Surgical Anatomy & Approaches MCQs

A 28-year-old patient sustains a closed midshaft humerus fracture and presents with a complete radial nerve palsy. Electromyography (EMG) performed at 4 weeks shows fibrillation potentials and positive sharp waves in the brachioradialis, but no motor unit action potentials. What pathophysiologic process best accounts for these findings distal to the injury site?

Following a traumatic transection of the radial nerve, the distal nerve segment undergoes Wallerian degeneration. Which of the following cells are primarily responsible for the rapid phagocytosis and clearance of myelin debris in the peripheral nervous system, thereby creating a permissible environment for axonal regeneration?

A 25-year-old man sustains a mid-shaft humerus fracture resulting in a complete radial nerve palsy. Three weeks later, an electromyogram (EMG) reveals fibrillation potentials and positive sharp waves in the brachioradialis. Which of the following pathophysiologic changes at the cellular level best explains these electrodiagnostic findings?

A 45-year-old male falls from a ladder and sustains an acetabular fracture. The CT scan demonstrates a transverse fracture line across the acetabulum with a large, comminuted posterior wall fragment. The femoral head is subluxated posteriorly. The surgeon plans for open reduction and internal fixation. Which surgical approach provides the most direct access for anatomic reduction and plating of the involved columns in this fracture pattern?

A 65-year-old woman undergoes open reduction and internal fixation of a 3-part proximal humerus fracture using a lateral deltoid-splitting approach and a locking plate. Postoperatively, she demonstrates a positive Hornblower's sign (inability to actively maintain external rotation of the arm in 90 degrees of abduction). Which nerve is most likely to have been injured?

A 45-year-old male is undergoing closed reduction and percutaneous pinning for a displaced proximal humerus fracture. To minimize the risk of injury to the axillary nerve, lateral pins should be inserted avoiding a specific zone. The axillary nerve typically courses transversely at what distance distal to the lateral edge of the acromion?

A 42-year-old female sustains a transverse posterior wall acetabular fracture. Radiographs and CT demonstrate a large posterior wall fragment and a medially displaced transverse component. The surgeon selects a Kocher-Langenbeck approach for fixation. During the procedure, the surgeon attempts to access the anterior extent of the transverse fracture line. Which of the following anatomic structures represents the primary limitation to the anterior/superior extension of the Kocher-Langenbeck approach?

A 55-year-old man is involved in a motor vehicle collision and sustains an associated both-column acetabular fracture. CT imaging demonstrates profound displacement of the anterior column, significant medial subluxation of the femoral head, and severe comminution of the quadrilateral plate. There is minimal displacement of the posterior column. Which of the following surgical approaches provides the most direct access for buttressing the quadrilateral plate to prevent medial subluxation?

A 40-year-old male sustains an isolated transverse acetabular fracture with a large, displaced posterior wall component. Preoperative computed tomography confirms the predominant displacement is posterior. Which surgical approach provides the most optimal visualization for direct reduction and fixation of this specific fracture pattern?

A 32-year-old male is evaluated in the emergency department after sustaining a closed spiral fracture of the distal third of the humeral shaft. His initial neurologic examination is completely intact. The fracture is managed with a closed reduction and application of a coaptation splint. Upon re-examination 30 minutes later, the patient is unable to extend his wrist or metacarpophalangeal joints, and has decreased sensation over the dorsal first web space. What is the most appropriate management of this neurologic deficit?

A 24-year-old man sustains a closed midshaft humerus fracture during an arm-wrestling match. On initial examination in the emergency department, his radial nerve motor and sensory functions are completely intact. A closed reduction is performed and a coaptation splint is applied. On post-reduction examination, the patient is unable to extend his wrist or fingers and has numbness in the first dorsal web space. What is the most appropriate next step in management?

A 45-year-old male undergoes open reduction and internal fixation of a transverse posterior wall acetabular fracture via a Kocher-Langenbeck approach. Postoperatively, the patient demonstrates a foot drop and inability to extend his toes. Which of the following intraoperative positioning or retraction errors most likely contributed to this complication?

A 68-year-old active female presents with an anterior shoulder dislocation and an associated displaced greater tuberosity fracture after a fall. Closed reduction of the shoulder is successful. Post-reduction radiographs confirm a concentrically located glenohumeral joint, but the greater tuberosity fragment remains displaced 12 mm superiorly. What is the most common nerve injury associated with this dislocation, and what is the appropriate management of the greater tuberosity?

A 42-year-old male requires surgery for severe insertional Achilles tendinopathy with a large retrocalcaneal exostosis (Haglund deformity) and prominent intratendinous calcification. Which surgical approach provides the best access for complete debridement and bony resection?

A 42-year-old male construction worker who smokes 1 pack per day falls from a ladder, sustaining a closed, displaced, intra-articular calcaneal fracture (Sanders Type II). Which of the following surgical approaches carries the lowest risk of wound complications for this patient?

A surgeon is performing an open reduction and internal fixation of a complex capitellar fracture involving the trochlea. The surgical plan requires exposing the radiocapitellar joint. If the surgeon utilizes the Kaplan approach, which of the following describes the correct internervous/intermuscular interval?

A 62-year-old woman sustains a displaced 3-part proximal humerus fracture. The orthopaedic surgeon plans open reduction and internal fixation via a deltopectoral approach. To avoid iatrogenic injury, the surgeon must be mindful of the axillary nerve. Which of the following accurately describes the normal anatomic course of the axillary nerve?

A 32-year-old man sustained a closed midshaft humerus fracture and presents with an inability to extend his wrist or fingers. He is treated nonoperatively with a functional brace. At 3 months, his fracture shows progressive healing, but there is no clinical or electromyographic (EMG) evidence of radial nerve recovery. What is the most appropriate next step in management?

A 55-year-old male manual laborer undergoes an open subpectoral biceps tenodesis for partial tearing of the long head of the biceps tendon. Which of the following represents a known advantage of open subpectoral biceps tenodesis compared to an arthroscopic suprapectoral tenodesis?

During open reduction and internal fixation of a displaced 3-part proximal humerus fracture using a deltopectoral approach, the surgeon needs to carefully retract the deltoid and protect the axillary nerve. At what approximate distance from the lateral edge of the acromion does the axillary nerve typically traverse the deep surface of the deltoid?