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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 38-year old unrestrained man is involved in a motor vehicle collision and presents with the injury depicted in Figures A and B. The patient undergoes the operative intervention depicted in Figure C through the extended iliofemoral approach. Which of the following variables below is a protective factor against early conversion of the fixation to total hip arthroplasty for this patient?
Femoral head cartilage defect
Initial fracture displacement > 20mm
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A 33-year-old male presents to the ER after a head-on motor vehicle collision complaining of severe left hip pain. Initial AP pelvis x-rays are shown in Figure A. You wish to further asses his injury pattern by ordering additional radiographs. Which of the following images will be the MOST helpful in visualizing the left posterior column?
Left obturator oblique inlet
Right iliac oblique
Left obturator oblique
Left iliac oblique
Right iliac oblique outlet
A 35-year-old male sustains the injury shown in Figure A. He is currently not cleared for surgery due to a severe head injury. At what time point after the injury is there an increased risk of a poor outcome?
What is the spur sign and on which view is it best seen?
Intact ilium; obturator oblique
Intact ilium; iliac oblique
Posterior wall fragment; iliac oblique
Posterior wall fragment; obturator oblique
Posterior wall fragment; oburator inlet
Which of the following acetabular fractures is classified as an elementary fracture pattern that involves two columns?
During which surgical approach to the acetabulum is the sciatic nerve placed at risk, and how should the patient be positioned to minimize the risk of injury?
Kocher-Langenbeck; hip extended and knee extended
Kocher-Langenbeck; hip extended and knee flexed
Kocher-Langenbeck; hip flexed and knee extended
Ilioinguinal; hip extended and knee extended
Ilioinguinal; hip extended and knee flexed
An 18-year-old male sustains a right hip injury after being tackled on the football field. Figure A shows his radiograph upon presentation to the emergency room three hours later. On physical exam, he is noted to have a foot drop and decreased sensation globally throughout his entire lower leg. Closed reduction under conscious sedation is immediately performed, and the hip is able to be ranged through a stable arc of motion following reduction. A post-reduction radiograph is shown in Figure B. Shortly after the reduction, the patient continues to have a foot drop, but his sensation is slightly improved. Which of the following is the most appropriate next step in management?
Exploration of his sciatic nerve
CT scan of his right hip
Touch-down weight bearing of his right leg and observation of his sciatic nerve palsy
Skeletal traction on the distal femur to relax tension on the sciatic nerve
The posterior wall of the acetabulum is best visualized on which of the following radiographic views?
Obturator oblique pelvis
Iliac oblique pelvis
A 34-year-old male presents with the right posterior wall acetabular fracture shown in Figure A. What is the most accurate method to test for hip stability in this patient?
The Keith method
The Moed method
The Calkins method
Dynamic fluoroscopic examination of the hip under anesthesia
A history of associated hip dislocation
A 35-year-old male suffers an anterior column acetabular fracture during a motor vehicle collision, and subsequently undergoes percutaneous acetabular fixation. Intraoperatively, fluoroscopy is positioned to obtain an obturator oblique-inlet view while placing a supraacetabular screw. Which of the following screw relationships is best evaluated with this view?
Intraarticular penetration of the screw
Position of the screw cephalad to the sciatic notch
Screw starting point at the anterior inferior iliac spine
Screw starting point at the gluteal pillar
Screw position between the inner and outer tables of the ilium
A 14-year-old presents on the request of her pediatrician for evaluation of her left hip. The patient reports having a recent history of lower abdominal pain, and as part of the work-up a KUB radiograph was obtained. The abdominal work-up was negative, and her pain has since resolved, however, the pediatrician noted an abnormal radiographic finding in the left hip and requested a formal orthopedic evaluation. The patient denies any history of hip trauma or pain. A left hip radiograph is shown in Figure A, and the the abnormality in question is indicated by the white arrow. The radiographic finding is most consistent with which of the following?
Os acetabuli marginalis superior
A 32-year-old male sustains a posterior wall acetabulum fracture as the result of a high-speed motor vehicle collision. Improved patient-reported outcomes after surgical treatment are associated with which of the following variables?
Increased hip flexion-extension arc
Increased hip muscle strength
Decreased stride length
A 74-year-old man falls, sustaining the injury shown in Figures A through C. In surgical planning, what is the best surgical approach to treat this injury?
A 35-year-old male undergoes closed reduction under sedation in the emergency department for a posterior hip dislocation with an associated posterior wall fracture. The post-reduction CT is seen in Figure A. What is the appropriate next step in management of this injury?
Nonoperative management based on the size of the posterior wall fragment
Operative management based on the size of the posterior wall fragment
Operative management based on the history of hip dislocation
Dynamic fluoroscopic stress exam under anesthesia in the obturator oblique view
Dynamic fluoroscopic stress exam under anesthesia in the iliac oblique view
When placing a percutaneous retrograde pubic ramus screw for fixation of an acetabular fracture, which of the following radiographic views can best ensure that the screw does not exit the posterior aspect of the superior pubic ramus?
Outlet obturator oblique view
Inlet iliac oblique view
Iliac oblique view
Obturator oblique view
A 78-year-old male undergoes the procedure shown in Figure A for treatment of a femoral neck fracture. As the patient passes through mid-rise during sitting to standing using the affected leg, what portion of the acetabulum experiences the highest contact pressures?
A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. Which of the following is the preferred approach for open treatment of this injury?
Modified Stoppa approach
Extended iliofemoral approach
Combined anterior and posterior approach
A 37-year-old male sustains the injury shown in Figure A following a motorcycle crash. During the approach, what limb position minimizes tension placed on the sciatic nerve?
Hip at 45 degrees, knee flexed to 90 degrees
Hip at 60 degrees, knee flexed to 90 degrees
Hip at 90 degrees, knee extended
Hip at 0 degrees, knee flexed to 90 degrees
Hip at 90 degrees, knee flexed to 90 degrees
A computed tomography (CT) scan has been shown to be indicated for evaluation of all of the following aspects of acetabular fractures, EXCEPT:
Determination of surgical planning
Intra-articular loose bodies
Fracture piece size and position
Determination of pre-existing degenerative changes
A 22-year-old female is involved in a motor vehicle collision and sustains the injury shown in Figures A through D. According to these images, what is the acetabular fracture classification?
Anterior column posterior hemitransverse
Transverse with posterior wall
A 33-year-old male sustains the injury seen in Figure A as a result of a high-speed motor vehicle collision. Based on this image, what is the most likely acetabular fracture pattern?
An acetabular fracture with all segments of the articular surface detached from the intact posterior ilium is defined as what fracture pattern?
Posterior column with posterior wall
Anterior column with anterior wall
A 25-year-old male is involved in a motor vehicle accident and presents with the injury shown in Figure A. Early fixation of this fracture pattern is associated with all of the following EXCEPT?
Decreased length of hospital stay
Improved functional outcome
Greater organ dysfunction
Higher likelihood of being discharged to home as opposed to a rehab facility
Improved fracture reduction
The pelvic spur sign on plain radiography is indicative of the following injuries?
Transtectal transverse acetabular fracture
Vertical shear pelvic ring injury
Displaced H-type sacral fracture
Both column acetabular fracture
Anterior-posterior type III pelvic ring injury
During the ilioinguinal approach to the pelvis, the corona mortis artery must be identified and ligated if present. The corona mortis artery joins the external illiac artery with which other major artery?
Deep illiac circumflex
A 42-year-old female sustains the injury seen in the computed tomography images seen in Figures A and B. According to the Letournel classification, what is the injury pattern shown?
Which statement is true with respect to acetabular fracture surgery as the time between injury and surgery increases?
decreased chance of anatomic fracture reduction
decreased risk of heterotopic ossification
decreased rate of neurologic injury
decreased rate of infection
decreased rate of multi-organ failure