Hand Fractures and Dislocations — MCQs
A patient presents with a history of arthritis involving the 1st CMC joint and other PIP & DIP joints, while sparing the wrist and ankle. What is the most likely diagnosis for this condition?
One of the common fractures that occur during boxing by hitting with a closed fist is:
Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)
After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?
A cricketer holds a catch and then presents with pain at the base of the right thumb; he should be examined to specifically rule out damage to which of the following structures?
A 30-year-old man involved in a fisticuff, injured his middle finger and noticed slight flexion of the distal interphalangeal (DIP) joint. X-rays were normal. The most appropriate management at this stage is:
A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
A 22-year-old male medical student was seen in the emergency department with a complaint of pain in his hand. He confessed that he had hit a vending machine in the hospital when he did not receive his soft drink after inserting money twice. The medial side of the dorsum of the hand was quite swollen, and one of his knuckles could not be seen when he "made a fist." The physician made a diagnosis of a "boxer's fracture." What was the nature of the impatient student's injury?
A 54-year-old female marathon runner presents with pain in her right wrist that resulted from a fall onto her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone. Which of the following bones is most likely dislocated?
In an extension type of supracondylar fracture, what is the usual direction of displacement?
Hand Fractures and Dislocations Indian Medical PG Practice Questions and MCQs
Question 1: A patient presents with a history of arthritis involving the 1st CMC joint and other PIP & DIP joints, while sparing the wrist and ankle. What is the most likely diagnosis for this condition?
- A. Osteoarthritis (Correct Answer)
- B. Rheumatoid arthritis
- C. Psoriatic arthritis
- D. Gout
Explanation: ***Osteoarthritis*** - This condition presents with **arthritis in the 1st carpometacarpal (CMC)**, **proximal interphalangeal (PIP)**, and **distal interphalangeal (DIP)** joints, which is highly characteristic of osteoarthritis [1]. - The sparing of the **wrist and ankle** joints further supports osteoarthritis, as these joints are more commonly affected in inflammatory arthropathies [1]. *Rheumatoid arthritis* - **Rheumatoid arthritis (RA)** typically affects the **small joints of the hands and feet**, but it characteristically spares the **DIP joints** and often involves the **wrists** symmetrically [1]. - It also usually presents with morning stiffness that lasts longer than 30 minutes, which is not mentioned here. *Psoriatic arthritis* - **Psoriatic arthritis** can affect the **DIP joints** and can present with an oligoarticular or polyarticular pattern, but it is typically associated with **psoriasis**, dactylitis, and enthesitis, none of which are described [1]. - The pattern of joint involvement, particularly the sparing of wrists and ankles, is less typical for psoriatic arthritis compared to osteoarthritis [1]. *Gout* - **Gout** typically presents as **acute, severe monoarthritis**, most commonly affecting the **first metatarsophalangeal (MTP) joint** (podagra). - While it can affect other joints, its episodic nature and sudden onset differentiate it from the chronic, progressive pattern often seen in osteoarthritis.
Question 2: One of the common fractures that occur during boxing by hitting with a closed fist is:
- A. Monteggia fracture dislocation
- B. Galeazzi fracture dislocation
- C. Bennett's fracture dislocation (Correct Answer)
- D. Smith's fracture
Explanation: ***Bennett's fracture dislocation*** - This is an **intra-articular fracture** of the base of the **first metacarpal**, extending into the carpometacarpal (CMC) joint. - It is frequently caused by axial compression with the thumb in a flexed and adducted position, a common injury mechanism in **punching a hard object** during boxing. *Monteggia fracture dislocation* - This injury involves a fracture of the **proximal ulna** coupled with an **anterior dislocation of the radial head**. - It is typically caused by a direct blow to the forearm or a fall on an outstretched hand with a hyperpronated forearm, not a direct punch. *Galeazzi fracture dislocation* - This involves a fracture of the **distal radius** with an associated **dislocation of the distal radioulnar joint (DRUJ)**. - It results from a fall on an outstretched hand with a hyperpronated forearm, which is not consistent with a boxing injury. *Smith's fracture* - Also known as a **reverse Colles' fracture**, this is a fracture of the **distal radius** with **volar displacement of the distal fragment**. - It typically results from a fall on a flexed wrist or a direct blow to the back of the wrist, not a punching injury.
Question 3: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)
- A. Navicular (scaphoid) fracture (Correct Answer)
- B. Monteggia's deformity
- C. Greenstick fracture
- D. Spiral fracture
Explanation: ***Navicular (scaphoid) fracture*** - Tenderness in the **anatomical snuffbox** is a classic and highly indicative sign of a **scaphoid fracture**. - The scaphoid bone forms the floor of the anatomical snuffbox, and injury to this bone often results from a fall on an **outstretched hand**. *Monteggia's deformity* - This injury involves a fracture of the **proximal ulna** with an associated **dislocation of the radial head**. - It presents with pain and deformity in the forearm, not typically isolated tenderness in the anatomical snuffbox. *Greenstick fracture* - A greenstick fracture is an **incomplete fracture** where one side of the bone is broken and the other is bent, commonly seen in children. - It does not specifically manifest with tenderness in the anatomical snuffbox, as it can occur in various bones. *Spiral fracture* - A spiral fracture occurs when a bone is broken by a **twisting force**, creating a helical pattern. - While it can occur in various long bones, it is not specifically associated with tenderness in the anatomical snuffbox.
Question 4: After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?
- A. Splint (Correct Answer)
- B. Wax bath
- C. Ignore
- D. Surgery
Explanation: ***Splint*** - The patient presents with **inability to extend the distal interphalangeal joint** after an injury, with a **normal X-ray**. This clinical picture is highly suggestive of a **mallet finger**. - **Splinting** the distal interphalangeal joint in **extension** for 6-8 weeks is the primary non-surgical treatment for mallet finger, aiming to allow the ruptured extensor tendon to heal. *Wax bath* - A **wax bath** is a form of thermotherapy used to relieve pain and stiffness in joints by applying heat. - While it can be helpful for chronic conditions like **arthritis**, it is not an appropriate initial treatment for an acute **tendon injury** like mallet finger, as it does not promote healing of the extensor mechanism. *Ignore* - **Ignoring** the symptoms would lead to a failure to treat the injury, potentially resulting in a **chronic extensor lag deformity** (mallet finger deformity). - Untreated, this condition can cause persistent functional impairment and cosmetic deformity of the affected finger. *Surgery* - **Surgery** is typically reserved for specific cases of mallet finger, such as those with a **large avulsion fracture** of the dorsal base of the distal phalanx (where the fragment involves more than 30-50% of the articular surface), or if non-surgical treatment fails. - Since the **X-ray was normal** in this case, indicating no significant bony avulsion, and it's an acute presentation, surgery is not the appropriate first-line management.
Question 5: A cricketer holds a catch and then presents with pain at the base of the right thumb; he should be examined to specifically rule out damage to which of the following structures?
- A. Extensor pollicis brevis
- B. Abductor pollicis longus
- C. Volar plate
- D. Ulnar collateral ligament (Correct Answer)
Explanation: ***Ulnar collateral ligament*** - A cricketer catching a ball can experience a sudden **valgus stress** at the thumb's metacarpophalangeal (MCP) joint, leading to a tear of the **ulnar collateral ligament (UCL)**. - This injury is commonly known as **"gamekeeper's thumb"** or "skier's thumb" and is characterized by pain, swelling, and instability at the base of the thumb on the ulnar side. *Extensor pollicis brevis* - This muscle is primarily involved in **extending the thumb** at the metacarpophalangeal joint. - Injury to the extensor pollicis brevis would more likely cause pain with active extension of the thumb rather than from a forceful catch mechanism. *Abductor pollicis longus* - The abductor pollicis longus is responsible for **abducting and extending the thumb** at the carpometacarpal joint. - While overuse can lead to conditions like de Quervain's tenosynovitis, acute injury from a catch is less common compared to UCL rupture. *Volar plate* - The volar plate is a fibrous structure on the palmar aspect of a joint that prevents **hyperextension**. - While it can be injured by hyperextension, its location and primary function make it less likely to be the primary structure damaged by the type of forceful valgus stress experienced during a catch, compared to the UCL.
Question 6: A 30-year-old man involved in a fisticuff, injured his middle finger and noticed slight flexion of the distal interphalangeal (DIP) joint. X-rays were normal. The most appropriate management at this stage is:
- A. Ignore
- B. Splint the finger in hyperextension (Correct Answer)
- C. Surgical repair of the flexor tendon
- D. Buddy strapping
Explanation: ***Splint the finger in hyperextension*** - The description of slight flexion of the **distal interphalangeal (DIP) joint** with normal X-rays after an injury suggests a **mallet finger**. This occurs due to rupture of the terminal extensor tendon, allowing unopposed flexion of the DIP joint. - The standard conservative treatment for **mallet finger** is continuous splinting of the DIP joint in slight **hyperextension** for 6 to 8 weeks, leaving the proximal interphalangeal (PIP) joint free. *Ignore* - Ignoring the injury is inappropriate as **mallet finger** will lead to a **permanent deformity** (extensor lag) and functional impairment if left untreated. - Early intervention with proper splinting provides a high success rate for tendon healing and restoration of function. *Surgical repair of the flexor tendon* - Surgical repair is indicated when the injury involves a **complex fracture**, severe subluxation, or chronic untreated cases of mallet finger that have failed conservative management. - The injury here affects the **extensor tendon**, not the flexor tendon, thus flexor tendon repair would be incorrect. *Buddy strapping* - **Buddy strapping** involves taping the injured finger to an adjacent healthy finger. This technique is primarily used for **phalangeal fractures** or dislocations to provide support and restrict movement. - For **mallet finger**, it would not adequately immobilize the DIP joint in hyperextension, which is crucial for healing the ruptured extensor tendon.
Question 7: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
- A. 1st metacarpal fracture
- B. Scaphoid fracture (Correct Answer)
- C. Trapezoid fracture
- D. Lower end of radius fracture
Explanation: ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.
Question 8: A 22-year-old male medical student was seen in the emergency department with a complaint of pain in his hand. He confessed that he had hit a vending machine in the hospital when he did not receive his soft drink after inserting money twice. The medial side of the dorsum of the hand was quite swollen, and one of his knuckles could not be seen when he "made a fist." The physician made a diagnosis of a "boxer's fracture." What was the nature of the impatient student's injury?
- A. Colles' fracture of the radius
- B. Fracture of the styloid process of the ulna
- C. Smith's fracture of the radius
- D. Fracture of the neck of the fifth metacarpal (Correct Answer)
Explanation: ***Fracture of the neck of the fifth metacarpal*** - A **boxer's fracture** specifically refers to a fracture of the neck of the fifth metacarpal bone. - This injury commonly occurs when punching a hard object, leading to swelling and loss of the knuckle prominence. *Colles' fracture of the radius* - A **Colles' fracture** involves the distal radius, typically caused by a fall on an outstretched hand, resulting in a "dinner fork" deformity. - It does not involve the metacarpals or knuckles. *Fracture of the styloid process of the ulna* - This fracture often accompanies a **Colles' fracture** of the radius but can also occur in isolation. - It's a fracture of the distal end of the ulna and does not cause the loss of a knuckle. *Smith's fracture of the radius* - A **Smith's fracture** is a fracture of the distal radius with volar displacement, often called a "reverse Colles' fracture." - It is caused by a fall on the back of the hand or a direct blow to the forearm and does not affect the metacarpals or knuckles.
Question 9: A 54-year-old female marathon runner presents with pain in her right wrist that resulted from a fall onto her outstretched hand. Radiographic studies indicate an anterior dislocation of a carpal bone. Which of the following bones is most likely dislocated?
- A. Capitate
- B. Lunate (Correct Answer)
- C. Trapezoid
- D. Triquetrum
Explanation: ***Lunate*** - The **lunate bone** is the most commonly dislocated carpal bone, especially with a fall onto an **outstretched hand**. - Its central position in the proximal carpal row and its articulation with the radius make it vulnerable to **anterior dislocation** with forced dorsiflexion. *Capitate* - The **capitate** is the largest carpal bone but is more stable due to its central position and strong ligamentous attachments. - Isolated dislocation of the capitate is **rare** and usually accompanies other carpal injuries. *Trapezoid* - The **trapezoid** is a small, irregularly shaped carpal bone in the distal row, which is very stable. - Its strong articulations with the trapezium, capitate, and second metacarpal make its dislocation **extremely uncommon**. *Triquetrum* - The **triquetrum** is the second most commonly fractured carpal bone but is less prone to dislocation than the lunate. - While it can dislocate, it typically occurs with **ulnar impaction** or other complex carpal instabilities rather than an isolated anterior dislocation from a fall onto an outstretched hand.
Question 10: In an extension type of supracondylar fracture, what is the usual direction of displacement?
- A. Posterolateral (Correct Answer)
- B. Anteromedial
- C. Anterolateral
- D. Posteromedial
Explanation: ***Posterolateral*** - In an **extension type supracondylar fracture**, the distal fragment (forearm and hand) is typically displaced **posteriorly and laterally**. - This common displacement pattern is often caused by a **fall on an outstretched hand** with the elbow in extension, forcing the olecranon against the humerus. *Anteromedial* - This is an **uncommon displacement** in supracondylar fractures and is not characteristic of the extension type. - While displacement can have a medial or lateral component, the primary displacement in extension type is posterior. *Anterolateral* - Displacement in an anterior direction is typically seen in **flexion-type supracondylar fractures**, which are much rarer. - Even in flexion-type fractures, the lateral component of displacement is less common than medial. *Posteromedial* - While posterior displacement is characteristic of extension supracondylar fractures, a **posteromedial displacement** is encountered, but **posterolateral** is the *most common* pattern. - The varus force often involved in these injuries tends to promote lateral displacement of the distal fragment.
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