Surgical Anatomy & Approaches MCQs

When performing an extensile posterior approach to the humerus using a triceps-splitting technique, the surgeon must be careful to avoid denervating the medial head of the triceps. Which branch of the radial nerve is at greatest risk during the distal split of the triceps muscle?

A patient is scheduled for ORIF of a proximal humerus fracture via a standard deltopectoral approach. During the deep dissection, the surgeon visualizes the conjoined tendon. Retraction of the conjoined tendon medially places which neurological structure at highest risk?

A 72-year-old male undergoes a minimally invasive plate osteosynthesis (MIPO) via an anterior approach for a proximal humerus fracture extending into the diaphysis. The surgeon passes a long locking plate submuscularly from proximal to distal. Which nerve is at greatest risk of iatrogenic injury during distal screw placement in this technique?

The Thompson approach to the proximal radius is often utilized for treating complex radius fractures. What is the precise internervous interval utilized in this surgical approach?

During an anterolateral approach to the humeral shaft, the surgeon splits the brachialis muscle longitudinally to expose the bone. What is the neurovascular rationale for splitting the brachialis muscle rather than retracting it entirely?

A 40-year-old female sustains a Bryan-Morrey Type I capitellar shear fracture. The surgeon elects to use the Kocher approach for open reduction and internal fixation. What is the superficial internervous interval utilized in this approach?

A surgeon is performing a volar Henry approach for fixation of a middle-third radius fracture. During the proximal exposure, careful dissection is required to protect the superficial radial nerve and radial artery. What is the internervous interval in the proximal portion of the volar Henry approach?

A 30-year-old male sustains a closed midshaft humerus fracture with an intact radial nerve on initial exam. Following closed reduction and placement of a coaptation splint in the emergency department, a complete radial nerve palsy is noted. According to AAOS guidelines, what is the most appropriate next step in management?

A patient with a closed humeral shaft fracture presents with a primary radial nerve palsy. The fracture is managed non-operatively. At what time point is an electromyogram (EMG) and nerve conduction study indicated if there is no clinical sign of nerve recovery?

When performing a posterior approach to the humeral shaft, the surgeon must be acutely aware of the radial nerve's location. On average, at what distance proximal to the lateral epicondyle does the radial nerve cross the posterior aspect of the humerus?

A surgeon utilizes the lateral (Kocher) approach to the elbow to access the radial head in a Bado Type II Monteggia variant. Which internervous plane is utilized in this approach?

When utilizing the posterior approach to the humerus for internal fixation of a diaphyseal fracture, at what approximate distance proximal to the lateral epicondyle does the radial nerve pierce the lateral intermuscular septum to enter the anterior compartment?

A 55-year-old carpenter with severe erosive osteoarthritis of the index finger PIP joint, refractory to conservative treatment, elects for surgical arthrodesis to achieve a stable, pain-free joint for his demanding profession. During the procedure, after preparing the articular surfaces, the surgeon aims to achieve the optimal fusion angle for the index finger PIP joint. Which of the following angles is generally considered most appropriate for fusion of the index finger PIP joint to facilitate optimal object manipulation, pinch, and grip?

A surgeon is performing a trapeziectomy with LRTI for advanced thumb CMC arthritis. After excising the trapezium, the next step involves preparing the FCR tendon for reconstruction. Referring to the provided image and the case description, which statement accurately describes the FCR tendon harvest for a standard LRTI?

When utilizing an anterolateral surgical approach for the open reduction and internal fixation of a severe pilon fracture, which of the following neurologic structures is at greatest risk of iatrogenic injury?

A 22-year-old athlete sustains a rotational ankle injury. Radiographs show a fracture of the proximal third of the fibula and widening of the medial clear space. What structure is highly at risk during surgical approach or from the injury itself in this specific fracture pattern?

During open reduction and internal fixation of a medial malleolus fracture, a longitudinal incision is made directly over the medial malleolus. Which neurological structure is most at risk of injury during the superficial dissection in this area?

When planning surgery for a severe, fixed positive sagittal imbalance in an adult deformity patient, which of the following osteotomies reliably provides the greatest amount of sagittal plane correction per level without complete segmental resection?

An adult patient with severe fixed positive sagittal imbalance and previous long-segment lumbar fusion requires surgical correction. The surgeon plans a three-column osteotomy to achieve the necessary lordosis. Approximately how much lordotic correction can typically be obtained from a single-level pedicle subtraction osteotomy (PSO)?

Which surgical approach provides the best exposure for ORIF of a radial head fracture while minimizing the risk to the posterior interosseous nerve (PIN)?