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Summer FDTN Exam 4 > Forearm > Flashcards

Forearm Flashcards

1
Q

Unstable forearm fractures include

A

Radial shaft Fx
Ulnar shaft Fx
Galiazzi (radial Fx, carpoulnar dislocation)
Monteggia (ulnar Fx, radial dislocation)

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2
Q

Stable forearm Fx is

A

Nightstick Fx (distal ulnar shaft Fx)

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3
Q

What is the MC distal radial injury

A

Colles Fracture 2/2 FOOSH

Distal radius fracture fragment tilts dorsally (distal part goes upwards)

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4
Q

Other distal radial Fx are

A

Smith’s: oppo of colles, distal radius fracture fragment tilts ventrally (fall on hand inwards)
Barton: Intraarticular Fx w/ carpal dislocation

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5
Q

What XR view is best for diagnosing colles vs smiths

A

Lateral! because you can see the way the bone is oriented

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6
Q

What is a radial torus buckle fracture

A

Fx of distal metaphysis causing buckling of cortex 2/2 compression failure
MC in kids <10
Can cause bone to lose structural integrity and predispose to easy fractures in the future

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7
Q

What is a greenstick Fx

A

complete Fx of tension side of cortex w/ buckling of compression side
AKA bending of the bone! tension side is the outer curve, compression side is the inner curve

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8
Q

How do you treat a Torus buckle fracture

A

Immobilize 4-6 wks until bone can heal

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9
Q

What are the carpal bones

A 
some lovers try positions that they cant handle; 
Scaphoid 
Lunate 
Triquetral
Pisiform 
Trapezium 
Trapezoid 
Capitate 
Hamate
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10
Q

What is the MC fractured carpal bone

A

Scaphoid!
MC 2/2 FOOSH in younger population
Limited blood supply leads to high incidence of nonunion and osteonecrosis

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11
Q

Clinical findings of scaphoid Fx are

A 
Snuffbox pain, ttp 
ROM limitations (limited extension and radial deviation
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12
Q

Why does scaphoid Fx result in limited blood supply

A

Radial artery passes through and provides blood supply (SF palmar branch), but is often damaged in the injury= no blood flow to the area

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13
Q

How do you manage Scaphoid Fx

A

Long arm thumb cast x 6-12 weeks

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14
Q

What imaging do you get with suspected scaphoid Fx

A

1: XR! but it takes 10-14 days for a Fx line to show, so if the 1st XR is negative but you highly suspect Fx, repeat in 10-14 days
2: If 2nd XR is negative for Fx but you still suspect it, get an MRI

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15
Q

What happens to different fractures of phalanges

A

Displaced transverse and oblique Fx: become angulated
Spiral Fx: tend to rotate (ex. you make a fist and the pinky rotates inwards)
Displaces, spiral, comminuted, intra-articular Fx: refer to specialist

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16
Q

Look at slide 31 and know how to associate Fx with it’s picture!

A

Do it

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17
Q

What is the MC Fx of the hand

A

Boxer’s Fx; distal metaphysis of 5th MC

Results from closed fist striking an object

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18
Q

How do you manage Boxer’s fracture

A
  • Ulnar gutter splint if <15 degrees angulated, to cover transverse, oblique, base, and head
  • Surg consult if >15 degrees angulated, intra-articular, comminuted, or spiral
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19
Q

What is DeQuervian’s tenosynovitis

A

Inflammation of the sheath around abductor pollicis longus and extensor pollicis brevis
Sheath thickens and constricts tendon

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20
Q

DeQuervian’s Tenosynovitis will show

A

pain in 1st dorsal extensor compartment (snuff box) worse w/ moving thumb and making a fist
Swelling
crepitus as pt flexes and extends thumb

21
Q

What is Finklestein’s test

A

pain with passive stretching of tendons used to test DeQuervian’s tenosynovitis
Tuck thumb into your fist, and ulnar deviate. this stretches the inflamed tendons over radial styloid causing pain

22
Q

How do you manage DeQuervian’s tenosynovitis

A

NSAIDs
Thumb spica splint
avoid offending activity
steroid injections

23
Q

Difference between DeQuervian’s and a scaphoid fracture

A

Usually, DeQuervian’s is non-traumatic while Scaphoid is traumatic

24
Q

What is Gamekeeper’s thumb

A

Ulnar collateral ligament sprain (1st MCP)
Caused by acute or chronic valgus stress
Will notice pain and swelling localized to ulnar (medial) aspect of thumb

25
Assessing for stability of 1st MCP UCL tear by applying valgus stress can reveal
Mild sprain: pain but no laxity Mod: pain and partial laxity Complete: pain and significant lacity
26
How do you treat Gamekeeper's thumb
Mild-Mod: brace | Surgical consult if complete tear, or if avulsion Fx involving >25% of articular surface
27
What is Mallet finger
Pain and inability to extend at DIP MC due to trauma to tip of a fully extended finger Rupture, avulsion, or laceration of extensor tendon at base of distal phalanx
28
How do you treat mallet finger
(not emergent, can obs first) 6-8 week splint- must be continuous. If extension is lost at any point, must start over w/ the 6-8 weeks If full extension is not achieved, consider surgical pinning
29
You need a surgical consult with mallet finger is
Failed conservative care Complete tendon laceration Fx involves >30% of articular surface
30
The surgical Tx for mallet finger is
You basically put a pin through the bone in the finger to keep it firm (Kind of like the penile implant) and then suture a button from the outside of the finger to the inner distal tip
31
What are the tendons of each finger
FDP: flexor digitorum profundus FDS: flexor digitorum superficialis
32
What is Jersey finger
Spontaneous (RA) or traumatic (forced extension of flexed finger), usually 4th finger, causing FDP to snap
33
Sx of jersey finger are
pain and swelling to palmar DIP Proximal fullness if tendon retracted Affected finger is more extended when hand is at rest Can't flex affected DIP
34
What should you never do when evaluating jersey finger
passively force finger into extension! you will pull the two parts further from each other and exacerbate the situation
35
How do yuo treat jersey finger
get an XR to assess for bony avulsion NEED surgery, pref in 7-10 days! Splint finger in presenting position while on their way to hand surgeon
36
Complications of jersey finger are
fibrosis and scarring of tendon sheath associated with delayed surgery
37
What is trigger finger
Nodular thickening of flexor tendon, usually idiopathic (or 2/2 RA and DM) MC at MP joint They try to make a fist and get resistance from affected finger, until they finally hear a pop
38
How do you treat trigger finger
``` Steroid injections (2 max) Surgical release if it persists despite injections ```
39
What is Dupuytren's contracture
Palmar fibromatosis (viking disease bc MC in men >50, northern european) Nodular thickening and contraction of palmar fascia, usually affecting 4th finger Does not cause much discomfort Affects flexion of MCP first, then PIP (travels distally)
40
How do you treat Dupuytren's contracture
Xiaflex injection: inject into contracted cord to break down cartilage. follow with manipulation the next day
41
What are ganglia of wrist and hand (synovial/mucous cysts)
cystic swelling overlying a joint or tendon sheath herniation of synovial tissue from a joint capsule or tendon sheath MC in 15-40 y/o
42
Where do ganglia of wrist and hand usually occur
Dorsum of wrist Volar radial aspect of wrist (less commonly over base of finger and DIP)
43
How do you treat ganglia cyst
Usually reassurance If acute, severe Sx: immobilize until size decreases and Sx relieve +/- needle aspiration (usually need to be repeated) If continued recurrence, surgical excision
44
How do you treat a mucous cyst
If closed: send to wrist and hand specialist 2/2 risk of infection in the joint being high If open: can drain in office
45
MCC of hand arthritis are
OA | secondary DJD
46
OA of hand commonly involves
DIP and PIP causes stiffness and loss of motion of fingers Herbeden and Bouchard nodes
47
What is a subungal hematoma
traumatic and painful blood collection under the nail | If traumatic, need an XR to make sure there is no fracture
48
How do you treat a subungal hematoma
If there is an underlying Fx, NO decompression! will cause an open fracture and increase risk of infx If no Fx: microcautery, 18g needle, or heated paperclip decompression

Summer FDTN Exam 4 (14 decks)

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