OITE & ABOS Orthopedic Board Prep: Arthroplasty, Hip, Knee & Spine | Part 248

Which of the following is a true statement regarding thoracic disk herniations?

Figure 50 shows the MRI scan of a 20-year-old female college soccer player with knee pain. What is the most likely diagnosis?

What is the primary concern for arthrodesis of a failed infected total knee arthroplasty using internal fixation?

During preparation for the NCAA wrestling championships, a participant reports the development of vesicular lesions on his right chest wall that are mildly painful; however, they have not affected his ability to wrestle. How should this athlete be managed? Review Topic

Which of the following properties apply to the human meniscus when compared with articular cartilage?

A 30-year-old man who sustained a work-related injury 6 weeks ago reports persistent back and left-sided buttock pain that has been attributed to lumbar transverse process fractures. A pelvic radiograph and CT scans obtained 2 days ago are seen in Figures 17a through 17c. What is the best treatment for his injury?

A patient has a displaced complex intra-articular distal humeral fracture. What factor is considered most important when deciding on what surgical approach to use?

A patient reports pain in the hip with functional positioning. With the patient supine, pain in which of the following positions would be typical for femoral acetabular impingement? Review Topic

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?

Figure 91 shows the radiograph of a 57-year-old man who fell 6 feet off a ladder. He is neurovascularly intact but reports shoulder pain. What is the most appropriate acute treatment for this patient?

A 45-year-old man underwent a fingertip amputation through the distal phalanx after his ring finger was caught in a garage door. He was treated in the emergency department with a revision amputation by advancement of the flexor digitorum profundus (FDP) tendon to the extensor mechanism. Three months following the injury, he is able to fully flex his injured ring finger to touch his palm, but he reports that it is difficult for him to make a tight fist due to decreased flexion of his other fingers. What is this complication called?

A 50-year-old woman with a 2-part surgical neck proximal humerus fracture and metaphyseal comminution

A 19-year-old college cross-country runner is amenorrheic and has recurrent stress fractures. Long-term management should consist of

A patient sustained a puncture wound to the plantar aspect of his foot. He was wearing shoes and socks at the time of the injury. Systemic antibiotic administration with specific coverage for which bacterial species (in addition to Staphylococcus aureus) should be instituted?

Figures 29a and 29b show the radiographs of a 13-year-old competitive gymnast who has had elbow pain for the past 2 weeks. The pain is worse with tumbling activities. Examination reveals a mild effusion and slight limitation of extension and forearm rotation with no locking. Initial management should consist of

A Trendelenburg gait is most likely to be seen in association with

A 25-year-old woman undergoes surgical treatment of a displaced proximal humeral fracture via a deltopectoral approach. At the first postoperative visit, she reports a tingling numbness along the anterolateral aspect of the forearm. What structure is most likely injured?

After trial placement of components in a primary total knee arthroplasty, the knee is unable to come to full extension, but the flexion gap is appropriately balanced. After adequate soft-tissue releases have been performed, what is the next most appropriate action to balance the reconstruction?

Which is the best initial study for the diagnostic evaluation of diskogenic low back pain? Review Topic

A 40-year-old man has a painful mass on his anterior ankle joint with limited range of motion. A radiograph, MRI scan, a gross specimen, and a hematoxylin/eosin biopsy specimen are shown in Figures 5a through 5d. What is the most likely diagnosis?

An elderly woman with osteoporosis falls from a standing height, sustaining a low-energy fracture of the acetabulum. What structures are most likely fractured?

An 80-year-old man has had increasing shoulder pain for the past 4 months. He reports that it began with soreness and stiffness after chopping some wood. A coronal MRI scan is shown in Figure 16. Initial management should consist of

A 32-year-old woman is ejected from her vehicle in a motor vehicle accident. She has a distant history of pacemaker implantation for an unknown arrthymia. She complains of neck pain. Examination reveals midline cervical tenderness but no neurological deficit. CT scans of her cervical spine are shown in Figures A and B. She requires an emergency laparotomy for a splenic injury. Regarding her cervical spine, what is the next best step? Review Topic

A 28-year-old man sustained a fracture-dislocation of T8 in a motor vehicle accident 1 week ago. The injury resulted in complete paraplegia. Management should consist of

Figures 1 and 2 are of a 51-year-old man who underwent open reduction and internal fixation of a right proximal humerus fracture with concomitant rotator cuff repair. Within 1 year, he develops heterotopic ossification, for which he undergoes excision and hardware removal. Postoperatively, he was noted to have progressive atrophy in the shoulder and anterior humeral head subluxation with attempted shoulder abduction. What nerve was damaged during the most recent procedure?

What is the most likely type of pathology seen in Figure 16?

A 35-year-old man who is involved in an improvised explosive device attack is hit by a piece 57 of shrapnel. He has a solitary penetrating wound in his left tibia. Radiographs show no fracture. He has significant pain and his calf is grossly swollen. He has good sensation and palpable dorsalis pedis and tibialis posterior pulses. He has elevated pressure in all 4 compartments. When performing a 4-compartment fasciotomy using the 2-incision technique, which structure is at risk when opening the deep posterior compartment?

A 15-year-old wrestler sustains an abduction, hyperextension, and external rotation injury to his right shoulder. The MRI scan findings shown in Figures 27a and 27b are most consistent with Review Topic

What part of the glenoid labrum has the least vascularity?

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 75-year-old man presents with a displaced femoral neck fracture. During your surgical exposure for a hemiarthroplasty, the femoral neck has fractured through a pathologic lesion which is diagnosed as a lymphoma on frozen section. The lesion is located in the center of the femoral neck and the calcar femorale is not involved. Your treatment should include:

Figures 9a and 9b show the radiographs of a 12-year-old girl who has had right hip pain for the past 4 months. She reports that the pain is so severe that she is unable to walk and is now using a wheelchair. Examination reveals pain with any attempted range of motion. Management should include

A 7-year-old boy sustains an acute injury to the distal radial metaphysis, along with a completely displaced Salter-Harris type I fracture of the ulnar physis, as shown by the arrows in Figure 12. After satisfactory reduction of both injuries, what is the major concern?

A 6-year-old boy is being treated for acute hematogeneous osteomyelitis of the distal femur with intravenous antibiotics. The best method to determine the success or failure of initial treatment is by serial evaluations of which of the following studies?

A 20-year-old man reports painless snapping about the lateral aspect of the right hip. He denies any history of trauma. Examination reveals no limp or tenderness. Hip range of motion is full, and there is good strength. Radiographs are normal. What anatomic structure is most likely causing these symptoms?

A patient with a transverse femur fracture undergoes statically locked antegrade intramedullary nailing. Postoperatively, the patient appears to have a

Figures 113a and 113b are the radiographs of a 7-year-old girl who was evaluated for a visible elbow deformity by a foster parent. She thought the child fell, but her history was vague. On physical examination, a large prominence was seen over the posterolateral elbow, and the girl lacks the terminal 20 degrees of elbow extension. She has 75 degrees of elbow pronation and supination. She was nontender on examination. What is the most appropriate next treatment step? Review Topic

A 24-year-old athlete has a painful right shoulder. Figure 30 shows an intra-articular photograph that was obtained through a posterior portal during arthroscopy; the labrum is indicated by the arrow. Based on these findings, management should consist of

A 24-year-old avid volleyball player has noted gradual onset of shoulder fatigue and weakness limiting his game. Radiographs done by his primary care physician were normal and he has failed to improve with 6 weeks of physical therapy. Given the MRI image shown in Figure A, this patients physical exam may reveal weakness with which of the following actions? Review Topic

Flow cytometry of tumors measures the

A 15-year-old wrestler sustains an abduction, hyperextension, and external rotation injury to his right shoulder. The MRI scan findings shown in Figures 27a and 27b are most consistent with

Figure 12 shows the radiograph of a patient who has anterior knee pain. History reveals a femoral fracture at age 5 years. What is the most likely cause of the deformity?

Which of the following is considered a reasonable goal for arthroplasty surgery in rotator cuff arthropathy?

A young active patient with a complete isolated posterior cruciate ligament (PCL) tear undergoes a double bundle PCL reconstruction. The tensioning pattern of the anterolateral (AL) and posteromedial (PM) bundles most likely to reproduce the most normal knee kinematics would be to tension

Figure 5 is a T2-weighted MR image of a 26-year-old man who has had left leg pain for 3 months that has failed nonsurgical treatment. Surgical decompression is planned. Which approach would provide the most direct ability to perform surgical decompression?

A 68-year-old man reports a 4-week history of progressive left-sided lower back and hip pain. The pain is in the posterior buttock region with radiation to the groin and to the left anterior knee region. The pain is aggravated with walking and improves with rest. There is no history of previous trauma. Radiographs are seen in Figures 14a and 14b, and MRI scans are seen in Figures 14c through 14e. What is the most appropriate treatment option at this time?

Which of the following statements best describes the typical early presentation of osteochondritis dissecans of the elbow? Review Topic

Triple arthrodesis in a reduced position

Among patients with lumbar degenerative disk disease and low back pain, what factor is most predictive of clinical outcomes after surgical management? Review Topic

Which of the following mechanisms of inhibition has been linked to cigarette smoking and lumbar spinal fusion?

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

The teardrop shape marked with an asterisk in Figure 61 represents what anatomic structure?

Figures 1 and 2 are the MR arthrogram images of a 16-year-old, right-hand-dominant baseball player who injured his left shoulder 4 weeks ago during a game. He now has pain, weakness, and the inability to swing a bat and can no longer do push-ups. He denies prior injury to his left shoulder. Radiographs are unremarkable. If present, what is the most likely complication after surgical treatment in this scenario?

Figure 17 shows the AP radiograph of a 5-year old child who has mild short stature and a painless bilateral gluteus medius lurch. Initial work-up should include

-An absolute contraindication for closed management of a humeral shaft fracture in a fracture brace is

Figure 53 shows the MRI scan of a 53-year-old carnival worker who has pain and swelling in the left shoulder as a result of attempting to stop a roller coaster car with his arm. Examination reveals decreased ROM, apprehension, and inability to move the dorsum of his hand away from his back. Treatment should consist of

A 21-year-old collegiate female cross-country athlete reports right hip pain that begins about 12 miles into a run, followed by pain resolution when she discontinues running. However, each time she tries to resume a running program, she experiences recurrence of pain deep in the anterior groin. A plain radiograph and MRI scan are shown in Figures 8a and 8b. Management should consist of

• A 7-year old boy has a painless abductor limp and limited hip abduction. Radiographs show varus of the proximal femur, with a narrow upper femoral epiphysis that has the shape of an inverted "Y". Which of the following factors best predicts the risk that the deformity will become worse?

An 18-year-old high school football player exits the field after making a tackle on the opening kickoff. He reports "feeling out of it" and states that he has a headache. He does not recall any loss of consciousness and has no amnesia. He is unable to list the months of the year in reverse order on questioning. He does not return to the game and feels normal at the completion of the game. What is the most sensitive test in assessing deficits after mild traumatic brain injury? Review Topic

What preoperative factor correlates best with the outcome of rotator cuff repair?

All of the following are advantages of supine over lateral positioning during intramedullary nailing of subtrochanteric femur fractures EXCEPT:

With the increasing availability of total hip arthroplasty (THA) to younger patients with hip osteoarthritis, there has been increased use of alternative bearing surfaces. Compared to a ceramic-on-ceramic articulation, which of the following is a specific advantage of a metal-on-metal bearing surface?

Which of the following patients has the highest risk of developing recurrent instability after an arthroscopic Bankart procedure for anterior shoulder instability? Review Topic

..The optimal method to treat a recurrent presentation of pigmented villonodular synovitis (PVNS) with diffuse joint involvement in a 24-year-old woman with pain and symptomatic effusions is

A 3-year-old child sustains a T2/T3 fracture-dislocation with complete paraplegia secondary to a car accident in which the child was an unrestrained passenger. What is the likelihood that this child will develop subsequent spinal deformity in the future?

Which of the following radiographic parameters is most predictive of a poor result following multilevel fusion surgery for adult degenerative scoliosis? Review Topic

A 12-year-old pitcher has had a 2-month history of pain in his right dominant shoulder after throwing. He reports that the pain has gradually progressed to the point where he cannot throw without pain. He also notes that the pain now awakens him at night if he has been active. Anti-inflammatory drugs have failed to provide relief. Examination reveals no abnormalities except for some localized tenderness over the proximal humerus. Figures 32a and 32b show radiographs of both shoulders. What is the most likely diagnosis?

Figure 54 shows the preoperative radiograph of a 45-year-old woman who is considering total hip arthroplasty with her orthopaedic surgeon. What femoral characteristic is a typical concern in this patient?

A 33-year old man sustains a posterior elbow dislocation after a fall. Attempts at closed reduction result in recurrent instability. What is the most common ligamentous injury found at the time of surgical stabilization?

A large circumferential proximal femoral allograft is to be used in the reconstruction of a failed femoral component in a total hip arthroplasty. To enhance fixation of the graft to the implant, which of the following strategies should be used?

Figure 25 shows an arthroscopic thermal capsular shrinkage device being used in the anterior inferior quadrant of a patient with a subluxating shoulder. Which of the following neurologic complications is most frequently reported with this technique?

What are the five major compartments of the foot?

The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw during fixation of what structure?

Hip pain of month duration has developed in a year-old man with a previous total hip arthroplasty. He underwent dental work 6 weeks ago. Aspiration shows a white blood cell count of more than 6,000 cells/μL (reference range 4,500 to 11,000 cells/μL) and the presence of gram-positive cocci in clusters on Gram stain. The orthopaedic surgeon recommends urgent debridement and irrigation. Fixation of the components is judged to be stable, and the surgeon elects to retain the implants. The patient has a final culture that reveals methicillin-resistant Staphylococcus  aureus (MRSA). If the attending physician recommends the two-stage protocol, including the use of an antibiotic-cement spacer, what is the most likely prognosis for this patient?

A 19-year-old running back lands directly on his anterior knee after being tackled. He has mild anterior knee pain, a trace effusion, a 2+ posterior drawer, a grade 1+ stable Lachman, no valgus laxity, and negative dial tests at 30 degrees and 90 degrees. What is the best treatment strategy at this time? Review Topic

Serum parathyroid hormone level The plain radiograph of the shoulder shows lytic lesions in the scapular spine, distal clavicle, and the proximal third of the clavicle. There is an elliptical erosion in the proximal clavicle. These three lesions suggest a diagnosis of metastatic bone disease or multiple myeloma. The biopsy specimen shows plasma cells. The plasma cells have these characteristic features: Eccentrically placed nucleus Peripheral clumping of the nuclear chromatin A perinuclear halo The diagnosis is multiple myeloma. Staging is important and is performed with a skeletal survey, bone marrow biopsy, hemoglobin level, and chemistry studies including kidney function and serum calcium determination. Serum protein electrophoresis is performed to assess the amount of abnormal gammaglobulin in the serum. There are three major criteria in the diagnosis of multiple myeloma:

Figures 87a and 87b are the radiographs of an 18-year-old pedestrian who was struck by a car. During intramedullary nailing, it is difficult to maintain proper alignment. Poller blocking screws placed in the proximal fragment at which position(s) relative to the nail can help prevent the typical deformity?

All of the following are characteristic of synovium affected by rheumatoid arthritis (RA) EXCEPT:

Figures 1 and 2 demonstrate the radiographs obtained from a 35-year-old woman with end-stage debilitating osteoarthritis of the right hip. She is contemplating total hip arthroplasty (THA). She has a history of right hip dysplasia and underwent hip osteotomy as an adolescent. Over the years, nonsurgical treatment, including weight loss, activity modifications, and intra-articular injections, has failed. Her infection work-up reveals laboratory findings within defined limits. Which bearing surface is contraindicated for this patient?

Figure 36a shows the current radiograph of a 65-year-old woman who slipped and fell. History reveals that prior to the fall she was actively functioning without pain. Figure 36b shows a radiograph obtained 1 year ago. Based on the fracture pattern, the failure is most likely related to

..First-line treatment recommendations include

A previously healthy 35-year-old man was involved in a rollover motor vehicle accident 2 days ago. He was placed in a semi-rigid cervical orthosis. He now reports mostly axial neck pain with attempted range of motion. Examination reveals the mechanical neck pain but no obvious neurologic deficits. AP, flexion, and extension radiographs are shown in Figures 10a through 10c, and sagittal and coronal CT scans are shown in Figures 10d and 10e. What is the most appropriate management at this time?

An 8-year-old girl was treated for a Salter-Harris type I fracture of the right distal femur 2 years ago. Examination reveals symmetric knee flexion, extension, and frontal alignment compared to the contralateral knee. She has 1-cm of shortening of the right femur. History reveals that she has always been in the 50th percentile for height, and her skeletal age matches her chronologic age. Radiographs are shown in Figure 9. What is the expected consequence at maturity?

Which of the following is considered the cause of Milwaukee shoulder, a joint disease similar to rotator cuff arthropathy?

--The patient is offered a VPHTO. What aspect of his history will determine the most appropriate VPHTO technique?

A still active 86-year-old pastry chef falls in her kitchen and notes pain and deformity of her little finger. There are no open wounds. Radiographs are shown in Figures 49a and 49b. What is the most appropriate management?

A collegiate lacrosse player is struck on the head by an opposing player’s stick. She is initially unresponsive. She regains consciousness within 2 minutes but remains confused and uncooperative, complaining of head and neck pain. This is her second concussion of the calendar year. Initial management should consist of

Progressive paralysis is most likely to be seen in association with what type of congenital vertebral abnormality?

Following its exit from the sciatic notch, the sciatic nerve passes between what two muscles?

A man who weighs 75 kg (165 pounds) is scheduled for elective total hip arthroplasty. He reports a history consistent with anaphylaxis from penicillin. Within 1 hour of the incision the patient should receive 1000 mg of

A 30-year-old man sustains a head injury as well as a femur and pelvis fractures as the result of a rollover motor vehicle accident. He is initially comatosed, but recovers cognitive function after 10 days in the hospital. Soon after awakening he complains of wrist pain and an x-ray demonstrates a distal radius fracture. What is the most likely explanation for this delayed diagnosis?

A 28-year-old woman undergoes a closing-wedge high tibial osteotomy (HTO) for medial compartment overload after medial meniscectomy. Postsurgically, she reports improvement in her medial pain and resumes normal activities. About 9 months after her surgery, however, she reports burning pain in the front of her knee with running. Her examination reveals no joint line tenderness, mild pain with patellar compression, and limited patellar glides. What is the most likely cause of her symptoms?

Figures 23a and 23b show the MRI scans of a 50-year-old woman who has increasing gait disturbance. She reports three falls in the past week. Examination reveals hyperreflexia, motor weakness in the biceps and triceps, and a positive Hoffman’s sign. What is the most appropriate treatment plan? Review Topic

-Which treatment approach for acetabular fractures carries the highest risk for heterotopic ossification?

Immediately after undergoing lumbar instrumentation, a patient reports severe right leg pain and has 4+/5 weakness. Figure 24 shows an axial CT scan of L5. Exploratory surgery will most likely reveal

An 18-year-old male soccer player sustains a knee injury during a game. Examination is notable for a positive pivot shift test. What other physical examination finding is most likely to be present? Review Topic

Figure 12a shows the clinical photograph of a 36-year-old man who has left shoulder pain and dysfunction after undergoing a lymph node biopsy 2 years ago. The appearance of the shoulder during abduction and a wall push-up maneuver is shown in Figures 12b and 12c, respectively. Which of the following procedures provides the best pain relief and function?

The patient does not improve with 1 year of rehabilitation exercises. MR arthrography reveals a normal glenoid labrum and rotator cuff. Surgical treatment should consist of

A 37-year-old man with a history of congenital flatfoot reports worsening pain on the medial aspect of his ankle for the past year. The pain is worse with weight bearing and is better with rest and the use of an ankle brace. What findings are shown on the MRI scans shown in Figures 18a through 18c?

A surgeon desires to use an implant that will be able to absorb as much energy as possible before it fails. The implant should be made of a material that has which of the following properties?