7. Hand and Wrist MCQs

A 28-year-old sustains an untreated dorsal laceration over the proximal interphalangeal (PIP) joint, transecting the central slip. Over weeks, a Boutonniere deformity develops due to the volar subluxation of the lateral bands. In the normal finger anatomy, which structure primarily prevents this volar subluxation of the lateral bands?

A 25-year-old carpenter sustains a volar oblique fingertip amputation of the index finger, resulting in a 1.5 cm soft tissue defect with exposed distal phalanx bone. The defect involves the pulp but spares the dorsal nail bed. Which of the following provides the most durable, robust coverage for this specific defect?

A 22-year-old polytrauma patient presents with a midshaft humerus fracture and a documented inability to actively extend the wrist, thumb, and fingers. However, active extension of the elbow against resistance is perfectly preserved. There is sensory loss over the dorsal first web space. Anatomically, where is the most likely level of the nerve injury?

In Scaphoid Nonunion Advanced Collapse (SNAC), degenerative changes progress through the wrist in a predictable anatomical sequence. Which of the following joints is typically the LAST to develop osteoarthritic changes and is specifically spared in early to middle stages?

A 65-year-old man with a history of Dupuytren's disease undergoes surgery for a severe proximal interphalangeal (PIP) joint contracture of his ring finger. During dissection, the surgeon encounters the spiral cord. Which of the following normal anatomic structures is NOT a component of the spiral cord?

During repair of a multiple-digit flexor tendon injury in Zone II, a surgical resident inadvertently advances the flexor digitorum profundus (FDP) tendon of the middle finger 1.5 cm distally before securing it. Postoperatively, the patient is unable to make a full composite fist with the adjacent, uninjured ring and small fingers. What is this phenomenon called?

A 55-year-old female with long-standing rheumatoid arthritis presents with an acute inability to flex the interphalangeal (IP) joint of her thumb. She reports a sudden 'pop' at the wrist level while lifting a pan. Physical exam reveals lack of active IP flexion but full passive motion. What is the most likely location of the attritional bony spur causing this tendon rupture?

A patient with carpal tunnel syndrome undergoes electrodiagnostic testing (EMG/NCS), which confirms median neuropathy at the wrist but also demonstrates anomalous innervation where motor fibers cross from the median nerve to the ulnar nerve in the forearm. This anomaly is known as:

A patient with an isolated, complete high ulnar nerve injury at the mid-arm level is evaluated. During physical examination, when asked to pinch a piece of paper between the thumb and index finger, the thumb IP joint hyperflexes while the MCP joint hyperextends. This finding (Froment's sign) occurs due to weakness of which muscle, and what muscle compensates to create the IP flexion?

A 55-year-old female sustains a distal radius fracture treated with a volar locking plate. Radiographs show the plate positioned distal to the watershed line (Soong Grade 2). Which of the following complications is she at highest risk for developing?

A patient undergoes open reduction and internal fixation of a Galeazzi fracture. Intraoperatively, after rigid anatomic fixation of the radius, the distal radioulnar joint (DRUJ) remains highly unstable in supination. What is the most appropriate intraoperative management of the DRUJ?

In the predictable progression of Scapholunate Advanced Collapse (SLAC) wrist arthritis, which specific carpal articulation is characteristically spared from degenerative changes?

A 55-year-old woman presents with the inability to flex her thumb interphalangeal joint 8 months after undergoing volar locking plate fixation for a distal radius fracture. Radiographs show a healed fracture but the plate is positioned anterior to the watershed line. Which of the following is the most likely cause of her current presentation?

A 22-year-old athlete presents with a proximal pole scaphoid nonunion. MRI demonstrates avascular necrosis of the proximal pole. Which surgical approach and graft choice is most appropriate for this specific injury?

Following a Zone II flexor tendon repair of the middle finger, a patient is started on an early active motion protocol. What is the primary biomechanical advantage of early active motion compared to passive motion protocols?

A 60-year-old woman undergoes a ligament reconstruction and tendon interposition (LRTI) for advanced thumb carpometacarpal arthritis. Postoperatively, radiographs show 3 mm of proximal subsidence of the thumb metacarpal. What is the most likely clinical consequence of this radiographic finding?

A 45-year-old mechanic complains of volar forearm pain and numbness in the radial three-and-a-half digits. He has a negative Phalen's test but experiences pain with resisted forearm pronation. Sensation over the thenar eminence is decreased. What is the most likely diagnosis?

A professional football player sustains a hyperdorsiflexion injury to his first metatarsophalangeal (MTP) joint, resulting in a tear of the plantar plate, commonly referred to as "turf toe." What is the primary biomechanical role of the sesamoids in the first MTP joint?