Surgical Anatomy & Approaches MCQs

A 45-year-old man sustains an unstable anteroposterior compression (APC-II) pelvic ring injury requiring anterior symphyseal plating. During exposure via a Pfannenstiel approach, brisk arterial bleeding is encountered on the posterior aspect of the superior pubic ramus. Which of the following is the most likely source of this bleeding?

A 25-year-old unrestrained driver is involved in a head-on motor vehicle collision. He presents to the trauma bay with a shortened, internally rotated, and adducted left lower extremity. A radiograph confirms a posterior hip dislocation. Which of the following nerve injuries is most commonly associated with this injury?

During the ilioinguinal approach for open reduction and internal fixation of an anterior column acetabular fracture, vigorous arterial bleeding is encountered on the posterior aspect of the superior pubic ramus, approximately 5 cm from the pubic symphysis. Which of the following anatomic structures is the most likely source of this bleeding?

A 40-year-old male motorcyclist experiences a severe lateral traction injury to his right shoulder. He presents with massive shoulder swelling, an absent right radial pulse, and a completely flail right upper extremity. Radiographs reveal a widened scapulothoracic articulation and lateral displacement of the scapula. What is the most likely associated neurologic injury?

A 35-year-old male is undergoing open reduction and internal fixation of a transverse posterior wall acetabular fracture via a Kocher-Langenbeck approach. To minimize iatrogenic traction injury to the sciatic nerve during retraction, what is the optimal position of the operative lower extremity?

During a midfoot surgical approach for tendon transfer, the surgeon isolates the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons at the Knot of Henry. What is the precise anatomic relationship between these two tendons at this location?

A 40-year-old female sustains a coronal shear fracture of the distal humerus extending into the trochlea (Dubberley Type 2B). What surgical approach is most appropriate for direct visualization and anterior-to-posterior fixation?

A 30-year-old male presents with a Hahn-Steinthal (Type I) capitellum fracture, characterized by a large osseous fragment involving the subchondral bone. Which surgical approach provides the most direct and appropriate exposure for internal fixation?

A 35-year-old male sustains a closed transverse fracture of the middle third of the humeral shaft. On examination, he has a weak wrist drop but normal triceps extension. He is treated with a functional brace. At 12 weeks, there is no clinical or EMG evidence of radial nerve recovery. What is the next best step?

During an anterolateral deltoid-splitting approach for minimally invasive plate osteosynthesis (MIPO) of a proximal humerus fracture, what is the generally accepted safe distance from the lateral tip of the acromion to avoid injury to the axillary nerve?

A patient has a humeral shaft fracture and is scheduled to undergo open reduction and internal fixation with a plate. What surgical approach will provide the greatest amount of exposure?

A 60-year-old man presents with chronic shoulder pain and weakness. On examination, he is unable to actively externally rotate his arm while it is held in 90 degrees of abduction (positive Hornblower's sign). This clinical finding indicates a deficiency in a muscle innervated by which of the following nerves?

When utilizing the volar approach to the distal radius (Modified Henry approach) for internal fixation of a volar Barton's fracture, the surgical interval is developed between which two anatomical structures?

A 25-year-old male sustains an acute anterior shoulder dislocation. Post-reduction, you suspect an axillary nerve injury. What area should be evaluated to assess the sensory distribution of the axillary nerve?

During a deltoid-splitting approach for proximal humerus fracture fixation, the surgeon must be careful to avoid the axillary nerve. At approximately what distance distal to the lateral edge of the acromion does the axillary nerve typically cross the deep surface of the deltoid?

A 35-year-old man sustains a distal third spiral fracture of the humerus. On examination, he is unable to extend his wrist or fingers. Which nerve is most commonly injured in this specific fracture pattern?

A patient sustains a closed midshaft humerus fracture and presents with a radial nerve palsy. An EMG at 4 weeks shows fibrillation potentials in the brachioradialis, but an MRI demonstrates an intact epineurium. Which Seddon classification describes this injury?

During the proximal extension of the volar (Henry) approach to the forearm, the surgeon elevates the supinator muscle to expose the proximal radius. Which nerve lies within the substance of the supinator and is at highest risk of iatrogenic injury if the muscle is elevated aggressively or incorrectly?

During a deltopectoral approach to the shoulder, the conjoint tendon is identified and retracted medially to access the subscapularis. Excessive medial retraction of the conjoint tendon places which of the following nerves at greatest risk of neuropraxia?

The anterior (Smith-Petersen) approach to the hip utilizes both superficial and deep internervous planes. Which of the following describes the deep internervous plane for this approach?