Trauma MCQ

  1. A patient is in your office after one of your colleagues has done an excision of a Morton’s neuroma and he is developing early CRPS. The patient is unhappy with the outcome. How do you proceed?



    A)
  2. 6- Which is true about midshaft humerus fractures?




    C)
  3. What is true with nail vs. plate in humeral shaft fractures?

    a) Nail gives more shoulder pain
    b) More non-unions with nail
    A)

    • IM nail vs ORIF:
    • Similar facture union rate
    • Similar Rate of nerve injury
    • Infection higher in plating than nail
    • No significant difference in shoulder and elbow function
    • Reoperation and complication rates higher in IM nail
    • IM nailing associated with more shoulder pain, more restriction to shoulder movement,more risk of shoulder impingement, increased risk of intraoperative fracture comminution, higher incidence of implant failure.
  4. What is the antibiotic of choice for open tendon laceration after a human bite?




    B)
  5. 23- What is the best approach for an elderly with a quadrilateral plate acetabulum fracture?




    A)
  6. 24- What is true about ABC acetabulum fractures in the elderly?

    a) More than 20% conversion rate to THA within 2 years
    b) Most are operated on through a posterior approach
    A)

    OKU 2016: 23% rate of conversion (21-45%) most often within the first 2 years
  7. 25- What is true about the Kocher-Langenbeck approach?




    C)



    • lateral position 
    • posterior wall and lip fxs (can use skeletal traction when using lateral position)
    • allows for femoral head dislocation
    • position of choice for joint arthroplasty
    • allows buttock tissue to "fall away" from the field

    • prone position 
    • for transverse fx (flex the knee to prevent stretching of sciatic nerve)
    • femoral head is maintained in  reduced position throughout procedure
    • improves quadrilateral surface access
    • improved access to cranial and anterior aspect of posterior wall fractures
  8. 27- What is the best option for a trauma patient with a pulmonary contusion, but hemodynamically stable and a femoral shaft fracture?





    A)
  9. 28- Polytrauma patient with multiple long bones fractures, unstable, about to go for laparotomy. Best option for open tibial shaft fracture with 12 cm bone loss, cold foot with 2-hour warm ischemia, 15 cm soft tissue wound, but major muscles are in continuity?

    a) I&D, re-vascularize, wash bone piece, re-implant, ex-fix
    b) Early amputation
    c) I&D, re-vascularize, throw out bone piece, ring ex-fix
    d) I&D, re-vascularize, throw out bone piece, unreamed nail


    C)


    Image Upload 1
  10. 29- Grade IIIa open tibia fracture in a heavy smoker and diabetic patient. What is the most important risk factor for infection?

    a) Failure of I&D within 1 hour
    b) Failure of giving IV antibiotics within 1 hour
    c) Smoking
    d) Diabetes

    B)
  11. 32- 29 year-old lady with radial head fracture in 2 pieces, what is the best option?





    Radial head excision
    Radial head replacement (titanium head)
    ORIF
    B)
  12. 34- Picture of Type IV capitellum fracture (McKee variant), what is true?




    C)
  13. 39- What is a common block to reduction of a posterior hip fracture?




    B)



    Anterior disloaction:

    Rectus femoris, Iliopsoas, anterior hip capsule, labrum

    Posterior dislocation:

    Posterior capsule, piriformis, gluteus maximus, legamentum teres, labrum, bony fragments
  14. 40- What is typically a block to reduction of a lateral subtalar dislocation?




    D)
  15. 45- Where do you put blocking (Poller screws) in proximal tibia fracture nailing?




    A)
  16. 50- You are called to assess a patient with possible compartment syndrome. What is true?




    C)
  17. 53- All are true about anteromedial coronoid facet fractures, except?

    a) Can happen in terrible triad
    b) Often associated with elbow subluxation
    Must fix with a locked plate
    C)

    Although classically its not associated with terrible triad (no radial head fracture, it can still happen

    As for C it should be fixed with a buttress plate
  18. 57- What is the position of a stress test for a right Weber B ankle fracture?




    B)
  19. 58- What is true about detecting syndesmotic injuries on xrays?



    A)

    • Xray findings for syndesmosis injuries:
    • decreased tibiofibular overlap
    • normal >6 mm on AP view
    • normal >1 mm on mortise view
    • increased medial clear space
    • normal less than or equal to 4 mm
    • increased tibiofibular clear space
    • normal <6 mm on both AP and mortise views
  20. 62- Nerve most at risk during volar FCR approach to the wrist?

    a) Palmar cutaneous branch of medial
    b) Medial branch to thenar muscles
    A)

    • 1- Palmar cutaneous branch of median nerve
    • -arises 5 cm proximal to wrist joint
    • -runs ulnar to FCR

    • 2- Radial artery
    • cannot ligate if Allen's test reveals no/poor ulnar artery contribution to hand
    • care must be taken when retracting during procedure
    • Volar wrist capsule ligaments
    • do not remove from volar distal radius unless access to wrist joint is needed
    • errant release will lead to radiocarpal instability
  21. 65- What is true regarding varus posteromedial rotatory instability of the elbow?




    C)
  22. 70- Patient with post-traumatic scapular winging, abductor weakness and lateral shoulder numbness. Where is the lesion?

    a) C6 root
    b) Upper trunk
    c) Long thoracic nerve
    d) Posterior cord
    B)
  23. 71- A 50yo female falls on her outstretched hand. She sustains a dorsal Barton’s fracture with dorsal carpal subluxation (described, no x-ray given). What is true?




    C)
  24. 80- What is true about S2 iliosacral screw?




    D)
  25. 81- Patient is stabbed to the medial arm causing complete ulnar nerve transection. What should be done at the same time as the nerve repair?



    B)
  26. 95 - Regarding total elbow arthroplasty versus ORIF in comminuted distal humerus in elderly, which of the following is true?




    D)

    Image Upload 2

    • Better Mayo elbow performance scores up to 2 years
    • Better DASH scores up to 6 months
    • 107˚ flexion arc vs 95˚ in the ORIF group
    • No difference in re-operation rate
  27. 100- All are true re: Hawkins sign after a Talus fx, except?



    A)
  28. 107- What is an indication of bullet removal?



    C)
  29. 123- With respect to converting an open tibia fracture that was in an ex-fix, all of the following are acceptable, except?






     

    Answer: C
    B)
  30. 117- Which of these is likely to require surgical intervention for a femoral head fracture



    C)


    Maybe the question is EXCEPT and then the answer is C= associated sciatic nerve palsy
  31. Best predictor for failure of distal BBFF




    C)



    Kamat et al. present a retrospective review of 1001 pediatric distal forearm fractures that required closed reduction to identify factors associated with re-displacement. They found the cast index (CI) - or ratio of sagittal (lateral) and coronal (AP) inner cast diameters - to be the only significant predictor. CI > 0.8 was associated with a significantly higher rate of displacement (26%) than CI <= 0.8 (5.6%).
  32. Bicondylar tibial plateau fracture, what is the most important aspect of treatment?



    A)



    Patients with a malalignment of more then 5 degrees developed a moderate to severe grade of osteoarthritis statistically significant more often (27% of the patients) compared to patients with an anatomic knee axis (9.2%; MWU, P = 0.02). Age did not appear to have any influence on the results.
  33. Patient with an ABC fracture of the acetabulum. What is the optimal approach?




    D)
  34. 22 year old female with pelvic trauma. They showed pelvis AP, inlet and outlet and asked what type of injury mechanism is likely according to her x-rays. (X-rays showed very mild symphyseal disruption but vertical displacement of left hemipelvis with SI disruption. They even drew a line on the outlet view going across the top of the iliac crest showing that the left was in fact vertically displaced): 




    A)
  35. Regarding posterior wall fractures, all are operative EXCEPT?




    A)



    • Indications:
    • displacement of roof (>2mm)
    • posterior wall fracture involving > 40-50%
    • marginal impaction
    • intra-articular loose bodies
    • irreducible fracture-dislocation
    • pregnancy is not contraindication to surgical fixation
  36. Which causes the least strain through the plate in a proximal tibial extra-articular fracture treated with lateral plating?




    A)
  37. What is improper alignment for the distal radius?




    D)
  38. 60F with an extra-articular fracture of the distal humerus. They show you an image of that.

    What is the treatment?






    A)
  39. Which of the following is a risk factor for clavicle fracture malunion? REPEAT




    B)
  40. What is acceptable reduction in a MC neck # (repeat)




    D)

    Image Upload 3
  41. What is true regarding olecranon fractures?




    A)


    knowledge that a larger PUDA equates to less TE will allow surgeons to better predict postoperative ROM after contracture release procedures(PUDA measured 47 mm from the tip of olecranon and normally less than 5.4 degrees)

    •  
    • Triceps reattachment in this manner creates a smooth, congruent transition from the triceps tendon to the articular cartilage of the olecranon but decreases the moment arm and may result in greater extensor weakness.
  42. Medial subtalar dislocation, what is the block to reduction REPEAT




    D)
  43. Regarding bone loss of greater than 6cm in an open fracture what is true?




    D)

    • The most common site of bone loss after fracture is the tibia, because of its
    • subcutaneous position which predisposes it to open fracture and extrusion of bone.

    The diaphysis is the most common site of involvement.
  44. What is the problem with a starting point that is too lateral in a femoral nail?

    a) Valgus
    b) Varus
    B)
  45. Which of the following is not an indication for IM nail of the humerus? REPEAT




    D)
  46. Patient has a significant scar over buttock and proximal thigh from a vascular bypass  that got infected or something but is now healed. However, the vessel is not re-occluded. Vascular studies show the tibia is viable 2cm distal to the joint line.

    What is the optimal level of amputation?



    C)

    Tibia ampuation: 5cm or distl to tubercle: below metaphyseal flare

    femur amputation: Level of adductor tubercle
  47. Which of the following tests is the best to assess a musculoskeletal infection: REPEAT


    B)



    In infections, the gallium scan has an advantage over indium leukocyte imaging (also called indium-111 white blood cell scan) in imaging osteomyelitis (bone infection) of the spine, lung infections and inflammation, and for chronic infections. In part this is because gallium binds to neutrophil membranes, even after neutrophil death. Indium leukocyte imaging is better for acute infections (where neutrophils are still rapidly and actively localizing to the infection), and also for osteomyelitis that does not involve the spine, and for abdominal and pelvic infections.

    Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.
  48. You are called to assess a patient with possible compartment syndrome. What is true?



    C)
  49. What is the most common mode of elbow instability?



    B)

    Posterolateral rotatory instability is the most common type of symptomatic chronic instability of the elbow. In this condition the forearm complex rotates externally in relation to the humerus, causing posterior subluxation or dislocation of the radial head. The lateral ligament complex, radial head and coronoid process are important constraints to posterolateral rotatory instability, and their disruption is involved in the pathogenesis of this condition
  50. Patient has an elbow dislocation with radial head fracture and coronoid fracture. All are true except



    D)



    Terrible Triad: MCL repair indicated if instability on exam after LCL and fracture fixation, especially with extension beyond 30°.
  51. Regarding posterior mal fractures, what is true? REPEAT



    D)
  52. Patient with severe trauma (splenic lac + femur) is resuscitated and goes to OR. Gen surg is done. They call you if you want to proceed. What is the best measure of resuscitation?



    D)
  53. What is true about joint depression type calcaneus fractures? REPEAT




    C)
  54. All are true about the management of pilon fractures except? REPEAT



    C)
  55. All are true regarding fixation (IM nailing vs Plating) of distal tibial metaphyseal/diaphyseal junction fracture, EXCEPT? REPEAT




    C)



    Although fibular plating may decrease the risk of fibular malunion, it does not substantially increase the risk of tibial malunion or nonunion.
  56. What is the limiting factor in treating obese patients?



    C)
  57. Patient has an open Grade IIIa fracture, what is true? REPEAT




    D)
  58. Patient suffers a femoral neck fracture. Which source of blood supply is least likely to be affected? REPEAT





    D)
  59. Repeat question about tib-fib overlap in a suspected syndesmotic injury?

    ON AP

    ON Mortice
    • AP View
    • Ankle Clear Space <6 mm
    • Tibia-Fibula Overlap >6 mm or >42% width of Fibula

     

    • Mortise View (15 degrees IR)
    • Ankle Clear Space <6 mm
    • Tibia-Fibula Overlap >1 mm
  60. What is the mechanism of injury for a Monteggia Type 1 fracture? REPEAT



    A)
  61. Technical difficulty with FCR approach to distal radius?




    D)
  62. When comparing locking vs non-locking proximal tibial plates, which is true? (REPEAT 2011)


    A)
  63. Regarding elbow dislocations, which is true?


    C)
  64. With a simple elbow dislocation:



    C)
  65. With a simple elbow dislocation:



    C)
  66. A patient presents to ER with C5/6 jumped facets and complete quadriplegia following an MVC (or some other similar trauma). It is an isolated injury. The patient is bradycardic (HR 60?) and hypotensive (80/45 mmHg). So far the patient has been given 6L of crystalloid. What should you do now?




    D)
  67. You are shown an x-ray (again not that great of a picture) of a volar carpal dislocation with a fleck of volar distal radius (in past years this was recalled as a trans-scaphoid perilunate, or a carpal dislocation, but we think it was really a volar Barton’s), also a thumb CMC dislocation. What is the best treatment?



    B)
  68. A 50yo female falls on her outstretched hand. She sustains a dorsal Barton’s fracture (described, no x-ray given). What is true?




    C)



    TDA is the angle between the central axis of the teardrop and the radius shaft. Medoff described how a decrease or increase in the TDA may indicate displaced intra-articular fracture elements when the radial inclination (RI) and volar tilt (VT) are restored in distal radius fractures.
  69. What is the best indication for performing a distal radius osteotomy?



    D)
  70. What is the most common fracture associated with a talar neck fracture?




    B)

    Medial Mal Fractures are seen in 26% of Talar Neck Fracture.
  71. What is the most common fracture associated with a talar neck fracture?




    B)



    Medial Mal Fractures are seen in 26% of Talar Neck Fracture.
  72. When fixing a syndesmotic injury with tibiofibular screws versus with an ORIF of the posterior malleolus, which of the following is true?




    B)
  73. 1- You are shown an x-ray of a periprosthetic oblique distal femur fracture just above a well fixed TKA. Bone quality is good. The patient is otherwise healthy. What is the best treatment?



    D)
  74. What is the risk of osteonecrosis in a pediatric displaced transcervical hip fracture?



    D)

    Image Upload 4
  75. A 5yo with a femur fracture treated is treated with a spica cast. What is an unacceptable deformity, except (maybe)?




    • C)
    • Image Upload 5
  76. A patient presents with a distal pole patella fracture with displacement and comminution. The patient has a large hemarthrosis and extensor mechanism disruption. What is the best treatment option?



    A)
  77. A 50yo male falls from a horse. You are shown an x-ray which demonstrates 2-3cm pubic diastasis and slight right SI joint widening but no vertical instability. What was the mechanism?



    D)
  78. After a distal radius fracture, a patient sustains a rupture of the EPL. What deficit will they have?



    C)



    EPL ruptures typically occur just distal to extensor retinaculum at listers tubercle. Occurs typically 3 weeks to 3 months following injury and is more common in nondisplaced distal radius fractures than displaced. This suggests possible an ischemic etiology rather than attitional rupture from friction.

    EPL test – An EPL rupture manifests as a loss of extension of the thumb IP and MP joints.
  79. A 25yo male is involved in a MVC. You are shown an x-ray of a basicervical fracture, fairly horizontal pattern, displaced. GT is intact. What is the optimal treatment?



    A)
  80. A 24yo male is found 24 hours after a single vehicle collision/rollover. He has a closed head injury (GCS12), a pneumothorax, and an open tibia fracture with a 10cm wound over the anteromedial tibia. Both of his legs have been lying in ditch water for 24 hours. You are shown x-rays which demonstrate a comminuted midshaft tibia fracture. Optimal treatment includes irrigation & debridement and what else?




    A)
  81. What is the most important factor in preventing infection in an open fracture in a pediatric patient?



    A)
  82. What is true regarding a type III supracondylar humerus fracture in a pediatric patient?




    D)
  83. What is the most common complication following use of locked plates in proximal humerus ORIF?



    D)
  84. An elderly woman has severe destructive changes of both elbows. She undergoes bilateral elbow fusion. What are the optimal positions?




    E)

    • 65 nondominant 110 dominant
    • 90 if unilateral
  85. What type of healing do you have with a statically locked femoral IM nail?



    A)
  86. For a 95-degree distal femoral locking plate, where should the first guide wire go?



    B)
  87. What is true regarding olecranon fractures?



    D)
  88. Which of the following is true regarding humeral shaft fractures?



    C)



    • criteria for acceptable alignment include:
    • < 20° anterior angulation
    • < 30° varus/valgus angulation
    • < 3 cm shortening
    • 90% union rate
  89. A patient suffers an open pilon fracture. You are shown an x-ray with a huge piece of the medial malleolus and distal articular surface. They tell you it is devoid of soft tissue attachment. How do you manage this patient?



    A)
  90. A patient has a midshaft femur fracture with 3cm bone loss. He is treated with irrigation and drainage (note – they never said it was open!). This was treated with an ex-fix, then converted to an IM nail. How should the bone loss be managed?



    C)
  91. What type of healing do you have with a statically locked femoral IM nail?



    B)
  92. Which of the following is considered a floating shoulder?



    D)
  93. You are shown an x-ray of the lateral elbow for a younger guy who falls. It is a capitellar fracture with a double density sign (the McKee variant to the Morrey classification). Which of the following is true regarding the treatment of this injury?

     


    B)

    Image Upload 6
  94. Where is the appropriate starting point for a tibial IM nail?


    A)
  95. All are true regarding fixation (IM nailing vs Plating) of distal tibial metaphyseal/diaphyseal junction fracture, EXCEPT?



    A)
  96. Regarding clavicle fractures, all have been shown to increase nonunion rates EXCEPT?



    B)
  97. patient has a proximal tibia fracture 6 cm distal to joint line. All are helpful for reduction EXCEPT?



    B)
  98. Regarding tension band wiring, all are true EXCEPT?



    D)

    • for
    • GT
    • GT
    • Olecranon
    • Patella
  99. Which is a reason for ex fix of BBFF?



    C)
  100. Guy in high speed MVA- poly trauma. Many injuries- esp. MSK. 2 hours out. Segmental bone loss 12cm of open tibia- leg is cold, but muscle appears viable. What to do?



    B)
  101. Lady with B pubic rami fx- PICTURE didn’t appear to have any posterior injury but pic was bad. Had lots of bleeding- large retroperitoneal hematoma. Had splenectomy. About 4 hrs post op. Not fully rescuitated and has no obvious bleed- she has a bp of 90/60 and HR 140. What is next step?- had hard time with this one. Injury didn’t seem like ex-fix worthy or would have been done before or during splenectomy.





    B)
  102. Bennets fx. You do all of the following to reduce except?



    D)



    • Bennett Fracture
    • Intra-articular fracture/dislocation of base of 1st metacarpal
    • volar lip of metacarpal based attached to volar oblique ligament
    • ligament holds this fragment in place
    • small fragment of 1st metacarpal continues to articulate with trapezium 
    • Pathoanatomy

    • lateral retraction of distal 1st metacarpal shaft by APL and adductor pollicis 
    • shaft pulled into adduction
    • metacarpal base supinated

    •  
    • Imaging
    • radiographs
    • recommended views
    • fracture best seen with hyper-pronated thumb view
    • findings
    • minimal joint step-off considered best
    • Treatment
    • nonoperative
    • closed reduction & cast immobilization
    • indications
    • nondisplaced fractures
    • technique
    • reduction maneuver with traction, extension, pronation, and abduction
    • operative
    • closed reduction and percutaneous pinning
    • indications
    • volar fragment is too small to hold a screw
    • anatomic reduction not held
    • technique
    • can attempt reduction of shaft to trapezium to hold reduction
    • ORIF
    • indications
    • large fragment
    • 2mm+ joint displacement
    • Complications
    • there is no agreement regarding the relationship of post-fixation joint incongruity and post-traumatic arthritis
  103. Which is not reason to do ORIF on humerus?



    C)
  104. All of the following are indications for ORIF of clavicle, except?



    C)
  105. Which of the following clavicle fractures is most likely to go on to non-union?



    A)
  106. 78yoF, Old lady with segmental, comminuted R femur fx, including shaft and intertroch, went from LT to distal 1/3 of femur. Osteoporotic maybe? Fixed with 95 deg very long blade plate- shown picture.   Plate spans nearly entire shaft and is fixed distally with about 6 bicortical screws. What is most likely?
    It will likely fail due to osteopenia and decreased healing ability
    It will not fail because stress is distributed over long plate
    It will fail
    It will fail
    A)
  107. All are reasons to fix post wall acetabular fx, except



    D)
  108. All of the following are true regarding post wall acetabular fx except



    A)



    ROOF ARC ANGLE:

    - show intact weight bearing dome if > 45 degrees on AP, obturator, and iliac oblique

    - not applicable for associated both column or posterior wall pattern because no intact portion of the acetabulum to measure
  109. You use BMP 2 Gustillo Grade ? Tibial fx treated with nail. You expect all of the following EXCEPT?



    D)



    Trials say that BMP-2 Decreases Infection for Grade 3A and B
  110. All true except for acute compartment syndrome?
    a) Give oxygen
    b) Give blood transfusion to get Hgb to 100
    c) Treat hypotension
    d) Remove all dressings
    A?
  111. Guy with elbow fx dislocation. You replace radial head, but it continues to dislocate in supination. All are reasons for this except?



    C)
  112. All are true re: decision to treat garden III/IV in elderly with THA/Hemi vs ORIF except?



    B)
  113. Young Pt. had ankle fx. Now 3 months out and has pain that never really resolved. Incisions healed. Shown XR of ankle fx immediate post op and now. Fixed with plate for fib and screws for medial mal. Was comminuted and fibular didn’t match the talus there was huge gap there and was at level of medial mal ie short. What is reason for talar tilt?



    D)
  114. All are true re: Hawkins sign after a Talus fx, except?



    A)

    hawkins 6-8 weeks
  115. Medial Talus fx/dislocation. You try reducing it, but cannot. Which is most likely block?



    C)


    MOST COMMON:

    Medial—extensor digitorum brevis/capsuleLateral—posterior tibial tendon
  116. 16 yo. Female with forearm injury shown- pt has Bado I monteggia (Anterior) but ulna segmental. What you do?



    C)
  117. Pt with spine injury and femur fracture, had bp 80/50 and Hr 110. What is the likely cause of hypotension?



    A)
  118. Lateral subtalar dislocation, block to reduction?
    a) Spring ligament
    b) FHL
    d) EDB
    c) Tibialis anterior
    B)
  119. You are shown an xray with a lateral tibial plateau Schatzker II. There is an arrow pointing to depressed piece in central plateau that needs to be elevated. How would you reduce this piece?



    A)
  120. Regarding intraarticular calcaneus fractures, which of the following is true?


    A)
  121. Anteromedial coronoid, all are true except?


    C)
  122. Roof-arc angle not helpful with which of the following acetabular fractures?


    B)
  123. Lateral Xray of elbow showing coronal fracture of capitellum, which is true?



    C)
  124. Blade plate question again... 73 yo lady with super long subtrochanteric spiral fracture, fixed with blade plate and 5-6 screws below. She did not look osteoporotic. Failure is? (note: likely because of posteromedial comminution was NOT an option).



    D)
  125. Young guy comes in with open tibia fracture. He gets an IM nail and 2 days later returns to the OR for soft-tissue management and injection of BMPs. What effect will the BMPs have?



    D)


    BMP reduced the amount of secondary interventions, accelerated fracture and wound healing, reduced infection rate

     

    JBJS 2011 may: Recombinant Human Bone Morphogenetic Protein-2: A Randomized Trial in Open Tibial Fractures Treated with Reamed Nail Fixation

    Conclusion: The healing of open tibial fractures treated with reamed intramedullary nail fixation was not significantly accelerated by the addition of an absorbable collagen sponge containing rhBMP-2.
  126. Best indication to apply ex-fix to both bone forearm? (contamination not an option)



    A)
  127. Talus fracture, fixed using dorsolateral approach only. Comes back with malunion. What is true?



    A)
  128. Garden III/IV in elderly, IF vs ORIF, all except?
    a) Higher mortality rate with ORIF
    b) Higher revision rate in ORIF
    A)
  129. Valgus intertroch osteotomy for nonunited femoral neck fracture in a young patient, all except?


    C)
  130. Stable and unstable intertrochanteric hip fractures can be fixed with both sliding screw constructs and minimally invasive cephalomedullary nails. Comparing these two methods, which is true?
    a) Similar rates of blood transfusion
    b) CM nail better overall results
    A)
  131. In a Bado type I Monteggia fracture, what is the mechanism of injury?



    B)



    Bado type 1 is an anterior radial head dislocation – from a fall onto outstretched arm in forced pronation
  132. Middle aged woman with olecranon fracture repaired with figure of 8 tension band. 4 months later she presents with an xray showing displacement of the olecranon proximally (wires still intact and well positioned in distal bone). Immediate postop xray looks like the one below.



    D)
  133. Shown Xray of trimal ankle fracture (SER, typical Weber B). Large posterior spike. Biomechanically, what is the best construct for the fibular fixation?



    A)
  134. Regarding SI screws, which of the following is true?


    C)
  135. Which of the following approaches provides the best exposure to the articular surface in Distal Humerus fracture?


    A)
  136. A patient has documented Group B Hemolytic Strep Necrotizing Fascitis. What should you do?


    B)
  137. 30-ish year-old male diagnosed with GAS necrotizing fasciitis of the arm. Treatment should consist of:



    B)
  138. Which of the following types of Tibial Plateau Fracture are most likely to cause Peroneal nerve palsy?



    B)
  139. All of the following are true with proximal humerus fractures EXCEPT:



    B)
  140. All of the following are true with radial fracture instability EXCEPT:
    a) Short >3mm
    b) >80 yo
    c) metaphyseal comminution
    d) dorsal angulation
    d?
  141. All of the following are true regarding SI screw for vertically unstable fractures EXCEPT:



    B)
  142. Vertical shear pelvic fracture treated with SI screws. Which of the following is NOT correct?

     



    D)
  143. A 40 y.o.male with a BMI of 40 sustains a right midshaft femur fracture. He is brought to the OR and placed in the hemilithotomy position with his left leg placed in a padded support. Postoperatively he complains of severe leg pain and he has swelling. What is the most likely cause?



    B)
  144. BMI of 40 with a R midshaft femur fracture. Treated with an IM nail in the hemilithotomy position (L leg in well-leg holder). In recovery has pain L leg with toe plantarflexion and swelling. What is the cause?


    C)
  145. GSW to axilla unable to flex elbow, no sensation to lateral forearm, motor to median/radial/PIN are okay. What’s the nerve injury?



    B)
  146. Locked vs. Regular plating for tibial plateau fracture



    D)
  147. Most common complication post talar neck fracture



    D)
  148. In a Type I Monteggia fx with anterior radial head dislocation. What is the mechanism?



    B)
  149. Acceptable ORIF distal radius, ongoing DRUJ instability intraop. Tiny ulnar styloid fragment.



    D)
  150. What is not an indication for ORIF of humeral shaft #?



    A)
  151. 68F # 2cm distal to LT



    B)
  152. Anterior sternoclavicular dislocation what to do



    C)
  153. 68 year-old with Parkinson’s has a displaced femoral neck fracture. No pre-existing hip arthritis. What is the MOST appropriate treatment?



    D)
  154. In the treatment of tibial shaft fractures which of the following is true:


    A)
  155. Which of the following is MOST correlated with the development of post-traumatic arthritis after an ankle fracture
    a) Posterior malleolar fracture
    b) Initial treatment with ORIF vs. closed reduction and casting
    A)
  156. Which of the following is not true with respect to proximal humerus fractures:



    B)


    • Vascular anatomy
    • anterolateral ascending branch of the anterior humeral circumflex artery (of which the terminal branch is the arcuate artery) 
    • one of primary blood supplies to the humeral head
    • runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove
    • interosseous anastomosis
    • beware not to injure when plating proximal humerus fractures
    • posterior humeral circumflex artery 
    • most current literature supports this as providing the main blood supply to humeral head 
    • vascularity of articular segment is more likely to be preserved if ≥ 8mm of calcar is attached to articular segment
  157. . Young man involved in MVC with flail chest, intubated and other injuries. Also said he had a radial nerve palsy. Showed AP and lateral of comminuted extra-articular distal humerus fracture with butterfly fragment. What is the best treatment for definitive management of this injury:




    B)
  158. It is acceptable to convert an ex-fix to ORIF in all the following scenarios EXCEPT:



    B)
  159. When would an IM nail be least indicated in the treatment of intertrochanteric fractures:
    a) IT with subtrochanteric extension
    b) Reverse oblique
    c) 4 part IT#
    d) large posteromedial fragment
    D if question is except
  160. 20 M in MVA. Hypotensive at the scene. He is given 2L RL en route to the hospital, but there is no response in his blood pressure. What is the next step in the hospital?



    C)
  161. A varus malreduction of an intertrochanteric hip fracture treated with a DHS does what?



    A)
  162. Which is not acceptable for a humeral shaft fracture



    D)
  163. All of the following are ok to do except: with respect to an open tibia fracture that was ex-fixed:



    D)
  164. 40M hit by car. Comes in with swollen left knee. Images given – Xray of AP and Lateral showing a fleck of bone posterior to joint line (fibular avulsion?); also clinical photograph showing an obviously swollen and erythematous knee. All of the following are appropriate routine tests except:




    D)
  165. 23F with a radial head fracture shown on the XR (picture of XR showing comminuted, displaced radial head fracture with one piece lying anterior). Exam shows she dislocates at 45 degrees flexion and is unstable on valgus. A CT scan was done and shows four fragments. What is the best treatment?



    D)
  166. Floating shoulder:
    a) Humeral neck and scapular neck
    b) Humeral neck and clavicle shaft
    c) Scapular neck and clavicle shaft
    d) Glenoid and scapular body fracture
    e) Humeral shaft and scapular body fracture
    f) Glenoid neck and clavicle Fracture
    g) None of the above
    (Different institutions remembered these answers differently)
    C + E
  167. Trauma patient, why can you not definitively fix long bone fractures




    E)
  168. Humeral shaft # what is unacceptable



    C)
  169. Following ankle fractures needs ORIF?



    B)
  170. Which of the following tibial shaft fractures can be treated with a cast:



    B)
  171. Which is least associated with non union? (Ottawa: 27 yo female with open grade III tibial shaft fracture. What is least likely to lead to non-union?)



    B)
  172. All are true with Talo-navicular fracture-dislocation, true except:



    B)

    Some people do well with talar AVN as long as they have no collapse. MRI is the most sensitive indicator of talus AVN.
  173. Open # tibial coverage, what is not correct:



    C)
  174. In trauma, advantage of pneumatic compression over LMWH?



    C)
  175. Open subtalar (peritalar) dislocation, you cannot reduce closed, it is medial, what is in way?



    B)
  176. Guy has open 3B tibia, totally neurovascularly intact, 2 cm bone loss, dirty and contaminated, what will most influence the decision to amputate the limb?




    C)
  177. Fireman, 4 mo shoulder pain, now acute in ER, prox bicep rupture on exam, what next:



    B)
  178. Hip fracture, post op poor outcome in all except:



    C)
  179. Patient with reperfusion injury and rhabdomyolysis, you will do all EXCEPT:



    B)
  180. Which ABI would not have vessel injuiry:



    B)
  181. Risk factors for poor outcome in calcaneus fracture operative are which of the following:




    D)
  182. Repeat on RSD/Complex Regional Pain Syndrome, picture of woman 3 months after CRPP and minimal trauma with no signs of infection or non-union that is in exquisite pain and has allodynia, all in the 1st web space and lateral hand dorsum, what should you do next?



    C)



    Start with medication. Stellate blocks are not 1st line! Stellate = sympathetic block

    (CRPS Type 1 – no nerve injury; type 2 – with an identified nerve injury, type 2 also known as causalgia)
  183. Give you a dude with a fracture dislocated elbow with coronoid of 25%, radial head fracture, treatment? Ottawa: Posterolateral elbow dislocation. No xray but told there was Radial head comminuted fracture, 25 % coronoid fracture. How to treat?



    D)
  184. Young healthy woman with isolated radial head fracture with 3 intra articular fragments, do? Ottawa: 29 secretary with mason 3 radial head fracture, 3 articular fragments. How to treat?



    B)
  185. All can help fixing proximal tibia fractures EXCEPT:



    D)
  186. Describe some pour soul with PLC and PCL injury, what exam finding?



    C)



    Dial test:

    > 10° external rotation asymmetry at 30° only consistent with isolated PLC injury  

    > 10° external rotation asymmetry at 30° & 90° consistent with PLC and PCL injury
  187. Open calc # and TN joint dislocation, proper tx is:



    C)
  188. Open calc fracture with TN disclo . treatment would include




    E)


    When immediate fracture fixation was attempted, the complication rate was 100%.
  189. BMP 2 and tibial nail that is non reamed, will do what? Calgary: Young guy w/ Grade I open tibia. I & D done and went back 72hrs later to close wound and give BMP. What is true?



    B)
  190. All is true about the use of BMP2 EXCEPT?
    a) Increases the amount of bone grafting needed
    b) Associated with lower infection rate
    c) Lessens the amount of secondary intervention
    d) Lowers fracture healing time
    A vs D?
  191. Calgary: Grade II open tibia. Give BMP. All of the following true except:



    D)
  192. XR of outlet view of pelvis. Asked what this view helps you to see?



    A)
  193. 65 yo female falls from own height and gets DR #, after healed, next step is?



    D)
  194. 132: 35-year old guy with ORIF of the midshaft humerus, returns 6 weeks later with increasing pain, pus draining out of the wound, and obvious crepitus and mobility of the fracture. Xray shows midshaft humerus fracture with a huge gap, screws loose on an LCDC-P. What do you do?



    D)
  195. Elderly lady with 13A of humerus and how to fix, xray shown:




    D)
  196. Xray of loser that plated an open tibial shaft # and slapped a VAC over the hole, most likely reason to get non union. Ottawa: Trauma patient with plated proximal tibial shaft fracture and fasicotomies. Xray showed a good reduction of the tibial shaft fracture with a fibular neck fracture. Four prox and distal screws. Well aligned. What would be the likely cause of non-union?



    D)
  197. Xray of super Lemos smashed wrist 23C in ex fix and was open #, stable, next step?



    B)
  198. Xray of polytrauma patient that is 90/60 and HR 120, saddle fracture of pelvis with minimal displacement, told we have a + DPL and is transiently stable hemodynamically, what is next step?



    D)
  199. Xray of a massively open APC type 3 and next step in management of this when no other source of bleeding can explain the hemodynamic instability: Ottawa: Unstable massively open book pelvic fracture with small bowel injury, but negative DPL for blood and positive DPL for bowel contents. Hypotensive and tachy. Next treatment is guided at what:




    D)
  200. 3 point restraint seat belts have been proven to do which of the following:



    D)
  201. Helmets (bike or motorcycle) are related to all of the following EXCEPT?



    C)
  202. Given shoulder AP and oblique AP and told patient had MVA last week and stuck his arm on the dashboard. Mild shoulder pain, now presents to you, images have no obvious fracture but you suspect dislocation somewhere b/c you are a good resident, next step?





    B)
  203. When is giving oxygen in the trauma situation contraindicated in the elderly?




    D)
  204. Pt previously had extra-articular supracondylar fracture and treated with two plates. After several months pt has non-union and plate and screws loosening, also reduction lost. x-ray is available. Rx:
    a) remove plate, IMN and BG.
    b) revision plate.
    B)
  205. Fight bite, initially treated w/ cephalosporin. Comes back 48hrs later w/ redness, pus, gram –ve rods. Next step?



    D)

    thus, intravenous treatment with ampicillin-sulbactam (penicillin) or cefoxitin is the best choice.
  206. Question on tension band technique, all correct EXCEPT?



    A)
  207. Dude in polytrauma and 90/60, HR 50, no fluid in abdo U/S, pelvis stable, reason?




    E)
  208. A question about the stability of the statically locked, reamed femoral nail and healing:





    D)
  209. Which knee fracture pattern will lead most likely to common peroneal nerve being out?



    C)
  210. You nail a dudes femur on the # table and now he cannot feel his sack, why?



    C)
  211. Dude got 10 units of PRBC in the trauma bay, noted to be bleeding during IM procedure in OR, reason most likely? Calgary: Trauma patient gets 10 units blood in trauma bay. In the OR you’re plating the distal femur and patient is bleeding a lot…..most likely why?



    C)

    The most common complication of massive transfusion is a dilutional thrombocytopenia, followed by hypothermia and metabolic alkalosis.
  212. Xray of simple Subtrochanteric hip#, best fixation?



    C)
  213. Person with humeral non union with dinky plating and infection work up totally negative, xray shows plate pulling off of bone with shit fixation, treatment will be? Calgary: XR elbow in elderly lady. Hypertrophic non-union. UBC: 45 year old with distal humerus fracture treated 6 months ago with ORIF. She reports pain and crepitus to the area. Examination shows that she is neurovascular status is normal, and gross mobility at the fracture site. Serum inflammatory markers are negative for infection. What do you do?




    D)
  214. Close tx of humeral shaft fracture and radial nerve palsy, no recovery at 3 months, EMG shows low amplitude voluntary contractions and fibrillation, management?



    A)



    So can OBSERVE for Up to SIX MONTHS…

    If after that time, see fibrillations, then you should consider neurolysis/nerve grafting/etcIf see longer amplitudes, indicates recovery is occurring, continue to observe
  215. Forearm radius and ulna fractures healed with 10 degree malrotation. What is the effect on motion?



    C)
  216. You have a displaced FN # fixed with screws, what is the rate of patients WITH AVN that go onto a second operation (I believe it said this and not just the rate of all patients with FN # that need re operation if AVN is the reason)? UBC: What is the rate of reoperation FOR AVN s/p ORIF of displaced Fem neck fracture?



    B)
  217. Do all in DCO except:




    D)
  218. With regard to burns and fractures, which would be the most correct:



    C)
  219. When reaming, pressures are decreased by all of the following except:



    C)
  220. If doing retrograde IM nail femur, where should the anterior to posterior locking screw be



    D)

    Proximal to the lesser trochanter reduces the risk of nerve and artery injury.

    All branches of the femoral artery cross at a point 4 cm distal to the lesser trochanter;

                     - Hence, keeping the drill bit above [i.e. PROXIMAL to] the level of the lesser trochanter and avoiding medial aspect of the bone will help prevent vascular injury

              - Note that the deep branch of the medial femoral circumflex artery invariably crosses the femur posteriorly at least 10 mm, and usually 16 to 20 mm, proximal to the superior aspect of the lesser trochanter
  221. OR for clavicle is which?



    B)
  222. Olecranon # have the most problems with which?



    D)
  223. Pt with DR # and loss of IP extension, which muscle:



    D)

    Extensor Indicis Proprius to Extensor Pollicis Longus Tendon Transfer.
  224. Lady w/ distal radius #, presents late w/ tendon rupture. What will you find on physical exam?



    B)
  225. They showed us a picture of an elderly woman with a previous total hip and an ipsilateral total knee. She had a supracondylar fracture with what they described as well fixed components. Six centimeters above the fracture line was the cement at the distal femoral stem. The knee replacement was a posterior cruciate sacrificing with a closed box femoral component. Which of the following would be most appropriate for this patient:

     




    E)
  226. Young guy, high energy trauma, with distal very comminuted 33C #, after ex fix and work up, what is best fixation?



    B)
  227. Xray of Pipkin that they tell you is reduced closed, then ask what is best approach to fix it? Ottawa: Xray shown of a man in a MVC. Shows posterior hip dislocation with femoral head fracture. They tell you that the closed reduction of the posterior dislocation is successful. Asked what your approach for ORIF is?



    B)


    Pipkin 1-2 & no posterior wall fracture: Smith Peterson Approach.

    Pipkin 3: Watson jones

    Pipkin 4: Kocher-Langenbeck
  228. Calgary: Which is the least likely complication of Hawkins II talar neck #?



    B)
  229. Acetabular fracture: in which type can you have “secondary congruence”?


    B)
  230. Proximal humerus #


    C)


    Intraoperative distance = 5 cm from TOP BORDER of PEC MAJOR to SUPERIOR HEAD of ARTHROPLASTY
  231. 18 yo male open # both bones forearm water skiing, immersed in lake water (FRESHWATER). I&D, ORIF and



     ciprofloxacin
    d) delayed closure for second look and doxycycline
    C)


    Salt Water = Abx = Doxycycline + Ceftazidime or Cipro/Levo è Vibrio, M marinum, Clostridium, Aerophillus & Pseudomonas

    Freshwater = Abx = Cipro/Levo or 3rd/4th Gen Cephalosporin è Vibrio, Aerophilus, M marinum
  232. Repeat: 68 years old had a Subtrochanteric femur fracture 2 cm below the lesser trochanter



    D)
  233. 16 yo with open # tibia, 10 cm laceration. Can’t remember details of his immunizations, last one was 10 yrs ago. Last immunization was at 6 years of age. Initial management would include all except:



    D)

    Image Upload 7
  234. All of the following are true, EXCEPT?



    C)
  235. All but which increase risk of fat embolism?



    B)


    Risk Factors = 5% in long-bone fractures, Pelvic Fractures, Young Patients, LE > UE, CLOSE > OPEN fracture, Reaming
  236. Radial Head Fractures. All are true except?



    B)

    it is a secondary constraint
  237. repeat burns and ORIF, which is true



    C)
  238. Mechanism of Talar Neck fracture


    A)
  239. repeat on radiographic markers of ankle fracture


    B)
  240. Prospective analysis has shown that lower extremity injury severity scores:



    C)

    Image Upload 8
  241. An elderly lady comes to clinic, five months following a distal radius fracture. She complains of ulnar sided wrist pain. What is the best option for treatment at this point? (assuming it is healed in mal union?)


    • A)
    • if it is because she is ulna positive secondary to the malunion
  242. Elbow dislocation with radial head Comminution and Type 1 coronoid #. When do you fix the Coronoid?



    A)
  243. Disruption of which vessels in femoral neck fracture most likely to give AVN



    C)
  244. Indication for osteotomy in distal radius malunion?




    E)
  245. Cervical spine injury. Patient’s BP is 80/40, pulse 60. Has received 6L ringer’s lactate. Most appropriate next management:



    A)
  246. A young guy is post-op 72 hrs from ORIF distal radius. He has significant pain, swelling and purulent drainage with gram + cocci in chains (GAS). How should he be treated.



    B)
  247. A 68 yo female presents with a transverse # 2 cm below the lesser trochanter. What is the optimal treatment?



    D)
  248. Infection after ORIF has several features. All are true EXCEPT



    B)
  249. Intra-articular wrist # - worst prognosis for DRUJ, except:



    D)
  250. Repeat Xray of comminuted subtrochanteric, blade plate, bridge plating, no medial bone grafting.
    a) Will heal because plate bridges large area
    b) Won’t heal because no bone grafting
    c) Won’t heal because she is osteoporotic
    d) Won’t heal because not anatomic reduction
    A vs C?
  251. Acetabular x-ray shown, Acetabular PW # and disruption of both Anterior + Posterior columns. What type is it?



    B)
  252. Management for a patient with hyponatremia, Hypovolemic and confusion == in a severe Trauma Patient (multiple fractures)?



    B)
  253. Neurogenic shock 80/50 and HR 50. 6L of NS in. What is next management




    C)
  254. Open tibia with 2 cm bone loss. What is an indication for amputation in Grade 3B open #





     

    Answer: C
    A)
  255. Presented with an X-ray of hypertrophic non-union of tibial diaphysis. You also get a picture of this non-union plated. You need to tell them which type of plating was used. The image showed use of an AO tensioning device.



    B)
  256. You are presented with an X-ray of some old lady with a distal humerus fracture fixed with two short, wimpy recon plates. Oddly enough, the next X-ray shows a hypertrophic non-union. You are left scratching your head and wondering what happened? There was new bone formation around every screw including the ones that had pulled off the proximal part of the plate 2-3 cm away from the fracture. (2 of us thought that although the hardware was inadequate there were obvious infectious signs on the xray)



    C)

    • Distal Humerus Non-Union
    • 10% after ORIF
    • Inadequate Fixation MOST COMMON Cause
  257. Presented with an X-ray showing a Type 1 Monteggia fracture and asked what is the most common neurological injury with this fracture.



    C)

    The posterior interosseous nerve is most commonly injured because of its proximity to the radial head and its intimate relation to the arcade of Frohse.
  258. Wide symphysis APC what is most injured in male



    A)

    • Most common urogenital injury is posterior urethra
    • injury to bulbous>membranous>prostatic urethra
  259. Multitrauma with femur and lung injuries. Hypoxic after Gen Surge laparotomy. What is Rx for femur #’s


    A)
  260. Which of the following is NOT an indication to do an open reduction, internal fixation of the clavicle?



    A)
  261. Acetabular fractures. All are true EXCEPT


    C)
  262. Which doesn’t influence the MESS?



    D)

    • MESS (Mangled Extremity Severity Score)
    • 4 categories = INJURY + SHOCK + ISCHEMIA + AGE
    • MESS <= 6 = Salvageable Limb
    • MESS >6 = Amputation more likely
  263. 12 y.o. patient with an L1 burst #, complaining of abdo pain, which of the following associated injuries does he most likely have?



    A)

    hollow viscous injury with seatbelt injury
  264. When choosing an approach for a Pipkin 2:



    B)
  265. Ottawa/MUN, the preferred surgical approach for management of Pipkin II femoral head fracture traverses which of the following intervals :



    C)
  266. Radial Neck # with 1cm shortening, most likely outcome?



    D)

    essex loppressi
  267. With regards to osteoporosis and proximal femur fractures, what is not true:


    B)

    - White skinny women and a fragility fracture before 50
  268. A geriatric patient is involved in a trauma. When is O2 contraindicated:



    A)
  269. While IM nailing femur fracture, a femoral neck # is discovered. What is the best treatment?



    D)
  270. Hip fractures are linked with
    a) associated with exercise
    b) 70% due to falls
    B)
  271. The least common complications in a talar neck fracture is



    C)
  272. What is the best treatment for a Grade IIIB tibial #?



    D)
  273. What is the most common fracture associated with talar neck fractures?



    A)
  274. A 60 yo female presents with a transverse fracture 2 cm below the lesser trochanter. What is the optimal treatment?



    A)
  275. These are Risk Factors of hip #’s EXCEPT



    B)

    risk factors

    • Smokers
    • ETOH
    • Caffeine
    • Phenytoin * (impairs Vit D. metabolism in LIVER)
    • PPI *


    • Age (strongest RF, along with Previous Fracture)
    • Postmenopausal
    • Women
    • White
    • EuropeanSedentary
  276. When you compare lateral compression pelvic injuries to moderate to severe APC pelvic injuries, LC has


    B)
  277. Pelvic sheets or binders may be detrimental in what injury?



    C)
  278. Symptomatic Anterior SC dislocations are best managed by



    D)
  279. Comparing cephalomedullary nail and side plate and screw constructs for unstable intertrochanteric fractures, which is true



    D)
  280. In a displaced subcapital hip fracture, what blood supply to the head is most likely intact?



    A)
  281. X-ray of an angulated hypertrophic non-union of a tibia, fibula intact, guy broke it 5 years ago, was treated with a cast for a few months, tender over fracture site, best option



    A)
  282. Young guy with x-ray of a Lisfranc



    C)
  283. Guy with inferior patella pole comminuted fracture



    A)
  284. 32 yo epileptic has a seizure and shoulder hurts, AP x-ray show an internally rotated proximal humerus (looking right down the GT), what to do



    C)
  285. Smashed up guy, pulmonary contusion, hypoxic and hypotensive after a laparotomy, best treatment for femoral shaft fracture



    A)
  286. AP x-ray of a widely medially displaced acetabular fracture (crappy film, looked like it was a transverse, went into the sciatic notch), what vessel would most likely be injured
    a) Superior gluteal
    b) Internal iliac
    c) Obturator
    d) External iliac
    A?


    Fractures that enter the superior portion of the greater sciatic notch can be associated with significant hemorrhage, possibly requiring angiography with embolization of the superior gluteal artery.


    One particularly noteworthy anatomical relationship is the occasional large anastomosis between the external iliac artery or inferior epigastric artery and the obturator artery known as the corona mortis.
  287. Outlet view of the pelvis, what does it best assess



    B)
  288. Posterior elbow dislocation with displaced radial neck fracture, best treatment



    C)
  289. X-ray of an angulated hypertrophic non-union of a tibia, fibula intact, guy broke it 5 years ago, was treated with a cast for a few months, tender over fracture site, best option



    C)
  290. Guy with inferior patella pole comminuted fracture



    A)
  291. Lateral compression pelvis fractures



    C)
  292. 50 yo horny housewife with greater tub fracture of proximal humerus, what is an operative indication



    45 degree rotation of anterior aspect of fragment
    A)
  293. An x-ray of trauma young patient with knee injury with medial plateau fracture, laterally subluxated knee with lateral joint opening. What is the expected nerve deficit?



    B)
  294. Elbow fracture dislocation, reduced concentrically but unstable at 45 degrees. Associated type 2 coronoid fracture. How do you treat?



    B)
  295. During I&D of an open tibia fracture you notice a piece of tibia completely devoid of soft tissue attachments. In previous exam the answer was to discard the piece. The actual exam x-ray shows the piece to be the entire medial malleolus with a huge chunk of articular cartilage. What do you do?



    C)
  296. 21 young guy with a segmental tibia fracture with articular extension. Distal extension of fracture is open grade 2. What is the most important thing to do?



    D)
  297. tx of 4 part proximal humerus fracture in 75 year old
    a) hemi arthroplasty
    b) ORIF
    A)
  298. avn rate of 4 part proximal humerus fracture:
    a) reported as high as 15 %
    b) 20 % (if valgus impacted 4 part)
    c) 0%
    A?



    AVN post 4 part humeral head #….18-70%

    Depends on type of fracture; 4 part 70-90% would probably be a safe answer, valgus impacted 4-part have a significantly lower rate of AVN

    In the four-part valgus impacted fracture, the rate of avascular necrosis is significantly lower (20%) than in the classically described four-part fracture, where it may approach 90%.
  299. Forearm radius and ulna fractures healed with 10 degree malrotation. What is the effect on motion?



    C)
  300. Multiple trauma patient with head injury, abdominal bleed requiring lap, is now stable. He also has a distal 1/3 humerus fracture extending to olecranon fossa with comminution and a radial nerve palsy. What is the best treatment?



    B)
  301. 18 year old dude with pulmonary contusion and mid-shaft femur fracture. What is best treatment


    B)
  302. Radial diaphysis short oblique fracture treated with lag screw and neutralization plate. What king of healing is seen



    C)
  303. 45 year old skier with displaced 4 part proximal humerus fracture. Best treatment



    A)
  304. Dude with grossly contaminated open tibia fracture. Most important reason to amputate



    B)
  305. Posteromedial plateau with anterior fragment. What is best approach?



    B)
  306. 10 year history of chronic osteomyelitis + draining ulcer, recently much worse. Picture shown of nasty leg ulcer looking like dog ass. Why sudden worsening?


    C)

    Skin and soft tissues are often involved and the sinus tract may develop into squamous cell carcinoma (Marjolin’s ulcer
  307. Chronic infected tibia with swab of draining sinus showing Proteus, enterococcus, pseudomonas. Which conclusions can be drawn from the swab?



    D)
  308. Forearm radius and ulna fractures healed with 10 degree malrotation. What is the effect on motion?



    A)
  309. Multiple trauma patient with head injury, abdominal bleed requiring lap, is now stable. He also has a distal 1/3 humerus fracture extending to olecranon fossa with comminution and a radial nerve palsy. What is the best treatment?



    B)
  310. 18 year old dude with pulmonary contusion and mid-shaft femur fracture. What is best treatment


    C)
  311. Loss of reduction after distal radius fracture is most likely due to what feature of the fracture?



    D)
  312. 3 months after distal radius fracture pinning 42 year old lady has persistent hypesthesia over thumb and hand dorsum. Which is correct?



    A)
Author
egusnowski
ID
345798
Card Set
Trauma MCQ
Description
Trauma mcq
Updated