Forearm/Wrist Flashcards

1
Q

What are the different types of adult forearm fractures?

A

UNSTABLE:

  • Both bone forearm fracture
  • Galiazzi fracture
  • Monteggia fracture

STABLE
Nightstick fracture

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2
Q

What is a both bone fx?

A

Radial shaft fracture

Ulnar shaft fracture

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3
Q

What is a glaiazzi fx?

A

Mid to distal radial shaft

Assoc. carpoulnar dislocation

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4
Q

What is a monteggia fx?

A

Mid to proximal ulnar shaft

Assocradial head dislocation

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5
Q

What is a nightstick fracture?

A

Mid to distal ulnar shaft fracture

stable fx

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6
Q

What are some common distal radial fxs in adults?

A

Colle’s (MC)

Smith’s

Barton

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7
Q

What is a Colle’s fracture?

A

MC

Distal radius fracture fragment is tilted dorsally

+/- involvement of articular surface of radius

+/- ulnar styloid fracture

MOA: FOOSH

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8
Q

What is a smith’s fx?

A

Distal radius fracture fragment is tilted ventrally

MOA: wrist down when pt falls

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9
Q

What is a barton fx?

A

Intra-articular fracture associated with dislocation of the carpus

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10
Q

What x-ray view should you use to dx a colle’s or smiths fx?

A

lateral view

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11
Q

What are colle’s fractures reduced?

A

by closed manipulation

wrist first dorsiflexed, traction initiated as distal and volar thumb pressure applied over distal fragment

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12
Q

What is a radial torus “buckle” fx? Who is it MCly seen in?

A

Distal metaphysis

Buckling of cortex due to compression failure

MC in children <10

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13
Q

What is a greenstick fracture?

A

Complete fx of the tension side of the cortex with buckling of the compression side

On x-ray complete disruption on one side with buckle on opposite side

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14
Q

Tx of radial torus “buckle” fracture?

A

Immobilization x 4-6 weeks (cast or brace)

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15
Q

What is the MCly scaphoid fx?

A

Scaphoid Fractures

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16
Q

MOA of scaphoid fx?

A

FOOSH

Limited blood supply leads to high incidence of nonunion and osteonecrosis

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17
Q

Who usually gets scaphoid fx from FOOSH? What about radial fx?

A

kids/younger pts

older pts

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18
Q

Clinical findings of scaphoid fx?

A

Snuffbox pain / TTP

ROM limitations

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19
Q

Management of scaphoid fractures?

A

Long-arm thumb spica cast x 6-12
weeks

If clinical exam is indicative of fracture but x-rays are negative, cast and repeat x-rays in 10-14 days**

If follow up x-rays still negative but clinical concern persists order MRI

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20
Q

What are some complications of scaphoid fxs?

A

Avascular necrosis or failure to union

tx: internal fixation
or bone graph with anastomosis

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21
Q

Describe fractures of the metacarpals and phalanges

A

Displaced transverse and oblique fractures tend to angulate

Spiral fractures tend to rotate

Displaced*, spiral, comminuted and intra-articular fractures should be referred to specialist for further evaluation

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22
Q

What is the MC fx of the hand?

A

boxer’s fracture

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23
Q

Describe a boxer’s fracture

A

Distal metaphysis of

5th metacarpal
Results from closed fist striking an object

24
Q

Management of a boxer’s fracture?

A

Ulnar gutter splint <15 degrees (transverse, oblique, base & head)

Surgconsult:

  • Intra-articular
  • > 15 degrees -angulation
  • Comminuted
  • Spiral
25
Q

What is DeQuervain’s tenosynovitis?

A

Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons

Tendon sheath thickens and constricts the tendons

26
Q

Presentation of DeQuervain’s tenosynovitis?

A

Pain + tenderness in the first dorsal extensor compartment (anatomic snuffbox) aggravated by attempts to move thumb or make a fist

+/-Swelling

Crepitation as patient flexes and extends thumb may be noted

27
Q

What test can be used to eval for DeQuervain’s tenosynovitis?

A

Finklestein Test: Pain with passive stretching of the tendons

  • Direct the patient to place the thumb in their palm.
  • Have them cover the thumb with the fingers of the same hand, forming a fist.
  • Gently deviate the wrist towards the ulna. This stretches the inflamed tendons over the radial styloid, reproducing the patient’s pain.
28
Q

Tx of DeQuervain’s tenosynovitis?

A

NSAIDs

Thumb spica splint

Avoid offending activity

Steroid injection

29
Q

What is an ulnar collateral ligament sprain?

A

“Gamekeeper’s thumb” or “Skier’s thumb”

UCL injury at 1st MCP joint
Acute or chronic valgus stress

30
Q

How can you dif. DeQuervain’s tenosynovitis v. scaphoid fx?

A

hx of traumatic fall with scaphoid fx

31
Q

eval for ulnar collateral ligament sprain?

A

Pain and swelling localized to ulnar
aspect of thumb

Assess for stability by stressing the UCL

  • pain only: mild sprain
  • pain + laxity: mod sprain
  • pain +sig laxity: complete tear
32
Q

Tx of ulnar collateral ligament sprain?

A

Brace: mild to moderate sprain

Surg consult: complete tear or avulsion fracture involving >25% of the articular surface

33
Q

What is a mallet finger?

A

MC due to traumatic injury to the tip of a fully extended finger

Rupture, avulsion or laceration of extensor tendon at base of distal phalanx

34
Q

Presentation of mallet finger?

A

Pain and inability to extend at the DIP

35
Q

Tx of mallet finger?

A

xray

CONTINUOUS splinting for 6-8 weeks

If extension is lost at any point, healing is disrupted and the clock starts again

Surgical pinning if full extension not achieve

36
Q

When should you make a surg consult for mallet finger?

A

Failure with conservative care

Complete tendon laceration

Fx involving >30% of the articular surface

37
Q

surg tx of mallet finger?

A

place pin into bone x 3-4 weeks

38
Q

What is a flexor tendon injury “jersey finger” ?

A

Spontaneous (RA) or Traumatic (forced extension of actively flexed finger)

MC flexor digitorum profundus

4th (ring) finger affected most commonly 75%

39
Q

Presentation of Flexor Tendon Injury “Jersey Finger”?

A

Pain/swelling at palmar aspect of DIP

Proximal fullness if tendon retracted

Affected finger more extended at DIP when hand at rest

Inability to flex at affected DIP joint

40
Q

During PE of pt with suspected Flexor Tendon Injury “Jersey Finger”, should you try to passively force the finger into extension?

A

NO

order xray to eval for bony avulsion

41
Q

Management of Flexor Tendon Injury “Jersey Finger”?

A

Early surgical repair in all cases

Splint finger in presenting position

Hand surgeon referral

Best recovery if repaired within 7-10 days of injury

42
Q

Possible complications of flex tendon injury?

A

Fibrosis and scarring of tendon sheath

Assoc. with delayed surg repair

43
Q

What is trigger finger?

A

Nodular thickening of the flexor tendon

MC at the MP joint

MC idiopathic (but RA and DM at increase risk)

44
Q

Tx of trigger finger?

A

Steroid injections x 2 only

Surg release if persistent despite injection

45
Q

What is Dupuytren’s Contracture? Who is it usually seen in?

A

Palmar fibromatosis

“Viking disease”

Nodular thickening and contraction of palmar fascia

Men >50, northern European descent

46
Q

Presentation of Dupuytren’s Contracture?

A

Minimal discomfort

MC ring finger

Flexion of finger at MCP then PIP which occurs gradually

47
Q

Tx for Dupuytren’s Contracture?

A

Xiaflex injection:
-Breaks down collagen adhesion

  • Injected into contracted cord
  • Manipulation the following day
48
Q

Describe ganglia of the wrist/hands

A

aka Synovial Cyst, Mucous cyst

Cystic swelling overlying a joint or tendon sheath

Herniation of synovial tissue from a joint capsule or tendon sheath

Generally affect persons 15-40 years of age

49
Q

Where do ganglia of the wrist/hand typically occur?

A

Common locations:

  • Dorsum of the wrist
  • Volar radial aspect of wrist

Less common:

  • Base of finger
  • DIP joint
50
Q

Tx of ganglia of wrist/hand?

A

If typical s/s
= reassurance

acute or severe sxs: =immobilization will relieve symptoms and may cause a decrease in size (not permanent)

Needle aspiration

Surgical excision

NOT biblical method

51
Q

Can you aspirate a mucous cyst?

A

no, risk of joint infection

52
Q

What are the MC causes of arthritis of the hand?

A

Osteoarthritis

Secondary degenerative joint disease

53
Q

Presentation of osteoarthritis of the hand?

A

DIP and PIP joints are most often involved

Stiffness and loss of motion in the fingers

54
Q

What are bouchard nodes? Herberden nodes?

A

bony nodules at the PIPs

nodules at the DIPs

55
Q

Presentation of subungual hematoma?

A

Traumatic and painful

MOA: hitting thumb with hammer, getting finger caught in door, drop a weight on foot, etc.

56
Q

Management of subungual hematoma

A

if traumatic: xray

Decompression:
Microcautery

18 G needle

Heated paperclip