7. Hand and Wrist MCQs

During the open reduction and internal fixation of the multiple metacarpal fractures, a single dorsal longitudinal incision was utilized to expose the 2nd, 4th, and 5th metacarpal shafts. Meticulous care was taken to identify and protect specific anatomical structures. Which of the following structures is MOST at risk of iatrogenic injury during this dorsal approach, particularly when retracting soft tissues to expose the metacarpals?

Immediately following open reduction and internal fixation, the patient's right hand was placed in a well-padded bulky dressing incorporating a dorsal protective plaster splint. The splint maintained the wrist in 20-30 degrees of extension, MCP joints in 70-90 degrees of flexion, and IP joints in full extension. What is the primary rationale for positioning the MCP joints in 70-90 degrees of flexion (the "position of safety")?

The patient undergoes post-operative radiographic assessment following open reduction and internal fixation of his multiple metacarpal fractures.

Based on the provided post-operative PA radiograph, which of the following statements is the MOST accurate assessment of the surgical outcome?

A 22-year-old male punches a wall and sustains a closed 5th metacarpal neck fracture. What is the maximum acceptable volar angulation for nonoperative management of this fracture without resulting in a significant functional deficit, such as pseudoclawing?

A 45-year-old mechanic presents with an acutely swollen and painful index finger 3 days after a puncture wound. Which of the following is NOT one of Kanavel's four cardinal signs of pyogenic flexor tenosynovitis?

In a Bennett fracture-dislocation of the thumb, the palmar ulnar beak fragment remains anatomically attached to the trapezium. Which of the following structures is responsible for this stabilization?

A 35-year-old woman is evaluated for a rapidly spreading, painful, erythematous infection on her hand 12 hours after sustaining a bite from a stray cat. Which organism is the most likely culprit and what is its characteristic feature?

A 29-year-old laborer sustains a transverse fracture of the 3rd metacarpal shaft. On physical examination, the fingers are crossed over one another during active digital flexion. This finding indicates which of the following uncorrected deformities?

A 31-year-old mechanic presents with an abscess located in the palmar web space between the index and middle fingers. The swelling extends to the dorsal web space. This "collar button" abscess typically communicates between the volar and dorsal hand via which of the following anatomical structures?

A 40-year-old carpenter develops severe, throbbing pain and fluctuant swelling of his thumb pulp after a splinter injury, diagnosed as a felon. The infection is compartmentalized within the distal pulp by which of the following structures?

A 35-year-old woman presents to the emergency department with a painful, swollen right index finger 3 days after a puncture wound to the volar crease. On examination, the finger is held in slight flexion, there is fusiform swelling, and tenderness is exquisite along the volar aspect of the digit. Which of the following is considered the earliest and most sensitive clinical sign for this patient's suspected diagnosis?

A 24-year-old male sustains a laceration over the dorsal aspect of his right 3rd metacarpophalangeal joint after striking another individual in the mouth. He presents 48 hours later with profound erythema, swelling, and purulent drainage. Which of the following organisms is the most characteristic pathogen in this specific injury mechanism and requires targeted antibiotic coverage?

A 28-year-old laborer sustains a closed fracture of the 3rd metacarpal shaft. Clinical examination reveals a rotational deformity. In the context of a metacarpal fracture, a 5-degree malrotation at the fracture site will typically lead to approximately how much digital overlap at the fingertips during composite flexion?

A 25-year-old male sustains a closed, isolated neck fracture of the index (second) metacarpal after a fall. Neurologic and vascular exams are normal, and there is no rotational malalignment. What is the maximum acceptable apex dorsal angulation for nonoperative management of this specific fracture?

A 50-year-old diabetic patient develops a severe infection originating in the right thumb flexor tendon sheath. The infection rapidly tracks proximally, leading to massive swelling of the wrist and simultaneous involvement of the little finger flexor tendon sheath. This specific pattern of spread (a 'horseshoe abscess') communicates through which of the following anatomic structures?

A 32-year-old woman presents with rapid onset of severe hand cellulitis and a localized abscess 12 hours after sustaining a deep bite from a stray cat. What is the primary causative organism, and what is the preferred first-line oral antibiotic therapy?

A 55-year-old male with a history of chronic joint pain presents for hand evaluation. Radiographs demonstrate well-defined periarticular erosions with sclerotic margins and 'overhanging edges' (rat-bite appearance) primarily affecting the distal interphalangeal joints, with preserved joint spaces until late in the disease.

What is the most likely diagnosis?

A 22-year-old athlete sustains an intra-articular fracture-dislocation of the base of the thumb metacarpal (Bennett fracture). The major metacarpal shaft fragment is displaced proximally, radially, and dorsally. The smaller volar-ulnar beak fragment remains anatomically aligned with the trapezium due to the strong stabilizing pull of which ligament?

A 40-year-old carpenter undergoes incision and drainage of a felon on his right index finger. The surgeon utilizes a longitudinal volar incision. If the incision is mistakenly extended too far proximally past the distal interphalangeal (DIP) joint flexion crease, which of the following complications is most likely to occur?

A 26-year-old manual laborer presents with severe hand pain. Examination reveals a swollen palmar web space between the middle and ring fingers, with the adjacent digits resting in an abducted position. There is marked dorsal swelling. What is the most likely anatomic pathway for the dorsal spread of this 'collar button' abscess?