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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 28-year-old jack-hammer operator presents with 4 years of wrist pain. The patient was seen three years ago and had normal wrist radiographs at that time. The PA who saw him diagnosed him with a wrist sprain, and he subsequently returned to work. His symptoms never improved, even after a period of casting, so he was referred to your clinic after an MRI was obtained (Figure A). On physical examination, he has dorsal wrist tenderness and limited wrist extension. What surgical procedure may offer him the most reliable pain relief while best preserving the native anatomy?
Vascularized bone graft
Proximal pole excision and tendon interposition
Scapho-capitate (SC) fusion
Proximal row carpectomy
Scaphoidectomy and four corner fusion (4CF)
Select Answer to see Preferred Response
A 30-year-old right-hand-dominant accountant has progressive wrist pain for the last 18 months. He was initially treated in a cast, however his symptoms have continuously worsened. Figures A and B are radiographs taken in the office today. He reports decreased grip strength, and physical exam is significant for decreased wrist extension and tenderness directly over the radiocarpal joint. Examination of the contralateral wrist is otherwise unremarkable. All of the following are described as etiologies for the above condition EXCEPT:
Ulnar negative variance
High interosseous pressure
Underlying medical conditions
Decreased radial inclination
Increased carpal height
Figures A through E depict various conditions affecting the pediatric hand and wrist. For which of the depicted conditions is temporary scaphotrapeziotrapezoidal pinning most indicated?
A 39-year-old male presents with longstanding right wrist pain. He has failed conservative measures including prolonged immobilization. His radiographs and MRI are seen in figures A and B. Which of the following options is an accepted treatment option?
Ulnar shortening osteotomy
Radius core decompression
Arthroscopic lunate chondroplasty and debridement
Scapholunate ligament reconstruction
A 32-year-old carpenter complains of progressively worsening wrist pain for the last 2 months. He denies any recent history of trauma to the wrist or hand. An MRI is obtained and a representative image is provided in Figure A. Which of the following surgical interventions is thought to be effective for this condition by inciting a local vascular healing response?
Distal radius core decompression
Proximal row carpectomy
A 30-year-old female undergoes arthroscopy for a chronically painful right wrist that failed to improve with 4 months of immobilization and NSAIDS. Her clinical examination revealed point tenderness dorsally over the lunate but no tenderness elsewhere in the wrist. A picture from the procedure is shown in Figure A where 'R' identifies the distal radius, 'L' the lunate, and '*' represents a chondral flap. The articular surface of the lunate is stable to probing. A radiograph and MRI image of the patients wrist are shown in Figures B and C respectively. What is the most appropriate next step in treatment?
Continue Immobilization and NSAIDS
Radial shortening osteotomy
A 37-year-old man has a 2-year history of increasing right wrist pain that is worse at night and aggravated by activity. He denies systemic symptoms, history of trauma, or recent weight loss. On physical exam he has tenderness over the dorsal radiocarpal joint. Radiographs of the right wrist are shown in Figure A. Which of the following imaging studies would be most sensitive for determining the stage of this patient's underlying condition?
CT scan of the wrist
Clenched fist AP radiograph of wrist
Bone scan of the wrist