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Semester 4 PM Exam 4 > Surgical Wrist and Hand > Flashcards

Surgical Wrist and Hand Flashcards

(55 cards)

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1
Q

Fractures and Dislocations - what is usually most important

A

Soft tissue injury is usually more important - esp. in the hand
Bone injury must be stabilized in order to adequately treat the soft tissue injury

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2
Q

Fracture treatment goals

A

Obtain and maintain fracture reduction

Early motion

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3
Q

Bone/Joint Injury - stages of healing

A
  1. Heal w/o infection (first 2 weeks)
  2. Fracture healing (up to 6 weeks)
  3. Regain function/mobility (6-12 wks) – ROM and Strength
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4
Q

Volar Locking Plate - advantage

A

able to start early ROM

Studies show now advantage over casting though

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5
Q

Most common carpal bone to fracture

A

Scaphoid and then triquetrum

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6
Q

Fracture of base of thumb metacarpal - what to do

A

Requires surgery

Predisposes to arthritis

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7
Q

Someone comes in with finger sprain and bruising, what do you do

A

Refer for x-ray

Bruising may indicate a fracture

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8
Q

Hand dislocations - named by

A

the direction of the displacement of the distal segment

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9
Q

Complications with hand dislocations

A

Stiffness, arthritis

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10
Q

Mechanism of injury for hand dislocation

A

hyperextension with axial load

Jammed finger

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11
Q

Thumb MP joint injury - acute vs. chronic

A

Acute - can repair for 3 weeks, but after 3 weeks is chronic and needs reconstruction

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12
Q

Finger Fracture Therapy - pins are removed when and what can be done with therapy

A

3-4 wks
A/AA ROM
Splint for rest

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13
Q

Finger fracture - when discontinue splint

A

6 wks when fx heals - can do PROM then too

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14
Q

Open Dorsal Fracture/Dislocation PIP joint

A 
Digital block
Washout
Closed reduction
Splint
Early protected motion
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15
Q

Types of arthritis -

A

Post traumatic arthritis (Malalignment - Lose cartilage)
OA (Lose cartilage - malalignment)
RA (Synovitis - malalignment and lose cartilage)

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16
Q

Scaphoid nonunion can lead to what

A

Post traumatic arthritis

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17
Q

RA typical deformities

A 
Caput Ulnae
MP volar subluxation
Ulnar drift of fingers
Swan neck deformity
Thumb boutonniere deformity
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18
Q

Problems in arthritis - what are they complaining of

A 
Pain
Stiffness
Weakness
Functional disability
Social and emotional disability
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19
Q

Therapy for arthritis

A 
Modalities
Splints 
Adaptive tools
ROM ex. 
Strengthening
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20
Q

Surgical options for arthritic of wrist

A 
Arthroscopy
Excision bone
Interposition arthroplasty
Limited fusions
Total wrist fusion
Implant arthroplasty
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21
Q

Soft tissue problems - define by

A

Tissue group

  • nerve
  • mm and tendon
  • blood vessel
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22
Q

Nerve compression syndromes - what do they all have in common

A 
Pain at compression site
Radiation of pain
Numbness
Grip weakness
mm weakness
Activity related sx
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23
Q

Carpal tunnel - nerve is compressed by

Study These Flashcards
A

Small space
Tenosynovitis
Position narrows space
Fracture hematoma

24
Q

CTS - More common in who

Study These Flashcards
A

2/3 females

mostly over 40

25
S/S CTS
Dec/altered sensation in thumb, index, middle, and ring Pain in wrist that radiates prox Night pain and numbness Aggravated by activity, worse in certain positions
26
Exam findings in CTS
Dec median n. distribution sensation Weak grip Thenar atrophy or weakness Pos Tinels (percussion), Phalens (position), Durkans (pressure)
27
What other pathologies are common with CTS
Diabetes Mellitus Hypothyroidism Positive family hx Obesity, smoking, poor aerobic fitness
28
Nonsurgical tx for CTS
Wrist splint - 3 to 6 wks Relative rest Cortisone injection (into carpal tunnel 80% benefit - good for dx)
29
Thenar atrophy sometimes need
mm transfers to restore function Abd dig min Palmaris longus Ext Indicis proprius
30
Goal with CTS surgery
Remove pressure from Median nerve | Cut transverse carpal tunnel ligament
31
DeQuervains Syndrome
Stenosing ext tenosynovitis of 1st dorsal compartment
32
Stenosing flexor tenosynovitis
Trigger finger, trigger thumb
33
Common feature of tendon entrapment is what
Tenderness of compartment
34
Tendon entrapment syndrome - early treatment
Activity modifications Splints Anti inflammatory meds Cortisone injection into tendon sheath
35
Trigger finger vs. Dupuytrens disease
Trigger finger = clicks, catches, painful to fully extend | Dupuy: No pain, unable to fully extend
36
Dupuytrens Dx
Palmar Fibromas Flexion contractures Loss of ext. even passively No loss of flexion
37
Treatment for Dupuy
Collagenase injections Fasciotomy Fasceiectomy
38
Newest nonsurgical tx for Dupuytrens
Xiaflex (collagenase clostridium)
39
Needle Aponeurotomy - pros and cons
For D. cont Pro - in office and local anesthetic use Con - recurrence, nerve injury, skin tear, bumps remain)
40
Subtotal palmar fasciotomy - therapy
early ROM, night time splinting 6 months
41
Pros and cons to subtotal palmar fasciotomy
Pro - bumps gone, safer for PIP and DIP | Con - need surgical anesthetic, recurrence, neurovascular injury, healing time
42
Ganglion cysts can relate to
Intra-articular pathology | SL ligament instability, TFCC tears, arthritis
43
Complications after infection
STIFFNESS | usually due to - swelling, tendon adhesion, joint contracture
44
Problems causing dysvascular fingers
Clotted vessels Raynauds Pseudoaneurysms
45
Flexor and Extensor tendon repairs - what is important
zone of injury | Need to protect repair for 12 weeks post op
46
Problems with flexor and extensor tendon repairs
Adhesions, rupture, contracture
47
Critcial pulleys
A4 | A2
48
What is essential with extensor tendon repairs
correct length is essential!
49
Micro-surgery would be to what
Nerve and BVs
50
Post op microsurgery to nerve and BVs
Immobilize as necessary in safe position Move joints ASAP Usually 3 wks post op immob for arterial repairs to prevent vessel spasm
51
Replantation indications
Any part in a child Thumb Multiple digits Sharp lacerations
52
Relative contraindications for replantation
Gorss contamination Aculsion or crush injury Single digit Comorbidities that preclude surgery
53
All thumb amputations should be evaluated for
reconstruction
54
Single digit replantation is feasible but
not always the best option
55
Function after replantation is always
less than normal! | cold intolerance, stiffness, numbess are 100% likely

Semester 4 PM Exam 4 (10 decks)

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