AAOS Orthopedic MCQs (Set 1): Scaphoid Fractures & Hand Surgery | 2026 Board Review

A patient undergoes a proximal tibial resection that is reconstructed with a fresh frozen osteoarticular allograft. Eleven months later, the graft is retrieved. Histologically, the articular cartilage and subchondral bone retrieved would be expected to show evidence of

The mother of a healthy 8-month-old boy reports that her son refuses to use his left arm. Examination reveals that the arm hangs limp at his side in an adducted and internally rotated position, and the affected shoulder subluxates posteriorly. Passive external rotation measures 15 degrees. Management should consist of

A 48-year-old man has recurrent right knee pain. Figure 52a shows the sagittal proton density T2-weighted MRI scan, and Figure 52b shows the sagittal T2-weighted MRI scan at the same level. The arrow is pointing to a

Figure 17 shows the radiograph of a 25-year-old professional football player who has superior shoulder pain that prevents him from sports participation. History reveals that he sustained a shoulder injury that was treated with closed reduction and temporary pinning 3 years ago. The best course of action should be

Which of the following primary prognostic factors best predicts the outcome of the knee lesion shown in Figure 22?

An adult with a distal humeral fracture underwent open reduction and internal fixation. What is the most common postoperative complication?

The main advantage of surgical repair of an acute Achilles tendon rupture, when compared with nonsurgical management, is reduced

Figure 11 shows a consecutive sequence of MRI scans obtained in a 12-year-old boy who has had increasing lateral knee pain and catching for the past 6 months. Examination reveals pain localized to the lateral joint line. Range-of-motion testing reveals a 5-degree lack of full extension on the involved side. Plain radiographs and laboratory values are within normal limits. What is the most appropriate management?

Mutations of what gene are associated with the subsequent development of osteosarcoma?

When performing surgery on a patient with insertional Achilles tendinitis and a Haglund's deformity, how much of the Achilles tendon insertion can be safely detached without having to consider reattachment with bone anchors?

A 43-year-old man reports a 3-year history of progressively worsening pain in the first metatarsophalangeal joint that is aggravated by activity. Larger shoes, intra-articular corticosteroid injections, and a Morton's extension pedorthic have failed to provide relief. Motion is limited to 10 degrees of dorsiflexion, and the "grind test" is positive. An AP radiograph is shown in Figure 39. What is the most appropriate surgical treatment?

A 50-year-old woman has a painful hallux valgus and a painful callus beneath the second metatarsal head. A radiograph is shown in Figure 46. To correct these problems, treatment of the great toe deformity should consist of

Using methylmethacrylate to fill a biopsy hole in the diaphysis of a femur theoretically achieves what purpose?

Figure 37 reveals a periprosthetic fracture around a cemented femoral stem in an 81-year-old patient with Paget's disease and mild coagulopathy. What is the most appropriate reconstructive management on the femoral side?

The attachments of the transverse carpal ligament include which of the following structures?

A 24-year-old dancer reports posterior ankle pain when in the "en pointe" position. Examination reveals posteromedial tenderness, no pain reproduction with passive forced planter flexion, and pain with motion of the hallux. What is the most likely diagnosis?

Figure 40 shows the radiograph of a 16-year-old wrestler who injured his elbow when he was thrown to the mat by his opponent. Closed reduction is readily accomplished, and the elbow seems stable. Management should now consist of application of a splint for

Figure 6 shows a sagittal oblique MRI scan. The arrow is pointing to what structure?

Which of the following agents have been shown to reduce the incidence of skeletal events in patients with multiple myeloma?

Figure 43 shows the lateral radiograph of a 12-year-old boy with mild osteogenesis imperfecta who injured his left elbow after pushing his brother. Treatment should consist of

A 47-year-old male tennis player has pain in his nondominant shoulder that has failed to respond to 4 months of nonsurgical management. Examination reveals acromial tenderness and pain at the supraspinatus tendon insertion. He has a positive impingement sign, pain on forward elevation, and minimal cuff weakness. The MRI scans are shown in Figures 30a and 30b. To completely resolve his symptoms, treatment should consist of

A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. A current radiograph is shown in Figure 40. What is the best treatment option?

Based on the findings seen in the posteroanterior radiograph of the wrist shown in Figure 17, which of the following structures is torn?

A 15-year-old boy reports leg pain after being tackled during football practice. Radiographs and a CT scan are shown in Figures 46a through 46c. The patient has a pathologic fracture through what underlying lesion?

A 5-year-old boy sustained an elbow injury. Examination in the emergency department reveals that he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. Radiographs are shown in Figures 6a and 6b. In addition to reduction and pinning of the fracture, initial treatment should include

An obese 10-year-old boy has had left groin pain and a limp for the past 2 months. Examination reveals decreased abduction and internal rotation. Laboratory studies show normal renal function and an elevated thyroid-stimulating hormone (TSH) level. AP and frog lateral radiographs of the pelvis are shown in Figures 30a and 30b. What is the best course of action?

A 21-year-old man who underwent repair of a distal biceps tendon rupture using a two-incision approach 4 months ago now reports difficulty gaining rotation of his forearm. Figures 49a and 49b show the AP and lateral radiographs. What is the most likely cause of his problem?

A 16-year-old boy has had thigh pain for the past several months. He denies any history of trauma. Examination reveals a large, deeply fixed, soft-tissue mass in the thigh. Laboratory results show an elevated erythrocyte sedimentation rate (ESR) and leukocytosis. A plain radiograph and MRI scan are shown in Figures 1a and 1b. Biopsy specimens are shown in Figures 1c and 1d. What is the most likely diagnosis?

A 73-year-old woman reports a 4-month history of severe left-sided posterior buttock pain and left leg pain. The leg pain radiates into the left lateral thigh and posterior calf with cramping. Examination reveals mild difficulty with a single-leg toe raise on the left side and a diminished ankle reflex. There is also a significant straight leg raise test at 45 degrees which exacerbates symptoms. An MRI scan is shown in Figure 4. What is the most appropriate treatment at this time?

A 14-year-old boy sustained a 100% displaced distal radius Salter-Harris type II fracture. Neurologic examination demonstrates normal motor examination and two-point discrimination. He undergoes fracture reduction to the anatomic position with the application of a long arm cast. Postreduction he reports increasing hand and wrist pain with diminution of two-point discrimination to 10 mm over the index and middle fingers over the next several hours after surgery. The cast is bivalved and the padding released relieving all external pressure over the arm. Reevaluation reveals increasing sensory deficit over the affected area. What is the next most appropriate management intervention?

Figures 20a through 20d show the radiographs and MRI scans of a 59-year-old woman who has had symptoms consistent with progressive neurogenic claudication and back pain for the past 9 months. In the last 6 months, nonsurgical management consisting of nonsteroidal anti-inflammatory drugs, physical therapy, and a series of epidural steroid injections have been used; however the injections, while beneficial, have provided only temporary relief of her symptoms. What is the most appropriate management at this time?

A patient with diabetic peripheral neuropathy undergoes a partial first ray amputation for a chronic ulcer beneath the first metatarsal head. The insertion of the anterior tibialis is preserved. The patient has 10 degrees of passive dorsiflexion at the ankle and no other foot deformities or ulcers. Which of the following is considered appropriate shoe wear for this patient?

A 78-year-old woman falls onto her nondominant left elbow and sustains the injury shown in Figure 5. What treatment option allows her the shortest recovery time and highest likelihood of good function and range of motion?

A 55-year-old man underwent cementless total hip arthroplasty for advanced painful osteoarthritis of the hip 2 years ago. The follow-up radiograph shown in Figure 30 shows

When using the direct lateral (or Hardinge) approach for hip arthroplasty, three muscles are detached from the femur. In addition to the vastus lateralis, they include the

A 50-year-old laborer sustained an isolated closed injury to his heel after falling 11 feet off a wall. A radiograph and a CT scan are shown in Figures 4a and 4b. To minimize the patient's temporary disability and allow him to return to work most rapidly, management should consist of

Management of a grade IV osteochondritis dissecans lesion of the capitellum should consist of

Figure 37 shows the clinical photograph of a 1-day-old infant who weighed 10.25 lb at birth. Examination reveals an absent right Moro reflex and limited active motion of the right shoulder, elbow, and wrist, but flexion of the fingers. Passive range of motion of the shoulder and elbow is normal. What is the most likely diagnosis?

Figure 14 shows an intra-articular gadolinium-enhanced MRI scan of a 52-year-old woman who has stopped playing tennis because of pain in her left shoulder while serving. What is the most likely diagnosis?

Based on the radiograph shown in Figure 4, the innervation of what muscle is most at risk with total hip arthroplasty?

Figure 24 shows the radiograph of a 10-year-old boy who sustained a valgus injury to the knee. Examination reveals grade III medial laxity. Initial management should consist of

When compared with the normal anterior cruciate ligament (ACL), placement of an anterior cruciate ligament graft in the over-the-top position on the femoral side has what effect on its function?

What is the most appropriate orthotic management for the lesion shown in Figure 6?

What is the average linear wear rate of a conventional, noncross-linked ultra-high molecular weight polyethylene liner used in total hip arthroplasty?

What is the main function of collagen found within articular cartilage?

Based on the appearance of the imaging studies shown in Figures 11a through 11c, what structure has most likely been injured?

A 30-year-old woman sustained a nondisplaced unilateral facet fracture of C5 in a motor vehicle accident. She is neurologically intact and has no other injuries. Management should consist of

The need for postoperative allogeneic blood transfusions after total hip arthroplasty has been shown to be reduced when using

When comparing surgical and nonsurgical extremities in patients who underwent anterior cruciate ligament (ACL) reconstruction using patellar tendon or hamstrings autografts, isokinetic strength measurements obtained 6 months after the surgery would most likely reveal

Ulnohumeral distraction interposition arthroplasty is considered the most appropriate treatment for which of the following patients?

In children with moderate to severe osteogenesis imperfecta (OI), intravenous pamidronate therapy has been shown to increase the thickness of cortical bone. This occurs primarily as a consequence of

A 20-year-old-man sustained a scapular fracture after attempting to grab a beam as he fell through a ceiling at a job site 3 months ago. A clinical photograph is shown in Figure 36. He now reports pain in the anterior shoulder and difficulty with overhead activities. What nerve roots make up the involved peripheral nerve?

In the anterior forearm approach to the distal radius (Henry approach), the radial artery is located between what two structures?

A 22-year-old man reports anterior knee pain, swelling, and is unable to perform a straight leg raise after undergoing endoscopic anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone autograft 1 week ago. He is afebrile. Examination reveals a clean incision, moderate effusion, a weak isometric quadriceps contraction, active knee range of motion of 5 degrees to 45 degrees, and the patella is ballottable. Knee radiographs show postoperative changes with good femoral and tibial tunnel placements, and normal patellar height. What is the next most appropriate step in management?

A 22-year-old right hand-dominant man who fell off his motorcycle onto the tip of his right shoulder 2 weeks ago now reports pain and difficulty raising his right arm. Examination reveals tenderness and gross movement over the lateral scapular spine and severe weakness during resisted abduction. A radiograph and 3D-CT scan are shown in Figures 24a and 24b. What is the next most appropriate step in management?

A 25-year-old man has had an insidious onset of left hip pain over the past 11 months. A radiograph, coronal MRI scan, and histopathologic specimens are seen in Figures 2a through 2d. What is the most likely diagnosis?

The radiograph shown in Figure 54 reveals that the plate on the second metacarpal is acting in what manner?

The most common mechanism of injury to the triangular fibrocartilage complex (TFCC) involves

In the majority of patients with chronic anterior cruciate ligament (ACL)-deficient knees, analysis of the gait pattern during level walking will most likely reveal which of the following changes?

What region of the thoracic curve is most dangerous for pedicle screw insertion while performing a posterior fusion for adolescent idiopathic scoliosis?

A 28-year-old hockey player has a shoulder deformity after being checked into the boards. Examination reveals that swelling has improved, but there is tenderness along the distal clavicle. Radiographs reveal a grade II acromioclavicular joint separation. Initial management should consist of

The dorsal digital cutaneous nerve of the great toe shown in Figure 8 is a branch of what nerve?

Radiating pain associated with a posterolateral thoracic disk herniation typically follows what pattern?

Figure 11 shows the radiograph of an 18-year-old soccer player who reports recurrent lateral foot pain after sustaining an inversion injury. History reveals that 6 months ago he had been treated in a non-weight-bearing cast for a fifth metatarsal fracture. Management should consist of

A 26-year-old ballet dancer reports posterolateral ankle pain, especially with maximal plantar flexion. Examination reveals maximal tenderness just posterior to the lateral malleolus, and symptoms are heightened with forced passive plantar flexion. Radiographs are shown in Figures 42a and 42b. What is the most likely cause of the patient's symptoms?

A 9-year-old boy falls from a scooter and sustains the injury shown in the radiographs in Figure 26. After closed reduction and cast immobilization, what is the most likely complication that can result?

One advantage of using onlay strut allograft in femoral revision surgery is that it can

The medial collateral ligament complex of the elbow originates on what portion of the medial epicondyle?

A 45-year-old man sustains an acute closed posterolateral elbow dislocation. The elbow is reduced, and examination reveals that the elbow dislocates posteriorly at 35 degrees with the forearm placed in supination. What is the best course of action?

A 51-year-old male truck driver has had progressive left hip pain for more than 2 years, and he reports that the pain has become severe in the past 9 months. He is now unable to work because of the pain. Examination reveals that range of motion of the hip is limited to 95 degrees of flexion, 0 degrees of internal rotation, and 20 degrees of external rotation. The plain radiograph, MRI scan, and intraoperative gross photographs are shown in Figures 9a through 9d. Management should consist of

Osteochondritis dissecans of the capitellum is a source of elbow pain and most commonly occurs in what patient population?

Which of the following is not a reported mode of failure for a constrained acetabular component?

Which of the following medications may have a negative effect on bone healing following fracture?

A 55-year-old woman with a long history of low back and left lower extremity pain has failed to respond to exhaustive nonsurgical management. MRI scans show bulging and degeneration at L3-4 and L4-5 as well as a normal disk at L2-3 and L5-S1. She undergoes provocative lumbar diskography at L3-4, L4-5, and L5-S1. Post-diskography axial CT images of L3-4 and L4-5 are shown in Figures 6a and 6b, respectively. The injections at L3-4 and L4-5 produce no pain. The injection at L5-S1 produces 10/10 concordant back pain with radiation to the lower extremity. What is the most appropriate recommendation at this time?

A 7-year-old girl has had a painful forearm for the past 2 months. Examination reveals fullness on the volar aspect of the forearm. Radiographs and an MRI scan are shown in Figures 42a through 42c. Biopsy specimens are shown in Figures 42d and 42e. What is the most likely diagnosis?

A 45-year-old man seen in the emergency department reports a 1-week history of worsening low back pain and a progressive neurologic deficit in the S1 distribution. Examination reveals 2/5 strength in the gastrocnemius. Laboratory studies show a WBC count of 13,500/mm3 and an erythrocyte sedimentation rate of 74 mm/h. Radiographs of the lumbosacral spine show narrowing of the L5-S1 disk space, with irregularity of the end plates. A sagittal T2-weighted MRI scan is shown in Figure 8. Definitive management should consist of

Titanium and its alloys are unsuitable candidates for which of the following implant applications?

Following a vertebroplasty of L2, cement is noted to protrude directly anterior to the L2 vertebral body. The cement is closest to which of the following structures?

A 42-year-old woman underwent an instrumented posterior spinal fusion at L3-S1 with transforaminal lumbar interbody fusion. She had an excellent clinical result with complete resolution of leg pain. Three months later she now reports increasing back pain and weakness in her legs. Examination reveals weakness in the quadriceps and tibialis anterior. Radiographs show no interval changes in the position of the hardware. MRI scans are shown in Figures 2a through 2c. What is the next most appropriate step in management?

A 21-year-old college student reports hearing a pop and has acute pain laterally over the ankle after twisting it during a recreational basketball game. Examination 1 hour after the injury reveals minimal swelling and ecchymosis. The anterior drawer sign is positive. Radiographs reveal no evidence of a fracture. What is the best course of action?

Figure 33 shows the venogram of a patient who has a long history of alcohol abuse. Warfarin should be used cautiously because of the interaction with which of the following factors?

Failure of high tibial osteotomy (HTO) is most closely associated with which of the following factors?

A 3-year-old boy with severe cerebral palsy is unable to sit independently and does not crawl. Examination reveals a 40-degree hip flexion contracture by the Thomas test and 25 degrees of passive abduction. A radiograph of the pelvis shows subluxation of both hips, with a migration index of 30%. Management should consist of

Closure of the rotator cuff interval results in elimination of which direction of shoulder instability?

In Figure 2, which of the following structures is the primary stabilizer in preventing valgus instability of the elbow?

The oblique radiograph of the foot and the CT scan shown in Figures 10a and 10b show a patient whose symptoms have failed to respond to rest and non-steroidal anti-inflammatory drugs. What is the best course of action?

A 25-year-old tennis player has shoulder pain and weakness to external rotation. MRI scans are shown in Figures 16a and 16b. What is the most likely cause of his weakness?

A 73-year-old man who underwent repair of the left rotator cuff 6 years ago reports good pain relief but notes residual weakness of the left shoulder, especially with overhead tasks. He denies having pain at night and has minimal discomfort with activities of daily living but is dissatisfied with his shoulder strength. Radiographs show an acromiohumeral interval of 2 mm. Appropriate management should consist of

Significant anterior tibial translation occurs during which of the following rehabilitation exercises?

A 25-year-old man sustained an L1 compression fracture in a fall from his roof. He is neurologically intact and has no other injuries. Radiographs reveal a 25% loss of height anteriorly and 5 degrees of kyphosis at the fracture site. A CT scan reveals no compromise of the posterior column. Management should consist of

A 28-year-old professional dancer reports a 3-month history of progressive pain in the posterior aspect of the left ankle. Her symptoms are worse when she assumes the en pointe position. Examination reveals tenderness to palpation at the posterolateral aspect of the ankle posterior to the peroneal tendons which is made worse with passive plantar flexion. There is no nodularity, fluctuance, or tenderness of the Achilles tendon. The neurovascular examination is unremarkable. A lateral radiograph and MRI scan are shown in Figures 16a and 16b, respectively. Management should consist of

A 42-year-old man who is right-hand dominant injured his right shoulder when he fell from a ladder onto his outstretched arm 1 hour ago. Radiographs reveal a two-part greater tuberosity anterior fracture-dislocation. Initial management should consist of

When harvesting an iliac crest bone graft from the posterior approach, what anatomic structure is at greatest risk for injury if a Cobb elevator is directed too caudal?

Figure 7 shows the CT scan of a 22-year-old professional baseball pitcher who has had elbow pain for the past 6 months despite rest from throwing. Management should consist of

A 3-year-old boy has a rigid 40-degree lumbar scoliosis that is the result of a fully segmented L5 hemivertebra. All other examination findings are normal. Management should consist of

A 13-year-old girl who is 2 years postmenarche has been referred for management of scoliosis. She denies any history of back pain. Radiographs show a right thoracic curve of 35 degrees. She has a Risser sign of 4 and a bone age of 15.5 years. Management should consist of

A collegiate football player who sustained a blow to the head during the first quarter of a game is confused for several minutes after the hit but does not lose consciousness. He had two similar episodes in games earlier in the season. When should he be allowed to return to play?

A Canale view best visualizes which of the following structures?

Figure 24 shows the radiograph of a 10-year-old boy who sustained a valgus injury to the knee. Examination reveals grade III medial laxity. Initial management should consist of

Which of the following is considered the most effective means of identifying an evolving motor tract injury during cervical spine surgery?