5. OITE > Trauma 2016 > Flashcards

Trauma 2016 Flashcards

(51 cards)

Study These Flashcards
1
Q
  1. What is the most biomechanically optimal fixation method to address the fracture shown in Figures 2a

and 2b?

  1. Bicortical lag screws
  2. Partially threaded cancellous screws
  3. Tension band construct with smooth wires
  4. Medial antiglide plate
  5. Precontoured lateral locking plate
A
  1. Medial antiglide plate

RECOMMENDED READINGS

Hak DJ, Egol KA, Gardner MJ, Haskell A. The “not so simple” ankle fracture: avoiding problems and pitfalls to improve patient outcomes. Instr Course Lect. 2011;60:73-88. PubMed PMID: 21553763.

Ricci WM, Tornetta P, Borrelli J Jr. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma. 2012 Oct;26(10):602-6. PubMed PMID: 22437423.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. A 25-year-old man had a severe pronation external rotation ankle injury with an oblique fibular fracture above the joint line and a 10% posterior malleolar fracture. After restoring fibular length and rotation after performing plate fixation, the approach to the posterior malleolar fracture and the optimal syndesmosis closure can be achieved by applying the clamp at which position?
  2. Proximal to the syndesmosis level with midmedial tibial and fibular placement with reduction

and fixation of the posterior malleolus

  1. A point distal to the syndesmosis level with the medial clamp at the mid anteroposterior (AP)

tibia and fibular diameter, with no reduction and fixation of the posterior malleolus

  1. At the syndesmosis level with the clamp applied to the anterior medial tibia and lateral malleolar ridge, with reduction and fixation of the posterior malleolus
  2. At the syndesmosis level with midmedial tibial and fibular placement with no reduction and fixation of the posterior malleolus
  3. At the syndesmosis level with the midmedial tibia and fibular ridge, with reduction and fixation of the posterior malleolus
A
  1. At the syndesmosis level with the midmedial tibia and fibular ridge, with reduction and fixation of the posterior malleolus

RECOMMENDED READINGS

Gardner MJ, Graves ML, Higgins TF, Nork SE. Technical Considerations in the Treatment of Syndesmotic Injuries Associated With Ankle Fractures. J Am Acad Orthop Surg. 2015 Aug;23(8):510-8. doi: 10.5435/ JAAOS-D-14-00233. PMID: 26209146.

Phisitkul P, Ebinger T, Goetz J, Vaseenon T, Marsh JL. Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study J Bone Joint Surg Am. 2012 Dec 19;94(24):2256-61. doi: 10.2106/ JBJS.K.01726. PMID: 23318616.

Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int. 2009 May;30(5):419-26. doi: 10.3113/FAI.2009.0419. PMID: 19439142.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

10.

Figures 10a and 10b are the emergency department radiographs of a 32-year-old healthy man who is involved in a motor vehicle collision. He has an isolated injury. What is the best next step?

  1. Anterior total hip arthroplasty (THA)
  2. Open reduction and internal fixation (ORIF)
  3. Closed reduction percutaneous pinning
  4. Posterior THA
  5. Hemiarthroplasty
A
  1. Open reduction and internal fixation (ORIF)

RECOMMENDED READINGS

Callaghan JJ, Liu SS, Haidukewych GJ. Subcapital fractures: a changing paradigm. J Bone Joint Surg Br. 2012 Nov;94(11 Suppl A):19-21. doi: 10.1302/0301-620X.94B11.30617. Review. PubMed PMID: 23118374.

Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003 Sep;85-A(9):1673-81. PubMed PMID: 12954824.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Loss of active knee extension after use of an anterior subcutaneous internal fixator in the surgical treatment of unstable pelvic fractures is attributable to
  2. lateral femoral cutaneous nerve injury.
  3. obturator nerve injury.
  4. saphenous nerve injury.
  5. femoral nerve injury.
  6. thrombosis of the femoral artery.
A
  1. femoral nerve injury.

RECOMMENDED READINGS

Hesse D, Kandmir U, Solberg B, Stroh A, Osgood G, Sems SA, Collinge CA. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma. 2015 Mar;29(3):138-43. doi: 10.1097/ BOT.0000000000000193. PubMed PMID: 24983430.

Lewallen DG. Neurovascular injury associated with hip arthroplasty. Instr Course Lect. 1998;47:275-83. Review. PubMed PMID: 9571429.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. Figures 18a and 18b are the clinical photographs of a 30-year-old man seen 1 year after undergoing locked antegrade intramedullary nailing for a comminuted right femoral fracture. He has pain over his right hip. What is the most likely diagnosis?
  2. A decrease in femoral anteversion on the right during surgery
  3. A malreduction externally rotating the proximal right femur during nailing
  4. A malreduction internally rotating the distal right femur during nailing
  5. An increase in femoral anteversion on the right during surgery
  6. An acceptable outcome
A
  1. A decrease in femoral anteversion on the right during surgery

RECOMMENDED READINGS

Dimitriou D, Tsai TY, Yue B, Rubash HE, Kwon YM, Li G. Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs. Orthop Traumatol Surg Res. 2016 Feb;102(1):91-7. doi: 10.1016/j.otsr.2015.11.004. Epub 2016 Jan 19. PubMed PMID: 26867707.

Karaman O, Ayhan E, Kesmezacar H, Seker A, Unlu MC, Aydingoz O. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life. Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1243-7. doi: 10.1007/s00590-013-1289-8. Epub 2013 Aug 11. PubMed PMID: 23934503.

Espinoza C, Sathy AK, Moore DS, Starr AJ, Reinert CM. Use of inherent anteversion of an intramedullary nail to avoid malrotation in femur fractures. J Orthop Trauma. 2014 Feb;28(2):e34-8. doi: 10.1097/ BOT.0b013e318298e48c. PubMed PMID: 23689227.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. A 72-year-old woman sustained a displaced femoral neck fracture after a fall. She is a community ambulator and plays tennis and golf weekly. What is the best functional treatment option for her hip?
  2. Total hip arthroplasty (THA)
  3. Hemiarthroplasty
  4. Hip resurfacing
  5. Internal fixation with sliding hip and antirotation screws
  6. Internal fixation with cannulated screws
A
  1. Total hip arthroplasty (THA)

RECOMMENDED READINGS

Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015 Mar;29(3):121-9. doi: 10.1097/BOT.0000000000000291. Review. PubMed PMID: 25635363.

Avery PP, Baker RP, Walton MJ, Rooker JC, Squires B, Gargan MF, Bannister GC. Total hip replacement and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a seven- to ten-year follow-up report of a prospective randomised controlled trial. J Bone Joint Surg Br. 2011 Aug;93(8):1045-8. PubMed PMID: 21768626.

Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four year follow-up of a randomized trial. J Bone Joint Surg Am. 2011 Mar 2;93(5):445-50. PubMed PMID: 21368076.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. When comparing sliding hip screw fixation to intramedullary nailing (IMN) in the management of transverse/reverse oblique trochanteric and subtrochanteric fractures, sliding hip screw fixation is associated with
  2. higher revision surgery rates.
  3. lower pain.
  4. better satisfaction.
  5. better quality of life.
  6. better mobility.
A
  1. higher revision surgery rates.

RECOMMENDED READINGS

Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B, Fevang JM. Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register. Injury. 2013 Jun;44(6):735-42. doi: 10.1016/j.injury.2012.12.010. Epub 2013 Jan 8. PubMed PMID: 23305689.

Miedel R, Ponzer S, Törnkvist H, Söderqvist A, Tidermark J. The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomised, controlled trial. J Bone Joint Surg Br. 2005 Jan;87(1):68-75. PubMed PMID: 15686240.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Which variable is associated with poor outcomes and early need for arthroplasty in the setting of acetabulum fracture?
  2. Anatomical fracture reduction
  3. Posterior hip dislocation
  4. Femoral head cartilage lesion
  5. Initial displacement of the articular surface of less than 20 mm
  6. Postsurgical congruence of the acetabular roof
A
  1. Femoral head cartilage lesion

RECOMMENDED READINGS

Tannast M, Najibi S, Matta JM. Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures. J Bone Joint Surg Am. 2012 Sep 5;94(17):1559-67. PubMed PMID: 22992846.

Liebergall M, Mosheiff R, Low J, Goldvirt M, Matan Y, Segal D. Acetabular fractures. Clinical outcome of surgical treatment. Clin Orthop Relat Res. 1999 Sep;(366):205-16. PubMed PMID: 10627737.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. A healthy 24-year-old woman who is identified as American Society of Anesthesiologists (ASA) class I has a Gustilo-Anderson grade I open bimalleolar ankle fracture. Antibiotics, irrigation with low-flow cystoscopy tubing, irrigation and debridement, open reduction and internal fixation (ORIF), and primary wound closure are associated with
  2. a high probability of wound healing.
  3. a high probability of wound necrosis.
  4. a higher probability of wound necrosis than if pulsatile lavage were used.
  5. no difference in wound necrosis for healthy patients and those with medical comorbidities.
  6. none of these; wounds should never be primarily closed in open fractures.
A
  1. a high probability of wound healing.

RECOMMENDED READINGS

Ovaska MT, Madanat R, Mäkinen TJ. Predictors of Postoperative Wound Necrosis Following Primary Wound Closure of Open Ankle Fractures. Foot Ankle Int. 2016 Apr;37(4):401-6. doi: 10.1177/1071100715609182. PubMed PMID: 26830839.

Jenkinson RJ, Kiss A, Johnson S, Stephen DJ, Kreder HJ. Delayed wound closure increases deep-infection rate associated with lower-grade open fractures: a propensity-matched cohort study. J Bone Joint Surg Am. 2014 Mar 5;96(5):380-6. doi: 10.2106/JBJS.L.00545. PubMed PMID: 24599199.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Impingement and penetration of the anterior cortex of the distal femur during intramedullary nailing (IMN) in the setting of proximal femur fractures are seen in patients with
  2. a posterior starting point.
  3. a small radius of curvature of the nail.
  4. tall stature.
  5. decreased femoral bow.
  6. an anterior starting point.
A
  1. a posterior starting point.

RECOMMENDED READINGS

Roberts JW, Libet LA, Wolinsky PR. Who is in danger? Impingement and penetration of the anterior cortex of the distal femur during intramedullary nailing of proximal femur fractures: preoperatively measurable risk factors. J Trauma Acute Care Surg. 2012 Jul;73(1):249-54. doi: 10.1097/ TA.0b013e318256a0b6. PubMed PMID: 22743391.

Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma. 2005 Oct;19(9):656-60. PubMed PMID: 16247312.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. During the classic Henry approach to the right forearm (Figure 78), where is the radial artery located?
  2. Above retractor A
  3. Between retractors A and C
  4. Below retractors B and C
  5. Below the pronator terres
  6. The artery is not seen in this approach

PREFERRED RESPONSE: 3

A
  1. Below retractors B and C

RECOMMENDED READINGS

Campbell WS, Canale ST, Beaty JS, eds. Campbell’s Operative Orthopaedics. Philadelphia, PA: Elsevier/ Mosby; 2013:120.

Catalano LW 3rd, Zlotolow DA, Hitchcock PB, Shah SN, Barron OA. Surgical exposures of the radius and ulna. J Am Acad Orthop Surg. 2011 Jul;19(7):430-8. Review. PubMed PMID: 21724922.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. Which soft-tissue structure associated with the fracture seen in Figures 82a through 82c is most

commonly injured?

  1. Medial collateral ligament
  2. Medial meniscus
  3. Popliteus tendon
  4. Lateral meniscus
  5. Lateral collateral ligament
A
  1. Lateral meniscus

RECOMMENDED READINGS

Gardner MJ, Yacoubian S, Geller D, Pode M, Mintz D, Helfet DL, Lorich DG. Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. J Trauma. 2006 Feb;60(2):319-23; discussion 324. PubMed PMID: 16508489.

Gardner MJ, Yacoubian S, Geller D, Suk M, Mintz D, Potter H, Helfet DL, Lorich DG. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005 Feb;19(2):79-84. PubMed PMID: 15677922.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Figure 91 depicts the external rotation stress test performed after open reduction and internal fixation on the lateral malleolus of a bimalleolar-equivalent ankle fracture. What is the best next step?
  2. Close the wounds and place a below-knee plaster splint
  3. Reduce the syndesmosis with a king tong clamp and fix it with 2- x 3.5-mm screws with 4 cortexes each
  4. Reduce the syndesmosis with a king tong clamp and fix it with a 3.5-mm screw with 4 cortexes
  5. Reduce the syndesmosis with a king tong clamp and fix it with a 4.5-mm screw with 4 cortexes
  6. Repair the deltoid ligament
A
  1. Close the wounds and place a below-knee plaster splint

RECOMMENDED READINGS

Lower extremity fractures. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Vol 2. 12th ed. Philadelphia, PA: Elsevier-Mosby; 2013:3044.

van den Bekerom MP. Diagnosing syndesmotic instability in ankle fractures. World J Orthop. 2011 Jul 18;2(7):51-6. doi: 10.5312/wjo.v2.i7.51. PubMed PMID: 22474636.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. When comparing intramedullary nailing (IMN) to percutaneous plating for the treatment of distal tibial metaphyseal fractures, IMN is associated with
  2. longer surgical time.
  3. more radiation.
  4. difficult implant removal.
  5. shorter surgical time.
  6. lower pain scores.
A
  1. shorter surgical time.

RECOMMENDED READINGS

Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010 Jul;92(7):984-8. doi: 10.1302/0301-620X.92B7.22959. PubMed PMID: 20595119.

Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005 Nov;59(5):1219-23; discussion 1223. PubMed PMID: 16385303.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Figures 102a through 102d are the anteroposterior and lateral radiographs and axial and sagittal CT scans of a 40-year-old woman who was mowing her lawn when she slipped on wet grass and sustained an ankle injury. When performing open reduction and internal fixation, which interval is best used to expose and reduce the structure marked by the arrow?
  2. Anterior tibial tendon and extensor hallucis longus
  3. Peroneus brevis and peroneus tertius
  4. Peroneus brevis and fibula
  5. Flexor hallucis longus and peroneus longus
  6. Flexor hallucis longus and flexor digitorum longus
A
  1. Flexor hallucis longus and peroneus longus

RECOMMENDED READINGS

Irwin TA, Lien J, Kadakia AR. Posterior malleolus fracture. J Am Acad Orthop Surg. 2013 Jan;21(1):32- 40. doi: 10.5435/JAAOS-21-01-32. Review. PubMed PMID: 23281469.

Tornetta P 3rd, Ostrum RF, Trafton PG. Trimalleolar ankle fracture. J Orthop Trauma. 2001 Nov;15(8):588-90. PubMed PMID: 11733680.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Figures 107a and 107b are the radiographs of a 45-year-old patient. Which fixation method can most effectively prevent malalignment?
  2. Intramedullary nailing (IMN)
  3. IMN with fibular fixation
  4. IMN with polar screws
  5. Plating of the distal tibia
  6. External fixation
A
  1. Plating of the distal tibia

RECOMMENDED READINGS

Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014 Sep;28(9):542-8. doi: 10.1097/BOT.0000000000000068. Review. PubMed PMID: 24464094.

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011 Dec;25(12):736-41. doi: 10.1097/BOT.0b013e318213f709. PubMed PMID: 21904230.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. The appropriate entry for an intramedullary tibia nail being used for fixation of a central third diaphyseal tibial fracture is ideally positioned at which point in Figure 111?
  2. A
  3. B
  4. C
  5. D
  6. E
A
  1. B

RECOMMENDED READINGS

McConnell T, Tornetta P III, Tilzey J, Casey D. Tibial portal placement: the radiographic correlate of the anatomic safe zone. J Orthop Trauma. 2001Mar-Apr;15(3):207-9. PubMed PMID: 11265012.

Song SJ, Jeong BO. Three-dimensional analysis of the intramedullary canal axis of tibia: clinical relevance to tibia intramedullary nailing. Arch Orthop Trauma Surg. 2010 Jul;130(7):903-7. Epub 2009 Nov 3. PubMed PMID: 19885665.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. Figure 114 is the radiograph of a 23-year-old man who is seen in the emergency department after a motor vehicle collision. He is hemodynamically stable, alert, and oriented, but he has pain in his left leg and hip. An examination should reveal that the limb is
  2. short and internally rotated.
  3. short and in neutral alignment.
  4. short and externally rotated.
  5. long and externally rotated.
  6. normal length and internally rotated.
A
  1. short and externally rotated.

RECOMMENDED READINGS

Canale ST, Beaty JH, Campbell WC. Fractures and dislocations. In: Campbell WS, Canale ST, Beaty JS, eds. Campbell’s Operative Orthopaedics. Philadelphia, PA: Mosby/Elsevier; 2013:3249.

Dislocations of the Hip. In: Rockwood CA, Green DP, Heckman JD, Bucholz RW, eds. Rockwood and Green’s Fractures in Adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:1789.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. A 33-year-old man injures his right wrist and left leg in a motorcycle collision. He has a closed left midshaft tibia fracture and a closed comminuted right intra-articular distal radius fracture. Prior to treatment, he reports mild paresthesias in his right hand but can identify light touch on all digits. The surgeon performs closed reduction and splinting of both injuries, and the patient reports resolution of the median nerve paresthesias. Eight hours later, the surgeon is called to evaluate the patient because of increasing pain in his right arm. He appears agitated and uncomfortable, with a heart rate of 120 and blood pressure of 135/90 mm Hg. The surgeon opens his splint, and his right forearm compartments are soft. His fingers are pink and well perfused with brisk capillary refill. He cannot identify light touch to his thumb, index, or long finger, but can identify light touch to his small finger. He can actively flex and extend the digits through a small arc of motion with pain and has discomfort with passive stretch. What is the best next step?
  2. Measure forearm compartment pressures
  3. Obtain a stat complete blood count (CBC) and electrocardiogram (EKG)
  4. Obtain electromyography (EMG) study
  5. Emergent forearm fasciotomies
  6. Emergent carpal tunnel release
A
  1. Emergent carpal tunnel release

RECOMMENDED READINGS

Niver GE, Ilyas AM. Carpal tunnel syndrome after distal radius fracture. Orthop Clin North Am. 2012 Oct;43(4):521-7. doi: 10.1016/j.ocl.2012.07.021. Epub 2012 Sep 4. Review. PubMed PMID: 23026468.

Davis DI, Baratz M. Soft tissue complications of distal radius fractures. Hand Clin. 2010 May;26(2):229- 35. doi: 10.1016/j.hcl.2009.11.002. Review. PubMed PMID: 20494749.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. Figures 123a and 123b are the radiographs of a 37-year-old man who was the front-seat passenger in a motor vehicle collision. He is unable to move his knee and describes a shifting sensation. An examination reveals limited range of motion and the appearance as shown in the clinical photograph in Figure 123c. Foot pulses are palpable with an ankle-brachial index of 0.95. Several unsuccessful attempts at closed reduction are made. What is the best next step?
  2. Skeletal traction using a proximal tibial pin in the emergency room
  3. Skeletal traction using a calcaneal pin in the emergency room
  4. Open reduction through a posterior approach
  5. Open reduction through an anteromedial approach
  6. Closed reduction in the operating room using femoral distraction.
A
  1. Open reduction through an anteromedial approach

RECOMMENDED READINGS

Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004 Sep-Oct;12(5):334-46. Review. PubMed PMID: 15469228.

Wand JS. A physical sign denoting irreducibility of a dislocated knee. J Bone Joint Surg Br. 1989 Nov;71(5):862. PubMed PMID: 2584265.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  1. An increased incidence of lateral meniscal tears is noted in lateral tibial plateau fractures associated with
  2. more than 10 mm of joint depression.
  3. less than 10 mm of joint depression.
  4. patients older than 48 years of age.
  5. a low-energy mechanism of injury.
  6. young female patients.
Study These Flashcards
A
  1. more than 10 mm of joint depression

RECOMMENDED READINGS

Ringus VM, Lemley FR, Hubbard DF, Wearden S, Jones DL. Lateral tibial plateau fracture depression as a predictor of lateral meniscus pathology. Orthopedics. 2010 Feb;33(2):80-4. doi: 10.3928/01477447- 20100104-05. PubMed PMID: 20192139.

Stahl D, Serrano-Riera R, Collin K, Griffing R, Defenbaugh B, Sagi HC. Operatively Treated Meniscal Tears Associated With Tibial Plateau Fractures: A Report on 661 Patients. J Orthop Trauma. 2015 Jul;29(7):322-4. doi: 10.1097/BOT.0000000000000290. PubMed PMID: 25635356.

22
Q
  1. Figures 132a and 132b are the radiographs of a 12-year-old boy who injured his right leg while playing football. He was urgently treated with a closed reduction and percutaneous pinning. A follow-up scanogram radiograph obtained 1 year later is shown in Figure 132c. His examination at this time demonstrates a nonantalgic smooth gait with full motion of the right knee and full symmetric strength in both lower extremities. A bone age radiograph is performed at this time, demonstrating a bone age of approximately 12 years. What is the best next step?
  2. Discharge from care
  3. Continued observation every 6 to 9 months
  4. Lengthening of the right femur using an external fixator
  5. Lengthening of the right femur using an intramedullary device
  6. Left distal femoral epiphysiodesis
Study These Flashcards
A
  1. Left distal femoral epiphysiodesis

RECOMMENDED READINGS

Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma. 2009 Oct;23(9):663-7. doi: 10.1097/ BOT.0b013e3181a4f25b. PubMed PMID: 19897989.

Arkader A, Warner WC Jr, Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. J Pediatr Orthop. 2007 Sep;27(6):703-8. PubMed PMID: 17717475.

23
Q
  1. Figure 135 is a fluoroscopic image seen during antegrade intramedullary nailing of a femur with a piriformis entry nail. What is the best next step?
  2. Move the starting awl laterally
  3. Move the starting awl posteriorly
  4. Move the starting awl medially
  5. Move the starting awl anteriorly
  6. Further tap the awl before using a starting reamer
Study These Flashcards
A
  1. Move the starting awl posteriorly

RECOMMENDED READINGS

Rudloff MI. Fractures of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Vol 2. 12th ed. Philadelphia, PA: Elsevier-Mosby; 2013:2617-2724.

Diaphyseal femoral fractures. In: Rockwood CA, Green DP, Heckman JD, Bucholz RW, eds. Rockwood and Green’s Fractures in Adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:1909.

Wheeless Textbook of Orthopaedic Surgery, http://www.wheelessonline.com/ortho/femoral_im_nail_ entry_point. (Accessed June 13, 2016)

24
Q
  1. When compared against unicortical screw fixation for medial malleolar fractures, bicortical screw fixation is associated with
  2. superior biomechanical strength.
  3. higher loosening rates.
  4. higher nonunion rates.
  5. higher screw removal rates.
  6. worse clinical outcomes.
Study These Flashcards
A
  1. superior biomechanical strength.

RECOMMENDED READINGS

Ricci WM, Tornetta P, Borrelli J Jr. Lag screw fixation of medial malleolar fractures: a biomechanical, radiographic, and clinical comparison of unicortical partially threaded lag screws and bicortical fully threaded lag screws. J Orthop Trauma. 2012 Oct;26(10):602-6. PubMed PMID: 22437423.

Perren SM, Frigg R, Hehli M, et al. Lag screw. In: Colton CL, Fernandez Dell’Oca A, Holz U, et al, eds. AO Principles of Fracture Management. Stuttgart, Germany: Thieme; 2000:157-167.

25
145. Figure 145 is the external rotation stress test performed after open reduction and internal fixation on the lateral malleolus of a bimalleolar-equivalent ankle fracture. What is the best next step? 1. Close the wounds and place a below-knee plaster splint 2. Close the wounds and place an above-knee plaster splint 3. Reduce and stabilize the syndesmosis 4. Repair the deltoid ligament and retest the ankle 5. Perform a Cotton test
3. Reduce and stabilize the syndesmosis RECOMMENDED READINGS van den Bekerom MP. Diagnosing syndesmotic instability in ankle fractures. World J Orthop. 2011 Jul 18;2(7):51-6. doi: 10.5312/wjo.v2.i7.51. PubMed PMID: 22474636. Sman AD, Hiller CE, Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. 2013 Jul;47(10):620-8. doi: 10.1136/ bjsports-2012-091702. Epub 2012 Dec 6. Review. PubMed PMID: 23222193.
26
150. Which nerve is most commonly injured when a patient sustains the fracture seen in Figures 150a and 150b? 1. Lateral antebrachial cutaneous 2. Radial 3. Median 4. Ulnar 5. Anterior interosseous
5. Anterior interosseous RECOMMENDED READINGS Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg. 2012 Feb;20(2):69-77. Review. PubMed PMID: 22302444. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010 Apr-May;30(3):253-63. PubMed PMID: 20357592.
27
157. Figure 157 is the radiograph of a 24-year-old man who sustained a low-velocity gunshot wound to his left humerus. He is neurovascularly intact. What is the best next step? 1. Intramedullary (IM) nailing with exploration of his radial nerve 2. Open reduction and internal fixation (ORIF) with a bridge plate 3. ORIF with lag screws and a neutralization plate 4. ORIF with compression plating 5. Indirect reduction and a coaptation splint
5. Indirect reduction and a coaptation splint RECOMMENDED READINGS Vaidya R, Sethi A, Oliphant BW, Gibson V, Sethi S, Meehan R. Civilian gunshot injuries of the humerus. Orthopedics. 2014 Mar;37(3):e307-12. doi: 10.3928/01477447-20140225-66. PubMed PMID: 24762161. Dougherty PJ, Najibi S. Gunshot and wartime injury. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P III, eds. Rockwood and Green's fractures in adults. Vol 1. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:303-330.
28
160. Figures 160a and 160b are the CT scans of a hemodynamically unstable 45-year-old polytrauma patient who arrived at the emergency department with a cervical spine collar. He is brought in on a spinal board and in a pelvic binder. The patient’s pelvic ring 1. has no injury; remove the binder. 2. has an injury; keep the binder. 3. has an anterior injury on CT scan; keep the binder. 4. has a posterior injury on CT scan; keep the binder. 5. may have an injury not seen on these CT images; keep the binder.
5. may have an injury not seen on these CT images; keep the binder. RECOMMENDED READINGS Swartz J, Vaidya R, Hudson I, Oliphant B, Tonnos F. Effect of Pelvic Binder Placement on OTA Classification of Pelvic Ring Injuries Using Computed Tomography. Does It Mask the Injury? J Orthop Trauma. 2016 Jun;30(6):325-30. doi: 10.1097/BOT.0000000000000515. PubMed PMID: 26709813. Clements J, Jeavons R, White C, McMurtry I. The Concealment of Significant Pelvic Injuries on Computed Tomography Evaluation by Pelvic Compression Devices. J Emerg Med. 2015 Nov;49(5):675-8. doi: 10.1016/j.jemermed.2015.03.014. PubMed PMID: 26054310.
29
161. A 42-year-old man has a severe impact injury to his knee. An examination reveals a split depressed lateral plateau fracture. MR imaging reveals a possibly torn lateral meniscus. What is the best surgical approach? 1. Arthroscopic evaluation, joystick elevation of the depressed fracture, and fixation 2. Arthroscopic detachment of the anterior tibio-meniscal ligament, fracture reduction, and fixation followed by meniscal repair 3. Anterolateral approach with partial meniscal excision if there is a radial tear, meniscal repair if there is a longitudinal injury, and fracture reduction and fixation 4. Anterolateral approach, detachment of the anterior meniscal ligament, repair of radial and longitudinal tears, and fracture reduction with fixation 5. Anterolateral approach with repair only of the meniscal rim and fracture reduction and fixation
3. Anterolateral approach with partial meniscal excision if there is a radial tear, meniscal repair if there is a longitudinal injury, and fracture reduction and fixation RECOMMENDED READINGS Stahl D, Serrano-Riera R, Collin K, Griffing R, Defenbaugh B, Sagi HC. Operatively Treated Meniscal Tears Associated With Tibial Plateau Fractures: A Report on 661 Patients. J Orthop Trauma. 2015 Jul;29(7):322-4. doi: 10.1097/BOT.0000000000000290. PubMed PMID: 25635356. Ruiz-Ibán MÁ, Diaz-Heredia J, Elías-Martín E, Moros-Marco S, Cebreiro Martinez Del Val I. Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med. 2012 Oct;40(10):2289-95. PubMed PMID: 22962298.
30
164. What is the most common complication after use of an anterior subcutaneous internal fixator in the surgical treatment of an unstable pelvic fracture? 1. Heterotopic ossification 2. Infection 3. Prominent hardware 4. Revision surgery 5. Quadriceps weakness
1. Heterotopic ossification RECOMMENDED READINGS Vaidya R, Kubiak EN, Bergin PF, Dombroski DG, Critchlow RJ, Sethi A, Starr AJ. Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study. Clin Orthop Relat Res. 2012 Aug;470(8):2124-31. doi: 10.1007/s11999-011-2233-z. PubMed PMID: 22219004. Vaidya R, Colen R, Vigdorchik J, Tonnos F, Sethi A. Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation: initial clinical series. J Orthop Trauma. 2012 Jan;26(1):1-8. doi: 10.1097/BOT.0b013e318233b8a7. PubMed PMID: 22048183. Hesse D, Kandmir U, Solberg B, Stroh A, Osgood G, Sems SA, Collinge CA. Femoral nerve palsy after pelvic fracture treated with INFIX: a case series. J Orthop Trauma. 2015 Mar;29(3):138-43. doi: 10.1097/ BOT.0000000000000193. PubMed PMID: 24983430
31
168. While preforming a piriformis entry femoral nail procedure for a midshaft femur fracture, the surgeon begins locking proximally through the guide handle; however, trouble is encountered while drilling the proximal part of the nail and a fluoroscopic shot is administered (Figure 168). What is the best next step? 1. Tighten the guide to the nail 2. Exchange the locking arm for a second-generation locking arm 3. Use a smaller-diameter drill 4. Remove the nail to assess if there is a fault with the guide device 5. Remove the guide wire
5. Remove the guide wire RECOMMENDED READINGS Lower extremity fractures. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Vol 2. 12th ed. Philadelphia, PA: Elsevier-Mosby; 2013:3200. Diaphyseal femoral fractures. In: Rockwood CA, Green DP, Heckman JD, Bucholz RW, eds. Rockwood and Green’s Fractures in Adults. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:1909.
32
173. When compared to autograft, use of calcium phosphate cement to augment subarticular defects in unstable tibial plateau fractures demonstrates 1. less time to union. 2. less subsidence. 3. better union rates. 4. higher subsidence. 5. early arthritis.
2. less subsidence. RECOMMENDED READINGS Russell TA, Leighton RK; Alpha-BSM Tibial Plateau Fracture Study Group. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg Am. 2008 Oct;90(10):2057-61. doi: 10.2106/JBJS.G.01191. PubMed PMID: 18829901. Welch RD, Zhang H, Bronson DG. Experimental tibial plateau fractures augmented with calcium phosphate cement or autologous bone graft. J Bone Joint Surg Am. 2003 Feb;85-A(2):222-31. PubMed PMID: 12571298.
33
182. Figures 182a and 182b are the clinical photograph and postsurgical radiograph of a 45-year-old man who sustained an open tibia fracture with loss of pulses in his leg. He goes into immediate surgery and his leg is reduced, which results in improved foot perfusion. An intraoperative angiogram is performed (Figure 182c). This is followed by debridement and irrigation and external fixation. This patient has a Gustilo and Anderson grade 1. I injury. 2. II injury. 3. IIIA injury. 4. IIIB injury. 5. IIIC injury.
4. IIIB injury. RECOMMENDED READINGS Canale ST, Beaty JH, Campbell WC. Fractures and dislocations. In: Campbell WS, Canale ST, Beaty JS, eds. Campbell’s Operative Orthopaedics. Philadelphia, PA: Elsevier/Mosby; 2013:3030. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984 Aug;24(8):742-6. PubMed PMID: 6471139
34
190. Outcomes following implant removal after ankle syndesmotic screw fixation have demonstrated 1. intact syndesmotic screws were associated with better outcomes. 2. loose screws were associated with the worst outcomes. 3. fractured screws were associated with the worst outcomes. 4. patients who underwent screw removal experienced the worst outcomes. 5. patients who underwent removal of loose or broken screws had similar outcomes.
5. patients who underwent removal of loose or broken screws had similar outcomes. RECOMMENDED READINGS Manjoo A, Sanders DW, Tieszer C, MacLeod MD. Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Orthop Trauma. 2010 Jan;24(1):2-6. doi: 10.1097/BOT.0b013e3181a9f7a5. PubMed PMID: 20035170. Lash N, Horne G, Fielden J, Devane P. Ankle fractures: functional and lifestyle outcomes at 2 years. ANZ J Surg. 2002 Oct;72(10):724-30. PubMed PMID: 12534384.
35
196. When surgically treating the acute injury shown in Figures 196a through 196c, what is the most important step in restoring the relationship between the tibia and the fibula? 1. Repairing the deltoid 2. Anatomically reducing the fibula 3. Debriding the medial gutter 4. Obtaining contralateral ankle figures for comparison 5. Using a clamp for reduction of the syndesmosis
2. Anatomically reducing the fibula RECOMMENDED READINGS Gardner MJ, Graves ML, Higgins TF, Nork SE. Technical Considerations in the treatment of Syndesmotic Injuries Associated With Ankle Fractures. J Am Acad Orthop Surg. 2015 Aug;23(8):510-8. doi: 10.5435/ JAAOS-D-14-00233. Review. PubMed PMID: 26209146. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int. 2006 Oct;27(10):788-92. PubMed PMID: 17054878. Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. Review. PubMed PMID: 17548882. Chen CY, Lin KC. Iatrogenic syndesmosis malreduction via clamp and screw placement. J Orthop Trauma. 2013 Oct;27(10):e248-9. doi: 10.1097/BOT.0b013e3182a70221. PubMed PMID: 24060696.
36
204. How does timing of open reduction and internal fixation (ORIF) for tibial plateau fractures after fasciotomy influence infection risk? 1. Increases risk for infection before fasciotomy closure 2. Increases risk for infection when performed during fasciotomy closure 3. Increases risk for infection after fasciotomy closure 4. Decreases risk for infection before fasciotomy closure 5. Timing does not influence infection risk
5. Timing does not influence infection risk RECOMMENDED READINGS Zura RD, Adams SB Jr, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA; Southeastern Fracture Consortium Foundation. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010 Dec;69(6):1523-6. doi: 10.1097/ TA.0b013e3181d40403. PubMed PMID: 20495494. Shah SN, Karunakar MA. Early wound complications after operative treatment of high energy tibial plateau fractures through two incisions. Bull NYU Hosp Jt Dis. 2007;65(2):115-9. PubMed PMID: 17581103.
37
208. In the management of displaced periprosthetic distal femoral fractures, when comparing locked plating, retrograde intramedullary nail (RIMN), nonlocking plating techniques, and nonsurgical treatment, locked plating has been shown to 1. offer no advantage over nonsurgical treatment. 2. offer no advantage over conventional (nonlocked) plating. 3. demonstrate an increased trend toward nonunion when compared to RIMN. 4. demonstrate an increased trend toward malunion when compared to RIMN. 5. demonstrate a statistically significant increase in the need for secondary surgical procedures.
3. demonstrate an increased trend toward nonunion when compared to RIMN. RECOMMENDED READINGS Ristevski B, Nauth A, Williams DS, Hall JA, Whelan DB, Bhandari M, Schemitsch EH. Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma. 2014 May;28(5):307-12. doi: 10.1097/BOT.0000000000000002. Review. PubMed PMID: 24149447. Kolb W, Guhlmann H, Windisch C, Marx F, Koller H, Kolb K. Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma. 2010 Sep;69(3):670-6. doi: 10.1097/TA.0b013e3181c9ba3b. PubMed PMID: 20838138.
38
212. A 30-year-old woman undergoes a CT scanogram to assess for rotation after locked intramedullary (IM) nailing of her right femur. Figures 212a and 212b, the resulting CT images, reveal 1. femoral anteversion of 11 degrees. 2. femoral anteversion of 19 degrees. 3. femoral retroversion of 11 degrees. 4. femoral retroversion of 19 degrees. 5. neutral version.
3. femoral retroversion of 11 degrees. RECOMMENDED READINGS Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. Femoral version of the general population: does "normal" vary by gender or ethnicity? J Orthop Trauma. 2013 Jun;27(6):308-11. doi: 10.1097/BOT.0b013e3182693fdd. PubMed PMID: 23032191. Gardner MJ, Citak M, Kendoff D, Krettek C, Hüfner T. Femoral fracture malrotation caused by freehand versus navigated distal interlocking. Injury. 2008 Feb;39(2):176-80. PubMed PMID: 17888433.
39
218. A 24-year-old man has an open forearm fracture with comminution and no significant contamination. The radius fracture is comminuted in the middle third of the radius, and there is a transverse fracture at the middle of the ulna. While discussing the case details with the operating room charge nurse, which plate should you use to treat the fracture? 1. One-third tubular plate 2. 3.5-mm reconstruction plate 3. 2.7-mm limited-contact dynamic compression plate (LC-DCP) 4. 4.5-mm LC-DCP 5. 3.5-mm LC-DCP
5. 3.5-mm LC-DCP RECOMMENDED READINGS Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975 Apr;57(3):287-97. PubMed PMID: 1091653. Moed BR, Kellam JF, Foster RJ, Tile M, Hansen ST Jr. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Bone Joint Surg Am. 1986 Sep;68(7):1008-17. PubMed PMID: 3745238. Jones JA. Immediate internal fixation of high-energy open forearm fractures. J Orthop Trauma. 1991;5(3):272-9. PubMed PMID: 1941308.
40
219. What is a statistically significant predictor of postsurgical infection for patients with pelvic and acetabular fractures? 1. No presurgical angiography embolization 2. No blood transfusion 3. Body mass index (BMI) lower than 30 4. Obesity with leukocytosis 5. Interfacility transfer
4. Obesity with leukocytosis RECOMMENDED READINGS Sagi HC, Dziadosz D, Mir H, Virani N, Olson C. Obesity, leukocytosis, embolization, and injury severity increase the risk for deep postoperative wound infection after pelvic and acetabular surgery. J Orthop Trauma. 2013 Jan;27(1):6-10. doi: 10.1097/BOT.0b013e31825cf382. PubMed PMID: 23263468. Manson TT, Perdue PW, Pollak AN, OʼToole RV. Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery. J Orthop Trauma. 2013 Jan;27(1):11-5. doi: 10.1097/ BOT.0b013e31824d96f6. PubMed PMID: 22495529.
41
224. A 32-year-old man fell and sustained an elbow hyperextension injury with a posterior dislocation that was reduced in the emergency department. Radiographs revealed a displaced 30% radial head fragment and a 10% coronoid fracture. An examination under anesthesia reveals both varus and valgus instability. What should be repaired? 1. Lateral collateral ligament (LCL) and radial head fixation 2. Medial collateral ligament (MCL) and LCL 3. MCL and LCL with fixation of the radial head and coronoid fractures 4. MCL and LCL and radial head fracture fixation 5. MCL and radial head fracture
4. MCL and LCL and radial head fracture fixation RECOMMENDED READINGS Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. PubMed PMID: 24474322. Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg. 2009 Mar;17(3):137-51. Review. PubMed PMID: 19264707.
42
226. An 82-year-old woman who underwent left total knee arthroplasty 5 years ago now has left knee pain and an inability to bear weight after falling onto her flexed left knee. Plain radiographs show a comminuted supracondylar femur fracture 6 cm proximal to the femoral component with no sign of component loosening. The fracture is displaced, shortened 2 cm, and aligned in 15 degrees of varus and 25 degrees of extension. Closed reduction is performed, but the fracture remains displaced. She had no antecedent knee pain. What is the best treatment at this time? 1. Surgical fixation with a locking plate or intramedullary nail (IMN) 2. Revision surgery with a stemmed revision femoral component combined with a distal femoral allograft 3. Revision surgery with a long-stem femoral component 4. Revision surgery with a distal femur-replacing implant 5. Placement of a long-leg cast in 30 degrees of knee flexion
1. Surgical fixation with a locking plate or intramedullary nail (IMN) RECOMMENDED READINGS Nauth A, Ristevski B, Bégué T, Schemitsch EH. Periprosthetic distal femur fractures: current concepts. J Orthop Trauma. 2011 Jun;25 Suppl 2:S82-5. doi: 10.1097/BOT.0b013e31821b8a09. Review. PubMed PMID: 21566481. Gliatis J, Megas P, Panagiotopoulos E, Lambiris E. Midterm results of treatment with a retrograde nail for supracondylar periprosthetic fractures of the femur following total knee arthroplasty. J Orthop Trauma. 2005 Mar;19(3):164-70. PubMed PMID: 15758669. Kolb W, Guhlmann H, Windisch C, Marx F, Koller H, Kolb K. Fixation of periprosthetic femur fractures above total knee arthroplasty with the less invasive stabilization system: a midterm follow-up study. J Trauma. 2010 Sep;69(3):670-6. doi: 10.1097/TA.0b013e3181c9ba3b. PubMed PMID: 20838138.
43
230. Functional outcomes after patella fracture fixation demonstrate that patients 1. have a high hardware removal rate. 2. have no limitations in maximum strength. 3. have no difficulty in achieving range of motion. 4. have outcome scores equal to scores for healthy knees. 5. with retained hardware have minimal pain.
1. have a high hardware removal rate. RECOMMENDED READINGS LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma. 2012 Jul;26(7):422-6. doi: 10.1097/BOT.0b013e318228c1a1. PubMed PMID: 22183197. Bayar A, Sener E, Keser S, Meray J, Simşek A, Senköylü A. What leads to unfavourable Cybex test results for quadriceps power after modified tension band osteosynthesis of patellar fractures? Injury. 2006 Jun;37(6):520-4. PubMed PMID: 16574121.
44
235. Figure 235 is the clinical photograph after performing a locked right femoral retrograde nail procedure for a midshaft femoral fracture. These findings are consistent with a/an 1. decrease in femoral anteversion on the right during surgery. 2. decrease in femoral anteversion on the left during surgery. 3. malreduction externally rotating the distal right femur during nailing. 4. malreduction internally rotating the distal right femur during nailing. 5. acceptable outcome.
4. malreduction internally rotating the distal right femur during nailing RECOMMENDED READINGS Dimitriou D, Tsai TY, Yue B, Rubash HE, Kwon YM, Li G. Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs. Orthop Traumatol Surg Res. 2016 Feb;102(1):91-7. doi: 10.1016/j.otsr.2015.11.004. PubMed PMID: 26867707. Karaman O, Ayhan E, Kesmezacar H, Seker A, Unlu MC, Aydingoz O. Rotational malalignment after closed intramedullary nailing of femoral shaft fractures and its influence on daily life. Eur J Orthop Surg Traumatol. 2014 Oct;24(7):1243-7. doi: 10.1007/s00590-013-1289-8. PubMed PMID: 23934503. Espinoza C, Sathy AK, Moore DS, Starr AJ, Reinert CM. Use of inherent anteversion of an intramedullary nail to avoid malrotation in femur fractures. J Orthop Trauma. 2014 Feb;28(2):e34-8. doi: 10.1097/ BOT.0b013e318298e48c. PubMed PMID: 23689227.
45
240. When comparing outcomes among elderly patients who undergo internal screw fixation vs hemiarthroplasty for treatment of displaced femoral neck fractures, internal screw fixation is associated with 1. higher revision surgery rates. 2. less pain at 12 months. 3. better satisfaction at 12 months. 4. better quality of life at 12 months. 5. lower revision surgery rates.
1. higher revision surgery rates. RECOMMENDED READINGS Gjertsen JE, Vinje T, Engesaeter LB, Lie SA, Havelin LI, Furnes O, Fevang JM. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg Am. 2010 Mar;92(3):619-28. doi: 10.2106/JBJS.H.01750. PubMed PMID: 20194320. Gjertsen JE, Vinje T, Lie SA, Engesaeter LB, Havelin LI, Furnes O, Fevang JM. Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: a comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register. Acta Orthop. 2008 Oct;79(5):594-601. doi: 10.1080/17453670810016597. PubMed PMID: 18839364.
46
250. Figures 250a and 250b are the radiographs of a 45-year-old man who sustained a comminuted left distal femoral extra-articular fracture. Which method was used to reduce and fix the fracture? 1. An absolutely stable construct demonstrating primary bone healing 2. An indirect reduction and healing by secondary intention 3. A relatively stable construct demonstrating primary bone healing 4. A relatively stable construct and secondary bone healing 5. Direct reduction and secondary bone healing
4. A relatively stable construct and secondary bone healing RECOMMENDED READINGS Sfeir C, Ho L, Doll BA, Azari K, Hollinger JO. Fracture repair. In: Lieberman JR, Friedlaender GE, eds. Bone Regeneration and Repair: Biology and Clinical Applications. Totowa, New Jersey: Humana Press; 2005:21-43. Perren SM. Fracture healing: fracture healing understood as the result of a fascinating cascade of physical and biological interactions. Part I. An Attempt to Integrate Observations from 30 Years AO Research. Acta Chir Orthop Traumatol Cech. 2014;81(6):355-64. Review. PubMed PMID: 25651289.
47
259. A 64-year-old man is seen in the emergency department after tripping over a rug. An examination reveals a midshaft femoral fracture through a lytic lesion. Laboratory studies including a complete blood count, metabolic panel to assess renal and hepatic function, urinalysis, prostate specific antigen, and protein electrophoresis are conducted; all values are within defined limits. What is the best next step? 1. MRI of the lesion; CT scans of the chest, abdomen, and pelvis; and an open biopsy for later planning 2. MRI of the lesion; CT scans of the chest, abdomen, and pelvis; and biopsy of the lesion at the time of fixation 3. MRI of the lesion; CT scan and positron emission tomography (PET)-CT scans of the chest, abdomen, and pelvis; biopsy of the lesion at the time of surgery 4. CT scans of the lesion, chest, abdomen, and pelvis and a closed biopsy with an oncology review for method of fixation 5. CT scan of the lesion; CT scan and PET-CT scans of the chest, abdomen, and pelvis; biopsy of the lesion at the time of surgery
5. CT scan of the lesion; CT scan and PET-CT scans of the chest, abdomen, and pelvis; biopsy of the lesion at the time of surgery RECOMMENDED READINGS Scolaro JA, Lackman RD. Surgical management of metastatic long bone fractures: principles and techniques. J Am Acad Orthop Surg. 2014 Feb;22(2):90-100. doi: 10.5435/JAAOS-22-02-90. PMID: 24486755. Hahn S, Heusner T, Kümmel S, Köninger A, Nagarajah J, Müller S, Boy C, Forsting M, Bockisch A, Antoch G, Stahl A. Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer. Acta Radiol. 2011 Nov 1;52(9):1009-14. doi: 10.1258/ar.2011.100507. PubMed PMID: 21969709.
48
261. What is a risk factor for distal femoral fracture locked plate fixation failure? 1. Closed fracture 2. Body mass index (BMI) lower than 25 3. Diabetes 4. Longer plate length 5. Osteopenia
3. Diabetes RECOMMENDED READINGS Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014 Feb;28(2):83-9. doi: 10.1097/BOT.0b013e31829e6dd0. PubMed PMID: 23760176. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA. Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma. 2004 Sep;18(8):509-20. PubMed PMID: 15475846.
49
266. Figures 266a through 266c are the radiographs and clinical photograph of a healthy 30-year-old man who arrived at the hospital with an unstable ankle fracture. The surgeon attempted to reduce and splint the injury; this failed, and a second attempt resulted in the resultant radiographs. What is the best next step? 1. Eventual surgery when the swelling improves 2. Closed reduction and percutaneous fixation 3. Indirect reduction and external fixation 4. Direct reduction and external fixation 5. Direct reduction and absolute stable fixation
3. Indirect reduction and external fixation RECOMMENDED READINGS Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv. 2011 Spring;20(1):74-81. PubMed PMID: 21477538. Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA. Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. J Orthop Trauma. 2006 Oct;20(9):618-22. PubMed PMID: 17088664.
50
51
5. OITE
flashcards
Decks in class (41)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions