Flashcards in Surgery (Upper Limb and Trauma) Deck (98):
How do we manage a sternoclavicular joint injury?
True or false; The acromioclavicular joint is rarely injured?
False!! It is a very common injury
What condtion does an acromioclavicular joint injury often overlap with?
What can cause a glenohumeral joint dislocation?
What movement is often the first, and greatest, affected motion in a glenohumeral injury?
What surgical options exist for treating a glenohumeral joint injury?
How can a rotator cuff tear result in OA?
1. Torn rotator cuff muscle
2. Deltoid pulls humeral head upwards
3. Abnormal forces on glenoid fossa
During a reverse shoulder arthroplasty what are some of the surgical techniques carried out?
Increased lever arm of deltoid
What does a reverse arthroplasty prevent?
What can OA of the radiocapitellar joint result in?
What does the radial head act as?
What three things can result in wrist instability?
1. Scapulolunate advanced collapse (SLAC)
2. Scaphoid non-union advanced collapse (SNAC)
3. Post-traumatic OA
How is wrist instability treated?
4 corner fusion
Proximal row carpalectomy
Total wrist arthrodesis
What can result due to base of thumb OA?
Subluxation of CMCJ
What causes an elevation in pain in base of thumb OA?
What causes a swan-neck deformity?
- Volar plate of PIP becomes attenuated
- SMall ligament and limbrical tendons fall dorsally
What causes a Boutonnière deformity?
1. Extensor hood of PIP is attenuated
2. Extensor tendon moves from dorsal -> Volar
- PIP flexion -> Middle phalangeal head through hood
3. Extensor tendon slips around PIPJ
- DIP hyperextension
A patient with known OA presents with a painful lump near the end of her finger. She says it changes in size. On examination it is tender and there is a discharge. You notice it is causing some nail ridging.
What is the process of events resulting in trigger finger?
1. Tendon swelling
3. More swelling
4. Tendon caught on A1 pulley
How can trigger finger be treated?
- Resolves spontaneously
Tendon sheath injection:
- Steroid + LA
- Repeat up to 3x
- Divide A1 pulley
What forms part of the 'Dupuytren's diasthesis'?
How do we examine a suspected Dupuytren's patient?
Measure angles (if MCP/PIP involvement)
Table top test
What is paronychia?
Nail fold infection
What people are at risk of paronychia?
How is paronychia treated?
Incision + drainage
How does a flexor tendon sheath infection present?
Tracking up palm + arm
How is a flexor tendon sheath infection treated?
- Wash out sheath
When and how do we treat a subungal haematoma?
If pressure is causing pain
Trephine -> Drills hole
What are the types of nailbed injuries?
Type 1 -> Soft tissue only
Type 2 -> Soft tissue + nail
Type 3 -> Soft tissue, nail + bone
Type 4 -> Proximal third of phalynx
Type 5 -> Proximal to DIPJ
How are nailbed injuries treated?
Types 1+2 -> Dressing only
Type 3 -> Repair nail bed + stabilise bone
Type 4 -> As above (If Ablate)
Type 5 -> Terminalise + V-Y flap (if tip unavailable)
What is a boxer's fracture?
- Minimal displacement
- No rotation
- More distal
How do we treat a boxer's fracture?
Buddy strap to another finger
What can cause a mallet finger?
Extensor digitorum tendon rupture
Avulsion as tendon rips off part of distal phalynx
How does mallet finger present?
Resited finger extension
How do we manage chronic mallet finger?
What is a Bennett's fracture?
Fracture of the base of 1st MC:
- Extends into 1st CMCJ
How do we treat a Bennett's fracture?
If very minor:
- Reduction and cast
- Closed reduction and pin fixation
What is a escharectomy?
Remove of eschar following a full thickness burn:
- Thick, leathery, inelastic skin
What is tendonosis?
A chronic injury resulting in damage at a cellular level
Where do tendons arise from?
Lateral plate mesoderm
What is a tendons size and strength related to?
Distance from insertion
What tendons to we not treat with injections and why?
Increases the risk of rupture
What tendons are typically treated by decompression surgery?
What tendons are typically treated by a synovectomy?
Wrist extensor tendons (in RA)
What tends are surgically treated with a tendon transfer?
A 51 year old painter and decorator presents with pain in his right shoulder. He has had difficulty sleeping and carrying out his day to day job as reaching up to paint is very painful and his arm tires out very quickly.
Rotator cuff impingement
What head of the biceps is most commonly injured?
What does the Popeye sign suggest?
Biceps tendon rupture
What can cause a biceps tendon rupture?
What movements aggravate the anterior shoulder pain in a biceps tendinopathy?
When is surgery considered in a biceps tendon rupture?
If it is a distal rupture
What can aggravate medial epicondylitis?
Pronation of forearm
What is medial epicondylitis also known as?
What is medial epicondylitis associated with?
What clinical test is useful in diagnosing lateral epicondylitis?
What can predispose a patient to an extensor knee problem?
In what situations will a fracture recover by primary bone healing?
Fixation with plate + screws
Explain the process of secondary bone healing
1. Gap fills with granulation tissue (fibroblasts):
- Angioblasts form blood vessels
2. Cartilage forms (soft callus)
3. Endochondral ossifcation (hard callus)
In what situations does secondary bone healing occur?
What are some skin signs of a high-energy comminuted fracture?
True or false; We can still operate if there are skin changes present over a fracture?
- Wound will not close
What are the 5 types of fracture pattern and what causes them?
Transverse -> Twisting (Compression + Tension)
Oblique -> Sheer stress + axial loading
Spiral -> Twisting
Comminuted -> High energy/Poor bone
Segmental -> Unstable
How do we describe the angulation of a bone if fractured?
The direction the distal end of the bone is pointing (relative to its normal anatomical position)
If do ends of bone are not in contact after a fracture without and displacement or angulation, how do we describe it?
What is shortening in regards to a fracture?
When the distal part of the bone overlaps with the proximal part
What part of the bone do we describe in a fracture?
The distal part
In what patients would we use traction to treat a fracture?
Elderly people who can't undergo surgery
What methods of internal fixation are usually employed?
- IM nail
How would we treat a simple, minimally displaced, extra-articular fracture that is in an acceptable alignment and is stable?
If a bone position is unacceptable what must we do?
If there is an unstable fracture in a patient fit for surgery what do we do?
How would we treat a high energy fracture with evidence of soft tissue injury?
What are the principles of treating an open fracture?
- Ig (if never have vaccine)
How do we treat compartment syndrome?
If there is a vascular injury, how will we treat it?
Reassess circulation - Vascular surgery?
If there is a nerve injury how is it treated?
- Reduce fracture
- Recheck and observe
Approximately how much blood is lost in a femoral shaft fracture?
What complications can occur in a femoral shaft fracture?
What analgesia is supplied in a femoral fracture?
Femoral nerve block
What splint do we use for a femoral shaft fracture?
In an unstable femoral shaft fracture, how is it treated?
What is the slowest healing bone in the body?
What are some signs of a radial nerve injury in the context of a humeral shaft fracture?
Loss of sensation in 1st web space
What tends to cause an olecranon fracture?
- Triceps contraction -> Fall onto outstretched hand
What is a Galeazzi fracture?
Isolated radius fracture with distal radio-ulnar joint dislocation
What is a Monteggia fracture?
Isolated ulna fracture with radial head dislocation
Describe a Colles fracture?
What are some complications of a Colles fracture?
Median nerve compression
Loss of grip strength
What is a Smiths fracture?
Fall onto back of hand:
- Volar displacement -> Wrist flexion deformity
- Volar angulation
What is a Barton fracture?
Volar/Dorsal rim fracture on lateral edge -> Carpus subluxation
What are some risk factors for femoral shaft fractures?
What classification grades intracapsular femoral fractures?
What are some signs of a proximal femoral fracture?
Unable to bear weight
What is an x-ray feature of an intracapsular femoral fracture?
Why do children suffer from greenstick fractures?
What is a greenstick fracture?
One side broken, other side bent
What features of a history may suggest a NAI?
Doesn't match nature/severity of injury
Accusations that child injured themselves intentionally
Child dressed inappropriately