Orthopedic Board Prep: Interactive Viva Exam Practice for Trauma & Surgical Cases

AParticipating in regular mock viva sessions where examiners present unfamiliar case scenarios and challenge management plans.
BConsistently reviewing the latest evidence-based guidelines and landmark orthopedic journals relevant to common trauma presentations.
CCreating detailed, memorized algorithms for every possible fracture pattern and surgical approach, without considering variations or complications.
DPracticing explaining surgical indications, contraindications, and potential complications aloud to a peer or mentor.
EAttending multidisciplinary team meetings (MDTs) for complex cases and actively participating in discussions about management controversies.

AApologize for not anticipating that specific question and ask for a moment to organize thoughts.
BState the principles clearly and concisely, then briefly elaborate on their rationale and practical application.
CContinue with the original planned description of the entire surgical procedure, assuming the examiner will allow it.
DAsk the examiner to clarify if they mean pre-operative, intra-operative, or post-operative soft tissue management.
EShift immediately to discussing specific techniques for soft tissue repair without first stating the principles.

AMy threshold is primarily dictated by the patient's age and activity level; younger, active patients always get surgery.
BI strictly adhere to the radiographic findings of nonunion and the presence of avascular necrosis, which mandate surgery.
CThe decision is multifactorial, considering patient factors like age, hand dominance, occupation, functional demands, pain, and their willingness to accept risks, alongside radiographic evidence of nonunion and any signs of instability or avascular changes.
DI would always refer this to a hand specialist for their expert opinion, as scaphoid nonunions are complex.
ESurgical intervention is indicated if the patient has persistent pain for more than six months, regardless of other factors.

AAseptic loosening and polyethylene wear.
BPeriprosthetic joint infection and instability/dislocation.
COsteolysis and heterotopic ossification.
DFemoral component fracture and nerve injury.
EVascular injury and deep vein thrombosis.

ADifficulty assessing motor and sensory deficits due to sedation.
BThe absence of classic pain out of proportion to injury due to analgesia.
CChallenges in measuring compartment pressures accurately without patient cooperation.
DLack of visible swelling or ecchymosis in early stages.
EThe high incidence of concomitant systemic inflammatory response syndrome (SIRS) masking local signs.

ATo eradicate all metastatic disease from the spine, primarily through aggressive surgical resection.
BTo prolong survival at all costs, often prioritizing extensive surgery over functional outcomes.
CTo stabilize the spine, alleviate pain, preserve or improve neurological function, and maintain quality of life, achieved through a multidisciplinary approach tailored to the patient's prognosis and general condition.
DTo prevent all future pathological fractures, irrespective of the patient's life expectancy.
ETo refer all patients to palliative care as surgical intervention offers limited benefit.

AList every conceivable complication from a comprehensive checklist, irrespective of individual patient relevance.
BFocus primarily on the most common risks, briefly mentioning others only if the patient specifically asks.
CDiscuss common and relevant patient-specific risks in detail, then group less common but serious risks (e.g., DVT/PE, infection, nerve injury) and explain their potential impact, ensuring the patient understands they are rare but possible.
DHave the patient sign a generic consent form and assume they have read and understood the small print.
EDelegate the discussion of all surgical risks to a junior resident to save time.

AAdministering intravenous antibiotics.
BDebridement and irrigation of the wound.
CAssessment for neurovascular compromise and temporary splinting.
DObtaining plain radiographs of the tibia and fibula.
EPreparing for definitive internal fixation.

APatient preference for a faster recovery time.
BPresence of a significant glenoid bone loss (>20-25%) or an engaging Hill-Sachs lesion.
CA history of only one prior dislocation with no apparent bone loss.
DThe patient's age being under 20 years old.
EHigh scores on the Western Ontario Shoulder Instability Index (WOSI).

AImmediate surgical fixation to reduce swelling and improve outcomes.
BStrict non-weight bearing, RICE (Rest, Ice, Compression, Elevation), and careful monitoring of soft tissue status until wrinkle sign appears and swelling subsides.
CApplication of an external fixator to distract the fracture and manage soft tissues.
DPrescription of strong analgesics and early mobilization to prevent stiffness.
EPlacement of a bulky compression dressing and immediate discharge home with follow-up in 2-3 weeks.

AInsidious onset of groin pain, often worse with weight-bearing, without a clear traumatic event, especially in the presence of risk factors such as corticosteroid use or alcohol abuse.
BAcute onset of severe pain after a fall onto the hip, with external rotation and shortening of the limb.
CChronic, dull ache in the buttock radiating down the posterior thigh, exacerbated by prolonged sitting.
DClicking or catching sensation in the hip with specific movements, often associated with a positive FADIR test.
ESudden, sharp pain in the lateral hip, reproducible with palpation over the greater trochanter.

AThe surgical goal is primarily to achieve perfect anatomical reduction of any associated fracture to optimize healing.
BThe surgical goal is to remove all devitalized, infected, and foreign material, creating a viable, well-vascularized bed for subsequent bone healing and antibiotic penetration. This is critical because antibiotics alone cannot sterilize necrotic tissue.
CThe surgical goal is to simply drain any obvious abscess and apply a local antibiotic bead pouch.
DThe surgical goal is to stabilize the bone with external fixation to prevent pathological fracture.
EThe surgical goal is to obtain cultures for targeted antibiotic therapy, making extensive debridement unnecessary until results are known.

APresence of multi-level degenerative disc disease seen on MRI.
BPatient preference for a single surgical procedure to avoid potential future surgeries.
CPre-existing spinal instability (e.g., degenerative spondylolisthesis) or iatrogenic instability created by extensive decompression (e.g., bilateral facetectomy).
DSevere intractable back pain that is unresponsive to conservative management.
EAge of the patient being greater than 65 years old.

AThe patient's Body Mass Index (BMI) and dietary habits.
BThe patient's age, activity level, functional demands (e.g., participation in pivoting sports), presence of meniscal or collateral ligament injuries, and psychological readiness.
CThe patient's socioeconomic status and access to rehabilitation facilities.
DThe specific graft choice available at your institution (autograft vs. allograft).
EThe patient's preference for crutches versus walking boot post-injury.

APresence of significant arm swelling and ecchymosis.
BPatient's age over 60 years old with low functional demands.
CShortening of greater than 2 cm, significant displacement/comminution, skin tenting, or neurovascular compromise.
DA simple transverse fracture pattern with minimal displacement.
EPatient expresses a strong preference for non-operative treatment.

AAn MRI is always the first diagnostic step for any patient with low back pain and radicular symptoms to confirm the diagnosis and rule out serious pathology.
BAn MRI is not typically indicated in the initial 6 weeks of symptoms unless 'red flag' signs suggest serious pathology (e.g., cauda equina syndrome, progressive neurological deficit, tumor, infection), or if symptoms persist despite adequate conservative treatment.
CAn MRI is primarily for surgical planning, so it should only be ordered after the patient has failed all conservative measures and has committed to surgery.
DAn MRI is primarily useful for assessing soft tissue injuries, so it is rarely helpful for bony pathologies in the spine.
EAn MRI is only ordered by neurologists; orthopedic surgeons rely on plain radiographs.

AAseptic loosening of the humeral component, mitigated by cementing the stem.
BAxillary nerve palsy due to surgical dissection, mitigated by careful nerve identification.
CScapular notching, caused by impingement of the humeral polyethylene liner on the inferior glenoid neck. It is mitigated by appropriate glenosphere lateralization, inferior placement, and proper soft tissue tensioning.
DInfection, mitigated by strict sterile technique and perioperative antibiotics.
ERotator cuff failure, mitigated by preserving the subscapularis.

ATo prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
BTo accelerate bone healing and consolidate fixation.
CTo promote synovial fluid circulation, enhance cartilage nutrition, and prevent joint stiffness and adhesions.
DTo reduce patient dependence on caregivers and facilitate early discharge.
ETo minimize post-operative pain and reliance on analgesics.

AEnsuring the patient has adequate financial resources for post-operative care.
BDetermining the patient's cosmetic preferences for limb salvage versus amputation.
CAccurately staging the tumor and planning a wide surgical margin while considering functional limb preservation or effective amputation to optimize oncologic outcomes.
DCoordinating with the physical therapy team for immediate post-operative rehabilitation.
ESelecting the most aesthetically pleasing reconstructive option for the limb.

AAny curve greater than 20 degrees in a skeletally immature patient.
BProgression of a curve to greater than 40-45 degrees, particularly in skeletally immature patients, or curves progressing despite bracing, along with consideration of spinal balance and cosmetic deformity.
CCosmetic concerns alone, regardless of curve magnitude or progression.
DPresence of back pain, even if the curve is small and non-progressive.
EFailure to achieve a perfect posture through physical therapy.

APersistent neck pain despite over-the-counter analgesics.
BGradual onset of numbness and tingling in one arm.
CProgressive motor weakness, signs of myelopathy (e.g., gait disturbance, Hoffman's sign, bowel/bladder dysfunction), or intractable pain refractory to all conservative measures.
DDifficulty sleeping due to discomfort.
EUnilateral arm pain radiating below the elbow.

AOrder an emergent CT scan to assess for hemorrhage.
BAdminister higher doses of analgesia and elevate the limb.
CMeasure compartment pressures in all four compartments of the lower leg immediately and prepare for emergent fasciotomy if pressures are elevated.
DConsult a vascular surgeon to rule out arterial injury.
EReassure the patient that post-operative pain is normal and monitor closely.

AEarly functional rehabilitation primarily aims to reduce the risk of deep vein thrombosis (DVT).
BTraditional prolonged immobilization leads to a higher rate of re-rupture due to delayed healing.
CEarly functional rehabilitation promotes collagen fiber alignment, improves tendon strength, reduces adhesion formation, and leads to faster return to activity without increasing the risk of re-rupture when carefully controlled.
DEarly functional rehabilitation is solely for patient comfort and psychological well-being.
EThere is no significant difference in outcomes; the choice is purely surgeon preference.

APlain radiographs of the foot to rule out osteomyelitis.
BBlood tests including HbA1c and inflammatory markers.
CAn Ankle-Brachial Index (ABI) and potentially toe pressures to assess peripheral arterial disease (PAD).
DSwab cultures for microbiology to identify pathogens.
EElectromyography (EMG) to assess for peripheral neuropathy.

ADCO involves definitive fixation of all fractures in the initial surgical setting to minimize hospital stay.
BDCO is applicable only to open fractures and involves immediate debridement and external fixation.
CDCO involves temporary stabilization of fractures (e.g., external fixation) in multiply injured patients or those in physiological extremis, followed by definitive fixation once the patient is physiologically stable, to avoid exacerbating systemic 'second hit' inflammatory responses.
DDCO primarily focuses on non-operative management of fractures to avoid surgical stress in critically ill patients.
EDCO is a strategy used only in military trauma settings for quick patient turnover.

AIntra-articular corticosteroids provide significant long-term structural modification and halt cartilage degeneration.
BIntra-articular corticosteroids offer consistent, durable pain relief for many years and should be repeated monthly.
CIntra-articular corticosteroids provide short-to-medium term pain relief (weeks to a few months) and can be useful as an adjunct in a comprehensive management plan, but they do not alter disease progression and should be used judiciously due to potential risks with frequent injections.
DIntra-articular corticosteroids are contraindicated in knee OA due to their catabolic effects on cartilage.
EIntra-articular corticosteroids are primarily used for inflammatory arthritides and have no role in OA.

AGram stain and urgent cell count with differential.
BAerobic and anaerobic cultures.
CGlucose and protein levels.
DLactate dehydrogenase (LDH) level.
ECrystal analysis for gout or pseudogout.

ATo excise the entire transverse carpal ligament to prevent recurrence of symptoms.
BTo decompress the median nerve by transecting the transverse carpal ligament, thereby relieving pressure and improving nerve function and symptom resolution.
CTo remove any osteophytes or inflamed synovium within the carpal tunnel to create more space.
DTo resect the flexor retinaculum and relocate the median nerve anteriorly.
ETo perform a neurolysis of the median nerve to improve its conductivity directly.

AAdvantage: Lower risk of deep vein thrombosis; Challenge: Longer operative time.
BAdvantage: Potentially lower dislocation rate due to preservation of posterior soft tissues; Challenge: Steeper learning curve, increased risk of lateral femoral cutaneous nerve injury, and potentially more difficult femoral exposure in obese patients.
CAdvantage: Superior visualization of the acetabulum; Challenge: Higher risk of sciatic nerve injury.
DAdvantage: Fewer restrictions post-operatively; Challenge: Increased blood loss.
EAdvantage: Easier access for revision surgery; Challenge: Higher risk of heterotopic ossification.

AMRI venography of the affected limb.
BComputed tomography pulmonary angiogram (CTPA) to rule out pulmonary embolism.
CDoppler ultrasound of the affected limb.
DD-dimer blood test, followed by ultrasound only if D-dimer is elevated.
EAscending venography as the gold standard.

APeriprosthetic joint infection and deep vein thrombosis.
BAseptic loosening of the glenoid component and polyethylene wear.
CMalposition of the tuberosities (leading to poor rotator cuff function) and glenoid erosion.
DHeterotopic ossification and nerve injury.
EStiffness and implant fracture.

AStrict bed rest to prevent any weight-bearing on the affected hip.
BAggressive pain management, early mobilization out of bed to a chair, pressure ulcer prevention, and nutritional support.
CImmediate placement in a spica cast to immobilize the fracture.
DLong-term antibiotic prophylaxis to prevent infection.
EMinimizing all movement to promote fracture healing.

ARefuse to operate due to the high risk of mortality without transfusion.
BProceed with surgery and transfuse blood if clinically necessary, overriding the patient's wishes for life-saving treatment.
CRespect the patient's autonomy and religious beliefs. Explore all blood conservation strategies (e.g., cell salvage, synthetic blood products, tranexamic acid, permissive hypotension) with the patient and involve an ethics committee if time permits, while making it clear the risks of non-transfusion.
DDelay surgery until the patient or their family consents to transfusion.
ETransfer the patient to another facility that specializes in treating Jehovah's Witnesses.

AQuadriceps muscle weakness, assessed by manual muscle testing.
BExcessive genu varum and external tibial torsion, assessed by clinical examination.
CTrochlear dysplasia, patella alta, increased tibial tuberosity-trochlear groove (TT-TG) distance, and generalized ligamentous laxity. These are assessed clinically (e.g., J-sign, apprehension test) and with imaging (radiographs for patella alta, MRI/CT for trochlear morphology and TT-TG distance).
DLateral retinacular tightness, assessed by palpation.
EMeniscal tears, assessed by MRI.

AIt's when the blood supply to the top of your thigh bone (femoral head) gets interrupted, causing the bone cells to die. This can lead to the bone collapsing and severe arthritis.
BIt's a rare bone infection that affects the hip joint and needs strong antibiotics.
CIt's similar to osteoporosis, where the bone becomes weak and brittle, leading to fractures.
DIt's a fancy term for early-onset osteoarthritis of the hip.
EIt means the femoral head is slowly dissolving due to an autoimmune condition.

AThe patient's Body Mass Index (BMI).
BThe exact anatomical location of the fracture within the femoral neck.
CThe patient's pre-injury functional status, cognitive ability, fracture displacement, and bone quality.
DThe availability of specific implants at your institution.
EThe presence of osteoporosis in the patient.

AAdmit that you might be wrong and retract your initial choice.
BDefensively state that your chosen approach is what you were taught and are most comfortable with.
CAcknowledge the examiner's point about infection rates, then articulate specific patient-related factors, anatomical considerations, or biomechanical advantages that, in this specific case, led you to favor your chosen approach, while briefly addressing how you mitigate the stated risk.
DChange the topic to another aspect of the case, avoiding the direct challenge.
EState that your institution's data shows no difference in infection rates, without further elaboration.

AThe athlete's preferred sport, as some sports are more prone to stress fractures.
BThe athlete's bone mineral density and underlying nutritional status, hormonal balance, and training errors (e.g., sudden increases in intensity or volume, inadequate recovery).
CThe type of shoe the athlete uses for training.
DThe specific analgesic medications the athlete is taking for pain control.
EThe family history of stress fractures.

AAchieving absolute anatomical reduction and immediate full weight-bearing.
BPreventing deep vein thrombosis (DVT) and minimizing post-operative pain.
CPreserving the physis (growth plate) to prevent growth arrest or angular deformity, and ensuring adequate reduction to prevent malunion.
DImmediate operative fixation with a large plate and screws to provide rigid stability.
EStrict bed rest to promote rapid healing and prevent displacement.

AA bone scan (technetium-99m) to identify metastatic lesions.
BPlain radiographs of the affected bone, including orthogonal views, and potentially of the entire bone and adjacent joint.
CAn MRI of the entire skeleton to detect occult lesions.
DA PET-CT scan for metabolic activity of the lesion.
EA biopsy of the fracture site before any imaging is performed.

AImmediately perform revision surgery to equalize leg lengths.
BPrescribe custom orthotics or shoe lifts for the patient.
CThoroughly assess the patient's symptoms, functional impact, and measure the discrepancy clinically and radiographically to differentiate true from perceived leg length discrepancy, and determine its magnitude and impact.
DRefer the patient to a physical therapist for gait training.
EReassure the patient that some leg length discrepancy is normal after hip replacement.

ARepeated corticosteroid injections into the subacromial space.
BComplete immobilization of the shoulder for 6 weeks.
CA structured, progressive physical therapy program focusing on rotator cuff strengthening, scapular stabilization, and postural correction.
DOral non-steroidal anti-inflammatory drugs (NSAIDs) as needed.
EImmediate referral for surgical repair of the rotator cuff.

AObtaining detailed radiographs and a CT scan of the hip to classify the fracture.
BConsulting with the family regarding their wishes for surgical intervention.
COptimizing the patient's medical comorbidities, physiological status (e.g., cardiac, pulmonary, renal function), and managing pain to make them medically fit for surgery.
DAdministering broad-spectrum antibiotics to prevent infection.
EArranging for immediate operating room availability.

ATo allow the patient to recover from the initial surgical insult before a second, more definitive procedure.
BTo enable multiple surgeons from different specialties to operate at different times.
CTo prioritize early comprehensive debridement and irrigation, obtain soft tissue coverage, and stabilize the fracture provisionally to prevent further contamination and facilitate soft tissue healing, deferring definitive fixation until the wound is clean and soft tissues are amenable.
DTo prevent bone shortening by delaying all fixation until soft tissues have healed completely.
ETo reduce the financial burden on the healthcare system by spreading out costs.

AAssessment of the range of motion of the elbow joint.
BDetailed neurovascular assessment (radial pulse, capillary refill, median/radial/ulnar nerve function) and documentation.
CPain assessment using a visual analog scale.
DReview of the child's vaccination history.
EObtaining a detailed history of the mechanism of injury from the parents.

AInadequate post-operative pain control and early return to sports.
BMalpositioning of the femoral or tibial tunnels, residual knee laxity, and significant concomitant meniscal or collateral ligament injuries that were not adequately addressed.
CPatient non-compliance with antibiotic prophylaxis and graft rejection.
DUse of an allograft instead of an autograft.
EExcessive rehabilitation and early full weight-bearing.

ATo prevent the development of shoulder adhesive capsulitis.
BTo restore rotator cuff function, improve pain, and prevent tear propagation and the eventual development of rotator cuff arthropathy.
CTo enable the patient to lift heavy weights above their head immediately post-operatively.
DTo avoid the need for any further physical therapy.
ETo reduce the risk of deep vein thrombosis.

ABilateral leg pain and weakness.
BUnilateral foot drop.
CProgressive low back pain radiating into the buttocks.
DSaddle anesthesia (numbness in the perineal/genital area), urinary retention or incontinence, and/or fecal incontinence, coupled with varying degrees of motor weakness and sensory changes in the lower extremities.
EAbsent ankle reflexes.

AThe patient's Body Mass Index (BMI).
BThe duration of symptoms before diagnosis.
CThe skeletal maturity of the patient (open vs. closed physes), the size and stability of the lesion, and the presence of loose bodies.
DThe specific location of the lesion (medial vs. lateral femoral condyle).
EThe patient's preferred level of sports activity.

APatient age greater than 65 years old.
BPatient preference for quicker recovery.
CActive or recurrent infection in the ankle joint, severe deformity that is non-correctable, significant bone loss, or severe peripheral vascular disease.
DHistory of a prior ankle sprain.
EPresence of moderate obesity.

AEpidural corticosteroid injections are curative for disc herniation and prevent the need for surgery in all cases.
BEpidural corticosteroid injections provide definitive, long-term pain relief and should be given repeatedly at monthly intervals.
CEpidural corticosteroid injections can provide short-to-medium term pain relief and reduce inflammation, often facilitating participation in physical therapy. They are not curative and should be used judiciously, with limited frequency, as part of a comprehensive non-operative regimen.
DEpidural corticosteroid injections are primarily used for axial back pain, not radiculopathy.
EEpidural corticosteroid injections have no proven benefit and carry significant risks, so they should be avoided.

APresenting a vast amount of scientific literature to demonstrate your expertise.
BUsing medical jargon to establish authority and quickly move on to the next topic.
CListening actively to their concerns, using clear and empathetic language, explaining the condition and proposed treatment simply, drawing diagrams, involving them in shared decision-making, and answering all questions patiently.
DAsking the nurse to answer all their questions as you are busy with other patients.
ESolely focusing on the surgical technique, assuming they understand the risks and benefits from prior discussions.

ATension-sided femoral neck stress fractures, due to their high risk of progression to complete fracture and displacement, which can lead to avascular necrosis.
BCompression-sided femoral neck stress fractures, due to their inherent instability.
CAny femoral neck stress fracture in a professional athlete, regardless of type.
DStress fractures involving the greater trochanter, as they are highly painful.
EOld, healed stress fractures that are asymptomatic.

AInadequate post-operative rehabilitation and early weight-bearing.
BFailure to address concomitant medial ankle instability and patient non-compliance.
CMalreduction of the syndesmosis during the initial surgery and/or hardware failure/loosening.
DDevelopment of deep vein thrombosis and subsequent swelling.
EOver-tightening of the syndesmotic screw leading to fusion.

AInform the patient that they are making a poor decision and refuse to continue care.
BDocument the refusal, re-educate the patient on the risks of non-operative management and benefits of surgery, explore their reasons for refusal, offer alternatives (e.g., second opinion), continue to offer conservative management if appropriate, and maintain an open dialogue for future reconsideration.
CImmediately refer them to another surgeon who might convince them.
DDischarge them from your care, as they are not compliant.
EForce the issue by emphasizing the negative consequences without further discussion.

AA course of oral steroids to reduce inflammation.
BImmediate surgical release of the extensor carpi radialis brevis origin.
CFurther comprehensive re-evaluation to confirm diagnosis, rule out alternative pathology, and consider advanced conservative options (e.g., PRP injections, dry needling, focused extracorporeal shockwave therapy) before considering surgery.
DReferral to a chronic pain specialist for opioid management.
EComplete cessation of all arm activities indefinitely.

AThey are used to assess the depth of anesthesia and ensure the patient is adequately sedated for the procedure.
BThey are primary tools for monitoring blood pressure and heart rate fluctuations during spinal instrumentation.
CThey are intraoperative neurophysiological monitoring techniques used to detect potential spinal cord ischemia or injury during corrective maneuvers, allowing for immediate intervention to prevent permanent neurological deficits.
DThey are post-operative tests to assess the success of spinal fusion.
EThey are preoperative tests to determine the patient's baseline neurological function.

APeriprosthetic joint infection and instability/dislocation.
BAseptic loosening and osteolysis.
CDeep vein thrombosis and pulmonary embolism.
DHeterotopic ossification and nerve injury.
EImplant fracture and leg length discrepancy.

AShort arm cast, including the thumb, for 2-4 weeks.
BLong arm cast, including the thumb, for 6-8 weeks, followed by a short arm thumb spica splint for an additional 4-6 weeks, or until radiographic union is confirmed.
CShort arm thumb spica cast for 2-3 weeks, then gradual mobilization.
DImmediate surgical fixation with a headless compression screw.
ENo immobilization required, just activity modification.

AInvolvement of the posterior facet joint.
BAn associated avulsion fracture of the anterior process.
CA markedly depressed Gissane's angle or decreased Böhler's angle indicating severe comminution and talar impingement.
DLateral wall blowout with peroneal tendon impingement.
EPresence of a fracture line extending into the cuboid.

ABecome defensive and reiterate your diagnosis with increasing conviction.
BAdmit uncertainty and state you need more time to think, without offering alternatives.
CAcknowledge the examiner's valid point, briefly state the differential diagnoses you considered (or would consider), and explain why you favored your primary diagnosis based on the available information, demonstrating critical thinking and a structured approach.
DChange your diagnosis immediately to appease the examiner.
EAsk the examiner what diagnosis they think is more likely.

AHypertrophic non-union requires biological stimulation (e.g., bone grafting), while atrophic non-union requires only mechanical stability.
BAtrophic non-union requires aggressive debridement to remove excess callus, while hypertrophic non-union requires minimal intervention.
CHypertrophic non-union indicates adequate biological response but insufficient mechanical stability, thus requiring robust fixation. Atrophic non-union indicates poor biological potential, requiring both mechanical stability and biological stimulation (e.g., bone grafting or growth factors).
DBoth hypertrophic and atrophic non-unions require the same treatment: external fixation with bone transport.
EHypertrophic non-union requires antibiotics, while atrophic non-union requires vascularized free flap.

ASuperficial wound infection, prevented by meticulous sterile technique.
BDeep vein thrombosis, prevented by pharmacological prophylaxis.
CNeurological deficit (e.g., paraplegia), primarily prevented by intraoperative neurophysiological monitoring (SSEPs, MEPs), careful surgical technique, and judicious use of corrective forces.
DPseudarthrosis, prevented by aggressive bone grafting.
EDistal junctional kyphosis, prevented by extending the fusion to the sacrum.

ATo excise the prominent medial eminence and reduce pain from shoe wear.
BTo realign the first metatarsal head and shaft to correct the metatarsus primus varus deformity, thereby addressing the underlying biomechanical cause and reducing recurrence.
CTo shorten the first metatarsal to relieve pressure on the forefoot.
DTo lengthen the adductor hallucis tendon and release the lateral capsule.
ETo fuse the first metatarsophalangeal joint to ensure permanent correction.

ATo eliminate all pain immediately and completely.
BTo restore normal blood supply to the femoral head to prevent avascular necrosis.
CTo maintain containment of the femoral head within the acetabulum to preserve its spherical shape and prevent deformity, thereby minimizing the risk of developing early osteoarthritis.
DTo accelerate the revascularization process of the femoral head.
ETo prolong the disease process to allow for maximal growth before healing.

AIncreased risk of patellofemoral pain syndrome.
BProgressive medial compartment osteoarthritis due to altered biomechanics and chronic varus thrust.
CDevelopment of a symptomatic popliteal cyst (Baker's cyst).
DIncreased risk of deep vein thrombosis.
EChronic anterior knee pain from quadriceps weakness.

ADeliver the news quickly and directly, then leave to allow the patient to process it.
BUse technical medical terms to demonstrate professionalism and expertise.
CDeliver the news in a quiet, private setting, ensuring you have adequate time, using clear and empathetic language, assessing the patient's understanding and emotional state, and offering support and a clear plan for next steps.
DHave a family member deliver the news to the patient to soften the blow.
EFocus solely on the statistics and prognosis without addressing the patient's feelings.

AArthrodesis (fusion) of the MTP joint to eliminate all pain.
BCheilectomy, with the primary goal of decompressing the MTP joint by removing dorsal osteophytes and often part of the dorsal metatarsal head, thereby improving range of motion and reducing impingement pain.
CResection arthroplasty (Keller procedure) to create a pseudoarthrosis.
DTotal MTP joint replacement to restore full range of motion.
EProximal phalangeal osteotomy (Moberg osteotomy) alone.