20241114 Wrist disorder p3a & 3b - Dr Ba Huang & Dr Trysha

A 24-year-old event crew fell 12 feet off a ladder while preparing a set. As he tried to brace his fall, he landed directly on his extended and ulnarly deviated left hand. He was taken to the local hospital where radiographs were taken. What additional information is most necessary to obtain before next step of management?

• A. Distal vascular examination

• B. Neurological examination

• C. Wrist MRI

• D. DRUJ stability assessment

• E. Allen test

In the type of injury this patient has sustained, what is the most likely order of structural failure?

• A. Scapholunate ligament -> disruption of capitolunate articulation -> disruption of lunotriquetral articulation-> failure of dorsal radiocarpal ligament

• B. Scapholunate ligament -> disruption of lunotriquetral articulation-> disruption of capitolunate articulation-> failure of dorsal radiocarpal ligament

• C. Scapholunate ligament -> disruption of capitolunate articulation-> failure of dorsal radiocarpal ligament-> disruption of lunotriquetral articulation

• D. Failure of dorsal radiocarpal ligament-> Scapholunate ligament -> disruption of capitolunate articulation -> disruption of lunotriquetral articulation

• E. Failure of dorsal radiocarpal ligament-> Scapholunate ligament-> disruption of lunotriquetral articulation-> disruption of capitolunate articulation

A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. A radiograph is shown in figure A. What joint is first affected if left untreated with subsequent development of a SLAC (scapholunate advanced collapse) wrist?

• A. Capitolunate joint

• B. Radioscaphoid joint

• C. Radioulnar joint

• D. Radiolunate joint

• E. Scaphotrapezotrapezoidal joint

A 60 year old male, a retired manual laborer working for 40 years at a road construction company was diagnosed with scapholunate advanced collapse. Which of the following joints are spared in the progression of scapholunate advanced collapse?

• A. Radioscaphoid

• B. Scapholunate

• C. Lunotriquetral

• D. Radiolunate

• E. Scaphotrapeziotrapezoid

A 57 year old, right hand dominant gentleman bread winner, working as a manual labourer complains of a 6 month history of persistent right dorsal wrist pain with occasional clunking felt upon radial / ulna deviation of the wrist. Based on the radiograph above, which of the following treatments would be most recommended?

• A. Proximal row carpectomy

• B. Radial styloidectomy

• C. Four corner fusion

• D. Total wrist arthrodesis

• E. Vascularised bone graft and screw fixation of scaphoid