A 10-year-old child reports acute leg pain after wrestling with his brother. AP and lateral radiographs are shown in Figures 21a and 21b. What is the best course of action?

Closed reduction and a long leg cast

A 58-year-old woman underwent a left total knee arthroplasty 6 years ago. She initially did well aftersurgery but sustained a fall 2 months ago while at work. She now describes left knee pain and instability and an inability to straighten her knee si

Extensor mechanism reconstruction using synthetic mesh or allograft

A 29-year-old woman is seen in the emergency department with a 24-hour history of severe back and leg pain precipitated by weight-lifting. The patient reports bilateral leg pain and is unable to urinate. She has dense anesthesia in the perineal regio

Improvement in her pain and sensory symptoms following surgery but may have residual bladder dysfunction

Top Orthopedic Board Review MCQs 2026: Practice Part 1

Question 1

A 68-year-old male presents with incapacitating low back pain and significant postural changes. Standing X-rays reveal a severe thoracolumbar kyphoscoliosis with a positive sagittal vertical axis (SVA) of +10 cm and a pelvic incidence (PI) of 60 degrees. The patient has undergone prior L3-S1 fusion. Revision surgery is planned.

Considering modern spinopelvic parameters, what is the MOST critical sagittal parameter to restore for optimal long-term outcomes and pain relief in this patient?

Explanation

For adult spinal deformity, particularly with significant positive sagittal vertical axis (SVA), restoring SVA to less than 5 cm is considered the most critical goal for improving pain and functional outcomes. While aligning Lumbar Lordosis (LL) with Pelvic Incidence (PI) (LL ≈ PI ± 9 degrees) and maintaining a Pelvic Tilt (PT) <20-25 degrees are vital components for achieving overall sagittal balance, a persistently positive SVA is independently correlated with worse outcomes and significantly higher disability. The global balance is ultimately reflected by SVA, which quantifies the deviation of the plumb line from the sacrum.

Question 2

A 72-year-old patient undergoes revision total knee arthroplasty due to persistent pain and effusion 18 months post-primary surgery. Preoperative workup showed ESR 45 mm/hr, CRP 3.2 mg/dL. Knee aspiration yielded 12,000 WBCs with 85% neutrophils. Intraoperatively, tissue cultures are sent. Synovial fluid for alpha-defensin is also sent, yielding a positive result. Given these findings, what is the MOST appropriate next diagnostic step to confirm or refute a diagnosis of periprosthetic joint infection (PJI)?

Explanation

The patient's preoperative markers (elevated ESR/CRP, high synovial WBC count, and positive alpha-defensin) are highly suggestive of PJI. Alpha-defensin is particularly sensitive and specific. Intraoperative frozen section analysis of periprosthetic tissue provides a rapid histological assessment (typically ≥5 neutrophils per high-power field) that can confirm the presence of acute inflammation indicative of PJI, allowing the surgeon to make an informed decision regarding the management strategy (e.g., debridement, implant retention vs. two-stage exchange) while still in the operating room. Other options are either redundant (repeat aspiration), less definitive (leukocyte esterase), or typically used in research settings/for confirmation rather than immediate intraoperative decision-making (PCR, D-dimer).

Question 3

A 35-year-old male sustains a high-energy pelvic injury after a motor vehicle collision, presenting with hemodynamic instability. Initial resuscitation includes two liters of crystalloid and two units of packed red blood cells. A physical exam reveals a shortened and externally rotated left lower extremity. Pelvic X-rays and CT scan demonstrate a Young-Burgess LC-III pattern injury with a symphyseal disruption, bilateral sacral fractures, and evidence of significant retroperitoneal hematoma.

What is the MOST appropriate immediate surgical management strategy?

Explanation

In a hemodynamically unstable patient with a high-energy pelvic fracture, the immediate priority is hemorrhage control. An anterior external fixator rapidly stabilizes the anterior pelvic ring, reduces pelvic volume, and indirectly tamponades venous bleeding from the retroperitoneal space. If hemodynamic instability persists despite initial anterior stabilization and fluid resuscitation, pelvic angiography with embolization is the next crucial step to identify and control arterial bleeding, which is less commonly addressed by mechanical stabilization alone. Definitive internal fixation (ORIF or percutaneous screws) is performed once the patient is hemodynamically stable. Exploratory laparotomy with pelvic packing is reserved for cases where arterial embolization fails or is unavailable, or if there's significant intra-abdominal injury.

Question 4

A 28-year-old professional athlete presents with a symptomatic 2.5 cm full-thickness chondral defect on the femoral condyle following an acute twisting injury. Previous microfracture surgery 6 months ago failed to provide lasting relief. MRI confirms the defect. The patient is keen on returning to high-level sports. Considering advanced biologic augmentation techniques, which option represents the MOST evidence-supported next-step treatment approach for superior hyaline-like cartilage repair in a young, active patient?

Explanation

For a symptomatic, large (2.5 cm) full-thickness chondral defect, especially after failed microfracture in a young, active patient desiring return to high-level sports, Autologous Chondrocyte Implantation (ACI) is a well-established and evidence-supported option. ACI aims to regenerate hyaline-like cartilage and has demonstrated good long-term outcomes for larger defects. OATS (osteochondral autograft) is typically better suited for smaller defects (<2.5 cm) due to donor site morbidity. Particulated juvenile articular cartilage allograft is a newer technique with promising early results but less long-term data compared to ACI. Repeat microfracture, even with PRP, is unlikely to succeed where primary microfracture failed for a defect of this size. MSC injection alone lacks robust evidence for stand-alone treatment of full-thickness defects.

Question 5

A 12-year-old child with cerebral palsy (GMFCS level V) develops a progressive thoracolumbar scoliosis exceeding 60 degrees, leading to significant sitting imbalance, worsening pain, and recurrent respiratory infections. The patient has severe spasticity and a history of gastric reflux. Surgical correction is planned. What is the MOST critical consideration in the preoperative evaluation and planning for this patient, beyond standard scoliosis workup?

Explanation

In patients with neuromuscular scoliosis, especially those with severe cerebral palsy (GMFCS V), cardiopulmonary complications are the leading cause of morbidity and mortality. These patients often have restrictive lung disease, aspiration risk, and impaired cough reflex, making a thorough preoperative cardiopulmonary assessment and optimization paramount. While gastrointestinal issues like reflux (option E) are common and require management, and bone density (option D) is important for fixation, the immediate surgical risks and long-term prognosis are most significantly impacted by pulmonary status. Halo traction (option B) is used for very rigid curves, and tethered cord (option C) is more relevant for myelomeningocele or rapidly progressive curves, not typically the primary concern in cerebral palsy scoliosis without specific neurological changes.

Question 6

A 58-year-old female with a history of breast cancer presents with severe, localized pain in her right humerus. X-rays reveal a lytic lesion in the proximal humerus with cortical destruction extending greater than 50%. She is ambulatory but guards her arm significantly. The Mirels' score is calculated to be 10.

What is the MOST appropriate management strategy?

Explanation

A Mirels' score of 10 indicates a high risk of impending pathological fracture (typically >30-50% risk for scores 9-12). For high-risk impending fractures of long bones like the humerus, prophylactic surgical stabilization is recommended to prevent fracture, relieve pain, and maintain function. Intramedullary nailing is often the preferred method for humeral shaft and proximal humeral lesions, offering stable internal fixation and allowing early mobilization. Radiation therapy is typically used as an adjuvant to surgery for local control and pain relief, or as primary treatment for low-risk lesions (Mirels' ≤ 7). Excisional biopsy is generally not performed for known metastatic disease, and ORIF/prosthetic replacement would be considered for an actual fracture, not an impending one (unless the destruction is so severe as to warrant reconstruction).

Question 7

A 62-year-old diabetic patient presents with a warm, swollen, red, and painful midfoot. Plain radiographs show subtle osteopenia, joint subluxation, and fragmentation of the midfoot bones, consistent with early Charcot neuroarthropathy. There are no skin breaks or signs of infection. What is the MOST critical initial step in management to prevent further progression and deformity?

Explanation

This patient's presentation (warm, swollen, red, painful midfoot with radiographic changes of osteopenia, subluxation, and fragmentation in a diabetic) is classic for acute Charcot neuroarthropathy (Eichenholtz Stage I). The MOST critical initial step in management for acute Charcot is aggressive offloading and immobilization to prevent further bone destruction and deformity. Total Contact Casting (TCC) is considered the gold standard for this stage, as it provides maximal immobilization, pressure distribution, and edema control. Surgical fusion (option A) is typically reserved for severe, unstable deformities or failed conservative treatment in later stages. Empiric antibiotics (option B) are not indicated without signs of infection. AFOs (option D) and offloading shoes (option E) are generally used for stable Charcot deformities (Eichenholtz Stage II/III) or for maintenance after the acute phase.

Question 8

A 45-year-old patient develops severe pain, swelling, skin discoloration, and allodynia in her left hand and wrist three weeks after a distal radius fracture. Radiographs show no hardware issues or signs of infection. Nerve conduction studies are normal. Based on the clinical presentation, Complex Regional Pain Syndrome (CRPS) Type I is suspected.

What is the MOST appropriate initial management strategy?

Explanation

Early diagnosis and aggressive multidisciplinary management are crucial for CRPS. The cornerstone of initial management for CRPS Type I is intensive physical and occupational therapy focused on desensitization, active range of motion, and functional restoration. This helps prevent stiffness and contractures, and retrains the nervous system. While medications (e.g., gabapentinoids, NSAIDs) and regional blocks (e.g., stellate ganglion blocks, option A) can be used as adjuncts for pain control, they are not the primary or sole treatment. Opioids and immobilization (option C) are generally avoided as they can worsen the condition. Surgical exploration (option D) is not indicated without specific signs of nerve compression. Sympathectomy (option E) is a more invasive option reserved for refractory cases.

Question 9

A 75-year-old female undergoes a reverse total shoulder arthroplasty (RTSA) for rotator cuff tear arthropathy. Six months postoperatively, she presents with persistent shoulder pain, weakness, and a positive 'drop arm' sign. X-rays show no signs of loosening or infection. Physical examination reveals impaired active external rotation. What is the MOST likely cause of her persistent symptoms and functional deficit?

Explanation

The combination of persistent pain, weakness, a positive 'drop arm' sign, and impaired active external rotation after RTSA, with normal X-rays, strongly points towards deltoid dysfunction. The deltoid muscle is the primary motor for abduction and elevation after RTSA, and its integrity and function are critical. Dysfunction can arise from fatty infiltration, scarring, denervation (e.g., axillary nerve injury), or disinsertion from the acromion. While acromial stress fracture (option A) causes pain and weakness, the 'drop arm' sign specifically points to a functional issue with the deltoid. Baseplate loosening (option C) would typically be evident on X-rays and cause more diffuse pain. Axillary nerve neuropraxia (option D) would typically manifest earlier post-operatively and also affect deltoid function, but 'deltoid dysfunction' encompasses a broader range of etiologies leading to the observed clinical picture. Impingement (option E) typically restricts motion rather than causing isolated weakness and a drop arm sign.

Question 10

A 78-year-old patient with a history of recurrent hip dislocations following a primary total hip arthroplasty (THA) is being considered for revision surgery. The patient has significant cognitive impairment and poor compliance with hip precautions. Which of the following bearing surface configurations would provide the BEST stability against future dislocations, while balancing wear characteristics?

Explanation

For patients at high risk of recurrent hip dislocation, particularly those with cognitive impairment or poor compliance, dual mobility (DM) articulations offer superior stability. Dual mobility systems combine a small femoral head articulating with a mobile polyethylene liner, which then articulates with a larger metal shell fixed to the acetabulum. This design effectively increases the 'jump distance' and the range of motion before dislocation, significantly reducing dislocation rates compared to conventional THA. While a constrained liner (option B) also enhances stability, it transfers greater stress to the implant-bone interface, increasing the risk of aseptic loosening over time. Large femoral heads (options A, D) improve stability but may not be sufficient for very high-risk patients, and ceramic-on-ceramic bears its own risks. Bipolar hemiarthroplasty (option E) is typically used for femoral neck fractures, not for revision of a THA for instability.

Question 11

A 28-year-old male sustains a vertically oriented Pauwels type III femoral neck fracture in a motorcycle collision.

Which fixation construct offers the greatest biomechanical stability against shear forces for this specific fracture pattern?

Explanation

For vertical shear fractures (Pauwels III), a fixed-angle device like a DHS with a derotational screw provides superior biomechanical stability compared to parallel cancellous screws. It effectively converts shear forces into compressive forces, reducing the risk of varus collapse and nonunion.

Question 12

A 65-year-old female presents with progressive groin pain and a palpable mass 8 years after a metal-on-metal total hip arthroplasty. Aspiration yields sterile, cloudy fluid. MRI demonstrates a solid and cystic periarticular mass. Which of the following histological findings is most characteristic of this condition?

Explanation

The patient has an Adverse Local Tissue Reaction (ALTR/ALVAL) secondary to metal wear. Histology typically shows a perivascular lymphocytic infiltrate and macrophages laden with metal particles, which is distinctly different from the macrophage and giant cell response seen in polyethylene osteolysis.

Question 13

A 12-year-old obese boy presents with right hip pain and a limp. Radiographs confirm a stable severe right slipped capital femoral epiphysis (SCFE) with a Southwick slip angle of 65 degrees.

What is the strongest primary indication for prophylactic in situ pinning of the contralateral, asymptomatic hip?

Explanation

Prophylactic pinning of the contralateral hip in SCFE is universally recommended in patients with underlying endocrine or metabolic disorders (e.g., hypothyroidism, renal osteodystrophy). These patients have an exceptionally high risk of developing bilateral disease.

Question 14

A 15-year-old male presents with a painful mass around his right knee. Radiographs reveal a mixed lytic and sclerotic lesion in the distal femoral metaphysis with a 'sunburst' periosteal reaction. Biopsy confirms high-grade intramedullary osteosarcoma. Which of the following genetic alterations is most frequently associated with the pathogenesis of this tumor?

Explanation

Osteosarcoma is characterized by profound, complex genomic instability, most commonly involving mutations or loss of heterozygosity in tumor suppressor genes like RB1 and TP53. In contrast, translocations like t(11;22) and t(X;18) are associated with Ewing sarcoma and synovial sarcoma, respectively.

Question 15

A 72-year-old male with degenerative cervical myelopathy is scheduled for a posterior cervical laminectomy and fusion. Preoperatively, he exhibits a modified Japanese Orthopaedic Association (mJOA) score of 12. Which of the following preoperative MRI findings correlates most strongly with a poor neurological recovery following decompression?

Explanation

In cervical spondylotic myelopathy, spinal cord signal changes showing high intensity on T2 and low intensity on T1-weighted MRI indicate myelomalacia (permanent cord necrosis and cystic changes). This combination is a strong predictor of poor postoperative neurological recovery.

Question 16

A 21-year-old female soccer player undergoes primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Six months postoperatively, she complains of anterior knee pain and a hard block to terminal knee extension at 10 degrees of flexion. What is the most likely surgical etiology of this complication?

Explanation

A hard block to terminal knee extension following ACL reconstruction is a classic presentation for intercondylar roof impingement. This is most commonly caused by placing the tibial tunnel too anteriorly, causing the graft to impinge against the notch in extension.

Question 17

A 12-year-old obese male presents with 3 weeks of left groin pain and a limp. Exam shows obligate external rotation with hip flexion. Radiographs confirm a stable left slipped capital femoral epiphysis (SCFE). Which of the following is the most appropriate absolute indication for prophylactic pinning of the contralateral asymptomatic hip?

Explanation

Prophylactic pinning of the contralateral hip is strongly recommended in patients with endocrine disorders (e.g., hypothyroidism, renal osteodystrophy) or prior radiation therapy, as their risk of bilateral SCFE approaches 100%. Age < 10 is also a significant risk factor, whereas older age and simple obesity are not absolute indications.

Question 18

A 6-year-old boy sustains a severe supracondylar humerus fracture resulting in a pink, pulseless hand. Closed reduction and percutaneous pinning are performed expeditiously. Postoperatively, the hand remains pink and capillary refill is less than 2 seconds, but the radial pulse remains completely absent. What is the most appropriate next step in management?

Explanation

In a pink, pulseless hand following adequate reduction and stabilization of a pediatric supracondylar fracture, the standard of care is careful observation. Vascular exploration is strictly indicated if the hand becomes persistently white and pulseless despite adequate fracture reduction.

Question 19

A 35-year-old male presents with a hypotensive APC-III pelvic ring disruption following a severe crush injury.

Despite initial massive transfusion protocols and appropriate application of a pelvic binder, he remains hemodynamically unstable. What is the most common anatomical source of massive hemorrhage in this specific fracture pattern?

Explanation

The presacral venous plexus and disrupted cancellous bone edges are the most common sources of bleeding in severe pelvic ring injuries, accounting for up to 80-90% of bleeding volume. While arterial bleeding (e.g., superior gluteal artery) is life-threatening and treated with embolization, it is less frequent overall.

Question 20

A 55-year-old male with severe cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) from C3-C6 presents for surgical evaluation. MRI and lateral radiographs show a fixed kyphotic alignment. The OPLL mass crosses the K-line (K-line negative). What is the most appropriate surgical strategy?

Explanation

In OPLL with a negative K-line and cervical kyphosis, posterior decompression fails to allow the spinal cord to drift backward away from the anterior mass. An anterior decompression and fusion (or combined anterior-posterior approach) is required to relieve cord compression.

Question 21

A 24-year-old female presents with a slow-growing, painful mass in her foot. MRI demonstrates a soft tissue mass with heterogeneous enhancement. Biopsy reveals a biphasic tumor with both epithelial and spindle cell components. Which of the following chromosomal translocations is highly specific to this diagnosis?

Explanation

The clinical and histologic description of a biphasic mass (epithelial and spindle cells) in the distal extremity of a young adult is characteristic of synovial sarcoma. This tumor is strongly associated with the t(X;18)(p11;q11) translocation involving the SYT-SSX fusion gene.

Question 22

During a posterior-stabilized total knee arthroplasty, the surgeon notes that the knee is symmetric and stable in extension, but overly tight in flexion, causing the trial femoral component to lift off anteriorly. What is the most appropriate step to balance the knee?

Explanation

A knee that is balanced in extension but tight in flexion requires increasing the flexion gap without altering the extension gap. Downsizing the femoral component decreases the posterior condylar offset, selectively enlarging the flexion gap.

Question 23

A 32-year-old male sustains a vertically oriented femoral neck fracture (Pauwels type III). Open reduction and internal fixation is performed. Which of the following fixation constructs provides the greatest biomechanical stability for this specific fracture pattern?

Explanation

Vertical femoral neck fractures (Pauwels III) experience extreme shear forces and varus instability. Biomechanical studies show that a fixed-angle sliding hip screw supplemented with an anti-rotation screw provides superior resistance to shear and varus collapse compared to parallel cannulated screws.

Question 24

A 6-year-old child presents with a pulseless, pink hand following a fall from monkey bars. Radiographs show a Garland III posterolaterally displaced supracondylar humerus fracture.

What is the most likely concomitant neurologic deficit?

Explanation

Posterolateral displacement of a supracondylar humerus fracture places the anterior interosseous nerve (AIN) at highest risk due to stretch over the proximal fracture fragment. AIN palsy presents as the inability to flex the thumb IP joint and index finger DIP joint (loss of the "OK" sign).

Question 25

A 45-year-old manual laborer presents with chronic dorsal wrist pain. Radiographs reveal advanced radiocarpal arthritis sparing the radiolunate joint, but with proximal migration of the capitate and capitolunate arthritis. He is diagnosed with Scapholunate Advanced Collapse (SLAC) Stage III. What is the most appropriate surgical treatment?

Explanation

SLAC Stage III involves arthritic changes of the capitolunate joint. Proximal row carpectomy is contraindicated because the arthritic capitate head would articulate with the lunate fossa, leading to rapid failure. Scaphoid excision with four-corner fusion is the treatment of choice.

Question 26

Denosumab is increasingly used as a targeted medical therapy for the treatment of giant cell tumor of bone. By which specific mechanism does this monoclonal antibody halt tumor progression?

Explanation

Denosumab binds directly to RANKL, preventing it from interacting with RANK on the surface of osteoclast precursors. In giant cell tumors, this stops the neoplastic stromal cells from recruiting and activating the destructive multinucleated giant cells.

Question 27

A 45-year-old male is involved in a severe motor vehicle collision. Pelvic radiographs demonstrate an acetabular fracture with a positive 'gull sign' on the AP view. What does this specific radiographic finding indicate?

Explanation

The 'gull sign' represents superomedial dome impaction of the acetabulum, frequently seen in elderly patients with osteopenic bone or after high-energy trauma. It is a critical finding because failure to appropriately elevate and graft this impacted fragment leads to rapid post-traumatic osteoarthritis.

Question 28

A 62-year-old female presents with persistent groin pain 6 years after a primary total hip arthroplasty using a metal-on-polyethylene bearing. Laboratory tests reveal a serum cobalt level of 12 ppb and a chromium level of 2 ppb. A MARS MRI shows a thick-walled cystic mass communicating with the joint. What is the most likely source of this patient's pathology?

Explanation

The presence of elevated cobalt out of proportion to chromium (Co/Cr ratio > 1) in a metal-on-polyethylene THA strongly suggests trunnionosis. This phenomenon is caused by mechanically assisted crevice corrosion at the modular head-neck taper junction, leading to adverse local tissue reactions.

Question 29

A 12-year-old boy with a BMI of 32 presents with right knee pain and an obligate external rotation of the hip during passive flexion. Radiographs confirm a severe, stable slipped capital femoral epiphysis (SCFE). Prophylactic pinning of the contralateral, asymptomatic hip is most strongly indicated if the patient has a history of which of the following?

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly recommended in patients with underlying endocrine disorders such as hypothyroidism, growth hormone deficiency, or renal osteodystrophy. These systemic factors significantly increase the risk of a subsequent contralateral slip.

Question 30

A 25-year-old athlete sustains a multi-ligament knee injury. Physical examination reveals a negative posterior drawer test but a dial test that shows 20 degrees of increased external rotation at 30 degrees of flexion, which reduces to symmetric rotation at 90 degrees of flexion compared to the uninjured side. Which structure or combination of structures is most likely injured?

Explanation

An isolated posterolateral corner (PLC) injury presents with increased external rotation at 30 degrees of flexion but symmetric rotation at 90 degrees on the dial test. If external rotation is increased at both 30 and 90 degrees, a combined PCL and PLC injury should be suspected.

Question 31

A 60-year-old Asian male presents with progressive bilateral hand dexterity loss and a wide-based gait. Cervical CT demonstrates continuous ossification of the posterior longitudinal ligament (OPLL) from C3 to C6.

The 'K-line' connects the midpoints of the spinal canal at C2 and C7 on a neutral sagittal image. In this patient, the OPLL mass crosses the K-line (K-line negative). What is the surgical implication of this finding?

Explanation

A 'K-line negative' cervical spine means the OPLL mass exceeds the K-line, indicating severe localized compression or cervical kyphosis. Posterior decompression alone allows insufficient posterior spinal cord shift in these patients, resulting in poor neurological recovery, thus mandating an anterior or combined approach.

Question 32

A 55-year-old female presents with a sudden inability to actively flex the interphalangeal joint of her right thumb, 8 months after undergoing open reduction and internal fixation of a distal radius fracture with a volar locking plate.

What technical error during the initial surgery most likely caused this complication?

Explanation

Attritional rupture of the flexor pollicis longus (FPL) tendon is a classic complication of volar plating for distal radius fractures. It is most commonly caused by positioning the plate too distally, allowing prominent hardware beyond the watershed line to cause friction and eventual tendon failure.

Question 33

A 42-year-old female presents with a destructive, lytic lesion in the proximal humerus with cortical breakthrough. Biopsy reveals malignant, pleomorphic spindle cells producing unmineralized osteoid. Which of the following is the most important prognostic factor for overall survival in a patient with this diagnosis without systemic metastasis on initial staging?

Explanation

The clinical scenario describes high-grade osteosarcoma. In patients presenting with non-metastatic osteosarcoma, the histological response (percentage of tumor necrosis) to neoadjuvant chemotherapy is the single most important prognostic factor for long-term survival.

Question 34

In the manufacturing of ultra-high molecular weight polyethylene (UHMWPE) for total joint arthroplasty, highly cross-linked polyethylene is utilized to reduce volumetric wear. However, the cross-linking process introduces free radicals. Which secondary process is most commonly used to extinguish these free radicals and prevent long-term oxidative degradation?

Explanation

Gamma irradiation is used to cross-link UHMWPE to reduce wear, but it inherently creates free radicals that cause long-term oxidative degradation. Thermal treatments, such as remelting or annealing, are utilized to extinguish these free radicals and stabilize the polyethylene.

Question 35

A 6-year-old boy sustains a supracondylar humerus fracture with complete posterior displacement. Initially, he has an absent radial pulse but the hand is warm and pink. Closed reduction and percutaneous pinning are performed. Post-reduction, the radial pulse remains non-palpable, but capillary refill in the fingers remains brisk (<2 seconds). What is the most appropriate next step in management?

Explanation

In the setting of a 'pulseless, pink' hand following successful, anatomically aligned reduction and pinning of a pediatric supracondylar humerus fracture, the standard of care is close clinical observation. Vascular exploration is strictly indicated only if the hand is cold, poorly perfused, and pulseless (white hand) after reduction.

Question 36

A 35-year-old male sustains an isolated, closed, mid-diaphyseal femur fracture. He is optimized and scheduled for an antegrade intramedullary nailing utilizing a trochanteric entry portal. To minimize the risk of a varus malalignment during nail insertion, where should the optimal starting point be located on the AP radiograph?

Explanation

For antegrade intramedullary nailing via the trochanteric entry portal, a starting point slightly medial to the tip of the greater trochanter is ideal. A starting point that is too lateral inherently forces the proximal fracture segment into a varus malalignment as the rigid nail traverses down the diaphysis.

Self Assessment Examination Adult S Review | Dr Hutaif - ...

Orthopedic Board Review MCQs (2026 Edition) - Part 1

Key Takeaway

Orthopedic Board Review MCQs (2026 Edition) - Part 1

Chapter Index