Flashcards on Reconstructive Hand Surgery for Rheumatic Conditions
Reconstructive Hand Surgery for Rheumatic Conditions
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Metacarpophalangeal joint surgery - General hand procedures
93 cards
Card 1
Question: What are common operative procedures for a rheumatoid metacarpophalangeal (MP) joint?
Answer: Synovectomy; synovectomy with reconstruction of the extensor mechanism; volar release with extensor mechanism reconstruction for fixed flexion deformi
Card 2
Question: Describe the skin incision and initial exposures used for a dorsal MP joint synovectomy.
Answer: A slightly curved dorsal longitudinal incision 3–4 cm over the MP joint. Radial and ulnar flaps are reflected to expose the extensor mechanism; joint
Card 3
Question: During MP joint synovectomy, what nerve branches must be protected?
Answer: The sensory branches of the radial nerve.
Card 4
Question: How is the proliferative synovium removed in MP joint synovectomy and what aids exposure?
Answer: Synovium is removed with a small rongeur; traction applied to the joint improves exposure. A small curet helps enter tight recesses beside the collate
Card 5
Question: Why must synovium be carefully removed from the recesses beside the collateral ligament attachment to the metacarpal head?
Answer: Synovitis in this area causes early bone erosions visible radiographically.
Card 6
Question: What is done to the extensor mechanism and postoperative positioning after MP synovectomy?
Answer: The extensor mechanism is closed and tightened. The joint is splinted in extension to prevent flexion deformity; splinting continued for 12–14 days be
Card 7
Question: When is synovectomy with reconstruction of the extensor mechanism indicated for the MP joint?
Answer: Indicated for early type I deformity when the joint is preserved and subluxation is passively correctable.
Card 8
Question: In MP extensor reconstruction, what are typical findings of the EPL and EPB tendons?
Answer: EPB is usually attenuated; EPL is often displaced ulnarly and volarly.
Card 9
Question: Outline Terrono-style EPL rerouting for MP reconstruction.
Answer: Identify interval between EPL and EPB. Transect EPL over proximal third of proximal phalanx and free proximally. Detach attenuated EPB from base of pr
Card 10
Question: What modification can improve IP joint extension when reconstructing the MP extensor mechanism?
Answer: Transect EPL more proximally and suture EPB tendon to the EPL stump to augment IP joint extension.