Professional Documents
Culture Documents
Hame SL, Melone CP Jr: Boxer’s knuckle: Traumatic disruption of the extensor hood.
Hand Clin 2000; 16: 375-380.
Ref: Light TR (ed): Hand Surgery Update 2. Rosemont, IL, American Academy of
Orthopaedic Surgeons, 1999, p 313-323.
1) release of A1 pulley
2) relocation of the common extensor tendon
1
3) reconstruction of the radial sagittal band
4) Exploration of the metacarpophalnageal joint radial collateral ligament
5) Radical flexor tenosynovectomy
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, and Shoulder. Rosemont
Il, American Society for Surgery of the Hnad, 2003, p 3-28.
1- sagittal bands.
2- lateral bands.
3- conjoined lateral bands.
4- triangular ligament.
5- oblique retinacular ligament.
2
Ref: Harris C Jr: The functional anatomy of the extensor mechanism of the finger. JBJS-
A 1972;54:713-726.
Mickes JE: Role of the controversial parts of the extensor of the finger. JBJS-A
1973;55:884.
Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, and Shoulder. Rosement IL,
ASSH 2003 pp 233-251
Hatanaka, H. and P. R. Manske (2000). "Effect of suture size on locking and grasping
flexor tendon repair techniques." Clin Orthop Relat Res(375): 267-74.
3
1- V-Y advancement
2- Thenar
3- Neurovascular island
4- Cross-finger
5- Axial flap
4
Ref: Horii E, et al. Comparative flexor tendon excursions after passive mobilization, an
in vitro study. J Hand Surg-Am 1992; 17:559-66.
Ref: Hagberg L, Selvik G: Tendon excursion and dehiscence during early controlled
mobilization after flexor tendon repair in Zone II: An xray stereophotogrammetric
analysis. J Hand Surg Am 1991; 16: 669-680.
Horri E, et al. Comparative flexor tendon excursions after passive mobilization: An in
vitro study. J Hand Surg Am 1992; 17: 559-566.
Ref: American Society for Surgery of the Hand: Hand Surgery Update.
Rosemont, IL, AAOS, 1996, pp 127-139.
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10) OITE 2001 Question 79
A 45-year-old man underwent a zone II flexor tendon repair. What type of splint will
allow for the greatest safe excursion of the repaired tendons in the first 6 weeks?
Ref: Horri E, et al. Comparative flexor tendon excursions after passive mobilization: An
in vitro study. J Hand Surg Am 1992; 17: 559-566.
Cooney WP et al: Improved tendon excursion following flexor tendon repair. J Hand
Ther 1989;2:102-106.
1. Myelin sheath
2. Perineurium
3. Endoneurium
4. Internal epineurium
5. External epineurium
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont, IL,
American Society for Surgery of the Hand, 2003, pp. 287-297
6
3- Endoneurium
4- Internal epineurium
5- External epineurium
Ref. Leffert, R. Thoracic outlet syndromes. Hand Clinic 1992; 8: 285 - 297
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow & Shoulder. Rosemont, IL,
American Academy for Surgery of the Hand, 2003, pp 299-312.
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4) OITE 2005 Question 195
A 65-year-old woman who has a distal radius fracture and mild parasthesias in the
median nerve distribution undergoes open reduction and internal fixation through a
limited Henry approach. One day after surgery, she reports dense numbness in the same
distribution and worsening wrist pain. Pre- and postoperative radiographs are shown in
Figures 68a through 68d. Management should now consist of:
Ref: Ford DJ, Ali MS: Acute carpal tunnel syndrome: Complications of delayed
decompression. JBJS Br 1986;68:758-759.
1- 4
2- 6
3- 8
4- 12
5- 20
Ref: Gellman H et al. Analysis of pinch and grip strength after carpal tunnel release.
JHS-A 1989;14:863-864.
1- 0%
2- 20%
3- 50%
4- 80%
5- 100%
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1- Incomplete release of the transverse carpal ligament
2- Cervical radiculopathy
3- Unrecognized Martin-Gruber anastomosis
4- Unrecognized transligamentous motor branch of the median nerve
5- Median artery pseudoanuerysm
Ref: Richmond DA: Carpal ganglion with ulnar nerve compression. JBJS-B
1963;45:513-515.
1- deQuervain’s tenosynovitis.
2- Radial Tunnel syndrome.
3- Intersection syndrome.
4- Lateral antebrachial nerve compression.
5- Superficial radial nerve compression.
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Ref: Gelberman et al. JBJS-A 1983;65:632-638.
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow and Shoulder. Rosemont,
IL, American Society for Surgery of the hand, 2003, pp 161-73.
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Ref: Green’s Operative Hand Surgery, 4th Edition, Vol 1, p.855
1- Bone scan
2- Ultrasound
3- CT
4- Electrodiagnostic studies of the median and ulnar nerves
5- MRI of the wrist
1- CT scan
2- 30 degree pronated view
3- 45 degree supinated view
4- Carpal tunnel view
5- Clenched fist view
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6) OITE 1998 Question 198
A patient sustains a closed dorsal dislocation of the proximal interphalangeal joint of the
middle finger without an associated fracture. Closed treatment results in a concentric
stable reduction. The finger is not immobilized. Which of the following conditions may
appear one year later?
1- Triggering
2- Lateral instability
3- Swan-neck deformity
4- Boutonniere deformity
5- Loss of distal interphalangeal joint flexion
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2) OITE 2006 Question 60
When comparing a formal course of physiotherapy to a regimen of home exercises
following an uncomplicated fracture of the distal radius, formal therapy offers which of
the following results?
1- No significant benefits
2- Less wrist pain at 1 year
3- Better grip strength at 1 year
4- Better patient satisfaction at 1 year
5- Better hand function at 1 year
Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont, IL,
American Society for Surgery of the Hand, 2003, pp 105-121.
Wakefield AE, McQueen MM: The role of physiotherapy and clinical predictors of
outcome after fracture of the distal radius. J Bone Joint Surg Br 2000;82:972-976.
Flatt, E: The Care of the Arthritic Hand. St. Louis, MO, Quality Medical Publishing,
Quality Medical Publishing, 1995, pp. 209-211.
Gelb, RIL Tendon Transfer for Rupture of the EPL tendon. Hand Clin. 1998; 11:412-414.
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5) OITE 2005 Question 46
A 40-year-old man reports unremitting ulnar-
sided wrist pain after undergoing closed treatment
of a distal radius fracture 3 years ago.
Radiographs are shown in Figures 12a and 12b.
What is the next most appropriate step in
treatment?
14
Ref: Scheker et al. Ulnar shortening for the treatment of early post-traumatic
osteoarthritis at the distal radioulnar joint. The journal of hand surgery: 2001 (26); pp 41-
44.
15
1) 10%
2) 25%
3) 40%
4) 75%
5) 90%
1- wrist flexion
2- wrist extension
3- volar shift of the carpus
4- forearm supination
5- forearm pronation
Ref: Agee JM: External fixation: Technical advances based upon multiplanar
ligamentotaxis. Orth Clin North Am 1993;24:265-274.
Ref: Magnussen PA et al: EIP transfer for rupture of EPL tendon. JBJS-B 1990;72:881-
883.
Lecture 7: Wrist Instability
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3 – complex regional pain syndrome – type I
4 – allergic reaction to the splint material
5 – rupture of the extensor pollicis longus tendon
Trumble TE (ed): Hand surgery update 3: Hand, Elbow and Shoulder. 2003 335-51.
1- neurovascular conduit.
2- stabilizing ligament of the scapholunate interval.
3- stabilizing ligament of the radiocarpal joint.
4- stabilizing ligament of the midcarpal joint.
5- septal ligament with the interfossal ridge.
Ref: Berger: The palmar radiocarpal ligaments: A study of adult and fetal human wrist
joints. JHS-A 1990;15:847-854.
1- Scapholunate
2- Radioscapholunate
3- Ulnar collateral
4- Volar radioulnar
5- Dorsal radiotriquetral
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5) OITE 1999 Question 15
What intercarpal arthrodesis procedure is associated with the highest rate of nonunion?
1- Scapholunate
2- Scaphocapitolunate
3- Capitolunate
4- Capitohamate-lunatotriquetral
5- Lunatotriquetral
Lecture 8: Elbow
1- Pronator teres
2- Flexor carpi ulnaris
3- Radial collateral ligament
4- Anterior bundle of the ulnar collateral ligament
5- Posterior bundle of the ulnar collateral ligament
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4) OITE 2001 Question 239
A 21-year-old male wrestler sustained a right posterolateral elbow dislocation with an
associated type I coronoid fracture 2 years ago. Management at the time of injury
consisted of application of a splint for 2 weeks. He now reports subsequent elbow
subluxation and pain. What is the most likely cause of the instability?
Ref: Josefsson PO: Long term sequelae of simple dislocation of the elbow. JBJS
1984;66:927-930.
O’Driscoll SW, et al. Elbow subluxation and dislocation: A spectrum of instability. Clin
Ortho 1992:280:186-187.
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder.
Rosemount, IL, American Society for Surgery of the Hand, 2003, pp
479-492.
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5- moberg advancement flap.
1. Unmeshed split-thickness
2. Meshed split-thickness
3. Multiple pinch
4. Full-thickness
5. Full-thickness with attached subcutaneous fat.
Ref: Browne EZ Jr. Skin grafts, in Green DP et al (eds): Green's Operative Hand Surgery,
ed 4. 1999, p 1759-1782.
4) OITE 2003 Question 95
A 27-year-old chef sustains a traumatic injury to the index finger in an electric mixing
machine. Examination reveals an isolated 2cm x 2cm loss of palmar skin over the
proximal phalanx with exposure of the flexor tendon. Coverage of this defect is best
accomplished with
Ref: Iselin f: the flag flap. Plast reconstr surg 1973; 52: 374-377.
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1. Will not affect functional outcome
2. Will result in diminished thumb motion
3. Will result in diminished pinch strength
4. Will result in diminished grip strength
5. Will result in moderate activity-related pain
Ref: Yang et al., First metacarpal subsidence during pinch after ligament reconstruction
and tendon interposition basal joint arthroplasty of the thumb, J Hand Surg Am
1998;23:879-883.)
1- trapeziometacarpal arthrodesis.
2- osteotomy of the thumb metacarpal.
3- arthrotomy and joint debridement.
4- ligament reconstruction using one half of the flexor carpi radialis.
5- trapezium resection, tendon interposition, and reconstruction of the ligament.
Ref: Eaton et al: Ligament reconstruction for the painful thumb CMC joint. JHS-A
1984;9:692-699.
Ref: Trumble (ed). Hand Surgery Update 3: Hand, Elbow, & Shoulder. 2003, 535-551.
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2) OITE 2004 Question 137
Which of the following changes typically occurs in the inflamed synovium in patients
with rheumatoid arthritis?
1- Abundant neutrophils
2- Intimal lining hypoplasia
3- Blood vessel proliferation
4- Thickening of the basement membrane
5- Reduction of CD4-positive T cells
1- Volar subluxation of the extensor tendons at the level of the metacarpal heads
2- Posterior interosseous nerve compression at the elbow
3- Intrinsic contractures preventing active extension
4- Attritional ruptures of the extensor tendons at the wrist
5- Cervical radiculopathy
Ref: Leslie BM: Rheumatoid extensor tendon ruptures. Hand Clin 1989;5:191-202
1- intrinsic releases
2- side-to-side extensor tenodesis
3- extensor hood reconstruction
4- flexor sheath tenosynovectomy
5- radial nerve decompression
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Lecture 13: Principles of Tendon Transfers
Ref: Trumble TE: Hand Surgery Update 3: Hand, Elbow, & Shoulder, Rosemont, IL,
American Society for Surgery of the Hand, 2003, pp 599-624
23
1. Presence of an extensor pollicis longus tendon
2. Presence of the thenar muscles
3. Presence of the flexor pollicis longus tendon
4. Stability of the metacarpophalangeal joint
5. Stability of the carpometacarpal joint
Ref: Kleinman WB, Strickland JW. Thumb Reconstruction. Green DP, Hotchkiss RN,
Pederson WC (eds.): Green’s Operative Hand Surgery, ed. 4. Philadelphia, PA, Churchill
Livingstone; 1999: 2068-170.
1- Symbrachydactyly
2- Camptodactyly
3- Syndactyly
4- Polydactyly
5- Constriction ring syndrome
Refs: Manske PR, et al. Reconstruction of the congenitally deficient thumb. Hand Clin
1992;8:177-196.
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4- articular deformity of the proximal interphalangeal joint.
5- anomalous lumbrical and superficialis insertions.
Ref: McFarlane RM, et al: The anatomy and treatment of camptodactyly of the small
finger. JHS-A 1192;17:35-44.
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont, IL,
American Society of Surgery of the Hand, 2003, pp 147-157.
Ref: Tulipian DJ, Eaton RG: The Darrach procedure defended: Technique redefined and
long-term follow-up. JHS-A 1991;16:438-444.
25
1- Triangular fibrocartilage complex tear
2- Distal radioulnar joint capsule tear
3- Extensor carpi ulnaris subluxation
4- Lunotriquetral instability
5- Pisotriquetral instability
Ref: Eckhardt WA, Palmer AK: Recurrent dislocation of the ECU tendon. JHS-A
1981;6:629-631.
1. Capsulotomy
2. Arthrodesis
3. Tenolysis
4. Neurolysis
5. Delayed amputation
1- Heparin
2- Dextran
3- Allopurinol
4- Aspirin
5- Tissue plasminogen activator
Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont, IL,
American Society for Surgery of the Hand, 2003, pp 469-477.
Waikakul S, Unnanantana A, Vanadurongwan V: The role of allopurinol in digital
replantation. J Hand Surg Br 1999;24:325-327.
26
1. Thumb at the level of the metacarpal neck
2. Index finger at the level of the proximal phalanx
3. Complete hand through the palm
4. Forearm through the radial metaphysis
5. Index, middle, and ring fingers through the proximal phalanges
Tamai, S. (1982). “Twenty years’ experience of limb replantation review of 293 upper
extremity replants.” J Hand Surg [Am] 67(4):549-56.
Urbaniak, J. R.H. Roth, et al (1985). “The results of replantation after amputation of a
single finger.” J Hand Surg [Am] 67(4):611-9.
1. Patient Age
2. Patient Gender
3. Ischemia Time
4. Mechanism of Injury
5. History of Smoking
Ref: Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont,
IL, American Society for Surgery of the Hand, 2003, pp 469-477.
27
5- Quadrigia effect to the hand
1 4
2 6
3 8
4 12
5 24
Ref: Axelrod TS et al: Severe complex injuries to the upper extremity: Revascularization
and replantation. J Hand Surg Am, 1991;16:574-584.
Ref: Brody GA, Maloney WJ, Hentz VR: Digit replantation applying the leech Hirudo
medicinalis. Clin Orthop 1989;245:133-137.
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1- Axial flag
2- First dorsal metacarpal artery
3- Second dorsal metacarpal artery
4- Reversed dorsal metacarpal artery
5- Digital artery island
1- Place the part in dry sterile gauze and then against the patient’s body to keep it
warm.
2- Place the part in saline of lactated Ringer’s solution ice bath.
3- Wrap the part in gauze moistened with saline or LR, then place it in a plastic
bag and place the bag on ice.
4- Wrap the part in gauze, then place it in a plastic bag immersed in an ice and
saline bag.
5- Wash the part in any available warm, clean nontoxic fluid to clear debris, then
palace it in a dry sterile gauze.
1 – Atypical macrophage
2 – Myofibroblast
3 – Tenocyte
4 – Dermatocyte
5 – Fibroblast
1- Cleland’s ligament.
2- Grayson’s ligament.
3- The natatory ligament.
4- The lateral digital sheet.
5- The spiral band.
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2- Intraoperative digital nerve laceration repair
3- Knuckle pad excision
4- PIP joint arthrodesis
5- Carpal tunnel release
1- Pretendinous band
2- Spiral band
3- Lateral cord
4- Natatory cord
5- Central cord
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Amadio PC, Wood MB, Cooney WP III, et al: Staged flexor tendon reconstruction in the
fingers and hand. J Hand Surg Am 1981;13:559-562.
LaSalle WB, Strickland JW: An evaluation of the two-stage flexor tendon reconstruction
technique. J Hand Surg Am 1983;8:263-267.
Schneider LH: Flexor tendons: Late reconstruction, in Green DP, Hotchkiss RN,
Pederson WC (eds): Green’s Operative Hand Surgery, ed 4. Philadelphia, PA, Churchill
Livingstone, 1999, pp 1898-1949.
1- Glomus tumor
2- Giant cell tumor
3- Intraosseous ganglion
4- Foreign body granuloma
5- Inclusion cyst
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4- carpal boss
5- anomalous extensor muscle
1. MRI
2. Electromyography and nerve conduction velocity studies
3. Intra-arterial urokinase infusion
4. Ethanol embolization
5. Surgical Exploration
REFERENCES: Koman LA, Ruch DS, Smith BP, et al: Vascular disorders, in Green’s
Operative Hand Surgery, ed 4. New York, NY, Churchhill Livingstone, 1999, pp2254-
2302. (2286-7)
Yajima H, Tamai S, Ono H: Aneurysms of the digital artery: A review and report of three
cases. Microsurgery 1995;16:566-570.
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2) OITE 2004 Question 86
Which of following best describes the anatomic relationship of the digital artery and
nerve?
1- Nerve ulnar to artery
2- Nerve radial to artery
3- Nerve palmar to artery
4- Artery palmar to nerve
5- Artery lateral to nerve
Ref: Upper Limb: Anterior aspect of wrist & hand, in Agar AM, Lee MJ (eds): Grant’s
Atlas of Anatomy, ed 10. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, pp
480-505.
1- CT scan
2- Bone scan
3- Arteriogram
4- Doppler ultrasound
5- Electrodiagnostic study
Ref: Koman LA, Urbaniak JR: Ulnar artery insufficiency: A guide to treatment. JHS-A
1981;6:16-24.
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posture, pain with passive stretching, and tenderness along the flexor tendon sheath.
Appropriate management should consist of
Trumble TE (ed): Hand Surgery Update 3: Hand, Elbow, & Shoulder. Rosemont, IL.,
American Society for Surgery of the Hand 2003, pp 433-457
Lille S, Hayakawa T, Neumeister MW, et al: Continuous postoperative catheter irrigation
is not necessary for the treatment of suppurative flexor tenosynovitis.
J. Hand Surg Br 2000;25:304-307
1. paronychia
2. felon (pulp infection)
3. thenar space abscess
4. herpetic whitlow
5. septic flexor tenosynovitis
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4) OITE 2000 Question 45
A 23-year-old house painter has mild pain and is unable to fully flex his finger after
accidentally discharging a high-pressure paint sprayer into the tip of his left nondominant
index finger 30 minutes ago. Examination reveals a 3-mm puncture wound over the
finger pulp, volar swelling of the digit, mildly restricted motion, and intact neurovascular
function. In addition to broad-spectrum antibiotics, management should consist of
Ref: Pinto et al.: High-pressure injection injuries of the hand: Review of 25 patients
managed by open wound technique. JHS-A 1993;18:125-130.
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