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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
An 85-year-old male trips while getting up to use the restroom overnight. He's brought directly to the emergency department by squad. Radiographs upon presentation are shown in Figure A. Operative treatment within 24 hours of admission has been shown to affect which of the following?
Quality of reduction
Postoperative time to ambulation
Ability to return to previous ambulatory status
Select Answer to see Preferred Response
A 37-year-old male presents to the trauma bay with left hip pain after falling 10 feet off a ladder. Radiographs demonstrate the injury seen in Figure A. Which of the following is the most important predictor of fracture healing after operative stabilization?
Surgery within 12 hours
A 78-year-old female presents with left hip pain after she tripped over a rug. Injury radiographs are depicted in figure A. What advantage does total hip arthroplasty over internal fixation for this injury pattern?
Shorter OR time
Lower intraoperative blood loss
Decreased infection rate
Lower reoperation rate
Shorter hospital stay
An 87-year-old male presents with left hip pain after a fall while going to the bathroom at night. His injury is demonstrated in Figure A. Which of the following treatment factors has been associated with decreased patient morbidity?
Early weight-bearing as tolerated and mobility
Use of internal fixation (IF) over arthroplasty
Use of general over neuraxial anesthesia
Post-op patient controlled analgesia (PCA) pain control
A 22-year-old male falls off a 15-foot ladder and sustains the injury depicted in figure A. He is treated with internal fixation and post-op radiographs are depicted in figure B. He returns for follow-up 9 months post-op with persistent groin pain that is worse with ambulation. The treating orthopedic surgeon orders a CT which is demonstrated in figure C. What would be the most appropriate treatment option at this time?
Conversion to a sliding hip screw
Implant removal and conversion to total hip arthroplasty
Placement of 7.0 mm partially-threaded screw perpendicular to the fracture site
Valgus intertrochanteric osteotomy with 130° angled blade plate
Varus intertrochanteric osteotomy with 95° angled blade plate
An 89-year-old male presents to the emergency department with left hip pain after a mechanical fall from standing height. He is found to have the injury depicted in Figure A. Which of the following has been associated with a delay in surgical treatment?
Fascia iliaca block in the emergency department
Admission to a geriatric medicine service
Hb <10 g/dL on presentation
Preoperative daily aspirin use
An 89-year-old female sustained the injury shown in Figure A and underwent a hemiarthroplasty. Which of the following has been associated with increased rates of post-operative dislocation?
Use of a bipolar implant
Use of a monopolar implant
A 65-year-old patient, who is a current smoker, presents with left hip pain after a fall from standing height and is unable to bear weight. The patient's radiograph is shown in figure A. The use of a sliding hip screw construct has been shown to have what benefit compared to multiple cannulated screws?
Decreased fracture shortening
Decreased non-union rate
Decreased implant failure
Lower reoperation rates
Lower rate of avascular necrosis
A 72-year-old woman falls onto her left hip after tripping over a curb during her daily 3-mile walk. An injury radiograph is shown in Figure A. What is the best long term solution?
Valgus intertrochanteric osteotomy
Total hip arthroplasty
A 72-year-old female sustains a displaced intracapsular femoral neck fracture. Which of the following is TRUE regarding the long term differences between possible treatment options for this injury?
Patients undergoing total hip arthroplasty are more likely to experience persistent pain than those undergoing internal fixation
Patients undergoing total hip arthroplasty are less likely to require reoperation than those undergoing internal fixation
There is no difference in functional outcome scores between internal fixation and total hip arthroplasty
Patients undergoing internal fixation perform activities of daily living better than those undergoing total hip arthroplasty
Mortality rates are higher following total hip arthroplasty than internal fixation
A 70-year-old patient with a history of Parkinson’s disease sustains a fall onto his hip. He denies a history of antecedent hip pain and is otherwise healthy. A radiograph of the affected hip is shown in Figure A. What is the best treatment option and best rationale for this patient?
Total hip arthroplasty; decrease his risk for dislocations
Total hip arthroplasty; decrease his risk for infection
Total hip arthroplasty; use a minimally invasive approach
Hip hemiarthroplasty; decrease his risk for dislocations
Hip hemiarthroplasty; decrease his risk for infection
A 65-year-old female sustained the injury seen in Figure A after a slip and fall getting out of the shower. She is an avid golfer and walks the course on most days. Her past medical history includes borderline hypertension and migraine headaches. Which treatment option has shown to have the lowest re-operation rate and best clinical outcomes scores in this patient population?
Closed reduction with cannulated screw fixation
Open reduction with cannulated screw fixation
Closed reduction and short intramedullary nail fixation
A 65-year-old patient sustains the injury shown in Figure A. His medical history is significant for hypertension, Type 2 diabetes and dialysis dependent chronic kidney failure. A postoperative radiograph is shown in Figure B. Based on his risk factors, what is his most likely post operative mortality at two years after surgery?
Which of the following injuries is anticipated to have a 20% chance of mortality and 50% chance of loss of independence at one year when sustained by an 85-year-old female?
Intra-articular distal humerus fracture
Distal radius fracture
Femoral neck fracture
Trimalleolar ankle fracture-dislocation
Periprosthetic distal femur fracture
A 48-year-old active female runner underwent percutaneous screw fixation of a minimally displaced femoral neck fracture six months ago. There were no immediate post-operative complications, and she was progressed to full weight bearing three months after surgical fixation. Initial post-operative radiographs, and radiographs taken 3 months post-op revealed anatomic reduction of the fracture with no shortening. At her latest clinic visit she reports severe right groin pain, and difficulty ambulating. A current radiograph is shown in Figure A. What is the most appropriate surgical treatment?
In situ dynamic hip screw revision fixation
Core decompression and bone grafting
Valgus intertrochanteric osteotomy with blade fixation
Open reduction, bone grafting, and revision percutaneous screw fixation
Which of the following cannulated screw configurations used in the treatment of subcapital femoral neck fractures is optimal?
Inverted triangle pattern with the inferior screw posterior to midline and adjacent to the calcar
Inverted triangle pattern with the inferior screw anterior to midline and adjacent to the calcar
Triangle pattern with the superior screw posterior to midline and adjacent to the calcar
Inverted triangle pattern with the inferior screw posterior to midline and central in the femoral neck
Inverted triangle pattern with the inferior screw anterior to midline and central in the femoral neck
A 15-year-old male falls from his bicycle and lands directly on his left hip. He is unable to bear weight and presents to the emergency department with the AP pelvis radiograph seen in Figure A. Which of the following radiographic views could aid in classifying this patient's fracture pattern?
Iliac oblique (Judet) view
Traction AP of the hip with the leg in neutral rotation
Outlet view of the pelvis
Traction AP of the hip with the leg internally rotated 15°
Traction AP of the hip with the leg externally rotated 15°
A 25-year-old man sustains the fracture seen in Figure A and is seen in pre-op holding prior to surgery. What position of his lower extremity would result in the lowest intracapsular hip pressure?
Neutral rotation and flexion
External rotation and flexion
Internal rotation and extension
External rotation and extension
Internal rotation and flexion
A 79-year-old cyclist is involved in an accident and sustains a displaced femoral neck fracture as seen in Figure A. What is the optimal treatment?
Open reduction internal fixation
Total hip arthoplasty
A 27-year-old man sustains a displaced femoral neck fracture and undergoes urgent open reduction internal fixation. What is the most prevalent complication after this injury?
Poor pre-injury cognitive function has been proven to increase mortality for which of the following injuries?
Proximal humerus fracture
Pelvic ring fracture
Distal femur fracture
A 70-year-old woman trips on the grass while playing golf and sustains a displaced comminuted femoral neck fracture. What is the optimal treatment for this patient?
Total hip arthroplasty
Traction and non operative treatment
A 65-year-old male falls from a standing height and sustains the injury seen in Figure A and undergoes the treatment seen in Figure B. Compared to a total hip arthroplasty, this treatment is associated with which of the following:
Increased blood loss
Lower incidence of revision surgery
Increased risk of peri-prosthetic fracture
Lower dislocation risk
Increased risk deep venous thrombosis
A 75-year-old ambulatory male who lives independently presents with the fracture shown in Figure A. Which of the following is true regarding timing of surgical fixation and post-operative mortality?
30 day mortality is decreased if surgery is delayed 4-7 days
1 year mortality is increased if surgery is delayed greater than 4 days
Delay of surgery due to treatment of acute medical comorbidities has no effect on post-operative mortality rates
90 day mortality rate is decreased if surgery is delayed greater than 7 days
Timing of surgical fixation has no statistically significant affect on post-operative mortality
A 25-year-old male is involved in an high-speed motor vehicle collision and sustains a closed femoral shaft fracture. During further evaluation, a CT scan of the chest/abdomen/pelvis reveals a non-displaced ipsilateral femoral neck fracture. Which of the following treatment options will most likely achieve anatomic healing of the femoral neck and minimize the risk of complications?
Retrograde femoral nail followed by compression hip screw
Lag screw fixation followed by plating of the femoral shaft
Antegrade femoral nail followed by lag screw fixation
Lag screw fixation followed by retrograde femoral nail
Proximal femoral locking plate
A 30-year-old male sustains the injury seen in Figure A after a motor vehicle collision. Which of the following is the most likely complication at 2-year follow-up?
Ipsilateral medial knee degenerative changes
An 82-year-old female sustains a valgus-impacted subcapital femoral neck fracture and undergoes cannulated screw fixation as shown in Figure A. She returns for her first follow-up visit one week later following another fall and now complains of severe hip pain. She is unable to bear weight on the limb, and a new radiograph reveals varus displacement of her fracture. She subsequently undergoes revision fixation but during this procedure, the femoral neck fracture displaces and becomes comminuted. Which is the most appropriate next step in management?
Revision fixation of the femoral neck fracture
Hardware removal and placement of a sliding hip screw device
Hardware removal and hip arthroplasty
Resection hip arthroplasty
Valgus intertrochanteric osteotomy with blade plate fixation is the most appropriate treatment for which of the following figures?
Increased hip intracapsular pressures can lead to diminished femoral head perfusion. Which of the following limb positions has been shown to create the lowest intracapsular hip pressures after a femoral neck fracture?
flexion and internal rotation
extension and external rotation
flexion, abduction, and external rotation
extension, adduction, and internal rotation
there are no differences in hip pressures with any position