7. Hand and Wrist MCQs

An anterior single-incision approach to distal biceps tendon repair places which of the following nerves at greatest risk of iatrogenic injury?

A 55-year-old woman presents with a highly comminuted, intra-articular fracture of the distal radius. Radiographs show a distinct volar marginal fragment that has subluxated palmarly with the carpus. When plating this specific fracture pattern, what is the most critical biomechanical principle for stabilization?

The proximal pole of the scaphoid is highly susceptible to avascular necrosis following a fracture due to its unique retrograde blood supply. Which of the following arteries provides the primary vascularity to the proximal pole?

A 28-year-old man presents with acute median neuropathy after falling onto an extended wrist. Radiographs show volar displacement of the lunate (perilunate dislocation). According to the Mayfield classification, what is the initial ligament to fail in this progressive instability pattern?

When stabilizing a dorsally comminuted distal radius fracture with a volar locking plate, what is the primary biomechanical advantage provided by the distal locking screws?

A 55-year-old woman was treated in a cast for a non-displaced distal radius fracture 6 weeks ago. She now presents with a sudden, painless inability to actively extend her thumb interphalangeal joint. What is the most appropriate surgical treatment?

A 45-year-old manual laborer presents with chronic right wrist pain. Radiographs demonstrate a scaphoid nonunion with radioscaphoid arthritic changes, but the capitolunate joint is preserved. Which of the following is the most appropriate surgical treatment to relieve pain while best preserving his grip strength?

During surgical fasciectomy for Dupuytren's contracture, the neurovascular bundle is at risk of iatrogenic injury. The spiral cord is known to displace the neurovascular bundle in which of the following directions?

A 28-year-old male sustained a closed midshaft humerus fracture and was placed in a coaptation splint in the emergency department. Two weeks later in clinic, he presents with a complete inability to extend his wrist or fingers, a deficit that was strictly documented as absent during his initial ED exam. What is the most appropriate next step in management?

A surgeon is performing a single-incision anterior approach to repair an acute distal biceps tendon rupture. Which of the following nerves is at the greatest risk of iatrogenic injury during this specific approach?

A 45-year-old female presents with severe basilar thumb pain and a positive grind test. In primary osteoarthritis of the thumb carpometacarpal (CMC) joint, which muscle acts as the primary deforming force leading to proximal, radial, and dorsal subluxation of the first metacarpal base?

A 55-year-old man presents with advanced scapholunate advanced collapse (SLAC) wrist. During surgical planning, the surgeon relies on the fact that a specific carpal articulation is characteristically spared from degenerative changes due to its concentric spherical anatomy. Which joint is this?

A 24-year-old gymnast falls from a height onto an extended, ulnar-deviated wrist. A lateral radiograph demonstrates the 'spilled teacup' sign with volar displacement of the lunate. She complains of severe pain and tingling in her thumb, index, and middle fingers. What is the most critical initial step in management?

A 60-year-old mechanic presents with intrinsic muscle wasting of the hand, a positive Froment sign, and numbness in the small and ulnar half of the ring fingers. He is diagnosed with severe cubital tunnel syndrome. Which structure typically forms the anatomical roof of the cubital tunnel?

A 28-year-old carpenter lacerates his index finger flexor tendons in Zone II. During surgical repair, strict adherence to the flexor pulley system anatomy is required. Preservation or reconstruction of which of the following pulleys is most critical to prevent significant tendon bowstringing?

During a carpal tunnel release, the surgeon encounters an aberrant transligamentous recurrent motor branch of the median nerve (Lanz variation) and inadvertently injures it. Weakness in which of the following muscles will most likely be observed?

A 45-year-old man presents with a claw-hand deformity and profound intrinsic muscle weakness. When asked to pinch a piece of paper between his thumb and index finger, his thumb interphalangeal joint strongly flexes (Froment's sign). This sign represents a compensatory mechanism for weakness in which muscle, and what is its primary innervation?

A 60-year-old man undergoes subtotal palmar fasciectomy for Dupuytren's contracture. The surgeon carefully identifies the pathologically thickened fascial bands causing a severe proximal interphalangeal (PIP) joint flexion contracture. Which of the following cords is most directly responsible for PIP joint contracture and often displaces the neurovascular bundle centrally?