ABPS Hand Surgery & Upper Extremity Reconstruction 2 — Questions and Answers
Question 1: In digital replantation, what is the recommended sequence for structural repair?
- Vessels → Tendons → Bone → Nerves
- Bone fixation → Tendons → Arteries → Veins → Nerves (Correct answer)
- Nerves → Bone → Tendons → Vessels
- Arteries → Bone → Veins → Tendons → Nerves
Correct answer: Bone fixation → Tendons → Arteries → Veins → Nerves
The standard replantation sequence is bone shortening/fixation, extensor then flexor tendon repair, arterial anastomosis, venous anastomosis, nerve repair, and skin closure to minimize ischemia time and allow stable structural repair before revascularization.
Question 2: De Quervain's tenosynovitis is caused by stenosis of which dorsal compartment of the wrist?
- First dorsal compartment (APL and EPB) (Correct answer)
- Second dorsal compartment (ECRL and ECRB)
- Third dorsal compartment (EPL)
- Sixth dorsal compartment (ECU)
Correct answer: First dorsal compartment (APL and EPB)
De Quervain's tenosynovitis involves inflammation and stenosis of the first dorsal compartment containing the abductor pollicis longus and extensor pollicis brevis.
Question 3: Dupuytren's contracture most commonly involves which digit first?
- Index finger
- Middle finger
- Ring finger (Correct answer)
- Thumb
Correct answer: Ring finger
Dupuytren's contracture most frequently affects the ring finger (followed by the little finger), causing flexion contracture at the MCP and PIP joints due to palmar fascial cord formation.
Question 4: Which clinical test is specifically used to evaluate triangular fibrocartilage complex (TFCC) tears?
- Watson scaphoid shift test
- Finkelstein test
- Ulnar fovea sign (Correct answer)
- Phalen's test
Correct answer: Ulnar fovea sign
The ulnar fovea sign (tenderness at the fovea between the ulnar styloid and FCU tendon) is sensitive and specific for TFCC peripheral tears and foveal disruptions.
Question 5: Which factor carries the greatest prognostic significance in high-pressure injection injuries of the hand?
- Size of the entry wound
- Type of injected material (Correct answer)
- Dominant versus non-dominant hand
- Age of the patient
Correct answer: Type of injected material
The type of injected material is the most important prognostic factor; organic solvents and paint cause severe tissue necrosis and amputation rates >50%, while grease and water-based fluids are less destructive.
Question 6: In trigger finger (stenosing tenosynovitis), which pulley is most commonly responsible for the triggering phenomenon?
- A2 pulley
- A1 pulley (Correct answer)
- C1 pulley
- A4 pulley
Correct answer: A1 pulley
The A1 pulley at the level of the MCP joint is the most common site of constriction in trigger finger, causing the flexor tendon nodule to catch during flexion and extension.
Question 7: What is the recommended treatment for an acute scaphoid waist fracture with displacement greater than 1 mm?
- Long arm thumb spica cast for 12 weeks
- Short arm thumb spica cast for 6 weeks
- Surgical fixation with a headless compression screw (Correct answer)
- Dynamic splinting with early mobilization
Correct answer: Surgical fixation with a headless compression screw
Displaced scaphoid waist fractures (>1 mm) require surgical fixation with a headless compression screw (e.g., Herbert screw) to restore alignment, improve union rates, and allow earlier mobilization.
ABPS Hand Surgery & Upper Extremity Reconstruction 2
In digital replantation, what is the recommended sequence for structural repair?