7. Hand and Wrist MCQs

A 26-year-old male boxer sustains a Bennett fracture-dislocation of the thumb base. The main metacarpal shaft is displaced proximally, dorsally, and radially by the deforming pull of the abductor pollicis longus (APL). However, a small volar-ulnar beak fragment remains anatomically located. Which ligament maintains the position of this volar-ulnar fragment?

A 28-year-old female sustains a Galeazzi fracture-dislocation. After Open Reduction and Internal Fixation (ORIF) of the radial shaft, the distal radioulnar joint (DRUJ) is noted to be unstable dorsally when evaluated. In what forearm position should the arm be splinted postoperatively to maximize DRUJ stability, and what anatomical structure is primarily tensioned in this position?

A 27-year-old construction worker sustains a Galeazzi fracture (fracture of the distal third of the radial shaft with associated distal radioulnar joint (DRUJ) disruption). Following anatomic open reduction and internal fixation of the radius with a volar plate, the surgeon must assess the DRUJ. Which fracture characteristic is most predictive of persistent DRUJ instability requiring intraoperative stabilization?

A 24-year-old male presents with severe wrist pain after a fall onto an outstretched hand. Radiographs show that the lunate is displaced volarly into the carpal tunnel, and the capitate is situated dorsal to the lunate. According to Mayfield's progressive stages of perilunate instability, the failure of which ligament marks the transition to this final stage (Stage IV)?

A 32-year-old male presents with persistent dorsal wrist pain after a fall. Radiographs demonstrate a widened scapholunate interval of 4 mm (the 'Terry Thomas' sign). The scapholunate interosseous ligament (SLIL) complex is disrupted. Which anatomical portion of the SLIL is the thickest and provides the primary biomechanical restraint to diastasis?

A 26-year-old male presents with a Galeazzi fracture-dislocation. Following rigid plate fixation of the radial shaft fracture, the distal radioulnar joint (DRUJ) remains dorsally dislocated and cannot be reduced with closed manipulation. What soft tissue structure is most likely interposing and blocking the reduction?

A 25-year-old male falls from a height onto a hyperextended wrist. Lateral radiographs show the capitate rests dorsally to the lunate, while the lunate maintains its normal articulation with the distal radius. According to Mayfield's stages of perilunate instability, which ligamentous structure is disrupted first?

A 42-year-old female presents with a highly comminuted radial head fracture and distal radioulnar joint (DRUJ) instability after a fall from a height. She undergoes radial head replacement. Intraoperatively, the DRUJ remains grossly unstable. What is the most appropriate next step in management for this Essex-Lopresti injury?

During a zone II flexor tendon repair in the hand, which two annular pulleys are considered absolutely critical to preserve or reconstruct to prevent bowstringing of the flexor tendons?

Following a Zone II flexor tendon repair in the hand, tendon healing relies on both intrinsic and extrinsic mechanisms. What provides the primary source of nutrition to the flexor tendons within the digital synovial sheath?

A patient with anterior interosseous nerve (AIN) syndrome will demonstrate targeted weakness when asked to perform which of the following clinical tests?

During closed reduction and percutaneous pinning of a pediatric supracondylar humerus fracture, placement of a medial pin carries the highest risk of iatrogenic injury to which of the following structures?

A 35-year-old manual laborer presents to the emergency department with a swollen, painful index finger 3 days after sustaining a puncture wound. Which of the following is NOT one of Kanavel's cardinal signs for acute suppurative flexor tenosynovitis?

In the context of flexor tendon injuries of the hand, Zone II (historically known as 'no man's land') is anatomically bounded by which of the following structures?

During repair of a flexor tendon laceration in Zone II of the hand, preserving the intrinsic blood supply to the tendon is critical. Blood is supplied to the flexor tendons within the digital sheath primarily through which of the following structures?

A 35-year-old manual laborer presents with a swollen, painful index finger three days after a puncture wound to the volar aspect of the digit. The physician evaluates for pyogenic flexor tenosynovitis. Which of Kanavel's four cardinal signs is generally considered the most reliable, earliest to appear, and last to resolve?

A patient with a laceration at the wrist presents with severe clawing of the ring and small fingers. Interestingly, a patient with a laceration of the same nerve near the medial epicondyle at the elbow presents with a much less pronounced claw deformity. What is the anatomical basis for this 'ulnar paradox' in the higher injury?

A 42-year-old mechanic presents with vague volar forearm pain and an inability to make an 'OK' sign with his thumb and index finger. Sensation in his hand is completely normal. Which of the following muscles is most likely paralyzed in this patient?