Wrist: scaphoid nonunion advanced collapse: 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 · Wrist: scaphoid nonunion advanced collapse

Sample item

A manual worker has chronic wrist pain years after an untreated scaphoid nonunion. Radiographs show arthritis between the radial styloid and the scaphoid, later involving the capitolunate joint. The radiolunate joint is spared. What is this called?

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

The answer and the reasoning

D. Scaphoid nonunion advanced collapse (SNAC) wrist

In SNAC wrist the distal scaphoid fragment rotates and the capitate migrates, so degeneration starts at the radial styloid and then involves the midcarpal joint, with the radiolunate joint spared until late. Treatment in advanced disease includes proximal row carpectomy or four-corner fusion. The radiolunate sparing is a useful feature.

Option by option

  • A. Rheumatoid wrist

    Rheumatoid arthritis affects the radiocarpal and ulnar joints diffusely.

  • B. Kienbock disease

    Kienbock disease is avascular necrosis of the lunate.

  • C. Preiser disease

    Preiser disease is avascular necrosis of the scaphoid without fracture.

  • D. Scaphoid nonunion advanced collapse (SNAC) wrist (correct)

    Correct. Arthritis from styloid to midcarpal joint with radiolunate sparing is SNAC wrist.

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 D, Scaphoid nonunion advanced collapse (SNAC) wrist. In SNAC wrist the distal scaphoid fragment rotates and the capitate migrates, so degeneration starts at the radial styloid and then involves the midcarpal joint, with the radiolunate joint spared until late.

Why is "Rheumatoid wrist" not the answer?

Rheumatoid arthritis affects the radiocarpal and ulnar joints diffusely.

Why is "Kienbock disease" not the answer?

Kienbock disease is avascular necrosis of the lunate.

Why is "Preiser disease" not the answer?

Preiser disease is avascular necrosis of the scaphoid without fracture.

What concept does this question test?

It tests Wrist: scaphoid nonunion advanced collapse in Orthopaedics. Treatment in advanced disease includes proximal row carpectomy or four-corner fusion. The radiolunate sparing is a useful feature.

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 Wrist: scaphoid nonunion advanced collapse?

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.