Surgical Anatomy & Approaches MCQs

A patient underwent a right hip arthroscopy, CAM resection, and labral repair while positioned supine on a fracture table with a perineal post. The leg was in traction for 4 hours, and no intrasurgical complications were noted. At the 2-week follow-up appointment, the patient was experiencing numbness and tingling in the perineum on the surgical side and noted pain predominantly while sitting. What is the likely cause of these symptoms?

When utilizing an anterolateral surgical approach to the distal tibia for open reduction and internal fixation of a pilon fracture, the vascularity of the lateral skin flap is predominantly supplied by which angiosome?

A surgeon utilizes the direct anterior approach for a total hip arthroplasty. To safely access the hip joint, an internervous plane is developed superficially. Which two nerves supply the muscles that form the boundaries of this superficial surgical interval?

During an ilioinguinal approach for the open reduction and internal fixation of an anterior pelvic ring fracture, the surgeon encounters brisk arterial bleeding near the superior pubic ramus. Which of the following vascular structures or anastomoses is the most likely source of this bleeding?

A surgeon utilizes the direct anterior approach (DAA) for a total hip arthroplasty using the internervous plane between the tensor fasciae latae (TFL) and the sartorius. During deep dissection, a nerve passing over the anterior aspect of the iliacus muscle is at risk of iatrogenic traction injury. What is the clinical consequence of an injury to this specific nerve?

The direct anterior approach (DAA) to the hip is increasingly popular for primary THA due to its use of a true internervous and intermuscular plane. Which of the following accurately describes the superficial internervous plane utilized in the direct anterior approach?

A 40-year-old male falls from a height and sustains a severely displaced comminuted fracture of the talar body. Surgical planning dictates that extensive exposure of the medial and central aspects of the talar dome is required for anatomical reduction.

Which surgical approach provides the most optimal visualization for this injury?

When utilizing the posterolateral approach to the ankle for fixation of a posterior malleolus fracture, the surgical interval is developed between which of the following muscle bellies?

A 33-year-old unrestrained driver sustains a posterior wall acetabular fracture with a posterior hip dislocation.

On initial evaluation, the patient has weakness in ankle dorsiflexion and great toe extension, with completely intact ankle plantar flexion. Which nerve division is most likely injured?

A 40-year-old male presents with a chronic anterior shoulder dislocation missed for 6 weeks. During open reduction and stabilization using a Latarjet procedure, the conjoint tendon is aggressively retracted medially to gain exposure to the glenoid. Postoperatively, the patient is unable to flex his elbow against resistance when the forearm is supinated and has sensory loss over the lateral forearm. Which nerve was most likely injured?

A 32-year-old male sustains a posterior hip dislocation. He presents with a foot drop but retains full strength in ankle plantar flexion and toe flexion. Why is the peroneal division of the sciatic nerve more frequently and severely injured than the tibial division in this clinical scenario?

A 28-year-old male is involved in a motor vehicle collision, sustaining a posterior wall acetabular fracture and a posterior hip dislocation.

Following a successful closed reduction, he demonstrates profound weakness in ankle dorsiflexion but preserved plantarflexion. Which division of the sciatic nerve is most commonly injured in this clinical scenario?

A 26-year-old unrestrained driver is involved in a motor vehicle collision. He presents with his right hip flexed, adducted, and internally rotated. Following closed reduction of the hip, he is unable to dorsiflex his right foot or extend his toes, but plantar flexion is symmetric to the contralateral side. Which of the following best explains the specific pattern of this neurological deficit?

A 45-year-old man is undergoing open reduction and internal fixation of a posterior wall acetabular fracture via a Kocher-Langenbeck approach. What intraoperative leg position is most critical to minimize iatrogenic tension on the sciatic nerve?

A 28-year-old male sustains a posterior hip dislocation. Following successful closed reduction, he is noted to have a dense foot drop and absent sensation over the dorsal aspect of his foot. Which anatomic characteristic makes the primarily involved nerve division most susceptible to this specific injury?

A 45-year-old man is involved in a motor vehicle collision, sustaining a posterior hip dislocation and a posterior wall acetabular fracture. Following closed reduction, he is unable to dorsiflex his ankle or extend his great toe, though plantar flexion remains intact. Which division of the affected nerve is most likely injured, and what is its typical relative prognosis?

A 40-year-old man sustains a Pipkin IV fracture-dislocation of the hip with an immediate, profound sciatic nerve palsy. He is reduced and placed in skeletal traction. A post-reduction CT scan clearly demonstrates a large posterior wall fragment directly impinging upon the sciatic nerve. What is the next best step in management?

During a direct anterior approach for total hip arthroplasty, the superficial internervous plane utilized is between muscles innervated by which of the following nerves?