Surgical Anatomy & Approaches MCQs

Figure 99 shows a dorsal approach for a midfoot arthrodesis following a Lisfranc injury in a 43-year-old woman. The base of the second metatarsal is labeled with the letter B. The interval used to create this exposure is

During a deltopectoral approach for an open reduction internal fixation (ORIF) of a proximal humerus fracture, the surgeon must be mindful of the axillary nerve. On average, at what distance distal to the lateral border of the acromion does the axillary nerve cross the deep surface of the deltoid?

A 30-year-old female sustains a shear fracture of the capitellum extending into the trochlea. During open reduction and internal fixation via a lateral approach, the surgeon decides to use the Kocher approach to visualize the capitellum while minimizing risk to the LUCL. The Kocher approach utilizes the internervous plane between which two muscles?

A 34-year-old female presents with elbow pain after a fall. Radiographs and CT demonstrate a coronal shear fracture of the capitellum that extends medially to include the majority of the trochlea, with a separate comminuted fracture of the posterior trochlea. According to the Dubberley classification, what is the most appropriate surgical approach for open reduction and internal fixation of this Type 3B injury?

A 25-year-old male sustains a closed transverse midshaft humerus fracture and presents with an immediate complete radial nerve palsy. He is treated with a functional brace. At what time point should an EMG/NCS be ordered if there is no clinical evidence of radial nerve recovery?

A 42-year-old man presents to the ER with his arm locked in hyperabduction over his head after a fall. Radiographs show an inferior glenohumeral dislocation (luxatio erecta). What is the most frequently injured neurovascular structure in this specific dislocation pattern?

A 28-year-old male sustains a closed transverse midshaft humerus fracture with an immediate complete radial nerve palsy. He is treated with a functional brace. At 12 weeks post-injury, the fracture is healing, but there is no clinical or EMG evidence of radial nerve recovery. What is the most appropriate next step?

During open reduction and internal fixation of a posterior wall acetabular fracture via a Kocher-Langenbeck approach, the surgeon places the patient's operative leg in a specific position to minimize tension on the sciatic nerve. Which position is most appropriate, and which division of the nerve is at highest risk of iatrogenic injury?

A 40-year-old male sustains a posterior wall acetabular fracture with a posterior hip dislocation. Post-reduction, he exhibits a foot drop and inability to actively extend his great toe. Which specific neural structure is most likely injured?

The direct anterior (Smith-Petersen) approach for total hip arthroplasty utilizes a true internervous plane. Which of the following best describes the nerves supplying the muscles that form the superficial boundary of this interval?

During an ilioinguinal approach for the fixation of an anterior column acetabular fracture, life-threatening hemorrhage occurs while dissecting over the superior pubic ramus near the symphysis. Which two vessels commonly anastomose in this region to form the 'corona mortis', the most likely source of this bleeding?

A 72-year-old female undergoes a reverse total shoulder arthroplasty via a deltopectoral approach. During glenoid exposure, a retractor is placed inferiorly on the glenoid neck. Which nerve is at greatest risk of injury from this specific retractor placement?

A 45-year-old male sustains a complex acetabular fracture. CT imaging demonstrates a fracture of the anterior column with a posterior hemitransverse component, alongside a medially displaced quadrilateral plate. Which surgical approach provides the most direct and optimal access to reduce the quadrilateral plate and place an infrapectineal buttress plate?

The direct anterior approach (Smith-Petersen) to the hip is favored by many due to its utilization of a true internervous and intermuscular plane. Which two nerves supply the muscles that form the superficial boundary of this surgical interval?

Following an open Latarjet procedure, the patient complains of an inability to actively flex the elbow and numbness along the lateral aspect of the forearm. Which nerve was most likely injured by excessive retraction of the conjoint tendon?

A surgeon performs a total hip arthroplasty via the direct anterior approach. Which of the following internervous planes is utilized during the deep surgical dissection?

During an ilioinguinal approach to the acetabulum, the surgeon encounters massive bleeding over the superior pubic ramus near the symphysis. This bleeding is most likely originating from an anastomosis between which two vascular systems?

A 24-year-old motorcyclist sustains a traumatic brachial plexus injury. Clinical examination reveals complete paralysis of the right upper extremity, an ipsilateral ptosis, and miosis. What does the presence of Horner's syndrome indicate regarding his nerve injury?

During an anterior shoulder stabilization procedure, the surgeon is carefully identifying the structures in the axilla to avoid injury to the axillary nerve. The axillary nerve exits the axilla posteriorly through the quadrilateral space. Which vascular structure directly accompanies the nerve through this space?

A 28-year-old man sustains a posterior fracture-dislocation of the hip. Following closed reduction, he is found to have weakness in ankle dorsiflexion and great toe extension, but intact plantar flexion. Sensation is decreased over the dorsum of the foot. Which specific neural structure is most likely injured?