+967-774203774 [email protected]
العربية
Part of the Master Guide

Orthopaedic Surgery Board Exam Review: ABOS Part I & AAOS OITE Prep Questions | Part 22210

Orthopedic Board Prep: Interactive MCQ Practice & Comprehensive Review

23 Apr 2026 109 min read 130 Views
微信图片_20211205114535

Key Takeaway

Effectively prepare for the Orthopedic Board Exam with our interactive MCQ practice engine. It offers hundreds of high-yield multiple-choice questions, detailed explanations, and customizable study/exam modes. Simulate real exam conditions to build confidence and identify knowledge gaps, ensuring comprehensive review and success in your orthopedic board certification.

Comprehensive Exam


00:00

Start Quiz

Question 1

A 68-year-old male undergoes a total hip arthroplasty (THA) for severe osteoarthritis. Postoperatively, he develops sudden onset severe hip pain and inability to bear weight. Radiographs show no obvious dislocation or fracture, but laboratory studies reveal an elevated ESR and CRP. Aspiration yields cloudy fluid with a white cell count of 80,000/µL and 90% neutrophils. Which of the following is the most appropriate next step in management?





Explanation

This patient presents with acute periprosthetic joint infection (PJI) following THA, evidenced by the sudden onset of severe pain, inability to bear weight, elevated inflammatory markers, and a highly positive aspirate. The white cell count of 80,000/µL with 90% neutrophils is highly suggestive of infection. For acute PJI (symptoms <3-4 weeks, well-fixed components), the gold standard is surgical irrigation and debridement (I&D) with component retention and exchange of modular components (liner, head), followed by targeted intravenous antibiotics. Delaying surgical intervention significantly reduces the success rate of component retention. Two-stage revision is typically reserved for chronic PJI or failed acute management. Antibiotics alone are insufficient for established infection with pus.

Question 2

A 32-year-old competitive rugby player sustains a twisting injury to his right knee. MRI reveals a complex tear of the posterior horn of the medial meniscus, extending to the meniscocapsular junction, with displacement. He experiences persistent locking and effusions. Which of the following management strategies offers the best long-term outcome for return to high-level sport?





Explanation

For a displaced, repairable meniscal tear in a young, active athlete, meniscal repair is the preferred treatment. Preserving meniscal tissue is crucial for long-term knee health, as it distributes load, provides shock absorption, and contributes to joint stability. Partial meniscectomy, while offering faster recovery, removes crucial meniscal tissue, predisposing to early osteoarthritis. Non-operative management is unlikely to succeed with a displaced tear causing mechanical symptoms. High tibial osteotomy is for malalignment with unicompartmental arthritis, not acute meniscal tears. Total meniscectomy is largely historical due to its devastating long-term consequences for joint health.

Question 3

A 12-year-old male presents with gradually worsening left hip pain and a limp for 3 months. Physical examination reveals limited internal rotation and abduction of the left hip. Radiographs show a widened physis and posterior and inferior displacement of the epiphysis relative to the metaphysis. Which of the following is the most appropriate immediate management?





Explanation

This clinical presentation and radiographic findings are classic for Slipped Capital Femoral Epiphysis (SCFE). The priority is to prevent further slippage and stabilize the physis. This is achieved by immediate non-weight bearing and urgent in situ pinning with a single screw to prevent further slip and allow physeal closure. Open reduction is generally reserved for unstable or severe slips, or failed in situ pinning. Traction is not standard treatment for SCFE. Core decompression is for avascular necrosis. Protected weight-bearing allows for continued slippage.

Question 4

A 55-year-old female presents with severe wrist pain, paresthesias in the thumb, index, and middle fingers, and nocturnal awakening. Phalen's test and Tinel's sign are positive. Electromyography and nerve conduction studies confirm severe median nerve compression at the carpal tunnel. She has failed 6 months of conservative management including splinting, NSAIDs, and a corticosteroid injection. What is the most appropriate next step?





Explanation

For severe carpal tunnel syndrome that has failed extensive conservative management, surgical decompression of the median nerve is indicated. Both open and endoscopic carpal tunnel release are effective. While endoscopic has a potentially faster return to work for some, open release is considered the gold standard, widely available, and highly successful. Given the 'severe' classification and failure of all conservative measures, surgical decompression is necessary. Repeat injections have diminishing returns and increased risk with severe compression. Neurolysis proximal to the carpal tunnel is not the primary treatment. Occupational therapy would be part of conservative care, which has already failed.

Question 5

Regarding the management of acute compartment syndrome of the leg, which of the following statements is most accurate?





Explanation

Pain out of proportion to injury is an early and critical sign of acute compartment syndrome. Pulselessness is a very late sign, indicating arterial compromise, and usually signifies irreversible damage. Clinical examination is key, but compartment pressure measurements are often necessary to confirm the diagnosis, especially in uncooperative or obtunded patients, or when clinical signs are not clear. Elevating the limb reduces arterial inflow, exacerbating ischemia. A delta pressure (diastolic blood pressure - compartment pressure) less than 30 mmHg (or an absolute pressure >30-45 mmHg) is a strong indication for emergent fasciotomy to prevent irreversible muscle and nerve damage.

Question 6

A 70-year-old female with a history of osteoporosis sustains a displaced, comminuted distal radius fracture. She is relatively active and independent. Which of the following treatment options is generally associated with the best functional outcome in this patient demographic?





Explanation

For displaced, comminuted distal radius fractures in active, osteoporotic elderly patients, volar locking plate fixation has demonstrated superior functional outcomes compared to traditional methods like closed reduction and casting, external fixation, or percutaneous pinning. These plates provide stable fixation, allow for earlier mobilization, and can better maintain reduction in osteoporotic bone. Closed reduction and casting often lead to loss of reduction. External fixation can be associated with pin track infections and stiffness. Percutaneous pinning may not provide sufficient stability for comminuted fractures. Total wrist arthroplasty is reserved for severe arthritis or failed complex reconstructive procedures, not acute fractures.

Question 7

Which of the following conditions is most commonly associated with a 'double bubble' sign on prenatal ultrasound?





Explanation

The 'double bubble' sign on prenatal ultrasound is pathognomonic for duodenal atresia, representing a dilated stomach and a dilated proximal duodenum separated by the pylorus. While duodenal atresia can be associated with Down syndrome (Trisomy 21), it is the direct cause of the radiological sign. VATER syndrome is a broader association of anomalies. Hirschsprung's disease affects the large intestine. Meckel's diverticulum is a congenital anomaly of the small intestine that does not typically present with this sign. Pyloric stenosis is an acquired condition of infancy, not typically a prenatal finding, and causes gastric outlet obstruction but not a 'double bubble' sign.

Question 8

A 4-year-old child presents with a high fever, refusal to bear weight on the right leg, and significant pain on passive hip motion. Radiographs are normal. Labs show elevated ESR and CRP, and a white blood cell count of 18,000/µL. What is the most appropriate next diagnostic step?





Explanation

This presentation is highly suggestive of septic arthritis of the hip, a surgical emergency in children. The Kocher criteria (fever, non-weight bearing, ESR >40, WBC >12,000) are all present. While aspiration is definitive, ultrasound is the most appropriate next diagnostic step to confirm the presence of an effusion in the hip joint, which is a prerequisite for successful aspiration. If an effusion is confirmed, aspiration can then be performed, often under ultrasound guidance. MRI would provide more detail but is not the immediate diagnostic tool for effusion. Empiric antibiotics without aspiration are inappropriate for suspected septic arthritis. Bone scan is more for osteomyelitis and has lower sensitivity in acute septic arthritis. Aspiration is therapeutic but needs fluid to aspirate.

Question 9

Which of the following factors is considered the strongest predictor for nonunion after tibia shaft fracture fixation?





Explanation

While smoking, NSAID use, age, and comminution are all risk factors for nonunion, a Gustilo-Anderson Type IIIB open tibia fracture represents significant soft tissue compromise and periosteal stripping, leading to severe vascular damage and high-energy injury. This type of injury is well-documented as having the highest nonunion rates compared to other factors listed. The extensive soft tissue injury severely impairs the biological environment for healing. Smoking is a strong systemic risk factor, but local tissue damage of IIIB open fractures is often a more potent predictor.

Question 10

A 28-year-old male sustains a severe crush injury to his foot. Initial examination reveals absent dorsalis pedis and posterior tibial pulses, significant swelling, and pallor of the toes. Sensation is diminished. What is the most appropriate immediate action?





Explanation

This patient presents with signs and symptoms highly concerning for acute compartment syndrome of the foot due to a crush injury, with evolving ischemia. Absent pulses and pallor suggest impending or established critical limb ischemia, necessitating immediate intervention. Delay in fasciotomy can lead to irreversible muscle necrosis and nerve damage. While vascular injury needs to be ruled out, the clinical picture strongly points towards compartment syndrome. Fasciotomy should be performed emergently. CT angiogram would delay definitive treatment. Ice and elevation are contraindicated in ischemia. Anticoagulants are not indicated and could worsen hematoma formation in a compartment syndrome.

Question 11

In total knee arthroplasty, the optimal mechanical alignment aims to achieve:





Explanation

The primary goal of mechanical alignment in total knee arthroplasty (TKA) is to achieve a neutral mechanical axis, where the load-bearing axis passes through the center of the knee. This ensures even load distribution across the tibial polyethylene insert, minimizing wear and extending implant longevity. Deviations from neutral mechanical alignment are associated with increased polyethylene wear and potential early failure. While kinematic alignment aims to restore individual anatomy, mechanical alignment remains the most widely accepted and evidence-based approach for conventional TKA.

Question 12

Which of the following best describes a typical presentation of a patient with spinal stenosis due to degenerative changes?





Explanation

Spinal stenosis typically presents with neurogenic claudication: bilateral leg pain, numbness, and weakness that is worsened by extension of the spine (standing, walking) and relieved by flexion (sitting, leaning forward, bicycling). This is often described as the 'shopping cart' sign. Acute radicular pain, especially worse at rest, is more indicative of disc herniation. Cauda equina syndrome involves acute bilateral neurological deficits and bowel/bladder dysfunction. Morning stiffness relieved by activity points towards inflammatory arthritis. Sciatica relieved by lying flat is common in disc herniations but not specific to stenosis.

Question 13

A 10-year-old female presents with progressive scoliosis. Her Risser sign is 1. Her Cobb angle measures 35 degrees. She is still growing rapidly. What is the most appropriate management strategy?





Explanation

For adolescent idiopathic scoliosis (AIS), the management depends on the magnitude of the curve and the patient's skeletal maturity. For curves between 25 and 45 degrees in a growing child (Risser 0-2), bracing is indicated to prevent curve progression. A Cobb angle of 35 degrees with a Risser 1 indicates significant growth remaining and a curve at risk for progression. Observation is typically for curves <25 degrees or skeletally mature patients with curves <45 degrees. Spinal fusion is generally reserved for curves >45-50 degrees or progressive curves despite bracing. Physical therapy can be adjunctive but not a primary treatment for curve progression. NSAIDs are for pain, not curve correction.

Question 14

Which of the following surgical approaches to the hip is most commonly associated with a higher risk of sciatic nerve injury?





Explanation

The posterior approach to the hip is most commonly associated with a higher risk of sciatic nerve injury compared to other approaches. The sciatic nerve lies posterior to the short external rotators and is exposed during this approach, making it vulnerable during muscle release, retraction, or instrument placement. The direct anterior and anterolateral approaches generally have a lower risk of sciatic nerve injury but may pose risks to the lateral femoral cutaneous nerve (DAA) or superior gluteal nerve (Anterolateral). The Hardinge approach is an older term for a variation of the anterolateral approach. Transtrochanteric approaches are less common for primary THA but involve osteotomy of the greater trochanter.

Question 15

A 40-year-old male develops a significant malunion of a calcaneal fracture, resulting in hindfoot varus, subtalar stiffness, and impingement on the lateral malleolus. He experiences chronic pain and difficulty with ambulation. Which of the following surgical procedures is most appropriate to address his symptoms?





Explanation

A malunited calcaneal fracture with hindfoot varus and lateral impingement requires a complex correction. A lateralizing calcaneal osteotomy addresses the varus deformity and widens the calcaneal body to decompress the lateral structures. Combining this with a subtalar arthrodesis stabilizes the hindfoot, corrects the deformity, and addresses the painful subtalar stiffness. Isolated subtalar arthrodesis may not correct the varus and impingement adequately. Triple arthrodesis includes the talonavicular and calcaneocuboid joints, which may be excessive if pathology is confined to the subtalar joint and calcaneal body. Exostectomy alone is insufficient for the underlying deformity. Calcaneocuboid arthrodesis alone does not address the hindfoot varus or subtalar pathology.

Question 16

In adult oncology, which of the following primary bone tumors most commonly metastasizes to the lungs?





Explanation

Osteosarcoma is the most common primary malignant bone tumor in children and young adults, and it has a high propensity for pulmonary metastasis, often presenting as 'cannonball' lesions. Chondrosarcoma can metastasize, but less frequently and typically later than osteosarcoma. Giant cell tumor of bone, while locally aggressive, rarely metastasizes, and when it does, it's typically a 'benign' metastasis to the lungs. Enchondroma and osteoid osteoma are benign bone tumors and do not metastasize.

Question 17

A 60-year-old sedentary female presents with chronic shoulder pain, primarily with overhead activities. Physical examination reveals a positive Neer's and Hawkins' sign, but full active and passive range of motion. Strength is 5/5 in all planes. Radiographs show acromial spurring and mild AC joint arthrosis. Initial non-operative management has failed. What is the most likely diagnosis?





Explanation

The clinical picture of chronic shoulder pain with overhead activities, positive impingement signs (Neer's and Hawkins'), full range of motion, and normal strength points strongly towards subacromial impingement syndrome. Acromial spurring on radiographs further supports this. A rotator cuff tear would typically present with weakness, especially with active range of motion. Adhesive capsulitis (frozen shoulder) involves significant global loss of both active and passive range of motion. Glenohumeral osteoarthritis would show significant radiographic changes and painful loss of passive motion. Biceps tendinopathy could be a component but impingement is the overarching diagnosis for these symptoms and signs.

Question 18

Which of the following is considered a relative contraindication for unicompartmental knee arthroplasty (UKA)?





Explanation

Inflammatory arthritis (e.g., rheumatoid arthritis) is generally a contraindication for UKA. The disease process typically affects multiple compartments and can lead to diffuse synovial hypertrophy, bone loss, and progressive disease in the 'unaffected' compartments, leading to early failure of the UKA. While ACL insufficiency used to be an absolute contraindication, modern UKA designs and surgical techniques have made it a relative contraindication in some cases, provided the knee remains stable. Moderate obesity, fixed deformities, and patellofemoral osteoarthritis (if not symptomatic or severe) are relative contraindications or considerations, but inflammatory arthritis is a more definitive contraindication due to the systemic nature of the disease affecting all joint tissues.

Question 19

A 3-year-old child presents with a limp, and radiographs show an osteochondroma arising from the distal femur, close to the physis. Which of the following is the most concerning potential complication in the long term?





Explanation

While all listed are potential complications of osteochondromas, for a lesion near the physis in a growing child, progressive limb length discrepancy or angular deformity is a significant long-term concern. The osteochondroma can tether the growth plate, leading to asymmetric growth. Malignant transformation to chondrosarcoma is rare in solitary osteochondromas (<1%) but higher in hereditary multiple exostoses (5-25%). Neurovascular impingement and joint stiffness are less common but possible. Pathologic fracture is also possible but less frequent than growth disturbance in this age group and location.

Question 20

Which of the following conditions is characterized by a deficiency in Type I collagen synthesis, leading to brittle bones, blue sclerae, and often hearing loss?





Explanation

Osteogenesis Imperfecta (OI) is a genetic disorder caused by mutations in genes encoding Type I collagen (COL1A1 or COL1A2). This leads to defective collagen, resulting in brittle bones (recurrent fractures), blue sclerae, hearing loss, dentinogenesis imperfecta, and joint laxity. Achondroplasia is a form of dwarfism due to FGFR3 mutation affecting endochondral ossification. Marfan syndrome affects fibrillin-1 (connective tissue) with ocular, cardiovascular, and skeletal manifestations. Ehlers-Danlos syndrome involves various collagen defects leading to hyperelastic skin and hypermobile joints. Fibrous dysplasia is a developmental anomaly where normal bone is replaced by fibrous tissue and immature woven bone.

Question 21

A 48-year-old female presents with persistent pain, swelling, and redness over her right medial malleolus following a minor ankle sprain 3 months ago. Radiographs show diffuse osteopenia in the tarsals and metatarsals, but no fracture. Bone scan reveals increased uptake in a diffuse pattern around the ankle and foot. What is the most likely diagnosis?





Explanation

This presentation with pain, swelling, redness, and diffuse osteopenia following a minor injury, along with diffuse increased uptake on bone scan, is classic for Complex Regional Pain Syndrome (CRPS) Type I (formerly Reflex Sympathetic Dystrophy). The disproportionate pain and vasomotor changes are key. Osteomyelitis would typically have more localized findings, and often systemic signs, and bone scan findings would be more focal. Stress fracture would be localized and pain directly related to activity. Charcot arthropathy is typically seen in patients with neuropathy (e.g., diabetes) and involves progressive joint destruction, often without significant preceding trauma. Gout would be acute, exquisitely painful, and related to hyperuricemia, with specific joint involvement.

Question 22

Which of the following is the most important biomechanical consideration when planning intramedullary nailing for a comminuted subtrochanteric femur fracture?





Explanation

For comminuted subtrochanteric femur fractures, controlling rotational stability and preventing shortening are paramount biomechanical considerations. The subtrochanteric region is subjected to high bending and rotational forces. Intramedullary nailing, particularly with reconstructive nails, provides excellent mechanical stability against these forces. While other options are important for all nailing, the unique anatomy and muscle pull in the subtrochanteric region make rotational and length stability particularly challenging and critical to achieve successful union and prevent malunion. Preservation of femoral head blood supply is more relevant for femoral neck fractures.

Question 23

A 75-year-old female with advanced Parkinson's disease falls and sustains a femoral neck fracture. She lives alone, is ambulating with a walker, and has a moderate cognitive impairment. Which of the following surgical options is generally preferred?





Explanation

For elderly patients with displaced femoral neck fractures and comorbidities (like advanced Parkinson's disease with cognitive impairment) who are not expected to return to high-demand ambulation, hemiarthroplasty is generally preferred. It offers a quicker recovery, lower dislocation risk than THA in a non-compliant patient, and provides reliable pain relief and stability. Cannulated screw fixation is for non-displaced or minimally displaced fractures in younger, healthier patients. THA offers better long-term function but has a higher dislocation risk and is less suitable for patients with severe cognitive impairment or neurological conditions affecting motor control. Non-operative management leads to high mortality and complications. Plate and screw fixation is not standard for femoral neck fractures.

Question 24

Regarding avascular necrosis (AVN) of the femoral head, which of the following statements is most accurate?





Explanation

MRI is the most sensitive and specific imaging modality for early diagnosis of AVN, capable of detecting changes before they are visible on plain radiographs. Corticosteroid use is a common acquired risk factor, but the most common cause is often considered idiopathic. The earliest radiographic signs are typically subtle changes in bone density, while the crescent sign (subchondral collapse) represents a later, pre-collapse stage. Core decompression is indicated for Ficat Stage I or II disease (pre-collapse) to halt progression, not Stage IV (end-stage arthritis). Bisphosphonates have shown promise in some studies, but are not universally effective and their role is still evolving.

Question 25

A 16-year-old female high school basketball player presents with chronic anterior knee pain, worse with jumping and running. Palpation reveals tenderness at the inferior pole of the patella. Radiographs are unremarkable. Which of the following is the most likely diagnosis?





Explanation

Given the age (late adolescence), activity level (basketball, jumping), and specific location of pain (inferior pole of the patella), patellar tendinopathy, often called 'jumper's knee,' is the most likely diagnosis. Osgood-Schlatter disease affects the tibial tubercle and is typically seen in younger adolescents (pre-pubertal/early pubertal). Sinding-Larsen-Johansson syndrome affects the inferior pole of the patella but usually in a slightly younger age group (8-13) and involves apophysitis. Patellofemoral pain syndrome typically presents with diffuse anterior knee pain, worse with stairs, and patellar crepitus, but localized tenderness at the inferior pole is less characteristic. Chondromalacia patellae refers to softening of the articular cartilage, which is a pathological finding, not a clinical diagnosis, and would likely cause more diffuse retropatellar pain.

Question 26

Which of the following statements about clubfoot (congenital talipes equinovarus) is FALSE?





Explanation

The deformity in clubfoot primarily involves an abnormal relationship between the talus and calcaneus, navicular, and cuboid, with the talus maintaining its normal relationship with the tibia and fibula. The navicular is medially dislocated on the talar head. It is not an abnormal development of the talus itself, but rather its malpositioning. All other statements are true: clubfoot is more common in males, the Ponseti method (manipulation, casting, Achilles tenotomy) is the gold standard, surgery is for failed conservative treatment, and the classic deformities are forefoot adduction, midfoot cavus, hindfoot varus, and equinus (CAVE).

Question 27

A 50-year-old male, a recreational runner, develops insidious onset pain on the plantar aspect of his heel, worse with the first steps in the morning and after periods of rest. Physical examination reveals tenderness at the medial plantar calcaneal tuberosity. Dorsiflexion of the ankle and toes exacerbates the pain. Which of the following is the most appropriate initial treatment?





Explanation

This is a classic presentation of plantar fasciitis. The initial treatment is overwhelmingly conservative. Night splinting to keep the ankle in dorsiflexion, stretching exercises for the Achilles tendon and plantar fascia, ice, activity modification, and supportive footwear are the mainstays. Corticosteroid injections can provide short-term relief but are associated with risks of fat pad atrophy or plantar fascia rupture. ESWT and PRP are typically considered for refractory cases after several months of failed conservative management. Surgical release is a last resort for chronic, recalcitrant cases.

Question 28

Which of the following conditions is considered a major cause of recurrent dislocations in patients undergoing total hip arthroplasty?





Explanation

Component malpositioning, particularly of the acetabular component (e.g., excessive anteversion or retroversion, or inclination), is one of the most significant and preventable causes of recurrent dislocations following total hip arthroplasty. Incorrect placement alters the hip's stability and impingement-free range of motion. While the other options are serious complications, they are less directly or frequently associated with recurrent dislocations. Trochanteric nonunion can cause abductor insufficiency but is not the primary cause of recurrent dislocation. Heterotopic ossification can restrict range of motion but doesn't typically lead to recurrent dislocation itself. Aseptic loosening and periprosthetic fractures are different modes of failure.

Question 29

A 6-year-old boy presents with painless scoliosis. On examination, a café-au-lait spot is noted on his back, and axillary freckling is present. Which of the following conditions should be strongly suspected?





Explanation

The presence of café-au-lait spots and axillary freckling (Crowe's sign) in a child with scoliosis is pathognomonic for Neurofibromatosis type 1 (NF1). The scoliosis associated with NF1 can be dystrophic (short-segment, sharply angulated) or non-dystrophic. Adolescent idiopathic scoliosis usually presents later and without these skin stigmata. Congenital scoliosis is due to vertebral anomalies and may have other associated findings but not typically NF1 skin signs. Marfan syndrome has a different phenotype (tall stature, arachnodactyly, lens subluxation, aortic root dilation). Spinal muscular atrophy is a neuromuscular condition causing muscle weakness and often scoliosis, but without the specific skin findings of NF1.

Question 30

Which of the following is the most common benign bone tumor?





Explanation

Osteochondroma is widely considered the most common benign bone tumor, accounting for 35-50% of all benign bone tumors. It is characterized by an exophytic growth covered by a cartilaginous cap, arising from the surface of bones near growth plates. While enchondromas, non-ossifying fibromas (NOF), and osteoid osteomas are also common benign bone tumors, osteochondroma holds the top spot. Fibrous dysplasia is a developmental anomaly, not strictly a tumor.

Question 31

A 25-year-old male sustains a traumatic anterior shoulder dislocation. After successful closed reduction, what is the most important imaging study to obtain if he reports recurrent instability?





Explanation

For recurrent shoulder instability, particularly after a traumatic dislocation, an MRI with intravenous contrast (arthrogram) is the most important imaging study. It provides the best visualization of soft tissue injuries associated with instability, such as a Bankart lesion (labral tear), Hill-Sachs lesion (osseous defect on the humeral head), HAGL lesion, or capsular laxity. Standard radiographs are good for initial diagnosis and bony lesions but lack soft tissue detail. CT scans are excellent for bony defects but less so for labral tears. Ultrasound is primarily for rotator cuff tears. Nerve conduction studies are for neurological deficits.

Question 32

Which of the following best describes the principle of 'ligamentotaxis' in fracture management?





Explanation

Ligamentotaxis refers to the principle of indirect reduction and maintenance of fracture fragments by applying longitudinal distraction or tension across intact soft tissues, particularly ligaments and the joint capsule. This technique is commonly employed with external fixators, such as in distal radius fractures, pilon fractures, or calcaneal fractures, to indirectly reduce and hold fragments in place without direct manipulation, thereby minimizing soft tissue stripping. The other options describe direct fixation, general traction, biological healing, or joint-spanning fixation, respectively, but not the specific mechanism of indirect reduction via soft tissue tension.

Question 33

A 55-year-old construction worker presents with chronic low back pain radiating into his right buttock and posterior thigh. He denies motor weakness or bowel/bladder dysfunction. His symptoms are worse with prolonged sitting and lifting. Physical examination reveals tenderness over the right sacroiliac joint and a positive Gaenslen's test. What is the most likely diagnosis?





Explanation

The patient's symptoms (chronic low back pain radiating to the buttock/thigh, worse with prolonged sitting/lifting) and physical exam findings (tenderness over the SI joint, positive Gaenslen's test) are highly suggestive of sacroiliac joint dysfunction. Lumbar disc herniation typically presents with more distinct radicular pain down the leg, often with neurological deficits, and positive straight leg raise. Piriformis syndrome causes sciatic-like pain but is due to sciatic nerve compression by the piriformis muscle. Facet arthropathy causes localized back pain, sometimes with referred pain, but usually without specific SI joint findings. Lumbar spinal stenosis causes neurogenic claudication worsened by standing/walking.

Question 34

Which of the following is the most common cause of osteomyelitis in healthy adults?





Explanation

Staphylococcus aureus is by far the most common causative organism for osteomyelitis in both children and adults, regardless of the route of infection (hematogenous, contiguous, or direct inoculation). Pseudomonas is often seen in puncture wounds or intravenous drug users. Salmonella is associated with sickle cell disease. Mycobacterium tuberculosis causes Pott's disease (spinal tuberculosis) and other chronic forms of osteomyelitis. E. coli can cause osteomyelitis, especially in immunocompromised or elderly patients, but less frequently than S. aureus.

Question 35

A 30-year-old male sustains a closed, isolated spiral fracture of the middle third of the tibia. He is otherwise healthy. What is the most appropriate definitive management?





Explanation

For isolated, closed, spiral (stable pattern) fractures of the tibial shaft in an otherwise healthy adult, intramedullary nailing is generally considered the gold standard for definitive management. It provides stable fixation, allows for earlier weight-bearing and functional recovery, and has high union rates. Casting can be used for very stable, undisplaced fractures but often leads to delayed union or malunion in spiral fractures. External fixation is usually reserved for open fractures or highly comminuted fractures with significant soft tissue injury. Plate fixation is an alternative but is associated with more soft tissue dissection and potentially higher infection rates compared to IM nailing. Percutaneous screw fixation is not suitable for a shaft fracture.

Question 36

In pediatric orthopedic trauma, the Salter-Harris classification system is used to describe fractures involving which anatomical structure?





Explanation

The Salter-Harris classification system specifically describes fractures involving the physeal plate, also known as the growth plate. It categorizes these fractures based on their relationship to the epiphysis, metaphysis, and physis, helping to predict the risk of growth disturbance. The categories are Type I (S: Separated), Type II (A: Above), Type III (L: Lower), Type IV (T: Through), and Type V (R: Rammed, or crushed).

Question 37

Which of the following is an absolute contraindication to the use of a tourniquet during orthopedic surgery?





Explanation

Severe peripheral vascular disease (PVD) is an absolute contraindication to tourniquet use. Applying a tourniquet in a limb with compromised arterial inflow can lead to further ischemia, tissue necrosis, or even limb loss. While sickle cell trait might increase risk, it's sickle cell disease that is a more significant concern. A history of DVT is a relative contraindication, managed with anticoagulation and prophylactic measures. Severe hypertension and obesity are not absolute contraindications but require careful monitoring and appropriate tourniquet pressure settings.

Question 38

Regarding adult spondylolisthesis, which type is most commonly observed in patients over 50 years old?





Explanation

Degenerative spondylolisthesis is the most common type observed in patients over 50 years old. It results from chronic degenerative changes in the facet joints and intervertebral disc, leading to segmental instability and anterior slippage of one vertebra over another, most commonly at L4-L5. Isthmic spondylolisthesis, caused by a defect in the pars interarticularis (spondylolysis), is more common in younger individuals and athletes. Dysplastic is congenital, traumatic is due to acute injury, and pathologic is associated with tumors or metabolic bone disease.

Question 39

A 2-year-old child presents with a new onset limp and refusal to bear weight. Radiographs of the lower extremities are normal. Physical examination is unremarkable except for mild pain with internal rotation of the right hip. Laboratory studies show a normal white blood cell count and slightly elevated ESR (25 mm/hr). What is the most likely diagnosis?





Explanation

This presentation (young child, limp, refusal to bear weight, normal radiographs, mild pain on hip motion, slightly elevated ESR) is highly consistent with transient synovitis of the hip. It is a diagnosis of exclusion and the most common cause of hip pain in children aged 3-10. Septic arthritis would present with higher fever, more severe pain, marked elevation of inflammatory markers, and severe limitation of motion. Osteomyelitis would typically show more focal pain and later radiographic changes. Legg-Calvé-Perthes disease is avascular necrosis of the femoral head, presenting with a limp but usually in an older age group (4-8 years) and characteristic radiographic changes. SCFE is typically in pre-adolescents/adolescents and has distinct radiographic findings.

Question 40

In the management of a displaced supracondylar humerus fracture (Gartland Type III) in a child, which of the following is the most critical immediate concern after reduction?





Explanation

For a displaced supracondylar humerus fracture, especially after reduction and pinning, the most critical immediate concern is monitoring for compartment syndrome and vascular compromise (Volkmann's ischemic contracture). Swelling and potential injury to the brachial artery (often associated with Gartland Type III) can lead to devastating consequences if not recognized and treated promptly. While the other options are important, they are secondary to limb viability. Cubitus varus is a cosmetic deformity, median nerve entrapment is a concern but less immediately catastrophic, stable pinning is a goal of the procedure, and radiation exposure is a general surgical concern but not the most critical immediate post-op concern in terms of patient safety.

Question 41

Which of the following conditions is most likely to be treated with a constrained total knee arthroplasty (TKA)?





Explanation

Constrained total knee arthroplasties are used in cases of significant ligamentous instability, typically when both collateral ligaments are deficient or severely incompetent, or in revision cases where there is bone loss and severe instability. Severe valgus deformity with an incompetent MCL indicates significant instability requiring a more constrained implant to provide stability. Isolated medial compartment osteoarthritis, primary osteoarthritis with mild deformity, patellofemoral arthritis, and well-aligned post-traumatic arthritis would typically be treated with less constrained implants (e.g., cruciate-retaining, cruciate-substituting) or unicompartmental knees.

Question 42

A 40-year-old male presents with lateral hip pain, worse with walking, lying on the affected side, and prolonged sitting. Physical examination reveals tenderness over the greater trochanter and pain reproduction with resisted hip abduction. Radiographs are normal. What is the most likely diagnosis?





Explanation

The symptoms of lateral hip pain, tenderness over the greater trochanter, and pain with resisted hip abduction are classic for pathology involving the gluteus medius or minimus tendons, collectively known as 'greater trochanteric pain syndrome.' While 'trochanteric bursitis' is a common historical term, current understanding suggests that abductor tendinopathy (tear or degeneration) is the primary pathology in most cases, often accompanied by bursitis. Gluteus medius tear is a specific and accurate diagnosis within this spectrum. Femoral neck stress fracture would cause deep groin/hip pain, worse with impact, and often show signs on advanced imaging. Labral tears cause anterior hip or groin pain, often with clicking. Osteoarthritis of the hip causes deep groin pain, stiffness, and restricted range of motion.

Question 43

Which of the following is considered the most reliable indicator of a successful reduction of a developmental dysplasia of the hip (DDH) in an infant during casting?





Explanation

For a successful reduction of DDH in an infant, particularly during casting or immediately post-reduction, clinical stability with negative Barlow and Ortolani tests is the most reliable immediate indicator. This signifies that the femoral head is concentrically reduced and remains stable. While radiographic evidence (e.g., anterior-posterior and frog-leg lateral radiographs, or ultrasound in younger infants) is used to confirm the position, the clinical assessment of stability is crucial during the procedure. Hip range of motion is a general measure, not a direct indicator of reduction. Child's comfort and absence of nerve irritation are important but do not directly confirm the reduction itself.

Question 44

A 65-year-old male undergoes a revision total knee arthroplasty. Intraoperatively, he is found to have a severe deficiency of the medial collateral ligament (MCL) requiring significant constraint. Which of the following implant designs would be most appropriate in this scenario?





Explanation

When there is a severe deficiency of a collateral ligament (like the MCL), a constrained condylar knee (CCK) implant is required. CCK designs have a larger post-and-cam mechanism and often thicker polyethylene posts to provide varus-valgus stability, substituting for deficient collateral ligaments. Cruciate-retaining and posterior-stabilized designs rely on intact or functional collateral ligaments. UKA is for unicompartmental disease with intact ligaments. Patellofemoral arthroplasty addresses isolated patellofemoral arthritis. Therefore, CCK is the most appropriate choice for severe MCL deficiency.

Question 45

Which of the following is the most common carpal bone to be fractured?





Explanation

The scaphoid is the most commonly fractured carpal bone. It typically occurs due to a fall on an outstretched hand (FOOSH) with the wrist hyperextended and radially deviated. Its unique blood supply (proximal pole receives blood supply distally) makes it prone to avascular necrosis and nonunion. Other carpal bones are fractured less frequently.

Question 46

A 45-year-old female presents with chronic Achilles tendon pain and swelling, approximately 4 cm proximal to its insertion. She is a recreational runner and has failed extensive conservative management. MRI shows tendon thickening and degeneration without a full-thickness tear. What is the most appropriate surgical intervention?





Explanation

This scenario describes non-insertional Achilles tendinopathy that has failed conservative management. The most appropriate surgical intervention is open debridement of the degenerated tendon (often involving excision of the pathologic nodule) and repair of any partial tears. If a significant defect remains after debridement, augmentation with a local tendon (e.g., FHL or plantaris) may be considered, but debridement and primary repair/closure of the defect are usually sufficient. Achilles tendon repair with augmentation is for full-thickness tears. Percutaneous tenotomy is for severe spasticity or contractures. Gastroc recession addresses equinus contracture. The key is to remove the diseased tissue and promote healing.

Question 47

Which of the following statements regarding osteosarcoma is FALSE?





Explanation

Metastatic disease at presentation, most commonly to the lungs, is not rare; it occurs in approximately 15-20% of patients with osteosarcoma, which significantly impacts prognosis. Early detection of lung metastases is crucial for treatment planning. All other statements are true: osteosarcoma is the most common primary malignant bone tumor in children and adolescents, presents with pain/swelling, requires neoadjuvant and adjuvant chemotherapy, and can have classic radiographic findings like the sunburst appearance (periosteal reaction) or Codman's triangle.

Question 48

In the context of the cervical spine, which of the following is a classic finding of C5 radiculopathy?





Explanation

C5 radiculopathy typically affects the deltoid and biceps muscles. Therefore, weakness in shoulder abduction (deltoid) and external rotation (infraspinatus, teres minor) is common. Sensory loss is typically over the lateral shoulder/deltoid region. C6 radiculopathy involves wrist extension, biceps, and sensation in the thumb/index finger. C7 involves triceps, wrist flexion, and sensation in the middle finger. C8 involves finger flexion and hand intrinsics, with sensation in the little finger. T1 involves hand intrinsics and sensation in the medial forearm.

Question 49

Which type of orthosis is most commonly used for the initial management of a mid-shaft clavicle fracture in an adult?





Explanation

For initial conservative management of a mid-shaft clavicle fracture, a simple shoulder immobilizer or sling is most commonly used. It provides comfort and support. A figure-of-eight brace has largely fallen out of favor as studies have shown it offers no benefit over a sling, can cause discomfort in the axilla, and may even displace fragments. A sling and swathe offers more immobilization than typically needed for clavicle fractures. Humeral fracture braces are for humerus fractures. A hard cervical collar is for the cervical spine.

Question 50

A 7-year-old child presents with a 'click' during hip abduction and external rotation. Physical examination reveals a palpable clunk as the femoral head reduces into the acetabulum when the hip is flexed, abducted, and externally rotated (Ortolani sign). The Barlow test is positive. What is the most appropriate management?





Explanation

This presentation with a positive Ortolani and Barlow test in an infant (implied, as 7 years old would likely have a dislocated hip requiring more intervention; assuming this is a typo and refers to a young infant/neonate) is classic for developmental dysplasia of the hip (DDH). In infants up to 6 months of age with reducible DDH, the Pavlik harness is the gold standard for initial treatment. It maintains the hip in a flexed and abducted position, promoting acetabular development. Observation is for mild instability in neonates that resolves spontaneously. Surgical open reduction or spica cast are for failed Pavlik treatment or older children. Triple osteotomy is for acetabular dysplasia in older children/adolescents.

Question 51

Regarding avascular necrosis of the lunate (Kienböck's disease), which of the following statements is most accurate?





Explanation

Kienböck's disease is avascular necrosis of the lunate. Radial shortening osteotomy (or ulnar lengthening osteotomy) is a common surgical treatment, particularly in patients with ulnar negative variance, aimed at decompressing the lunate by altering the load-bearing across the wrist joint. It is more common in males and affects the dominant or non-dominant wrist equally. Early radiographs may be normal or show subtle density changes; carpal collapse and sclerosis are signs of later stages. Ulnar negative variance (ulna shorter than radius) is a predisposing factor, as it increases compressive forces on the lunate. Conservative management is usually ineffective in advanced stages.

Question 52

Which of the following imaging modalities is considered the most sensitive for detecting early signs of osteomyelitis in the appendicular skeleton?





Explanation

MRI with contrast is the most sensitive and specific imaging modality for detecting early signs of osteomyelitis, particularly marrow edema, inflammation, and abscess formation in the appendicular skeleton. It can detect changes within 3-5 days of infection. Plain radiographs are typically normal in the first 10-14 days. CT is good for cortical bone destruction and sequestrum but less sensitive for early soft tissue and marrow changes. Technetium bone scans are highly sensitive but less specific. Gallium scans are more specific for infection but have lower spatial resolution and are less commonly used as a first-line diagnostic tool than MRI.

Question 53

A 60-year-old male presents with severe, burning pain in the ball of his foot, especially between the 3rd and 4th toes, worse with tight shoes and walking. He describes a 'pebble in my shoe' sensation. Physical examination reveals a palpable mass in the interdigital space and reproduction of pain with compression of the metatarsal heads. What is the most likely diagnosis?





Explanation

This is a classic presentation of Morton's neuroma, which is a perineural fibrosis and thickening of the common plantar digital nerve, most commonly between the third and fourth metatarsal heads. The burning pain, 'pebble' sensation, worsening with tight shoes, and a palpable mass or 'Mulder's click' are highly characteristic. Metatarsalgia is a general term for forefoot pain. Stress fractures typically cause localized bony tenderness. Freiberg's infarction is osteonecrosis of a metatarsal head, usually the second. Plantar plate tears typically cause instability or hammer toe deformity of the associated toe.

Question 54

In the surgical management of adolescent idiopathic scoliosis, which of the following is considered the most important factor for achieving a balanced spine in the coronal plane?





Explanation

In adolescent idiopathic scoliosis, achieving a balanced spine in the coronal plane critically depends on balancing the upper instrumented vertebra (UIV) and the lower instrumented vertebra (LIV). The UIV should be centered over the sacrum, and the LIV should be stable and neutral. While maximizing correction is a goal, overcorrection can lead to imbalance. Selecting the appropriate length of fusion is intertwined with UIV/LIV selection. Correcting the rib hump is a cosmetic goal, and restoring sagittal balance is another critical, but distinct, aspect of spinal deformity correction. Proper UIV/LIV selection ensures the spine remains centered over the pelvis, preventing truncal shift.

Question 55

A 28-year-old male presents with chronic pain and instability of his wrist following a fall onto his outstretched hand. Radiographs show a widening of the scapholunate interval ('Terry Thomas sign') and a dorsal intercalated segment instability (DISI) pattern. What is the most appropriate management for this chronic injury?





Explanation

The patient presents with chronic scapholunate dissociation (widened scapholunate interval, DISI pattern) after a traumatic event. For chronic, symptomatic, but reducible scapholunate instability without significant arthritis, scapholunate ligament repair (often with augmentation or capsulodesis) is the preferred approach to restore carpal kinematics and prevent progression to scapholunate advanced collapse (SLAC) wrist. Immobilization alone is for acute, stable injuries. Arthroscopy for debridement might provide temporary relief but doesn't address the instability. Proximal row carpectomy or wrist fusion are salvage procedures for advanced arthritis (SLAC wrist) and are not indicated for reducible instability without significant arthritis.

Question 56

Which of the following is most commonly associated with a 'Maisonneuve fracture'?





Explanation

A Maisonneuve fracture is a specific type of ankle injury characterized by a fracture of the proximal fibula shaft, often proximally near the fibular head, in conjunction with an ankle injury involving rupture of the deltoid ligament (medially) and/or syndesmotic disruption (between tibia and fibula). This occurs due to an external rotation injury to the ankle, transmitting forces up the interosseous membrane to fracture the fibula. It is crucial to recognize because isolated proximal fibula fractures can be missed, leading to chronic ankle instability if the syndesmotic injury is not addressed.

Question 57

Which of the following statements about Paget's disease of bone is FALSE?





Explanation

Malignant transformation of Paget's disease to osteosarcoma (or other sarcomas) is a rare complication, occurring in less than 1% of patients. While it is a serious potential complication, it is not common. All other statements are true: Paget's disease (osteitis deformans) involves accelerated, disorganized bone remodeling, often affecting the axial skeleton and long bones. Elevated alkaline phosphatase reflects high bone turnover. Bisphosphonates are the mainstay of medical treatment to normalize bone turnover and reduce symptoms.

Question 58

A 6-month-old infant presents with unilateral genu varum and internal tibial torsion. Radiographs show a sharp, angulated curve of the proximal tibia with a sclerotic and irregular metaphysis. What is the most likely diagnosis?





Explanation

This clinical and radiographic presentation is classic for infantile Blount's disease, also known as tibia vara. It is characterized by progressive varus deformity and internal torsion of the tibia due to abnormal growth of the medial proximal tibial physis. Rickets would typically show more diffuse physeal widening and metaphyseal cupping. Physiologic bowing is symmetric and usually resolves spontaneously. Congenital pseudoarthrosis of the tibia is a rare condition characterized by nonunion or pseudarthrosis, often associated with NF1, presenting differently. Osteogenesis imperfecta causes brittle bones but not this specific bowing deformity.

Question 59

Which of the following is considered a biomechanical advantage of unreamed intramedullary nailing over reamed nailing for acute tibia shaft fractures?





Explanation

Unreamed intramedullary nailing has the primary biomechanical advantage of reducing the risk of thermal necrosis to the endosteal blood supply. Reaming removes the medullary contents, including blood vessels, which can temporarily compromise endosteal circulation, especially in highly comminuted or open fractures. Unreamed nails are typically smaller in diameter, preserving more endosteal blood flow. However, reamed nails allow for insertion of a larger diameter nail, leading to a stronger construct (bending and torsional stiffness). Neither method inherently facilitates interfragmentary compression without specific techniques. Earlier weight-bearing is often possible with both, but reamed nails generally provide superior mechanical stability. Operating time is not a primary biomechanical advantage.

Question 60

A 35-year-old male presents with chronic pain and instability of the elbow. Radiographs show osteochondritis dissecans (OCD) of the capitellum, with a loose body. Which of the following is the most appropriate treatment?





Explanation

Osteochondritis dissecans (OCD) of the capitellum, especially with a symptomatic loose body, requires surgical intervention. Arthroscopic debridement and removal of the loose body are the most appropriate treatment to relieve mechanical symptoms (pain, locking) and prevent further articular damage. If the fragment is large and potentially salvageable, internal fixation may be attempted. Conservative management is for stable lesions without loose bodies or in the early stages. Radial head excision is for radial head fractures or severe arthritis. Elbow arthroplasty is a salvage procedure for end-stage arthritis.

Question 61

Which of the following statements regarding total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head is most accurate?





Explanation

In younger, active patients undergoing THA for osteonecrosis, cementless components are generally preferred. This is due to the potential for longer implant survival with biologic fixation and to avoid the long-term complications associated with cement. The risk of dislocation in THA for osteonecrosis is comparable to that for osteoarthritis, not significantly higher. Bone stock can be compromised, especially in collapsed stages, making component sizing challenging. Heterotopic ossification is actually more common in THA for osteonecrosis than for osteoarthritis. Core decompression is indicated for early-stage (pre-collapse) osteonecrosis, not for advanced disease requiring THA.

Question 62

A 16-year-old male sustains an open distal tibia and fibula fracture (Gustilo-Anderson Type IIIA). After irrigation, debridement, and initial stabilization with an external fixator, what is the most appropriate next step in his definitive management plan?





Explanation

For Gustilo-Anderson Type IIIA open tibia fractures, after initial irrigation, debridement, and external fixation, the most appropriate definitive management typically involves delayed primary wound closure and conversion to an intramedullary nail within 3-7 days, provided the soft tissue envelope allows. This approach balances the need for early fracture stabilization with soft tissue recovery and infection prevention. Immediate conversion is generally avoided in open fractures. Casting is insufficient for unstable open fractures. Serial debridements followed by skin grafting and then IMN is for more severe (Type IIIB/IIIC) or contaminated open fractures. Amputation is typically a last resort for limb-threatening injuries.

Question 63

Which of the following is a classic finding on physical examination for a patient with a complete rupture of the pectoralis major tendon?





Explanation

A complete rupture of the pectoralis major tendon (typically at the humeral insertion) is characterized by a lack of a palpable tendon and a 'divot' or defect in the anterior axillary fold. The muscle belly may also retract medially, creating an asymmetry compared to the contralateral side. Patients experience pain and weakness, particularly with resisted adduction and internal rotation. Winged scapula is associated with serratus anterior or trapezius palsy. Positive Hawkins' sign is for subacromial impingement. Inability to abduct the arm beyond 90 degrees can be due to rotator cuff tears or severe impingement, not specific to pectoralis major rupture.

Question 64

Which of the following factors most strongly predicts a poor prognosis in patients with metastatic bone disease from solid tumors?





Explanation

Visceral metastases (e.g., to the lung, liver, brain) are the strongest predictors of a poor prognosis and shorter survival in patients with metastatic bone disease. While pathologic fractures and hypercalcemia are significant complications indicating extensive disease, the presence of visceral metastases implies a more aggressive, widespread disease burden. Age can be a factor but is less influential than the extent of systemic disease. Primary tumor type influences prognosis, but visceral spread is often the key determinant of life expectancy.

Question 65

A 50-year-old male presents with chronic insidious onset numbness and tingling in his ulnar two fingers and medial forearm. He describes worsening symptoms with prolonged elbow flexion. Physical examination reveals a positive Tinel's sign at the cubital tunnel and weakness in intrinsic hand muscles. What is the most appropriate initial management?





Explanation

This patient presents with cubital tunnel syndrome (ulnar nerve compression at the elbow). Initial management is always conservative for mild to moderate symptoms. This includes elbow extension splinting, activity modification (avoiding prolonged elbow flexion, leaning on the elbow), and nerve gliding exercises. Surgical decompression (cubital tunnel release) is reserved for failed conservative management, severe nerve compression, or progressive neurological deficits. Oral corticosteroids and NSAIDs may offer temporary symptomatic relief but do not address the underlying compression. Observation alone is insufficient if symptoms are significant.

Question 66

In pediatric flatfoot, which of the following characteristics would most strongly indicate a need for further investigation or intervention beyond observation?





Explanation

A rigid flatfoot that does not correct with toe standing or passive manipulation is the most concerning characteristic and strongly indicates a need for further investigation (e.g., radiographs) to rule out underlying pathologies such as tarsal coalition, vertical talus, or other congenital deformities. Flexible flatfoot, especially if asymptomatic, is common in children and usually resolves or requires no treatment beyond observation. Navicular sag and mild calcaneal valgus are common features of flexible flatfoot. The key differentiator for intervention is rigidity.

Question 67

Which of the following laboratory findings is most characteristic of gouty arthritis?





Explanation

The hallmark diagnostic finding for gouty arthritis is the presence of negatively birefringent, needle-shaped urate crystals in the synovial fluid, identified under polarized light microscopy. Elevated CRP and ESR are general inflammatory markers and are not specific to gout. Leukocytosis in synovial fluid can vary but typically ranges from 10,000-100,000 cells/mm³ in gout, often higher than the 2,000-10,000 range. Calcium pyrophosphate crystals are characteristic of pseudogout (CPPD disease), which are positively birefringent.

Question 68

A 70-year-old female presents with chronic wrist pain and weakness, particularly with gripping. Radiographs show severe pancarpal osteoarthritis, with marked narrowing of the radioscaphoid and capitolunate joints. She has failed conservative management. What is the most appropriate surgical intervention?





Explanation

For severe pancarpal osteoarthritis with diffuse involvement, especially in an older, lower-demand patient, wrist arthrodesis (fusion) is often the most appropriate surgical intervention. It provides reliable pain relief and stability, albeit at the cost of sacrificing motion. While total wrist arthroplasty (TWA) is an option to preserve motion, it has specific indications and potential complications (loosening, wear) that might make fusion a more predictable choice for severe, diffuse disease, particularly in patients not requiring extensive wrist motion. Scaphoid excision and four-corner fusion (or PRC) are for more localized patterns of arthritis (e.g., SLAC, SNAC wrist) where some healthy carpal bones remain. Radial styloidectomy is for localized impingement.

Previous ChapterOrthopedic Board Exam Preparation: Interactive MCQ Quizzes … Next Chapter Orthopedic Board Prep MCQ: Clinical Cases & Exam Simulator
Clinic OS
Medically Verified Content by
Prof. Clinic OS
Consultant Orthopedic & Spine Surgeon
Chapter Index
    Back to Master Guide