Resuscitate Me!
Oh my ankle bone!
I think I Broke my Coccyx
Femur Shemur
Pot Pourri
100
A 36-year-old woman presents with a grade 2 open midshaft femoral shaft fracture as the result of a high-speed motor vehicle collision. Concomitant injuries include a high-grade splenic laceration requiring splenectomy as well as a subdural hematoma that requires monitoring and maintenance of cerebral perfusion pressure. After irrigation and debridement of the open fracture, which of the following is the most appropriate management of the femoral shaft fracture at this time? 1 Placement of antibiotic beads, wound closure and immobilization 2 Reamed antegrade intramedullary nailing 3 Unreamed antegrade intramedullary nailing 4 Wound closure and Hare traction splint placement 5 Placement of an external fixator
5- Placement of external fixator
100
A 32-year-old female sustains the injury shown in Figure A. What is the most reliable method to evaluate the competence of the deltoid ligament? 1-Medial ankle tenderness 2-Medial ankle ecchymosis 3-Squeeze test 4-Stress radiography of the ankle 5-Canale view radiograph
4- Stress radiography of the ankle
100
A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. Which of the following is the preferred approach for open treatment of this injury? 1-Modified Stoppa approach 2-Extended iliofemoral approach 3-Kocher-Langenbeck approach 4-Ilioinguinal approach 5-Combined anterior and posterior approach
3- Kocher-Langenbeck approach
100
A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury? 1-Total hip arthroplasty 2-Bipolar hemi-arthroplasty 3-Sliding hip screw 4-Percutaneous screw fixation 5-Cephalomedullary nail fixation
5- Cephalomedullary nail
100
Primary bone healing occurs in an environment of how much strain? 1- 3-5% 2- < 2% 3- 10-15% 4- 2-10% 5- 6%
2- < 2%
200
A 20-year-old female presents following a motor vehicle collision with the injuries seen in Figures A and B. She was initially hypotensive and tachycardic however she now has stable vital signs following a 2 liter bolus of saline and 2 units of packed red blood cells. Which of the following would indicate that this patient has occult end-organ hypoperfusion and should be further resuscitated prior to definitive fixation? 1 Heart rate of 80 beats per minute 2 Systolic blood pressure of 120 mmHg 3 Base deficit of -1.8 mEq/L 4 Serum lactate of 5 mmol/Liter 5 Urine output of 40ml/hour
4 Serum lactate of 5 mmol/Liter
200
In the Lauge-Hansen classification system, a pronation-abduction ankle fracture has what characteristic fibular fracture pattern? 1-Transverse fracture below the level of the syndesmosis 2-Short oblique fracture running from anteroinferior to posteriosuperior 3-Short oblique fracture running from posteroinferior to anteriosuperior 4-Comminuted fracture at or above the level of the syndesmosis 5-Wagstaff fracture
4-Comminuted fracture at or above the level of the syndesmosis
200
The posterior wall of the acetabulum is best visualized on which of the following radiographic views? 1-Inlet pelvis 2-Outlet pelvis 3-Anteroposterior pelvis 4-Obturator oblique pelvis 5-Iliac oblique pelvis
4- Obturator oblique pelvis
200
A 24-year-old male sustains the isolated injuries shown in Figures A and B during a high-speed motor vehicle accident. On physical examination, the overlying skin is intact and there is no evidence of a Morel-Lavallée lesion. Which of the following surgical techniques is considered to have the highest rate of fracture malreduction with this combined injury? 1-Antegrade cephalomedullary nail 2-Retrograde intramedullary nail and 3 cannulated screws 3-Retrograde intramedullary nail and sliding hip screw 4-Antegrade intramedullary nail and 3 cannulated screws 5-Plate fixation of the diaphyseal fracture and 3 cancellous screws
1- Antegrade cephalomedullary nail
200
Which malunion is most commonly associated with intramedullary nailing (IMN) fixation of proximal tibial shaft fractures? 1. Procurvatum, varus 2. Procurvatum, valgus 3. Recurvatum, varus 4. Recurvatum, valgus 5. Recurvatum, internal rotation
2- Procurvatum, valgus
300
Which of the following factors has been shown to increase mortality in poly-trauma patients with severe head injuries? 1-Delayed fixation of fractures 2-Decreased intracranial pressure 3-Intra-abdominal injury 4-Intra-operative hypotension 5-Decreased platelet count
4-Intra-operative hypotension
300
A 27-year-old man presents to the emergency department with an ankle fracture. CT scans note anteromedial marginal impaction. Which radiograph (Figures A-E) would best correlate with this finding?
D
300
A 23-year-old female is an unrestrained driver in a motor vehicle collision, sustaining an LC III pelvic ring injury. She subsequently undergoes reduction and percutaneous bilateral iliosacral screw placement. Which of the following is the most likely neurologic complication associated with percutaneous iliosacral screw insertion? 1-Weakness in knee extension 2-Decreased patellar reflex 3-Weakness in great toe extension 4-Weakness in ankle plantar flexion 5-Decreased Achilles reflex
3- Weakness in great toe extension
300
A 38-year-old male was struck by a truck and sustained the injury seen in figure A. Treating this injury with an intramedullary nail with a larger radius of curvature can lead to what complication? 1-Posterior perforation of the distal femur 2-Varus malreduction 3-Comminution of the fracture site 4-Iatrogenic femoral neck fracture 5-Anterior perforation of the distal femur
5- Anterior perforation of the distal femur
300
When compared to compression plating, antegrade intramedullary nailing (IMN) of humeral shaft fractures in adults is associated with increased risk for 1. implant failure. 2. fracture nonunion. 3. radial nerve palsy. 4. periprosthetic fracture. 5. rotational shoulder stiffness.
5. Rotational shoulder stiffness
400
What percentage of normal circulating blood loss is needed for a patient to become tachycardic with a narrowed pulse pressure? 1-5% 2-10% 3-25% 4-40% 5-50%
3- 25%
400
A 34-year-old female requests a second opinion following open reduction internal fixation (ORIF) of her left ankle three weeks ago. Which of the following is most appropriate step based on Figures A and B? 1-Progressive weightbearing in 3-4 weeks based on radiographs 2-Deltoid ligament repair vs reconstruction 3-Revision ORIF of fibula with lengthening 4-Revision ORIF of fibula and syndesmosis 5-Removal of syndesmotic screws in 3-6 months
4- Revision ORIF of fibula and syndesmosis
400
A 32-year-old male sustains an APC-III pelvic ring disruption after a motor vehicle collision. Which of the following imaging techniques best describes the correct utilization of intraoperative flouroscopy for percutaneous iliosacral screw placement across S1? 1-Inlet view helps best guide superior-inferior orientation 2-AP pelvis best guides anterior-posterior screw orientation 3-AP pelvis best guides superior-inferior screw orientation 4-Outlet view best guides anterior-posterior screw orientation 5-Outlet view best guides superior-inferior screw orientation
5- Outlet view best guides superior-inferior screw orientation
400
A 22-year-old male sustains the injury shown in Figure A. When placing an antegrade intramedullary nail with manual traction in a supine position, which of the following is true when compared to placement of a nail using a fracture table? 1-Increased operative time 2-Decreased internal malrotation deformities 3-Increased external malrotation deformities 4-Increased pudendal nerve injury 5-Increased need for revision
3- Decreased internal malrotation deformities
400
Figures A and B are the radiographs of a 35-year-old man who has an elbow injury. What is the best surgical approach for this fracture? 1. Medial through the flexor-pronator split 2. Straight posterior, through an olecranon osteotomy 3. Anterolateral between the brachialis and biceps 4. Lateral column, elevating off of common extensors and the capsule 5. Limited Kocher approach between the anconeus and extensor carpi ulnaris
4. Lateral column, elevating off of common extensors and the capsule
500
What is the Injury Severity Score (ISS) for a patient with an open chest wound (Abbreviated Injury Scale, AIS=4), colon transection (AIS=4), femoral fracture (AIS=3), shoulder dislocation (AIS=2), and a thyroid gland contusion (AIS=1) 1-11 2-13 3-41 4-45 5-46
3-41
500
When comparing the fibular plating techniques shown in Figures A and B, the plate position shown in Figure B is associated with which of the following? 1-Increased stiffness 2-Increased strength 3-Decreased rate of hardware prominence 4-Increased risk of intra-articular screw penetration 5-Increased peroneal tendinitis
4- Increased risk of intra-articular screw penetration
500
A 33-year-old male sustains the injury seen in Figure A as a result of a high-speed motor vehicle collision. Based on this image, what is the most likely acetabular fracture pattern? 1-Both column 2-Anterior column 3-Anterior column posterior hemitransverse 4-Transverse 5-T-type
4- Transverse
500
A patient undergoes the treatment seen in Figure A for a displaced intertrochanteric femoral fracture. With use of this construct, a starting point 3 mm anterior to the center of the piriformis fossa has which of the following benefits? 1-Improved placement of screws through the nail into the femoral head 2-Decreased risk of varus alignment 3-Decreased risk of joint penetration 4-Decreased risk of avascular necrosis of femoral head 5-Decreased risk of iatrogenic proximal femur fracture
1- Improved placement of screws through the nail into the femoral head
500
Which of the following is not a radiographic sign of sacral dysmorphism? 1- Noncircular S1 anterior neural tunnel on an outlet film 2- Laterally upward sloping sacral ala 3- Prominent mammillary processes 4- Top of iliac wing at level of L5/S1 instead of L4/L5 5- Residual vestigial disc space between S1 and S2
2- Laterally upward sloping sacral ala
M
e
n
u