Surgery of the Hand and Wrist

Question 1

For vascular injuries to the hand requiring tourniquet, the maximum time the tourniquet should be applied to prevent tissue necrosis is ___________

Answer 1

2 hours

• Initial treatment for an actively bleeding wound should be direct local pressure for not less than 10 continuous minutes.
• If unsuccessful, an upper extremity tourniquet inflated to 100 mmHg above the sytolic pressure

Question 2

Anesthetic agents with epinephrine should not be used in

Answer 2

Fingertip

• not in concentrations higher than 1: 100,000

Question 3

Most nondisplaced fractures do not require surgical treatment except _____

Answer 3

Scaphoid bone of the wrist

• Due to peculiarities in its vascular supply, particularly vulnerbale at its proximal end
• can fail to unite in up to 20% of paients

Question 4

A patient shown to have wasting at the interdigital web spaces, experiences numbness of the ring finger and exhibits wartenburg sign most likely is suffering from

Answer 4

Cubital tunnel syndrome

• Froment sign (palcing a sheet of paper between the thumb and index finger)
  
  • Strength of the adductor pollicis and the first dorsal interosseous muscles

Question 5

The msot common primary malignant tumor of the hand is

Answer 5

Squamous cell carcinoma

• 75 to 90% of all malignancies
• Most common malignancy of nail bed
• Rsik factors
  
  • sun exposure
  • radiation exposure
  • chronic ulcers
  • immunosuppresion
  • xeroderma pigmentosa
  • actinic keratosis

Question 6

Nectorizing infections

Answer 6

Often present with pain out of proportion to findings

• Bacteria spread to fascial layers’Group A B-hemolytic streptococcus being the msot common pathogen followed by alpha hemolytic streptococcus
• Dirty dishwater fluid
• Crepitus
• Gas formation
• Nectorizing myositis - Clostridium perfringens

Question 7

The majority of acute cases of flexor tenosynovitis are due to ?

Answer 7

Purulent infection

Question 8

Most common soft tissue tumor

Answer 8

Ganglion cyst

• 50 to 70% of all soft tissue tumors
• They can occur at any age but ar emost common in the second to fourth decades with a slight predilection toward females

Question 9

All hand infections Except _________ require surgical management

Answer 9

Cellulitis

Question 10

PAtients with _______- has 1000 fold increased risk of developing squamous cell carcinoma?

Answer 10

Xeroderma pigmentosa

Question 11

Enchondromas

Answer 11

Have never been reported in the trapezoid

• Most common primary benign bone tumor of the hand and wrist and is of cartilage origin
• Most common location : proximal phalanges
• 2nd and 3rd decade of life
• Two variants
  
  • Ollier disease (multiple enchondromatosis)
  • Maffucci syndrome ( multiple enchondromatosis associated with multiple soft tissue hemangiomas)
• There is a well defined multilobulated cebtral lucency in the metaphysis or diaphysis that can expand causing cortical thinning or sometimes, thickening

Question 12

Proper Handling of a traumatically amputated digit or limb includes

Answer 12

Prep and wrapped in moistened gauze