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A 67-year-old female falls and sustains the injuries shown in figures A and B. The decision is made to treat her with a trochanteric entry nail. Intraoperative fluoroscopy is seen in figure C. When attempting to remove the guide wire, there is a mechanical block, impeding its extraction. What should be performed next?
Insert wire for lag screw
Remove the nail and re-ream canal
Remove the nail to re-assess fracture reduction
Remove the nail and guide wire
Remove the jig
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A 86-year-old man slips on the ice and falls sustaining the injury shown in Figure A. He has Type 2 diabetes mellitus, atrial fibrillation, coronary artery disease, end-stage renal disease on dialysis and chronic obstructive lung disease. All of the following variables are associated with increased mortality at one year after injury EXCEPT?
Two or more pre-existing medical conditions
Age of eighty-five years or more
Operative fixation within 48 hours
Which of the following deformities is most likely to occur with dynamic hip screw fixation of unstable left sided standard obliquity hip fractures?
Posterior spike displacement of the proximal fragment
Anterior spike displacement of the proximal fragment
Lateral displacement of the proximal fragment relative to the distal fragment
Shortening of the proximal fragment relative to the distal fragment
Medial displacement of the proximal fragment in relation to the distal fragment
Which of the following methods accurately describes the measurement of tip-apex-distance as it relates to placement of a lag screw in the femoral head?
Summation of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs
Distance from the acetabular teardrop to the tip of the screw on an AP radiograph of the hip
Multiplication of the distance between the end of the screw and the apex of the femoral head on AP and lateral radiographs
Distance from the center of the lesser trochanter to the tip of the screw on an AP hip radiograph
Summation of the distance between the tip of the greater trochanter and end of the screw on AP and lateral hip radiographs
A 74-year-old female falls from a standing height and sustains the fracture shown in Figure A. The occurrence of this injury most increases her risk of sustaining which of the following fractures?
Distal radius fracture
Distal fibula fracture
Distal humerus fracture
Which of the following is an advantage of sliding hip screws compared to cephalomedullary nails for the treatment of appropriate intertrochanteric femur fractures?
Decreased risk of deep venous thrombosis
Biomechanically advantageous under physiologic loading
Decreased blood loss
Decreased risk of nonunion
None of the above
Which of the following statements is true regarding treatment of intertrochanteric hip fractures with an intramedullary nail versus a sliding hip screw?
The use of intramedullary nail has increased in the last ten years
The use of sliding hip screws has increased in the last ten years
Medicare reimbursement is more for a sliding hip screw
Intramedullary nails have demonstrated superior outcomes in randomized-controlled studies
Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures
A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. This patient is at increased risk of what complication?
lag screw cutout
lag screw breakage
Which of the following factors has been shown to be the strongest predictor of screw cutout of a dynamic compression hip screw used for an intertrochanteric femur fracture?
Age of the patient
Intrinsic stability of the fracture
Quality of reduction
Angle of the sideplate
An 82-year-old female sustains an intertrochanteric hip fracture and is treated with a sliding hip screw. What is the most appropriate definitive step in treating the failure seen in figure A?
Valgus proximal femoral osteotomy
Total hip arthroplasty
Revision open reduction and internal fixation
Proximal femoral resection
Anterior perforation of the distal femur from antegrade femoral nailing has been attributed to what factor?
Mismatch of the radius of curvature of implant and bone
Usage of too large an implant
Lateral patient positioning
Lateral proximal starting point
Which of the following is not an appropriate implant for treatment of the fracture seen in Figure A?
Proximal femoral locking plate
95 degree blade plate
Sliding hip screw
A 72-year-old male sustains the injury shown in Figure A as a result of a fall from a ladder. Which of the following factors has been shown to be associated with increased collapse or sliding displacement?
Use of a long intramedullary device
Use of a short intramedullary device
Use of external fixation
Postoperative weight bearing status
Intraoperative fracture of the lateral femoral wall
Which of the following is a recognized predictor of mortality after hip fracture?
American Society of Anesthesiologist (ASA) classification
Post-operative weight bearing status
Fixation device used
Type of anesthetic used
When treating a stable 2-part intertrochanteric hip fracture with a sliding hip screw construct, what is the minimum number of screw holes that are needed in the side plate for successful fixation?
All of the following implants offer adequate fracture fixation of the injury shown in Figure A EXCEPT:
Trochanteric entry point cephalomedullary nail
Piriformis fossa entry point cephalomedullary nail
Dynamic hip screw
Fixed angle blade plate
95 degree dynamic condylar screw
A 55-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. What is the most appropriate treatment for this type of injury?
Percutaneous screw fixation
Cephalomedullary nail fixation