Orthopedic Anatomy 2026 MCQs: Board Review Questions & Answers (Part 3)

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Orthopedic Anatomy 2026 MCQs: Board Review Questions & Answers (Part 3)
Comprehensive 100-Question Exam
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Question 1
Following a vertebroplasty of L2, cement is noted to protrude directly anterior to the L2 vertebral body. The cement is closest to which of the following structures?
Explanation
Question 2
Figures 28a and 28b show AP and lateral radiographs of the knee. Based on these findings, which of the following structures has most likely been injured?
Explanation
Question 3
A patient who sustained a knife wound to the axilla 4 months ago now has profound interosseous wasting and generalized hand weakness. A brachial plexus injury is likely at which of the following locations in Figure 29?
Explanation
Question 4
During an anterior retroperitoneal approach to the low lumbar spine, the iliac vessels are mobilized along the lateral side, allowing them to be retracted toward the midline. To gain adequate mobility of the common iliac vein for exposure of L5, it is important to identify which of the following structures?
Explanation
Question 5
Figure 30 shows an axial T1-weighted MRI scan of a patient's right shoulder. The arrows are pointing to what normal structure?
Explanation
Question 6
The arthroscopic views shown in Figures 31a and 31b reveal extensive synovitis in the anterolateral corner of the ankle overlying a band of tissue sometimes implicated in soft-tissue impingement of the ankle following a chronic sprain injury. This band is a portion of the
Explanation
Question 7
Figures 32a and 32b show the AP and lateral radiographs of an 11-year-old boy who has a severe limp, a fever, and swelling and tenderness of the thigh. Aspiration of the bone reveals purulent material. The patient has most likely been symptomatic for
Explanation
Question 8
Figure 33 shows the CT scan of a 40-year-old man who injured his left shoulder while skiing. What structure is attached to the bony fragment?
Explanation
Question 9
What structure is located immediately posterior to the capsule at the posterior cruciate ligament tibial insertion?
Explanation
Question 10
A 21-year-old man has mild but persistent aching pain in his left proximal thigh during impact loading activities. He denies pain at rest and has no other symptoms. Figures 34a through 34e show the radiographs and T1-weighted, T2-weighted, and gadolinium MRI scans of the left hip. What is the most likely diagnosis?
Explanation
Question 11
What nerve is at greatest risk when developing the superficial plane between the tensor fascia lata and sartorious during the anterior (Smith-Peterson) approach to the hip?
Explanation
Question 12
An axial T1-weighted MRI scan of the pelvis is shown in Figure 35. Which of the following structures is enclosed by the circle?
Explanation
Question 13
At the level of the midcalf, the plantaris tendon is found at which of the following locations?
Explanation
Question 14
In the posterior approach to the proximal radius (proximal Thompson approach), the supinator is exposed through the interval between what two muscles?
Explanation
Question 15
Figure 36 shows the hip arthrogram of a newborn. Which of the following structures is enclosed by the circle?
Explanation
Question 16
Figures 37a and 37b show radiographs of a 24-year-old man who has a humeral bone lesion that was found during a screening chest radiograph. He denies any symptoms despite leading a very active lifestyle. What is the most likely diagnosis?
Explanation
Question 17
Figures 38a and 38b show the CT scans of a 64-year-old woman. What is the most likely diagnosis?
Explanation
Question 18
The arrow in Figure 39 is pointing to which of the following ligaments?
Explanation
Question 19
The medial collateral ligament complex of the elbow originates on what portion of the medial epicondyle?
Explanation
Question 20
Figures 40a and 40b show the pre- and postoperative radiographs of an 82-year-old woman with bilateral hip pain who has had staged total hip arthroplasties. To minimize potential injury to the sciatic nerve at the time of surgery, the surgeon should
Explanation
Question 21
Based on the radiographic findings shown in Figure 41, which of the following wrist ligaments is most likely disrupted?
Explanation
Question 22
Which of the following extensor tendons commonly have multiple slips?
Explanation
Question 23
The nerve to the abductor digiti quinti, implicated in some patients who have chronic heel pain, is most commonly a branch of what larger nerve?
Explanation
Question 24
Figure 42 shows the sagittal T2-weighted MRI scan of a patient's right knee. These findings are most commonly seen with a complete tear of the
Explanation
Question 25
Thermal capsulorrhaphy of the inferior glenohumeral ligament can cause iatrogenic injury to which of the following nerves?
Explanation
Question 26
A patient undergoes open reduction and internal fixation of a distal fibula fracture via a standard lateral approach. Postoperatively, she complains of numbness over the dorsum of her foot, sparing the first web space. The injured structure typically crosses the fibula from posterior to anterior at what average distance proximal to the distal tip of the fibula?
Explanation
Question 27
During an anatomic reconstruction of the posterolateral corner of the knee, the surgeon must accurately identify the femoral footprints of the fibular collateral ligament (FCL) and the popliteus tendon (PT). On the lateral femoral epicondyle, what is the anatomic relationship of the PT insertion relative to the FCL origin?
Explanation
Question 28
A 28-year-old overhead athlete presents with chronic posterior shoulder pain and selective deltoid weakness. An MRI reveals an isolated paralabral cyst compressing the axillary nerve within the quadrilateral space. Which of the following muscles forms the superior border of this space?
Explanation
Question 29
A patient presents with an inability to extend the metacarpophalangeal joints of the fingers following a surgical approach to the proximal radius. The most likely injured nerve typically enters the supinator muscle beneath a dense fibrous arch. What is the proper anatomical name of this arch?
Explanation
Question 30
A surgeon is performing a posterolateral approach to the hip for total hip arthroplasty. To minimize the risk of avascular necrosis and preserve the main blood supply to the femoral head, aggressive release or division of the quadratus femoris muscle near its femoral insertion should be avoided. The vessel protected by this maneuver is the:
Explanation
Question 31
A patient sustained a deep laceration to the thenar eminence, resulting in an inability to oppose the thumb despite intact sensation. The injured nerve branch typically takes which of the following paths relative to the transverse carpal ligament to innervate the thenar musculature?
Explanation
Question 32
During an anterior cervical discectomy and fusion (ACDF), excessive lateral bone removal using a burr puts the vertebral artery at significant risk. The vertebral artery typically enters the transverse foramen first at which cervical level?
Explanation
Question 33
During a plantar approach to the foot for an extensive midfoot fusion, the surgeon encounters the "Master knot of Henry." This structure is anatomically defined as the location where:
Explanation
Question 34
During an anterior retroperitoneal approach to the L4-L5 disc space, the surgeon is at risk of injuring a neural structure situated on the anterolateral aspect of the L4 vertebral body. Injury to this structure most commonly results in which of the following?
Explanation
Question 35
A patient sustains a laceration to the volar wrist, dividing the ulnar nerve distal to the takeoff of the dorsal ulnar cutaneous branch. Which of the following physical examination findings is most likely to be observed?
Explanation
Question 36
During an extensile lateral approach to the calcaneus for open reduction and internal fixation of a displaced intra-articular fracture, a specific nerve is contained within the inferior (plantar) full-thickness flap. Which nerve is most at risk if this flap is poorly handled?
Explanation
Question 37
To avoid iatrogenic injury to the axillary nerve during a lateral deltoid-splitting approach to the proximal humerus, the split should not extend beyond what distance distal to the lateral edge of the acromion?
Explanation
Question 38
During reconstruction of the posterolateral corner of the knee, a graft is placed at the anatomical femoral attachment of the fibular collateral ligament (FCL). Relative to the lateral epicondyle, where is the precise origin of the FCL?
Explanation
Question 39
The Smith-Petersen approach to the hip utilizes a superficial internervous plane between which of the following muscle pairs?
Explanation
Question 40
A surgeon is performing a surgical exposure of the hip via the anterior (Smith-Petersen) approach. Which of the following represents the correct internervous plane for the superficial dissection?
Explanation
Question 41
A 45-year-old mechanic presents with vague dorsal forearm pain and an inability to actively extend the metacarpophalangeal joints of his fingers and thumb. There is no sensory deficit. Compression of a nerve at which of the following anatomic structures is the most likely cause?
Explanation
Question 42
A 28-year-old patient sustains a displaced talar neck fracture (Hawkins Type III). Which of the following arteries provides the major blood supply to the body of the talus, placing it at highest risk for avascular necrosis if disrupted?
Explanation
Question 43
During an open reduction and internal fixation of a distal humerus shaft fracture via an anterolateral approach, the surgeon identifies a supracondylar process. An anomalous fibrous band extending from this process to the medial epicondyle can compress which of the following structures?
Explanation
Question 44
A 32-year-old bodybuilder complains of vague posterior shoulder pain and numbness over the lateral aspect of his shoulder. MRI reveals a paralabral cyst compressing structures within the quadrangular space. Which of the following muscles forms the superior border of this space?
Explanation
Question 45
A surgeon is planning an extensile posterolateral approach to the tibia to plate a complex tibial plateau fracture. Which internervous plane is predominantly utilized in this approach?
Explanation
Question 46
A 22-year-old soccer player develops an acute compartment syndrome of the leg following a tibial fracture. To adequately decompress the deep posterior compartment, the surgeon must identify and protect its neurovascular contents. Which of the following structures normally resides within the deep posterior compartment of the leg?
Explanation
Question 47
A 29-year-old professional volleyball player presents with progressive weakness in external rotation of the shoulder. Examination reveals isolated atrophy of the infraspinatus muscle, while the supraspinatus is clinically normal. Where is the most likely location of nerve entrapment?
Explanation
Question 48
While performing an open reduction and internal fixation of a distal radius fracture via a dorsal approach, the surgeon elevates the third extensor compartment. Which of the following tendons is contained within this compartment?
Explanation
Question 49
A 19-year-old collegiate baseball pitcher undergoes reconstruction of the ulnar collateral ligament (UCL) of the elbow. Which bundle of the UCL is considered the primary restraint to valgus stress between 30 and 120 degrees of elbow flexion?
Explanation
Question 50
During an extensile lateral approach to the calcaneus for open reduction and internal fixation, the vertical limb of the incision is placed between the posterior aspect of the fibula and the Achilles tendon. If the incision is placed too anteriorly, which of the following structures is at greatest risk of iatrogenic injury?
Explanation
Question 51
The standard deltopectoral approach to the shoulder utilizes a true internervous plane. This interval is developed between muscles innervated by which of the following combinations of nerves?
Explanation
Question 52
During a dorsal approach to the proximal radius (Thompson approach), the interval is developed between the extensor digitorum communis and extensor carpi radialis brevis. To safely expose the proximal radial shaft, how should the supinator muscle be managed to best protect the posterior interosseous nerve (PIN)?
Explanation
Question 53
During a posterior approach to the hip (Kocher-Langenbeck), the short external rotators are divided. The deep branch of the medial femoral circumflex artery (MFCA) provides the main blood supply to the femoral head. It is at greatest risk of iatrogenic injury if which of the following structures is released too close to its femoral insertion?
Explanation
Question 54
A 28-year-old elite volleyball player presents with painless weakness in external rotation of the right shoulder. Physical examination reveals isolated atrophy of the infraspinatus muscle with normal bulk of the supraspinatus. An MRI is most likely to show a paralabral cyst compressing a nerve at which of the following anatomical locations?
Explanation
Question 55
A rock climber experiences a sudden "pop" in his middle finger while aggressively pulling on a crimp hold. He subsequently demonstrates visible bowstringing of the flexor tendons over the proximal phalanx. Complete rupture of which of the following flexor tendon pulleys is the primary cause of this bowstringing?
Explanation
Question 56
Anatomical femoral tunnel placement is critical during reconstruction of the posterolateral corner (PLC) of the knee. Relative to the fibular collateral ligament (FCL) femoral attachment, where is the femoral footprint of the popliteus tendon located?
Explanation
Question 57
When placing a pedicle screw at the L4 vertebral level, the ideal anatomical starting point is identified at the intersection of a line bisecting the transverse process and a vertical line plumb with which of the following structures?
Explanation
Question 58
A patient is treated nonoperatively for a closed proximal radius fracture. Four weeks later, they are unable to form a true "OK" sign, instead making a flat pinch with the thumb and index finger. Sensation in the hand is entirely normal. Which of the following muscles is definitively denervated?
Explanation
Question 59
During an external rotation injury to the ankle resulting in a syndesmotic disruption, the anterior inferior tibiofibular ligament (AITFL) is avulsed from its fibular attachment. This specific anatomical bony prominence is known as the:
Explanation
Question 60
During an anterior intrapelvic (modified Stoppa) approach for acetabular fracture fixation, significant hemorrhage occurs while dissecting over the superior pubic ramus. This is likely due to an injury to the corona mortis, an anastomosis connecting the obturator vessels with which of the following systems?
Explanation
Question 61
A 45-year-old mechanic with severe cubital tunnel syndrome undergoes surgical decompression. The ulnar nerve is compressed as it passes between the two heads of the flexor carpi ulnaris. The thick fascial band bridging these two heads is known anatomically as:
Explanation
Question 62
During a medial approach to the midfoot for an acquired flatfoot deformity correction, the surgeon identifies the "Master Knot of Henry". Which of the following accurately describes the anatomical relationship at this site?
Explanation
Question 63
Following a severe motorcycle crash, a patient presents with paralysis of the latissimus dorsi, deltoid, and all extensor muscles of the arm, forearm, and hand. Sensation is preserved over the lateral aspect of the forearm. The lesion is most accurately localized to which structure of the brachial plexus?
Explanation
Question 64
A 65-year-old patient treated non-operatively for a distal radius fracture presents 8 weeks later with a sudden inability to actively extend the interphalangeal joint of the thumb. The involved tendon typically travels through which extensor compartment of the wrist?
Explanation
Question 65
A 30-year-old athlete complains of vague lateral shoulder pain and weakness. Examination reveals isolated teres minor and deltoid atrophy. An MRI demonstrates a paralabral cyst within the quadrilateral space. Which muscle forms the superior boundary of this anatomical space?
Explanation
Question 66
The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following statements correctly describes the kinematic behavior of the anteromedial (AM) bundle?
Explanation
Question 67
The Lisfranc ligament is crucial for midfoot stability. Anatomically, this ligament provides a direct, stout connection between which of the following two osseous structures?
Explanation
Question 68
During a multi-level anterior cervical discectomy and fusion (ACDF), lateral dissection places the vertebral artery at risk. In normal cervical anatomy, the vertebral artery typically enters the foramen transversarium at which cervical vertebral level?
Explanation
Question 69
A 24-year-old athlete sustains a multiligamentous knee injury with a severe posterolateral corner injury. During surgical reconstruction, the surgeon identifies the correct anatomical footprint for the fibular collateral ligament on the fibular head. This footprint is located in which anatomical relationship to the biceps femoris tendon?
Explanation
Question 70
A 25-year-old sustains a displaced fracture of the surgical neck of the humerus. On examination, weakness in shoulder abduction and external rotation is noted. The injured nerve exits the axilla through a space that is bordered superiorly by which of the following muscles?
Explanation
Question 71
During a right-sided anterior cervical discectomy and fusion (ACDF) at C5-C6, the surgeon carefully mobilizes the visceral structures to avoid nerve injury. Which of the following anatomic characteristics makes the recurrent laryngeal nerve more susceptible to injury on the right compared to the left?
Explanation
Question 72
A surgeon is performing a modified Hardinge (direct lateral) approach for total hip arthroplasty. To prevent denervation of the anterior portion of the gluteus medius, the proximal split in the muscle should not extend beyond what distance from the tip of the greater trochanter?
Explanation
Question 73
During a Henry (volar) approach to the proximal radius for plate fixation of a fracture, the surgeon heavily supinates the forearm while exposing the radial shaft. What is the primary anatomic rationale for this maneuver?
Explanation
Question 74
A trauma patient undergoes open reduction and internal fixation of an anterior pelvic ring fracture via an ilioinguinal approach. The surgeon identifies substantial bleeding from a vascular anastomosis coursing over the superior pubic ramus. This structure primarily connects which two vessel systems?
Explanation
Question 75
A 32-year-old volleyball player presents with shoulder pain and isolated wasting of the infraspinatus muscle without supraspinatus involvement. An MRI is expected to show a paralabral cyst compressing a nerve at which of the following anatomic locations?
Explanation
Question 76
While performing a tarsal tunnel release for compressive neuropathy, the surgeon identifies a sensory nerve branch originating from the tibial nerve proximal to its bifurcation into the medial and lateral plantar nerves. This branch courses distally to supply the medial heel pad. Which structure is this?
Explanation
Question 77
A patient sustains a midshaft femur fracture. During an anterolateral approach, the surgeon utilizes the interval between the rectus femoris and the vastus lateralis. Which of the following nerves innervates the muscle that is retracted medially?
Explanation
Question 78
A 27-year-old rock climber presents with a closed rupture of the A2 pulley in the ring finger. To plan surgical reconstruction, the surgeon reviews the local anatomy. The A2 pulley is anatomically attached directly to which of the following skeletal structures?
Explanation
Question 79
A 35-year-old male suffers a traction injury to his brachial plexus following a motorcycle accident. Examination reveals profound winging of the scapula with forward elevation of the arm. The injured nerve originates from which of the following anatomic components?
Explanation
Question 80
During a posterior lumbar interbody fusion at L4-L5, the surgeon places pedicle screws into the L4 vertebrae. To avoid radicular injury, the surgeon must remember that the exiting L4 nerve root passes in which relationship to the L4 pedicle?
Explanation
Question 81
When establishing the 3-4 portal for wrist arthroscopy, the surgeon places the trocar between the extensor pollicis longus (EPL) and the extensor digitorum communis (EDC) tendons. Which of the following extensor compartments is immediately radial to this portal?
Explanation
Question 82
Following a traumatic posterior knee dislocation, a patient presents with an ischemic lower extremity. The popliteal artery is highly susceptible to stretch injury due to its fixed anatomic location between the adductor hiatus proximally and which of the following structures distally?
Explanation
Question 83
A 28-year-old bodybuilder tears his pectoralis major at the musculotendinous junction. During the surgical repair, the surgeon must restore the normal bilaminar insertion footprint on the humerus. The clavicular head inserts at which relative position on the humerus?
Explanation
Question 84
A patient develops acute compartment syndrome of the lateral compartment of the leg following a complex fibular shaft fracture. Which of the following nerves courses through this specific compartment and is at greatest risk for ischemic injury?
Explanation
Question 85
A surgeon uses a single-incision anterior approach to repair an acute distal biceps tendon rupture. During dissection, a cutaneous nerve is identified and protected to avoid lateral forearm numbness. This nerve is the terminal sensory branch of which parent nerve?
Explanation
Question 86
During a posterior approach to the humerus for plate fixation of a midshaft fracture, the radial nerve is identified within the spiral groove. Which muscle head must be sharply split to expose the bone directly beneath the nerve in this region?
Explanation
Question 87
An orthopedic surgeon is evaluating an ankle MRI for a suspected syndesmotic injury. Which ligament in the syndesmotic complex constitutes the primary restraint to excessive anterior translation of the distal fibula relative to the tibia?
Explanation
Question 88
During an anterior approach to the hip (Smith-Petersen), careful hemostasis is required as major vessels are encountered traversing the surgical interval. The ascending branch of the lateral femoral circumflex artery crosses between which two muscles?
Explanation
Question 89
During a posterior approach to the hip, an artery is at risk of iatrogenic injury if the quadratus femoris is divided too far proximally. This artery typically courses between the quadratus femoris and which of the following structures?
Explanation
Question 90
A patient undergoes surgical decompression of the ulnar nerve in Guyon's canal. Which of the following structures forms the primary floor of this anatomic canal?
Explanation
Question 91
When reconstructing the posterolateral corner of the knee, anatomic placement of the popliteus tendon on the femur is critical. What is the normal anatomic relationship of the popliteus femoral attachment relative to the lateral collateral ligament (LCL) attachment?
Explanation
Question 92
During a deltopectoral approach to the shoulder for a fracture dislocation, you must identify the boundaries of the quadrangular space to protect the axillary nerve. Which of the following constitutes the superior boundary of this space?
Explanation
Question 93
A 45-year-old mechanic presents with an inability to extend his metacarpophalangeal joints following a proximal radius fracture. Sensation in the hand is completely normal. The injured nerve most commonly becomes entrapped at which of the following anatomic structures?
Explanation
Question 94
Transforaminal endoscopic lumbar discectomy utilizes the Triangle of Kambin for safe access to the disc space. Which of the following structures forms the anterior boundary (hypotenuse) of this anatomic triangle?
Explanation
Question 95
A patient with adult-acquired flatfoot deformity requires a repair of the spring ligament complex. Which of the following bands of the spring ligament is the primary stabilizer of the talar head and longitudinal arch?
Explanation
Question 96
During an anterior intrapelvic (modified Stoppa) approach for an acetabular fracture, significant hemorrhage occurs near the superior pubic ramus. This is most likely due to injury to an anastomotic vessel (corona mortis) communicating between the obturator vessels and the:
Explanation
Question 97
In flexor tendon repairs of the hand (Zone II), preserving the pulley system is crucial to prevent bowstringing. Which of the following pulleys is considered most biomechanically critical and originates directly from the periosteum of the proximal phalanx?
Explanation
Question 98
A patient undergoes a fasciotomy for acute compartment syndrome of the lower leg. The deep posterior compartment is decompressed. Which of the following structures is located most anteriorly and medially within the retromalleolar groove as it passes into the foot?
Explanation
Question 99
A surgeon is performing a volar (Henry) approach to the proximal radius for plate fixation. The internervous plane for this exposure lies between muscles supplied by which of the following nerve pairs?
Explanation
None