20231117 Wrist disorders p3a - Dr Tiw

A 24-year-old male construction worker fell 15 feet, landing primarily on his outstretched arm. Noted obvious deformity to the wrist and brought him to the emergency department. Radiographs are shown in the figure below. In the type of injury this patient has sustained, what is the most likely order of structural failure?

• Dorsal radiocarpal ligament -> Lunotriquetral ligament -> Capitolunate ligament -> Scapholunate ligament

• Volar radiocarpal ligament -> Dorsal radiocarpal ligament -> Scapholunate ligament -> Lunotriquetral ligament

• Radioscaphocapitate ligament -> Scapholunate ligament -> Lunotriquetral ligament -> Dorsal radiocarpal ligament

• Scapholunate ligament -> Capitolunate ligament -> Lunotriquetral ligament -> Dorsal radiocarpal ligament

• Scapholunate ligament -> Lunotriquetral ligament -> Capitolunate ligament -> Dorsal radiocarpal ligament

A 24-year-old male fell 12 feet off of a ladder He landed directly on his extended and ulnarly deviated left hand. He was taken to hospital where radiographs were taken, as shown in Figures A and B. What additional data is most necessary to obtain before a reduction is attempted?

• Distal vascular exam

• Neurological exam

• Wrist MRI

• Doppler Allen test

• DRUJ stability assessment

A 35-year-old professional football player complains of severe wrist pain after making a tackle. He reports paraesthesia in his thumb and index finger. AP and lateral radiographs of the wrist are shown in Figures A and B respectively. What is the most appropriate next step in management?

• Short arm thumb spica cast

• Long arm thumb spica cast

• Urgent closed reduction and splinting

• MR arthrogram of the wrist to assess ligamentous injuries

• Bone scan to assess vascularity

A 28-year-old woman fell on her right wrist. She was seen in the emergency department at the time of injury and was told she had a sprain. Examination now reveals dorsal tenderness in the proximal wrist but no snuffbox or ulnar tenderness. Standard wrist radiographs are normal. What is the next most appropriate step in management?

• Arthroscopy of the wrist

• CT of the wrist

• Bilateral PA clenched fist radiograph

• Electromyography and nerve conduction velocity studies

• AP and lateral radiographs of the forearm

A 40-year-old right-handed professional football player reports persistent right wrist pain after falling 5 days ago. A radiograph is shown in Figure 21. Management should consist of

• Immobilization in a short arm thumb spica cast.

• Immobilization in a long arm thumb spica cast.

• Arthroscopic repair and percutaneous pinning.

• Open repair and percutaneous pinning.

• Dorsal capsulodesis.