Hand Surgery Practice Questions

Q: What is symphalangism?

Fusion of the interphalangeal joints. **Explanation:** **Symphalangism** refers to the **congenital ankylosis (fusion) of the interphalangeal joints** of the fingers or toes. It occurs due to a failure of the joint space to differentiate during fetal development. It is most commonly seen in the proximal interphalangeal (PIP) joints and is often inherited as an autosomal dominant trait. **Analysis of Options:** * **Option B (Correct):** Symphalangism is derived from the Greek words *syn* (together) and *phalanges*. It specifically describes the end-to-end fusion of phalanges within a single digit, leading to a loss of joint motion. * **Option A (Incorrect):** Reduplication of fingers is known as **Polydactyly**. * **Option C (Incorrect):** Shortening of the fingers due to small phalanges is known as **Brachydactyly**. * **Option D (Incorrect):** Joined or webbed fingers (fusion of adjacent digits) is known as **Syndactyly**. **High-Yield Clinical Pearls for NEET-PG:** * **Cushing’s Symphalangism:** A specific syndrome where symphalangism is associated with hearing loss (stapes fixation). * **Radiological Sign:** On X-ray, the joint space is absent, and there is continuous bony trabeculation across the phalanges. * **Associated Conditions:** It is frequently seen in syndromes like **Apert syndrome** (which also features craniosynostosis and syndactyly). * **Clinical Presentation:** Patients present with "stiff" fingers and an absence of normal skin creases over the affected joints.

Q: Carpal fusion is seen in which of the following conditions?

All of the above. **Explanation:** Carpal fusion (carpal coalition) refers to the abnormal union of two or more carpal bones. It can be classified into **congenital** (failure of segmentation during development) or **acquired** (secondary to inflammatory or traumatic processes). * **Apert’s Syndrome:** This is a congenital acrocephalosyndactyly syndrome. It is characterized by craniosynostosis, midface hypoplasia, and symmetric syndactyly of hands and feet. Carpal and tarsal fusions are hallmark skeletal features of this condition. * **Rheumatoid Arthritis (RA):** In chronic inflammatory conditions like RA, the destruction of articular cartilage leads to joint space narrowing. As the disease progresses, the resulting pannus and subsequent fibrous or bony ankylosis frequently lead to acquired carpal fusion. * **Post-traumatic cases:** Severe trauma, especially intra-articular fractures or dislocations (e.g., perilunate injuries), can lead to secondary osteoarthritis. The end-stage of localized joint destruction and immobilization often results in bony fusion. **Clinical Pearls for NEET-PG:** * **Most common congenital carpal fusion:** Lunotriquetral fusion (often asymptomatic and an incidental finding). * **Ellis-van Creveld Syndrome:** Another high-yield congenital cause of carpal fusion (specifically capitate-hamate fusion) associated with polydactyly and dwarfism. * **Turner Syndrome:** Often associated with a short fourth metacarpal and occasionally carpal abnormalities. * **Infection:** Chronic infections like **Tuberculosis** of the wrist are a classic cause of acquired bony ankylosis (fusion).

Q: Fracture of the base of the first metacarpal joint without associated dislocation is called?

Rolando fracture. **Explanation:** The correct answer is **Rolando fracture**. This is a **comminuted intra-articular fracture** at the base of the first metacarpal. Classically, it presents as a T-shaped or Y-shaped fracture pattern. Unlike a Bennett fracture, the fragments often remain relatively in place without a gross dislocation of the shaft, although the joint surface is severely disrupted. **Analysis of Options:** * **Bennett fracture:** This is an oblique, intra-articular fracture-dislocation at the base of the first metacarpal. The hallmark is the **dislocation** of the metacarpal shaft proximally and radially due to the pull of the Abductor Pollicis Longus (APL) muscle, while a small volar fragment remains attached to the trapezium. * **Jones fracture:** This occurs at the **base of the fifth metatarsal** (foot), specifically at the junction of the diaphysis and metaphysis (Zone 2). It is notorious for poor healing due to a watershed blood supply. * **Boxer's fracture:** This is a fracture of the **neck of the fifth metacarpal**, typically caused by striking a hard object with a closed fist. **High-Yield Pearls for NEET-PG:** * **Mechanism:** Both Bennett and Rolando fractures result from axial loading along the first metacarpal (e.g., a punch). * **Prognosis:** Rolando fractures have a **worse prognosis** than Bennett fractures because the comminution makes anatomical reduction difficult, leading to early-onset osteoarthritis. * **Treatment:** Bennett fractures usually require K-wire fixation (CRIF/ORIF), while Rolando fractures often require open reduction with a T-plate or external fixation if highly comminuted. * **Gamekeeper’s Thumb:** An injury to the Ulnar Collateral Ligament (UCL) of the first MCP joint, often associated with an avulsion fracture.

Q: A 23-year-old construction worker presents to the emergency room after falling on his outstretched right hand. X-ray reveals a fracture of one of the wrist bones. The ER physician is concerned about the risk for avascular necrosis. Which of the following bones was fractured?

Scaphoid. **Explanation:** The **Scaphoid** is the most commonly fractured carpal bone, typically occurring after a fall on an outstretched hand (FOOSH) [1]. The high risk for **Avascular Necrosis (AVN)** is due to its unique **retrograde blood supply**. The scaphoid receives its primary blood supply from the radial artery via branches that enter the bone at its distal pole or waist. Consequently, a fracture across the waist can disrupt the blood flow to the proximal pole, leading to ischemia and subsequent necrosis. **Analysis of Options:** * **A. Capitate:** The largest carpal bone; it is centrally located and less prone to fracture compared to the scaphoid. While it has some retrograde flow, AVN is clinically rare. * **B. Lunate:** The second most commonly fractured carpal bone. While it is prone to **Kienböck’s disease** (idiopathic AVN), it is more frequently associated with anterior dislocation rather than fracture-induced AVN following FOOSH. * **C. Pisiform:** A sesamoid bone within the Flexor Carpi Ulnaris tendon. Fractures are rare and usually result from direct trauma to the hypothenar eminence; it does not carry a high risk of AVN. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox** is pathognomonic for a scaphoid fracture. * **Radiology Tip:** Scaphoid fractures may not appear on initial X-rays [1]. If clinical suspicion is high, the wrist should be immobilized and re-imaged in 10–14 days [1]. * **Complications:** Non-union and AVN (Preiser’s disease is the term for idiopathic scaphoid AVN, though post-traumatic is more common). * **Blood Supply:** Primarily via the **dorsal carpal branch** of the radial artery.

Q: A patient presents with pain and cold insensitivity at the fingertip, accompanied by bluish discoloration under the nail. What is the most likely diagnosis?

Glomus tumor. ### Explanation **Correct Answer: B. Glomus Tumor** The clinical triad of **paroxysmal pain, pinpoint tenderness, and cold hypersensitivity** localized to the subungual region (under the nail) is pathognomonic for a **Glomus tumor**. **Medical Concept:** A glomus tumor is a benign vascular neoplasm arising from the **glomus body**, a specialized neuromyoarterial apparatus involved in thermal regulation. These bodies are most concentrated in the fingertips. The characteristic bluish/purplish discoloration is due to the vascular nature of the tumor. Diagnosis is often confirmed clinically via **Hildreth’s test** (relief of pain upon application of a tourniquet) and **Love’s pin-test** (localized exquisite tenderness). --- ### Why the other options are incorrect: * **A. Neurofibroma:** While these are nerve sheath tumors that can be painful, they typically present as soft, flesh-colored subcutaneous nodules along nerve trunks, not specifically as subungual lesions with cold insensitivity. * **C. Turret Tumor:** This is an acquired dome-shaped osteochondromatous proliferation (exostosis) on the dorsal aspect of the phalangeal bone, usually following trauma. It presents as a hard mass rather than a painful vascular lesion. * **D. Raynaud’s Disease:** While this involves cold sensitivity and skin color changes (white-blue-red), it is a vasospastic disorder affecting multiple digits symmetrically. It does not present as a localized, exquisitely tender subungual mass. --- ### NEET-PG High-Yield Pearls: * **Classic Location:** Subungual (75% of cases). * **Clinical Tests:** * **Love’s Pin-test:** Point tenderness using a pinhead (Most sensitive). * **Hildreth’s Test:** Disappearance of pain after inflating a proximal cuff. * **Imaging:** MRI is the investigation of choice; it shows a well-defined lesion with high signal intensity on T2-weighted images. * **Treatment:** Complete surgical excision of the nidus.

Q: Pollicization can be best described as:

Thumb reconstruction. **Explanation:** **Pollicization** is a surgical procedure where a functional finger (most commonly the **index finger**) is repositioned and reconstructed to function as a **thumb**. The goal is to restore the essential functions of the thumb, such as opposition, grasp, and pinch, in cases where the thumb is congenitally absent (e.g., radial club hand, hypoplasia) or lost due to trauma. Therefore, it is fundamentally a method of **thumb reconstruction**. **Analysis of Options:** * **Option A (Toe to thumb transfer):** While this is a method of thumb reconstruction, it is a microsurgical procedure involving a free tissue transfer from the foot. Pollicization specifically refers to using an existing digit from the same hand. * **Option C (Finger shortening):** This is a descriptive term for reducing the length of a digit, often part of a larger procedure, but it does not define pollicization. * **Option D (Amputation of thumb):** This is the removal of the thumb, which is the clinical problem that pollicization aims to solve, not the procedure itself. **High-Yield Clinical Pearls for NEET-PG:** * **Buck-Gramcko Technique:** The most widely used surgical technique for pollicization, particularly in congenital cases. * **Indications:** Blauth Grade IIIb, IV, and V thumb hypoplasia (where the CMC joint is unstable or absent). * **Key Step:** The index finger is transposed on its neurovascular bundle, and the metacarpophalangeal (MCP) joint of the index finger becomes the new carpometacarpal (CMC) joint of the reconstructed thumb. * **Nerve Supply:** The sensory and motor supply is preserved by meticulous dissection of the digital nerves and vessels.

Q: Mallet finger is a common traumatic lesion resulting in flexion deformity of the distal interphalangeal joint. What is the basic pathology of this condition?

Rupture of collateral slips of the extensor expansion. **Explanation:** **Mallet Finger** (also known as Baseball finger) is a common injury caused by sudden forced flexion of an extended finger, typically when a ball hits the fingertip. **1. Why the Correct Answer is Right:** The extensor mechanism of the finger divides into a **central slip** (inserting on the middle phalanx) and two **lateral/collateral slips** (lateral bands). These lateral slips converge to form a single terminal tendon that inserts into the base of the **distal phalanx**. Mallet finger occurs due to the disruption of this terminal extensor mechanism—either through a pure tendon rupture or an avulsion fracture at the dorsal base of the distal phalanx. This loss of extensor continuity allows the Flexor Digitorum Profundus (FDP) to act unopposed, resulting in a characteristic flexion deformity at the Distal Interphalangeal (DIP) joint. **2. Why the Other Options are Wrong:** * **Option A:** An avulsion fracture in Mallet finger involves the **distal phalanx**, not the middle phalanx. * **Option C:** Rupture of the **central slip** leads to a **Boutonnière deformity**, characterized by PIP joint flexion and DIP joint hyperextension. * **Option D:** While trauma can cause DIP dislocation, Mallet finger specifically refers to the extensor mechanism disruption, not a loss of joint congruity. **3. Clinical Pearls for NEET-PG:** * **Clinical Feature:** Patient cannot actively extend the DIP joint but passive extension is possible. * **Management:** Most cases are treated conservatively with a **Mallet splint** (holding the DIP in continuous extension/slight hyperextension) for 6–8 weeks. * **Boutonnière Deformity:** Remember the "Central Slip" rule for PIP joint pathology to distinguish it from Mallet finger.

Question 1

What is symphalangism?

Accepted Answer

Fusion of the interphalangeal joints

Answer

Reduplication of fingers

Answer

Shortening of the fingers as a result of decreased length of the phalanges

Answer

Joined fingers

Question 2

Boutonniere deformity involves which of the following joint alterations?

Accepted Answer

Flexion at the proximal interphalangeal (PIP) joint and extension at the distal interphalangeal (DIP) joint

Answer

Flexion at the proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint

Answer

Extension at the proximal interphalangeal (PIP) joint and distal interphalangeal (DIP) joint

Answer

Extension at the proximal interphalangeal (PIP) joint and flexion at the distal interphalangeal (DIP) joint

Question 3

Carpal fusion is seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Apert's syndrome

Answer

Rheumatoid arthritis

Answer

Post-traumatic cases

Question 4

Fracture of the base of the first metacarpal joint without associated dislocation is called?

Accepted Answer

Rolando fracture

Answer

Bennett fracture

Answer

Jones fracture

Answer

Boxer's fracture

Question 5

A 23-year-old construction worker presents to the emergency room after falling on his outstretched right hand. X-ray reveals a fracture of one of the wrist bones. The ER physician is concerned about the risk for avascular necrosis. Which of the following bones was fractured?

Accepted Answer

Scaphoid

Answer

Capitate

Answer

Lunate

Answer

Pisiform

Question 6

Which tendon is typically used for flexor tendon injury reconstruction in the hand, originating from the forearm to the finger?

Accepted Answer

Plantaris

Answer

Palmaris longus

Answer

Extensor digitorum communis

Answer

Extensor digiti minimi

Question 7

A 26-year-old engineering student presents with wrist pain after a fall on an outstretched hand. Examination reveals swelling, diffuse tenderness, deformity, and limited wrist movement. A PA view X-ray of the wrist shows a 'spilled teacup' sign. What is the likely diagnosis?

Accepted Answer

Perilunate dislocation

Answer

Scaphoid fracture

Answer

Post-traumatic arthritis

Answer

Fracture of the radial styloid

Question 8

A patient presents with pain and cold insensitivity at the fingertip, accompanied by bluish discoloration under the nail. What is the most likely diagnosis?

Accepted Answer

Glomus tumor

Answer

Neurofibroma

Answer

Turret tumor

Answer

Raynaud's disease

Question 9

Pollicization can be best described as:

Accepted Answer

Thumb reconstruction

Answer

Toe to thumb transfer

Answer

Finger shoening

Answer

Amputation of thumb

Question 10

Mallet finger is a common traumatic lesion resulting in flexion deformity of the distal interphalangeal joint. What is the basic pathology of this condition?

Accepted Answer

Rupture of collateral slips of the extensor expansion

Answer

Avulsion fracture of the middle phalanx

Answer

Rupture of the central slip of the extensor expansion

Answer

Dislocation of the distal interphalangeal joint

Hand Surgery — MCQs

Hand Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?