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What are the acceptable angulation for MCB fracture?
- Distal -> 15, 30 and 60º
- Proximal -> 20, 30 and 40º
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Deforming forces for reverse Bennett fracture?
- Medial fragment attached to hamate
- Proximal MCB - proximal force and dorsal angulated by ECU
- Head of MCB - adducted by hypothenar muscle
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What is hasting classification? And when is it being used in?
- A classification for dorsal fracture dislocation of the PIPJ
- - I - < 30% fracture fragment, stable
- - II - 30-50% fracture fragment, stable/unstable (cut-off point 40º)
- - III - > 50% fracture fragment, unstable
Unstable -> OR and screw fix or kwire
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Where does the angulation in MCB fracture?
- DORSAL apex
- - neck fracture -> intrinsic pull (C)
- - shaft fracture -> interossei pull
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Where is the common angulation site on P1 fracture?
- VOLAR APEX:
- - pulled by central slip
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Where does the fracture angulated in P2 fracture?
Depending on the location of the fracture:
Proximal to FDS insertion site -> APEX DORSALLY
Distal to FDS insertion site -> APEX VOLARLY
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Acceptable criteria of MCB fracture displacement?
- Rotatory angulation - 0º
- Shortening < 5mm
- Angulation - depends on the locations (15,20, 60º and 20, 30 and 40º)
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What is Bewerton’s view? And how to do it?
It’s a xray view to visualise the head of MCB fracture
MCPJ flexed to 60º and with the dorsum of P1-P3 lying on cassette film
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How does dislocations of MCPJ and IPJ being classified by?
- simple and complex
- - simple - can be reduced by CMR and without volar plate interposition
- - complex - difficult to reduce and associated with volar plate interposition
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PIPJ dislocations and associated deformity?
Volar dislocation - boutonnières dislocation -> central slip injury
Dorsal dislocation - swan neck deformity -> volar plate injury
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Base of thumb fracture, types?
- Bennett fracture
- Rolando fracture
- Transverse fracture
- Salter-Harris fracture
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Mechanism of Bennett and Rolando fracture?
Axial force
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Deforming force for Bennett fracture?
Proximal volar fragment - anchored by the volar oblique ligament - still articulating with trapezium
- Adductor pollicis muscle - attached to head of the P1
- - supinate, ulnar angulated and adducted
- APL and EPL - attached to the base of the P1
- - proximal displacement
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Acceptable extra articular fracture displacement of thumb P1?
- 30 degrees of angular deformity
- Step off < 2mm
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What is Robert’s view? And how to perform?
A true AP view of the thumb
- Elbow extended and shoulder internal rotated
- Dorsum of the thumb lying on the film
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What is rolando fracture?
A comminuted intraarticular fracture of the base of the P1 of thumb
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How to reduce a Bennett fracture?
Longitudinal traction and applying pronation, adduction and adduction of the thumb
- Apply:
- - dorsal force over the base of the thumb
- - palmar force over the head of the thumb
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