Introduction Overview distal radius fractures are the most common orthopaedic injury treatment is based on fracture pattern and stability Epidemiology incidence accounts for 17.5% of all fractures in adults demographics more common in females (2-3:1) bimodal distribution younger patients due to high energy mechanisms older patients due to low energy mechanisms (i.e. FOOSH) location intraarticular in 50% risk factors osteoporosis high incidence of distal radius fractures in women > 50 years old distal radius fractures are a predictor of subsequent fractures DEXA scan is recommended for women with distal radius fractures Pathophysiology mechanism of injury usually FOOSH can also be due to higher energy mechanisms Associated conditions DRUJ injuries must be evaluated radial styloid fractures indicates higher energy mechanism soft tissue injuries seen in 70% TFCC injury (40%) scapholunate ligament injury (30%) lunotriquetral ligament injury (15%) Prognosis poorer functional outcomes associated with worker's compensation low socioeconomic status low education levels low bone density successful outcomes correlate with accuracy of articular reduction restoration of anatomic relationships early efforts to regain motion of wrist and fingers Anatomy Distal radius responsible for 80% of axial load articulates with scaphoid via scaphoid fossa lunate via lunate fossa distal ulna via ulnar/sigmoid notch comprised of 3 columns radial column includes the radial styloid and scaphoid fossa functions provides attachment sites for the brachioradialis tendon, long radiolunate ligament, and radioscaphocapitate ligament serves as a buttress to resist radial carpal translation functions as a load-bearing platform for activities performed with the wrist in ulnar deviation holds the carpus out to length radially, allowing a more uniform distribution of load across the scaphoid and lunate facets serves as an anchor for the radioscaphocapitate ligament that prevents ulnar translation of the carpus intermediate column includes the lunate fossa functions transmits load from the carpus to the forearm ulnar column includes the TFCC and distal ulna functions plays an essential role in the stability of the DRUJ and forearm motion Classification Fernandez based on mechanism of injury Frykman based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture Melone divides intra-articular fractures into 4 types based on displacement AO comprehensive but cumbersome Eponyms Eponyms Die-punch fx Depressed fracture of the lunate fossa of the articular surface of the distal radius Barton's fx Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx) Chauffer's fx Radial styloid fx x Colles' fx Low energy, dorsally displaced, extra-articular fx Smith's fx Low energy, volarly displaced, extra-articular fx Presentation History usually a fall onto outstretched hand (FOOSH) Symptoms wrist pain & swelling wrist deformity Physical exam inspection ecchymosis & swelling diffuse tenderness visible deformity if displaced motion limited by pain Imaging Radiographs recommended views AP lateral oblique findings View Measurement Normal Acceptable criteria AP Radial height 13mm < 5mm shortening Radial inclination 23° change < 5° Articular stepoff congruous < 2 mm stepoff Lateral Volar tilt 11° dorsal angulation < 5° or within 20° of contralateral distal radius CT indications evaluate intra-articular involvement surgical planning MRI indications evaluate for soft tissue injury TFCC injuries scapholunate ligament injuries (DISI) lunotriquetral injuries (VISI) Treatment Nonoperative closed reduction and splint/cast immobilization indications extra-articular < 5mm radial shortening dorsal angulation < 5° or within 20° of contralateral distal radius Operative CRPP indications extra-articular with stable volar cortex outcomes 82-90% good results if used appropriately ORIF indications radiographic findings indicating instability (pre-reduction radiographs best predictor of stability) dorsal angulation > 5° or > 20° of contralateral distal radius volar or dorsal comminution displaced intra-articular fractures > 2mm radial shortening > 5mm associated ulnar fracture associated ulnar styloid fractures do not require fixation severe osteoporosis articular margin fractures (dorsal and volar Barton's fractures) the volar ulnar corner (critical corner) supports the volar lunate facet with its strong radiolunate ligament attachments failure to address this fragment can result in volar carpal subluxation comminuted and displaced extra-articular fractures (Smith's fractures) die-punch fractures progressive loss of volar tilt and radial length following closed reduction and casting external fixation indications open fractures highly comminuted fractures medically unstable patients unable to undergo a lengthy procedure outcomes important adjunct with 80-90% good/excellent results alone cannot reliably restore 10° palmar tilt therefore usually combined with percutaneous pinning technique or plate fixation Techniques Closed reduction and splint/cast immobilization technique reduction requires adequate anesthesia apply longitudinal traction and volar/dorsal pressure to the distal fracture fragment immobilization avoid positions of extreme flexion and ulnar deviation (Cotton-Loder Position) due to risk of carpal tunnel syndrome rehabilitation no significant benefit of physical therapy over home exercises for simple distal radius fractures treated with cast immobilization outcomes repeat closed reductions have < 50% satisfactory results LaFontaine predictors of instability patients with three or more factors have high chance of loss of reduction dorsal angulation > 20° dorsal comminution > 50%, palmar comminution, intraarticular comminution initial displacement > 1cm initial radial shortening > 5mm associated ulnar fracture severe osteoporosis radial shortening is the most predictive of instability, followed by dorsal comminution Meta-analyses and systematic reviews demonstrate no difference in functional outcomes between closed treatment versus operative methods in elderly patients (>65 years old) complications specific to this treatment acute carpal tunnel syndrome EPL rupture CRPP technique Kapandji intrafocal technique K wires are placed dorsally into the fracture and used as reduction tools until they are driven into the proximal radius Rayhack technique with arthroscopically assisted reduction complications specific to this treatment radial sensory nerve injury pin tract infections ORIF technique guides distal radius extra-articular fracture ORIF with volar approach distal radius intra-articular fracture ORIF with dorsal approach types volar plating preferred over dorsal plating associated with irritation of both flexor and extensor tendons rupture of FPL is most common with volar plates associated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendons can have hyperesthesia over the base of the thenar eminence due to palmar cutaneous nerve injury during retraction of the digital flexor tendons when plating the distal radius new volar locking plates offer improved support to subchondral bone dorsal plating indicated for displaced intra-articular distal radius fractures with dorsal comminution historically associated with extensor tendon irritation and rupture technique can combine with external fixation and percutaneous pinning perform bone grafting if complex and comminuted study showed improved results with arthroscopically-assisted reduction volar lunate facet fragments may require fragment-specific fixation to prevent early postoperative failure complications specific to this treatment screw penetration into the radiocarpal joint or DRUJ assess intra-articular screws with a 23 degree elevated lateral view assess dorsal cortex penetration with a skyline view tendon rupture External fixation technique guides distal radius fracture spanning external fixator distal radius fracture non-spanning external fixator types spanning ex-fix useful for fractures with small articular fragment non-spanning ex-fix useful for fractures with large articular fragment technique relies on ligamentotaxis to maintain reduction place radial shaft pins under direct visualization to avoid injury to superficial radial nerve avoid overdistraction (carpal distraction < 5mm in neutral position) and excessive volar flexion and ulnar deviation limit duration to 8 weeks and perform aggressive OT to maintain digital ROM complications specific to this treatment malunion/nonunion stiffness and decreased grip strength pin complications (infections, fractures through pin site, skin difficulties) pin site care comprising daily showers and dry dressings recommended neurologic (iatrogenic injury to radial sensory nerve, median neuropathy, RSD) Complications Median nerve neuropathy (CTS) incidence most frequent neurologic complication seen in 1-12% of low energy fxs and 30% of high energy fxs risk factors prevent by avoiding immobilization in excessive wrist flexion and ulnar deviation (Cotton-Loder position) treatment acute carpal tunnel release indications progressive paresthesias, weakness in thumb opposition paresthesias that do not respond to reduction and last > 24-48 hours Ulnar nerve neuropathy risk factors DRUJ injury EPL rupture risk factors nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon extensor mechanism is thought to impinge on the tendon following a nondisplaced fracture and causes either a mechanical attrition or a local area of ischemia in the tendon volar plating with screw fixation that penetrates the dorsal cortex and is proud dorsally treatment EIP to EPL transfer FPL rupture risk factors very distal volar plate placement on the radius (distal to watershed line) is associated with FPL rupture due to physical contact of tendon on plate and subsequent tendinopathy Radiocarpal arthrosis (2-30%) incidence 90% young adults will develop symptomatic arthrosis if articular stepoff > 1-2mm may also be nonsymptomatic Malunion/nonunion intra-articular malunion treatment revision at > 6 weeks extra-articular angulation malunion treatment opening wedge osteotomy with ORIF and bone grafting radial shortening malunion radial shortening associated with greatest loss of wrist function and degenerative changes in extra-articular fractures treatment ulnar shortening ECU or EDM entrapment risk factors DRUJ injury Compartment syndrome RSD/CRPS prevention AAOS 2010 clinical practice guidelines recommend vitamin C supplementation to prevent incidence of RSD postoperatively
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Distal Radius Intraarticular Fracture ORIF with Dorsal Approach Orthobullets Team Trauma - Distal Radius Fractures Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Distal Radius Extra-articular Fracture ORIF with Volar Appr Orthobullets Team Trauma - Distal Radius Fractures Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Distal Radius Fracture Non-Spanning External Fixator Orthobullets Team Trauma - Distal Radius Fractures Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Distal Radius Fracture Spanning External Fixator Orthobullets Team Trauma - Distal Radius Fractures
QUESTIONS 1 of 43 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ17SE.28) A 45-year-old female barista from Portland fell off her skateboard and sustained a closed distal radius fracture. The patient undergoes open reduction internal fixation (ORIF). Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. Which of the following has evidence to support its utility in this clinical situation? Tested Concept QID: 211413 Type & Select Correct Answer 1 Alendronate 700mg once per week for 3 months 2% (27/1376) 2 Vitamin C 500mg once daily for 50days 85% (1171/1376) 3 Alendronate 70mg once per week for 3 months 4% (58/1376) 4 Vitamin C 200mg once daily for 50days 2% (32/1376) 5 Vitamin C 1500mg once daily for 100days 6% (81/1376) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (SBQ17SE.64) A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? Tested Concept QID: 211809 Type & Select Correct Answer 1 Extended wrist tangential view 6% (83/1297) 2 Flexed wrist tangential view 15% (199/1297) 3 PA anatomic tilt view 12% (151/1297) 4 Radial inclination view 63% (818/1297) 5 Standard lateral view 3% (42/1297) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ17.87) A 57-year-old woman underwent open reduction internal fixation from a volar approach for a displaced distal radius fracture. Immediate post-operative radiographs are seen in Figure A. The patient recovered well initially but presents after 6 months with grip weakness. What complication is most likely to occur in this patient? Tested Concept QID: 210174 FIGURES: A Type & Select Correct Answer 1 Inability to extend the index finger proximal interphalangeal joint. 2% (56/2432) 2 Inability to flex the index finger proximal interphalangeal joint. 9% (218/2432) 3 Inability to extend the thumb interphalangeal joint. 10% (234/2432) 4 Inability to flex the thumb interphalangeal joint. 74% (1806/2432) 5 Inability to abduct the thumb. 4% (93/2432) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ16.228) Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture? Tested Concept QID: 8990 Type & Select Correct Answer 1 Dorsal skyline view 19% (315/1640) 2 AP wrist view 0% (6/1640) 3 PA wrist view 1% (19/1640) 4 23° elevated lateral view 71% (1165/1640) 5 45° oblique lateral view 8% (125/1640) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.140) A 76-year-old male sustains a minimally displaced distal radius fracture and undergoes closed treatment with a cast. Four months post-injury, he presents to the office with an inability to extend his thumb. Which of the following injuries is the most likely cause of this finding? Tested Concept QID: 4775 Type & Select Correct Answer 1 Extensor pollicis brevis rupture 3% (86/3300) 2 Posterior interosseous nerve palsy 2% (81/3300) 3 Adhesions within the first and third dorsal wrist compartments 3% (83/3300) 4 Dorsal wrist septic tenosynovitis 0% (10/3300) 5 Extensor pollicis longus rupture 92% (3027/3300) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ13.78) A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Radiographs of the affected wrist are shown in Figure A. After soft tissue swelling subsides, open reduction and internal fixation of the distal radius is performed. Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Incompetence of which of the following anatomic structures is the most likely etiology of this finding? Tested Concept QID: 4713 FIGURES: A Type & Select Correct Answer 1 Radioulnar ligaments of the TFCC 88% (6574/7486) 2 Ulnar collateral ligament 1% (93/7486) 3 Fracture fixation 2% (177/7486) 4 Ulnolunate ligament of the TFCC 3% (251/7486) 5 Ulnotriquetral ligament of the TFCC 5% (350/7486) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (OBQ12.244) A 65-year-old female sustains a fall onto her outstretched right hand. The injury is closed and she is neurovascularly intact. There is no median nerve paresthesias. Radiographs are shown in Figures A and B. What is the next best step in management of this patient? Tested Concept QID: 4604 FIGURES: A B Type & Select Correct Answer 1 Admit for acute carpal tunnel syndrome monitoring 1% (14/1740) 2 Admit for acute open reduction/internal fixation 1% (25/1740) 3 Place into removable soft splint and follow-up in clinic 4% (78/1740) 4 Place into rigid splint and follow-up in clinic 90% (1565/1740) 5 Place into rigid splint and schedule for outpatient open reduction/internal fixation 3% (52/1740) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ12.105) A 17-year-old male falls from a retaining wall onto his left arm. He sustains the injury shown in Figure A. The patient undergoes open reduction and internal fixation of the fracture. Upon discharge from the hospital the medication reconciliation includes an order for daily Vitamin C 500mg supplementation. This medication is given in an effort to decrease the incidence of which of the following? Tested Concept QID: 4465 FIGURES: A Type & Select Correct Answer 1 Upper extremity deep vein thrombosis (DVT) 1% (51/5039) 2 Acute carpal tunnel syndrome (ACTS) 2% (111/5039) 3 Complex regional pain syndrome (CRPS) 92% (4630/5039) 4 Lower extremity deep vein thrombosis (DVT) 0% (25/5039) 5 Surgical site infection (SSI) 4% (193/5039) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ12.38) A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. He denies any new trauma, and has followed all post-operative activity restrictions. Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? Tested Concept QID: 4398 FIGURES: A B C D E Type & Select Correct Answer 1 Failure to support the lunate facet with fragment specific fixation 76% (2756/3621) 2 Use of a non-locking plate 6% (220/3621) 3 Lack of volar tilt restoration 4% (154/3621) 4 Lack of radial styloid column plating 6% (232/3621) 5 Use of only three bicortical screws in the intact radial shaft proximally 6% (218/3621) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.273) A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. Radiographs obtained at the time of injury are shown in Figure A. She underwent open reduction and fixation of the distal radius fracture, and current radiographs are shown in Figure B. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. Which of the following is true post-operatively regarding this patient's ulnar styloid fracture? Tested Concept QID: 3696 FIGURES: A B Type & Select Correct Answer 1 Worse outcomes on the Mayo wrist score are expected without fixation 2% (55/3020) 2 Chronic distal radioulnar joint instability can be expected to occur without fixation 3% (90/3020) 3 Wrist function depends on the level of ulnar styloid fracture and initial displacement 12% (359/3020) 4 Grip strength and wrist range of motion are improved with fixation 3% (79/3020) 5 There is no adverse effect on wrist function or stability without fixation 80% (2414/3020) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ10.127) A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. She complains of wrist pain and deformity. On physical exam she has no sensation of the volar thumb, index, and middle fingers. Radiographs are provided in Figure A. Two hours following closed reduction, the deformity is corrected, but the numbness and wrist pain is worsening. Which of the following interventions should be taken? Tested Concept QID: 3224 FIGURES: A Type & Select Correct Answer 1 Evaluation of volar compartment pressures with a needle monitor 3% (65/2523) 2 Icing and elevation of the arm with follow-up evaluation in 8 hours 3% (64/2523) 3 Immediate EMG evaluation of the left upper extremity 0% (9/2523) 4 Closed reduction, carpal tunnel release, and sugar tong splinting 3% (71/2523) 5 Emergent open reduction internal fixation with carpal tunnel release 91% (2295/2523) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.254) A 64-year-old female sustains a nondisplaced distal radius fracture and undergoes closed treatment using a cast. Three months after the fracture she reports an acute loss of her ability to extend her thumb. What is the most likely etiology of her new loss of function? Tested Concept QID: 3067 Type & Select Correct Answer 1 Posterior interosseous nerve entrapment 5% (51/949) 2 Extensor pollicis longus rupture 83% (787/949) 3 Extensor pollicis longus entrapment 7% (63/949) 4 Distal radius malunion 1% (9/949) 5 Intersection syndrome 3% (28/949) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.179) A 51-year-old female presents with an acute inability to extend her thumb, four months after she was treated with cast immobilization for a minimally-displaced distal radius fracture. What is the most appropriate treatment at this time? Tested Concept QID: 565 Type & Select Correct Answer 1 Occupational therapy for strengthening 5% (116/2272) 2 Extensor carpi radialis longus transfer to extensor pollicus longus 4% (83/2272) 3 Extensor pollicis brevis transfer to extensor pollicus longus 2% (51/2272) 4 Extensor indicis proprius transfer to extensor pollicus longus 77% (1747/2272) 5 Primary repair of extensor pollicus longus 12% (265/2272) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ07.226) A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. Which of the following factors has been associated with redisplacement of the fracture after closed manipulation? Tested Concept QID: 887 FIGURES: A Type & Select Correct Answer 1 Triangular fibrocartilage complex tear 6% (65/1047) 2 Open injury 1% (6/1047) 3 Ipsilateral radial head fracture 4% (42/1047) 4 Time to reduction 1% (13/1047) 5 Severity of initial displacement 87% (914/1047) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ07.8) Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? Tested Concept QID: 669 FIGURES: A B Type & Select Correct Answer 1 Abductor Pollicis Longus 5% (74/1595) 2 Extensor Pollicis Brevis 8% (122/1595) 3 Extensor Indicis Proprius 14% (225/1595) 4 Flexor Pollicis Brevis 1% (18/1595) 5 Flexor Pollicis Longus 72% (1148/1595) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ06.102) Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios? Tested Concept QID: 288 Type & Select Correct Answer 1 Non-displaced distal radius fracture 83% (681/816) 2 Non-displaced Rolando fracture 5% (40/816) 3 Second metacarpal base fracture 5% (40/816) 4 Boxer's fracture 1% (7/816) 5 Non-displaced radial styloid fracture 5% (43/816) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (OBQ06.60) A 46-year-old woman sustains an extra-articular fracture of the distal radius and undergoes open reduction and internal fixation with a volar plate and screw construct. During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? Tested Concept QID: 171 Type & Select Correct Answer 1 Greater grip strength at 6 months 9% (77/905) 2 Less wrist pain at 1 year 1% (12/905) 3 Better hand dexterity at 1 year 2% (17/905) 4 No difference in functional outcomes 75% (680/905) 5 Quicker return to work 12% (108/905) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ06.136) A 25-year-old female falls from her horse and injures her left wrist. There are no open wounds and the hand is neurovascularly intact. Radiographs are provided in Figures A-C. Which of the following will best achieve anatomic reduction, restore function, and prevent future degenerative changes of the wrist? Tested Concept QID: 322 FIGURES: A B C Type & Select Correct Answer 1 Long arm cast above the elbow for 6 weeks 0% (2/1053) 2 Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks 1% (6/1053) 3 Closed reduction and external fixation 1% (10/1053) 4 Closed reduction and percutaneous pinning 2% (16/1053) 5 Open reduction and internal fixation 96% (1012/1053) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (OBQ05.195) A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. Preoperatively, he reported some mild sensory disturbances in the volar thumb and index finger, but had 2-point discrimination of 6mm in each finger. Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. Two-point discrimination is now >10mm in these fingers. Radiographs show a well-fixed fracture in good alignment. What is the most appropriate treatment at this time? Tested Concept QID: 1081 Type & Select Correct Answer 1 Strict elevation 7% (158/2423) 2 Removal of hardware 1% (33/2423) 3 Immediate carpal tunnel release 88% (2132/2423) 4 Carpal tunnel release if no resolution at 6-12 weeks 3% (65/2423) 5 Trial of night splinting 1% (28/2423) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (OBQ05.25) A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Adequate maintenance of reduction by non-operative treatment is unsuccesful. Which plating option provides the most appropriate treatment of this fracture? Tested Concept QID: 62 Type & Select Correct Answer 1 semitubular 1% (9/967) 2 dynamic compression 3% (31/967) 3 limited-contact dynamic compression 4% (41/967) 4 peri-articular locked 91% (880/967) 5 pelvic reconstruction 0% (1/967) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (OBQ04.233) A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. What is the appropriate surgical treatment at this time? Tested Concept QID: 1338 FIGURES: A Type & Select Correct Answer 1 Distal radius corrective osteotomy 92% (908/982) 2 Total wrist arthrodesis 1% (8/982) 3 Proximal row carpectomy 3% (34/982) 4 Scaphoid excision and four corner fusion 2% (16/982) 5 Interposition arthroplasty 1% (5/982) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept
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