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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 5-year-old boy presents to the ER at 9 pm with the injury shown in Figure A after falling off the monkey bars. Examination reveals the ability to make an a-ok sign, cross his fingers, and give a thumbs up. He has no radial pulse and his hand is cold. The decision is made to proceed with closed reduction and percutaneous pinning. When should the procedure be performed?
Urgently, within 6-8 hours
First case the following morning (~6 am)
8 hours after his last meal
Emergently, as soon as the operating room allows
As a scheduled procedure the following day with a vascular surgeon present
Select Answer to see Preferred Response
For which of the following injuries should lateral pins be placed with the elbow in an extended position?
Fracture with the anterior humeral line intersecting the middle third of the capitellum
Fracture with the supracondylar region of the humerus displaced anteriorly to the humeral shaft
Fracture with the supracondylar region of the humerus displaced posteriorly to the humeral shaft with an intact posterior periosteal hinge
Fracture with the supracondylar region of the humerus with complete periosteal disruption and instability in flexion and extension
Fracture with the supracondylar region of the humerus displaced posteriorly to the humeral shaft with a disrupted posterior periosteal hinge
An 8-year-old sustains the injury shown in Figure A after falling downstairs. He is able to cross his fingers, flex and extend the IP joint of his thumb, and has intact sensation. His fingers have a brisk capillary refill but there is no palpable or dopplerable pulse. Injury films are shown in Figure A. This patient should undergo:
Emergent vascular exploration
Open reduction and internal fixation
Close monitoring for compartment syndrome perioperatively and urgent surgery
Closed reduction and casting
Delayed surgical intervention to allow for soft tissue rest
Aaron and Randy are twin 8-year-old brothers who fall off a trampoline and sustain supracondylar humerus fractures that undergo closed reduction and percutaneous pinning. 6 weeks postoperatively Randy is placed into physical therapy for elbow range of motion while Aaron is not. In long-term follow up how will Randy's outcome compare to Aaron's?
Randy will have a decreased rate of heterotopic ossification
Aaron will be less likely to have a cubitus varus deformity
Randy will have superior functional an motion recovery compared to Aaron
Randy will have improved motion but the functional recovery will be similar
There will be no difference in functional and motion recovery
A 7-year-old patient presents with right elbow swelling and deformity after falling off of a trampoline. Figures A and B demonstrate the injury radiographs. In the emergency department, the patient has a warm pink hand with a strong radial pulse and intact AIN motor function. The patient is taken to the OR the next morning for closed reduction and percutaneous pinning. After the fracture is reduced and the pins are placed, the patient's hand appears pale and cool with absent radial pulses. What is the next appropriate step?
Apply a splint and reassess pulses in the PACU
Warm the extremity and reassess pulses
Perform a doppler examination
Remove the pins, re-displacement of the fracture, and reassess pulses
Perform an anterior exploration
A 7-year-old girl falls in the park and sustains the injury depicted in Figure A and B. The most commonly observed nerve injury would result in deficits in which of the following muscles?
Extensor digitorum communis
Extensor pollicis longus
Flexor pollicis longus
An 8-year-old male sustained the injury shown in Figures A-B. On physical examination, he is found to have a nerve deficit. Which of the following is the most likely nerve deficit and how should the nerve injury be managed after the fracture has been reduced and stabilized?
Anterior interosseous nerve (AIN); observation
Median nerve; observation
Median nerve; neurolysis
Ulnar nerve; observation
A 7-year-old girl presents to the emergency room after a fall with right arm pain. She has full motor and sensory function. Her fingers are warm and pink with a capillary refill <3 seconds, and she is noted to have ecchymosis in her antecubital fossa. Radiographs are seen in Figures A and B. What is the most appropriate management plan?
Closed reduction, long arm casting, and discharge home
Closed reduction, long arm casting, and admission for a 24-hour observation
Closed reduction, percutaneous pin fixation, and discharge home
Closed reduction, percutaneous pin fixation, and admission for arteriography
Open reduction with brachial artery exploration and admission for observation
A young child falls during gymnastics practice and sustains the isolated injury shown in Figure A. She is admitted to hospital for surgery. The prevalence of which complication is increased with this injury pattern?
A 6-year-old sustains the injury shown in Figures A and B. The nerve most commonly affected by this fracture pattern innervates which of the following motor groups?
Intrinsics of the hand
Thumb IP flexor
A 7-year-old sustains the isolated injury shown in Figures A and B. On physical examination there is no evidence of soft tissue compromise and he is able to make an okay sign, give a thumbs up sign and cross his fingers. Which treatment will minimize complications?
Closed reduction with casting in > 90 degrees of flexion
Closed reduction with casting at 90 degrees of flexion
Closed reduction and a percutaneous pinning construct using laterally based pins
Closed reduction and a percutaneous pinning construct using crossed pins
A 6-year-old presents with an elbow deformity after falling from the monkey bars. The skin is intact and no evidence of puckering is seen. The patient is neurovascularly intact. Representative radiographs of the injury are shown in Figures A and B. What is the optimal initial treatment for this injury based on the AAOS guidelines?
Primary open reduction and internal fixation
Closed reduction with medial and lateral crossed pins
Closed reduction with two or three lateral pins
Figures A through E are injury radiographs of elbow injuries in children. A child complains of decreased sensation over the small finger acutely after an elbow injury. Which of the following radiographs is consistent with his injury?
Following successful operative treatment, routine removal of hardware is recommended at 3-4 weeks for which of the following procedures?
A 7-year-old patient presents with a fracture of her left supracondylar humerus and distal radius as evidenced in Figure A. She is neurovascularly intact and the skin shows no evidence of open wounds. Radiographs of the elbow show a displaced supracondylar fracture. Radiographs of the wrist show an extra-articular distal radius fracture with 25 degrees of dorsal angulation. This injury is most appropriately treated with which of the following?
Closed reduction and casting of the supracondylar humerus fracture and distal radius fracture
Closed reduction and pinning of both the supracondylar humerus fracture and distal radius fracture
Closed reduction and casting of the supracondylar humerus fracture and pinning of distal radius fracture
Open reduction and pinning of both the supracondylar humerus and the distal radius fracture
Closed reduction and pinning of the supracondylar humerus fracture and closed reduction and casting of distal radius fracture
A 9-year-old-female presents with her parents who have concerns regarding the appearance of her elbow (Figure A). Her past medical history is significant for a supracondylar fracture treated in a cast when as a younger child. She has no pain with motion and has 0 to 120 degrees range of motion. She does not have functional limitations but her parents would like to improve the appearance of her elbow. Which of the following procedures will correct the cubitus varus but may result in a lateral prominence?
Reverse V Osteotomy
Medial opening-wedge osteotomy with medialization of the distal fragment
Lateral closing-wedge osteotomy
Which of the following elbow apophyses is the last to fuse during growth?
External (lateral) epicondyle
Internal (medial) epicondyle
A 22-year-old male presents with worsening right-hand pain and numbness. He localizes his symptoms to the ring and small finger with the involvement of the dorsoulnar aspect of the hand. He does have a distant history of a supracondylar humerus fracture that was treated with closed reduction percutaneous pinning when he was 5 years of age. A radiograph of the right elbow is depicted in figure A. What is the most likely cause of nerve irritation in this patient?
Compression by Osborne's ligament
Anterior nerve subluxation
Compression by the ligament of Struthers
Compression in Guyon canal
A child falls off of the monkey bars at school and sustains the left elbow injury shown in Figure A. What is a disadvantage of the fixation construct shown in Figure B compared to Figure C for this injury pattern?
Less biomechanical stability
Higher incidence of compartment syndrome
Higher chance of osteomyelitis
Higher risk of iatrogenic injury to the ulnar nerve
Higher risk of iatrogenic injury to the anterior interosseous nerve
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
repair of the posterior interosseous nerve.
repair of the median nerve at the elbow.
neurolysis of the anterior interosseous nerve.
observation of the nerve palsy.
immediate electromyography and nerve conduction velocity studies.
A 7-year-old boy falls off the playground and sustains the injury shown in figure A. What motor deficit is associated with the nerve most commonly injured in this fracture pattern?
Weakness of the flexor digitorum profundus to the index finger
Weakness of the extensor pollicis longus
Weakness of the flexor pollicis longus
Hand intrinsic weakness
What is the advantage of medial and lateral crossed pins compared to two lateral pins in the treatment of supracondylar humerus fractures?
Greater ultimate clinical arc of elbow motion
Lower revision rate
Lower incidence of ulnar nerve injury
Greater experimental biomechanical stability
More anatomic fracture reduction
What is the etiology of cubitus varus following a supracondylar humerus fracture in a child?
Overgrowth of the lateral physis
Malreduction of the fracture
Growth arrest of medial physis
Injury to the ulnar nerve
Radial head dislocation
A 10-year-old boy sustained the injury shown in figure A while jumping off a trampoline. His hand is pulseless and cold. What is the next step in management?
Loose-fitting splint application and reassess in 1 hour
Emergent closed reduction and pin fixation
Open vascular exploration
Forearm skeletal traction pin
The most common nerve injured in the fracture shown in Figure A innervates all of the following muscles EXCEPT?
flexor digitorum profundus index finger
flexor digitorum profundus middle finger
flexor pollicis longus
extensor pollicis longus
A 5-year-old boy sustains a type II (Gartland classification) supracondylar fracture which is treated with cast immobilization. Healing results in a mild gunstock deformity. Surgical treatment of this will most likely result in:
improved functional outcome
improved pain relief
improved range of motion
reduce non-union rates
A 8-year-old boy has a cubitus varus deformity of his left elbow after a supracondylar humerus fracture was treated in a splint. What is the most common cause of this deformity?
Malreduction causing malunion
Medial epicondyle growth arrest
Lateral condyle overgrowth
Medial epicondyle avascular necrosis
Unrecognized compartment syndrome