4.0 of 53 Ratings
While on call at the local rural community hospital, you're called by an emergency medicine colleague. He states he has a 30-year-old lumberjack who earlier today was playing softball in the county championship when he slid into home plate in the bottom of the 9th inning. While celebrating the historic victory, he noticed his finger was deformed and painful. He came to the ER at that point to be evaluated. On exam, he is neurovascularly intact. Which of the following acute fracture patterns would best be treated with open reduction and internal fixation?
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A 20-year-old male military recruit slams his index finger on a tank hatch and sustains the injury seen in Figure A. An attempt at reduction and immobilization is made in the field by his unit physician assistant, and he returns to your office one week later. Indications to treat proximal phalanx fractures operatively include all of the following EXCEPT:
20° apex volar angulation
5° apex dorsal angulation
Grossly contaminated open fracture
A 34-year-old male sustains the closed finger injury shown in Figure A one week ago. He undergoes closed reduction and pinning shown in Figure B to correct alignment. Which of the following is responsible for the apex palmar fracture deformity noted on the preoperative radiographs?
Indirect pull of the central slip on the distal fragment and the interossei insertions at the base of the proximal phalanx
Intrinsic muscle fibrosis and intrinsic minus contracture
PIP joint volar plate attenuation and extensor tendon disruption
Rupture of the central slip with attenuation of the triangular ligament and palmar migration of the lateral bands
Flexor tendon disruption with associated overpull of the extensor mechanism
What is the optimal treatment for the proximal phalanx fracture shown in Figure A?
Open reduction and placement of two 0.045-inch K-wires placed longitudinally through the metacarpal head
Application of a 1.5-mm straight plate applied dorsally through and extensor tendon splitting approach
Open reduction and lag screw fixation with 1.3mm screws through a radial approach
Placement of a 1.5-mm condylar blade plate through a radial approach
Open reduction and retrograde passage of two 0.045-inch K-wires retrograde trough the PIP joint
A 39-year-old male sustained an index finger injury 6 months ago and has failed eight weeks of splinting. A radiograph taken at the time of injury is shown in Figure A, and a current radiograph is shown in Figure B. Which of the following is true regarding open reduction and screw fixation of this injury?
High risk of symptomatic implant
Immobilization of the distal interphalangeal joint is required for 2 weeks post-operatively
High rates of post-operative infection are common
Open reduction via an approach through the nail bed leads to significant post-operative nail deformity
Range of motion of the DIP joint in the affected finger is usually less than 10 degrees post-operatively