Wrist & Carpus MCQs

A 65-year-old female undergoes volar locking plate fixation for a comminuted distal radius fracture. Six weeks postoperatively, she presents with a sudden inability to flex the interphalangeal joint of her thumb. Radiographs confirm stable fracture fixation, but the plate is positioned distally, crossing the watershed line. Which of the following structures has most likely ruptured?

A 55-year-old woman undergoes volar locked plating for a displaced distal radius fracture. At her 6-week postoperative visit, she reports a sudden inability to actively flex her thumb interphalangeal joint. Radiographs show a healed fracture with the plate positioned distally, volar to the watershed line. Which of the following tendons was most likely injured?

A 62-year-old female presents to the clinic complaining of an inability to actively flex the tip of her thumb. Nine months ago, she underwent open reduction and internal fixation of a distal radius fracture with a volar locking plate. On physical examination, she has a full passive range of motion of the thumb interphalangeal (IP) joint but lacks active flexion. Radiographs demonstrate the volar plate is positioned distal to the watershed line. Which of the following is the most appropriate definitive management for her current condition?

Six weeks after nonoperative management of a nondisplaced distal radius fracture, a 62-year-old woman presents with the sudden inability to actively extend the interphalangeal joint of her thumb. An extensor indicis proprius (EIP) to extensor pollicis longus (EPL) tendon transfer is planned. At the level of the metacarpophalangeal joint of the index finger, where is the EIP tendon located relative to the extensor digitorum communis (EDC) tendon?

A 38-year-old man falls from a height of 10 feet, sustaining a severely comminuted, unsalvageable radial head fracture. The surgeon performs an isolated radial head excision. Six months later, the patient develops severe, progressive ulnar-sided wrist pain. Radiographs reveal 5 mm of positive ulnar variance. What concurrent injury was missed at the time of the initial trauma?

A 55-year-old woman sustained a distal radius fracture treated with a volar locking plate. Three months postoperatively, she presents with inability to actively flex the interphalangeal joint of her thumb. Radiographs show plate placement distal to the watershed line. Which tendon is most commonly ruptured in this scenario?

A 28-year-old male falls from a height and sustains a highly comminuted radial head fracture, diffuse forearm tenderness, and distal radioulnar joint (DRUJ) instability, consistent with an Essex-Lopresti injury. He undergoes prompt radial head replacement to restore length. Intraoperatively, following the radial head replacement, the DRUJ remains grossly unstable in neutral rotation. What is the next best step in management?

A 65-year-old woman presents to the emergency department after falling on an outstretched hand. Radiographs demonstrate a displaced volar shear fracture of the distal radius (volar Barton's fracture).

Which of the following is the most appropriate surgical approach and fixation strategy to prevent displacement?

A 55-year-old woman was treated nonoperatively in a short-arm cast for a nondisplaced distal radius fracture. Eight weeks post-injury, she returns to the clinic reporting a sudden inability to actively lift her thumb off a flat table. Physical examination demonstrates intact IP joint flexion but absent active IP joint extension of the thumb. Which of the following is the most appropriate surgical treatment?

A 62-year-old woman sustained a nondisplaced distal radius fracture treated nonoperatively with a short arm cast for 6 weeks. Two weeks after cast removal, she reports a sudden, painless inability to actively extend her thumb interphalangeal joint. Radiographs confirm a healed distal radius fracture in anatomic alignment. Which of the following is the most appropriate surgical treatment for this specific complication?

Six months after undergoing volar locking plate fixation for a distal radius fracture, a 58-year-old woman reports the sudden inability to actively flex the interphalangeal joint of her right thumb. Radiographs confirm that the fracture is fully healed, but the plate is noted to be placed prominent and distal to the watershed line. Which of the following is the most likely cause of her current symptoms?

A 55-year-old woman is seen 8 weeks after a nondisplaced distal radius fracture treated with cast immobilization. She reports a sudden inability to extend her thumb at the interphalangeal joint, which occurred while lifting a light pan. Examination reveals full passive extension of the thumb IP joint but a complete lack of active extension. Radiographs show a healed distal radius fracture. What is the most appropriate management?

A 62-year-old woman is 6 months status post volar locked plating of a comminuted distal radius fracture. She reports a sudden inability to flex her thumb interphalangeal joint. Radiographs show a well-healed fracture, but the distal margin of the plate is positioned directly on the watershed line. Which tendon is most likely ruptured?

A 45-year-old man presents with chronic radial-sided wrist pain 10 years after a fall on his outstretched hand. Radiographs demonstrate a scaphoid waist fracture nonunion with sclerosis and cystic changes. There is joint space narrowing and osteophyte formation between the distal scaphoid fragment and the radial styloid. The radiolunate and midcarpal joints are well preserved. What is the diagnosis and the most appropriate surgical management?

A 55-year-old woman is seen in the clinic 6 weeks after sustaining a nondisplaced distal radius fracture treated conservatively in a short arm cast. The cast is removed, and radiographs show early healing with maintained alignment. Two weeks later, she returns reporting a sudden inability to actively extend her thumb at the interphalangeal joint. She denies any new trauma. What is the most appropriate management for this complication?

A 60-year-old woman undergoes volar locked plating for a comminuted distal radius fracture. Six months postoperatively, she presents to the clinic with an inability to actively flex the interphalangeal joint of her thumb. Which of the following technical errors during the index procedure is most likely responsible for this complication?

A patient presents with chronic wrist pain and instability following a fall. Imaging suggests disruption of the distal radioulnar joint (DRUJ). Which component of the Triangular Fibrocartilage Complex (TFCC) is the most critical stabilizer of the DRUJ?

A 24-year-old elite gymnast presents with ulnar-sided wrist pain after a fall. An MR arthrogram demonstrates a Palmer Class 1A tear in the central articular disc of the triangular fibrocartilage complex (TFCC). Following a failed trial of conservative management, arthroscopic debridement is planned instead of primary repair. What is the fundamental anatomical rationale for debriding rather than repairing this specific type of tear?

A 45-year-old patient sustains a nondisplaced distal radius fracture and is treated in a cast. Six weeks later, she presents with sudden inability to extend her thumb interphalangeal joint. The ruptured tendon normally travels in which extensor compartment, and what is its radial boundary?

Following an open reduction and internal fixation of a distal radius fracture via a standard volar approach, a patient cannot actively flex the interphalangeal joint of the thumb. Which tendon was most likely injured?