week 10

Question 1

Distal Radius Fractures common in who

Answer 1

females 60-70 from a FOOSH

Question 2

Smith’s #

Answer 2

is a “Reverse Colles” with volar displacement

Question 2

Colles’ #:

Answer 2

originally defined as a non-articular fracture, occurring 3-5 cm proximal to the radiocarpal
joint

Question 3

Barton’s #

Answer 3

is a displaced, unstable articular fracture
subluxation with carpus following

Question 4

DRF Medical Management - 3 Steps

Answer 4

Step One - Obtain a good reduction
Step Two - Maintain a good reduction
Step Three - Early motion as fracture stability allows

Question 5

What is a good reduction

Answer 5

1. Articular congruity
2. Radial shortening/Ulnar variance
3. Dorsal angulation
4. Radial inclination

Question 6

Treatment Options

Answer 6

Ligamentotaxis
- Closed reduction
- Pins and Plaster
- External fixation
Percutaneous Pinning
ORIF +/- bone grafting

Question 7

Hand Surgery – post operative care

Answer 7

 minimizing postoperative swelling = compression, elevation
 relieve pain – adequate analgesia
 limiting immobilisation – back slab/splint
 Hand Therapy

Question 8

INFLAMMATION lasts for

Answer 8

0 - 48 hours

Question 9

what happens during the inflammation response

Answer 9

Vascular response, Phagocytosis

Question 10

Mx of inflammation

Answer 10

Rest, Elevation, Oedema control

Question 11

PROLIFERATION OF FIBROPLASTS lasts for

Answer 11

12 hr - 10 days

Question 12

Mx PROLIFERATION OF FIBROPLASTS

Answer 12

Rest, Elevation, Oedema, Light exercise

Question 13

FIBROPLASIA lasts

Answer 13

Day 4 - 28 days

Question 14

FIBROPLASIA what’s happening

Answer 14

Collagen deposition

Question 15

FIBROPLASIA Mx

Answer 15

Exercise, oedema control, function

Question 16

REMODELLING time

Answer 16

1 month - 2 years

Question 17

REMODELLING what is happening

Answer 17

scar maturation

Question 18

REMODELLING Mx

Answer 18

Exercise, manual techniques, function

Question 19

Oedema Management

Answer 19

 Gentle decline in elevation from hand to shoulder
 Early active range of motion and tendon gliding exercises
 Cold packs
 Compression
 Manual Oedema Mobilisation

Question 20

Jersey Finger

Answer 20

 Rupture of FDP at level of distal phalanx
 Occurs in contact sports where finger caught on jersey or pocket
 May feel pop, pain

Question 20

DRF Complications

Answer 20

1. Significant Malunion
   - stiffness, OA, pain
2. Carpal Tunnel Syndrome
3. TFCC tears
4. EPL rupture
5. Complex Regional Pain Syndrome Type 1

Question 21

Zones of Injury

Answer 21

 Zone 1
 Distal to FDS insertion, adhesions A4 & A5 pulley
 Zone 2
 FDS & FDP in fibro-osseous sheath,  ruptures/adhesions
 Zone 3
 Distal to Transverse carpal ligament, better results
 Zone 4
 Beneath TCL, accompanying nerve injury
 Zone 5
 Wrist and forearm
 Less frequent adhesions

Question 22

extrinsic tendon healing

Answer 22

• Ingrowth of fibroblasts
• Scars with tendon sheath & surrounding structures
• increased adhesions, decreased mobility

Question 23

intrinsic tendon healing

Answer 23

- Intratendinous blood supply - end to end tendon fibroplastic activity

Question 24

Healing Timeframes muscle

Answer 24

1-20 Days - Dependent of suture material and type of repair 1-10 Days - Strength decreases, minimum at 5 days 3-6 Weeks - Strength increases 12 Weeks - Full strength

Question 25

Post operative therapy goals Treatment Aims:

Answer 25

- Restore maximal active Flexor tendon gliding

Question 26

Tendon Gliding Exercises

Answer 26

 Fist – Maximum FDP excursion  Straight Fist – Maximum FDS excursion  Hook – Maximum differential glide, Much more FDP than FDS

Question 27

extensor tendons Divided into seven zones

Answer 27

Zone 1& 2 - Mallet Finger Zone 3 & 4 - Central Slip -Boutonneire deformity Zone 5 - Level of MCPs

Question 28

MOI Mallet Finger - Zone I & II injur

Answer 28

Injury: Passive DIP flexion with resisted extension

Question 29

Mallet Finger: Therapy

Answer 29

 Splint continuously for 6-8 weeks  Skin care  Splint don & doff technique  ROM of other joints  At 6-8 weeks – gentle active flexion, wean from splint

Question 30

healing times of nerve lacerations

Answer 30

3-4 weeks

Question 31

Ulnar Nerve – Low Lesion

Answer 31

 Muscles: ADM, FDM, ODM, Interossei, Lumbricals ring and little, AP, FPB deep head  Claw Hand  Loss of Lateral pinch – Froment’s sign  Decreased power grip

Question 31

Median Nerve – Low lesion

Answer 31

 Muscles: FPB, OP, ABP, Lumbricals I & II  Ape Hand  Inability to oppose thumb  Loss of web space which can lead to contracture

Question 32

Skier’s Thumb def

Answer 32

Injury to ulnar collateral lig of the Th MCP joint involving instability