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Arab Board Orthopedic Surgery Clinical study materials
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Arab Board Orthopedic Surgery Clinical practice questions

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Question 1Trauma and Fracture Management

A 25-year-old man has an isolated closed tibial shaft fracture that is minimally displaced and stable after closed reduction. Which treatment is most appropriate?

  1. Immediate intramedullary nailing in all such cases
  2. Open reduction and plate fixation
  3. Long leg cast or functional brace with weight-bearing as tolerated Correct answer.
  4. Above-knee amputation

Explanation

Minimally displaced, stable closed tibial shaft fractures can be managed non-operatively with cast or functional bracing and early weight-bearing, which promotes healing. Surgery is reserved for unstable, displaced, open, or failing conservative cases.

Question 2Trauma and Fracture Management

Which nerve is most commonly injured in a fracture of the surgical neck of the humerus?

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

Explanation

The axillary nerve winds around the surgical neck of the humerus and is at risk in proximal humeral fractures, with deltoid weakness and lateral shoulder numbness as clues. The radial nerve is more associated with humeral shaft fractures.

Question 3Trauma and Fracture Management

A patient has a distal radius fracture with dorsal angulation and dorsal displacement of the distal fragment. What is the eponymous name of this fracture pattern?

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

Explanation

A Colles fracture is a distal radius fracture with dorsal displacement and dorsal angulation, often from a fall on an outstretched hand. Smith fractures have volar displacement, Barton fractures involve the articular rim, and chauffeur fractures involve the radial styloid.

Question 4Trauma and Fracture Management

Which of the following is the most reliable clinical sign of compartment syndrome in the leg?

  1. Low-grade fever
  2. Pain out of proportion to the injury, especially with passive stretch Correct answer.
  3. Absent distal pulses
  4. Visible swelling alone

Explanation

Pain out of proportion and pain on passive stretch of the compartment muscles are the earliest and most reliable clinical indicators. Pulselessness is a late finding and its absence does not exclude compartment syndrome.

Question 5Trauma and Fracture Management

In an adult with an open tibial fracture, which classification system is most commonly used to grade the soft-tissue injury?

  1. Neer classification
  2. Gustilo-Anderson classification Correct answer.
  3. Gartland classification
  4. Salter-Harris classification

Explanation

The Gustilo-Anderson system grades open fractures by wound size, contamination, and soft-tissue injury, guiding treatment. Salter-Harris classifies physeal fractures, Neer classifies proximal humerus fractures, and Gartland classifies supracondylar fractures.

Question 6Trauma and Fracture Management

A 70-year-old woman sustains a displaced femoral neck fracture. Which complication is most specifically associated with this injury?

  1. Peroneal nerve palsy
  2. Avascular necrosis of the femoral head Correct answer.
  3. Volkmann contracture
  4. Compartment syndrome of the thigh

Explanation

The blood supply to the femoral head runs along the femoral neck, so intracapsular neck fractures carry a high risk of avascular necrosis. This drives the choice of arthroplasty in many elderly patients.

Question 7Trauma and Fracture Management

Which of the following best describes the mechanism of a posterior hip dislocation?

  1. Hyperextension of the hip with external rotation
  2. Direct blow to the greater trochanter
  3. Axial load on a flexed and adducted hip, as in a dashboard injury Correct answer.
  4. Forced abduction of the hip

Explanation

Posterior hip dislocation typically results from axial loading of a flexed, adducted hip, classically in motor vehicle dashboard injuries. It is the most common type of hip dislocation.

Question 8Trauma and Fracture Management

A patient has a both-bone forearm fracture in an adult with significant displacement. Which treatment is generally preferred?

  1. Observation with analgesia
  2. Skeletal traction for six weeks
  3. Closed reduction and cast immobilization alone
  4. Open reduction and internal fixation Correct answer.

Explanation

Adult both-bone forearm fractures are unstable and prone to malunion and loss of rotation, so anatomical reduction with plate fixation is standard. Conservative casting is generally reserved for minimally displaced fractures in children.

Question 9Trauma and Fracture Management

A 30-year-old falls and holds the arm out; radiographs show a transverse fracture through the middle third of the humeral shaft with the radial nerve injured. Which clinical finding is most consistent with radial nerve injury?

  1. Wrist drop Correct answer.
  2. Loss of thumb opposition
  3. Clawing of the ring and little fingers
  4. Loss of sensation over the little finger

Explanation

The radial nerve supplies the wrist and finger extensors, so injury produces wrist drop. Median nerve injury affects thumb opposition, and ulnar nerve injury causes clawing and little-finger sensory loss.

Question 10Trauma and Fracture Management

A 6-year-old has a supracondylar humeral fracture with an absent radial pulse and a pale, painful hand. What is the immediate priority?

  1. Observation for 24 hours before any intervention
  2. Urgent reduction and stabilization with reassessment of vascular status Correct answer.
  3. Application of a backslab and outpatient follow-up in one week
  4. Immediate amputation of the limb

Explanation

A pulseless, pale, painful hand after a supracondylar fracture suggests vascular compromise, often from brachial artery injury or compartment swelling. Urgent reduction and stabilization restores alignment and often perfusion; persistent ischemia requires vascular exploration.

Question 11Trauma and Fracture Management

Which finding on ankle radiographs indicates an unstable ankle fracture pattern requiring surgical consideration?

  1. Small posterior malleolar flake without displacement
  2. Bimalleolar fracture with talar shift Correct answer.
  3. Isolated non-displaced lateral malleolus fracture
  4. Isolated avulsion of the tip of the lateral malleolus

Explanation

Bimalleolar fractures with talar shift indicate loss of the ankle mortise and are unstable, generally requiring fixation. Isolated non-displaced or avulsion fractures can often be treated conservatively.

Question 12Trauma and Fracture Management

A young adult has a displaced midshaft clavicle fracture with skin tenting and 100% displacement. Which management is most appropriate?

  1. Operative fixation with plate or intramedullary device Correct answer.
  2. Figure-of-eight bandage alone
  3. Immediate shoulder manipulation
  4. Sling immobilization alone

Explanation

Markedly displaced midshaft clavicle fractures, especially with skin tenting or shortening, have higher nonunion and malunion rates and benefit from operative fixation. Simple sling treatment suits minimally displaced fractures.

Question 13Trauma and Fracture Management

A patient has a Garden I femoral neck fracture (incomplete, valgus impacted). What is the most appropriate initial management?

  1. Protected weight-bearing with close follow-up Correct answer.
  2. Urgent closed reduction and cannulated screws
  3. Hemiarthroplasty
  4. Total hip replacement

Explanation

Garden I fractures are incomplete and stable, with a lower risk of avascular necrosis, so protected weight-bearing is reasonable. Displaced fractures (Garden III-IV) usually require arthroplasty or fixation.

Question 14Trauma and Fracture Management

Which of the following is a classic radiographic feature of a posterior shoulder dislocation on an anteroposterior view?

  1. V-sign of the lateral malleolus
  2. Light bulb sign Correct answer.
  3. Dinner fork deformity
  4. Teardrop angle

Explanation

Posterior shoulder dislocation produces an internally rotated humeral head with a rounded 'light bulb' appearance on AP view. A dinner fork deformity describes a Colles fracture, and the teardrop angle relates to the distal radius.

Question 15Trauma and Fracture Management

A patient with a pelvic ring fracture becomes hypotensive and does not respond to fluids. Which initial maneuver is most appropriate as part of resuscitation?

  1. Application of a pelvic binder and activation of massive transfusion protocol Correct answer.
  2. Immediate MRI of the pelvis
  3. Log-rolling the patient every 30 minutes
  4. Immediate hip spica casting

Explanation

Hemodynamically unstable pelvic fractures require pelvic binding to reduce volume and stabilize the ring, along with hemorrhage control and transfusion. Repeated log-rolling worsens bleeding and is avoided.

Question 16Trauma and Fracture Management

A 45-year-old has a displaced intra-articular distal radius fracture with articular step-off greater than 2 mm. What is the most appropriate management?

  1. Wrist traction for four weeks
  2. Operative reduction and fixation Correct answer.
  3. Cast immobilization alone
  4. Observation with early range of motion

Explanation

Intra-articular step-off above 2 mm predisposes to post-traumatic arthritis and loss of function, so surgical reduction and fixation are indicated. Non-operative treatment suits extra-articular or minimally displaced fractures.

Question 17Trauma and Fracture Management

Which of the following findings suggests an ipsilateral femoral neck fracture in a patient with a femoral shaft fracture?

  1. A vertical radiolucent line at the femoral neck on a dedicated hip view Correct answer.
  2. Widening of the knee joint space
  3. Overlying bowel gas on the chest radiograph
  4. Lateral displacement of the greater trochanter

Explanation

Ipsilateral femoral neck fractures are commonly missed with shaft fractures, and dedicated hip imaging is needed to detect a vertical lucency or displacement at the neck. Missing this injury risks displacement and avascular necrosis.

Question 18Trauma and Fracture Management

A patient sustains a talar neck fracture. Which complication is most characteristic?

  1. Achilles tendon shortening
  2. Peroneal tendon rupture
  3. Plantar fasciitis
  4. Avascular necrosis of the talar body Correct answer.

Explanation

The talus has a tenuous retrograde blood supply, and talar neck fractures, especially displaced ones, carry a high risk of avascular necrosis of the body. Hawkins classification helps predict this risk.

Question 19Trauma and Fracture Management

Which of the following best describes the Salter-Harris type II physeal injury?

  1. Crush injury of the physis
  2. Fracture through the physis and epiphysis
  3. Fracture through the physis extending through the metaphysis Correct answer.
  4. Fracture through the physis, epiphysis, and metaphysis

Explanation

Salter-Harris II involves the physis with a metaphyseal fragment (the 'Thurston Holland' fragment) and is the most common type. Type III involves the epiphysis, type IV both epiphysis and metaphysis, and type V is a physeal crush.

Question 20Trauma and Fracture Management

A 60-year-old with a displaced femoral neck fracture is independently mobile and cognitively intact. Which treatment offers the best functional outcome?

  1. Total hip arthroplasty Correct answer.
  2. Cannulated screw fixation
  3. Traction for six weeks
  4. Hemiarthroplasty in all cases

Explanation

In active, independent older patients with displaced femoral neck fractures, total hip arthroplasty gives better function and lower reoperation rates than hemiarthroplasty or fixation. Internal fixation is preferred in younger patients.

Question 21Trauma and Fracture Management

A patient with a tibial plateau fracture has a tense swollen limb and pain with passive toe extension. What is the most appropriate next step?

  1. Elevation and observation
  2. Immediate total knee replacement
  3. Emergent fasciotomy after clinical confirmation of compartment syndrome Correct answer.
  4. Discharge with analgesia

Explanation

Tense swelling with pain on passive stretch after a tibial plateau fracture indicates compartment syndrome, which requires emergent fasciotomy to prevent muscle and nerve necrosis. Delay leads to irreversible injury.

Question 22Trauma and Fracture Management

Which of the following best describes a Monteggia fracture?

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

Explanation

A Monteggia injury is a proximal ulnar fracture with dislocation of the radial head. A Galeazzi injury is a distal radial shaft fracture with distal radioulnar joint disruption.

Question 23Trauma and Fracture Management

A patient has an open grade IIIB tibial fracture with extensive soft-tissue loss and periosteal stripping. Which management principle is most important?

  1. Immediate bone grafting at the first debridement
  2. Urgent debridement, antibiotics, and staged soft-tissue coverage Correct answer.
  3. Primary closure over the wound without debridement
  4. Delayed debridement after one week

Explanation

High-grade open fractures require urgent debridement, antibiotics, and stabilization, followed by soft-tissue coverage, often with a flap. Primary closure of contaminated wounds and early bone grafting increase infection risk.

Question 24Trauma and Fracture Management

A patient has a posterior knee dislocation with a pulseless limb that remains pulseless after reduction. What is the most appropriate next step?

  1. Application of a cast and observation
  2. Discharge with aspirin
  3. Immediate knee arthroscopy
  4. Urgent vascular exploration or angiography with revascularization Correct answer.

Explanation

Knee dislocation can injure the popliteal artery, and a limb that remains pulseless after reduction requires urgent vascular assessment and revascularization. Prolonged ischemia threatens limb viability.

Question 25Trauma and Fracture Management

Which of the following is the most appropriate initial management of a hemodynamically stable patient with an isolated nondisplaced pubic ramus fracture?

  1. Bed rest for six weeks
  2. Immediate external fixation
  3. Analgesia and protected weight-bearing with mobilization Correct answer.
  4. Percutaneous sacroiliac screws

Explanation

Isolated nondisplaced pubic ramus fractures in stable patients are managed with analgesia and progressive mobilization. Operative stabilization is reserved for unstable ring disruptions or hemodynamic instability.

Question 26Trauma and Fracture Management

A 25-year-old man sustains a closed tibial shaft fracture after a motorcycle accident. He is neurovascularly intact and the fracture is minimally displaced. Which of the following is the most appropriate initial management?

  1. Open reduction and plating
  2. Intramedullary nailing Correct answer.
  3. External fixation
  4. Long leg cast with immediate weight bearing

Explanation

Intramedullary nailing is the treatment of choice for most closed tibial shaft fractures in adults because it provides stable fixation with high union rates and allows early mobilization. Casting is associated with higher rates of malunion and knee stiffness, and is reserved for select minimally displaced fractures in children or compliant patients. Plating and external fixation are typically reserved for specific indications such as periarticular extension or severe soft-tissue injury.

Question 27Trauma and Fracture Management

A 35-year-old woman falls on an outstretched hand and presents with wrist pain. Radiographs show a fracture of the scaphoid waist with no displacement. Which of the following is the most appropriate management?

  1. Short arm cast with thumb spica Correct answer.
  2. Below-elbow cast without thumb inclusion
  3. Wrist splint and early range of motion
  4. Immediate screw fixation

Explanation

Undisplaced scaphoid waist fractures are typically treated nonoperatively with a thumb spica cast to immobilize the fracture and promote healing. This approach is preferred because the blood supply to the scaphoid is precarious and immobilization reduces the risk of nonunion. Surgery is reserved for displaced fractures, proximal pole fractures, or those with delayed presentation.

Question 28Trauma and Fracture Management

A 40-year-old man sustains a closed femoral shaft fracture. He is hemodynamically stable. Which of the following is the most appropriate definitive treatment?

  1. Plate and screw fixation
  2. Intramedullary nailing Correct answer.
  3. Hip spica cast
  4. Skeletal traction for 6 weeks

Explanation

Intramedullary nailing is the gold standard for definitive treatment of closed femoral shaft fractures in adults because it provides stable fixation, allows early mobilization, and has high union rates. Traction and casting are associated with prolonged immobilization and complications. Plating is an alternative but is less commonly used for diaphyseal fractures.

Question 29Trauma and Fracture Management

A 28-year-old man presents with a swollen, painful knee after a twisting injury. Radiographs are normal. Which of the following is the most appropriate next step in management?

  1. MRI of the knee
  2. CT scan of the knee
  3. Arthrocentesis Correct answer.
  4. Weight-bearing radiographs

Explanation

In a patient with an acute knee injury and a large effusion, arthrocentesis is indicated to evaluate for hemarthrosis, which may indicate an occult fracture or ligamentous injury. Fat droplets in the aspirate suggest an intra-articular fracture. MRI is typically reserved for further evaluation after initial management.

Question 30Trauma and Fracture Management

A 45-year-old woman sustains a distal humeral fracture with displacement. She has weakness in finger abduction and loss of sensation over the dorsum of the first web space. Which nerve is most likely injured?

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

Explanation

The radial nerve is the most commonly injured nerve in distal humeral fractures, particularly with fractures of the humeral shaft. It supplies the extensor compartment of the forearm and provides sensation to the dorsum of the first web space. Injury results in weakness of wrist and finger extension and sensory loss in its distribution.

Question 31Trauma and Fracture Management

A 50-year-old man falls from a ladder and sustains an axial load injury to the lower extremity. He has severe heel pain and swelling. Radiographs show a comminuted intra-articular calcaneal fracture with loss of height and widening. Which of the following is the most appropriate management?

  1. Percutaneous pin fixation
  2. Closed reduction and cast application
  3. Immediate open reduction and internal fixation
  4. Elevation, ice, and early range of motion Correct answer.

Explanation

Initial management of a comminuted intra-articular calcaneal fracture includes elevation, ice, and early range of motion to reduce swelling and prevent stiffness, while awaiting definitive treatment. Surgery is often delayed until swelling subsides to reduce wound complications. Nonoperative management may be appropriate for minimally displaced fractures or patients with contraindications to surgery.

Question 32Trauma and Fracture Management

A 32-year-old man presents with a gunshot wound to the thigh. He has a small entry and exit wound with no signs of vascular injury. Radiographs show a comminuted femoral shaft fracture. Which of the following is the most appropriate management?

  1. Debridement and external fixation
  2. Cast application
  3. Skeletal traction
  4. Immediate intramedullary nailing Correct answer.

Explanation

Low-energy gunshot fractures are treated similarly to closed fractures, and intramedullary nailing is appropriate after appropriate wound care. High-energy gunshot wounds with extensive soft-tissue injury may require debridement and external fixation. Vascular injury should be ruled out clinically.

Question 33Trauma and Fracture Management

A 70-year-old woman sustains a distal radius fracture with dorsal comminution and volar tilt. Which of the following is the most appropriate definitive treatment?

  1. Percutaneous K-wire fixation
  2. Closed reduction and cast immobilization
  3. Volar locking plate fixation Correct answer.
  4. External fixation

Explanation

Volar locking plate fixation is the treatment of choice for unstable distal radius fractures with dorsal comminution, as it provides stable fixation and allows early mobilization. Casting is associated with a high risk of loss of reduction in such fractures. External fixation and K-wires are alternatives but are less commonly used for this pattern.

Question 34Trauma and Fracture Management

A 22-year-old football player sustains a direct blow to the lateral aspect of the knee. He has pain over the lateral joint line and instability. Radiographs show a Segond fracture. Which of the following is the most likely associated injury?

  1. Posterior cruciate ligament tear
  2. Anterior cruciate ligament tear Correct answer.
  3. Patellar dislocation
  4. Medial collateral ligament tear

Explanation

A Segond fracture is an avulsion fracture of the lateral capsular ligament and is highly associated with an anterior cruciate ligament tear. It is considered a pathognomonic sign of ACL injury. Medial collateral ligament tears are more commonly associated with valgus stress.

Question 35Trauma and Fracture Management

A 55-year-old man sustains a both-bone forearm fracture. He has severe pain, pallor, and paresthesia in the hand. Which of the following is the most appropriate immediate management?

  1. Immediate fasciotomy Correct answer.
  2. Elevation and observation
  3. Cast application
  4. Analgesia and reassessment

Explanation

The clinical picture suggests acute compartment syndrome, which is a surgical emergency requiring immediate fasciotomy to prevent irreversible muscle and nerve damage. Delay in treatment can lead to Volkmann's contracture. Elevation and observation are contraindicated as they may worsen ischemia.

Question 36Trauma and Fracture Management

A 65-year-old woman falls and sustains a fracture of the distal humerus. She has a history of osteoporosis. Which of the following is the most appropriate management?

  1. External fixation
  2. Open reduction and internal fixation Correct answer.
  3. Total elbow arthroplasty
  4. Nonoperative treatment with a sling

Explanation

Open reduction and internal fixation is the treatment of choice for most displaced distal humeral fractures in older adults, as it restores anatomy and allows early mobilization. Total elbow arthroplasty is an option for severely comminuted fractures in low-demand elderly patients. Nonoperative treatment is associated with poor outcomes.

Question 37Trauma and Fracture Management

A 30-year-old man sustains a fracture of the femoral neck. He is treated with cannulated screws. Six months later, he presents with groin pain and radiographs show sclerosis and collapse of the femoral head. Which of the following is the most likely diagnosis?

  1. Infection
  2. Avascular necrosis Correct answer.
  3. Nonunion
  4. Post-traumatic osteoarthritis

Explanation

Avascular necrosis of the femoral head is a complication of femoral neck fractures, especially when the blood supply is disrupted. It presents with groin pain and radiographic signs of sclerosis and collapse. Nonunion would show a persistent fracture line without collapse.

Question 38Trauma and Fracture Management

A 45-year-old man sustains a pelvic fracture after a high-speed motor vehicle collision. He is hemodynamically unstable despite fluid resuscitation. A pelvic binder is applied. Which of the following is the most appropriate next step in management?

  1. Exploratory laparotomy
  2. Immediate angiography and embolization Correct answer.
  3. CT scan of the pelvis
  4. Application of external fixation

Explanation

In a hemodynamically unstable patient with a pelvic fracture, after application of a pelvic binder, the next step is angiography and embolization to control arterial bleeding. External fixation may be used as a temporizing measure but is less effective for arterial hemorrhage. CT scan is contraindicated in unstable patients.

Question 39Trauma and Fracture Management

A 60-year-old woman sustains a distal femoral fracture with intra-articular extension. Which of the following is the most appropriate definitive treatment?

  1. Intramedullary nailing
  2. Cast application
  3. Open reduction and internal fixation with a locking plate Correct answer.
  4. Skeletal traction

Explanation

Distal femoral fractures with intra-articular extension require anatomic reduction of the joint surface and stable fixation, typically with a locking plate. Intramedullary nailing is an option for extra-articular fractures but is less suitable for intra-articular extension. Traction and casting are not definitive treatments.

Question 40Trauma and Fracture Management

A 25-year-old man sustains a closed tibial shaft fracture. He is treated with an intramedullary nail. Two days postoperatively, he develops severe pain in the anterior compartment of the leg, and the compartment pressure is measured at 40 mmHg. Which of the following is the most appropriate management?

  1. Split the cast
  2. Elevation and observation
  3. Immediate fasciotomy Correct answer.
  4. Mannitol infusion

Explanation

Acute compartment syndrome is a surgical emergency requiring immediate fasciotomy to prevent irreversible damage. A compartment pressure of 40 mmHg in a symptomatic patient is an indication for fasciotomy. Nonoperative measures such as elevation or mannitol are not effective and delay treatment.

Question 41Arthroplasty and Reconstructive Surgery

A 68-year-old with end-stage hip osteoarthritis is scheduled for total hip arthroplasty. Which bearing couple has the lowest rate of wear-related osteolysis in young, active patients?

  1. Metal-on-metal with large-diameter heads
  2. Metal-on-highly cross-linked polyethylene Correct answer.
  3. Ceramic-on-conventional polyethylene
  4. Ceramic-on-ceramic

Explanation

Highly cross-linked polyethylene substantially reduces volumetric wear compared with conventional polyethylene, and when paired with a metal or ceramic head it gives very low wear rates in active patients. Large-head metal-on-metal bearings have been associated with adverse reactions to metal debris and high revision rates. Ceramic-on-ceramic reduces wear but carries a risk of squeaking and fracture.

Question 42Arthroplasty and Reconstructive Surgery

Which surgical approach to the hip is most strongly associated with a higher rate of postoperative dislocation?

  1. Direct lateral (Hardinge) approach
  2. Posterolateral approach Correct answer.
  3. Lateral approach with trochanteric osteotomy
  4. Direct anterior approach

Explanation

The posterolateral approach requires division or detachment of the short external rotators and posterior capsule, which compromises posterior stability and gives the highest dislocation rate unless repaired. Anterior and lateral approaches preserve posterior soft tissues and have lower dislocation rates.

Question 43Arthroplasty and Reconstructive Surgery

During primary total knee arthroplasty, which step most reliably reduces the risk of patellar maltracking?

  1. Balancing the flexion and extension gaps with symmetric medial and lateral releases
  2. Restoring a neutral mechanical axis with appropriate component rotation and soft tissue balance Correct answer.
  3. Resecting additional lateral patellar facet
  4. Placing the femoral component in relative internal rotation

Explanation

Patellar tracking depends on combined limb alignment, femoral and tibial component rotation, and balanced soft tissues; restoring a neutral mechanical axis with correct rotation and balance addresses all these contributors. Isolated measures such as over-resection of the patella or internal rotation of the femoral component worsen tracking.

Question 44Arthroplasty and Reconstructive Surgery

Which finding on preoperative evaluation most strongly predicts the need for a constrained liner or revision shell in revision total hip arthroplasty?

  1. Osteolysis confined to the proximal femur
  2. Aseptic loosening of a cemented stem
  3. A well-fixed acetabular shell with a worn liner
  4. Abductor deficiency with trochanteric escape Correct answer.

Explanation

Abductor deficiency removes the active soft tissue restraint against dislocation, so a constrained liner or other stability-enhancing construct is often required. Isolated osteolysis or a worn liner in a well-fixed shell can usually be managed with liner exchange.

Question 45Arthroplasty and Reconstructive Surgery

What is the primary purpose of a tranexamic acid protocol in total joint arthroplasty?

  1. Reduce postoperative thromboembolic events
  2. Improve cement penetration into cancellous bone
  3. Reduce perioperative blood loss and transfusion requirements Correct answer.
  4. Reduce the risk of periprosthetic joint infection

Explanation

Tranexamic acid is an antifibrinolytic that reduces perioperative blood loss and the need for transfusion in both hip and knee arthroplasty. It does not primarily prevent infection or improve cement technique, and current evidence does not show an increased thromboembolic risk.

Question 46Arthroplasty and Reconstructive Surgery

A patient undergoing total hip arthroplasty has a history of prior ipsilateral pelvic fracture with retained hardware near the acetabulum. Which preoperative consideration is most important?

  1. Using a smaller femoral head to increase range of motion
  2. Planning for hardware removal and assessment of acetabular bone stock Correct answer.
  3. Routine use of a cemented femoral stem
  4. Selecting a metal-on-metal bearing

Explanation

Retained pelvic hardware and distorted anatomy complicate exposure and screw placement and may compromise acetabular bone stock, so planning for hardware removal and bone stock assessment is essential. Bearing choice and femoral head size do not address this anatomic problem.

Question 47Arthroplasty and Reconstructive Surgery

Which of the following is the most appropriate management for a chronically infected total knee arthroplasty with a well-fixed implant, a sinus tract, and a highly resistant organism?

  1. Two-stage revision with an antibiotic-loaded spacer Correct answer.
  2. Single-stage revision with the same implant type
  3. Debridement with polyethylene exchange and retention of components
  4. Long-term oral suppressive antibiotics alone

Explanation

A sinus tract and a resistant organism make component retention unreliable, and two-stage revision with an antibiotic-loaded spacer is the standard for chronic periprosthetic joint infection. Suppressive antibiotics alone do not eradicate infection and are reserved for patients unfit for surgery.

Question 48Arthroplasty and Reconstructive Surgery

Which radiographic parameter is used to assess acetabular component inclination on an anteroposterior pelvis radiograph?

  1. The distance from the teardrop to the component center
  2. The angle between the component face and the vertical
  3. The angle between the femoral neck and the component face
  4. The angle between the component face and the horizontal Correct answer.

Explanation

Acetabular inclination (abduction angle) is measured as the angle between the plane of the acetabular component face and the horizontal on an AP pelvis view. The other measurements do not define inclination.

Question 49Arthroplasty and Reconstructive Surgery

In total knee arthroplasty, what is the consequence of leaving a flexion gap significantly larger than the extension gap?

  1. Patellar clunk syndrome
  2. Flexion instability with a sense of giving way Correct answer.
  3. Extension lag with limited flexion
  4. Recurrent hemarthrosis

Explanation

A flexion gap larger than the extension gap produces instability in flexion, with the patient reporting giving way when the knee is bent. It does not cause extension lag or patellar clunk, which relate to other mechanisms.

Question 50Arthroplasty and Reconstructive Surgery

Which of the following is a recognized advantage of a cemented femoral stem in total hip arthroplasty?

  1. Immediate fixation and excellent long-term results in older patients Correct answer.
  2. Lower risk of bone cement implantation syndrome
  3. Better osseointegration in young active patients
  4. Easier revision with less bone loss

Explanation

Cemented stems achieve immediate fixation and have excellent documented survivorship in older, lower-demand patients. They carry a risk of bone cement implantation syndrome and are generally harder to revise than cementless stems.