Surgical Anatomy & Approaches MCQs

A 28-year-old man presents to the emergency department after a motor vehicle collision with a closed, significantly displaced spiral fracture of the middle third of the humerus. On initial physical exam, he has 5/5 wrist and finger extension. Following closed reduction and placement of a coaptation splint, he is completely unable to extend his wrist or fingers, and lacks sensation over the dorsal first web space. What is the most appropriate next step in management?

During a standard deltopectoral approach to the shoulder for open reduction internal fixation of a proximal humerus fracture, the surgeon attempts to identify the axillary nerve to protect it. At the inferior border of the subscapularis muscle, the axillary nerve passes posteriorly through the quadrangular space. Which of the following structures forms the superior border of this anatomic space?

A 40-year-old man undergoes a single-incision anterior approach for a distal biceps tendon repair using cortical button fixation. Postoperatively, he notes numbness and tingling over the lateral aspect of his forearm but demonstrates normal strength in wrist and finger extension. Which structure was most likely injured during the procedure, and during which step of the surgery does this typically occur?

A 42-year-old right-hand-dominant male undergoes a single-incision anterior repair of an acute complete distal biceps tendon rupture using cortical button fixation. Two weeks postoperatively, he complains of profound numbness over the lateral aspect of his forearm. His motor examination is completely intact. Which of the following nerves was most likely injured or compressed during the surgical exposure?

A patient presents with an inability to extend their fingers at the metacarpophalangeal (MCP) joints following a penetrating injury to the proximal forearm. When asked to extend the wrist, it strongly deviates radially. This clinical presentation is most consistent with an injury to which nerve?

During an extensile anterior approach to the humerus for fracture fixation, the surgeon must be cautious to identify and protect a nerve that pierces the lateral intermuscular septum to enter the anterior compartment of the arm. This nerve innervates which of the following muscles?

Following a closed humerus fracture, a patient develops a complete radial nerve palsy. Electromyography (EMG) performed 4 weeks later reveals fibrillation potentials and no voluntary motor unit action potentials. Assuming this is a Sunderland third-degree nerve injury, which structural components of the nerve have been disrupted?

A 28-year-old man sustains a closed midshaft humerus fracture and subsequently develops a complete radial nerve palsy. According to the Sunderland classification of peripheral nerve injuries, which of the following accurately defines a third-degree nerve injury?

A 28-year-old man sustains a closed midshaft humerus fracture and immediately develops a complete radial nerve palsy. At 12 weeks post-injury, he has zero motor recovery. An electromyogram (EMG) shows prominent fibrillation potentials but no motor unit action potentials. What pathophysiologic process best describes what is occurring in the nerve segment distal to the fracture site?

During an anterior surgical approach to the proximal radius (Henry approach), the surgeon must protect the posterior interosseous nerve (PIN). The PIN enters the supinator muscle beneath a fibrous arch. Which muscle's fascial edge forms the Arcade of Frohse?

During an ilioinguinal approach for an acetabular fracture, significant hemorrhage occurs while dissecting near the superior pubic ramus. The injured vessel represents an anastomosis between which two vascular systems?

A patient sustains a displaced fracture of the surgical neck of the humerus. Which neurovascular bundle is at the highest risk of injury due to its location in the quadrangular space?

A surgeon is performing an ilioinguinal approach for an anterior pelvic ring fracture. Severe hemorrhage is encountered while dissecting over the superior pubic ramus. This bleeding is most likely originating from an anomalous vascular connection between which two vessels?

When utilizing the anterior approach (Henry) to the proximal radius, the posterior interosseous nerve (PIN) is at risk. The nerve typically enters the supinator muscle through which of the following anatomic structures?

During open reduction and internal fixation of a midshaft humerus fracture via a posterior approach, the radial nerve must be identified. At what approximate distance proximal to the lateral epicondyle does the radial nerve pierce the lateral intermuscular septum?

During the ilioinguinal approach to the acetabulum, the "corona mortis" poses a significant bleeding risk. This vascular structure is an anastomosis between which two systems?

The internervous plane for the distal extension of the anterolateral approach to the humerus lies between which two muscles?

A 28-year-old volleyball player presents with isolated weakness in external rotation of the shoulder. Abduction strength is 5/5. MRI reveals a paralabral cyst compressing a nerve. At which anatomical location is the cyst most likely located?

During a posterior approach to the humerus, the radial nerve is identified. Approximately how far proximal to the lateral epicondyle does the radial nerve typically pierce the lateral intermuscular septum to enter the anterior compartment?

The quadrangular space of the shoulder is bound by the teres minor, teres major, long head of the triceps, and surgical neck of the humerus. Which two structures pass through this space?