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7. Hand and Wrist MCQs

Practice Set 49 of 266

This practice set contains high-yield board review questions covering key concepts in 7. Hand and Wrist. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 961

Topic: 7. Hand and Wrist

A 65-year-old male with long-standing cervical spondylosis experiences a hyperextension injury during a motor vehicle collision. He presents with severe bilateral upper extremity weakness and relatively preserved lower extremity strength. What is the expected prognosis regarding his motor recovery?

. Complete recovery is expected within 4 weeks
. Lower extremity strength will likely deteriorate before improving
. Bowel and bladder function are typically the last to recover
. Fine motor control of the hands is the least likely to fully recover
. Surgical decompression is required within 12 hours for any meaningful recovery

Correct Answer & Explanation

. Fine motor control of the hands is the least likely to fully recover

Explanation

The patient has central cord syndrome, which disproportionately affects the upper extremities due to the central location of the upper extremity tracts in the corticospinal tract. Recovery typically follows a predictable pattern: lower extremities recover first, followed by bowel/bladder, then proximal arms, with fine motor control of the hands recovering last and often incompletely.

Question 962

Topic: Nerve & Tendon

The orthopedic surgeon proceeds with open reduction internal fixation (ORIF) of the displaced proximal humerus surgical neck fracture in the 45-year-old active male, utilizing a deltopectoral approach. During this approach, which of the following neurovascular structures is most directly at risk of iatrogenic injury?

. A. Radial nerve
. B. Ulnar nerve
. C. Axillary nerve
. D. Median nerve
. E. Long thoracic nerve

Correct Answer & Explanation

. C. Axillary nerve

Explanation

Correct Answer: CThe axillary nerve is the neurovascular structure most directly at risk during a deltopectoral approach to the proximal humerus, especially when dissecting laterally or extending the approach distally. The axillary nerve wraps around the surgical neck of the humerus, approximately 5-7 cm distal to the acromion, and innervates the deltoid and teres minor muscles. Care must be taken to protect it during plate application and screw insertion, particularly with bicortical screws.Option A (Radial nerve)is primarily at risk with humeral shaft fractures, particularly in the spiral groove, and is less directly exposed or at risk during a standard deltopectoral approach to the proximal humerus.Option B (Ulnar nerve)is located medially at the elbow (cubital tunnel) and is not typically at risk during a deltopectoral approach to the proximal humerus.Option D (Median nerve)is located in the anterior compartment of the arm and forearm and is not typically at risk during a deltopectoral approach to the proximal humerus.Option E (Long thoracic nerve)innervates the serratus anterior muscle and runs along the lateral chest wall. While it can be injured in shoulder girdle trauma or surgery involving the scapula, it is not directly at risk during a deltopectoral approach to the proximal humerus.

Question 963

Topic: 7. Hand and Wrist

A patient is scheduled for ORIF of a radial head fracture. Pre-operative assessment reveals a high-riding radial head relative to the ulna on the ipsilateral wrist X-ray. This finding suggests which associated injury?

. Distal radius fracture
. Olecranon fracture
. Scaphoid non-union advanced collapse (SNAC) wrist
. Essex-Lopresti lesion
. Carpal tunnel syndrome

Correct Answer & Explanation

. Essex-Lopresti lesion

Explanation

Correct Answer: DA high-riding radial head (or a positive ulnar variance, relative shortening of the radius) on an ipsilateral wrist X-ray following a radial head fracture is a classic sign of an Essex-Lopresti lesion. This indicates disruption of the interosseous membrane and/or distal radio-ulnar joint, allowing for proximal migration of the radius due to the loss of the radial head's stabilizing effect. This finding is critical for surgical planning as it indicates the need for radial head replacement to restore radial length.

Question 964

Topic: Nerve & Tendon

During surgical exposure for an olecranon fracture, the ulnar nerve is identified. What is the *most appropriate* management strategy if the nerve is found to be intact but compressed by surrounding hematoma or scar tissue, especially in a fracture requiring internal fixation?

. No intervention, close the wound
. Neurolysis in situ
. Anterior transposition of the ulnar nerve
. Posterior interosseous nerve release
. Immediate nerve graft

Correct Answer & Explanation

. Anterior transposition of the ulnar nerve

Explanation

Correct Answer: CIf the ulnar nerve is found to be compressed or at high risk of post-operative compression/irritation (e.g., due to hardware placement or significant swelling, or pre-existing cubital tunnel syndrome), anterior transposition (C) is often performed prophylactically or therapeutically. This moves the nerve out of the cubital tunnel and into a less constrained anterior position, reducing the risk of neuropathy. Neurolysis in situ (B) may be considered for milder cases but is less definitive if significant risk factors for ongoing compression are present. No intervention (A) would be inappropriate if compression is present or anticipated. Posterior interosseous nerve release (D) is for radial nerve issues. Immediate nerve graft (E) is for transected nerves.

Question 965

Topic: Nerve & Tendon

During a posterior approach to the distal humerus for fracture fixation, the ulnar nerve is identified, mobilized, and protected. After successful fracture reduction and plating, what is the most common and often recommended management strategy for the ulnar nerve to prevent post-operative complications?

. It is resected to prevent future entrapment.
. It is always left in situ in the cubital tunnel.
. It is commonly transposed anteriorly, either subcutaneously or submuscularly.
. It is repaired to the triceps muscle.
. It is rarely identified, as it is deep to the bone.

Correct Answer & Explanation

. It is commonly transposed anteriorly, either subcutaneously or submuscularly.

Explanation

Correct Answer: CAfter identification and protection during distal humerus fracture surgery, the ulnar nerve iscommonly transposed anteriorly. This is done to prevent potential entrapment in scar tissue, hardware, or malunion post-operatively, as well as to accommodate for any changes in the cubital tunnel anatomy during fixation. Anterior transposition (either subcutaneously or submuscularly, under the flexor-pronator mass) moves the nerve to a less vulnerable position. This is a proactive measure to prevent delayed ulnar nerve neuropathy.Option A (Resection)is highly detrimental and would cause permanent neurological deficit; it is never performed for nerve protection.Option B (Leaving it in situ)carries a significant risk of post-operative entrapment, especially after extensive dissection, hardware placement, or if the cubital tunnel anatomy is altered.Option D (Repairing it to the triceps muscle)is not a recognized procedure for ulnar nerve management in this context.Option E (Rarely identified)is incorrect; the ulnar nerve is superficial in the cubital tunnel and is routinely identified and protected during posterior approaches to the distal humerus.

Question 966

Topic: 7. Hand and Wrist

A 50-year-old patient presents with a distal humerus fracture. During the initial physical examination, you note an inability to extend the wrist and fingers, along with sensory loss over the dorsal aspect of the hand and forearm. Which nerve injury is most likely?

. Ulnar nerve
. Median nerve
. Radial nerve
. Musculocutaneous nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

Correct Answer: CThe clinical presentation of an inability to extend the wrist and fingers (often described as 'wrist drop' and 'finger drop'), combined with sensory loss in the dorsal forearm and hand, is pathognomonic for aradial nerve injury. The radial nerve innervates the extensor muscles of the wrist and fingers and provides sensation to the dorsal aspect of the forearm and hand (excluding the small finger and ulnar half of the ring finger, which are ulnar nerve territory).Option A (Ulnar nerve injury)typically affects intrinsic hand muscles (e.g., interossei, hypothenar muscles), causing clawing of the ring and small fingers, and sensory loss on the ulnar side of the hand and small finger.Option B (Median nerve injury)affects forearm pronation, wrist flexion, thumb opposition, and sensation in the radial 3.5 digits (thumb, index, middle, and radial half of ring finger).Option D (Musculocutaneous nerve injury)primarily affects elbow flexion (biceps and brachialis) and sensation over the lateral forearm.Option E (Anterior interosseous nerve injury)is a motor branch of the median nerve affecting deep forearm flexors (flexor pollicis longus, flexor digitorum profundus to index/middle fingers, pronator quadratus) and does not cause sensory loss or wrist/finger drop.

Question 967

Topic: 7. Hand and Wrist
A 24-year-old rugby player presents 48 hours after sustaining an injury to his left ring finger while tackling an opponent. He reports his finger was forcibly extended while he was gripping the opponent's jersey. On examination, he has swelling and tenderness over the palmar aspect of the distal phalanx. He is unable to actively flex the DIP joint of the ring finger. The remaining fingers show normal cascade. Passive DIP flexion is full. X-rays show no bony avulsion. Which of the following Leddy and Packer types is most likely, and what is the primary concern driving urgent treatment?
. Type II; preservation of tendon vascularity.
. Type III; prevention of further bone retraction.
. Type I; preservation of tendon vascularity.
. Type I; prevention of intrinsic muscle contracture.
. Type IV; reduction of articular incongruity.

Correct Answer & Explanation

. Type I; preservation of tendon vascularity.

Explanation

This scenario describes a classic Type I Jersey finger. A Type I injury involves rupture of the FDP tendon without a bony avulsion, and the tendon typically retracts into the palm, losing its vincula blood supply. The primary concern driving the urgency for repair (ideally within 7-10 days, but sooner if possible) is the preservation of the tendon's intrinsic vascularity to prevent necrosis and facilitate healing. Type II also lacks a bony avulsion but the tendon is retained at the A3 pulley level, often with intact vincula, making it less urgent than Type I. Type III involves a bony avulsion fragment, which prevents further retraction and maintains tendon blood supply, making it less urgent. Type IV involves an avulsed bone fragment with the tendon avulsed from the fragment, and Type V involves an intra-articular fracture with tendon avulsion; these are also distinct from the given scenario.

Question 968

Topic: Nerve & Tendon

A 19-year-old basketball player presents with a suspected Jersey finger of his small finger. On examination, he has full active flexion of his PIP joint but lacks active flexion of his DIP joint. A modified tabletop test reveals a normal cascade for all fingers except the small finger, which remains extended at the DIP joint. What is the most reliable maneuver to confirm an FDP rupture in this digit?

. Assessing passive range of motion of the DIP joint.
. Palpating for a tender gap in the distal palm.
. Stabilizing the PIP joint and asking the patient to flex the DIP joint.
. Comparing grip strength to the contralateral hand.
. Performing a Finkelstein's test to rule out De Quervain's tenosynovitis.

Correct Answer & Explanation

. Stabilizing the PIP joint and asking the patient to flex the DIP joint.

Explanation

Correct Answer: CThe most reliable maneuver to confirm an FDP rupture is to isolate the action of the FDP tendon. This is done by stabilizing the PIP joint in full extension and asking the patient to actively flex the DIP joint. If the FDP is ruptured, active DIP flexion will be absent. Assessing passive range of motion will typically be full, as the FDP rupture is an active deficit. Palpating a tender gap can be indicative but is not always reliable, especially with swelling. Grip strength is a global measure and not specific enough. Finkelstein's test is for De Quervain's and irrelevant here.

Question 969

Topic: 7. Hand and Wrist
A 40-year-old construction worker sustained a Jersey finger injury to his index finger 3 weeks ago. X-rays reveal a small bony avulsion fragment from the palmar aspect of the distal phalanx, with the fragment retracted to the level of the A4 pulley. He has minimal pain but lacks active DIP flexion. Which Leddy and Packer type is this, and what is the typical management recommendation?
. Type I; immediate surgical repair due to high risk of tendon necrosis.
. Type II; surgical repair within 2-3 weeks.
. Type III; surgical repair is recommended but can be delayed up to 3-4 weeks.
. Type IV; surgical repair with management of the intra-articular fracture.
. Type V; non-operative management with protected immobilization.

Correct Answer & Explanation

. Type III; surgical repair is recommended but can be delayed up to 3-4 weeks.

Explanation

This is a classic Type III Leddy and Packer injury. It involves a bony avulsion fragment from the distal phalanx that typically retracts to the A4 pulley. The key feature is that the bone fragment prevents further tendon retraction and, importantly, preserves the tendon's blood supply via the vincula. This makes the repair less urgent than a Type I or even Type II injury, allowing for repair up to 3-4 weeks post-injury without significantly compromising outcomes. Immediate repair is for Type I. Type II lacks a bony fragment. Type IV involves tendon avulsed from the fragment. Type V involves an intra-articular fracture.

Question 970

Topic: Nerve & Tendon

A 28-year-old rock climber presents with chronic stiffness and an inability to fully extend her ring finger DIP joint 8 months after a surgically repaired Jersey finger. Radiographs show no fracture or hardware issues. This is most likely due to:

. Re-rupture of the FDP tendon.
. A quadriga effect involving the adjacent fingers.
. Adhesions within the flexor sheath.
. Lumbrical plus phenomenon.
. Insufficient strength of the extensor digitorum communis.

Correct Answer & Explanation

. Adhesions within the flexor sheath.

Explanation

Correct Answer: CChronic stiffness and limited range of motion, particularly an inability to fully extend, following flexor tendon repair are most commonly due to adhesions forming within the flexor sheath. This restricts the smooth gliding of the repaired tendon. Re-rupture would present with loss of active flexion, not stiffness in extension. Quadriga effect limits flexion of adjacent fingers. Lumbrical plus phenomenon involves paradoxical DIP extension with attempted strong grip. Insufficient extensor strength would primarily affect active extension, not passive range of motion if adhesions are the cause.

Question 971

Topic: Nerve & Tendon

A 16-year-old athlete presents with an acute Jersey finger (Type I Leddy and Packer) of his long finger. He is scheduled for surgical repair. What is the most common approach to access the FDP tendon and achieve primary repair?

. Dorsal approach with extensor tendon splitting.
. Midaxial incision along the side of the finger.
. Transverse volar incisions (Brunner incisions).
. Volar approach with a straight incision over the tendon sheath.
. A zigzag incision over the volar aspect of the finger (Brunner's approach).

Correct Answer & Explanation

. A zigzag incision over the volar aspect of the finger (Brunner's approach).

Explanation

Correct Answer: EThe Brunner's zigzag incision is the most common and preferred approach for surgical access to the flexor tendons in the finger. This incision provides excellent exposure, allows for good visualization of the flexor sheath and tendon, and minimizes the risk of creating a longitudinal scar that could lead to flexion contracture. A midaxial incision is typically used for bony procedures or accessing the neurovascular bundles, not direct flexor tendon repair. Transverse incisions would limit exposure. A straight volar incision is contraindicated due to the high risk of contracture. A dorsal approach is for extensor tendon or dorsal bony injuries.

Question 972

Topic: Wrist & Carpus

A surgeon is repairing a Galeazzi fracture in a 32-year-old male. Following anatomic open reduction and rigid internal fixation of the radial shaft, the distal radioulnar joint (DRUJ) remains grossly unstable. What is the most appropriate next step in management?

. Percutaneous pinning of the DRUJ with the forearm positioned in maximal supination
. Percutaneous pinning of the DRUJ with the forearm positioned in maximal pronation
. Immediate open repair of the triangular fibrocartilage complex (TFCC) through a dorsal approach
. Resection of the distal ulna (Darrach procedure)
. Application of a hinged elbow external fixator

Correct Answer & Explanation

. Percutaneous pinning of the DRUJ with the forearm positioned in maximal supination

Explanation

If the DRUJ remains unstable after anatomic fixation of the radius in a Galeazzi fracture, the joint should be reduced and stabilized with K-wires in maximal supination, which is the most stable position for the DRUJ.

Question 973

Topic: Wrist & Carpus

A 55-year-old female presents with sudden inability to flex the interphalangeal joint of her thumb. Seven months prior, she underwent volar locking plate fixation for a distal radius fracture. Radiographs reveal the volar plate is positioned distal to the watershed line. Which tendon is most likely injured?

. Flexor carpi radialis (FCR)
. Flexor digitorum superficialis (FDS) to the index finger
. Flexor digitorum profundus (FDP) to the index finger
. Flexor pollicis longus (FPL)
. Abductor pollicis longus (APL)

Correct Answer & Explanation

. Flexor pollicis longus (FPL)

Explanation

Volar plates placed distal to the watershed line of the distal radius are a well-documented cause of flexor tendon irritation and rupture. The flexor pollicis longus (FPL) tendon is most commonly affected due to its immediate proximity to the hardware.

Question 974

Topic: Wrist & Carpus
According to the Mayfield classification of progressive perilunate instability, a Stage III injury is defined by the disruption of which of the following specific ligamentous structures?
. Scapholunate interosseous ligament
. Dorsal radiocarpal ligament
. Lunotriquetral interosseous ligament
. Volar radioscaphocapitate ligament
. Ulnocarpal complex

Correct Answer & Explanation

. Scapholunate interosseous ligament

Explanation

The Mayfield sequence describes the typical progression of perilunate instability: Stage I is scapholunate failure, Stage II involves capitate dislocation, Stage III is lunotriquetral disruption, and Stage IV is complete lunate dislocation.

Question 975

Topic: Wrist & Carpus

A 60-year-old female presents with a sudden inability to actively extend her thumb interphalangeal joint 6 weeks after a non-operatively treated, undisplaced distal radius fracture. What is the primary pathomechanism of this specific complication?

. Iatrogenic nerve injury from an improperly molded cast
. Anterior interosseous nerve palsy secondary to hematoma
. Mechanical attrition and localized hypovascularity of the extensor pollicis longus tendon
. Entrapment of the extensor pollicis brevis tendon within the fracture site
. Failure of the sagittal band at the metacarpophalangeal joint

Correct Answer & Explanation

. Mechanical attrition and localized hypovascularity of the extensor pollicis longus tendon

Explanation

Spontaneous rupture of the extensor pollicis longus (EPL) tendon is a known complication of minimally displaced distal radius fractures. It is caused by mechanical attrition of the tendon against the fracture callus at Lister's tubercle, compounded by a watershed area of hypovascularity in the tendon.

Question 976

Topic: 7. Hand and Wrist

A 30-year-old male sustains a Bennett fracture during a fistfight. Radiographs reveal a fracture at the base of the first metacarpal with significant proximal and dorsal displacement of the metacarpal shaft. Which muscle is primarily responsible for this displacing force?

. Adductor pollicis
. Extensor pollicis brevis
. Abductor pollicis longus
. Flexor carpi radialis
. Opponens pollicis

Correct Answer & Explanation

. Abductor pollicis longus

Explanation

In a Bennett fracture, the volar ulnar beak fragment is held in place by the anterior oblique ligament. The abductor pollicis longus (APL) inserts on the base of the first metacarpal and pulls the shaft proximally, dorsally, and radially.

Question 977

Topic: 7. Hand and Wrist

Following an anterolateral approach and plate osteosynthesis for a humeral shaft fracture, a patient is in the immediate post-operative protection phase (Weeks 0-2). Which of the following rehabilitation activities is MOST appropriate during this phase?

. Active abduction and external rotation of the shoulder to prevent stiffness.
. Progressive resistive exercises for the biceps and triceps muscles.
. Full active range of motion for the elbow, including terminal extension against gravity.
. Gentle active range of motion for the hand, wrist, and fingers.
. Weight-bearing on the affected extremity for light activities of daily living.

Correct Answer & Explanation

. Gentle active range of motion for the hand, wrist, and fingers.

Explanation

Correct Answer: DThe teaching case outlines the 'Phase 1 Immediate Post-Operative Protection (Weeks 0-2)' with the goal to 'protect surgical site, initiate gentle distal ROM, prevent shoulder stiffness.' Under exercises, it states: 'Hand, Wrist, Finger ROM: Active flexion/extension, circumduction, grip strengthening. Encourage frequently to prevent stiffness and edema.'Option A is incorrectbecause the protocol states: 'Avoid active abduction and external rotation' in Phase 1 to protect the healing fracture and soft tissues.Option B is incorrectbecause progressive resistive exercises are introduced in Phase 3 (Weeks 6-12), not in the immediate post-operative phase.Option C is incorrectbecause while gentle active and passive elbow ROM is initiated, it is typically within a comfortable range (e.g., 30°-120° initially), avoiding excessive stress on the fracture site. Full active range of motion, especially against gravity, is usually progressed later.Option E is incorrectbecause the protocol explicitly states: 'Non-weight-bearing on the affected extremity' during Phase 1.

Question 978

Topic: Wrist & Carpus

A 42-year-old male presents to the emergency department after falling onto his outstretched left hand with his forearm in pronation. He complains of severe pain and deformity in his distal forearm. Physical examination reveals a shortened, radially deviated forearm with a prominent ulnar head dorsally. Initial radiographs are shown below. Which of the following is the most appropriate initial management step?

. Closed reduction and long arm cast immobilization in pronation.
. Immediate open reduction and internal fixation (ORIF) of the radial shaft with assessment of DRUJ stability.
. Application of a sugar tong splint and referral for delayed surgical consultation.
. Percutaneous pinning of the distal radioulnar joint (DRUJ) followed by a short arm cast.
. Attempted closed reduction of the DRUJ followed by a long arm cast in supination, without addressing the radial fracture.

Correct Answer & Explanation

. Immediate open reduction and internal fixation (ORIF) of the radial shaft with assessment of DRUJ stability.

Explanation

Correct Answer: BThe patient's presentation (fall on outstretched hand in pronation, shortened/radially deviated forearm, prominent dorsal ulnar head) and the described radiographs are classic for a Galeazzi fracture-dislocation (fracture of the distal third of the radial diaphysis with associated distal radioulnar joint (DRUJ) disruption). In adults, Galeazzi fractures are inherently unstable due to the loss of radial support and muscle forces (brachioradialis, pronator quadratus) acting on the fragments, as well as the associated DRUJ injury. Non-operative management in adults is associated with unacceptably high rates of malunion, nonunion, and persistent DRUJ instability (often 50-100%). Therefore, the definitive management for an adult Galeazzi fracture is immediate open reduction and internal fixation (ORIF) of the radial shaft to restore anatomical length, rotation, and alignment. This is followed by a careful assessment of DRUJ stability, which often reduces indirectly once radial anatomy is restored. If the DRUJ remains unstable, direct stabilization (e.g., temporary K-wire fixation) is performed.Option A is incorrect because closed reduction and casting are rarely successful in adults due to the inherent instability and high risk of malunion/redislocation. Option C is incorrect as delayed surgical consultation for an adult Galeazzi fracture is inappropriate; definitive fixation is required. Option D is incorrect because pinning the DRUJ without addressing the radial shaft fracture will not provide stability or restore radial length. Option E is incorrect as it prioritizes DRUJ reduction over the primary radial fracture, and attempting to reduce the DRUJ without stabilizing the radius is futile and will not lead to a stable construct.

Question 979

Topic: 7. Hand and Wrist

During open reduction and internal fixation (ORIF) of a Galeazzi fracture via a volar (Henry) approach to the distal radius, which of the following anatomical structures is most susceptible to iatrogenic injury?

. Ulnar nerve
. Posterior interosseous nerve (PIN)
. Superficial radial nerve
. Anterior interosseous nerve (AIN)
. Radial artery

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

Explanation

Correct Answer: DThe volar (Henry) approach to the distal radius is commonly used for Galeazzi fractures. During this approach, the interval between the brachioradialis and the flexor carpi radialis is utilized. The anterior interosseous nerve (AIN), a motor branch of the median nerve, is the most vulnerable neurovascular structure. It courses on the interosseous membrane, deep to the flexor digitorum profundus and lateral to the flexor pollicis longus. Injury can occur during aggressive retraction, stripping of the pronator quadratus, or direct trauma during plate application. An AIN injury results in the inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joints of the index and middle fingers (loss of FPL and FDP to index/middle), and loss of pronator quadratus function.Option A (Ulnar nerve) is located on the ulnar side of the forearm and is not typically at risk with a volar radial approach. Option B (Posterior interosseous nerve) is at risk with a dorsal (Thompson) approach to the radius, not the volar approach. Option C (Superficial radial nerve) is a sensory nerve located more superficially and radially, usually avoided with careful skin incision and dissection. Option E (Radial artery) is located more radially and can be protected with careful dissection, but the AIN is more intimately associated with the deeper dissection plane.

Question 980

Topic: Wrist & Carpus

Following successful open reduction and internal fixation of the radial shaft in an adult Galeazzi fracture, the surgeon performs an intraoperative assessment of the distal radioulnar joint (DRUJ). Despite anatomical reduction and stable plating of the radius, the DRUJ remains unstable with excessive dorsal translation of the ulna during forearm rotation. What is the most appropriate next step?

. Accept the DRUJ instability, as it will resolve with early rehabilitation.
. Perform an ulnar shortening osteotomy to decompress the DRUJ.
. Explore the DRUJ for soft tissue interposition (e.g., pronator quadratus, ECU tendon) and stabilize with temporary K-wires in supination.
. Apply a short arm cast and refer for a second-stage DRUJ reconstruction.
. Perform a Darrach procedure (ulnar head excision) immediately.

Correct Answer & Explanation

. Explore the DRUJ for soft tissue interposition (e.g., pronator quadratus, ECU tendon) and stabilize with temporary K-wires in supination.

Explanation

Correct Answer: CThe primary goal of Galeazzi fracture management is to restore anatomical radial length, rotation, and alignment, which often indirectly reduces and stabilizes the DRUJ. However, if the DRUJ remains unstable after stable radial fixation, direct intervention is necessary. The most appropriate next step is to explore the DRUJ for any incarcerated soft tissues (such as the pronator quadratus muscle, extensor carpi ulnaris (ECU) tendon, or capsule) that might be preventing full reduction. After ensuring no interposition, the DRUJ should be stabilized with temporary K-wires. For dorsal instability, the forearm is typically placed in full supination to tighten the volar radioulnar ligaments, and K-wires are inserted from the dorsal ulna into the radius. These pins are usually left in place for 4-6 weeks to allow capsuloligamentous healing.Option A is incorrect because persistent DRUJ instability after radial fixation will lead to chronic pain, limited forearm rotation, and poor functional outcomes. Option B (ulnar shortening osteotomy) and Option E (Darrach procedure) are salvage procedures for chronic DRUJ pathology or malunion, not acute management for persistent instability after primary fixation. Option D is incorrect as a second-stage reconstruction is not the initial approach for acute instability; it should be addressed during the primary surgery.

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