Fractures and dislocations: ulnar impaction syndrome: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: ulnar impaction syndrome

Sample item

A 40-year-old carpenter has ulnar-sided wrist pain that worsens with gripping and forearm rotation. A pronated grip radiograph shows the ulna 3 mm longer than the radius at the wrist, with cystic change in the ulnar side of the lunate. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Ulnar impaction syndrome

Positive ulnar variance causes abutment of the ulnar head against the lunate and triquetrum, with TFCC wear, subchondral cysts and sclerosis. Treatment is ulnar shortening osteotomy or wafer resection. Kienbock disease, by contrast, is associated with negative ulnar variance.

Option by option

  • A. Scapholunate ligament injury

    A scapholunate injury shows widening of the scapholunate gap and pain at the dorsoradial wrist.

  • B. Pisotriquetral arthritis

    Pisotriquetral arthritis causes pain over the pisiform at the volar ulnar wrist and does not need ulnar plus variance.

  • C. Ulnar impaction syndrome (correct)

    Correct. A long ulna abutting the ulnar lunate with cystic change defines ulnar impaction.

  • D. Kienbock disease

    Kienbock disease is avascular necrosis of the lunate that is linked to negative ulnar variance and shows lunate sclerosis and collapse.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Ulnar impaction syndrome. Positive ulnar variance causes abutment of the ulnar head against the lunate and triquetrum, with TFCC wear, subchondral cysts and sclerosis.

Why is "Scapholunate ligament injury" not the answer?

A scapholunate injury shows widening of the scapholunate gap and pain at the dorsoradial wrist.

Why is "Pisotriquetral arthritis" not the answer?

Pisotriquetral arthritis causes pain over the pisiform at the volar ulnar wrist and does not need ulnar plus variance.

Why is "Kienbock disease" not the answer?

Kienbock disease is avascular necrosis of the lunate that is linked to negative ulnar variance and shows lunate sclerosis and collapse.

What concept does this question test?

It tests Fractures and dislocations: ulnar impaction syndrome in Orthopaedics. Treatment is ulnar shortening osteotomy or wafer resection. Kienbock disease, by contrast, is associated with negative ulnar variance.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: ulnar impaction syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.