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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 36-year-old male is ejected from his motorcycle after losing control around a corner. He presents to the trauma bay with the injuries shown in Figures A-C. All fractures are closed, and the patient is neurovascularly intact. He undergoes intramedullary nailing of his tibial shaft fracture and closed reduction and splinting of his ankle fracture with the plan for definitive fixation once soft tissue swelling allows. Of the following, what would be the most preferred management and corresponding weightbearing status of the patient’s right humeral shaft fracture?
Open reduction and internal fixation with plate osteosynthesis, partial-weightbearing
Non-operative with acute Sarmiento bracing, partial-weightbearing
Intramedullary nail fixation, partial-weightbearing
Non-operative with a coaptation splint, non-weightbearing
Open reduction and internal fixation with plate osteosynthesis, full-weightbearing
Select Answer to see Preferred Response
Figure A is the AP radiograph of a 32-year-old right-hand dominant male who was involved in a motor vehicle accident and sustained an isolated injury. On examination, he has good distal pulses, weakness with attempted wrist extension, and some reported numbness of the dorsal radial hand. He is treated conservatively in a Sarmiento functional brace. Which muscle function is expected to be the LAST to return in this patient?
A 60-year-old male with a history of diabetes presents to the trauma bay after sustaining a ground-level fall onto his right arm. His injury films are shown in Figures A and B. He is treated conservatively with closed reduction and his post-reduction radiographs are shown in Figures C and D. At 6 weeks followup he presents with persistent fracture site motion. His current imaging studies are shown in Figures E and F. Which of the following is the best next step in management?
Adjust Sarmiento brace and repeat followup in 3 weeks
Continue current management for another 6 weeks and then discontinue brace
Proceed with surgical management at this time
Continue current management for another 6 weeks and if no evidence of clinical union, proceed with surgical management
Discontinue sarmiento brace and allow for progressive weight-bearing at this time
A 45-year-old man presents to your clinic with a closed mid-shaft humerus fracture after a fall 1 week prior. He is neurovascularly intact. After a discussion of his treatment options, he is adamant about proceeding with surgical management. With respect to open reduction and internal fixation with a plate versus intramedullary nailing, what advice can you offer him?
Nailing is associated with a decreased rate of surgical site infections
Nailing is associated with a higher rate of transient radial nerve injury
Plating is associated with a higher rate of fracture union
Plating is associated with a higher re-operation rate
No difference between rate of radial nerve palsy between plating or nailing this injury
A 65-year-old man sustained the closed injury seen in Figures A and B and is being treated nonoperatively in a functional brace. At what time point after the injury does the lack of callus formation and motion at the fracture site first become concerning for nonunion?
A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. He is neurovascularly intact in his left arm and leg. Figure A shows a radiograph of his left humerus. What would be the most appropriate definitive treatment?
Non-operative management of the humerus and plating of the femur
Plating of the humerus and intramedullary nailing of the femur
Non-operative management of the humerus and intramedullary nailing of the femur
Plating of both the humerus and femur
Intramedullary nailing of the humerus and plating of the femur
A 21-year-old male is brought to the emergency department with multiple gun shot wounds. Initial radiographic evaluation discovers a femoral shaft fracture, distal tibia fracture, and the injury shown in Figure A. Figure B shows a single entry wound located at the left distal humerus. Systemic injuries include multiple abdominal bullet wounds with associated intra-abdominal free fluid. Using the 'damage-control' approach to orthopaedic trauma, what would be the best initial management for the injury seen in Figure A?
Closed reduction and splinting in the emergency room
Irrigation and debridement, then splinting in the operating room
Irrigation and debridement, then spanning external fixation in the emergency room
Open reduction and internal fixation with a compression plate in the operating room
Irrigation and debridement, then intramedullary nailing of the humerus in the operating room
A 45-year-old female presents to the office wearing a right upper arm splint with radiographs shown in Figure A and B. She sustained an isolated closed injury to the right arm 9 days ago. Her soft-tissues and neurological examination are normal. What would be the most appropriate treatment for this injury?
Continue current splint for 6 weeks
Continue current splint for 3 weeks and transition to hanging arm sling for additional 3 weeks
Transition to functional brace for additional 6-8 weeks
Open reduction internal fixation with compression plating
Staged procedure with humeral external fixator, then open reduction internal fixation with compression plating
A 25 year-old-male presents with the injury seen in Figure A. Which of the following would be a contraindication to closed management with a functional brace?
Radial nerve injury
1 cm shortening
20 degree varus deformity
Brachial plexus injury
Comminuted fracture pattern
A 23-year-old man presents with the injury seen in Figure A after a motor vehicle collision. He undergoes the treatment seen in Figure B. Which of the following statements is most accurate when comparing his treatment with open reduction and internal fixation?
Higher rates of radial nerve injury
Higher total complication rate
Lower rates of nonunion
Lower rates of shoulder impingement
Lower rates of malunion
A 42-year-old man sustains the injury shown in Figure A after a fall from 6 feet. Physical exam after the injury reveals a flaccid ipsilateral limb. An MRI is performed that reveals nerve root avulsions from C5-T1. Which of the following is the most appropriate management of his fracture at this time?
Closed management with a coaptation splint
Closed management with a coaptation splint followed by transition to a functional brace after 7-10 days
External fixation of humeral shaft fracture until brachial plexus injury resolves
Open reduction, surgical fixation with plating
Closed management with a sling until brachial plexus injury resolves
A 26-year-old right hand dominant male is involved in a motor vehicle collision and sustains the left humerus injury demonstrated in Figure A. The brachial artery is disrupted and requires urgent attention in the operating room. The patient's preoperative nerve evaluation demonstrates that the patient is unable to initiate extensor carpi radialis longus, extensor carpi radialis brevis, extensor pollicis brevis, extensor digitorum, extensor indicis proprius, and extensor pollicis longus motor activity. What is the most likely etiology for this observed neurologic examination?
Neurapraxia of the median nerve
Axonotmesis of the radial nerve
Neurotmesis of the ulnar nerve
Neurotmesis of the radial nerve
Axonotmesis of the ulnar nerve
A 45-year-old male sustains a Gustilo and Anderson Type II open transverse humeral shaft fracture. He undergoes the treatment shown in Figures A and B. What is the advantage of this treatment choice as compared to antegrade intramedullary nailing?
Decreased risk of post-operative elbow pain
Decreased risk of radial nerve injury
Decreased risk of reoperation
Decreased risk of infection
Decreased risk of blood loss
A 32-year-old man presents to the emergency department with a humeral shaft fracture. He has wrist drop as well as impaired finger and thumb extension. Which motor function would be expected to recover last?
Wrist extension in radial deviation
Middle finger MCP extension
Index finger MCP hyperextension
During an open reduction internal fixation of a humerus fracture using the posterior approach, a surgeon can identify the posterior antebrachial cutaneous nerve and trace it proximally to which of the following nerves?
On average, the radial nerve travels from the posterior compartment of the arm and enters the anterior compartment at which of the following sites?
Spiral groove of the humerus
At the arcuate ligament of Osborne
10 cm distal to the lateral acromion
10 cm proximal to radiocapitellar joint
At the origin of the deep head of the triceps
All of the following are considered contraindications to the use of functional bracing of a humeral shaft fracture EXCEPT:
Mid-diaphyseal segmental fracture with ipsilateral pilon fracture
Mid-diaphyseal fracture with radial nerve palsy from nonballistic penetrating injury
Proximal one-third oblique fracture
Mid-diaphyseal closed fracture with a radial nerve palsy on presentation
Mid-diaphyseal fracture with a L1 burst fracture and paraplegia on presentation
Which of the following is true regarding plating of humeral shaft fractures compared to intramedullary nailing?
worse functional results
higher need for subsequent surgeries
higher incidence of radial nerve injury
lower complication rates
decreased nonunion rates
Which of the following is the strongest indication for surgical treatment of an acute humeral shaft fracture?
radial nerve palsy
long oblique fracture type
Holstein-Lewis fracture type
ipsilateral both bone forearm fracture
A 25-year-old male sustains a humeral shaft fracture and is treated with the implant seen in Figure A. Compared with open reduction and internal fixation with a plate and screw construct, the treatment shown in Figure A is associated with all of the following EXCEPT?
Increased shoulder impingement
No difference in rate of union
Increased shoulder range of motion
No difference in rate of radial nerve injury
Increased risk of revision surgery
A polytrauma patient sustains a right bicondylar tibial plateau fracture and a right humeral shaft fracture both treated with open reduction and internal fixation. He also underwent statically locked intramedullary nailing of a left femoral shaft fracture. What is the appropriate weightbearing status?
Non-weight bearing bilateral lower extremities and right upper extremity
Weight bearing as tolerated bilateral lower extremities and right upper extremity
Non-weight bearing left lower extremity and weight bearing as tolerated right upper and right lower extremities
Non-weight bearing right lower extremity and weight bearing as tolerated right upper and left lower extremities
Weight bearing as tolerated bilateral lower extremities and non-weight bearing right upper extremity
A 25-year-old male involved in a motor vehicle accident sustains multiple injuries. He undergoes operative treatment for his humeral shaft fracture. Figures A and B show his preoperative and postoperative radiographs. The distal interlocks for this implant place which of the following nerves at risk?
A 68-year-old male sustains the humeral shaft fracture shown in Figures A and B. Upon presentation, he is unable to extend his thumb, fingers, and wrist. After 4 months of non-operative management, the fracture has healed, but his physical exam is unchanged. What is the next most appropriate step in management?
EMG and nerve conduction tests
Immediate surgical exploration
CT scan of the humerus