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Chapter 19 - Hand oral core topics

from Section 5 - The hand oral

By
John W. K. Harrison
Edited by
Paul A. Banaszkiewicz  and
Deiary F. Kader
John W. K. Harrison
Affiliation:
Queen Elizabeth Hospital, Gateshead, UK
Paul A. Banaszkiewicz
Affiliation:
Queen Elizabeth Hospital, Gateshead
Deiary F. Kader
Affiliation:
Queen Elizabeth Hospital, Gateshead
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Summary

Hand surgery syllabus for the FRCS (Tr & Orth) examination

‘The hand’ covers the hand and forearm and the structures anatomically contained within. Knowledge of the structural anatomy and the biomechanics of joint and tendon function is required.

Pathology

A working knowledge of the acute conditions and trauma of the hand is required, i.e. injury to the bones, joints, tendons, nerves, skin and vessels of the hand and infective processes.

Type
Chapter
Information
Postgraduate Orthopaedics
The Candidate's Guide to the FRCS (Tr and Orth) Examination
 , pp. 299 - 356
Publisher: Cambridge University Press
Print publication year: 2012

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References

McGrouther, DAColditz, JCHarris, JMStoller, DWInteractive Hand TherapyLondonPrimal Pictures
Controversial. Some authorities recommend extending your incision proximal to the distal wrist crease to make sure the fascia of the distal forearm is released as this can cause compression of the nerve
The third occasion on which the examiner had prompted the candidate with this particular question but the candidate still didn't pick it up
The candidate's answer was reasonable but the examiner wasn't particularly happy
To find palmaris longus, oppose tip of thumb to radial side of the distal phalanx of the little finger
Atroshi, ILarsson, GUOrnstein, E 2006 Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trialBritish Medical Journal 332 1473CrossRefGoogle ScholarPubMed
Although it is called pronator syndrome
Occasionally only the thumb or index finger is involved
Very common examination question
Confusingly the names of various retinaculum/fascia around the elbow seem to be interchanged/different depending on which textbooks are read
The following differentiate low lesions from high lesions
Shao, YCHarwood, PGrotz, MRLimb, DGiannoudis, PV 2005 Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic reviewJournal of Bone and Joint Surgery [Br] 87 1647CrossRefGoogle ScholarPubMed
Geoghegan, JMForbes, JClark, DISmith, CHubbard, R 2004 Dupuytren's disease risk factorsJournal of Hand Surgery 29 423CrossRefGoogle ScholarPubMed
Bulstrode, NMJemec, BSmith, PJ 2005 The complications of Dupuytren's contracture surgeryJournal of Hand Surgery 30 1021CrossRefGoogle ScholarPubMed
Moermans, JP 1991 Segmental aponeurectomy in Dupuytren's diseaseJournal of Hand Surgery [Br] 16 237CrossRefGoogle ScholarPubMed
Armstrong, JRHurrens, JSLogan, AM 2000 Dermofasciectomy in the management of Dupuytren's diseaseJournal of Bone and Joint Surgery [Br] 82 90CrossRefGoogle ScholarPubMed
It is very likely that one will be asked what type of skin incision to use for excision of a ganglion
Staging of the disease was first described by Eaton and Littler 1973
Downing, NDDavis, TR 2001 Trapezial space height after trapeziectomy: mechanism of formation and benefitsJournal of Hand Surgery [Am] 26 862CrossRefGoogle ScholarPubMed
Davis, TRBrady, ODias, JJ 2004 Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interpositionJournal of Hand Surgery [Am] 29 1069CrossRefGoogle ScholarPubMed
Some surgeons believe it is probably the operation of choice for young and middle-aged men who perform moderately heavy manual work
Arthrodesis of the thumb should certainly be mentioned as a possible treatment option for base of thumb arthritis
Davis, TRBrady, OBarton, NJ 1997 Trapeziectomy alone, with tendon interposition or with ligament reconstruction?Journal of Hand Surgery [Br] 22 689CrossRefGoogle ScholarPubMed
ADLs – washing, dressing, feeding
You press down on the ulnar head like a piano key and you get a note from the patient
Differential diagnosis of ‘dropped fingers’: extensor tendon ruptures, ubluxed MCP joints, ulnar subluxation of the extensor tendons
In the rheumatoid patient there is a natural tendency to bony ankylosis of the wrist
Grennan, DMGray, JLoudon, JFear, S 2001 Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgeryAnnals of Rheumatic Diseases 60 214CrossRefGoogle ScholarPubMed
For simplicity we have combined Nalebuff's classification with management options
Rates as high as 64% have been reported
Results can be mixed, with some authors reporting poor results
Acute test for central slip disruption before deformity is evident
To be on top of your game for the FRCS (Tr & Orth) hand oral you should aim to be able to reel off this classification system ad verbatim and similarly be able to discuss the various treatment options
McQueen, MMGelbke, MKWakefield, AWill, EMGaebler, C.Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: a prespective randomised studyJBJS-Br 2008 90 66Google Scholar
Dias, JJDhukaram, VAbhinav, ABhowal, BWildin, CJ 2008 Clinical and radiological outcome of cast immobilisation versus surgical treatment of acute scaphoid fractures at a mean follow-up of 93 monthsJBJS–Br 90 899Google Scholar
Berger, RABishop, ATBettinger, PC 1995 New dorsal approach for the surgical exposure of the wristAnnals of Plastic Surgery 35 54CrossRefGoogle ScholarPubMed
Mayfield, JKJohnson, RPKilkoyne, RK 1980 Carpal dislocations: pathomechanics and progressive perilunar instabilityJournal of Hand Surgery [Am] 5 226CrossRefGoogle ScholarPubMed
This test is known by various names, such as the Kirk–Watson test, the Watson test or the scaphoid shift test
Talwalkar, SCEdwards, ATHayton, MJ 2006 Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instabilityJournal of Hand Surgery [Br] 31 110CrossRefGoogle ScholarPubMed
http://www.orthoteers.co.uk/Nrujp~ij33lm/Images/Cut.jpg
In the FRCS (Tr & Orth) exam, play it safe and start your discussion of surgical options with this statement
After making this general statement, although the examiners will still probably wish to discuss the various surgical options available, they will generally make allowances if you do not know them in particularly great detail; in reality you have covered yourself beforehand
Some examiners ask you to draw out the brachial plexus. Needless to say, practise several times beforehand
Neurotization refers to transfer of a healthy nerve to reinnervate a more important nerve and is used in the same way as muscle–tendon transfer

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