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Which of the following is the most significant risk factor for lateral meniscal tears associated with lateral tibial plateau fractures?
Age greater than 50
Ipsilateral calcaneus fracture
Greater than 10mm of articular depression
Schatzker I fracture pattern
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A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. A post-fixator CT scan image is shown in Figure C. After allowing her soft tissues to improve, the optimal definitive stabilization of this fracture is which of the following?
Continued use of knee-spanning external fixator
Conversion of external fixator to a simple hinged knee fixator
Conversion to intramedullary nailing
Open reduction and internal fixation with a lateral locked plate
Open reduction and internal fixation with medial and lateral plates
Which of the following injuries is most likely associated with the fracture seen in Figure A?
Medial meniscal tear
Lateral meniscal tear
Lateral collateral ligament rupture
Medial collateral ligament rupture
Posterior cruciate ligament rupture
An ankle-brachial index is most commonly indicated after sustaining which of the following fracture patterns, seen in Figures A-E?
A 35-year-old female presents with the orthopaedic injuries shown in Figures A-D following a high-speed motor vehicle collision. She is also found to have a right-sided diaphragmatic hernia (Figure E) and a stable subarachnoid hemorrhage. The femoral and tibial plateau fractures are open with no gross contamination, and there is an ipsilateral Morel-Lavelle lesion of the left thigh. What is the most appropriate initial management of the patient’s injuries in addition to debridement and irrigation of the open injuries?
Application of a knee immobilizer, splinting of the ankle and forearm
External fixation of the femur and tibial plateau, splinting of the ankle and forearm
Retrograde intramedullary nailing of the femur, limited internal fixation of the tibial plateau, splinting of the ankle and forearm
External fixation of the femur, ORIF of the tibial plateau, splinting of the ankle and forearm
Retrograde intramedullary nailing of the femur, ORIF of the tibial plateau, ORIF of the ankle and forearm
Figure A shows an acute, isolated and closed, left knee injury in a 40-year-old male struck by a motor vehicle. What would be the most appropriate surgical fixation for this injury?
Definitive external fixation
Temporary external fixation then lateral percutaneous screws
Lateral nonlocking plate +/- bone graft substitutes
Medial and lateral locking plate +/- bone graft substitutes
Lateral percutaneous screws with assisted arthroscopy
A 32-year-old male sustains the injury shown in Figures A through D as the result of a high-speed motorcycle collision. He initially undergoes spanning external fixation and returns to the office for soft tissue evaluation prior to his definitive surgery. During this visit, you discuss that the most appropriate fixation is which of the following?
Lateral precontoured locked plating
Posterior buttress plating
Medial antiglide plating
Anterolateral and posteromedial plating
Posterolateral neutralization plating
A 45-year-old patient sustains the injury shown in figure A. What radiographic finding most highly suggests a lateral meniscal injury?
Joint depression of 3mm
Ipsilateral femoral shaft fracture
Joint widening of 6mm
Ipsilateral tibial shaft fracture
Displaced tibial spine fracture
A 23-year-old healthy male was involved in a motor vehicle collision and sustained the injury seen in Figure A. Physical examination after ORIF of the plateau fracture revealed a Grade 3 Lachman, varus laxity at both 0 and 30 degrees of knee flexion, and 15 degrees of external rotation asymmetry at 30 degrees of knee flexion. Which of the following structures (indicated with asterisk*) must be surgically repaired to restore stability to the knee?
A 32-year-old man sustains the knee injury seen in Figure A after falling from a ladder. Which of the following options is the most biomechanically stable and appropriate definitive surgical treatment?
Spanning knee external fixation
Lateral plateau locking plate
Posteromedial locking plate
Lateral plateau percutaneous lag screws and posteromedial plate
Lateral plateau and posteromedial plating
Which of the following tibial plateau fractures would be most appropriately treated by buttress plating alone?
A 38-year-old male suffers the injury shown in Figure A. During operative fixation, free osteoarticular fragments are encountered and reconstruction of these pieces is attempted. Postoperatively, which of the following will have the most beneficial effect on the healing potential of the surviving chondrocytes within these reconstructed articular segments?
Gentle compressive loading of the affected joint through early range of motion exercises
Strict joint immobilzation for three weeks
Shear loading of the affected joint
Joint distraction with a spanning external fixator for three weeks
Glucosamine chondroitin sulfate supplementation
A 21-year-old male sustains the injury shown in Figures A through D. Which of the following is the most appropriate definitive treatment of this injury?
Spanning external fixation
Lateral locking plate
Lateral buttress plate
Posteromedial buttress plate
Medial bridging plate
A 58-year-old man injures his knee in a high-speed motor vehicle collision. Radiographs and CT are shown in Figures A thru C. What is the most appropriate surgical plan based on the images provided?
ORIF with medial and lateral plating with grafting of metaphyseal defect
ORIF with lateral plating with grafting of metaphyseal defect
ORIF with medial plating
ORIF with lateral plating
Percutaneous articular fragment reduction and screw fixation
Vascular complications are most commonly seen with which of the following fractures about the knee?
Lipohemarthrosis of the knee is most likely secondary to which of the following?
Seronegative monoarticular arthritis
Patellar tendon rupture
Medial meniscus tear
Medial patellofemoral ligament rupture
A 53-year-old man sustains the injury seen in figure A and later undergoes open reduction and internal fixation. What variable will most significantly increase his rate of degenerative arthritis in the long-term?
Postoperative joint stepoff
Alteration of limb mechanical axis
A large posteromedial tibial plateau fracture pattern, as seen with the bicondylar tibial plateau fracture shown in Figures A and B, is important to recognize because of which of the following factors?
Association with posteromedial corner of the knee injury
Association with anterior tibial artery injury
Possible need for dual plate fixation
Possible need for single extensile anterior approach to the knee
Increased risk of deep venous thrombosis
A 56-year-old carpenter sustains the closed injury seen in Figures A, B, and C. After temporary spanning external fixation is performed and soft tissue conditions improve, what strategy provides the optimal fixation for this fracture pattern?
Anatomic lateral locking plate
Posteromedial and lateral plates
Anatomic medial locking plate
Conversion of the spanning external fixator to a hinged external fixator
Posterior buttress plate
In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau?
More concave and more proximal
More convex and more proximal
More concave and more distal
More convex and more distal
Symetric in conture and more distal
In treating a lateral split-depression type tibial plateau fracture, which of the following adjuncts has been shown to have the least articular surface subsidence when used to fill the bony void?
Crushed cancellous allograft
Calcium phosphate cement
Autogenous iliac crest
Bisected diaphyseal humeral allograft
Buttress plating is most appropriate in which of the following clinical situations?
A 40-year-old female sustains the injury seen in Figure A. What other associated soft-tissue knee injury is most commonly associated with this fracture?
Anterior cruciate ligament midsubstance tear
Horizontal cleavage lateral meniscus tear
Peripheral lateral meniscus tear
Lateral collateral ligament and popliteofibular ligament tear
Lateral meniscus posterior root avulsion
Based on the following radiographs of tibial plateau fractures, which one is most likely to have a concomitant medial meniscus tear?
When elevating the joint surface in the injury pattern seen in Figure A, what material has the highest compressive strength when filling the metaphyseal void?
A 35-year-old male sustains a closed Schatzker VI tibial plateau fracture. Two weeks following external fixation, examination reveals intact sensation, palpable pulses and no soft tissue compromise. An axial CT image is shown in Figure A. What is the optimal surgical plan?
Medial and lateral plate fixation through two approaches
Medial and lateral plate fixation through a single anterior approach
Lateral locking plate fixation
Continued external fixation until union
Multiplanar transarticular external fixator
A 28-year-old man is thrown from his motorcycle and sustains the closed injury seen in Figure A. The limb remains neurovascularly intact. What is the most appropriate initial treatment of this injury?
Bulky compressive splint
Open reduction and internal fixation
Closed intramedullary nailing
Hinged spanning external fixation
A 35-year-old male sustains the fracture seen in Figures A and B. Which of the following substances has been shown to result in the least radiographic subsidence when combined with open reduction and internal fixation?
Cancellous allograft bone chips
Autograft iliac crest
Femoral intramedullary reamings
Calcium sulfate cement
A 69-year-old female sustains the injuries seen in Figures A and B. This injury is best classified as which of the following?
Schatzker type I tibial plateau fracture
Schatzker type III tibial plateau fracture
Schatzker type IV tibial plateau fracture
Schatzker type V tibial plateau fracture
Schatzker type VI tibial plateau fracture
A 27-year-old male is involved in a motor vehicle accident and sustains the injury shown in Figures A through E. The articular surface is depressed 2 mm while there is 3 mm of condylar widening. Valgus instability of the knee is noted. Which of the following is most important to long-term success in surgical treatment of this case?
Restoration of joint stability
Repair of associated meniscal pathology
Surgical fixation within 48 hours of injury
Correction of the articular depression
Tibial condylar diastasis < 3 mm