Deck 2

Question 1

AAOS practice guidelines defining acceptable distal radius fracture reduction

Answer 1

• <3mm height loss
• <10 degrees of difference in volar tilt between contralateral
• > 10 degrees radial inclination (normal 20)
• <2mm intra-articular stepoff

Question 2

do you need to treat the ulnar styloid in association with distal radius fracture?

Answer 2

no
no difference in outcome if there is ulnar styloid nonunion even if >2mm displaced

• only fix it if there is a DRUJ instability issue

Question 3

management of type 1 TFCC tears

Answer 3

these are traumatic and involve either debridement or repair
1A (central tear) = debridement, leave the remaining 2mm peripheral rim to prevent instability

1B = peripheral tear at ulnar fovea = repair

1C = avulsion from volar ulnocarpal ligaments = repair

Question 4

management of type 2 TFCC tears?

Answer 4

typically a combination of debridement and ulnar shortening osteotomy regardless of the subtype.
- a component of ulnar impaction syndrome

Question 5

unexplained dorsal wrist pain in a patient 20-40 years, get this test

Answer 5

MRI

- rule out keinbock’s

Question 6

nonunion rate for scpahoid fractures when tehre has been a delay in treatment?

Answer 6

> 28 days delay yields a 45% nonunion rate

Question 7

indications for surgery on scaphoid fracture

Answer 7

anything indicating instability

• displacement >1mm
• humpback deformity (intra-scaphoid angle >35 degrees)
• proximal pole fracture

Question 8

diagnosis of scaphoid fracture AVN by:

Answer 8

MRI with contrast

- no enhancement = AVN

Question 9

bone grafts to use for scaphoid nonunions

Answer 9

1,2 intercompartmental superior retinacular artery

OR medial femoral condyle on a superior medial genicular pedicle

Question 10

what ligament inserts on triquetrum and accounts for avulsion fractures

Answer 10

dorsal radiocarpal

Question 11

most common carpal instability:

Answer 11

DISI (SL ligament, SL angle >60 degrees)

• leads to arthritis
• proximal migration of capitate

Question 12

gold standard for evaluating DISI?

Answer 12

wrist arthroscopy

Question 13

Mayfield’s 4 stages of lunate instability

Answer 13

1. SL disruption
2. capitolunate (capitate) dislocation dorsally
3. lunotriquetral dissociation
4. lunate dislocation volarly

Question 14

what happens when metacarpal fractures shorten

Answer 14

extensor lag

7 degrees for every 2mm of shortening

Question 15

fracture fragment seen in Bennett fracture

Answer 15

volar beak fracture

- tethered by the palmar oblique ligament

Question 16

main deforming force in bennet’s fracture

Answer 16

APL

- secondarily it is the EPL and thumb adductors

Question 17

indication for treating epibasal thumb metacarpal fractures

Answer 17

angulation >30 degrees is indicatdion for pinning

Question 18

what’s a bony gamekeeper’s thumb

Answer 18

bony avulsion of the collateral ligament off of P1

- never stress until you see an xray because you can displace this

Question 19

indications for acellular autograft for nerve repair

Answer 19

up to 3-5cm defects
schwann cells migrate along the graft
almost as good as autograft?

Question 20

autografts for nerve reconstructions

Answer 20

• sural nerve, MABC, LABC

- gold standards

Question 21

if you notice a sympathetic chain disruption, yo ushould assume:

Answer 21

a pre-ganglionic root avulsion of the plexus

- look for Horner’s syndrome (C8/T1)

Question 22

rules for nerve injuries:

Answer 22

• if open wound, then explore
• if closed, and no return by 3-6 months, then explore
• if deficit with pre-ganglioninc injury, reconstruct at 3 monhts

Question 23

what is Oberlin’s transfer

Answer 23

• a FCU fascicle (ulnar) to biceps (msc) transfer for a C5-6 root injury

Question 24

NCS findings in CTS:

Answer 24

distal motor latency of >4.5msec

distal sensory latency of >3.5msec

Question 25

EMG findings in CTS:

Answer 25

APB and OP - positive sharp waves - fibrillations at rest

Question 26

long term benefits of steroids in CTS:

Answer 26

20% will have symptomatic improvement at 1 year | - but if symptoms improve, 95% of patients then improve with surgery

Question 27

comparative outcomes of endoscopic vs open CTS:

Answer 27

earlier return to work, less post op pain with endoscopic - by 6 weeks, no clinical differences higher complication rates in endoscopic, nerve injuries, superficial palmar arch injury

Question 28

the ligament of struthers (NOT the arcade)

Answer 28

lateral supracondylar ligament in 1% of population which can cause median nerve compression

Question 29

differentiating pronator syndrome from CTS

Answer 29

- proximal forearm pain - sensory disturbance in palmar cutaneous branch of median nerve - tinel's sign over the proximal forearm

Question 30

manifestations of AIN syndrome

Answer 30

- inability to flex the thumb IP or the index DIP

Question 31

treatment of AIN syndrome

Answer 31

OBSERVATION | - surgery if no resolution by 3-6 months for exploration and decompression

Question 32

first late manifestation of ulnar neuropathy

Answer 32

wartenberg's sign

Question 33

Zones of Compression at Guyon's canal

Answer 33

1: prpximal to bifurcation = sensory and motor 2: deep motor branch compression only 3: superficial sensory branch only

Question 34

most common radial nerve palsy tendon transfers

Answer 34

- PL to EPL - PT to ECRB - FCR to EDC

Question 35

common transfers for loss of thumb opposotiion in low median nerve palsy:

Answer 35

this is called opponensplasty - FDS - EIP - add digiti minimi - palmaris longus (Camitz)

Question 36

transfers for high median nerve palsy

Answer 36

- opponensplasty same as low median nerve palsy - BR to PL for thumb IP flexion - side to side FDP transfer for index DIP function

Question 37

lumbrical plus finger:

Answer 37

cuased by FDP injury and retraction putting tension on the FDP which originates from it - IP joint extension - do a lumbrical release