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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 54-year-old Bavarian baker presents to your clinic 5 years after undergoing a Radio-Scapho-Lunate (RSL) fusion for post-traumatic osteoarthritis of the wrist. He has persistent pain and significantly decreased range of motion about the wrist, particularly after a long day in the bakery or when applying his lederhosen. On exam, he has noticeably weaker grip strength and poor motion, particularly in radial deviation, compared to his contralateral wrist. A current radiograph of the affected wrist is seen in Figure A. What additional surgical step, performed at the time of the index RSL fusion, may have prevented this outcome?
Excision of the distal pole of the scaphoid
Excision of the proximal pole of the scaphoid
Excision of the proximal pole of the capitate
Excision of the scaphoid, lunate, and triquetrum
No additional surgical adjuvant may have prevented this complication
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A 45 year old dairy farmer from rural Michigan returns to a local hand surgeon with wrist pain, loss of motion, and loss of strength despite previously receiving an injection for this condition. His radiographs are shown in Figure 1. Surgical options are discussed with the farmer. Degeneration of which joint is a contraindication to a proximal row carpectomy?
Scaphoid - radial styloid
Scaphoid - radius
Scaphoid - capitate
Scaphoid - lunate
Capitate - lunate
A 35-year-old female presents after a fall on an outstretched hand with the injury shown in figures A & B. What articulation is expected to develop osteoarthritis in the third stage of scapholunate advanced collapse (SLAC)?
Radial styloid and scaphoid
A 52-year-old farmer’s periodic wrist pain has been managed with non-operative modalities to include two injections in the last 8 months. A recent imaging study is seen in Figure A. The patient now reports increasing pain and inability to use his wrist. The next best step in management would be:
Distal pole scaphoid excision
Total wrist arthroplasty
Scaphoid excision and four-corner fusion
Proximal row carpectomy
A 65-year-old man fell and injured his right wrist. Radiographs taken in the emergency room are seen in Figure A. He was treated as a sprain and no further follow-up was planned. He sustained 2 minor falls over the next 6 years and his wrist pain recurred. Recent radiographs are seen in Figure B. Surgical treatment that will best address his symptoms and preserve wrist motion consists of
Anterior and posterior interosseous neurectomy
Scaphotrapezialtrapezoidal (STT) fusion
Complete wrist arthrodesis
Proximal row carpectomy
Four-corner fusion with scaphoidectomy
A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. A radiograph is shown in figure A. What joint is first affected if left untreated with subsequent development of a SLAC (scapholunate advanced collapse) wrist?