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A 30-year-old plastic surgery resident fell from a height of 12' and sustained a right both-bone forearm fracture. The patient underwent open reduction and internal fixation with 3.5mm Limited Contact Dynamic Compression Plating. Three months after fixation the patient has no forearm tenderness and has full active range of motion of his fingers, hand, and wrist. However, pronation and supination are severely limited. This affects his ability to suture during surgery and knit, although he has returned to his other recreational activities. His most recent radiographs are shown in Figures A and B. What is the most likely cause for his lack motion?
Posterior interosseous nerve (PIN) palsy
ECU interposition at the DRUJ
Loss of radial bow
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During proximal exposure for plating of a radial shaft fracture through a classic volar Henry approach, the radial artery should be retracted ______ and the supinator muscle should be retracted ______ with the forearm in ______.
medially; laterally; pronation
laterally; medially; supination
laterally; laterally; supination
laterally ; medially; pronation
medially; laterally; supination
Which of the following has been shown to be the greatest risk factor for refracture after plate removal from a radial shaft?
Removal of locking screws
Removal of small fragment plates
Removal of metaphyseal implants
Removal of implants less than 1 year after insertion
Removal of protective splinting from limb earlier than 10 weeks postoperatively
An otherwise healthy young adult male sustains a transverse radial shaft and ulna fracture. He undergoes definitive surgical fixation with two non-locking compression plates (LCPs) as shown in Figure A. What is the principle of this fixation technique on bone healing?
Absolute stability with direct healing by callus formation
Relative stability with indirect healing by callus formation
Absolute stability with direct healing by internal remodeling
Relative stability with indirect healing by internal remodeling
Absolute stability with endochondral bone formation
Longitudinal radioulnar dissociation, including Essex Lopresti fractures, requires disruption of the interosseous membrane (IOM). The interosseous membrane (IOM) consists of all of the following ligaments EXCEPT?
Central band ligament
Accessory band ligament
Dorsal oblique accessory cord ligament
Distal oblique bundle ligament
Excision of heterotopic bone about the forearm or elbow can be done with limited recurrence rates as early as which of the following after initial injury?
Once ankylosis of the forearm or elbow occurs
A 22-year-old male sustains the closed injury seen in figure A. The injury is best treated with which of the following methods?
Flexible intramedullary nailing
Open reduction and internal fixation with acute bone grafting
Open reduction and internal fixation
Closed reduction and functional bracing
A 25-year-old man sustains an open forearm fracture from an auger as depicted in Figures A and B. After debridement of nonviable bone, a 10cm bone defect is left. In planning future definitive treatment of the bone void, the use of an interposed strut allograft instead of transfer of a vascularized fibula graft would most likely result in which of the following complications?
Higher incidence of infection
Lower nonunion rate
Decreased forearm arc of rotation
Complex regional pain syndrome
A 27-year-old male sustains a type I open both bone forearm fracture as seen in Figure A. During irrigation and debridement a 1 cm of cortex is removed leaving a segmental gap. Which of the following adjuvants is recommended to supplement your internal fixation?
What is the primary advantage of two incisions compared to one for open reduction internal fixation of a both bones forearm fracture?
lower risk of synostosis
lower risk of wound complications
lower rate of radial neuritis
less pronator teres denervation
lower malunion rate
All of the following have been shown to increase the risk of refracture following removal of forearm plates used for internal fixation EXCEPT:
initial fracture comminution
initial fracture displacement
use of 3.5 mm dynamic compression plate
plate removal before 12 months
immediate activity as tolerated following removal
Treatment of an atrophic nonunion of the radial diaphysis should include which of the following?
Ultrasound bone stimulator
Plate exchange with autogenous cancellous grafting
Plate exchange with ulnar shortening osteotomy
An otherwise healthy 30-year-old male sustains a left forearm injury as a result of a fall from a ladder. Initial examination in the emergency room reveals a clean 2 centimeter laceration over the volar forearm associated with the radiographs shown in Figures A and B. Treatment should consist of irrigation and debridement of the wound followed by which of the following?
Closed reduction and casting of left radius and ulna
Temporary external fixation of the left radius and ulna
Definitive external fixation of the left radius and ulna
Open reduction and internal fixation of the left radius and ulna with delayed skin closure
Open reduction and internal fixation of the left radius and ulna with immediate skin closure
During open reduction and internal fixation of a both bone forearm fracture, restoration of the radial bow has been most associated with which of the following?
Improvement in wrist extension strength
Improvement in wrist flexion strength
Restoration of forearm rotation
Restoration of elbow range of motion
Decreased incidence of synostosis