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Trauma 2014 Flashcards

1
Q
  1. In a patient with an isolated closed fracture of the tibial shaft that is treated with medullary nailing, which factor is associated with an increased risk for adverse events such as nonunion, revision surgery, or fracture of implants?
  2. Patient is a smoker
  3. Patient uses nonsteroidal anti-inflammatory drugs. 􀀃 􀀕􀀑􀀃􀀃􀀃􀀳􀁄􀁗􀁌􀁈􀁑􀁗􀀃􀁘􀁖􀁈􀁖􀀃􀁑􀁒􀁑􀁖􀁗􀁈􀁕􀁒􀁌􀁇􀁄􀁏􀀃􀁄􀁑􀁗􀁌􀀐􀁌􀁑􀃀􀁄􀁐􀁐􀁄􀁗􀁒􀁕􀁜􀀃􀁇􀁕􀁘􀁊􀁖
  4. Reaming was performed prior to nailing.
  5. A stainless steel nail was used.
  6. There was a 72-hour surgical delay after the injury occurred.
A
  1. A stainless steel nail was used.

RECOMMENDED READINGS

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkowski M, Sanders D,

Walter SD. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008 Dec;90(12):2567-78. doi: 10.2106/JBJS.G.01694. PubMed PMID: 19047701; PubMed Central PMCID: PMC2663330.

Schemitsch EH, Bhandari M, Guyatt G, Sanders DW, Swiontkowski M, Tornetta P, Walter SD, Zdero R, Goslings JC, Teague D, Jeray K, McKee MD; Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) Investigators. Prognostic factors for predicting outcomes after intramedullary nailing of the tibia. J Bone Joint Surg Am. 2012 Oct 3;94(19):1786-93. doi: 10.2106/ JBJS.J.01418. PubMed PMID: 23032589; PubMedCentral PMCID: PMC3448300.

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2
Q
  1. When using the piriformis entry point for antegrade medullary nailing, an entry point too anterior will result in
  2. an increased risk for malalignment.
  3. an increased risk for iatrogenic fracture.
  4. an increased risk for a subcapital femoral neck fracture.
  5. weakness of the abductors with a resultant limp.
  6. difficulty with proximal locking screw placement􀀃 􀀘􀀑􀀃􀀃􀀃􀁇􀁌􀁉􀂿􀁆􀁘􀁏􀁗􀁜􀀃􀁚􀁌􀁗􀁋􀀃􀁓􀁕􀁒􀁛􀁌􀁐􀁄􀁏􀀃􀁏􀁒􀁆􀁎􀁌􀁑􀁊􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀁓􀁏􀁄􀁆􀁈􀁐􀁈􀁑􀁗􀀑
A
  1. an increased risk for iatrogenic fracture.

REFERRED RESPONSE: 2

RECOMMENDED READINGS

Johnson KD, Tencer AF, Sherman MC. Biomechanical factors affecting fracture stability and femoral bursting in closed intramedullary nailing of femoral shaft fractures, with illustrative case presentations. J Orthop Trauma. 1987;1(1):1-11. PubMed PMID: 3506582.

Ricci WM, Gruen GS, Summers H, Siska PA. Fractures of the femoral diaphysis. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:431-444.

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3
Q
  1. A 45-year-old man fell from a 10-foot scaffold and has an isolated injury on his right lower extremity that reveals varus angulation. The emergency physician straightened his limb and obtained the radiograph shown in Figure 10a. Figures 10b through 10d are his CT and axial and coronal images. Which treatment is the most appropriate fixation
  2. Open reduction and lateral locked plating
  3. Open reduction and medial buttress plating
  4. Open reduction and lateral compression plating
  5. Closed reduction and hybrid external fixation
  6. Closed reduction and medial lag scrwe fixation with washers􀀃 􀀗􀀑􀀃􀀃􀀃􀀦􀁏􀁒􀁖􀁈􀁇􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁋􀁜􀁅􀁕􀁌􀁇􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

􀀃 􀀘􀀑􀀃􀀃􀀃􀀦􀁏􀁒􀁖􀁈􀁇􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁐􀁈􀁇􀁌􀁄􀁏􀀃􀁏􀁄􀁊􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁚􀁄􀁖􀁋􀁈􀁕􀁖

A
  1. Open reduction and medial buttress plating

RECOMMENDED READINGS

Ratcliff JR, Werner FW, Green JK, Harley BJ. Medial buttress versus lateral locked plating in a cadaver medial tibial plateau fracture model. J Orthop Trauma. 2007 Aug;21(7):444-8. PubMed PMID: 17762474.

Berkson EM, Virkus WW. High-energy tibial plateau fractures. J Am Acad Orthop Surg. 2006 Jan;14(1):20-31. Review. PubMed PMID: 16394164.

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4
Q
  1. Which anatomic structure is associated with the highest rate of injury during application of a pelvic fixator like the one in Figure 14?
  2. Femoral artery
  3. Ilioinguinal nerve
  4. Iliohypogastric nerve
  5. Lateral femoral cutaneous nerve
  6. Spermatic cord/round ligament
A
  1. Lateral femoral cutaneous nerve

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 fracures: a multicentre study. Clin. Orthop Relat Res. 2012 Aug;470(8):2124-31. doi: 10.1007/s11999-011-2233-z. PubMed PMID: 22219004; PubMed Central PMCID: PMC3392373.

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5
Q
  1. A 22-year-old man has bilateral femur fractures, an open grade IIIB tibia fracture, and a pneumothorax treated with a thoracostomy. After performing debridement and irrigation, he becomes unstable and hypoxic. In addition to resuscitative measures, what is the most appropriate next step?
  2. Rapid unreamed nailing of both femurs and the tibia
  3. Rapid unreamed nailing of both femurs and external fixation of the tibia.
  4. External fixation of both femurs and temporary plating of the tibia
  5. External fixation of both femurs and external fixation of the tibia
  6. Temporary plating of both femurs and external fixation of the tibia

RECOMMENDED READINGS

Wolinsky PR, Charlton MT. Damage control orthopaedics: practical issues. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:171-178.

􀀃 􀀖􀀑􀀃􀀃􀀃􀀨􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁅􀁒􀁗􀁋􀀃􀁉􀁈􀁐􀁘􀁕􀁖􀀃􀁄􀁑􀁇􀀃􀁗􀁈􀁐􀁓􀁒􀁕􀁄􀁕􀁜􀀃􀁓􀁏􀁄􀁗􀁌􀁑􀁊􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁗􀁌􀁅􀁌􀁄

􀀃 􀀗􀀑􀀃􀀃􀀃􀀨􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁅􀁒􀁗􀁋􀀃􀁉􀁈􀁐􀁘􀁕􀁖􀀃􀁄􀁑􀁇􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁗􀁌􀁅􀁌􀁄

􀀃 􀀘􀀑􀀃􀀃􀀃􀀷􀁈􀁐􀁓􀁒􀁕􀁄􀁕􀁜􀀃􀁓􀁏􀁄􀁗􀁌􀁑􀁊􀀃􀁒􀁉􀀃􀁅􀁒􀁗􀁋􀀃􀁉􀁈􀁐􀁘􀁕􀁖􀀃􀁄􀁑􀁇􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁗􀁌􀁅􀁌􀁄

A
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6
Q
  1. A 62-year-old otherwise healthy man sustains the fractures shown in Figures 32a and 32b. Which intervention will likely provide the best outcome?
  2. Hip hemiarthroplasty
  3. Total hip replacement
  4. Closed reduction percutaneous pinning
  5. Open reduction and sliding hip screw placement
  6. Capsulotomy with cephalomedullary nail placement
A
  1. Total hip replacement

RECOMMENDED READINGS

Chammout GK, Mukka SS, Carlsson T, Neander GF, Stark AW, Skoldenberg OG. Total hip replacement versus open reduction and internal fixation of displaced femoral neck fractures: a randomized long-term follow-up study. J Bone Joint Surg Am. 2010

􀁙􀁈􀁕􀁖􀁘􀁖􀀃􀁒􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁇􀁌􀁖􀁓􀁏􀁄􀁆􀁈􀁇􀀃􀁉􀁈􀁐􀁒􀁕􀁄􀁏􀀃􀁑􀁈􀁆􀁎􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀁖􀀝􀀃􀁄􀀃􀁕􀁄􀁑􀁇􀁒􀁐􀁌􀁝􀁈􀁇􀀃􀁏􀁒􀁑􀁊􀀐􀁗􀁈􀁕􀁐􀀃

follow-up study. J Bone Joint Surg Am. 2012 Nov 7;94(21):1921-8. PubMed PMID: 23014835.

􀀵􀁒􀁊􀁐􀁄􀁕􀁎􀀃􀀦􀀏􀀃􀀦􀁄􀁕􀁏􀁖􀁖􀁒􀁑􀀃􀀤􀀏􀀃􀀭􀁒􀁋􀁑􀁈􀁏􀁏􀀃􀀲􀀏􀀃􀀶􀁈􀁕􀁑􀁅􀁒􀀃􀀬􀀑􀀃􀀤􀀃􀁓􀁕􀁒􀁖􀁓􀁈􀁆􀁗􀁌􀁙􀁈􀀃􀁕􀁄􀁑􀁇􀁒􀁐􀁌􀁖􀁈􀁇􀀃􀁗􀁕􀁌􀁄􀁏􀀃􀁒􀁉􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁙􀁈􀁕􀁖􀁘􀁖􀀃

arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two

years. J Bone Joint Surg Br. 2002 Mar;84(2):183-8. PubMed PMID: 11922358.

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7
Q
  1. Weight bearing to tolerance through the surgical extremity is not safe after which procedure?
  2. Statically locked medullary nailing of a tibial shaft fracture
  3. Statically locked medullary nailing of a femoral shaft fracture
  4. Open reduction with-plate-and screw fixation of an ankle fracture
  5. Open reduction with plate-and- screw fixation of humeral shaft fracture
  6. Open reduction with plate and screw fixation of midshaft-radius and ulna fractures􀀃 􀀖􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁓􀁏􀁄􀁗􀁈􀀐􀁄􀁑􀁇􀀐􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁄􀁑􀀃􀁄􀁑􀁎􀁏􀁈􀀃􀁉􀁕

􀀃 􀀗􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁓􀁏􀁄􀁗􀁈􀀐􀁄􀁑􀁇􀀐􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁄􀀃􀁋􀁘􀁐􀁈􀁕􀁄􀁏􀀃􀁖􀁋􀁄􀁉􀁗􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈

􀀃 􀀘􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁓􀁏􀁄􀁗􀁈􀀐􀁄􀁑􀁇􀀐􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁐􀁌􀁇􀁖􀁋􀁄􀁉􀁗􀀃􀁕􀁄􀁇􀁌􀁘􀁖􀀃􀁄􀁑􀁇􀀃􀁘􀁏􀁑􀁄􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀁖

A
  1. Open reduction with plate and screw fixation of midshaft-radius and ulna fractures􀀃 􀀖􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁓􀁏􀁄􀁗􀁈􀀐􀁄􀁑􀁇􀀐􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁄􀁑􀀃􀁄􀁑􀁎􀁏􀁈􀀃􀁉􀁕􀁄

RECOMMENDED READINGS

Starkweather MP, Collman DR, Schuberth JM. Early protected weightbearing after open reduction internal fixation of ankle fractures. J. Foot Ankle Surg. 2012 Sept-Oct; 51(5):575-8. Epub 2012 Jul 20. PubMed PMID: 22819002.

Schemitsch EH, Bhandari M, Guyatt G, Sanders DW, Swiontkowski M, Tornetta P, Walter SD, Zdero R, Goslings JC, Teague D, Jeray K, McKee MD; Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) Investigators. Prognostic factors for predicting outcomes after intramedullary nailing of the tibia. J Bone Joint Surg Am. 2012 Oct 3;94(19):1786-93. doi: 10.2106/ JBJS.J.01418. PubMed PMID: 23032589; PubMed Central PMCID: PMC3448300.

Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma. 2000 Aug;49(2):278-80. PubMed PMID: 10963539.

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8
Q
  1. Figure 48 is the radiograph of a patient who slipped on the stairs. CT imaging did not identify associated

return of function?

  1. Closed reduction and casting
  2. Closed reduction and percutaneous pinning
  3. Open reduction and arthrodesis of the medial 2 tarsometatarsal joints
  4. Open reduction and screw fixation across the medial 2 tarsometarasal joints􀀃 􀀗􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁖􀁆􀁕􀁈􀁚􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁄􀁆􀁕􀁒􀁖􀁖􀀃􀁗􀁋􀁈􀀃􀁐􀁈􀁇􀁌􀁄􀁏􀀃􀀕􀀃􀁗􀁄􀁕􀁖􀁒􀁐􀁈􀁗􀁄􀁗􀁄􀁕􀁖􀁄􀁏􀀃􀁍􀁒􀁌􀁑􀁗􀁖
  5. Open reduction and excision of intra-articular loose bodies from the tarsometatarsal joints

followed by transarticular pinning

A
  1. Open reduction and arthrodesis of the medial 2 tarsometatarsal joints

RECOMMENDED READINGS

Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 2006 Mar;88(3):514-20. PubMed PMID: 16510816.

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9
Q
  1. What is the most appropriate fluid resuscitation for a patient wih hemodynamic instability by severe pelvic fracture?
  2. Factor VIII and platelets at a 1:3 ratio
  3. Tranexamic acid, platelets, and plasma at a 1:1:1 ratio
  4. Warmed saline, platelets, and whole blood at a 1:1:1 ratio
  5. Packed red blood cells, platelets, and plasma at a 1:1:1 ratio
  6. Packed red blood cells and warmed lactated ringers at a 2:1 ratio
A
  1. Packed red blood cells, platelets, and plasma at a 1:1:1 ratio

RECOMMENDED READINGS

Langford JR, Burgess AR, Liporace FA, Haidukewych GJ. Pelvic fractures: part 1. Evaluation, classification, and resusitation. J Am Acad Orthop Surg. 2013 Aug;21(8): 448-56. doi:10.5435/ JAAOS-21-08-448. Review. PubMed PMID: 23908251.

Elmer J, Wilcox SR, Raja AS. Massive transfusion in traumatic shock. J Emerg Med. 2013 Apr;44(4):829- 38. doi: 10.1016/j.jemermed.2012.11.025. Epub 2013 Jan 30. PubMed PMID: 23375220.

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10
Q
  1. The fracture shown in Figure 63 is best treated with which fixation method?
  2. Reamed/locked nailing
  3. Reamed/nonlocked nailing
  4. Unreamed/locked nailing
  5. Plating using locked screws
  6. Plating using nonlocked screws
A
  1. Reamed/locked nailing

RECOMMENDED READINGS

Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed. J Am Acad Orthop Surg. 2000 Mar-Apr;8(2):83-90. Review. PubMed PMID: 10799093.

Ricci WM, Gruen GS, Summers H, Siska PA. Fractures of the femoral diaphysis. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons;2010:431-444.

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11
Q
  1. Figures 73a and 73b are the radiographs of a 28-year-old man who sustained a fracture after a bicycle injury 1 week ago. He cannot perform a straight-leg raise. What poses the highest risk for short-term complications after surgery?
  2. Refracture
  3. Patella baja
  4. Hardware removal
  5. Anterior knee pain
  6. Extensor lag greater than 5 degrees
A
  1. Anterior knee pain

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.

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12
Q
  1. A patient who is status postreduction of a low-energy knee dislocation has faintly palpable pulses of the affected extremity with 2-second capillary refil of the nail beds. What is the most appropriate management step?
  2. Arteriogram
  3. CT angiogram
  4. Surgical exploration
  5. Serial examinations
  6. Ankle brachial index evaluation
A
  1. Ankle brachial index evaluation

RECOMMENDED READINGS

Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004 Jun;56(6):1261-5. PubMed PMID: 15211135.

Levy BA, Stuart MJ, Kottmeier SA. Knee injuries. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:461- 473.

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13
Q
  1. A 24-year-old woman is involved in a motor vehicle collision and sustains liver, spleen, and pelvic injuries and a right open grade 1 midshaft humeral fracture (Figures 82a and 82b). Her condition is now stable in the operating room after receiving 4 units of packed red blood cells, 4 units of fresh frozen plasma, and 20 units of platelets. What is the best next step?
  2. Relocate the hip, place an external fixator on the pelvis, and splint the humerus.
  3. Open reduction and internal fixation (ORIF) of the humerus, relocate the hip, and place and external fixator on the plevis
  4. ORIF of the pelvis, relocate the hip, and ORIF of the humerus
  5. ORIF of the humerus, place an external fixator on the plvis, and perform an open reduciton of the right hip joint.
  6. Allow the patient to go to the intensive care unit and take care of her orthopaedic injuries at a later date
A
  1. Relocate the hip, place an external fixator on the pelvis, and splint the humerus.

RECOMMENDED READINGS

D’Alleyrand JC, O’Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013 Oct;44(4):499-507. doi: 10.1016/j. ocl.2013.06.004. Epub 2013 Aug 21. Review. PubMed PMID: 24095066.

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14
Q
  1. An 85-year-old man sustains a displaced distal left femur fracture above a nonstemmed cemented, cruciate-retaining total knee arthroplasty (TKA). Radiographs reveal that the distal femoral component is loose. The main fracture line was minimally comminuted and is located 1 cm proximal to the anterior flange of the distal femoral component. The patient has mutliple medical comorbidities, but also is a community ambulator who uses a cane. What is the best next step?
  2. Nonsurgical treatment
  3. Retrograde nailing of the distal femur fracture
  4. Open reduction and internal fixation (ORIF) o the distal femur fracture􀀃 􀀖􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀀋􀀲􀀵􀀬􀀩􀀌􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁇􀁌􀁖􀁗􀁄􀁏􀀃􀁉􀁈􀁐􀁘􀁕􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈
  5. ORIF of the distal femur fracture and resection arthroplasty of the knee
  6. Revision TKA using a distal femoral endoprosthetic replacement
A
  1. Revision TKA using a distal femoral endoprosthetic replacement

RECOMMENDED READINGS

Kim KI, Egol KA, Hozack WJ, Parvizi J. Periprosthetic fractures after total knee arthroplasties. Clin Orthop Relat Res. 2006 May;446:167-75. Review. PubMed PMID: 16568003.

Johnston AT, Tsiridis E, Eyres KS, Toms AD. Periprosthetic fractures in the distal femur following total knee replacement: A review and guide to management. Knee. 2012 Jun;19(3):156-62. doi: 10.1016/j. knee.2011.06.003. Epub 2011 Jul 8. Review. PubMed PMID: 21741844.

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.

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15
Q
  1. Figures 97a through 97c illustrate the 3-dimensional CT injury reconstructions of a 45-year-old man who was involved in a motorcycle collision. In the emergency department, he had a clean 4-cm open wound over his anterior thigh and normal neurvascular examiniation findings. First responders brought a bag containing a circumferentially intact 12-cm section of his femur to the trauma bay. After appropriate debridement, what is the best femoral deficiency nanagement technique?
  2. Above-knee amputatation
  3. Acute shortneing with open reduction and internal fixation (ORIF) followed by stanged distraction osteogenesis
  4. Autoclave of the 12-cm section, replanting the femoral segment, and ORIF
  5. ORIF, placement of a polymethylmethacrylate spacer, and staged bone grafting
  6. ORIF and acute bone grafting using intramedullary graft from the contralateral femur
A
  1. ORIF, placement of a polymethylmethacrylate spacer, and staged bone grafting

RECOMMENDED READINGS

Ashman O, Phillips AM. Treatment of non-unions with bone defects: which option and why? Injury. 2013 Jan;44 Suppl 1:S43-5. doi: 10.1016/S0020-1383(13)70010-X. PubMed PMID: 23351870.

Taylor BC, French BG, Fowler TT, Russell J, Poka A. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg. 2012 Mar;20(3):142-50. doi: 10.5435/JAAOS-20-03-142. Review. PubMed PMID: 22382286.

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16
Q
  1. Figures 102a and 102b are the radiographs of a 37-year-old woman who has knee pain and instability 20 years after sustaining a traumatic injury to her knee. She has an intact extensor mechanism. What is the best treatment recommendation?
  2. Hinged total knee arthroplasty (TKA)
  3. Cruciate-retaining TKA
  4. Posterior stabilized TKA
  5. Proximal tibial osteotomy with deformity correction. 􀀃 􀀗􀀑􀀃􀀃􀀃􀀳􀁕􀁒􀁛􀁌􀁐􀁄􀁏􀀃􀁗􀁌􀁅􀁌􀁄􀁏􀀃􀁒􀁖􀁗􀁈􀁒􀁗􀁒􀁐􀁜􀀃􀁚􀁌􀁗􀁋􀀃􀁇􀁈􀁉􀁒􀁕􀁐􀁌􀁗􀁜􀀃􀁆􀁒􀁕􀁕􀁈􀁆􀁗􀁌􀁒􀁑􀀃􀁘􀁖􀁌􀁑􀁊􀀃􀁄􀀃􀁕􀁌􀁑􀁊􀀃􀂿􀁛􀁄􀁗􀁒􀁕
  6. Physical therapy focusing on quadriceps strengthening and proprioceptive exercises
A
  1. Hinged total knee arthroplasty (TKA)

RECOMMENDED READINGS

Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, Gavras M. Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up. J Bone Joint Surg Br. 2004 Aug;86(6):813-7. PubMed PMID: 15330020.

Yang JH, Yoon JR, Oh CH, Kim TS. Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees. Knee Surg Sports Traumatol Arthrosc. 2012 Mar;20(3):517-23. doi: 10.1007/ s00167-011-1590-1. Epub 2011 Jul 20. PubMed PMID: 21773833.

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17
Q
  1. Figures 107a and 107b are the radiographs of a 17-year-old girl who fell from a second-story window and sustained a lower-extremity fracture. Advanced trauma life support and secondary musculoskeletal evaluations reveal a closed ankle injury and an L3 vertebral body fracture. Neurosurgery recommends a thoracic lumbar sacral orthosis for the vertebral injury. The skin around the ankle is blistering but intact. What is the best next step?
  2. Revision splinting and open reduction and internal fixation (ORIF)􀀃 􀀔􀀑􀀃􀀃􀀃􀀵􀁈􀁙􀁌􀁖􀁌􀁒􀁑􀀃􀁖􀁓􀁏􀁌􀁑􀁗􀁌􀁑􀁊􀀃􀁄􀁑􀁇􀀃􀁒􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀀋􀀲􀀵􀀬􀀩􀀌
  3. Revision splinting and plan for staged ORIF
  4. External fixation without ORIF􀀃 􀀖􀀑􀀃􀀃􀀃􀀨􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀁒􀁘􀁗􀀃􀀲􀀵􀀬􀀩
  5. Open reduction with combined external and internal fixation
  6. Open tibial reduciton with multiplanar external fixation. 􀀃 􀀗􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁆􀁒􀁐􀁅􀁌􀁑􀁈􀁇􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀁄􀁑􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

􀀃 􀀘􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁗􀁌􀁅􀁌􀁄􀁏􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀀃􀁐􀁘􀁏􀁗􀁌􀁓􀁏􀁄􀁑􀁄􀁕􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

A
  1. External fixation without ORIF􀀃 􀀖􀀑􀀃􀀃􀀃􀀨􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁚􀁌􀁗􀁋􀁒􀁘􀁗􀀃􀀲􀀵􀀬􀀩

RECOMMENDED READINGS

Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg. 2011 Oct;19(10):612-22. Review. PubMed PMID: 21980026.

Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004 Sep;18(8 Suppl):S32-8. PubMed PMID: 15472563.

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18
Q
  1. A 75-year-old woman had total knee arthroplasty 8 years ago. Until she sustained a ground-level fall, her knee was functioning well. Radiographs reveal a patella fracture with 2 mm of displacement and mild lucency around her patellar implant. Examination reveals that her extensor mechanism is intact when gravity is eliminated. What is the best treatment option?
  2. Partial patellectomy with resection of the component
  3. Cylinder cast for 6 weeks with weight bearing as tolerated
  4. Open reduction and internal fixation with revision of the patellar component
  5. Open reduction and intenral fixation with resection of the patellar component.
  6. Open reduction and internal fixation, component resection, and extensor allograft augmentation
A
  1. Cylinder cast for 6 weeks with weight bearing as tolerated

RECOMMENDED READINGS

Adigweme OO, Sassoon AA, Langford J, Haidukewych GJ. Periprosthetic patellar fractures. J Knee Surg. 2013 Oct;26(5):313-7. doi: 10.1055/s-0033-1353991. Epub 2013 Aug 23. Review. PubMed PMID: 23975335.

Sarmah SS, Patel S, Reading G, El-Husseiny M, Douglas S, Haddad FS. Periprosthetic fractures around total knee arthroplasty. Ann R Coll Surg Engl. 2012 Jul;94(5):302-7. doi: 10.1308/003588412X131712215 92537. Review. PubMed PMID: 22943223.

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19
Q
  1. When considering the lifetime prevalence of intimate partner violence (IPV) among women who are patients at orthopaedic fracture clinics in Canada and the United States, what are the actual and orthopaedic surgeon-perceived prevalences?
  2. 25% actual lifetime IPV prevalence, 25% surgeon-perceived IPV prevalence
  3. 30% actual lifetime IPV prevalence, 20% surgeon-perceived IPV prevalence
  4. 40% actual lifetime IPV prevalence, 10% surgeon-perceived IPV prevalence
  5. 50% actual lifetime IPV prevalence, 2% surgeon-perceived IPV prevalence
  6. 60% actual lifetime IPV prevalence, 1% surgeon-perceived IPV prevalence
A
  1. 40% actual lifetime IPV prevalence, 10% surgeon-perceived IPV prevalence

RECOMMENDED READINGS

PRAISE Investigators, Sprague S, Bhandari M, Della Rocca GJ, Goslings JC, Poolman RW, Madden K, Simunovic N, Dosanjh S, Schemitsch EH. Prevalence of abuse and intimate partner violence surgical evaluation (PRAISE) in orthopaedic fracture clinics: a multinational prevalence study. Lancet. 2013 Sep 7;382(9895):866-76. doi: 10.1016/S0140-6736(13)61205-2. Epub 2013 Jun 12. PubMed PMID: 23768757.

Bhandari M, Sprague S, Tornetta P 3rd, D’Aurora V, Schemitsch E, Shearer H, Brink O, Mathews D, Dosanjh S; Violence Against Women Health Research Collaborative. (Mis)perceptions about intimate partner violence in women presenting for orthopaedic care: a survey of Canadian orthopaedic surgeons. J Bone Joint Surg Am. 2008 Jul;90(7):1590-7. doi: 10.2106/JBJS.G.01188. PubMed PMID: 18594110.

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20
Q
  1. Which postsurgical regimen would minimize joint reaction forces of a transtectal transverse posterior wall fracture that has been fixed anatomically with stable fixation?
  2. Nonweight-bearing activity with active abduction of the hip
  3. Nonweight-bearing activity with passive abduction of the hip
  4. Weight-bearing activity as tolerated with no hip motion restriction
  5. Touch-down weight bearing with active abduction of the hip
  6. Touch-down weight bearing with passive abduction of the hip
A
  1. Touch-down weight bearing with passive abduction of the hip

RECOMMENDED READINGS

Hertling D, Kessler R. Management of Common Musculoskeletal Disorders: Hip. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2005:441-486.

Hodge WA, Carlson KL, Fijan RS, Burgess RG, Riley PO, Harris WH, Mann RW. Contact pressures from an instrumented hip endoprosthesis. J Bone Joint Surg Am. 1989 Oct;71(9):1378-86. PubMed PMID: 2793891.

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21
Q
  1. An 8 year old has a Gartland type III extension fracture of the supracondylar humerus. No pulses are palpable after reduction and percutaneous pinning, but the child’s hand has brisk capillary refill and no neurological symptoms. What is the best next step?
  2. Maintain fixation and observation overnight.
  3. Maintain fixation and initiate immediate surgical exploration.
  4. Remove the fixation and use Doppler to evaluate flow.
  5. Reove the fixation and intitiate immediate surgical exploration.
  6. Remove fixation and perform re-reduction followed by re-evaluation.
A
  1. Maintain fixation and observation overnight.

RECOMMENDED READINGS

Scannell BP, Jackson JB 3rd, Bray C, Roush TS, Brighton BK, Frick SL. The Perfused, Pulseless Supracondylar Humeral Fracture: Intermediate-Term Follow-up of Vascular Status and Function. J Bone Joint Surg Am. 2013 Nov 6;95(21):1913-9. doi: 10.2106/JBJS.L.01584. PubMed PMID: 24196460.

Weller A, Garg S, Larson AN, Fletcher ND, Schiller JR, Kwon M, Copley LA, Browne R, Ho CA. Management of the pediatric pulseless supracondylar humeral fracture: is vascular exploration necessary? J Bone Joint Surg Am. 2013 Nov 6;95(21):1906-12. doi: 10.2106/JBJS.L.01580. PubMed PMID: 24196459.

22
Q
  1. A 33-year-old woman has an open comminuted midshaft tibia fracture. She receives a full evaluation, tetanus prophylaxis, and antibiotics with cephalosporin and aminoglycoside within 1 hour of presentation and 2 hours after the injury. She is taken to the operating room 8 hours after sustaining the injury for a thorough debridement and irrigation. The surgeon sees no contamination, determines that this is a modified Gustilo-Anderson type IIIa injury, and proceeds with immediate fixation with reamed intramedullary nailing and primary closure. The soft-tissue flap surrounding the open injury is robust, well perfused, and closes without tension. What is the most influential determinant of infection risk for this patient?
  2. Dose of aminoglycoside given
  3. Modified Gustilo-Anderson type􀀃 􀀕􀀑􀀃􀀃􀀃􀀰􀁒􀁇􀁌􀂿􀁈􀁇􀀃􀀪􀁘􀁖􀁗􀁌􀁏􀁒􀀐􀀤􀁑􀁇􀁈􀁕􀁖􀁒􀁑􀀃􀁗􀁜􀁓􀁈
  4. Thoroughness of the debridement
  5. Timing of definitive internal fixation
  6. Use of reaming in the intramedullary fixation.􀀃 􀀗􀀑􀀃􀀃􀀃􀀷􀁌􀁐􀁌􀁑􀁊􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁇􀁈􀂿􀁑􀁌􀁗􀁌􀁙􀁈􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

􀀃 􀀘􀀑􀀃􀀃􀀃􀀸􀁖􀁈􀀃􀁒􀁉􀀃􀁕􀁈􀁄􀁐􀁌􀁑􀁊􀀃􀁌􀁑􀀃􀁗􀁋􀁈􀀃􀁌􀁑􀁗􀁕􀁄􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

A
  1. Thoroughness of the debridement

RECOMMENDED READINGS

Pape HC, Webb LX. History of open wound and fracture treatment. J Orthop Trauma. 2008 Nov- Dec;22(10 Suppl):S133-4. doi: 10.1097/BOT.0b013e318188e26b. PubMed PMID: 19034158.

Schenker ML, Yannascoli S, Baldwin KD, Ahn J, Mehta S. Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg Am. 2012 Jun 20;94(12):1057-64. doi: 10.2106/JBJS.K.00582. Review. PubMed PMID: 22572980.

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkowski M, Sanders D,

Walter SD. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008 Dec;90(12):2567-78. doi: 10.2106/JBJS.G.01694. PubMed PMID: 19047701; PubMed Central PMCID: PMC2663330.

23
Q
  1. A patient recently underwent open reduction and internal fixation of an acetabular fracture. Which activity would result in the highest risk for fixation failure?
  2. Getting on a bedpan
  3. Getting up from a chair using the affected leg
  4. Standing with full weight bearing on the affected leg
  5. Performing the gait swing phase with the affected leg while using a walker
  6. Holding the affected leg off the floor for nonweight-baring transfers.􀀃 􀀘􀀑􀀃􀀃􀀃􀀫􀁒􀁏􀁇􀁌􀁑􀁊􀀃􀁗􀁋􀁈􀀃􀁄􀁉􀁉􀁈􀁆􀁗􀁈􀁇􀀃􀁏􀁈􀁊􀀃􀁒􀁉􀁉􀀃􀁗􀁋􀁈􀀃􀃀􀁒􀁒􀁕􀀃􀁉􀁒􀁕􀀃􀁑􀁒􀁑􀁚􀁈􀁌􀁊􀁋􀁗􀀐􀁅􀁈􀁄􀁕􀁌􀁑􀁊􀀃􀁗􀁕􀁄􀁑􀁖􀁉􀁈􀁕􀁖
A
  1. Getting up from a chair using the affected leg

RECOMMENDED READINGS

Hertling D, Kessler R: Management of Common Musculoskeletal Disorders: Hip, ed 4. Philadelphia, PA:Lippincott Williams & Wilkins; 2005:441-486.

Hodge WA, Carlson KL, Fijan RS, Burgess RG, Riley PO, Harris WH, Mann RW. Contact pressures from an instrumented hip endoprosthesis. J Bone Joint Surg Am. 1989 Oct;71(9):1378-86. PubMed PMID: 2793891.

24
Q
  1. Which combination of numbers seen in Figures 135a and 135b indicates the appropriate starting position for a tibial intramedullary nail?
  2. 1 and 4
  3. 2 and 4
  4. 2 and 5
  5. 3 and 5
  6. 3 and 6
A
  1. 3 and 5

RECOMMENDED READINGS

Walker RM, Zdero R, McKee MD, Waddell JP, Schemitsch EH. Ideal tibial intramedullary nail insertion point varies with tibial rotation. J Orthop Trauma. 2011 Dec;25(12):726-30. doi: 10.1097/ BOT.0b013e31821148c7. PubMed PMID: 21886003.

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

25
Q
  1. A 45-year-old man was involved in a motorcycle collision. He sustained an open tibial fracture that necessitated flap coverage for closure after initial irrigation and debridement. What is the most important infection-prevention factor?
  2. Fixation method
  3. Number of debridements
  4. Soft-tissue coverage method
  5. Time to definitive soft tissue coverage. 􀀃 􀀗􀀑􀀃􀀃􀀃􀀷􀁌􀁐􀁈􀀃􀁗􀁒􀀃􀁇􀁈􀂿􀁑􀁌􀁗􀁌􀁙􀁈􀀃􀁖􀁒􀁉􀁗􀀐􀁗􀁌􀁖􀁖􀁘􀁈􀀃􀁆􀁒􀁙􀁈􀁕􀁄􀁊􀁈
  6. Extended use of vacuum-assisted closure to reduce wound size
A
  1. Time to definitive soft tissue coverage. 􀀃 􀀗􀀑􀀃􀀃􀀃􀀷􀁌􀁐􀁈􀀃􀁗􀁒􀀃􀁇􀁈􀂿􀁑􀁌􀁗􀁌􀁙􀁈􀀃􀁖􀁒􀁉􀁗􀀐􀁗􀁌􀁖􀁖􀁘􀁈􀀃􀁆􀁒􀁙􀁈􀁕􀁄􀁊􀁈

RECOMMENDED READINGS

Bhattacharyya T, Mehta P, Smith M, Pomahac B. Routine use of wound vacuum-assisted closure does not allow coverage delay for open tibia fractures. Plast Reconstr Surg. 2008 Apr;121(4):1263-6. doi: 10.1097/01.prs.0000305536.09242.a6. PubMed PMID: 18349645.

Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2010.

26
Q
  1. What is the current U.S. Food and Drug Administration (FDA) indication for implanting recombinant human bone morphogenetic protein-2 (BMP-2) after a fracture occurs?
  2. Aseptic tibial nonunion repair
  3. Acute open tibial fracture after intramedullar nail fixation􀀃 􀀕􀀑􀀃􀀃􀀃􀀤􀁆􀁘􀁗􀁈􀀃􀁒􀁓􀁈􀁑􀀃􀁗􀁌􀁅􀁌􀁄􀁏􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀀃􀁄􀁉􀁗􀁈􀁕􀀃􀁌􀁑􀁗􀁕􀁄􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀁑􀁄􀁌􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
  4. Acute open femoral fracture after plate stabilization
  5. Acute open femoral fracture with segmental bone loss after intramedullary nail fixation. 􀀃 􀀗􀀑􀀃􀀃􀀃􀀤􀁆􀁘􀁗􀁈􀀃􀁒􀁓􀁈􀁑􀀃􀁉􀁈􀁐􀁒􀁕􀁄􀁏􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀀃􀁚􀁌􀁗􀁋􀀃􀁖􀁈􀁊􀁐􀁈􀁑􀁗􀁄􀁏􀀃􀁅􀁒􀁑􀁈􀀃􀁏􀁒􀁖􀁖􀀃􀁄􀁉􀁗􀁈􀁕􀀃􀁌􀁑􀁗􀁕􀁄􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀁑􀁄􀁌􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
  6. There is currently no FDA-indicated use for rhBMP-2 after fracture.
A
  1. Acute open tibial fracture after intramedullar nail fixation􀀃 􀀕􀀑􀀃􀀃􀀃􀀤􀁆􀁘􀁗􀁈􀀃􀁒􀁓􀁈􀁑􀀃􀁗􀁌􀁅􀁌􀁄􀁏􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀀃􀁄􀁉􀁗􀁈􀁕􀀃􀁌􀁑􀁗􀁕􀁄􀁐􀁈􀁇􀁘􀁏􀁏􀁄􀁕􀁜􀀃􀁑􀁄􀁌􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

RECOMMENDED READINGS

Govender S, Csimma C, Genant HK, Valentin-Opran A, Amit Y, Arbel R, Aro H, Atar D, Bishay M, Börner MG, Chiron P, Choong P, Cinats J, Courtenay B, Feibel R, Geulette B, Gravel C, Haas N, RaschkeM, Hammacher E, van der Velde D, Hardy P, Holt M, Josten C, Ketterl RL, Lindeque B, Lob G, MathevonH, McCoy G, Marsh D, Miller R, Munting E, Oevre S, Nordsletten L, Patel A, Pohl A, Rennie W,Reynders P, Rommens PM, Rondia J, Rossouw WC, Daneel PJ, Ruff S, Rüter A, Santavirta S, SchildhauerTA, Gekle C, Schnettler R, Segal D, Seiler H, Snowdowne RB, Stapert J, Taglang G, Verdonk R, VogelsL, Weckbach A, Wentzensen A, Wisniewski T; BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT)Study Group. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am. 2002Dec;84-A(12):2123-34. PubMed PMID: 12473698.

27
Q
  1. Which vitamin protocol is recommended to decrease the prevalence of complex regional pain syndrome after wrist fractures?
  2. Vitamin A 200 mg for 50 days
  3. Vitamin C 200 mg for 7 days
  4. Vitamin C 500 mg for 50 days
  5. Vitamin E 200 mg for 7 days
  6. Vitamin E 500 mg for 50 days
A
  1. Vitamin C 500 mg for 50 days

RECOMMENDED READINGS

􀀶􀁋􀁌􀁅􀁘􀁜􀁄􀀃􀀱􀀏􀀃􀀫􀁘􀁐􀁓􀁋􀁈􀁕􀁖􀀃􀀭􀀰􀀏􀀃􀀤􀁊􀁄􀁕􀁚􀁄􀁏􀀃􀀰􀀵􀀏􀀃􀀭􀁘􀁓􀁌􀁗􀁈􀁕􀀃􀀧􀀦􀀑􀀃􀀨􀁉􀂿􀁆􀁄􀁆􀁜􀀃􀁄􀁑􀁇􀀃􀁖􀁄􀁉􀁈􀁗􀁜􀀃􀁒􀁉􀀃􀁋􀁌􀁊􀁋􀀐􀁇􀁒􀁖􀁈􀀃􀁙􀁌􀁗􀁄􀁐􀁌􀁑􀀃􀀦􀀃Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am. 2007 Jul;89(7):1424-31. PubMed PMID: 17606778.

28
Q
  1. A 4-year-old child sustains a posteriorly displaced supracondylar fracture of the humerus, is neurovascularly intact, and is taken to the operating room the next day. After a successful closed reduction of the fracture, what is the best next step?
  2. Percutaneously fix the fracture with 1 lateral and 1 medial K-wires
  3. Percutaneously fix the fracture with 2 lateral and 1 medial K-wires
  4. Percutaneously fix the fracture with 2 or 3 lateral K-wires.
  5. Percutaneously fix the fracture with 1 lateral and 2 medial K-wires
  6. Place the patient in a cast.
A
  1. Percutaneously fix the fracture with 2 or 3 lateral K-wires.

RECOMMENDED READINGS

Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman CT, Scherl S, Goldberg M, Turkelson CM, Wies JL, Boyer K; American Academy of Orthopaedic Surgeons. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg. 2012 May;20(5):320-7. doi: 10.5435/JAAOS-20-05-320. PubMed PMID: 22553104.

29
Q
  1. When performing nailing of a proximal tibia fracture as shown in Figures 161a and 161b, you elect to place blocking screws to prevent angular malreduction. In which positions would you place these screws to prevent malreduction?
  2. A and B
  3. A and C
  4. A and D
  5. B and C
  6. B and D
A
  1. A and D

RECOMMENDED READINGS

Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001 May;15(4):264-70. PubMed PMID: 11371791.

30
Q
  1. Which test result most effectively helps physicians predict the need for a walking aid 2 years after hip hemiarthroplasty is performed as fracture treatment?
  2. Timed Up and Go
  3. Timed stair ascent
  4. Shuttle run
  5. Illinois Agility
  6. Leg Stance
A
  1. Timed Up and Go

RECOMMENDED READINGS

Kristensen MT, Henriksen S, Stie SB, Bandholm T. Relative and absolute intertester reliability of the timed up and go test to quantify functional mobility in patients with hip fracture. J Am Geriatr Soc. 2011 Mar;59(3):565-7. doi: 10.1111/j.1532-5415.2010.03293.x. PubMed PMID: 21391955.

31
Q
  1. What is the best way to address a Vancouver B2 periprosthetic femoral fracture?

1, Retain the existing implant and plate/cable fixation

  1. Retain the existing implant, strut allograft, and plate/cable fixation
  2. Revision implant using a long-stem cemented prosthesis
  3. Revision implant using a long-stem cementless prosthesis
  4. Cement augmentation of the existing implant and plate/cable fixation

􀀃 􀀘􀀑􀀃􀀃􀀃􀀦􀁈􀁐􀁈􀁑􀁗􀀃􀁄􀁘􀁊􀁐􀁈􀁑􀁗􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁈􀁛􀁌􀁖􀁗􀁌􀁑􀁊􀀃􀁌􀁐􀁓􀁏􀁄􀁑􀁗􀀃􀁄􀁑􀁇􀀃􀁓􀁏􀁄􀁗􀁈􀀒􀁆􀁄􀁅􀁏􀁈􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑

A
  1. Revision implant using a long-stem cementless prosthesis

RECOMMENDED READINGS

O’Shea K, Quinlan JF, Kutty S, Mucahy D, Brady OH. The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br. 2005 Dec;87(12):1617-1621. PMID 16326872.

Ellis TJ, White RR, Lhowe DW. Periprosthetic fractures. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:569- 577.

32
Q
  1. How does a bridging synostosis (Ertl) transtibial amputation compare with a traditional nonbone-bridging amputation (modified Burgess) with regards1. Ertl is functionally inferior with fewer complications?
  2. Ertl is functionally inferior with fewer complications.
  3. Ertl is functionally superior with more complications
  4. Ertl is functionally equivalent with more complications
  5. Modified Burgess is functionally superior with fewer complications
  6. Modified Burgess functionally equivalent with more complications􀀃 􀀗􀀑􀀃􀀃􀀃􀀰􀁒􀁇􀁌􀂿􀁈􀁇􀀃􀀥􀁘􀁕􀁊􀁈􀁖􀁖􀀃􀁌􀁖􀀃􀁉􀁘􀁑􀁆􀁗􀁌􀁒􀁑􀁄􀁏􀁏􀁜􀀃􀁖􀁘􀁓􀁈􀁕􀁌􀁒􀁕􀀃􀁚􀁌􀁗􀁋􀀃􀁉􀁈􀁚􀁈􀁕􀀃􀁆􀁒􀁐􀁓􀁏􀁌􀁆􀁄􀁗􀁌􀁒􀁑􀁖

􀀃 􀀘􀀑􀀃􀀃􀀃􀀰􀁒􀁇􀁌􀂿􀁈􀁇􀀃􀀥􀁘􀁕􀁊􀁈􀁖􀁖􀀃􀁌􀁖􀀃􀁉􀁘􀁑􀁆􀁗􀁌􀁒􀁑􀁄􀁏􀁏􀁜􀀃􀁈􀁔􀁘􀁌􀁙􀁄􀁏􀁈􀁑􀁗􀀃􀁚􀁌􀁗􀁋􀀃􀁐􀁒􀁕􀁈􀀃􀁆􀁒􀁐􀁓􀁏􀁌􀁆􀁄􀁗􀁌􀁒􀁑􀁖

A
  1. Ertl is functionally equivalent with more complications

RECOMMENDED READINGS

Keeling JJ, Shawen SB, Forsberg JA, Kirk KL, Hsu JR, Gwinn DE, Potter BK. Comparison of functional outcomes following bridge synostosis with non-bone-bridging transtibial combat-related amputations. J Bone Joint Surg Am. 2013 May 15;95(10):888-93. doi: 10.2106/JBJS.L.00423. PubMed PMID: 23677355.

33
Q
  1. What is the best next step for the patient whose radiograph is seen in Figure 182?
  2. Open reduction and internal fixation􀀃 􀀔􀀑􀀃􀀃􀀃􀀲􀁓􀁈􀁑􀀃􀁕􀁈􀁇􀁘􀁆􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁌􀁑􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑
  3. Manual stress testing with internal rotation
  4. Gravity stress testing with external rotation
  5. Palpation of the medial soft tissues of the ankle (deltoid)
  6. Closed reduction with Quigley traction followed by casting
A
  1. Gravity stress testing with external rotation

RECOMMENDED READINGS

Barei DP, Crist BD. Fractures of the ankle and distal tibial pilon. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:499-516.

34
Q
  1. Which problem is most commonly associated with antegrade nailing of a comminuted diaphyseal femoral fracture?
  2. Varus
  3. Valgus
  4. Knee pain
  5. Malrotation
  6. Missed femoral neck fracture
A
  1. Malrotation

RECOMMENDED READINGS

Jaarsma RL, van Kampen A. Rotational malalignment after fractures of the femur. J Bone Joint Surg Br. 2004 Nov;86(8):1100-4. Review. PubMed PMID: 15568519.

Ricci WM, Gruen GS, Summers H, Siska PA. Fractures of the femoral diaphysis. In: Schmidt AH, Teague DC, eds. Orthopaedic Knowledge Update: Trauma 4. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2010:431-444.

35
Q
  1. Which injury is most commonly associated with a gunshot wound to the hip?
  2. Bowel perforation
  3. Bladder perforation
  4. Major vein laceration
  5. Major arterial laceration
  6. Major peripheral nerve laceration
A
  1. Bowel perforation

RECOMMENDED READINGS

Bartkiw MJ, Sethi A, Coniglione F, Holland D, Hoard D, Colen R, Tyburski JG, Vaidya R. Civilian gunshot wounds of the hip and pelvis. J Orthop Trauma. 2010 Oct;24(10):645-52. doi: 10.1097/ BOT.0b013e3181cf03ea. PubMed PMID: 20871253.

Najibi S, Matta JM, Dougherty PJ, Tannast M. Gunshot wounds to the acetabulum. J Orthop Trauma. 2012 Aug;26(8):451-9. doi: 10.1097/BOT.0b013e31822c085d. PubMed PMID: 22357085.

36
Q
  1. An 82-year-old patient sustains a comminuted intra-articular fracture of the nondominant right distal humerus. When attempting open reduction and internal fixation of the distal humerus, which intervention sould be avoided in the event the repair is deemed impossible and total elbow arthroplasty is selected as the most appropriate treatment?
  2. Olecranon osteotomy
  3. Ulnar nerve transposition
  4. Direct extensile posterior approach
  5. Triceps-splitting approach to the distal humerus
  6. Addition of a medial plate to fracture fixation construct􀀃 􀀘􀀑􀀃􀀃􀀃􀀤􀁇􀁇􀁌􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁄􀀃􀁐􀁈􀁇􀁌􀁄􀁏􀀃􀁓􀁏􀁄􀁗􀁈􀀃􀁗􀁒􀀃􀁉􀁕􀁄􀁆􀁗􀁘􀁕􀁈􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁆􀁒􀁑􀁖􀁗􀁕􀁘􀁆􀁗
A
  1. Olecranon osteotomy

RECOMMENDED READINGS

Lapner M, King GJ. Elbow arthroplasty for distal humeral fractures. Instr Course Lect. 2014;63:15-26. PubMed PMID: 24720290.

Githens M, Yao J, Sox AH, Bishop J. Open Reduction And Internal Fixation Versus Total Elbow Arthroplasty For The Treatment Of Geriatric Distal Humerus Fractures: A Systematic Review and Metaanalysis. J Orthop Trauma. 2013 Dec 26. PubMed PMID: 24375273.

37
Q
  1. To counteract the common deforming forces in a proximal tibia fracture, blocking screws should be placed

at which locations in Figures 208a and 208b?

  1. 1 and 8
  2. 2 and 6
  3. 3 and 5
  4. 4 and 7
  5. 5 and 8
A
  1. 2 and 6

RECOMMENDED READINGS

Stinner DJ, Mir H. Techniques for intramedullary nailing of proximal tibia fractures. Orthop Clin North Am. 2014 Jan;45(1):33-45. doi: 10.1016/j.ocl.2013.09.001. Epub 2013 Oct 5. PubMed PMID: 24267205.

38
Q
  1. What is the best pin care method for long-term external fixation?
  2. Twice-daily cleaning with peroxide
  3. Twice-daily cleaning with chlorhexidine
  4. Once-daily cleaning with peroxide
  5. Once-daily cleaning with chlorhexidine
  6. Once-daily showers and dry dressings
A
  1. Once-daily showers and dry dressings

RECOMMENDED READINGS

Stinner DJ, Hsu JR, Iobst C. The half-pin and the pin tract: a survey of the Limb Lengthening and Reconstruction Society. Am J Orthop (Belle Mead NJ). 2013 Sep;42(9):E68-71. PubMed PMID: 24078969.

39
Q
  1. A 56-year-old otherwise healthy woman underwent surgical intramedullary fixation of a midshaft tibial fracture 5 months ago. She continues to have mild soreness at the fracture site but is walking up to 1 mile each day and does not stop daily activities because of pain. Incisions are well healed with no warmth or redness. She denies malaise, fevers, chills, nausea, or vomiting. Her radiographs reveal an interval increase in callus formation, with 1 cortex that appears to be bridged on the anteroposterior and lateral views and an approximate 1-mm to 2-mm gap at the fracture site. The distal locking screw appears to be bending. The nail is intact. What is the most appropriate next step?
  2. Exchange nailing
  3. No change in current therapy
  4. Ultrasound bone stimulator therapy
  5. Surgical dynamization of the nail
  6. Nonunion takedown with bone grafting
A
  1. No change in current therapy

RECOMMENDED READINGS

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkowski M, Sanders D,

Walter SD. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008 Dec;90(12):2567-78. doi: 10.2106/JBJS.G.01694. PubMed PMID: 19047701; PubMed Central PMCID: PMC2663330.

Hak DJ. Management of aseptic tibial nonunion. J Am Acad Orthop Surg. 2011 Sep;19(9):563-73. Review. PubMed PMID: 21885702.

40
Q
  1. Figure 219 is the radiograph of a 65-year-old man with a severe valgus deformity of the right lower extremity. To anatomically align the limb, which osteotomy would provide the most bone contact with the least amount of translation and shortening?
  2. Dome osteotomy on line C
  3. Dome osteotomy on line D
  4. Sliding osteotomy on line E
  5. Lateral opening-wedge osteotomy at point A
  6. Medial closing-wedge osteotomy at point B
A
  1. Dome osteotomy on line C

RECOMMENDED READINGS

Paley D. Principles of deformity correction. Berlin; New York, NY: Springer;2002:129.

41
Q
  1. A 23-year-old man with an unknown medical history sustains multiple gunshot injuries to the abdomen. After an advanced trauma life support evaluation, he is noted to have 4 gunshot wounds that resulted in a colon performation just distal to the splenic flexure. He is taken for laparotomy and diverting colostomy by the surgical trauma service. Secondary review of the CT scans shows disruption of the periacetabular tissue planes and air in the hip joint. He is tachycardic and normotensive postsurgically, with a serum lactate level of 3.2 mmol/L . Treatment should consist of
  2. antibiotics only.
  3. antibiotics and urgent surgical debridement of the hip.
  4. antibiotics, normalization of the lactate, and surgical debridement of the hip.
  5. antibiotics, normalization of the lactate, colostomy reversal and surgical debridement of the hip.
  6. no further treatment.
A
  1. antibiotics, normalization of the lactate, and surgical debridement of the hip.

RECOMMENDED READINGS

Miller AN, Carroll EA, Pilson HT. Transabdominal gunshot wounds of the hip and pelvis. J Am Acad Orthop Surg. 2013 May;21(5):286-92. doi: 10.5435/JAAOS-21-05-286. Review. PubMed PMID: 23637147.

Bartkiw MJ, Sethi A, Coniglione F, Holland D, Hoard D, Colen R, Tyburski JG, Vaidya R. Civilian gunshot wounds of the hip and pelvis. J Orthop Trauma. 2010 Oct;24(10):645-52. doi: 10.1097/ BOT.0b013e3181cf03ea. PubMed PMID: 20871253

42
Q
  1. Figures 226a and 226b are the initial radiographs of a 93-year-old community-ambulating man who sustained a ground-level fall. He is seen in the emergency department with right hip pain. His CT scan reveals no abnormalities. He has a pacemaker to address his sick sinus syndrome. He is unable to bear weight on his right lower extremity. What is the best next step?
  2. Repeat the CT scan
  3. Surgical fixation of the femoral neck􀀃 􀀕􀀑􀀃􀀃􀀃􀀶􀁘􀁕􀁊􀁌􀁆􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁉􀁈􀁐􀁒􀁕􀁄􀁏􀀃􀁑􀁈􀁆􀁎
  4. Bone scan within 6 hours of the initial injury
  5. Bone scan 72 hours after the initial injury was sustained
  6. Crutches and weight-bearing activity as tolerated with close clinical follow-up
A
  1. Bone scan 72 hours after the initial injury was sustained

RECOMMENDED READINGS

Cannon J, Silvestri S, Munro M. Imaging choices in occult hip fracture. J Emerg Med. 2009 Aug;37(2):144-52. doi: 10.1016/j.jemermed.2007.12.039. Epub 2008 Oct 28. Review. PubMed PMID: 18963720.

Iwata T, Nozawa S, Dohjima T, Yamamoto T, Ishimaru D, Tsugita M, Maeda M, Shimizu K. The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip. J Bone Joint Surg Br. 2012 Jul;94(7):969-73. doi: 10.1302/0301-620X.94B7.28693. PubMed PMID: 22733955.

43
Q
  1. Figure 230 is the radiograph of a 35-year-old man who has his displaced femoral neck fracuture fixed 12 months ago. However, he still has persistent groin pain. Based on his clinical examination and radiographic findings, what is the next best step?1. Open bone grafting
  2. Total hip arthroplasty
  3. Valgus intertrochanteric osteotomy
  4. Oral weekly alendronate for 12 weeks
  5. Hardware removal and core decompression
A
  1. Valgus intertrochanteric osteotomy

RECOMMENDED READINGS

Hartford JM, Patel A, Powell J. Intertrochanteric osteotomy using a dynamic hip screw for femoral neck nonunion. J Orthop Trauma. 2005 May-Jun;19(5):329-33. PubMed PMID: 15891542.

Ballmer FT, Ballmer PM, Baumgaertel F, Ganz R, Mast JW. Pauwels osteotomy for nonunions of the femoral neck. Orthop Clin North Am. 1990 Oct;21(4):759-67. PubMed PMID: 2216406.

44
Q
  1. What is the most appropriate treatment for the fracture shown in Figure 235?
  2. Closed reduction and casting
  3. Reamed nailing of the tibia with fibular plating
  4. Reamed nailing of tibia without fibular fixation
  5. Unreamed nailing of the tibia with fibular plating
  6. Unreamed nailing of the tibia without fibular fixation
A
  1. Reamed nailing of the tibia with fibular plating

RECOMMENDED READINGS

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, Tornetta P 3rd, Schemitsch EH, Swiontkowski M, Sanders D,

Walter SD. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2008 Dec;90(12):2567-78. doi: 10.2106/JBJS.G.01694. PubMed PMID: 19047701; PubMed Central PMCID: PMC2663330.

45
Q
  1. Figures 240a and 240b are the radiographs of a 46-year-old obese woman who has left shoulder pain and a grossly deformed right knee after a bicycle collision. Evaluation reveals paresthesia along the peroneal and tibial distributions and pulseless right foot with capillary refill exceeding 5 seconds. An emergent reduction maneuver is performed and a clunk is palpated and “heard,” but the knee feels grossly unstable. The foot is still pulseless and capillary refill is about 5 seconds. In addition to obtaining new radiographs, what is the most appropriate next step?
  2. Ankle brachial index measurement
  3. Standard angiography in the vascular lab
  4. CT angiography of the right lower extremity
  5. Immediate surgical vascular evaluation and reperfusion
  6. Emergent knee-spannign external fixatation and vascular re-evaluation􀀃 􀀘􀀑􀀃􀀃􀀃􀀨􀁐􀁈􀁕􀁊􀁈􀁑􀁗􀀃􀁎􀁑􀁈􀁈􀀐􀁖􀁓􀁄􀁑􀁑􀁌􀁑􀁊􀀃􀁈􀁛􀁗􀁈􀁕􀁑􀁄􀁏􀀃􀂿􀁛􀁄􀁗􀁌􀁒􀁑􀀃􀁄􀁑􀁇􀀃􀁙􀁄􀁖􀁆􀁘􀁏􀁄􀁕􀀃􀁕􀁈􀀐􀁈􀁙􀁄􀁏􀁘􀁄􀁗􀁌􀁒􀁑
A
  1. Immediate surgical vascular evaluation and reperfusion

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.

Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop Relat Res. 2014 Sep;472(9):2621-9. doi: 10.1007/ s11999-014-3511-3. PubMed PMID: 24554457; PubMed Central PMCID: PMC4117866.

46
Q
  1. Figures 250a through 250c are the radiographs of a healthy 34-year-old man who was a restrained driver in a high-speed motor vehicle collision. He is seen in the emergency department with a closed injury. His right lower extremity is neurovascularly intact but swollen. There is no clinical concern for compartment syndrome. Which treatment strategy for this type of intra-articular distal tibia fracture has been shown to yield excellent radiographic union and alignment outcomes and is also associated with minimal soft-tissue complications?
  2. Closed reduction and immobilization in a nonweight-bearing short-leg cast
  3. Closed reduction and immobilization in a long-leg cast with immediate weight bearing
  4. Immediate tibial intramedllary nail fixation with percutaneous treatment of the intra-articular fracture fragment.
  5. Immediate open reduction and internal fixatino of the fibula through a posteriolateral approach and the tibia through an anterolateral approach.
  6. Immediate open reduction and internal fixation of the fibula through a posteriolateral approach and the tibia through an anteromedial approach
A
  1. Immediate tibial intramedllary nail fixation with percutaneous treatment of the intra-articular fracture fragment.

RECOMMENDED READINGS

Marcus MS, Yoon RS, Langford J, Kubiak EN, Morris AJ, Koval KJ, Haidukewych GJ, Liporace FA. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury. 2013 Aug;44(8):1107-11. doi: 10.1016/j.injury.2013.02.014. Epub 2013 Apr 6. PubMed PMID: 23566706.

Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004 Sep;18(8 Suppl):S32-8. PubMed PMID: 15472563.

47
Q
  1. A 55-year-old woman fell on her outstretched right hand and sustained the injury shown in Figure 259.

What is the best next step?

  1. Triceps-sparing approach and open reduction and internal fixation (ORIF) with column screws
  2. Triceps-splitting approach with total elbow arthroplasty
  3. Triceps-sparing approach with total elbow arthroplasty
  4. Olecranon osteotomy and ORIF including dual-column plating
  5. Olecranon osteotomy and ORIF with column screws
A
  1. Olecranon osteotomy and ORIF including dual-column plating

RECOMMENDED READINGS

Galano GJ, Ahmad CS, Levine WN. Current treatment strategies for bicolumnar distal humerus fractures. J Am Acad Orthop Surg. 2010 Jan;18(1):20-30. Review. PubMed PMID: 20044489.

Coles CP, Barei DP, Nork SE, Taitsman LA, Hanel DP, Bradford Henley M. The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma. 2006 Mar;20(3):164-71. PubMed PMID: 16648697.

48
Q
  1. A 42-year-old man sustains a gunshot wound to his right femur. He is neurovascularly intact. What is the best treatment option?
  2. A retrograde nail because the procedure takes much less time
  3. A retrograde nail because it is associated with a higher chance of union
  4. A retrograde or antegrade locked intramedullary nail would be acceptable.
  5. An antegrade nail because there is less knee pain after antegrade nailing
  6. An antegrade nail because a retrograde nail is associated with a high incidence of knee sepsis after gunshot wound injury
A
  1. A retrograde or antegrade locked intramedullary nail would be acceptable.

RECOMMENDED READINGS

Dougherty PJ, Gherebeh P, Zekaj M, Sethi S, Oliphant B, Vaidya R. Retrograde versus antegrade intramedullary nailing of gunshot diaphyseal femur fractures. Clin Orthop Relat Res. 2013 Dec;471(12):3974-80. doi: 10.1007/s11999-013-3058-8. PubMed PMID: 23690149; PubMed Central PMCID: PMC3825896.

Cannada LK, Jones TR, Guerrero-Bejarano M, Viehe T, Levy M, Farrell ED, Ostrum RF. Retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Orthopedics. 2009 Mar;32(3):162. PubMed PMID: 19309067.

49
Q
  1. A 24-year-old man sustains a gunshot wound to his right midshaft humerus. It is an isolated injury. He has complete radial nerve palsy. In addition to antibiotic treatment, what is the best option?
  2. External fixation of the humerus with exploration of the radial nerve
  3. External fixation of the humerus without exploration of the radial nerve
  4. Intramedullary nailing of the humerus without exploration of the radial nerve
  5. Open reduction and internal fixation of the fracture using a plate and screws with exploration of the radial nerve
  6. Immobilization in a coaptation splint and radial nerve observation to assess possible return of function
A
  1. Immobilization in a coaptation splint and radial nerve observation to assess possible return of function

RECOMMENDED READINGS

Joshi A, Labbe M, Lindsey RW. Humeral fracture secondary to civilian gunshot injury. Injury. 1998;29 Suppl 1:SA13-7. PubMed PMID: 9764224.

Bercik MJ, Kingsbery J, Ilyas AM. Peripheral nerve injuries following gunshot fracture of the humerus. Orthopedics. 2012 Mar 7;35(3):e349-52. doi: 10.3928/01477447-20120222-18. PubMed PMID: 22385445.

Dougherty PJ, Vaidya R, Silverton CD, Bartlett C, Najibi S. Joint and long-bone gunshot injuries. J Bone Joint Surg Am. 2009 Apr;91(4):980-97. Review. PubMed PMID: 19339586.

50
Q
A

5. OITE (41 decks)

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