4.4 of 107 Ratings
A 24-year-old male computer programmer injures his wrist two years ago while LARPing. At the time he was diagnosed with a scaphoid fracture but he was finishing school and did not seek treatment. He presents to your office two years later. Figure A is the patient's X-Ray from your clinic. Advanced imaging confirms the cystic nature of the fracture site. To aid in fracture healing, you elect to harvest a vascularized graft and an intraoperative photo is seen in Figure B. What is the pedicle most often supplying this graft?
Longitudinal branch of the descending geniculate artery
Transverse branch of the descending geniculate artery
Superomedial genicular artery
1,2 intercompartmental supraretinacular artery
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A 25-year-old soldier fell during combat training and sustained the injury seen in Figure A. Operative and non-operative management were discussed with the patient who elected for non-operative treatment. Which of the following should be immobilized for optimal management of the injury?
Thumb, wrist, and elbow
Wrist and elbow
Thumb and wrist
Immobilization is not necessary
A 19-year-old military service-member visits your office and complains of significant wrist pain. He was able to pass basic training but had considerable discomfort with pushups. When he was a senior in highschool he hurt his wrist playing football. He underwent surgery in his hometown but never felt like he got back to his pre-injury level of function. Radiographs are provided in Figures A and B. What modification of surgical technique may have better served this fracture pattern on the index procedure?
Achieving a more center-center screw position
Using a dorsal approach with an anterograde screw
Using a non-cannulated screw
Using a vascularized bone transfer
Using a percutaneous approach
A 22-year-old male snowboarder falls on an outstretched hand and presents with the radiograph shown in Figure A. Which of the following techniques is MOST important in optimizing biomechanical fixation?
Using a screw placed in the central axis of the scaphoid into the subchondral bone
Using a supplementary K-wire transfixing the distal pole of the scaphoid to the capitate
Using a screw placed in the dorsal axis of the scaphoid into the subchondral bone
Using a larger diameter screw placed in the dorsal axis of the scaphoid
Using a larger diameter screw placed in the volar axis of the scaphoid
Which of the following statements is TRUE about force transmission based on wrist position?
neutral wrist position decreases force through the lunate fossa
extended wrist position increases force through the lunate fossa
neutral wrist position increases force through the scaphoid fossa
extended wrist position increases force through the scaphoid fossa
wrist position has no effect on force transmission
An open dorsal approach for antegrade screw fixation of a nondisplaced scaphoid waist fracture differs in which of the following ways compared to a percutaneous dorsal approach?
Decreased risk of proximal pole AVN
Increased risk of posterior interosseous nerve injury
Decreased risk of injury to the APL tendon
Increased risk of injury to the EPL tendon
Decreased risk of screw prominence above subchondral bone
Percutaneous screw fixation for non-displaced scaphoid waist fractures has been shown to have which of the following differences compared to closed treatment?
Decreased direct costs
Slower return to work
Higher union rates
Reduced time to fracture union
Improved motion and grip strength after 2 years
A 27-year-old professional cowboy is thrown from a bull during the rodeo and lands on his hand. No deformity is identified and the hand is completely neurovascularly intact. Pain is present upon palpation of the anatomic snuffbox. A radiograph is provided in Figure A. The cowboy wants to return to competitive riding tomorrow. Which of the following is the best next step in management?
Cock-up wrist splint and immediate return to sport as tolerated by pain
Steroid injection of the snuffbox, taping of the wrist and return to sport
Percutaneous screw fixation of the nondisplaced fracture
Scapholunate ligament repair and percutaneous pin fixation
A 35-year-old woman reports wrist pain after a fall onto an outstretched hand. On exam, she has focal tenderness over the wrist snuffbox. A radiograph and CT image are shown in Figures A and B. What is the proper treatment of her injury?
Rest, ice, elevation
Removable splint for comfort
Thumb spica cast
Open reduction, internal fixation
Vascularized bone grafting