20

Signs of DRUJ injury on X-ray?

Answer 20

Ulnar styloid fracture
Widened DRUJ
Subluxed ulna on lateral
>5 mm shortening of radius