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Orthopedic Board study materials
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Orthopedic Board practice questions

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Question 1Part I (Written) Examination

Which structure is most at risk of injury during the posterior approach to the proximal humerus?

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

Explanation

The axillary nerve and posterior circumflex humeral artery pass through the quadrangular space and lie close to the surgical neck and surgical approach posteriorly. Protecting it is essential to avoid deltoid denervation.

Question 2Part I (Written) Examination

A patient has a distal radius fracture with dorsal angulation and dorsal comminution after a fall on an outstretched hand. What is the most likely diagnosis?

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

Explanation

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

Question 3Part I (Written) Examination

Which of the following is the most sensitive early clinical sign of compartment syndrome in the lower leg?

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

Explanation

Pain out of proportion and pain with passive stretch are the earliest and most reliable clinical findings in compartment syndrome. Pulses are typically preserved because compartment pressures do not occlude major arteries until late.

Question 4Part I (Written) Examination

A 65-year-old woman sustains a low-energy femoral neck fracture. Which factor most strongly predisposes her to this injury?

  1. High bone mineral density
  2. Vitamin D excess
  3. Male sex
  4. Osteoporosis Correct answer.

Explanation

Osteoporosis reduces bone mineral density and trabecular strength, making the femoral neck susceptible to low-energy fractures. It is most common in postmenopausal women.

Question 5Part I (Written) Examination

Which nerve is most commonly injured in a supracondylar humerus fracture in children?

  1. Posterior interosseous nerve
  2. Radial nerve
  3. Ulnar nerve
  4. Anterior interosseous nerve Correct answer.

Explanation

The anterior interosseous nerve is the most commonly injured nerve in pediatric supracondylar humerus fractures, presenting with weakness of the flexor pollicis longus and index flexor digitorum profundus. The radial and ulnar nerves can also be injured but less commonly.

Question 6Part I (Written) Examination

Which of the following is the classic radiographic finding of developmental dysplasia of the hip (DDH) in an infant?

  1. Increased acetabular index Correct answer.
  2. Coxa valga
  3. Premature closure of the triradiate cartilage
  4. Decreased acetabular index

Explanation

In DDH the acetabulum is shallow, producing an increased acetabular index on radiographs. The femoral head may also be laterally and proximally displaced.

Question 7Part I (Written) Examination

Which antibiotic is typically used for prophylaxis in clean orthopedic surgery to cover Staphylococcus aureus?

  1. Gentamicin
  2. Cefazolin Correct answer.
  3. Vancomycin as first-line for all patients
  4. Metronidazole

Explanation

Cefazolin is a first-generation cephalosporin with good activity against Staphylococcus aureus and is the standard prophylactic agent for clean orthopedic procedures. Vancomycin is reserved for MRSA colonization or beta-lactam allergy.

Question 8Part I (Written) Examination

A 25-year-old sustains a knee injury with a positive Lachman test and a hemarthrosis. Which structure is most likely torn?

  1. Anterior cruciate ligament Correct answer.
  2. Medial collateral ligament
  3. Lateral collateral ligament
  4. Posterior cruciate ligament

Explanation

A positive Lachman test indicates anterior cruciate ligament insufficiency, and an acute hemarthrosis after a twisting injury is classic for ACL tear. The Lachman test is the most sensitive clinical test for ACL injury.

Question 9Part I (Written) Examination

A 45-year-old man has a distal radius fracture treated with closed reduction and cast. Two weeks later he develops severe pain with passive finger extension and a tense forearm. What is the most appropriate next step?

  1. Obtain an MRI of the wrist
  2. Immediate measurement of compartment pressures and consideration of fasciotomy Correct answer.
  3. Prescribe stronger analgesics and observe
  4. Reassure and continue casting

Explanation

The presentation suggests acute compartment syndrome, which is a surgical emergency. Compartment pressure measurement confirms the diagnosis, and fasciotomy is indicated when pressures are elevated or clinical suspicion is high.

Question 10Part I (Written) Examination

A patient has a displaced midshaft clavicle fracture with 100% displacement and shortening. Which factor most strongly favors operative fixation?

  1. Nondisplaced fracture pattern
  2. Patient age under 60 with high functional demand Correct answer.
  3. Presence of a single rib fracture
  4. Fracture located in the medial third

Explanation

Displaced midshaft clavicle fractures with significant shortening in active patients have improved outcomes with operative fixation, including lower nonunion rates and better functional recovery. Patient demand and displacement are key decision factors.

Question 11Part I (Written) Examination

Which imaging modality is most appropriate to confirm a suspected scaphoid fracture when initial radiographs are normal but clinical suspicion remains high?

  1. MRI of the wrist Correct answer.
  2. Repeat plain radiographs in 6 weeks without immobilization
  3. Ultrasound of the wrist
  4. Bone scan after 3 months

Explanation

MRI is highly sensitive and specific for occult scaphoid fractures and allows early definitive diagnosis, avoiding prolonged unnecessary immobilization. It can also detect other occult injuries.

Question 12Part I (Written) Examination

A 70-year-old woman has a displaced femoral neck fracture. Which treatment is most appropriate for an independent, community-ambulating patient with good bone stock?

  1. Traction and bed rest
  2. Hemiarthroplasty
  3. Total hip arthroplasty or internal fixation depending on displacement Correct answer.
  4. Above-knee amputation

Explanation

For a displaced femoral neck fracture in an active older patient, arthroplasty (hemiarthroplasty or total hip arthroplasty) or internal fixation in selected cases provides the best function and lowers reoperation risk compared with nonoperative care. The choice depends on age, activity, and bone quality.

Question 13Part I (Written) Examination

A 30-year-old has an open tibial shaft fracture with a 5 cm wound. According to the Gustilo-Anderson classification, what grade is this?

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

Explanation

A Gustilo-Anderson type IIIA open fracture has a wound larger than 10 cm or extensive soft tissue damage but adequate soft tissue coverage after debridement. Type IIIB requires a flap for coverage, and type II wounds are larger than 1 cm without extensive damage.

Question 14Part I (Written) Examination

Which of the following best describes the role of BMP-2 in fracture healing?

  1. It inhibits osteoblast differentiation
  2. It primarily stimulates cartilage resorption
  3. It promotes osteogenic differentiation and bone formation Correct answer.
  4. It blocks angiogenesis

Explanation

Bone morphogenetic protein-2 is an osteoinductive growth factor that promotes mesenchymal stem cell differentiation into osteoblasts and enhances bone formation. It is used clinically in certain spinal fusion and fracture nonunion settings.

Question 15Part I (Written) Examination

A patient presents with a hot, swollen knee and fever. Joint aspiration shows a white blood cell count of 80,000 cells/mm3 with 90% neutrophils. What is the most appropriate management?

  1. Urgent irrigation and debridement with intravenous antibiotics Correct answer.
  2. Oral antibiotics and outpatient follow-up
  3. Observation with serial examinations
  4. Intra-articular corticosteroid injection

Explanation

A septic knee with a highly elevated synovial white blood cell count and neutrophilia requires urgent surgical irrigation and debridement along with intravenous antibiotics. Delays increase the risk of cartilage destruction and systemic sepsis.

Question 16Part I (Written) Examination

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

  1. Periarticular osteopenia with erosions
  2. Joint space widening
  3. Uniform joint space narrowing with large effusion
  4. Subchondral sclerosis and osteophyte formation Correct answer.

Explanation

Osteoarthritis is characterized by asymmetric joint space narrowing, subchondral sclerosis, osteophyte formation, and subchondral cysts. These reflect degenerative cartilage loss and reactive bone changes.

Question 17Part I (Written) Examination

A 55-year-old has a distal humerus fracture with a comminuted intra-articular pattern. Which approach provides the best exposure for open reduction and internal fixation?

  1. Olecranon osteotomy Correct answer.
  2. Anterior approach
  3. Lateral approach alone
  4. Medial approach alone

Explanation

An olecranon osteotomy provides excellent exposure of the distal humeral articular surface for complex intra-articular fractures. It is particularly useful for comminuted fractures requiring anatomic reduction.

Question 18Part I (Written) Examination

Which of the following is the most common cause of carpal tunnel syndrome?

  1. Ulnar nerve entrapment at the elbow
  2. Brachial plexus injury
  3. Radial nerve palsy
  4. Idiopathic median nerve compression Correct answer.

Explanation

Most carpal tunnel syndrome cases are idiopathic, resulting from increased pressure in the carpal canal compressing the median nerve. Secondary causes include pregnancy, hypothyroidism, diabetes, and rheumatoid arthritis.

Question 19Part I (Written) Examination

A 12-year-old obese boy has hip pain and an antalgic gait. Radiographs show a widened growth plate and medial displacement of the femoral head. What is the diagnosis?

  1. Slipped capital femoral epiphysis Correct answer.
  2. Legg-Calve-Perthes disease
  3. Septic arthritis of the hip
  4. Developmental dysplasia of the hip

Explanation

Slipped capital femoral epiphysis presents in obese adolescents with hip or referred knee pain and radiographic displacement of the femoral head relative to the neck. It requires stabilization, typically with in situ pinning.

Question 20Part I (Written) Examination

Which of the following best describes the mechanism of action of bisphosphonates in osteoporosis?

  1. Direct stimulation of osteoblast proliferation
  2. Stimulation of osteoclast activity
  3. Increased renal calcium excretion
  4. Inhibition of osteoclast-mediated bone resorption Correct answer.

Explanation

Bisphosphonates bind to hydroxyapatite and inhibit osteoclast-mediated bone resorption, reducing bone loss and fracture risk. They are a first-line treatment for osteoporosis.

Question 21Part I (Written) Examination

A 35-year-old sustains a posterior hip dislocation in a motor vehicle collision. Which complication should be monitored for in the weeks after reduction?

  1. Avascular necrosis of the femoral head
  2. Both avascular necrosis and sciatic nerve injury Correct answer.
  3. Sciatic nerve palsy
  4. Femoral artery injury

Explanation

Posterior hip dislocation is associated with both sciatic nerve injury, which may be present at the time of injury, and avascular necrosis of the femoral head, which can develop later. Prompt reduction reduces the risk of both.

Question 22Part I (Written) Examination

A patient with a tibial plateau fracture has a Schatzker type VI pattern. What does this classification indicate?

  1. A split fracture of the lateral plateau
  2. A bicondylar fracture with metaphyseal-diaphyseal dissociation Correct answer.
  3. A medial plateau fracture with lateral plateau involvement
  4. A depression fracture of the lateral plateau

Explanation

Schatzker type VI is a bicondylar tibial plateau fracture with dissociation of the metaphysis from the diaphysis. It is a high-energy injury often requiring dual plating or a spanning external fixator.

Question 23Part I (Written) Examination

A patient has a displaced talar neck fracture. Which blood supply is most critical to preserve to reduce the risk of avascular necrosis?

  1. Posterior tibial artery at the ankle
  2. Artery of the tarsal canal Correct answer.
  3. Perforating peroneal artery branches
  4. Dorsalis pedis artery only

Explanation

The artery of the tarsal canal, a branch of the posterior tibial artery, provides the dominant blood supply to the talar body. Displaced talar neck fractures disrupt this supply and increase the risk of avascular necrosis.

Question 24Part I (Written) Examination

Which of the following is the most appropriate initial management of a patient with a suspected cauda equina syndrome from a lumbar disc herniation?

  1. Outpatient physical therapy
  2. Urgent MRI and surgical decompression Correct answer.
  3. Bed rest and NSAIDs
  4. Epidural steroid injection

Explanation

Cauda equina syndrome is a surgical emergency requiring urgent MRI to confirm the diagnosis and prompt decompression to prevent permanent neurologic deficits, including bowel and bladder dysfunction. Delay worsens outcomes.

Question 25Part I (Written) Examination

A patient has a proximal humerus fracture-dislocation with an absent axillary nerve examination. Which finding best indicates axillary nerve injury?

  1. Loss of sensation over the medial arm
  2. Weakness of elbow flexion
  3. Loss of sensation over the lateral deltoid and weakness of shoulder abduction Correct answer.
  4. Loss of wrist extension

Explanation

The axillary nerve supplies the deltoid and teres minor and provides sensation over the lateral shoulder (deltoid patch). Injury causes weakness of shoulder abduction and sensory loss in that distribution.

Question 26Part I (Written) Examination

A 6-year-old boy has a 3 cm lytic lesion in the distal femoral metaphysis with a sclerotic rim and no periosteal reaction. He is otherwise asymptomatic. What is the most likely diagnosis?

  1. Osteoid osteoma
  2. Osteosarcoma
  3. Non-ossifying fibroma Correct answer.
  4. Ewing sarcoma

Explanation

Non-ossifying fibromas are common benign fibroxanthomatous lesions of childhood that arise in the metaphysis of long bones, appear lytic with a sclerotic rim, and are typically asymptomatic and self-limiting. Their eccentric metaphyseal location and lack of aggressive features distinguish them from malignancy.

Question 27Part I (Written) Examination

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

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

Explanation

The superior gluteal nerve runs between the gluteus medius and minimus and is at risk during the direct lateral (Hardinge) approach, and injury leads to a Trendelenburg gait. The nerve lies roughly 3 to 5 cm above the greater trochanter as it courses toward the tensor fascia lata.

Question 28Part I (Written) Examination

A 28-year-old sustains a both-bone forearm fracture treated with open reduction and internal fixation. Six months later he cannot fully supinate the forearm. Which structure is most likely tethered by scar?

  1. Interosseous membrane Correct answer.
  2. Pronator quadratus
  3. Biceps tendon
  4. Extensor pollicis longus

Explanation

The interosseous membrane between the radius and ulna can become scarred or synostosed after forearm fractures, restricting pronation and supination. Post-traumatic radioulnar synostosis is a recognized complication of diaphyseal forearm fractures, especially those treated surgically.

Question 29Part I (Written) Examination

What is the primary biomechanical function of the anterior cruciate ligament?

  1. Limiting anterior tibial translation Correct answer.
  2. Resisting valgus stress in extension
  3. Restraining external rotation of the tibia in flexion
  4. Preventing posterior tibial translation

Explanation

The ACL's main role is to resist anterior translation of the tibia relative to the femur, which is why the Lachman and pivot shift tests assess its integrity. It also provides secondary restraint to internal rotation and valgus stress.

Question 30Part I (Written) Examination

A 62-year-old woman has a Colles fracture with dorsal angulation. Which deformity is classically described on inspection?

  1. Claw hand
  2. Dinner fork deformity Correct answer.
  3. Gunstock deformity
  4. Swan neck deformity

Explanation

A Colles fracture involves dorsal displacement and angulation of the distal radius, producing the classic dinner fork profile. This pattern results from a fall onto an outstretched hand with the wrist in extension.

Question 31Part I (Written) Examination

A patient has a complete radial nerve palsy after a humeral shaft fracture with a closed injury. What is the most appropriate initial management?

  1. Primary nerve exploration and grafting
  2. Immediate tendon transfer
  3. Observation with a functional brace and serial examination Correct answer.
  4. Above-elbow amputation

Explanation

Most radial nerve palsies associated with closed humeral shaft fractures are neuropraxic and recover spontaneously within 3 to 4 months, so observation with functional bracing is standard. Early exploration is reserved for open fractures, penetrating injury, or failure to recover.

Question 32Part I (Written) Examination

Which of the following is the most sensitive physical examination test for detecting a meniscal tear?

  1. Apley grind test
  2. McMurray test
  3. Thessaly test Correct answer.
  4. Joint line tenderness

Explanation

The Thessaly test, performed with the patient standing and rotating on a flexed knee, has been shown to have higher sensitivity for meniscal tears than McMurray or joint line tenderness. Sensitivity matters most for a screening examination, though specificity is lower than for some other tests.

Question 33Part I (Written) Examination

A 14-year-old gymnast has chronic wrist pain and tenderness over the distal radial physis. Radiographs show widening of the physis. What is the most likely diagnosis?

  1. Gymnast wrist Correct answer.
  2. De Quervain tenosynovitis
  3. Scapholunate dissociation
  4. Kienbock disease

Explanation

Repetitive axial loading of the wrist in young gymnasts can cause stress injury to the distal radial physis, termed gymnast wrist, with physeal widening and pain. Rest and activity modification usually allow the physis to heal.

Question 34Part I (Written) Examination

Which of the following is the most common site of osteomyelitis in children?

  1. Epiphysis of long bones
  2. Pelvis
  3. Metaphysis of long bones Correct answer.
  4. Vertebral body

Explanation

In children, the metaphysis of long bones is the most common site because the sluggish blood flow in the capillary loops there favors bacterial seeding. The physis acts as a barrier limiting spread into the epiphysis.

Question 35Part I (Written) Examination

A patient has a suspected compartment syndrome of the leg. Which finding is the most reliable clinical indicator?

  1. Pallor of the skin
  2. Decreased capillary refill
  3. Absent distal pulses
  4. Pain with passive stretch out of proportion to injury Correct answer.

Explanation

Pain with passive stretch that is out of proportion to the injury is the earliest and most reliable clinical sign of compartment syndrome. Pulses are typically preserved because compartment pressures below arterial pressure do not occlude the major vessels.

Question 36Part I (Written) Examination

Which of the following best describes the mechanism of action of methotrexate in rheumatoid arthritis?

  1. B-cell depletion
  2. Dihydrofolate reductase inhibition Correct answer.
  3. TNF-alpha inhibition
  4. COX-2 selective inhibition

Explanation

Methotrexate inhibits dihydrofolate reductase and related folate-dependent enzymes, which increases extracellular adenosine and produces anti-inflammatory effects. It is the anchor disease-modifying drug for rheumatoid arthritis.

Question 37Part I (Written) Examination

A 65-year-old man has a lytic lesion in the proximal femur from metastatic prostate cancer. Which of the following is the most appropriate initial treatment for an impending pathologic fracture?

  1. Radiation alone
  2. Prophylactic intramedullary nailing Correct answer.
  3. External fixation
  4. Amputation

Explanation

Prophylactic stabilization with an intramedullary device is indicated for impending pathologic fractures of the proximal femur to prevent completion and allow early mobilization. Lesions are assessed using Mirels criteria, and scores of 8 or higher generally warrant prophylactic fixation.

Question 38Part I (Written) Examination

Which of the following is the most common site of a ganglion cyst?

  1. Dorsum of the wrist Correct answer.
  2. Popliteal fossa
  3. Volar aspect of the elbow
  4. Anterior ankle

Explanation

Ganglion cysts most commonly arise on the dorsum of the wrist, often communicating with the scapholunate joint. They are mucin-filled and may fluctuate in size with activity.

Question 39Part I (Written) Examination

A 40-year-old has a displaced transverse patella fracture with intact extensor mechanism function on examination. Which treatment is most appropriate?

  1. Tension band wiring Correct answer.
  2. Cylinder cast immobilization
  3. Quadriceps tendon repair
  4. Patellectomy

Explanation

Displaced transverse patella fractures with a disrupted extensor mechanism require operative fixation, and tension band wiring is the standard technique for this pattern. The construct converts tensile forces into compression at the articular surface.

Question 40Part I (Written) Examination

A 55-year-old has a complete Achilles tendon rupture. Which clinical test is most specific for this injury?

  1. Finkelstein test
  2. Thompson test Correct answer.
  3. Anterior drawer test
  4. McMurray test

Explanation

The Thompson test squeezes the calf and assesses whether the foot plantarflexes; absence of plantarflexion indicates a complete Achilles rupture. It is highly specific because an intact tendon transmits the squeeze to the foot.

Question 41Part I (Written) Examination

A 70-year-old woman has a distal radius fracture with an associated ulnar styloid fracture. Which factor most strongly predicts instability after closed reduction?

  1. Hand dominance
  2. Presence of an ulnar styloid fracture
  3. Patient age
  4. Initial dorsal comminution Correct answer.

Explanation

Initial dorsal comminution, along with displacement and intra-articular extension, predicts loss of reduction after closed treatment of distal radius fractures. These features reflect loss of the dorsal cortical buttress that maintains reduction.

Question 42Part I (Written) Examination

Which of the following is the most appropriate initial imaging study for a suspected scaphoid fracture with normal radiographs?

  1. Bone scan
  2. MRI of the wrist Correct answer.
  3. CT of the wrist
  4. Repeat radiographs in 6 weeks

Explanation

MRI is the most sensitive and specific early study for occult scaphoid fractures and can also identify ligamentous injury. Early diagnosis allows timely immobilization and reduces the risk of nonunion.

Question 43Part I (Written) Examination

Which of the following best describes the role of the labrum in the shoulder?

  1. It produces synovial fluid
  2. It deepens the glenoid and contributes to stability Correct answer.
  3. It acts as the main restraint to inferior translation
  4. It provides the primary blood supply to the humeral head

Explanation

The glenoid labrum is a fibrocartilaginous ring that deepens the shallow glenoid socket and increases the contact area, contributing to stability. It also serves as an attachment point for the capsule and ligaments.

Question 44Part I (Written) Examination

A patient has a high-energy tibial pilon fracture with severe soft tissue compromise. Which staged treatment approach is most appropriate?

  1. Immediate open reduction and internal fixation through the compromised skin
  2. Primary arthrodesis of the ankle
  3. Immediate below-knee amputation
  4. Temporary external fixation followed by delayed internal fixation after soft tissue recovery Correct answer.

Explanation

Pilon fractures with severe soft tissue injury are best managed with staged treatment: temporary spanning external fixation to restore length and alignment, followed by definitive fixation once the soft tissue envelope has recovered. This reduces wound complications and infection.

Question 45Part I (Written) Examination

Which of the following is the classic clinical presentation of developmental dysplasia of the hip in a newborn?

  1. Painful hip rotation
  2. Leg-length discrepancy with a waddling gait
  3. Positive Ortolani and Barlow maneuvers Correct answer.
  4. Fixed hip flexion contracture

Explanation

In newborns, DDH is detected by the Ortolani maneuver, which relocates a dislocated hip, and the Barlow maneuver, which dislocates a reducible hip. These tests become less reliable after the neonatal period as soft tissues contract.

Question 46Part I (Written) Examination

A 45-year-old has a supracondylar humerus fracture with a pulseless, pale hand. Which of the following is the most appropriate next step?

  1. Application of a splint and discharge
  2. Closed reduction and casting with observation
  3. Immediate closed reduction and pinning with reassessment of vascular status Correct answer.
  4. Observation for 24 hours

Explanation

A pulseless, pale hand after a supracondylar fracture indicates vascular compromise, and urgent reduction and stabilization are required to restore perfusion. If perfusion does not return after reduction, vascular exploration is indicated.

Question 47Part I (Written) Examination

Which of the following is the most common cause of a positive Trendelenburg sign after total hip arthroplasty?

  1. Superior gluteal nerve injury or abductor weakness Correct answer.
  2. Sciatic nerve palsy
  3. Femoral component loosening
  4. Aseptic loosening of the acetabular cup

Explanation

A positive Trendelenburg sign reflects abductor weakness, which may result from superior gluteal nerve injury, abductor detachment, or inadequate restoration of offset during arthroplasty. It produces pelvic drop on the contralateral side during single-leg stance.

Question 48Part I (Written) Examination

A 60-year-old has a femoral shaft fracture treated with an intramedullary nail. Which of the following is the most common cause of fat embolism syndrome?

  1. Distal radius fracture
  2. Femoral shaft fracture Correct answer.
  3. Clavicle fracture
  4. Metacarpal fracture

Explanation

Fat embolism syndrome most often follows long-bone fractures, particularly femoral shaft fractures, because marrow fat enters the venous circulation. It presents with hypoxemia, neurologic changes, and a petechial rash.

Question 49Part I (Written) Examination

A 35-year-old has chronic lateral elbow pain with tenderness over the lateral epicondyle and pain with resisted wrist extension. Which diagnosis is most likely?

  1. Cubital tunnel syndrome
  2. Medial epicondylitis
  3. Olecranon bursitis
  4. Lateral epicondylitis Correct answer.

Explanation

Lateral epicondylitis, or tennis elbow, arises from degeneration of the extensor carpi radialis brevis origin and produces pain with resisted wrist extension. It is a tendinopathy rather than an inflammatory condition.

Question 50Part I (Written) Examination

A patient has a type II odontoid fracture that is displaced and unstable. Which treatment is most appropriate?

  1. Posterior C1-C2 fusion or anterior screw fixation Correct answer.
  2. Cervical collar immobilization
  3. Observation with serial radiographs
  4. Halo vest immobilization

Explanation

Displaced type II odontoid fractures are unstable because the fracture line lies at the base of the dens where blood supply is tenuous, and they have a high rate of nonunion with conservative treatment. Surgical stabilization with anterior odontoid screw fixation or posterior C1-C2 fusion is therefore recommended.