Can you answer our FREE Question of the Day? A 32-year-old chef presents with worsening dorsal wrist pain that is exacerbated while holding heavy objects at work. His radiographs appear normal with some mild cystic changes to the capitate. An MRI displays cystic changes primarily to the proximal pole of the capitate without subchondral collapse or fracture (Figure A). A trial of short arm casting, NSAIDs, occupational therapy, and activity modifications do not provide adequate relief. The pain has significantly limited their ability to perform duties at work. An updated MRI remains unchanged. Which of the following would be the most appropriate next step in management? 1. 4+5 extensor compartment vascularized bone graft 2. Proximal pole excision with pyrocarbon resurfacing 3. Proximal row carpectomy 4. Scaphocapitolunate arthrodesis 5. Four corner wrist fusion QID: 218093 Comment your answer below, then check to see if you got it correct by clicking the link below to see the answer & explanation. https://bit.ly/4ejCB6k #Medical #Medicine #Doctor #MedicalStudent #MedicalEducation #MedSchool #Surgery #Orthopedics #OrthopedicSurgery #OrthoLife #Orthopedicsurgeon #SportsMedicine #TraumaSurgery #Rehabilitation #PainManagement #BoneHealth #Arthroscopy #FractureCare #SpineHealth #JointPain #SportsInjury
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Dominant hand?
Estoy de acuerdo1
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Handchirurg
6dDefinitely a long distance to mobilize, but possible: Bishop 4/5. But I would prefer more information like the T1 slices (MRI) and a CT scan (fragmentation?). I wouldn’t advise to rule out fragmentation with MRI only in such a setting…And: what about a temporary STT-arthrodesis (3 months) in combination with vascularized bone graft (load-reduction on the capitate).