Forearm, wrist and hand orthopaedics and trauma Flashcards Preview

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Flashcards in Forearm, wrist and hand orthopaedics and trauma Deck (74)
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1

What is the name given to a fracture of the radius with dislocation of the ulna at the distal radioulnar joint?

Galeazzi fracture dislocation

2

What is a Monteggia fracture dislocation?

A fracture of the ulna occurs with dislocation of the radial head at the elbow

3

What is the management for a Monteggia fracture dislocation and why?

ORIF, even in children

Manipulation alone has a high recurrence rate

4

What is Dupuytren's contracture?

A proliferative connective tissue disorder where the specialized palmar fascia undergoes hyperplasia with normal fascial bands forming nodules and cords progressingto contractures at the MCP and PIP joints

5

What is the pathology involved in Dupuytren's contracture?

Proliferation of myofibroblast cells and the production of abnormal collagen (type 3 rather than type 1)

6

What proportion of cases of Dupuytren's contracture are bilateral?

50%

7

Which fingers are most commonly involved in Dupuytren's contracture?

Ring and little fingers

8

Which gender is more affected by Dupuytren's contracture?

Males 10:1

9

What can cause Dupuytren's?

Familial - autosomal dominant inheritance

Alcoholic disease

A side effect of phenytoin therapy

Common in diabetics

10

What other fibromatosis is Dupuytren's associated with?

Peyronie’s disease, which affects the penis

Plantar fibromatosis affecting the feet (Ledderhose disease)

11

When is surgical treatment for Dupuytren's disease offered?

If contractures are interfering with function

Up to 30° of contracture can be tolerated at the MCP joint and but the PIPJ readily stiffens and any contracture here is usually an indication for surgery

12

What surgical management is avaliable for Dupuytren's contracture?

 Removal of all diseased tissue (fasciectomy)

Division of cords (fasciotomy)

13

What causes trigger finger?

Tendonitis of a flexor tendon to a digit can result in nodular enlargement of the affected tendon, and can get stuck in a fascial pulley, holding the finger in a 'trigger' position

14

What fascial pulley is usually involved in trigger finger?

A1

15

What will relieve the symptoms of trigger finger in most patients?

Injection of steroid around the tendon

16

Which site of the hands is very common for development of OA in post-menopausal women?

Distal interphalangeal joints

 

17

Which metocarpal joint is commonly affected by OA, especially in women?

1st - base of thumb

 

18

Which joints in the hands tend to be spared by RA?

DIP joints

19

What are the three stages of RA in the hands?

Synovitis and tenosynovitis

Erosions of the joints – inflammatory pannus denudes the joints of articular cartilage

Joint instability and tendon rupture – patients can progress to subluxation and chronic tenosynovitis predisposes to extensor tendon ruptures

20

What are the deformities of the hands seen in RA?

Volar MCPJ subluxation

Ulnar deviation

Swan neck deformity

Boutonniere deformity

Z-shaped thumb

21

What is a swan neck deformity?

Hyperextension at PIPJ with flexion of DIPJ

22

What is Boutonniere's deformity?

Flexion at PIPJ with hyperextension of DIPJ

23

Which procedure may prevent tendon rupture in the hands in RA?

Tenosynovectomy (excision of synovial tendon sheath)

24

What procedure may be required for distal radio-ulnar joint RA?

Resection of the distal ulna

25

What are ganglion cysts?

Mucinous filled cysts found adjacent to a tendon or synovial joint, commonly found in the hand or wrist

26

What are the most common soft tissue swellings of the hand?

Ganglion cysts

27

Where are giant cell tumours of the tendon sheath found?

 They are usually on the palmar surface of the hand

Common around the PIP joint of the index and middle fingers 

28

Where can giant cell tumours of the tendon sheath spread locally?

They can envelop the digital artery or nerve and erode into bone

29

What is the significance of the radius and ulna being connected proximally and distally by strong ligaments around the proximal and distal radio‐ulnar joints in relation to fractures?

 The forearm acts as a ring where if one bone is fractures, there is usually a fracture or dislocation involving the other bone

30

What is a nightstick fracture?

A fracture of the ulnar shaft