Test on Metacarpal and Phalangeal Fractures

Question 1: For a closing wedge osteotomy, final fixation is typically performed with multiple Kirschner pins.

A. Ano

B. Ne

Explanation: For a closing wedge osteotomy, the preferred fixation is with a 2.4-mm or 2.7-mm dorsal plate and supplemental cancellous bone graft, or a locking plate in certain cases. Kirschner pins are not mentioned as the typical fixation method for this procedure.

Question 2: According to the study materials, which statement accurately describes the treatment approach for intra-articular malunions?

A. They are always treated with multiple Kirschner pins for stable fixation.

B. Corrective osteotomy is rarely a suitable treatment option.

C. An opening wedge osteotomy with iliac crest bone graft is the preferred method.

D. Osteotomy with reconstitution of the articular surface is the optimal treatment if the fracture line is visible and bone quality is good.

Explanation: The study materials state that "Intra-articular malunions are rarely amenable to corrective osteotomy." It also specifies that "If the fracture line can be visualized, and bone quality is satisfactory, osteotomy with reconstitution of the articular surface is the optimal treatment." The other options are either incorrect or describe treatments for other types of malunions.

Question 3: In children with epiphyseal fractures of the distal phalanx, discarding the avulsed nail plate is recommended as it helps prevent infection.

A. Ano

B. Ne

Explanation: The study materials state that 'There is some risk in discarding the nail plate because it is useful in maintaining fracture reduction.' The nail plate's utility for reduction, not infection prevention, is highlighted, and its removal is only mentioned in the context of suspicion of nail matrix injury, not as a general recommendation for preventing infection in open epiphyseal fractures.

Question 4: Which of the following statements about stiffness and deformity after phalangeal fractures is supported by the study materials?

A. Digital stiffness was an almost inevitable result of phalangeal fractures in early observations.

B. Maintaining metacarpophalangeal (MP) flexion is important to prevent collateral ligament contracture.

C. Mobilizing fractured digits within the first 4 weeks after fracture generally leads to a better return of function compared to later mobilization.

D. Improper treatment of stable phalangeal fractures frequently results in stiffness and deformity.

Explanation: The study materials state that 'Early on, digital stiffness was an almost inevitable sequela of phalangeal fractures,' making option 0 correct. James realized the importance of maintaining '70 degrees of MP flexion to avoid the contracture of the collateral ligaments that occurs with MP extension,' confirming option 1. Strickland and co-workers found 'a return of function to 75% to 80% of normal in fractured digits mobilized within the first 4 weeks after fracture. When mobilization was initiated after 4 weeks, only 66% return of function resulted,' supporting option 2. Option 3 is incorrect because the material states that 'Improper treatment of unstable fractures often leads to stiffness and deformity,' not stable fractures.

Question 5: Pilon fractures are comminuted intra-articular fractures that specifically occur at the base of the middle phalanx.

A. Ano

B. Ne

Explanation: Comminuted intra-articular fractures, particularly fractures at the base of the middle phalanx, have been termed pilon fractures.