Download In relation to the carpal bones shown, which of the following

In relation to the carpal bones shown, which of the following statements is NOT TRUE:
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There is an un-united fracture of the scaphoid
There is osteochondritis of the lunate Correct, There is an un-united fracture through the waist of
the scaphoid with the distal fragment rotated about 90 degrees to its normal axis. In all other
respects the wrist joint is normal.
There is no scapho-lunate diastasis
The carpo-metacarpal joint of the thumb is normal
The hook of the hamate is in its normal position
This patient has:
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A complete ulnar nerve lesion
A dislocation of the carpo-metacarpal joint of the little finger
Spasm of the extensor of the little finger
Cut both flexors of the little finger Correct, There is a small laceration at the base of the little
finger and the finger is held in extension, suggesting loss of normal flexor tone. An ulnar nerve
lesion would not affect one finger selectively. The loss of ulnar innervation would cause flexion
of the inter-phalangeal joint. Spasm of the finger extensors is not a significant clinical
occurrence. Infective tenosynovitis would cause more swelling, the finger is also more flexed.
Infective tenosynovitis
In order to get a manual worker back to work as quickly as possible, with minimum disability, which form of
treatment would you recommend?
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Trimming of the distal phalanx and primary closure of the wound orrect, The quickest and surest
way of getting someone back to work is to trim the bone back to a point at which the skin can be
closed without any tension. Provided that there is no infection healing occurs rapidly and the
patient can resume work within 2 - 3 weeks. The mistake that is often made is to resect too little
bone and therefore make the skin closure under tension. There is then a risk of skin necrosis, of
getting a painful neuroma trapped in the skin and making the finger tip liable to shearing injuries.
The finger can be trimmed to about halfway down the middle phalanx without losing much in
functional terms. Waiting for spontaneous closure is effective, especially in children, but does
take several weeks. Free skin grafts are insensitive and therefore not very useful on the finger
tips. They are liable to re-injury because of their insensitivity. Vascularised grafts are also
insensitive. The quality of the skin may be better but the operation is much more complex. The
tip tends to show significant sensitivity to cold.
Skin grafting using a local skin flap
Split skin grafting
Waiting for spontaneous closure
Free vascularised skin graft
The lateral view of this wrist:
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Is normal
Shows a dislocation of the lunate
Shows a peri-lunate dislocation Correct, This lateral of the wrist shows a peri-lunate dislocation.
The relationship between the lunate and the radius is unchanged. The straight line down the
radius would go through the body of the lunate. The rest of the carpus however is dislocated
dorsally. Therefore it is not the lunate that is dislocated but the rest of the bones around it. The
ulnar styloid is in line with the radius and is therefore not dislocated. It is impossible to see the
scaphoid on this x-ray because it is in with the rest of the carpus which is dislocated dorsally.
Shows a dislocation of the ulnar styloid
Shows a subluxation of the scaphoid
There is a fracture in one of the bones of the carpus. It is:
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The trapezium
The lunate
The capitate
The scaphoid Correct, The carpus bone that is fractured is the scaphoid. The fracture runs
across the waist of the scaphoid. There is also a fracture of the distal radius. In fact this patient
has a trans scaphoid peri-lunate dislocation of the wrist, which has been reduced very
adequately.
The test that is being performed tests:
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The median nerve
The ulnar nerve
The ulnar nerve and/or the T1 nerve root Correct, The test being performed is testing abduction
of the fingers. This is a function of the interossei, more specifically the dorsal interossei. These
small muscles are innervated by the ulnar nerve. The nerve root value for the intrinsic muscles is
T1, therefore this answer is correct.
The radial nerve
The posterior cord of the brachial plexus
This patient has:
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A pathological dislocation of the wrist Correct, The wrist is clearly dislocated in a palmar
direction. There is a 'Z' deformity of the thumb, and swelling of the metacarpo-phalangeal joints.
All these features are compatible with rheumatoid arthritis. In a Smith's fracture the deformity is
more proximal. In a Colles fracture the deformity is also more proximal, and it is in the opposite
direction (dorsal displacement and angulation). A ganglion does not alter the long axis
alignment.
A Colles fracture
A Smiths (reverse Colles) fracture
A ganglion
None of the above
The form of splinting shown here is used for:
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Phalangeal fractures Correct, This is the 'buddy' splint used for fractures of the phalanges and
ligamentous injuries of the fingers. The normal finger splints its injured neighbour and helps it to
move. The objective is to encourage movement and to direct it so that the fracture aligns itself. It
is an effective way of preventing rotary malalignments. No arthropathy can be controlled in this
way.
Correction of rheumatoid deformities
Soft tissue injuries of the fingers
Tenosynovitis
Degenerative disease of the finger joints
This rotational problem of the fingers is not associated with:
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Fractures of the metacarpal
Fractures of the proximal phalanx
Osteoarthritis of the metacarpo-phalangeal joint Correct, A rotary mal-alignment of the finger can
be caused by a fracture anywhere along the appropriate 'ray', with the deformity then being distal
to the fracture. Most commonly it is the metacarpal or the proximal phalanx that is affected.
Rheumatoid arthritis also causes rotary deformities, by stretching of the joint capsule and
displacing the tendons that run over the joint. It is not however a feature of osteoarthritis.
Rheumatoid arthritis of the metacarpo-phalangeal joints
Any of the above