ABPS Surgery of the Hand flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Syndactyly release timing

Border digits are released at 12–18 months and central digits at 18–24 months to permit growth and prevent angular deformity; operating before about 6 months increases stiffness and web creep.

Notta nodule

A palpable swelling at the A1 pulley of a child's thumb that produces fixed interphalangeal flexion; most trigger thumbs resolve spontaneously by 12–24 months, so pulley release is reserved for persistent cases.

Blauth thumb hypoplasia

A five-grade classification of thumb deficiency; grade IIIB through grade V have an unstable or absent carpometacarpal joint and are treated by ablating the remnant and pollicizing the index finger.

Radial longitudinal deficiency

Absence or hypoplasia of the radius producing radial clubhand; screen for Fanconi anemia, VACTERL association, and Holt-Oram syndrome because associated cardiac and hematologic anomalies alter surgical timing.

Scaphoid proximal pole necrosis

The scaphoid receives retrograde blood supply from the dorsal branch of the radial artery; proximal pole fractures therefore risk nonunion and avascular necrosis, favoring rigid fixation or bone grafting.

Bennett fracture

An intra-articular fracture of the first metacarpal base with a volar-ulnar fragment held by the anterior oblique ligament, while the shaft displaces dorsally and radially; treatment is reduction with pinning or screw fixation.

Stener lesion

Interposition of the adductor aponeurosis between a torn thumb ulnar collateral ligament and its phalangeal insertion; the ligament cannot heal and operative repair is required.

Delta pressure

Diastolic blood pressure minus the compartment pressure; a value below 30 mmHg in the forearm or hand suggests compartment syndrome and warrants urgent fasciotomy.

Leddy-Pack classification

A system for flexor digitorum profundus avulsion from the distal phalanx insertion; type I retracts into the palm with disrupted vincula and needs early surgical repair.

LOAF muscles

Median-innervated muscles of the hand: two lumbricals, opponens pollicis, abductor pollicis brevis, and the superficial head of flexor pollicis brevis; they atrophy in advanced carpal tunnel syndrome.

Ulnar paradox

A distal ulnar nerve lesion spares the long flexors, so claw hand deformity is more pronounced than with a proximal lesion, where profundus weakness masks the intrinsic imbalance.

Neurapraxia

Seddon's mildest nerve injury, with segmental demyelination but intact axons; conduction fails temporarily and recovery is complete, usually over days to weeks, without Wallerian degeneration.

Advancing Tinel sign

Tapping over a regenerating nerve produces distal paresthesias; the point of maximal response approximates the growth cone, which advances about one millimeter per day after axonotmesis.

Zone II flexor tendons

The region within the fibro-osseous sheath where flexor digitorum superficialis and profundus lie together; repair here is the most demanding flexor zone because of adhesion formation.

Kleinert protocol

Postoperative flexor tendon rehabilitation using a dorsal blocking splint with rubber-band traction for passive flexion and active extension, protecting a multi-strand core repair.

Vaughan-Jackson lesion

Attritional rupture of the extensor pollicis longus over Lister's tubercle after a minimally displaced distal radius fracture, presenting as loss of thumb interphalangeal extension.

Eaton staging

Radiographic staging of first carpometacarpal osteoarthritis from I to IV; stage IV includes scaphotrapezial disease and requires trapeziectomy or arthrodesis rather than ligament reconstruction alone.

SLAC wrist

Scapholunate advanced collapse progresses from radial styloid–scaphoid arthritis to the whole scaphoid fossa and then capitolunate arthritis; stages II–III are treated with proximal row carpectomy or four-corner fusion.

Swan neck deformity

PIP hyperextension with DIP flexion caused by intrinsic tightness or volar plate laxity; treatment addresses the underlying MCP joint, intrinsic, or terminal tendon imbalance.

Glomus tumor

A painful subungual hamartoma of the glomus body causing cold sensitivity and point tenderness; the Love pin test and Hildreth test localize it, and MRI assists before excision.

Enchondroma

The most common benign bone tumor of the hand, a cartilaginous lesion of the phalanges that may present with pathologic fracture; multiple lesions suggest Ollier disease or Maffucci syndrome.

Giant cell tumor of tendon sheath

A lobulated, firm, slowly enlarging benign soft-tissue mass on the volar digits; it is the second most common hand tumor and recurs in roughly 10–20% after excision.

Kanavel signs

Four signs of pyogenic flexor tenosynovitis: fusiform swelling, semi-flexed resting posture, tenderness along the sheath, and severe pain on passive finger extension.

Fight bite

A clenched-fist injury over the metacarpophalangeal joint that inoculates oral flora into the joint or extensor tendon; it needs exploration, culture, antibiotics, and splinting rather than simple suture.

Felon

A closed-space infection of the distal fingertip pulp that can cause pressure necrosis and osteomyelitis of the distal phalanx; treatment is prompt drainage through a midlateral or palmar incision.

Replantation indications

Strong indications include thumb amputation, multiple digits, wrist or forearm level, and pediatric amputations; a single digit distal to the superficialis insertion is a relative indication.

Warm ischemia time

Muscle tolerates roughly 6–12 hours of warm ischemia, while digits survive longer; cooling to 4 °C extends tolerance to about 12–24 hours before revascularization.

Hypothenar hammer syndrome

Ulnar artery thrombosis or aneurysm from repeated palmar trauma causing digital ischemia in the ring and small fingers; the Allen test is abnormal and treatment ranges from observation to reconstruction.

Hueston tabletop test

A test in which the patient cannot lay the palm flat on a table because of Dupuytren contracture; a positive result is a classic functional indication for operative release.

Dupuytren diathesis

Features predicting aggressive disease and recurrence: young age at onset, bilateral involvement, positive family history, knuckle pads, and ectopic fibromatosis deposits.

Moberg advancement flap

A volar advancement flap based on both thumb neurovascular bundles used to cover tip defects up to about 2 cm; it preserves sensation but may limit interphalangeal joint extension.

Commissure web creep

Progressive distal migration of a reconstructed web space after syndactyly release, caused by scarring and inadequate skin grafting of the commissure at the time of surgery.