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ABPS Orthopedic Surgery study materials
ABPS Orthopedic Surgery study resources

ABPS Orthopedic Surgery practice questions

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Question 1Orthopedic Surgery Knowledge and Skills (written exam)

A 24-year-old man sustains a closed tibial shaft fracture. Which finding is the earliest reliable clinical sign of compartment syndrome?

  1. Pain with passive stretch of the compartment muscles Correct answer.
  2. Absent distal pulses
  3. Motor paralysis of the compartment
  4. Pallor of the overlying skin

Explanation

Compartment syndrome is a clinical diagnosis in which pain out of proportion and pain on passive stretch of the involved compartment are the earliest dependable findings. Pulselessness, paralysis, and pallor are late signs reflecting advanced ischemia and tissue death. Distal pulses are typically preserved because compartment pressures rarely exceed arterial pressure.

Question 2Orthopedic Surgery Knowledge and Skills (written exam)

Which nerve is most commonly injured during a direct lateral approach to the hip?

  1. Sciatic nerve
  2. Femoral nerve
  3. Obturator nerve
  4. Superior gluteal nerve Correct answer.

Explanation

The superior gluteal nerve runs between the gluteus medius and minimus and is at risk with the direct lateral (Hardinge) approach, especially if the split extends more than about 5 cm proximal to the greater trochanter. Injury produces a Trendelenburg gait from gluteus medius weakness. The sciatic nerve is at risk in posterior approaches, and the femoral and obturator nerves are not in the field of a lateral approach.

Question 3Orthopedic Surgery Knowledge and Skills (written exam)

A 62-year-old woman has a displaced femoral neck fracture. Which factor most strongly predicts the development of avascular necrosis of the femoral head?

  1. Time to weight bearing
  2. Displacement of the fracture Correct answer.
  3. Patient age at injury
  4. Side of the fracture

Explanation

The blood supply to the femoral head, chiefly the medial femoral circumflex artery via the lateral epiphyseal vessels, is disrupted in proportion to fracture displacement. Increasing displacement (higher Garden grade) correlates with higher rates of avascular necrosis. Age, laterality, and weight-bearing timing do not determine vascular compromise at the time of injury.

Question 4Orthopedic Surgery Knowledge and Skills (written exam)

Which organism is the most common cause of acute hematogenous osteomyelitis in otherwise healthy adults?

  1. Staphylococcus aureus Correct answer.
  2. Pseudomonas aeruginosa
  3. Neisseria gonorrhoeae
  4. Streptococcus pyogenes

Explanation

Staphylococcus aureus accounts for the majority of acute hematogenous osteomyelitis across age groups, including adults. Pseudomonas is characteristically associated with intravenous drug use, puncture wounds, or immunocompromise, and gonococcus causes a septic arthritis rather than typical osteomyelitis. Streptococcus is a much less frequent cause.

Question 5Orthopedic Surgery Knowledge and Skills (written exam)

A 55-year-old man has a painful, stiff shoulder with restricted active and passive forward elevation and external rotation. Radiographs show preserved joint space. Which diagnosis is most consistent with these findings?

  1. Rotator cuff tear
  2. Calcific tendinitis
  3. Adhesive capsulitis Correct answer.
  4. Acromioclavicular osteoarthritis

Explanation

Adhesive capsulitis produces global loss of both active and passive motion, especially external rotation, with normal radiographs. A rotator cuff tear typically causes weakness and loss of active elevation with relatively preserved passive motion. AC arthritis is localized to the joint, and calcific tendinitis shows calcification on imaging.

Question 6Orthopedic Surgery Knowledge and Skills (written exam)

Which finding on the Ottawa Ankle Rules indicates that an ankle radiograph is required?

  1. Bone tenderness at the posterior edge of the distal 6 cm of the lateral malleolus Correct answer.
  2. Pain with weight bearing that resolves after a few steps
  3. A history of a prior ankle sprain
  4. Swelling over the dorsum of the foot

Explanation

The Ottawa Ankle Rules require radiographs if there is pain in the malleolar zone plus bone tenderness along the posterior edge or tip of either malleolus within the distal 6 cm, or an inability to bear weight for four steps. Swelling alone, prior sprain, or transient pain are not criteria. The rules are designed to reduce unnecessary imaging while detecting fractures.

Question 7Orthopedic Surgery Knowledge and Skills (written exam)

A 70-year-old woman has an osteoporotic distal radius fracture. Which fracture pattern is most characteristic of a Colles fracture?

  1. Volar angulation of the distal fragment
  2. Associated radial head dislocation
  3. Intra-articular fracture with volar lip fragment
  4. Dorsal angulation of the distal fragment Correct answer.

Explanation

A Colles fracture is a distal radius fracture with dorsal displacement and dorsal angulation of the distal fragment, typically from a fall on an outstretched hand. Volar angulation describes a Smith fracture, and a volar lip fragment with radiocarpal subluxation describes a Barton fracture. Radial head dislocation with ulnar fracture is a Monteggia injury.

Question 8Orthopedic Surgery Knowledge and Skills (written exam)

Which imaging modality is the most sensitive for detecting early occult scaphoid fracture when initial radiographs are normal but clinical suspicion persists?

  1. Ultrasound
  2. Bone scan
  3. Computed tomography
  4. Magnetic resonance imaging Correct answer.

Explanation

MRI is the most sensitive and specific test for occult scaphoid fracture and can also detect avascular necrosis and ligamentous injury. CT is useful for assessing displacement and union but is less sensitive for early occult fracture. Ultrasound and bone scan are less specific and generally not first-line.

Question 9Orthopedic Surgery Knowledge and Skills (written exam)

A patient has a complete radial nerve palsy after a humeral shaft fracture. Which motor deficit is expected?

  1. Inability to oppose the thumb
  2. Inability to abduct the shoulder
  3. Inability to extend the wrist and fingers Correct answer.
  4. Inability to flex the elbow

Explanation

The radial nerve supplies the wrist and finger extensors, so injury produces wrist drop and loss of finger extension. Elbow flexion is mediated by the musculocutaneous nerve, shoulder abduction by the axillary and suprascapular nerves, and thumb opposition by the median nerve. Radial nerve palsy spares elbow flexion.

Question 10Orthopedic Surgery Knowledge and Skills (written exam)

Which radiographic parameter is used to assess the severity of a developmental dysplasia of the hip on an anteroposterior pelvis radiograph in a child?

  1. Cobb angle
  2. Acetabular index Correct answer.
  3. Green line
  4. Meary angle

Explanation

The acetabular index measures the slope of the acetabular roof and is increased in developmental dysplasia of the hip. The Cobb angle measures scoliosis, the Meary angle assesses the foot arch, and the Green line is not a standard dysplasia measure. Serial acetabular index measurements help guide treatment.

Question 11Orthopedic Surgery Knowledge and Skills (written exam)

A 45-year-old man has a displaced midshaft clavicle fracture with skin tenting. Which treatment is most appropriate?

  1. Open reduction and internal fixation Correct answer.
  2. Figure-of-eight bandage
  3. Immediate shoulder range-of-motion exercises
  4. Sling immobilization alone

Explanation

Displaced midshaft clavicle fractures with skin compromise, shortening, or high displacement benefit from operative fixation to restore length and alignment and to protect the skin. Sling or figure-of-eight treatment is reserved for minimally displaced fractures. Early aggressive motion is inappropriate before stabilization.

Question 12Orthopedic Surgery Knowledge and Skills (written exam)

Which laboratory finding is most consistent with osteomalacia?

  1. Elevated serum calcium with low alkaline phosphatase
  2. Elevated serum phosphate with low alkaline phosphatase
  3. Low serum phosphate with elevated alkaline phosphatase Correct answer.
  4. Normal vitamin D with high serum calcium

Explanation

Osteomalacia results from defective mineralization, often from vitamin D deficiency, and typically shows low or normal calcium, low phosphate, and elevated alkaline phosphatase. Hypercalcemia with low alkaline phosphatase is not characteristic. These biochemical markers help distinguish osteomalacia from osteoporosis, which usually has normal values.

Question 13Orthopedic Surgery Knowledge and Skills (written exam)

Which structure is most at risk during proximal interphalangeal joint dorsal approach for a mallet finger?

  1. The flexor digitorum profundus tendon
  2. The median nerve
  3. The ulnar artery
  4. The extensor tendon insertion Correct answer.

Explanation

A mallet finger results from disruption of the terminal extensor tendon insertion at the distal phalanx, so dorsal approaches near the distal interphalangeal joint risk the extensor mechanism. The flexor profundus lies volarly, and the median nerve and ulnar artery are far proximal to the digit. Careful soft tissue handling protects the extensor tendon.

Question 14Orthopedic Surgery Knowledge and Skills (written exam)

A 30-year-old runner has lateral knee pain worsened by running downhill. Which finding best supports a diagnosis of iliotibial band syndrome?

  1. Tenderness over the medial joint line
  2. Point tenderness over the lateral femoral epicondyle Correct answer.
  3. Positive McMurray test
  4. Positive Lachman test

Explanation

Iliotibial band syndrome produces focal tenderness over the lateral femoral epicondyle where the band rubs during knee flexion, and pain is often worse with downhill running. A positive McMurray test suggests meniscal pathology, a positive Lachman indicates ACL insufficiency, and medial joint line tenderness suggests medial meniscal or collateral ligament injury.

Question 15Orthopedic Surgery Knowledge and Skills (written exam)

Which finding on examination is most consistent with a posterior cruciate ligament tear?

  1. Medial joint line opening with varus stress
  2. Anterior translation of the tibia with the knee flexed
  3. Lateral joint line opening with valgus stress
  4. Posterior sag of the tibia with the knee flexed Correct answer.

Explanation

The posterior drawer test and posterior sag sign reflect posterior tibial translation due to loss of the posterior cruciate ligament restraint. Anterior translation indicates ACL insufficiency, while valgus and varus stress opening indicate collateral ligament injury. The posterior sag sign is a reliable indicator of PCL deficiency.

Question 16Orthopedic Surgery Knowledge and Skills (written exam)

A 65-year-old man has a displaced femoral neck fracture and is independently ambulatory. Which treatment is generally preferred?

  1. Total hip arthroplasty Correct answer.
  2. Traction immobilization
  3. Cannulated screw fixation
  4. Hemiarthroplasty with a bipolar prosthesis

Explanation

For an active, independent older patient with a displaced femoral neck fracture, total hip arthroplasty offers better function and lower reoperation rates than hemiarthroplasty or fixation. Cannulated screws are reserved for younger patients or nondisplaced fractures. Traction immobilization is not definitive treatment.

Question 17Orthopedic Surgery Knowledge and Skills (written exam)

Which of the following best describes the mechanism of injury in a posterior shoulder dislocation?

  1. Direct blow to the anterior shoulder
  2. Fall onto an outstretched hand with the arm abducted and externally rotated
  3. Forced hyperextension of the elbow
  4. Seizure or electrical shock Correct answer.

Explanation

Posterior shoulder dislocation typically results from violent muscle contraction as in seizures or electrical shock, or from a direct blow to the anterior shoulder. The classic anterior dislocation occurs with abduction and external rotation. Hyperextension of the elbow does not cause shoulder dislocation.

Question 18Orthopedic Surgery Knowledge and Skills (written exam)

A 50-year-old woman has a distal radius fracture treated with cast immobilization. Three months later she has persistent pain and a swollen, glossy hand with stiffness. Which diagnosis is most likely?

  1. Carpal tunnel syndrome
  2. Complex regional pain syndrome Correct answer.
  3. Dupuytren contracture
  4. de Quervain tenosynovitis

Explanation

Complex regional pain syndrome presents with disproportionate pain, swelling, skin changes, and stiffness after fracture, often with vasomotor and trophic features. Carpal tunnel syndrome causes median nerve symptoms, de Quervain causes radial wrist pain with tendon sheath tenderness, and Dupuytren causes palmar cords. The diffuse glossy swelling and pain best fit CRPS.

Question 19Orthopedic Surgery Knowledge and Skills (written exam)

Which radiographic view is best for evaluating a suspected scaphoid fracture?

  1. Lateral view of the wrist
  2. Oblique view of the hand
  3. Anteroposterior view of the elbow
  4. Posteroanterior view with ulnar deviation Correct answer.

Explanation

The scaphoid is best seen on a PA view with ulnar deviation, which extends the scaphoid and reduces overlap. A lateral wrist view assesses alignment rather than the scaphoid detail, and elbow or hand oblique views do not optimally profile the scaphoid. Additional scaphoid views are often obtained when clinical suspicion is high.

Question 20Orthopedic Surgery Knowledge and Skills (written exam)

Which physical examination finding is most specific for a meniscal tear?

  1. Diffuse knee swelling
  2. Weakness of knee extension
  3. Positive patellar apprehension test
  4. Joint line tenderness with a positive McMurray test Correct answer.

Explanation

Joint line tenderness combined with a positive McMurray test suggests a meniscal tear, though no single test is definitive and MRI is often used to confirm. Diffuse swelling is nonspecific, patellar apprehension suggests patellar instability, and quadriceps weakness suggests extensor mechanism pathology.

Question 21Orthopedic Surgery Knowledge and Skills (written exam)

Which of the following is a classic radiographic feature of osteoarthritis of the knee?

  1. Asymmetric joint space narrowing with marginal osteophytes Correct answer.
  2. Periarticular osteopenia with erosions
  3. Uniform joint space widening
  4. Chondrocalcinosis with preserved joint space

Explanation

Osteoarthritis is characterized by asymmetric joint space narrowing, subchondral sclerosis, marginal osteophytes, and subchondral cysts. Uniform widening is not typical, erosive changes suggest inflammatory arthritis, and chondrocalcinosis points to calcium pyrophosphate deposition disease. These features help distinguish OA from inflammatory arthropathy.

Question 22Orthopedic Surgery Knowledge and Skills (written exam)

A 20-year-old athlete has anterior knee pain with a positive patellar apprehension test and a history of patellar dislocation. Which structure is most likely injured?

  1. Iliotibial band
  2. Biceps femoris tendon
  3. Medial patellofemoral ligament Correct answer.
  4. Popliteus tendon

Explanation

The medial patellofemoral ligament is the primary restraint to lateral patellar displacement, and its disruption is the key lesion after lateral patellar dislocation. The iliotibial band and biceps femoris are lateral structures, and the popliteus contributes to posterolateral knee stability. Patellar apprehension supports this diagnosis.

Question 23Orthopedic Surgery Knowledge and Skills (written exam)

Which of the following is the most appropriate initial management for a suspected open fracture of the tibia in the emergency department?

  1. Antibiotics and tetanus prophylaxis with urgent surgical debridement Correct answer.
  2. Delayed irrigation until definitive fixation in the operating room
  3. Immediate closed reduction and cast application without antibiotics
  4. Observation with serial examinations

Explanation

Open fractures require early intravenous antibiotics, tetanus prophylaxis, wound coverage, and urgent surgical irrigation and debridement to reduce infection risk. Delaying antibiotics or debridement increases infection rates. Observation is inappropriate for an open fracture.

Question 24Orthopedic Surgery Knowledge and Skills (written exam)

Which of the following best describes the role of the anterior cruciate ligament?

  1. Restraining varus opening of the knee
  2. Restraining valgus opening of the knee
  3. Restraining posterior translation of the tibia on the femur
  4. Restraining anterior translation of the tibia on the femur Correct answer.

Explanation

The ACL primarily limits anterior translation of the tibia relative to the femur and controls rotational stability. The PCL limits posterior translation, while the medial and lateral collateral ligaments resist valgus and varus stress respectively. This functional anatomy underlies the Lachman and anterior drawer tests.

Question 25Orthopedic Surgery Knowledge and Skills (written exam)

A 40-year-old man has a low-energy tibial plateau fracture with a split-depression pattern. Which imaging study is most useful for preoperative planning of articular depression?

  1. Ultrasound
  2. Computed tomography Correct answer.
  3. Bone scan
  4. Plain radiography

Explanation

CT with reconstructions better characterizes articular depression, fragment displacement, and surgical planning for tibial plateau fractures than plain radiographs. Ultrasound and bone scan do not provide the bony detail needed for operative planning. CT often changes the surgical plan compared with radiographs alone.

Question 26Orthopedic Surgery Knowledge and Skills (written exam)

A 25-year-old man sustains a shoulder injury and presents with the arm held in internal rotation and adduction. An AP radiograph shows a 'light bulb' sign. Which additional finding is most commonly associated with this injury?

  1. Reverse Hill-Sachs lesion Correct answer.
  2. Bankart lesion
  3. Hill-Sachs lesion
  4. Superior labral tear

Explanation

Posterior shoulder dislocations are frequently associated with an impaction fracture of the anteromedial humeral head, the reverse Hill-Sachs lesion, caused by the head striking the posterior glenoid rim. The 'light bulb' sign reflects fixed internal rotation of the humeral head.

Question 27Orthopedic Surgery Knowledge and Skills (written exam)

Which nerve is most commonly injured during a direct lateral approach to the hip for hemiarthroplasty?

  1. Sciatic nerve
  2. Femoral nerve
  3. Obturator nerve
  4. Superior gluteal nerve Correct answer.

Explanation

The direct lateral (Hardinge) approach splits the gluteus medius and minimus near their insertion, placing the superior gluteal nerve at risk and potentially causing postoperative abductor weakness. The sciatic nerve is more typically at risk with a posterior approach.

Question 28Orthopedic Surgery Knowledge and Skills (written exam)

A 55-year-old woman has a distal radius fracture with dorsal angulation, dorsal displacement, and a dorsal cortical comminution. Which eponym best describes this fracture pattern?

  1. Chauffeur fracture
  2. Smith fracture
  3. Colles fracture Correct answer.
  4. Barton fracture

Explanation

A Colles fracture is a distal radius fracture with dorsal displacement and dorsal angulation, often with dorsal comminution and classically from a fall on an outstretched hand. Smith fractures are volar equivalents, and Barton fractures involve the articular surface.

Question 29Orthopedic Surgery Knowledge and Skills (written exam)

Which clinical feature most strongly suggests a diagnosis of compartment syndrome in the leg after a tibial shaft fracture?

  1. Diffuse pitting edema of the foot
  2. Pain with passive stretch of the toes Correct answer.
  3. Numbness confined to the heel
  4. Absent dorsalis pedis pulse

Explanation

Pain out of proportion and pain with passive stretch of the compartment musculature are the earliest and most reliable clinical signs of compartment syndrome. Pulses are typically preserved until very late because compartment pressures exceed capillary but not arterial pressure.

Question 30Orthopedic Surgery Knowledge and Skills (written exam)

A 12-year-old boy has a slipped capital femoral epiphysis confirmed on radiographs. Which radiographic finding is characteristic on an AP pelvis view?

  1. Coxa valga deformity
  2. Klein line failing to intersect the lateral femoral head Correct answer.
  3. Positive Thomas test
  4. Shenton line disruption

Explanation

In SCFE, Klein line drawn along the superior femoral neck fails to intersect the lateral portion of the femoral head because the epiphysis has slipped medially and posteriorly. This is the classic AP radiographic sign of the disorder.

Question 31Orthopedic Surgery Knowledge and Skills (written exam)

A 35-year-old woman has a painful, swollen, erythematous knee and a joint aspirate showing a white cell count of 80,000 cells/mm3 with 90% neutrophils. Which management step is most appropriate next?

  1. Immobilization in a long leg cast
  2. Oral antibiotics and outpatient follow-up
  3. Intra-articular corticosteroid injection
  4. Urgent arthroscopic or open irrigation and intravenous antibiotics Correct answer.

Explanation

A joint aspirate with a markedly elevated white cell count and neutrophilic predominance is highly suggestive of septic arthritis, which requires urgent drainage and intravenous antibiotics to prevent joint destruction. Delay in surgical drainage worsens outcomes.

Question 32Orthopedic Surgery Knowledge and Skills (written exam)

Which imaging modality is the reference standard for evaluating the extent of soft tissue and bone involvement in a suspected bone tumor?

  1. Bone scan
  2. Computed tomography
  3. Ultrasound
  4. Magnetic resonance imaging Correct answer.

Explanation

MRI provides superior soft tissue contrast and delineates the intramedullary extent, soft tissue mass, and relationship to neurovascular structures, making it essential for staging bone tumors. CT is better for cortical detail, and bone scan is used for staging metastases.

Question 33Orthopedic Surgery Knowledge and Skills (written exam)

A 60-year-old man has a complete Achilles tendon rupture. Which clinical test is most specific for this diagnosis?

  1. Thompson test Correct answer.
  2. Lachman test
  3. McMurray test
  4. Finkelstein test

Explanation

The Thompson (Simmonds) test squeezes the calf; absence of plantar flexion indicates a complete Achilles tendon rupture. The other tests evaluate the meniscus, ACL, and de Quervain tenosynovitis respectively.

Question 34Orthopedic Surgery Knowledge and Skills (written exam)

A 45-year-old man has a closed tibial shaft fracture treated with an intramedullary nail. Six months later he has no pain and radiographs show bridging callus across three cortices. Which statement best describes the current status?

  1. Infection requiring debridement
  2. Delayed union requiring bone grafting
  3. Union has occurred Correct answer.
  4. Nonunion requiring revision

Explanation

Clinical union is defined by absence of pain at the fracture site with radiographic evidence of bridging callus across at least three cortices. This patient meets those criteria, indicating successful union.

Question 35Orthopedic Surgery Knowledge and Skills (written exam)

Which biomechanical function is primarily provided by the menisci of the knee?

  1. Load transmission and shock absorption Correct answer.
  2. Active knee extension
  3. Anterior tibial translation restraint
  4. Proprioceptive feedback to the quadriceps

Explanation

The menisci increase contact area and distribute load across the tibiofemoral joint, functioning as shock absorbers and reducing peak contact stresses. Loss of meniscal tissue accelerates cartilage degeneration.

Question 36Orthopedic Surgery Knowledge and Skills (written exam)

A 65-year-old woman has a fragility fracture of the distal radius. Which medication class is most appropriate as first-line pharmacologic therapy for her underlying osteoporosis?

  1. Glucocorticoids
  2. Bisphosphonates Correct answer.
  3. Loop diuretics
  4. Thiazolidinediones

Explanation

Bisphosphonates inhibit osteoclast-mediated bone resorption and are first-line therapy for postmenopausal osteoporosis, reducing future fracture risk. They are typically combined with calcium and vitamin D supplementation.

Question 37Orthopedic Surgery Knowledge and Skills (written exam)

A 28-year-old man has an isolated fibular (lateral malleolus) fracture at the level of the syndesmosis with widening of the medial clear space on stress radiographs. Which structure is most likely injured?

  1. Deltoid ligament complex Correct answer.
  2. Spring ligament
  3. Anterior talofibular ligament
  4. Calcaneofibular ligament

Explanation

A fibular fracture at the level of the syndesmosis with medial clear space widening indicates a syndesmotic injury with associated deltoid ligament disruption, creating an unstable equivalent of a bimalleolar fracture. Medial-sided injury must be recognized because it changes stability and treatment.

Question 38Orthopedic Surgery Knowledge and Skills (written exam)

Which organism is the most common cause of native vertebral osteomyelitis in adults?

  1. Staphylococcus aureus Correct answer.
  2. Mycobacterium tuberculosis
  3. Escherichia coli
  4. Pseudomonas aeruginosa

Explanation

Staphylococcus aureus is the most common pathogen in native vertebral osteomyelitis, typically arising from hematogenous spread. Empiric therapy is generally directed against this organism.

Question 39Orthopedic Surgery Knowledge and Skills (written exam)

A 40-year-old man has a low-energy tibial plateau fracture. Which fracture pattern is most strongly associated with a high risk of compartment syndrome?

  1. Schatzker type III pure depression fracture
  2. Schatzker type IV medial plateau fracture Correct answer.
  3. Schatzker type II split-depression fracture
  4. Schatzker type I split fracture

Explanation

Schatzker type IV fractures involve the medial plateau and are frequently associated with high-energy injury and significant soft tissue injury, carrying the highest risk of compartment syndrome among tibial plateau fractures. Medial plateau fractures also have a higher association with vascular injury.

Question 40Orthopedic Surgery Knowledge and Skills (written exam)

A 70-year-old man has a suspected hip fracture but plain radiographs are negative and he cannot bear weight. Which imaging study is most appropriate next?

  1. Ultrasound of the hip
  2. Computed tomography of the pelvis
  3. Repeat radiographs in 6 weeks
  4. Magnetic resonance imaging of the hip Correct answer.

Explanation

MRI is highly sensitive for occult hip fractures, including femoral neck fractures not visible on plain radiographs, and should be obtained when clinical suspicion remains high. Early diagnosis allows timely surgery and reduces complications.

Question 41Orthopedic Surgery Knowledge and Skills (written exam)

Which structure is most commonly injured in a 'turf toe' injury?

  1. Plantar fascia
  2. Achilles tendon
  3. Peroneus longus tendon
  4. Plantar plate of the first metatarsophalangeal joint Correct answer.

Explanation

Turf toe is a hyperextension injury of the first metatarsophalangeal joint that typically disrupts the plantar plate and capsule. It is common in athletes playing on artificial surfaces.

Question 42Orthopedic Surgery Knowledge and Skills (written exam)

A 30-year-old woman has a painless, firm mass on the dorsum of the wrist that transilluminates and becomes more prominent with wrist flexion. What is the most likely diagnosis?

  1. Giant cell tumor of tendon sheath
  2. Rheumatoid nodule
  3. Ganglion cyst Correct answer.
  4. Lipoma

Explanation

A dorsal wrist ganglion cyst arises from the scapholunate joint capsule and is characteristically transilluminant, cystic, and accentuated by wrist flexion. It is the most common soft tissue mass of the hand and wrist.

Question 43Orthopedic Surgery Knowledge and Skills (written exam)

Which finding on a lateral cervical spine radiograph most reliably indicates a disruption of the posterior ligamentous complex?

  1. Increased interspinous distance Correct answer.
  2. Loss of cervical lordosis
  3. Disc space narrowing
  4. Osteophyte formation

Explanation

Widening of the interspinous distance indicates disruption of the posterior ligamentous complex and suggests an unstable flexion-distraction injury. Loss of lordosis and degenerative changes are nonspecific.

Question 44Orthopedic Surgery Knowledge and Skills (written exam)

A 55-year-old man has a displaced transverse patella fracture with disruption of the extensor mechanism. Which treatment is most appropriate?

  1. Open reduction and internal fixation Correct answer.
  2. Immediate range-of-motion exercises
  3. Patellectomy
  4. Cylinder cast immobilization alone

Explanation

Displaced patella fractures with extensor mechanism disruption require operative fixation to restore the extensor mechanism and articular congruity. Nonoperative treatment is reserved for nondisplaced fractures with an intact mechanism.

Question 45Orthopedic Surgery Knowledge and Skills (written exam)

Which of the following is a recognized risk factor for the development of a deep vein thrombosis after total hip arthroplasty?

  1. Obesity Correct answer.
  2. Early mobilization
  3. Use of regional anesthesia
  4. Administration of chemoprophylaxis

Explanation

Obesity increases venous stasis and is a well-established risk factor for venous thromboembolism after major orthopedic surgery. Early mobilization and chemoprophylaxis reduce risk.

Question 46Orthopedic Surgery Knowledge and Skills (written exam)

A 22-year-old man has an open tibial shaft fracture with a 4-cm wound and no periosteal stripping. According to the Gustilo-Anderson classification, what grade is this fracture?

  1. Type IIIB
  2. Type IIIA
  3. Type II Correct answer.
  4. Type I

Explanation

A Type II open fracture has a wound larger than 1 cm without extensive soft tissue damage or periosteal stripping. Type I wounds are smaller than 1 cm, and Type III injuries involve extensive soft tissue damage.

Question 47Orthopedic Surgery Knowledge and Skills (written exam)

A patient sustains a fracture of the surgical neck of the humerus. Which structure is most at risk of injury?

  1. Median nerve
  2. Radial nerve
  3. Axillary nerve Correct answer.
  4. Musculocutaneous nerve

Explanation

The axillary nerve winds around the surgical neck of the humerus and is at risk with fractures at this level, potentially causing deltoid weakness and sensory loss over the lateral shoulder. The radial nerve is more commonly associated with humeral shaft fractures.

Question 48Orthopedic Surgery Knowledge and Skills (written exam)

A 50-year-old man has a complete high median nerve palsy. Which motor deficit is expected?

  1. Loss of finger abduction
  2. Loss of thumb interphalangeal joint flexion Correct answer.
  3. Loss of elbow flexion
  4. Loss of wrist extension

Explanation

A high median nerve palsy affects the anterior interosseous nerve, causing loss of flexor pollicis longus and thus thumb interphalangeal flexion, along with the 'OK sign' and thenar wasting. Finger abduction is ulnar, wrist extension is radial, and elbow flexion is musculocutaneous.

Question 49Orthopedic Surgery Knowledge and Skills (written exam)

Which finding is most characteristic of a Lisfranc injury on a weight-bearing anteroposterior foot radiograph?

  1. Widening of the first metatarsophalangeal joint
  2. Medial displacement of the first metatarsal
  3. Fracture of the fifth metatarsal base
  4. Lateral displacement of the second metatarsal base relative to the middle cuneiform Correct answer.

Explanation

The keystone of the Lisfranc complex is the second metatarsal base seated in the mortise of the middle cuneiform; lateral displacement of this base indicates Lisfranc injury. Weight-bearing views are important because the injury may be subtle on non-weight-bearing films.

Question 50Orthopedic Surgery Knowledge and Skills (written exam)

A 10-year-old boy has a Monteggia fracture. Which injury pattern defines this fracture?

  1. Distal humerus fracture with elbow dislocation
  2. Radial shaft fracture with distal ulnar dislocation
  3. Distal radial fracture with distal radioulnar joint dislocation
  4. Proximal ulnar fracture with radial head dislocation Correct answer.

Explanation

A Monteggia fracture is a fracture of the proximal ulna with dislocation of the radial head, requiring assessment of the radiocapitellar line. A Galeazzi fracture is a distal radial shaft fracture with distal radioulnar joint disruption.