CHAPTER 43 - Overview of Minimally Invasive Osteosynthesis Principles

Question 1

A noticeable difference between open reduction and internal fixation and minimally invasive
osteosynthesis techniques is the emphasis placed on restoration of anatomic ….X…. rather
than anatomic ….Y….

A) X: apposition Y: reconstruction
B) X: apposition Y: realignment
C) X: reconstruction Y: realignment
D) X: realignment Y: apposition

Answer 1

D) X: realignment Y: apposition

Question 2

Which of the following statements are true regarding preoperative planning in minimally
invasive osteosynthesis?

1. Imaging of the contralateral segment is not particularly recommended in minimally
   invasive osteosynthesis
2. Advanced imaging is indicated for the assessment of complex structures such as the
   sacroiliac region

A) 1 true 2 true
B) 1 false 2 true
C) 1 true 2 false
D) 1 false 2 false

Answer 2

B) 1 false 2 true

Question 3

Which of the following statements is true regarding operative room set-up and reduction
maneuvers in minimally invasive osteosynthesis?

1. A C-arm position with the generator located under the table and the receptor over the
   patient ensure that operating room personal experience a higher exposure to
   backscatter radiation
2. For intra-articular fractures the emphasis is placed on restoration of anatomic
   realignment rather than anatomic reconstruction.

A) 1 true 2 true
B) 1 false 2 true
C) 1 true 2 false
D) 1 false 2 false

Answer 3

D) 1 false 2 false

Question 4

Which reduction tools are shown in this figure?

A) Fracture reduction handles
B) Traction table
C) Foot and Ankle distractor
D) Custom build retraction frame

Answer 4

A) Fracture reduction handles

Question 5

Regarding the biomechanical concepts applied to minimally invasive osteosynthesis, which
answer is correct?
A) A distance of 2 mm between the cis-cortex and a 4.5 mm locking compression plate
significantly increase the risk of plate failure.
B) Two to three screws with a minimum of four cortices per fragment provide adequate
stability.
C) 10 degrees changes of screw insertion in monoaxial systems is appropriate because
it increases push out force by 77% in the 4.5 mm LCP system.
D) The primary biomechanical weakness of external skeleton is the fixation pin-bone
interface.

Answer 5

D) The primary biomechanical weakness of external skeleton is the fixation pin-bone
interface.

Question 6

What do the terms retrocurvatum and procurvatum mean? A malalignment in the…
A) Frontal plane
B) Sagittal plane
C) Transverse plane
D) Coronal plane

Answer 6

B) Sagittal plane

Question 7

You are going to fix a fracture of the tibia in which the fracture extends into the proximal
metaphyseal region. You know four strategies to prevent screw placement into the joint.
What is not an ideal strategy in this case?
A) Use of non-locking screws directed away from the joint surface
B) Reduce the length of the pilot hole and use shorter locking screws
C) Bend the plate so that the screw hole is directed away from the joint
D) Use a slightly shorter plate for safer insertion of a locking screw

Answer 7

D) Use a slightly shorter plate for safer insertion of a locking screw

Question 8

What is the most significant challenge that orthopedic surgeons have to overcome with
minimally invasive osteosynthesis?
A) Neurovascular injuries
B) Joint space violation
C) Malalignment
D) Infection

Answer 8

C) Malalignment

Question 9

Which of the following statements are correct?
1. Careful creation of an epiperiosteal tunnel and gentle sliding of the plate against the
medial cortex of the humerus is necessary to avoid neurovascular injury to the radial
nerve.
2. Once reduction of a fractured tibia is achieved, the tibial crest and the calcaneus
should be slightly medial to the sagittal plane of the crus.
A) 1 true 2 true
B) 1 true 2 false
C) 1 false 2 false
D) 1 false 2 true

Answer 9

C) 1 false 2 false

Question 10

To reduce the working length of each screw, the plate should be placed no more than a few
millimeters away from the bone cortex. How many millimeters are recommended?
A) 2 mm
B) 3 mm
C) 4 mm
D) 5 mm

Answer 10

A) 2 mm

Question 11

Bonus questions
1. What determines the plate working length?

2. In which procedure is a long plate working length desirable?
3. What does ligamentotaxus mean?
4. List four (4) specific steps to avoid delayed or nonunions during minimally invasive
   osteosynthesis.
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5. Describe the malalignment you see on this radiograph.

Answer 11

No answers