20240816 Hand fractures P2 - Dr Tan

An 32-year-old male, works as mechanics presents with pain in the ulnar aspect of his right hand after he punched a wall 2 hours earlier. He has increased pain with motion, and  immediate swelling over his knuckles. Below is the clinical picture, and X ray right hand provided shows less than 40 degrees of angulation.

 What is the most suitable treatment for him ?

• Ulnar gutter splint without closed manipulative reduction

• Ulnar gutter splint with closed manipulative reduction

• Closed manipulative reduction with k wiring

• Open reduction and plating

• Static external fixation

A middle age lady had a fall with right 3^rd MCPJ in hyperextension. Xray showed a right 3^rd MCPJ dislocation. Which of the following treatment is correct?

• CMR with sedation, provide axial tractional force, and flex the MCPJ

• CMR with sedation, flex the MCPJ, and apply pressure on dorsum of proximal phalanx volarly

• CMR with sedation, provide axial tractional force, and apply pressure on dorsum of proximal phalanx

• Open reduction with volar approach and A1 pulley release

• Open reduction with dorsal approach and release of volar plate entrapment

Which of the following muscles provide the primary deforming forces to Bennett and Rolando fractures (base of the 1st metacarpal fractures)?

• Pronator quadratus

• Flexor pollicis longus

• Extensor pollicis longus

• Abductor pollicis brevis and abductor pollicis

• Abductor pollicis longus and adductor pollicis

Which of following statement regarding thumb ulnar collateral ligament injury is true?

• Injury to radial collateral ligament is more common than ulnar collateral ligament

• Ulnar collateral ligament rupture usually rupture at its proximal attachment site at head of metacarpal

• Joint instability of MCPJ refer to without endpoint and 15 degrees joint space opening more than contralateral thumb during ulnar collateral ligament test

• Stener lesion can be treated by splint application for 3 months, then reassess pain and instability to decide on surgical intervention

• Ulnar collateral ligament avulsion fracture less than 15% of articular surface can be treated with screw fixation

A 55 years old patient is referred to hand clinic with chief complaint of left second MCPJ extensor lag of 15 degrees and reduced grip strength. Further history revealed that patient had neglected fracture over midshaft 2nd metacarpal after seeking ‘Bomoh’ treatment 3 months ago. Below is X-ray on arrival. Which of the following is the best explanation of his findings?

• Shortening of 2mm

• Rotational deformity

• Apex dorsal angulation of 30 degrees

• Extensor tendonitis

• Non union