Orthopedic Board Review MCQs: Sports & Trauma Part 37

Question 1

During an ilioinguinal approach for an anterior column acetabulum fracture, massive bleeding is encountered near the superior pubic ramus. What vascular structure is most likely injured?

Explanation

The corona mortis is a vascular anastomosis between the external iliac (or inferior epigastric) and obturator vessels. It crosses the superior pubic ramus, typically located 4-6 cm from the pubic symphysis, making it highly susceptible to iatrogenic injury during anterior approaches to the acetabulum or pelvis.

Question 2

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness with elbow flexion and supination, and numbness over the lateral forearm. Which nerve is most likely injured?

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure, particularly when retracting the conjoined tendon (coracobrachialis and short head of the biceps). The nerve typically enters the coracobrachialis 3-8 cm distal to the coracoid tip. Injury causes weakness in elbow flexion and supination, and sensory deficits in the lateral antebrachial cutaneous nerve distribution.

Question 3

A 65-year-old female presents with a low-energy subtrochanteric femur fracture with a transverse configuration, lateral cortical thickening, and a medial spike. She has been on alendronate for 8 years. What is the most appropriate management regarding her bone health medications?

Explanation

This presentation is pathognomonic for an atypical femur fracture (AFF) associated with long-term bisphosphonate use, which suppresses normal osteoclastic bone remodeling. Standard medical management includes discontinuing the bisphosphonate and initiating teriparatide, a recombinant parathyroid hormone that acts as an anabolic agent to stimulate bone formation and improve healing rates in AFFs.

Question 4

A patient sustains a knee dislocation. Physical exam reveals a positive dial test at 30 degrees of flexion that normalizes to symmetry at 90 degrees of flexion. Which structures are most likely injured?

Explanation

The dial test assesses external rotation of the tibia relative to the femur. A positive test is defined as >10 degrees of external rotation compared to the contralateral side. Increased external rotation at 30 degrees that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If it is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 5

A 30-year-old male sustains a Hawkins Type III talar neck fracture. Which of the following best describes the articulations subluxated or dislocated in this injury pattern?

Explanation

The Hawkins classification describes talar neck fractures. Type I is non-displaced. Type II involves subtalar subluxation/dislocation. Type III involves dislocation of the subtalar, tibiotalar, and talonavicular joints (extruded talar body). Type IV adds talonavicular subluxation/dislocation to a Type III, though a true Type III intrinsically often involves disruption of all three surrounding articulations of the body. Type III has an avascular necrosis (AVN) rate approaching 100%.

Question 6

A 55-year-old female presents with acute posterior knee pain after descending stairs, followed by an immediate pop. MRI demonstrates a medial meniscus posterior root tear and extrusion of the meniscus by 4 mm. What is the biomechanical consequence of this injury if left untreated?

Explanation

A complete posterior root tear of the medial meniscus destroys the meniscal hoop stresses, leading to meniscal extrusion. Biomechanically, this makes the meniscus nonfunctional, leading to increased peak contact pressures in the medial compartment that are equivalent to the pressures seen after a total medial meniscectomy. This strongly predisposes the patient to rapid cartilage loss and subchondral insufficiency fractures.

Question 7

During an open reduction and internal fixation of a posteromedial tibial plateau fracture, the surgeon utilizes a posteromedial approach. Which structure represents the lateral interval boundary when accessing the posteromedial tibia?

Explanation

The posteromedial approach to the proximal tibia utilizes the interval between the medial head of the gastrocnemius laterally and the pes anserinus medially. Retracting the medial head of the gastrocnemius laterally is critical as it acts as a soft-tissue shield to protect the popliteal neurovascular bundle.

Question 8

A 25-year-old hockey player is diagnosed with symptomatic cam-type femoroacetabular impingement (FAI). During arthroscopic osteochondroplasty, excessive resection of the femoral neck can lead to a femoral neck fracture. What is the recommended maximum depth of resection to minimize this risk?

Explanation

Biomechanical studies have demonstrated that resecting more than 30% of the anterolateral femoral neck diameter during osteochondroplasty for cam impingement significantly alters the load-bearing capacity of the proximal femur, exponentially increasing the risk of an iatrogenic postoperative femoral neck fracture.

Question 9

A 40-year-old male sustains a closed, displaced intra-articular calcaneus fracture. When considering an extensile lateral approach for ORIF, which specific soft-tissue complication is most classically associated with this surgical exposure?

Explanation

The extensile lateral approach for calcaneus fractures relies on an L-shaped incision. The corner of the flap is highly susceptible to tip necrosis and wound dehiscence due to its blood supply (lateral calcaneal artery). Additionally, the sural nerve is directly in the surgical field and is at high risk of iatrogenic injury or neuroma formation.

Question 10

A 62-year-old laborer undergoes a superior capsular reconstruction (SCR) using a dermal allograft for a massive, irreparable posterosuperior rotator cuff tear. Which two anatomical structures serve as the primary medial and lateral attachment sites for the graft?

Explanation

In Superior Capsular Reconstruction (SCR), the allograft or autograft is attached medially to the superior glenoid (often incorporating the superior labrum) and laterally to the greater tuberosity footprint. This reconstructs the superior restraint of the shoulder, helping to depress the humeral head and allowing the deltoid to effectively elevate the arm.

Question 11

According to the Young-Burgess classification, an Anteroposterior Compression Type II (APC-II) pelvic ring injury opens the symphysis greater than 2.5 cm. Which ligaments remain intact in this injury, preventing complete vertical instability of the hemipelvis?

Explanation

An APC-II injury ('open book' pelvis) is characterized by disruption of the pubic symphysis, anterior sacroiliac (SI) ligaments, sacrospinous ligaments, and sacrotuberous ligaments. The posterior SI ligaments, which are the strongest ligaments in the body, remain intact. Thus, the pelvis is rotationally unstable but vertically stable.

Question 12

A 19-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction. Which bundle of the UCL is the primary restraint to valgus stress during the late cocking and early acceleration phases of throwing, and is the primary structure reconstructed?

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress of the elbow. It is subdivided into the anterior and posterior bands. The anterior band of the anterior bundle is taut in extension and up to 90 degrees of flexion, making it the primary stabilizer during the late cocking and early acceleration phases of pitching. It is the target for reconstruction.

Question 13

A 28-year-old male develops acute compartment syndrome following a tibial plateau fracture. A dual-incision four-compartment fasciotomy is performed. Through the medial incision, the soleus is detached from the posterior tibia. Which compartment is directly accessed by this specific step?

Explanation

In a two-incision fasciotomy of the lower leg, the medial incision is used to release the superficial and deep posterior compartments. After incising the fascia over the gastrocnemius-soleus complex to release the superficial posterior compartment, the soleus bridge must be detached from the posterior aspect of the tibia to expose and release the fascia covering the deep posterior compartment (tibialis posterior, FDL, FHL).

Question 14

A 32-year-old male sustains an isolated Grade III posterior cruciate ligament (PCL) injury. Non-operative management is chosen. Which of the following rehabilitation protocols is most appropriate during the first 2-4 weeks to optimize ligament healing?

Explanation

For acute isolated PCL injuries, conservative management emphasizes immobilization in full extension (or slight hyperextension) for 2 to 4 weeks. This position minimizes posterior tibial sag, keeping the PCL in a shortened, reduced position to promote healing. Active hamstring exercises pull the tibia posteriorly and must be avoided in the early phases.

Question 15

A surgeon is performing an open reduction and internal fixation of a proximal humerus fracture via a deltopectoral approach. To facilitate plate placement, the deltoid insertion is partially released. Which nerve is most at risk of injury when dissecting on the deep surface of the deltoid muscle, 5-7 cm distal to the lateral acromial edge?

Explanation

The axillary nerve travels from posterior to anterior along the deep surface of the deltoid muscle, typically traversing 5 to 7 cm distal to the lateral edge of the acromion. It is highly vulnerable to traction or direct transection during extended lateral approaches to the proximal humerus or aggressive dissection beneath the deltoid belly.

Question 16

A 13-year-old male baseball pitcher complains of lateral elbow pain. Radiographs reveal a radiolucent lesion with a sclerotic margin on the capitellum, and MRI demonstrates a detached osteochondral fragment. He has open physes. Which of the following most accurately differentiates osteochondritis dissecans (OCD) of the capitellum from Panner's disease?

Explanation

Panner's disease is a self-limiting osteochondrosis of the capitellum that affects younger children (typically ages 7-10), involves the entire ossific nucleus, and rarely produces loose bodies. Capitellar OCD affects older adolescents (typically ages 12-15) involved in repetitive overhead sports, creates focal osteochondral defects, frequently results in loose bodies, and often requires surgery if unstable.

Question 17

In a subtrochanteric femur fracture, the proximal fragment typically assumes a characteristic deformed position due to uninhibited muscle forces. Which muscle group is primarily responsible for the external rotation of the proximal fragment?

Explanation

The classic deformity of the proximal fragment in a subtrochanteric fracture includes flexion (driven by the iliopsoas), abduction (driven by the gluteus medius and minimus), and external rotation (driven by the short external rotators, including the piriformis, gemelli, and obturator internus).

Question 18

A 42-year-old recreational athlete sustains an acute Achilles tendon rupture. He elects for non-operative management with a functional rehabilitation protocol. Compared to traditional surgical repair, current high-quality literature demonstrates that functional non-operative management is associated with:

Explanation

Recent high-quality Level I evidence demonstrates that when a dynamic, functional rehabilitation protocol (early weight-bearing and early ROM) is utilized, the re-rupture rates between non-operative and operative management of Achilles ruptures are statistically equivalent. However, the non-operative group avoids the soft tissue, wound, and nerve complications inherent to surgery.

Question 19

A 30-year-old female is involved in a high-speed motor vehicle collision and sustains a Denis Zone III sacral fracture. Which of the following clinical findings is most likely associated with this specific injury pattern compared to Zone I or Zone II fractures?

Explanation

The Denis classification of sacral fractures divides them into Zone I (alar), Zone II (transforaminal), and Zone III (central sacral canal). Zone III injuries carry the highest risk of neurologic deficits (approaching 60%), typically manifesting as cauda equina syndrome, which includes saddle anesthesia, loss of sphincter tone, and bowel/bladder/sexual dysfunction.

Question 20

A 17-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. According to Schöttle's point, where is the optimal anatomic femoral origin of the MPFL located radiographically on a true lateral view?

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. On a true lateral radiograph, it is found 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line. Placing the graft here ensures proper isometry, avoiding over-tensioning in flexion.

Question 21

A 25-year-old football player sustains a lateral blow to his knee. On examination, he has a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the uninjured side. Which structure is most likely injured?

Explanation

The dial test assesses for posterolateral knee instability. Asymmetry at 30 degrees of flexion with symmetry at 90 degrees indicates an isolated posterolateral corner (PLC) injury, whereas asymmetry at both 30 and 90 degrees suggests combined PLC and PCL injury.

Question 22

A 30-year-old male fell from a height, sustaining a displaced talar neck fracture treated with open reduction and internal fixation. At 8 weeks postoperatively, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

Explanation

The described finding is Hawkins sign, a subchondral radiolucent band seen 6-8 weeks post-injury. It represents subchondral atrophy from disuse and local hyperemia, indicating intact vascularity and predicting the absence of avascular necrosis.

Question 23

An 18-year-old female is undergoing medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To ensure proper graft isometry, the femoral tunnel is placed at Schöttle's point. Where is this point located anatomically and radiographically on a true lateral view?

Explanation

Schöttle's point is the radiographic anatomical origin of the MPFL. It is located 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior extension of Blumensaat's line.

Question 24

A 45-year-old man sustains a high-energy supracondylar femur fracture. A CT scan reveals an intra-articular coronal plane fracture of the lateral femoral condyle. What is the optimal internal fixation strategy for this specific articular fragment?

Explanation

A coronal shear fracture of the femoral condyle is known as a Hoffa fracture. It is optimally treated with anterior-to-posterior lag screws placed perpendicular to the fracture plane to achieve anatomic reduction and absolute stability.

Question 25

A 40-year-old recreational tennis player presents with persistent shoulder pain and a confirmed type II SLAP tear. After failing non-operative management, surgery is planned. Compared to a SLAP repair, what is the primary advantage of a primary biceps tenodesis in this specific patient demographic?

Explanation

In patients over the age of 35-40 with type II SLAP tears, primary biceps tenodesis has been shown to result in greater patient satisfaction and a significantly decreased risk of postoperative stiffness compared to SLAP repair.

Question 26

A 28-year-old weightlifter felt a pop in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold. MRI confirms an isolated rupture of the sternal head of the pectoralis major. Where does the sternal head normally insert relative to the clavicular head on the humerus?

Explanation

The pectoralis major tendon twists 90 degrees before inserting on the lateral lip of the bicipital groove. This twist causes the sternal head to insert proximal and deep to the clavicular head.

Question 27

A 32-year-old male presents with a comminuted midshaft tibia fracture and reports severe leg pain out of proportion to the injury. His blood pressure is 110/70 mmHg. Intracompartmental pressure monitoring is performed. At what specific pressure threshold is a four-compartment fasciotomy definitively indicated?

Explanation

The most reliable threshold for diagnosing acute compartment syndrome and indicating fasciotomy is a Delta P (diastolic blood pressure minus intracompartmental pressure) of less than 30 mmHg.

Question 28

A 55-year-old female presents with sudden medial knee pain. MRI shows a medial meniscus posterior root tear with 4 mm of meniscal extrusion. What is the primary biomechanical consequence of this specific injury pattern?

Explanation

A meniscal root tear results in complete loss of circumferential hoop stresses, making it biomechanically equivalent to a total meniscectomy. This leads to increased peak contact pressures and rapid progression of osteoarthritis.

Question 29

A 22-year-old gymnast sustains a hyperplantarflexion injury to her midfoot. Weight-bearing radiographs show 3 mm of widening between the medial and middle cuneiforms with no associated fractures. What is the most appropriate definitive management for this purely ligamentous injury?

Explanation

Purely ligamentous Lisfranc injuries have a high rate of failure, hardware breakage, and post-traumatic arthritis with ORIF. Primary arthrodesis is the preferred treatment as it yields significantly better long-term functional outcomes in pure ligamentous variants.

Question 30

A 29-year-old unrestrained driver is involved in a motor vehicle collision. Radiographs demonstrate a posterior hip dislocation. Post-reduction, he exhibits a foot drop and inability to extend his great toe, with decreased sensation over the dorsum of the foot. Which specific neural structure is most likely injured?

Explanation

Posterior hip dislocations most commonly injure the sciatic nerve. The peroneal division is lateral, firmly tethered, and has less supportive connective tissue, making it significantly more susceptible to stretch injury than the tibial division.

Question 31

A patient undergoes primary ACL reconstruction with a bone-patellar tendon-bone autograft. Postoperatively, he achieves full terminal extension but has significantly limited flexion, describing a tight block at 90 degrees. What technical error in femoral tunnel placement most likely caused this specific complication?

Explanation

A femoral tunnel placed too far anteriorly (non-isometric) creates a graft that is relatively lax in extension but becomes increasingly taut as the knee flexes. This excessive tension causes a mechanical block to flexion.

Question 32

A 65-year-old woman undergoes locked plating for a 3-part proximal humerus fracture. The surgeon ensures the placement of an inferomedial calcar screw. What is the primary biomechanical purpose of this specific screw?

Explanation

Inferomedial calcar screws provide critical medial column support in proximal humerus locking plates. This support strongly resists the deforming forces that lead to varus collapse of the humeral head and subsequent intra-articular screw cut-out.

Question 33

A 20-year-old collegiate basketball player sustains an acute, non-displaced Zone 2 fifth metatarsal base fracture (Jones fracture). Operative fixation with a solid intramedullary screw is planned. What is the most critical anatomical factor to consider when selecting the screw size to prevent iatrogenic lateral cortex blowout?

Explanation

The fifth metatarsal has a natural plantar and lateral bow. Using a rigid intramedullary screw that is too long or too large in diameter fails to accommodate this curvature, straightening the bone and causing a lateral cortex blowout or fracture distraction.

Question 34

A 24-year-old male presents with recurrent anterior shoulder instability. Imaging reveals a 15% anterior glenoid bone loss and an engaging Hill-Sachs lesion that is determined to be 'off-track'. What is the most appropriate surgical management?

Explanation

Although 15% glenoid bone loss is considered subcritical, an engaging Hill-Sachs lesion makes it 'off-track'. Arthroscopic Bankart repair combined with remplissage is indicated for off-track lesions with subcritical glenoid bone loss to prevent engagement.

Question 35

A 35-year-old male is brought to the trauma bay with an Anterior Posterior Compression (APC) III pelvic ring injury following a crush accident. He is hemodynamically unstable despite a pelvic binder and fluid resuscitation. What is the most common anatomic source of massive hemorrhage in this fracture pattern?

Explanation

Up to 80% of pelvic bleeding in blunt trauma is venous, originating primarily from the presacral venous plexus and fractured cancellous bone. Arterial bleeding is less common but more frequently associated with severe lateral compression or high-energy shear injuries.

Question 36

A 9-year-old boy (Tanner stage 1) sustains a mid-substance anterior cruciate ligament (ACL) tear. He and his family elect for surgical reconstruction. Which of the following techniques minimizes the risk of physeal arrest?

Explanation

In a Tanner stage 1 patient with significant remaining growth, physeal-sparing techniques such as an all-epiphyseal or an iliotibial band extra-articular (over-the-top) reconstruction are indicated. Placing bone plugs or drilling large tunnels across open physes carries a high risk of growth arrest.

Question 37

A 42-year-old female sustains a Schatzker IV tibial plateau fracture with a large posteromedial shear fragment. What is the optimal surgical approach and internal fixation strategy?

Explanation

A Schatzker IV fracture involving a posteromedial shear fragment requires rigid buttress fixation applied from posterior to anterior. A posteromedial approach allows optimal placement of an anti-glide plate to neutralize these specific vertical shear forces.

Question 38

A 22-year-old collegiate baseball pitcher undergoes evaluation for medial elbow pain and a positive moving valgus stress test. The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at what degrees of elbow flexion?

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress of the elbow between 30 and 120 degrees of flexion. Clinical testing is optimally performed at 30 degrees of flexion to unlock the olecranon from its fossa and isolate the anterior bundle.

Question 39

During an extensile lateral approach for the open reduction and internal fixation of a severe intra-articular calcaneus fracture, the surgeon must carefully elevate the full-thickness flap. Which artery provides the primary blood supply to the corner of this flap?

Explanation

The lateral extensile approach to the calcaneus relies heavily on the lateral calcaneal artery, a terminal branch of the peroneal artery. Subperiosteal, full-thickness 'no-touch' dissection is critical to preserve this blood supply and prevent devastating flap necrosis.

Question 40

A 25-year-old hockey player is diagnosed with Femoroacetabular Impingement (FAI). Radiographs demonstrate an alpha angle of 65 degrees. Where is the cam lesion most commonly located on the femoral head-neck junction?

Explanation

Cam lesions in FAI represent an osseous bump at the femoral head-neck junction that decreases the normal concavity. They are most commonly located in the anterosuperior quadrant, leading to labral impingement during hip flexion and internal rotation.

Question 41

A 30-year-old motorcyclist sustains a Hoffa fracture (coronal plane fracture of the lateral femoral condyle). What is the most biomechanically sound fixation strategy for this fracture pattern?

Explanation

A Hoffa fracture is a coronal shear fracture that requires rigid interfragmentary compression. This is best achieved with anterior-to-posterior (or posterior-to-anterior) lag screws, often supplemented with a lateral buttress or neutralization plate to counteract vertical shear.

Question 42

A 50-year-old female experiences a sudden pop in the back of her knee while squatting. MRI reveals a medial meniscus posterior root tear with meniscal extrusion. Biomechanically, what is the primary consequence if this injury is left untreated?

Explanation

A meniscal root tear disrupts the circumferential continuity of the meniscus, preventing the proper generation of hoop stresses. This converts normal compressive loads into shear stresses, functioning biomechanically like a total meniscectomy and leading to rapid cartilage wear.

Question 43

A 28-year-old construction worker falls from a height and sustains a Hawkins type III talar neck fracture. Which vascular supply to the talar body is disrupted in a true type III injury?

Explanation

A Hawkins type III fracture involves dislocation of the subtalar, tibiotalar, and talonavicular joints. This massive displacement completely disrupts all three primary blood supplies to the talar body (tarsal canal, deltoid, and tarsal sinus arteries), resulting in an extremely high risk of avascular necrosis.

Question 44

A 55-year-old active laborer with an irreparable posterosuperior rotator cuff tear is evaluated for a latissimus dorsi tendon transfer. Which of the following is a strict prerequisite for a successful functional outcome?

Explanation

Latissimus dorsi transfer for an irreparable posterosuperior rotator cuff tear requires an intact or repairable subscapularis to maintain an anterior force couple. Without it, the humeral head cannot be centered in the glenoid, leading to transfer failure.

Question 45

A 7-year-old boy falls onto an outstretched hand, sustaining a Bado type I Monteggia fracture-dislocation. The radial head is dislocated in which direction, and which nerve is at the highest risk of injury?

Explanation

A Bado type I Monteggia fracture is characterized by an anterior dislocation of the radial head and an apex anterior fracture of the ulnar diaphysis. The posterior interosseous nerve (PIN) wraps around the radial neck and is the most commonly injured nerve in this pattern.

Question 46

A 30-year-old male presents with a closed tibial shaft fracture. His blood pressure is 110/65 mmHg. Intracompartmental pressure testing reveals an anterior compartment pressure of 45 mmHg. What is the most appropriate next step in management?

Explanation

A Delta P (Diastolic BP minus compartment pressure) of less than 30 mmHg (65 - 45 = 20 mmHg) is highly indicative of acute compartment syndrome. The definitive treatment is an emergent four-compartment fasciotomy.

Question 47

During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral tunnel must be placed anatomically to avoid non-isometric graft tension. Which anatomical landmarks define Schöttle's point for the femoral origin?

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located in the saddle-shaped depression between the adductor tubercle and the medial epicondyle. Accurate placement prevents graft overtensioning during knee flexion.

Question 48

A 25-year-old female sustains a Hawkins Type III talar neck fracture following a motor vehicle collision. Which of the following best describes the specific pattern of dislocation and the associated risk of avascular necrosis (AVN)?

Explanation

A Hawkins Type III fracture involves a talar neck fracture with both subtalar and tibiotalar dislocations. This severe disruption of the blood supply leads to an avascular necrosis rate approaching 100% in some series.

Question 49

To minimize the risk of popliteal artery injury during tibial tunnel reaming in an arthroscopic posterior cruciate ligament (PCL) reconstruction, in what position should the knee be placed and why?

Explanation

Flexing the knee beyond 90 degrees allows the popliteal artery to fall posteriorly away from the joint capsule. This maximizes the safe distance between the reamer and the neurovascular bundle during PCL tibial tunnel creation.

Question 50

A 28-year-old male sustains a Pauwels type III vertical femoral neck fracture. Which of the following fixation constructs provides the greatest biomechanical stability against shear forces for this specific fracture pattern?

Explanation

Pauwels type III fractures are highly vertical and subject to significant shear forces. A fixed-angle device, such as a sliding hip screw combined with a derotational screw, provides superior biomechanical stability compared to multiple cancellous screws.

Question 51

A 45-year-old female sustains a posterior root tear of the medial meniscus. From a biomechanical perspective, what is the consequence of leaving this tear untreated?

Explanation

A complete posterior root tear disrupts the circumferential continuity of the meniscus. This eliminates the meniscus's ability to convert axial loads into hoop stresses, rendering it biomechanically equivalent to a total meniscectomy.

Question 52

A 35-year-old male involved in a crush injury presents with an anteroposterior compression (APC) type III pelvic fracture. He has blood at the urethral meatus and a high-riding prostate on rectal exam. What is the most appropriate next step in the urologic management of this patient?

Explanation

Blood at the meatus and a high-riding prostate are classic signs of urethral injury associated with pelvic ring disruptions. A retrograde urethrogram (RUG) must be performed to evaluate urethral integrity before any attempt at catheterization.

Question 53

A 22-year-old football player sustains a complex knee injury. Physical examination reveals a positive Dial test with increased external rotation at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of flexion. Which structures are most likely injured?

Explanation

An increase in external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is suspected.

Question 54

A 24-year-old male sustains a closed, distal-third spiral humeral shaft fracture (Holstein-Lewis type). His initial examination shows an intact radial nerve. Following closed reduction and placement of a coaptation splint, he develops a complete radial nerve palsy. What is the most appropriate next step in management?

Explanation

A secondary radial nerve palsy occurring after closed reduction of a humeral shaft fracture, particularly a Holstein-Lewis variant, indicates possible entrapment of the nerve in the fracture site. This is an absolute indication for immediate surgical exploration.

Question 55

A 19-year-old female undergoes an anterior cruciate ligament (ACL) reconstruction. If the femoral tunnel is placed too vertically (at the 12 o'clock position) in the intercondylar notch, what is the most likely clinical outcome?

Explanation

A vertically placed ACL graft will adequately resist anterior tibial translation but fails to control rotational kinematics. This commonly presents postoperatively as a persistent pivot shift despite a negative Lachman test.

Question 56

A 29-year-old male is involved in a motorcycle collision, sustaining an ipsilateral closed midshaft femur fracture and a closed midshaft tibia fracture (floating knee). To minimize the risk of systemic complications such as ARDS, what is the most appropriate timing and method of surgical management?

Explanation

In a hemodynamically stable patient with a floating knee, early total care with reamed intramedullary nailing of major long bone fractures within 24 hours minimizes the risk of ARDS and systemic inflammatory response.

Question 57

A 21-year-old collegiate baseball pitcher is undergoing ulnar collateral ligament (UCL) reconstruction. Which of the following technical steps regarding the ulnar nerve is currently recommended for routine primary UCL reconstructions to minimize postoperative neuropathy?

Explanation

Current evidence suggests avoiding routine ulnar nerve transposition during primary UCL reconstruction unless there are preoperative ulnar nerve symptoms or intraoperative nerve subluxation. In situ handling decreases the risk of iatrogenic neuropathy.

Question 58

A 65-year-old female presents with a displaced supracondylar distal femur fracture proximal to a well-fixed total knee arthroplasty with a closed-box posterior-stabilized femoral design. What is the preferred surgical treatment?

Explanation

A closed-box posterior-stabilized TKA femoral component prevents the passage of a retrograde intramedullary nail. Therefore, a lateral distal femoral locking plate is the optimal fixation method for this periprosthetic fracture.

Question 59

A 26-year-old professional volleyball player presents with persistent shoulder pain during overhead serving. MRI arthrogram reveals a detachment of the superior labrum and biceps anchor from the glenoid. Which classification type does this describe, and what is the primary surgical management for this young overhead athlete who failed conservative care?

Explanation

A detachment of the superior labrum and biceps anchor from the glenoid is a Type II SLAP tear. In young overhead athletes who fail conservative management, arthroscopic repair of the labrum is generally preferred to restore native anatomy and function.

Question 60

A 22-year-old male presents with severe midfoot pain after falling from a horse with his foot caught in the stirrup. Examination reveals plantar midfoot ecchymosis. Radiographs show a 3 mm diastasis between the bases of the first and second metatarsals. What is the primary stabilizing ligament of the Lisfranc joint complex that is compromised in this injury?

Explanation

The Lisfranc ligament is an intra-articular interosseous ligament that connects the medial cuneiform to the base of the second metatarsal. It is the strongest and most critical primary stabilizer of the tarsometatarsal joint complex.

Question 61

A 16-year-old female presents with recurrent lateral patellar instability and is scheduled for medial patellofemoral ligament (MPFL) reconstruction. To restore normal kinematics, the femoral tunnel must be placed at the anatomic MPFL footprint (Schöttle's point). Where is this landmark located radiographically on a strict lateral view?

Explanation

Schöttle's point defines the radiographic femoral footprint of the MPFL on a strict lateral X-ray. It is located 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior border of Blumensaat's line, and proximal to the posterior aspect of the medial femoral condyle.

Orthopedic Surgery Board Review MCQs: Arthroplasty, Trauma & Spine Part 255

Orthopedic Surgery Board Review MCQs: Sports Medicine & Orthopedic Trauma Part 37

Key Takeaway

Orthopedic Surgery Board Review MCQs: Sports Medicine & Orthopedic Trauma Part 37

Chapter Index