The Forearm, Wrist, Hand dislocation and fractures

Question 1

What are the three types of Unstable Forearm fractures

Answer 1

1. Both bone forearm fracture
2. Galiazzi fracture
3. Monteggia

Question 2

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Answer 2

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Question 3

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Answer 3

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Question 4

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Answer 4

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Question 5

What is a Colle’s Fracture of the Distal radius

What is the MOI

Answer 5

MOST COMMON

Distal radius fracture fragment is tilted dorsally

Falling on outstretched hand

Question 6

What is a Smith’s fracture of the distal radius

What is the MOI

Answer 6

Distal radius fracture fragment is tilted ventrally

Falling on wrist while flexed

Question 7

Which view on x-ray is best used to diagnose a Collie’s or Smith’s fracture?

Answer 7

Lateral view- shows angulation of the radius if it is titled dorsally (Collie’s) or Ventrally (Smith’s)

Question 8

What is a Barton’s fracture

Answer 8

Intra-articular fracture associated with dislocation of the carpus

Question 9

How is a Colle’s Fracture reduced

Answer 9

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Question 10

Who is a Radial Torus “Buckle” Fracture MC in?

How is it caused and what part of the bone is involved

Answer 10

MC in children less than 10

Buckling of cortex due to compression failure

Children have more stable bones that wont break on a FOOSH

Question 11

What is a Greenstick fracture

How does it appear on x-ray

Answer 11

Complete fracture 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

Question 12

How is a Radial Torus “Buckle” Fracture treated?

Answer 12

Immobilization x 4-6 weeks

Question 13

MC fractured carpal bone

Answer 13

Scaphoid bone

Question 14

What is the MOI for Scaphoid Fracture?

Answer 14

FOOSH

Question 15

What are the clinical findings of a Scaphoid Fracture

Answer 15

Snuffbox pain and tenderness to palpation

ROM limitation

Question 16

Limited blood supply during a scaphoid fracture can cause what complications

Answer 16

Limited blood supply leads to high incidence of nonunion (of the bones again) and osteonecrosis

Question 17

What is a initial treatment for scaphoid fractures?

What if clinical exam is indicative of fracture but x-rays are negative?

Answer 17

Long-arm thumb spica cast x 6-12 weeks

If x-rays are neg. , cast and repeat x-rays in 10-14 days

Question 18

If a follow up x-ray for a scaphoid fracture is still negative after 10-14 days what should be done?

Answer 18

Still treat the patient as if it is a scaphoid fracture

ORDER MRI

Question 19

How are displaced transverse and oblique fractures charactised?

Answer 19

The tend to angulate

Question 20

What tendency do spiral fractures have?

Answer 20

The tend to rotate

Question 21

MC fracture of the hand?

Answer 21

Boxer’s fracture

Question 22

What is the MOI of a Boxer’s fracture and which bone does it involve?

Answer 22

Results from closed fist striking an object

Distal metaphysis of 5th metacarpal

Question 23

When would you manage a boxer’s fracture with just an Ulnar gutter?

Answer 23

tranvserve/oblique fracture at the base or head and is less than 15 degrees

Question 24

When would you refer to surgery of a Boxer’s fracture?

Answer 24

Intra-articular
> 15 degrees angulation
Comminuted
Spiral

Question 25

What is a DeQervain's tenosynovitis?

Answer 25

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

Question 26

How do patients with DeQervain's tenosynovitis present?

Answer 26

They will have pain and tenderness in the first dorsal extensor compartment (anatomic snuffbox) Aggravated by attempts to move thumb or make a fist

Question 27

What test can be used to diagnose DeQervain's tenosynovitis? What would a positive test show?

Answer 27

Finklestein Test Positive if pain with passive stretching of the tendons

Question 28

How is DeQervain's tenosynovitis managed?

Answer 28

NSAIDs Thumb spica splint Avoid offending activity Steroid injection

Question 29

What is a Ulnar Collateral Ligament Sprain also known as? Where is the sprain located?

Answer 29

Skiier's thumb or Gamekeeper's thumb UCL injury at 1st MCP joint

Question 30

How do you test stability of a UCL sprain?

Answer 30

Pain but no laxity indicates mild sprain Pain and partial laxity indicates moderate sprain Pain and significant laxity indicates complete tear

Question 31

How is a UCL sprain managed? | When is surgery needed?

Answer 31

Brace: mild to moderate sprain Surgical consult: complete tear or avulsion fracture involving >25% of the articular surface

Question 32

MOI of a Mallet Finger?

Answer 32

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

Question 33

How does a Mallet finger present?

Answer 33

Pain and inability to extend at the DIP

Question 34

How is a Mallet finger treated? What is imperative for full recovery?

Answer 34

Continuous splinting for 6-8 weeks | If extension is lost at any point, healing is disrupted and the clock starts again

Question 35

When is surgery needed to treat Mallet finger?

Answer 35

Failure with conservative care Complete tendon laceration Fracture involving >30% of the articular surface

Question 36

what are the two flexor tendons that supply the fingers?

Answer 36

FDP – Flexor digitorum profundus FDS – Flexor digitorum superficialis

Question 37

What is the MOI of a Flexor Tendon injury "Jersey Finger"

Answer 37

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

Question 38

Which tendon and finger is MC involved in a Flexor Tendon injury?

Answer 38

MC flexor digitorum profundus 4th (ring) finger affected most commonly 75%

Question 39

Symptoms of a Flexor Tendon Injury?

Answer 39

Pain and 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

Question 40

What imaging is needed for a Jersey Finger? What is the best management?

Answer 40

Splint finger in presenting position Hand surgeon referral Best recovery if repaired within 7-10 days of injury

Question 41

What is a Trigger Finger injury? Where is it most common at?

Answer 41

Nodular thickening of the flexor tendon MC at the MP join

Question 42

How is Trigger finger injury treated?

Answer 42

Steroid injections x2

Question 43

What is Dupuytren’s Contracture also called and why?

Answer 43

"Viking disease" Due to being most common in Men > 50, northern European descent

Question 44

What is the Dupuytren's Contracture involve? Which finger is mostly involved?

Answer 44

Nodular thickening and contraction of palmar fascia Flexion of finger at MCP then PIP MC ring finger

Question 45

How do treat Dupuytren's Contracture

Answer 45

Xiaflex injection - Breaks down collagen adhesion - Injected into contracted cord - Manipulation the following day

Question 46

What are synonyms of Ganglia of Wrist and Hand

Answer 46

Synovial Cyst | Mucous cyst

Question 47

How are synovial cysts or ganglia presented?

Answer 47

Cystic swelling overlying a joint or tendon sheath

Question 48

What are common locations of cysts in the wrist or hand

Answer 48

Dorsum of the wrist Volar radial aspect of wrist

Question 49

If typical i presentation how do you treat ganglia of the wrist or hand? What are other treatments for severe or reoccuring cysts?

Answer 49

reassurance Needle aspiration Sugery

Question 50

Which joints are involved in Osteoarthritis of the hands? | How does this present

Answer 50

DIP and PIP joints are most often involved | Stiffness and loss of motion in the fingers

Question 51

Herbendens vs Bouchards nodes

Answer 51

Heberden nodes = nodules at the DIPs | Bouchard nodes = bony nodules at the PIPs

Question 52

What is the MOI for a Subungual Hematoma

Answer 52

Hammering nail into the finger | Dropping weight on foot

Question 53

Treatment for a Sunungual Hematoma

Answer 53

If traumatic --> Get an X-ray Followed by decompression