Surgical Anatomy & Approaches MCQs

Anatomical variation of the sciatic nerve as it exits the greater sciatic foramen is well documented. In approximately 10-15% of the population, a variant exists that can predispose to iatrogenic injury or piriformis syndrome. What is the most common anatomical variant of the sciatic nerve?

During a direct anterior (Smith-Petersen) approach to the hip for total hip arthroplasty, the surgeon utilizes both superficial and deep internervous planes. Which of the following accurately describes the deep internervous plane for this approach?

An orthopedic surgeon is performing an anterior intrapelvic (modified Stoppa) approach for an acetabular fracture. The surgeon must identify and ligate the 'corona mortis' to prevent massive hemorrhage. This vascular structure is most commonly an anastomosis between which of the following systems?

In the setting of a complex posterior pilon fracture, a posterolateral surgical approach is planned. Which of the following anatomic intervals is typically utilized to access the posterolateral fragment (Volkmann's fragment)?

A 24-year-old unrestrained driver is involved in a motor vehicle collision. He presents with his right lower extremity positioned in flexion, adduction, and internal rotation.

Which of the following structures is at greatest risk of injury?

A 30-year-old male sustains a closed midshaft humerus fracture and presents with an immediate, complete radial nerve palsy. The fracture is acceptably reduced and placed in a coaptation splint. If there is no clinical sign of nerve recovery, at what post-injury timeframe is an EMG/NCS most indicated to evaluate for subclinical reinnervation?

A 35-year-old restrained driver in a motor vehicle collision sustains a traumatic posterior hip dislocation. Following successful closed reduction, the patient exhibits weak ankle dorsiflexion and decreased sensation over the dorsum of the foot. Which nerve division is most commonly injured in this injury pattern?

During open reduction and internal fixation of a volar Barton's fracture, the surgeon decides to use a classic volar Henry approach. Which surgical interval is primarily utilized for this approach?

A 55-year-old man with iatrogenic flatback syndrome requires surgical correction. The surgeon plans a single-level procedure to achieve approximately 30 to 35 degrees of sagittal correction. Which of the following osteotomies is most appropriate?

Examination of a 30-year-old professional singer who has persistent neck and shoulder pain reveals a positive Hoffman's sign and clonus because of anterior C2-3 cord compression. The MRI scan shown in Figure 11a and the cervical CT scan shown in Figure 11b reveal focal anterior cord compression at the C2-3 level. Which of the following surgical approaches would least affect her professional career?

A 25-year-old male sustains a closed midshaft humerus fracture after a fall. Upon presentation, he has a wrist drop and inability to extend his fingers, but normal sensation in the axillary nerve distribution. Radiographs show acceptable alignment. What is the most appropriate initial management of the nerve injury?

During an open Latarjet procedure, aggressive medial retraction of the conjoint tendon places a specific nerve at risk of traction injury. Which nerve is most vulnerable, and what is its expected distance from the tip of the coracoid?

During an open Latarjet procedure, the surgeon inadvertently places a self-retaining medial retractor deep to the conjoined tendon and applies excessive traction. Which of the following nerves is at greatest risk of injury from this maneuver?

A 42-year-old man is undergoing an open subpectoral biceps tenodesis. The surgeon makes an incision in the axillary fold and exposes the intertubercular groove. Which nerve is most at risk of injury during medial retraction of the conjoint tendon in this approach?

During a deltopectoral approach for a proximal humerus fracture, the axillary nerve must be protected. Which of the following describes its anatomical course relative to the shoulder joint?

Following an acute anterior shoulder dislocation, a 24-year-old male is unable to actively elevate his arm and reports numbness over the lateral aspect of his shoulder. Which nerve is most likely injured?

A 28-year-old man sustains an anterior shoulder dislocation with a concomitant greater tuberosity fracture. Following closed reduction, the patient is unable to actively abduct the shoulder and has diminished sensation over the lateral aspect of the shoulder. Injury to which of the following nerves is most likely?

During an open repair of a massive, retracted subscapularis tendon tear, extensive medial mobilization of the muscle belly is required. Which neural structure is at greatest risk of iatrogenic injury during this mobilization?

A 50-year-old male arrives in the emergency department with an acute anterior shoulder dislocation after a fall. Following successful closed reduction, he reports a patch of numbness over the lateral aspect of his shoulder and exhibits weakness when attempting to actively abduct the arm. Which nerve is most commonly injured in this injury pattern?

During a Latarjet procedure, the coracoid process is osteotomized and transferred to the anterior glenoid. Which of the following nerves is at greatest risk of iatrogenic injury during the coracoid mobilization and transfer?