1. General Principles & Basic Science MCQs

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?

When utilizing an anterolateral approach to the humeral shaft, the brachialis muscle is split longitudinally to expose the bone. This splitting technique relies on the dual innervation of the brachialis to prevent denervation. Which two nerves supply the brachialis?

A 55-year-old male smoker presents with persistent pain 8 months after a midshaft humerus fracture treated nonoperatively. Radiographs show an atrophic nonunion with minimal callus. What is the most reliable definitive treatment?

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 58-year-old woman with a long history of erosive osteoarthritis of the index finger PIP joint presents with severe, unremitting pain and a progressive 'gull-wing' deformity. Radiographs confirm advanced joint space narrowing, central subchondral collapse, and significant osteophyte formation. She has failed all conservative treatments. The biomechanical changes in EOA, particularly the central collapse, disrupt normal joint congruity and alter load distribution. Which of the following best describes the primary consequence of this central collapse and altered load distribution in the index finger PIP joint?

A 65-year-old right-hand dominant woman presents with severe, persistent pain in her left index finger PIP joint due to erosive osteoarthritis. She has a 35-degree fixed flexion contracture and significant lateral deviation, making it difficult to hold objects and perform daily tasks. She has undergone 9 months of non-operative treatment, including NSAIDs, corticosteroid injections, and extensive hand therapy, with no significant improvement. Radiographs show advanced joint space narrowing, subchondral collapse, and large osteophytes. Which of the following is the most appropriate indication for surgical intervention in this patient?

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 52-year-old painter presents with mild to moderate pain at the base of his dominant thumb, exacerbated by fine brushwork. Radiographs show Eaton-Littler Stage II changes. He has tried NSAIDs with some relief. Which of the following non-operative interventions is most appropriate as the next step in his management, specifically targeting joint stabilization and pain reduction during activity?

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?