ABOS Part I Comprehensive Review - Batch 72

Question 1

A patient presents with a crush injury to the fingertip resulting in a deep laceration extending into the proximal nail fold area, involving the structure primarily responsible for 90% of nail plate volume and thickness. Injury to this specific struc

Accepted Answer

Split nail

Question 2

A 32-year-old carpenter sustains a crush injury to his right index finger. Examination reveals a painful subungual hematoma covering 60% of the nail plate, an intact eponychial fold, and no obvious nail plate avulsion. Radiographs show a non-displace

Accepted Answer

Nail plate removal, exploration, and repair of any underlying nail bed laceration, followed by splinting.

Question 3

During meticulous repair of a germinal matrix laceration in a 28-year-old patient, which of the following suture materials and sizes is most appropriate for optimal anatomical restoration and minimal scarring?

Accepted Answer

6-0 Chromic gut, absorbable

Question 4

A 6-year-old child presents with a crush injury to the distal phalanx of the thumb, exhibiting a Salter-Harris Type I physeal fracture with an associated nail bed laceration and dorsal displacement of the distal fragment. This injury pattern, commonl

Accepted Answer

Open reduction, meticulous repair of the germinal matrix tear, and percutaneous K-wire fixation across the physis.

Question 5

Following a complex nail bed repair and distal phalanx fracture stabilization, the surgeon decides to use a splint to maintain the patency of the eponychial fold and provide a scaffold for new nail growth. If the original nail plate is too damaged, w

Accepted Answer

Silicone sheeting, removed at 3-4 weeks.

Question 6

A 45-year-old patient, 1 year post-nail unit repair for a severe crush injury, presents with a persistent, symptomatic split nail (onychoschisis). Despite initial meticulous repair, this complication has significantly impacted their quality of life.

Accepted Answer

Surgical exploration, excision of scar tissue, meticulous primary repair of the nail bed defect, potentially with local advancement flaps or free matrix grafts.

Question 7

A patient sustains a laceration primarily affecting the sterile matrix of the nail unit. Based on the anatomical description, which of the following is the most likely long-term consequence of an inadequately repaired injury to this specific structur

Accepted Answer

Nail plate dystrophy, non-adherence, or onycholysis.

Question 8

During preoperative planning for a nail unit repair, the surgeon discusses anesthesia options. While a digital block with plain lidocaine is commonly used, the case mentions an evolving concept regarding the use of vasoconstrictors. Which statement a

Accepted Answer

Current evidence suggests judicious use of lidocaine with epinephrine is safe for digital blocks in non-compromised digits, though many surgeons still prefer plain lidocaine.

Question 9

A 30-year-old patient undergoes nail bed repair for a laceration without an associated distal phalanx fracture. In the early healing phase (Weeks 1-4), what is the most appropriate recommendation regarding mobilization of the injured digit?

Accepted Answer

Begin gentle active and passive range of motion exercises for the distal interphalangeal (DIP) joint once skin sutures are removed (10-14 days), if no fracture.

Question 10

Beyond protection, the nail unit serves crucial biomechanical roles. Which of the following best describes a primary biomechanical function of the nail plate in conjunction with the fingertip pulp?

Accepted Answer

Acting as a counterforce for the pulp, essential for precision pinch and grip.

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Key Takeaway