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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 45-year-old man is struck while crossing a major highway and sustains the injury depicted in Figure A. Which of the following statements comparing the techniques in Figure B and C is most accurate?
Technique depicted in Figure B is associated with an increased risk of septic arthritis
Technique depicted in Figure B is associated with larger nail placement
Technique depicted in Figure B is associated with improved postoperative fracture alignment
Technique depicted in Figure C is associated with an increased risk of septic arthritis
Technique depicted in Figure C is associated with improved postoperative fracture alignment
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When placing an intramedullary nail for closed distal tibia shaft fractures, all of the following methods are described techniques to aid anatomic reduction EXCEPT:
Plating of a concomitant fibula fracture
Percutaneous placement of reduction foreceps at the fracture site
Placing a Poller screw
Placing a small-fragment plate at the fracture site
Placing syndesmotic fixation
A 35-year-old male presents with the post-traumatic deformity shown in Figures A and B. He has pain and difficulty walking, and deformity correction with a ring fixator is planned. When considering the principles of deformtiy surgery, it should be noted that angular corrections performed as opening or closing wedges NOT at the level of the apex of the deformity will create which of the following secondary deformities?
A 35-year-old male patient sustains a twisting injury to his leg while playing soccer. Radiographs are seen in Figures A and B. You decide to treat this fracture with intramedullary nailing. In order to prevent a missed injury that should be addressed during the same surgery, you order the following test
MRI of the ipsilateral knee
MRI of the ipsilateral hip
CT scan of the ipsilateral knee
Radiographs of the ipsilateral ankle
Axial radiograph of the ipsilateral calcaneus
A 25-year-old male pedestrian sustained a Type II open tibia fracture after being struck by a car at 10:00PM. He was transported to a Level I trauma hospital where he was given intravenous antibiotics and tetanus at 10:45PM. He underwent irrigation and debridement of the wound with 9L of saline solution and was treated with reamed intramedullary nail fixation at 11:45PM. A vacuum assisted dressing was placed over a 5x3cm skin deficit. What part of his overall treatment has shown to reduce the risk of infection THE MOST at the site of injury?
Early tetanus administration
Early intravenous antibiotic administration
Reamed intramedullary nail fixation
Irrigation and debridement of the open fracture with 9L of solution
Vacuum assisted dressings over skin deficit
A 27-year-old male presented to the trauma bay following a motor vehicle crash and was diagnosed with a comminuted open tibia fracture. He was subsequently treated with an irrigation and debridement, and un-reamed intramedullary nail. At 4 months follow-up, despite some signs of healing, the fracture is not fully united. Which of the following is true?
Patient should be scheduled for exchange nailing.
Use of an un-reamed nail increased this patients risk of infection.
Use of an un-reamed nail increased this patient's risk of non-union.
Patient should continue to be observed without intervention.
Use of an un-reamed nail decreased this patient's risk of infection.
Which of the following is true regarding the center of rotation of angulation (CORA) as it refers to tibial diaphyseal angular deformity?
It is the point at which the proximal mechanical axis and distal mechanical axis meet
It is the point at which the proximal anatomical axis and proximal mechanical axis meet
It is always the point on the cortex at the most concave portion of the deformity
It is the point at which the distal anatomical axis and distal mechanical axis meet
It is always the point on the cortex at the most convex portion of the deformity
A 67-year-old male is involved in a motor vehicle accident and presents with the closed orthopedic injuries shown in Figures A and B. He is also noted to have a grade 1 splenic laceration and lung contusion. He is cleared by the trauma team, and undergoes early total care with reamed femoral and tibial nailing. A tourniquet is used for the tibial nailing portion of the case, and the tibial isthmus is over reamed to accept a larger nail. The use of a tourniquet in this case has been most clearly shown to be associated with which of the following?
Tibia shaft necrosis post-operatively
Increased pulmonary morbidity post-operatively
Increased cortical bone temperature during reaming
Increased nonunion rates
Decreased pain post-operatively
Which of the following fracture patterns is classically associated with varus malunion if treated with closed reduction and casting?
A 21-year-old male undergoes intramedullary nailing of the closed tibial shaft fracture shown in Figure A. At his 6-week follow-up, he is noted to have peroneal nerve deficits that were not present preoperatively. Which of the following findings is most consistent with a diagnosis of transient peroneal nerve neurapraxia as the result of his intramedullary nailing?
Decreased lateral hindfoot sensation
Decreased Achilles reflex
Decreased peroneus longus strength
Decreased extensor hallucis longus strength
Decreased plantar forefoot sensation
A 35-year-old male suffers the injury seen in Figures A and B following a motor vehicle collision. He is initially taken to a local hospital. The treating surgeon, concerned that his hospital does not have a plastic surgeon available for soft-tissue coverage, arranges for transfer of the patient to a nearby level I trauma center for definitive care. Upon arrival at the definitive treatment center, the patient is taken for formal debridement and external fixator application. Which of the following options has the greatest effect on this patient's risk of infection?
External fixator application
Operative debridement within 6 hours
TIme to transfer to definitive trauma center
Soft-tissue coverage within 48 hours
A 54-year-old female sustains a communited tibial shaft fracture from an accident at work. She undergoes simultaneous external fixation and ORIF using minimally invasive plate osteosynthesis. Following surgery, she complains of numbness along the dorsum of her medial and lateral foot. In which location (labeled A - E) on Figure A did percutaneous placement without careful dissection of a pin/screw likely cause her nerve injury?
A 27-year-old female sustains a twisting injury to her leg while rollerblading. Radiographs of the tibia and fibula are provide in Figures A and B. A closed reduction is performed and the patient is placed in a long leg cast. Radiographs following cast placement are provided in Figures C and D. The decision is made to proceed with closed treatment instead of operative. Which of the following is most likely to occur with nonoperative management?
Malunion due to unacceptable coronal alignment
Malunion due to unacceptable sagittal alignment
Fracture displacement due to the mechanism of injury
Fracture displacement due to the age of the patient
Shortening due to the oblique nature of the tibia fracture
Isolated exchange reamed interlocking nailing is most likely indicated as the next step in treatment for which of the following clinical scenarios:
Tibial shaft nonunion with a 4cm bone defect
Infected tibial shaft nonunion
Hypertrophic diaphyseal tibial nonunion
Atrophic tibial shaft nonunion
Hypertrophic metadiaphyseal distal tibia nonunion
A 45-year-old female pedestrian is hit by an automobile. A clinical photo and radiograph are shown in Figure A and B. What is the most important factor in a surgeon's decision of determining between limb salvage and amputation?
Level of education
Lack of plantar sensation
Contralateral lower extremity open fracture(s)
Severity of soft tissue injury
Amount of tibial bone loss
Which of the following nonunions is appropriately treated with exchange reamed nailing without bone graft augmentation?
Infected tibial shaft nonunion 6 months status post intramedullary nail fixation
Oligotrophic humeral shaft nonunion 7 months status post non-operative management
Hypertrophic tibial shaft nonunion 7 months status post intramedullary nail fixation
Comminuted open tibial shaft nonunion with segmental bone loss 8 months status post intramedullary nail fixation
Supracondylar femoral shaft nonunion 6 months status post intramedullary nail fixation with 4 distal locking screws
Percutaneous placement of a lateral proximal tibial locking plate that extends down to the distal third of the leg is associated with postoperative decreased sensation of which of the following distributions?
First dorsal webspace
A 21-year-old male sustains the open injury shown in Figure A, which is associated with a 12 centimeter laceration over the fracture site. This laceration is able to be closed during initial surgery. What adjunct treatment has been shown to improve outcomes when using an intramedullary nail?
Adjunctive fracture plating
Antibiotic impregnated cement beads
Which of the following types of nonunions is most likely to achieve union following a reamed exchange intramedullary nailing only?
Distal femoral nonunion with less than 10% bone loss
Infected nonunion of the femoral shaft
Mid-diaphyseal humeral nonunion with less than 10% bone width loss
Proximal humeral shaft nonunion with less than 10% bone width loss
Diaphyseal tibial shaft nonunion with less than 30% cortical width bone loss
A 45-year-old male presents with the fracture seen in Figures A and B after a motor vehicle collision. After debridement and external fixation, he is taken to the operating room for definitive soft tissue flap coverage and intramedullary nailing. Administration of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) at the time of fracture fixation will lead to which of the following?
Decreased need of subsequent bone grafting procedures
Shorter hospital stay
Increased blood loss
Decreased risk of angular deformity at final union
Increased risk of deep vein thrombosis
Which of the following factors has been shown in a clinical trial to be equivalent to autologous bone graft for treatment of tibial nonunions that were treated with intramedullary nailing?
Demineralized bone matrix
Cancellous bone allograft chips
A 32-year-old male sustains the injury shown in Figure A and undergoes treatment as shown in Figure B. Following placement of this implant, what is the best technique to confirm it is not too proud proximally?
Lateral radiograph of the knee
AP radiograph of the knee
Oblique radiographs of the knee
Merchant radiograph of the knee
Internally rotated 45 degree view of the knee
What is the most common type of malalignment after intramedullary nailing of distal 1/3 extra-articular tibia fractures using a infrapatellar approach when compared with plating?
A 30-year-old man presents with a distal third tibia fracture that has healed in 25 degrees of varus alignment. The patient is at greatest risk of developing which of the following conditions as a result of this malunion?
Degenerative lumbar spine changes
Ipsilateral ankle pain and stiffness
Ipsilateral hip joint degenerative changes
Contralateral hip joint degenerative changes
Ipsilateral medial knee degenerative changes
A 25-year-old man is struck by car while crossing the street. His injuries include the closed left tibial shaft fracture shown in Figure A. He is a smoker, but is otherwise healthy. Intramedullary nailing is performed without initial complications. Which of the following puts this patient at greatest risk for tibial nonunion?
Use of anti-inflammatories post-operatively
Post-operative gapping at the fracture site
Presence of an associated fibular fracture
History of smoking
Mechanism of injury
A 25-year-old male is a driver in a motor vehicle accident and sustains the isolated closed injury seen in Figures A and B. He is treated with an intramedullary nail, and postoperative radiographs are shown in Figures C and D. Which of the statements concerning reaming and nails is true?
Unreamed tibias have the highest amount of mineral apposition rates
Unreamed tibias result in the highest amount of new bone formation
Unreamed nails result in the lowest porosity of bone
Reamed and unreamed tibias have similar mineral apposition rates
Tight nails results in higher cortical reperfusion than loose nails
When discussing treatment options with a 35-year-old healthy male with an isolated, closed tibial shaft fracture, the surgeon should inform him that in comparison to closed treatment, the advantages of intramedullary nail fixation include all of the following EXCEPT?
Quicker time to union
Decreased risk of malunion
Decreased risk of compartment syndrome
Decreased risk of shortening
Quicker return to work
A 36-year-old male is brought to the trauma center following a motor vehicle accident. Physical exam shows a deformed left lower extremity with a 1-cm open wound over the anterolateral aspect of his leg. Radiographs are provided in Figures A and B. Which of the following interventions has been shown in the literature to decrease the occurrence of infection at the fracture site?
Operative debridement within 6 hours of injury
Immediate prophylactic antibiotic administration
Immediate stabilization with internal fixation after debridement
Irrigating with a saline solution that is mixed with an antibiotic
Irrigating with high pressure pulsatile lavage following surgical debridement
What percentage of patients will complain of knee pain at the time of union of a tibial shaft fracture treated with a reamed intramedullary nail?