Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
47 Cards in this Set
- Front
- Back
What changes occur in the proximal carpal row with radial deviation?
|
Scaphoid, lunate, and triquetrum flex
|
|
What changes with ulnar deviation?
|
Scaphoid, lunate, and triquetrum extend
|
|
What should the scapholunate (SL) angle be on a lateral wrist x-ray?
|
<6O degrees and >3O degrees
|
|
What is the definition of carpal instability dissociative (CID)?
|
Intercarpal ligament (within a given carpal row) disrupted
|
|
What are the three types of CID?
|
Dorsal intercalated segmental instability (DISI)
Volar intercalated segmental instability (VISI) Axial instability (carpal collapse) |
|
What are the dehnition and mechanism of carpal instability nondissociative (CIND)?
|
Malposition or abnormal movement of the entire proximal or distal carpal row with normal relationships
within the row (for example, midcarpal instability, SIT instability, distal radius malunion) |
|
What is the definition of carpal instability complex (CIC)?
|
Carpal instability within and between carpal rows
Combination of dissociative and nondissociative |
|
What is VISI?
|
Volar flexion of the lunate relative to the long axis ofthe radius and capitate
|
|
What two structures are necessarily disrupted with VISI?
|
Lunotriquetral (LT) ligament
Dorsal radiotriquetral ligament |
|
What are four radiographic features consistent with VISI?
|
Broken Gilula’s arc
Radiolunate angle >15 degrees Capitolunate angle >15 degrees Scapholunate angle <30 degrees |
|
What is the preferred treatment for an acute LT disruption?
|
LT pinning
|
|
What is the preferred treatment for chronic LT disruption?
|
LT fusion
|
|
lf the patient has an ulnar positive wrist, and the LT is unstable, what should be done?
|
Ulnar shortening osteotomy with or without LT pinning may be effective in restoring stability because of tightening extrinsic 6 ligaments
|
|
What is the typical clinical presentation of CIND?
|
Clunking wrist with radial and ulnar deviation
|
|
What is the characteristic radiographic finding?
|
Sudden shift of proximal carpal row with radial and ulnar deviation
Midcarpal instability |
|
What joints can be affected with CIND?
|
Midcarpal
Radiocarpal |
|
What is the general treatment approach to midcarpal nondissociative instability?
|
Nonoperative treatment first (immobilization and activity
modification) Arthroscopic heat shrinkage capsulodesis Dorsal wrist ligament repair reconstruction If unsuccessful, then fusion across the midcarpal joint |
|
What is the most common leading to the development of cause radiocarpal instability?
|
Malunion of distal radius fracture
|
|
What are the most common causes leading to combined carpal instability?
|
Scaphocapitate syndrome
Periluriate dislocation |
|
What is scaphocapitate syndrome?
|
A unique injury: a force causes proximal capitate and scaphoid waist fractures, which can lead to perilunate dislocation
|
|
What is the treatment of choice for scaphocapitate syndrome?
|
ORIF if displaced fractures or instability
|
|
What are the four Mayfield stages of perilunate dislocation?
|
I: scapholunate
II: scapholunate, lunocapitate III: scapholunate, capitolunate, lunotriquetral IV: volar Iunate dislocation |
|
What mechanism reproduced Mayfield stages of perilunate dislocation in a cadaver model? What is the position of the wrist and forearm?
|
Pronation + ulnar deviation on a hyperextended wrist
|
|
Based on cadaver modeling, what position of the wrist and forearm is required for a perilunate dislocation to result?
|
ORIF followed by 8 to 12 weeks casting
|
|
What radiographic marker predicts poor outcome after ORIF for perilunate dislocation?
|
Persistent scapholunate gap
|
|
With what radius/ulna relationship are class II TFCC injuries generally
associated? |
Ulnar positive
|
|
What are the five types of Palmer’s class II (degenerative) TFCC injury?
|
A: TFCC wear without perforation or chondromalacia
B: Iunate/ulna chondromalacia C: TFCC perforation with Iunate chondromalacia D: Iunate and/or ulnar chondromalacia, and lunotriquetral ligament perforation E: TFCC perforation with generalized arthritic changes involving the Iunate and ulna, and perforation of the lunatotriquetral ligament |
|
In general, what are the initial forms of treatment for class II tears?
|
Immobilization
NSAIDs |
|
What is the condition of the TFCC with IIA and IIB tears?
|
TFCC is intact
|
|
What does operative treatment for IIA, IIB injuries entail?
|
Open ulnar shortening
Arthroscopic evaluation |
|
What is the maximum resection allowed for the wafer resection (partial resection of the ulnar dome)?
|
4 mm
|
|
In IIC injuries, the TFCC is perforated, so operative treatment generally includes what two procedures?
|
Arthroscopic debridement of
perforation and water resection of distal ulna through perforation |
|
What is a key contraindication to a wafer procedure?
|
If >2 mm of shortening is required
|
|
What is the difference between D and E class II injuries?
|
IID: LT ligament disrupted, no VISI
IIE: LT ligament disrupted and VISI and generalized arthritis |
|
What operative procedures are appropriate for type IID, IIE degeneration?
|
Arthroscopic debridement of TFCC and LT ligament
Ulnar shortening |
|
What is an indirect benefit of ulnar shortening?
|
Lunotriquetral stability improves
|
|
If the LT articulation remains unstable after ulnar shortening, what is the next
step? |
Pin across lunate and triquetrum
|
|
In general, which condition begins the process leading to eventual caput ulnae?
|
DRUJ synovitis
May be caused by such disorders as rheumatoid arthritis |
|
What is caput ulnae syndrome?
|
Results from synovitis and stretching of ulnar carpal ligaments
Progresses to dorsal dislocation of the yulna, supination of the carpus, and subluxation of the extensor carpi ulnaris tendon If untreated, ulnar translocation can occur |
|
In which direction does the ECU sublux?
|
Volar
Ulnar |
|
What is the operative treatment for ECU subluxation if nonoperative treatment fails?
|
Extensor retinacular flap used for ECU sheath reconstruction
|
|
What events classically follow ECU subluxation?
|
Volar ECU subluxation causes loss of ulnar deviation and extension, which radially deviates the wrist and brings the ulnar extensor tendons directly over the distal ulmi
Vaughn—Jackson syndrome develops (attritional extensor tendon rupture) |
|
How can Vaughn-Jackson syndrome be clinically differentiated from PIN palsy?
|
Tenodesis test: tendons are intact in PIN palsy
|
|
What is the preferred surgical treatment for early DRU] synovitis?
|
Synovectomy
|
|
Once caput ulnae develop, what treatment options are available?
|
Darrach resection of the ulna (stabilized by volar capsule) and ECU relocation with retinacular flap
Suave-Kapandji |
|
After Suave-Kapandji, why can pain develop with resisted elbow flexion?
|
Instability of the proximal ulna
|
|
What operative options are available for DRUj arthritis?
|
Ulnar head resection (hemiresection arthroplasty)
Darrach procedure Suave-Kapandji DRUj prosthetic replacement |