7. Hand and Wrist MCQs

A reverse radial forearm osteocutaneous flap is planned for a patient with a first metacarpal bone and soft tissue defect. To prevent a late iatrogenic radius fracture, what is the maximum recommended cross-sectional diameter of the radius that can be safely harvested?

A patient requires soft tissue coverage for a dorsal hand defect. The surgeon opts against a reverse radial forearm flap to avoid sacrificing a major artery and instead chooses a posterior interosseous artery (PIA) flap. The PIA flap relies on retrograde flow from which of the following vessels?

Several hours after a successful reverse radial forearm flap transfer, the patient exhibits an acutely ischemic hand with absent capillary refill in the digits. The flap itself remains pink with brisk capillary refill. What is the most likely cause of this presentation?

A 42-year-old female presents with severe, radiating neuropathic pain on the dorsoradial aspect of her hand 6 months after undergoing a reverse radial forearm flap. Tinel's sign is strongly positive over the mid-forearm at the donor site. Which structure was most likely injured during flap harvest?

A patient requires a reverse radial forearm flap, but pre-operative angiography demonstrates a complete, co-dominant superficial palmar arch with a hypoplastic deep palmar arch. How does this finding affect the surgical plan?

During the elevation of a reverse radial forearm flap, the surgeon dissects deep to the deep fascia. Which of the following neurological structures is most at risk of injury and must be carefully preserved along the deep surface of the brachioradialis?

A 30-year-old trauma patient requires soft tissue coverage for a dorsal hand defect. An Allen test shows a capillary refill time of 15 seconds in the hand when the radial artery is compressed and the ulnar artery is released. What is the most appropriate next step in management?

Postoperatively, a reverse radial forearm flap used for a dorsal hand defect develops severe venous congestion, characterized by a bluish hue and rapid capillary refill. To salvage the flap intraoperatively or during early re-exploration, what is the most effective surgical maneuver?

A surgeon plans to reconstruct a dorsal hand defect using a reverse radial forearm flap but wishes to minimize donor site morbidity and avoid a conspicuous contour defect or a split-thickness skin graft over the volar forearm. Which of the following flap modifications is most appropriate?

A reverse radial forearm flap is planned to reconstruct a combined soft tissue and 3 cm bony defect of the first metacarpal. An osteocutaneous flap is designed. To prevent an iatrogenic radius fracture, what is the maximum recommended cross-sectional area of the radius that can be safely harvested with the pedicle?

During a volar approach for open reduction internal fixation of a distal radius fracture, the surgeon identifies the 'volar watershed line.' What is the primary anatomical significance of this landmark in preventing a specific complication?

Which of the following radiographic measurements is typically *increased* in a malunited Colles fracture with significant radial shortening?

A 72-year-old patient undergoes closed reduction and casting for a Colles fracture. Three weeks post-reduction, they develop increasing pain, swelling, skin discoloration (mottling), and temperature changes (warmth then coolness) in the affected hand, out of proportion to the injury. Active and passive range of motion of the digits is severely limited due to pain. What is the most likely diagnosis?

A 68-year-old male, 6 months post-Colles fracture treated conservatively, complains of chronic pain on the ulnar side of his wrist, especially with pronation and ulnar deviation. Radiographs show a healed distal radius fracture with significant radial shortening and positive ulnar variance. What is the most likely diagnosis for his current symptoms?

A 30-year-old carpenter presents with a swollen, erythematous, and exquisitely tender index finger 3 days after sustaining a minor puncture wound. Which of the following Kanavel signs is considered the most sensitive and earliest indicator of pyogenic flexor tenosynovitis?

A 45-year-old female complains of numbness and tingling in her thumb, index, and middle fingers, which awakens her at night. Which physical examination maneuver has the highest documented sensitivity for diagnosing carpal tunnel syndrome?

A 22-year-old male sustains a proximal pole scaphoid fracture. Which of the following represents the primary source of arterial blood supply to the proximal pole, increasing its risk for avascular necrosis?

A 22-year-old male presents with a new onset of weakness in dorsiflexion and eversion of his right foot, consistent with foot drop. Imaging reveals a large osteochondroma near the knee. Which anatomical structure's involvement by an osteochondroma would typically cause symptoms of foot drop?

A 35-year-old woman sustains a minor injury to her ring finger. Radiographs show a minimally displaced fracture through a well-circumscribed, lytic lesion with stippled calcifications within the proximal phalanx. What is the appropriate initial step?