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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury?
Improved functional outcomes with open reduction internal fixation (ORIF) through FCR approach vs. closed treatment
No difference in radiographic outcomes after ORIF vs. closed treatment
No difference in functional outcomes after ORIF vs. closed treatment
Improved functional outcomes with closed treatment vs. ORIF
Improved functional outcomes with external fixation and K wire fixation vs. ORIF
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Which of the following distal radius fractures is associated with volar translation of carpus relative to the radial articulation?
Displaced impaction fracture of the lunate fossa
Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner
Displaced radial styloid fracture
Displaced extra-articular fracture with apex volar
Displaced extra-articular fracture with apex dorsal
A 56-year-old woman sustains the closed injury depicted in Figures A-B. On examination, her wrist is mildly swollen and she is unable to actively oppose her thumb. She also complains of some paresthesias in her thumb and index finger. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. What is the likely mechanism of her paresthesias and what is the most appropriate treatment?
Nerve compression; open reduction internal fixation with open carpal tunnel release
Nerve laceration; open reduction internal fixation with primary nerve repair or grafting
Decreased arterial inflow; fasciotomy with open reduction internal fixation
Reflex sympathetic dystrophy; vitamin C
Nerve compression; repeat closed reduction
A 56-year-old male presents to your clinic with a 4-month history of inability to extend the IP joint of his thumb. He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. His radiograph is shown in Figure A. Which of the following tendons is most commonly transferred to address the patient's deficiency?
Flexor digitorum superficialis
Extensor pollicis brevis
Extensor indicis proprius
Extensor pollicis longus
Extensor digitorum communis
A 40-year-old slips on the ice on a wintery Michigan day and sustains a comminuted intra-articular distal radius fracture. Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability?
A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. He underwent operative fixation by and presents to your clinic for his 2 week follow-up visit. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. The patient shows you the lateral film in Figure A. You remove his splint, he has no difficulty moving any fingers, very minimal pain, and is not taking any narcotic medication. How do you counsel him about his post-operative period?
The plate may need to removed once the fracture is healed to reduce the chance of flexor pollicis longus injury
The plate may need to removed once the fracture is healed to reduce the chance of flexor carpi radialis injury
The plate may need to removed once the fracture is healed to reduce the chance of flexor digitorum superficialis – index finger injury
The patient should undergo revision fixation as soon as possible
The plate is in appropriate position and will likely never need to be removed
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?
Alendronate 700mg once per week for 3 months
Vitamin C 500mg once daily for 50days
Alendronate 70mg once per week for 3 months
Vitamin C 200mg once daily for 50days
Vitamin C 1500mg once daily for 100days
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?
Extended wrist tangential view
Flexed wrist tangential view
PA anatomic tilt view
Radial inclination view
Standard lateral view
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?
Inability to extend the index finger proximal interphalangeal joint.
Inability to flex the index finger proximal interphalangeal joint.
Inability to extend the thumb interphalangeal joint.
Inability to flex the thumb interphalangeal joint.
Inability to abduct the thumb.
Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture?
Dorsal skyline view
AP wrist view
PA wrist view
23° elevated lateral view
45° oblique lateral view
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?
Extensor pollicis brevis rupture
Posterior interosseous nerve palsy
Adhesions within the first and third dorsal wrist compartments
Dorsal wrist septic tenosynovitis
Extensor pollicis longus rupture
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?
Radioulnar ligaments of the TFCC
Ulnar collateral ligament
Ulnolunate ligament of the TFCC
Ulnotriquetral ligament of the TFCC
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?
Admit for acute carpal tunnel syndrome monitoring
Admit for acute open reduction/internal fixation
Place into removable soft splint and follow-up in clinic
Place into rigid splint and follow-up in clinic
Place into rigid splint and schedule for outpatient open reduction/internal fixation
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?
Upper extremity deep vein thrombosis (DVT)
Acute carpal tunnel syndrome (ACTS)
Complex regional pain syndrome (CRPS)
Lower extremity deep vein thrombosis (DVT)
Surgical site infection (SSI)
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?
Failure to support the lunate facet with fragment specific fixation
Use of a non-locking plate
Lack of volar tilt restoration
Lack of radial styloid column plating
Use of only three bicortical screws in the intact radial shaft proximally
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?
Worse outcomes on the Mayo wrist score are expected without fixation
Chronic distal radioulnar joint instability can be expected to occur without fixation
Wrist function depends on the level of ulnar styloid fracture and initial displacement
Grip strength and wrist range of motion are improved with fixation
There is no adverse effect on wrist function or stability without fixation
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?
Evaluation of volar compartment pressures with a needle monitor
Icing and elevation of the arm with follow-up evaluation in 8 hours
Immediate EMG evaluation of the left upper extremity
Closed reduction, carpal tunnel release, and sugar tong splinting
Emergent open reduction internal fixation with carpal tunnel release
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?
Posterior interosseous nerve entrapment
Extensor pollicis longus entrapment
Distal radius malunion
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?
Occupational therapy for strengthening
Extensor carpi radialis longus transfer to extensor pollicus longus
Extensor pollicis brevis transfer to extensor pollicus longus
Extensor indicis proprius transfer to extensor pollicus longus
Primary repair of extensor pollicus longus
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?
Triangular fibrocartilage complex tear
Ipsilateral radial head fracture
Time to reduction
Severity of initial displacement
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?
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Indicis Proprius
Flexor Pollicis Brevis
Flexor Pollicis Longus
Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios?
Non-displaced distal radius fracture
Non-displaced Rolando fracture
Second metacarpal base fracture
Non-displaced radial styloid fracture
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?
Greater grip strength at 6 months
Less wrist pain at 1 year
Better hand dexterity at 1 year
No difference in functional outcomes
Quicker return to work
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?
Long arm cast above the elbow for 6 weeks
Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks
Closed reduction and external fixation
Closed reduction and percutaneous pinning
Open reduction and internal fixation
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?
Removal of hardware
Immediate carpal tunnel release
Carpal tunnel release if no resolution at 6-12 weeks
Trial of night splinting
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?
limited-contact dynamic compression
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?
Distal radius corrective osteotomy
Total wrist arthrodesis
Proximal row carpectomy
Scaphoid excision and four corner fusion