7. Hand and Wrist MCQs

During a standard volar (Henry) approach for open reduction and internal fixation of a distal radius fracture, the surgeon must carefully position the volar locking plate to minimize postoperative complications. Which of the following technical errors in plate placement is most strongly associated with late iatrogenic rupture of the flexor pollicis longus (FPL) tendon?

A 25-year-old man complains of persistent radial-sided wrist pain 10 months after falling onto an outstretched hand. Radiographs demonstrate a nonunion of the proximal pole of the scaphoid. A subsequent MRI reveals lack of enhancement in the proximal pole, consistent with avascular necrosis (AVN). There is no radiographic evidence of radiocarpal or midcarpal osteoarthritis.

Which of the following is the most appropriate surgical intervention?

A 55-year-old woman undergoes volar locked plating for a displaced distal radius fracture.

Six months postoperatively, she presents with a new-onset inability to actively flex the interphalangeal joint of her thumb. Which of the following technical errors during the initial surgery most likely caused this complication?

A 65-year-old woman is treated nonoperatively in a short arm cast for a nondisplaced extra-articular fracture of the distal radius. Six weeks later, the cast is removed, and radiographs show a healed fracture. However, she suddenly notes an inability to actively extend her thumb interphalangeal joint. The tenodesis effect is absent for the thumb. What is the most appropriate surgical treatment for this complication?

A 55-year-old woman returns to the clinic 6 weeks after a non-displaced distal radius fracture that was treated successfully in a short-arm cast. She reports a sudden inability to actively extend the interphalangeal joint of her right thumb. Examination confirms an isolated loss of active thumb extension. What is the most appropriate surgical treatment?

A 65-year-old female undergoes volar locked plating for a displaced intra-articular distal radius fracture. Four months postoperatively, she returns to the clinic with a sudden inability to actively flex the interphalangeal joint of her thumb. Which of the following surgical technique errors is most likely responsible for this complication?

A 55-year-old woman undergoes volar locked plating for a comminuted intra-articular distal radius fracture. Six months postoperatively, she presents with a sudden inability to actively flex the interphalangeal joint of her thumb. Radiographs confirm that the fracture has healed in anatomic alignment. What is the most likely cause of this complication?

A 55-year-old woman was treated non-operatively in a cast for 6 weeks for a minimally displaced, extra-articular distal radius fracture. Three weeks after cast removal, she reports a sudden inability to actively extend her thumb interphalangeal joint. She denies any new trauma. Radiographs show a healing distal radius fracture with maintained alignment. What is the most appropriate surgical management for this complication?

A 55-year-old woman undergoes volar locked plating for a displaced intra-articular distal radius fracture. Postoperative radiographs show the plate positioned distal to the watershed line of the distal radius. Six months later, she presents to the clinic with an inability to actively flex the interphalangeal joint of her thumb. Which of the following is the most likely cause?

A 65-year-old woman undergoes volar locked plating for a displaced distal radius fracture. Four months postoperatively, she suddenly loses the ability to actively flex the interphalangeal joint of her thumb. She reports no recent acute trauma. What is the most likely cause of this complication?

A 45-year-old man presents with severe right-sided neck and arm pain. Physical examination reveals weakness in right elbow extension, wrist flexion, and finger extension. His triceps reflex is diminished on the right. Sensation is decreased over the middle finger. Which of the following nerve roots is most likely compressed?

A 52-year-old female presents with right-sided neck pain radiating down her arm. On examination, she has profound weakness in elbow extension and wrist flexion on the right side. She also exhibits diminished pinprick sensation over her middle finger and an absent triceps reflex. Which cervical nerve root is most likely compressed?

A 58-year-old male presents with deteriorating handwriting, difficulty buttoning his shirts, and frequent tripping over the last six months. On physical examination, flicking the nail of his middle finger results in reflexive flexion of the thumb and index finger. This specific clinical sign indicates pathology in which of the following anatomic locations?

A 30-year-old man sustains a midshaft humerus fracture resulting in a complete, high radial nerve palsy. After 14 months of observation and serial EMGs showing no signs of reinnervation, tendon transfers are planned. To optimally restore active wrist extension, which of the following is the most standard and reliable donor muscle?

A 42-year-old woman reports sudden onset of severe, unprovoked left forearm and shoulder pain that lasted for two weeks and has now resolved. However, she currently complains of difficulty writing and an inability to form an 'OK' sign with her thumb and index finger. She has no numbness or tingling. What is the most likely diagnosis and recommended initial management?

A 55-year-old woman is seen 6 months after undergoing volar locking plate fixation for a displaced distal radius fracture.

She reports a recent, sudden inability to flex the interphalangeal joint of her thumb. She experienced some volar wrist crepitus in the weeks prior. What is the most likely etiology of her new deficit?

A 65-year-old woman undergoes open reduction and internal fixation of a distal radius fracture with a volar locking plate. Six months postoperatively, she presents with inability to actively flex the interphalangeal joint of her thumb. Radiographs show the fracture is fully healed. What was the most likely surgical error that led to this complication?