Hand surgery

Question 1

Scaphoid fracture most common localisation

Answer 1

80% are im middle 1/3

Question 2

Perilunate dislocation

Answer 2

Needs reinsertion of ligaments and K-Wire temporary arthrodesis

Question 3

De Quervain’s Fracture Dislocation

Answer 3

Fracture of scaphoid and lunate dislocation (motorbike)

Question 4

Triquetrum avulsion fracture

Answer 4

typically dorsal
often with perilunate injuries
needs osteosynthesis

Question 5

Hamatum fracture

Answer 5

often with carpo-metacarpal dislocation

Screw Osteosynthesis and K Wire temporary Arthrodesis

Question 6

Winterstein fracture

Answer 6

extra-articular
palmar multifragmentary zone
OP if > 30° with LCP T Plate

Question 7

Bennett fracture

Answer 7

partial articular with ulnopalmar fragment
fragment stays in place because of intact bands
rest of metacarpalia pulled by APL towards radial proximal

OP if > 1mm

• ideally with 2 lag screws if fragment big enough
• if too small Kwire through Trapezium and Metacarpal II

Undisplaced : Scaphoid Cast for 6 weeks

Question 8

Rolando fracture

Answer 8

Y or T fracture
ORIF unless undisplaced
T plate via dorsal approach

Question 9

Metacarpal basis II-V

Answer 9

isolated (except V) very seldom
OP if : >1mm articular step/gap or dislocation
K-wire

Question 10

Metacarpal shaft oblique or spiral

Answer 10

OP if :

• rotation
• palmar tilt :
  
  • > 10° for II and III
  • > 20° for IV and V
• lateral tilt > 20°
• shortening > 2mm

Ideally 2 screws for spiral if length = 2 shaft
if not, 1 Screw + dorsal plate 2,0

Question 11

Metacarpal shaft transverse

Answer 11

2,0 compression plate

very high pseudarthrosis risk

Question 12

Metacarpal subcapital fracture

Answer 12

OP if palmar tilt :
V : >30°
IV : 20°
III II : 10°
Rotation

2 K Wires from proximal (endomedular)
mobilisation with removable splint
K Wire ex at 8 weeks

conservative : 3-4 weeks intrinsinc +

Question 13

Metacarpal capital fractrues

Answer 13

OR if > 1mm

subcondral screws

Question 14

Phalanx fracture Basis P1

Answer 14

Basis P1
- Iselin or functional
if displaced : dorsal plate

Question 15

Phalanx fracture Shaft P1 P2

Answer 15

Shaft P1 P2

• conservative if not dislocated (single finger for P2)
• screw or plate if dislocation

Question 16

Phalanx fracture Subcapital

Answer 16

Subcapital

• if displaced : K Wire or Screw
• bicondylar : T plate

Question 17

Phalanx fracture Basis P2

Answer 17

dorsal fragment : extensor avulsion fracture by palmar dislocation
- > 2mm : ORIF

palmar fragment : flexor avulsion by dislocation or hyperextension

• undisplaced : fingersplint nights
• displaced or big fragment : screws

Question 18

Mallet finger

Answer 18

Osseus >40% : screws

undisplaced < 2mm : conservative hyperextension splint