Question 1

Accelerated rehabilitation after anterior cruciate ligament reconstruction has resulted in:

Explanation

Accelerated rehabilitation focusing on gaining and maintaining full extension, early unrestricted range of motion, and progression of rehabilitation based on achieving functional goals rather than a strict timeline has resulted in earlier return to sporting activities without compromising the ultimate result.

Question 2

Strain in the anterior talofibular ligament (ATFL) _ as the ankle moves from dorsiflexion to plantarflexion.

Explanation

The ATFL primarily functions to restrict internal rotation of the talus in the mortis Strain in the ATFL increases as the ankle moves from dorsiflexion and plantarflexion, and it is the primary restraint to anterior translation and adduction in this position.

Question 3

The most commonly injured ligament after inversion ankle sprains is the:

Explanation

Isolated anterior talofibular ligament (ATFL) injuries are reported to occur in 67% of ankle sprains. The anterior talofibular ligament is the most commonly injured ligament after inversion ankle sprains.

Question 4

What is a common complication of total hip arthroplasty?

Explanation

Dislocation is a known complication of total hip arthroplasty, particularly in the early postoperative period. Careful patient education and surgical technique are crucial to minimize this risk.

Question 5

Which nerve is most commonly injured in a distal humerus fracture?

Explanation

The ulnar nerve runs posterior to the medial epicondyle and is vulnerable to injury in distal humerus fractures, particularly supracondylar fractures.

Question 6

What is the gold standard for diagnosing osteomyelitis?

Explanation

Bone biopsy with subsequent histopathological examination and culture is considered the gold standard for confirming the diagnosis of osteomyelitis.

Question 7

Which of the following describes a Salter-Harris Type III fracture?

Explanation

A Salter-Harris Type III fracture involves a fracture line extending from the physis into the epiphysis, typically involving the articular surface.

Question 8

What is the most appropriate initial treatment for a displaced femoral neck fracture in an elderly patient?

Explanation

In elderly patients with displaced femoral neck fractures, the risk of avascular necrosis and non-union is high with internal fixation, making arthroplasty (hemiarthroplasty or total hip arthroplasty) the preferred treatment.

Question 9

Which ligament prevents excessive anterior translation of the tibia relative to the femur?

Explanation

The Anterior Cruciate Ligament (ACL) is the primary restraint to anterior translation of the tibia relative to the femur, as well as to rotational forces.

Question 10

Which rotator cuff muscle is most commonly torn?

Explanation

The supraspinatus tendon is the most commonly torn of the rotator cuff muscles, often due to its position in the subacromial space and its role in abduction.

Question 11

Which type of scoliosis is most common in adolescents?

Explanation

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, usually developing around puberty with no clear cause.

Question 12

Avascular necrosis of the femoral head is most commonly associated with which fracture?

Explanation

Femoral neck fractures, especially displaced ones, often disrupt the blood supply to the femoral head, leading to a high risk of avascular necrosis.

Question 13

Which of the following is characteristic of osteosarcoma on imaging?

Explanation

Osteosarcoma is often characterized by an aggressive periosteal reaction on X-ray, including a "sunburst" or "Codman's triangle" appearance, indicative of rapid bone formation and destruction.

Question 14

Which classification system is used for open fractures?

Explanation

The Gustilo-Anderson classification system is widely used to describe the severity of open fractures, taking into account wound size, soft tissue damage, and contamination.

Question 15

What is the primary function of the menisci in the knee joint?

Explanation

The menisci are C-shaped cartilaginous structures that act as shock absorbers, increase the contact area between the femur and tibia, and contribute to knee joint stability.

Question 16

Which of the following is considered a hallmark sign of compartment syndrome?

Explanation

While all listed are "5 Ps" of compartment syndrome, pain out of proportion to the injury (especially with passive stretching of the muscles in the affected compartment) is often the earliest and most reliable sign.

Question 17

Which surgical approach for total hip arthroplasty is known for having a lower risk of dislocation but potentially higher risk of nerve injury?

Explanation

The direct anterior approach often involves working between muscle planes, theoretically reducing dislocation risk. However, it can put the lateral femoral cutaneous nerve (LFCN) at higher risk of injury, leading to meralgia paresthetica.

Question 18

Which bone is most commonly affected by osteosarcoma in adolescents?

Explanation

Osteosarcoma commonly affects the metaphysis of long bones, with the distal femur being the most frequent site, followed by the proximal tibia and proximal humerus.

Question 19

Which of the following is a non-weight-bearing bone of the lower leg?

Explanation

The fibula primarily serves as a site for muscle attachment and helps stabilize the ankle, but it does not bear significant weight. The tibia is the main weight-bearing bone of the lower leg.

Question 20

What is the most common cause of septic arthritis in adults?

Explanation

Staphylococcus aureus is the most common causative organism for septic arthritis across all age groups, including adults.

Question 21

Which of the following describes a Greenstick fracture?

Explanation

A greenstick fracture is an incomplete fracture in children where one side of the bone cortex is broken, and the other side is bent, resembling a breaking green branch.

Question 22

The most common site for a stress fracture in runners is the:

Explanation

The tibia, specifically the proximal or mid-shaft, is a very common site for stress fractures in runners due to repetitive loading during impact activities. Metatarsals are also common.

Question 23

What is the most common cause of shoulder instability?

Explanation

Traumatic anterior shoulder dislocation is the most common cause of glenohumeral instability, often leading to a Bankart lesion or Hill-Sachs lesion.

Question 24

Which physical exam maneuver tests for meniscal tears?

Explanation

The McMurray test is a common orthopedic test used to detect meniscal tears, producing an audible click or palpable clunk with knee flexion, extension, and rotation.

Question 25

Which vitamin deficiency is associated with rickets in children and osteomalacia in adults?

Explanation

Vitamin D deficiency leads to impaired mineralization of bone, causing rickets in children (growth plate abnormalities) and osteomalacia in adults (softening of mature bone).

Question 26

Which tendon is commonly involved in "tennis elbow"?

Explanation

Tennis elbow, or lateral epicondylitis, is an overuse injury primarily affecting the origin of the extensor carpi radialis brevis muscle at the lateral epicondyle of the humerus.

Question 27

What is the most common primary malignant bone tumor in children and young adults?

Explanation

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, typically occurring during growth spurts.

Question 28

Which structure is commonly entrapped in a supracondylar humerus fracture in children?

Explanation

The brachial artery and median nerve are most at risk for injury or entrapment in displaced supracondylar humerus fractures, potentially leading to Volkmann's ischemic contracture.

Question 29

What is the common term for degeneration of the patellar tendon due to overuse?

Explanation

Jumper's knee, or patellar tendinopathy, is a condition characterized by pain at the inferior pole of the patella, resulting from overuse and degenerative changes in the patellar tendon.

Question 30

Which of the following describes a Colles' fracture?

Explanation

A Colles' fracture is a common distal radius fracture, characterized by dorsal displacement and angulation of the distal fragment, often resulting from a fall onto an outstretched hand.

Question 31

Which anatomical structure is commonly involved in De Quervain's tenosynovitis?

Explanation

De Quervain's tenosynovitis affects the tendons of the abductor pollicis longus and extensor pollicis brevis as they pass through the first dorsal compartment of the wrist, leading to pain and swelling at the radial side of the wrist.

Question 32

What is the common term for inflammation of the plantar fascia?

Explanation

Plantar fasciitis is a common cause of heel pain, resulting from inflammation and microtears in the plantar fascia at its attachment to the calcaneus.

Question 33

Which of the following factors increases the risk of developing osteoporosis?

Explanation

Estrogen deficiency after menopause significantly accelerates bone loss, making post-menopausal women highly susceptible to osteoporosis.

Question 34

Which nerve is compressed in carpal tunnel syndrome?

Explanation

Carpal tunnel syndrome results from compression of the median nerve as it passes through the carpal tunnel in the wrist, leading to numbness, tingling, and weakness in the thumb, index, middle, and radial half of the ring finger.

Question 35

The main blood supply to the scaphoid bone comes from which artery?

Explanation

The scaphoid bone receives its primary blood supply from branches of the radial artery, particularly the dorsal carpal branch, which enters distally. This tenuous blood supply makes it prone to avascular necrosis after fracture.

Question 36

Which of the following is NOT a component of the "Terrible Triad" knee injury?

Explanation

The "Terrible Triad" (or O'Donoghue's Triad) involves simultaneous injury to the ACL, MCL, and medial meniscus. A PCL tear or lateral meniscus tear is not part of the classic triad.

Question 37

Which medication class is associated with an increased risk of Achilles tendon rupture?

Explanation

Fluoroquinolone antibiotics (e.g., ciprofloxacin, levofloxacin) are known to be associated with an increased risk of tendinopathy and tendon rupture, particularly of the Achilles tendon.

Question 38

Which of the following is a classic clinical finding in developmental dysplasia of the hip (DDH) in infants?

Explanation

Asymmetrical thigh skin folds (along with gluteal folds) are a common sign of DDH in infants, though they are not diagnostic. Ortolani and Barlow maneuvers are more definitive clinical tests.

Question 39

What is the most common primary benign bone tumor?

Explanation

Osteochondroma is the most common primary benign bone tumor, typically appearing as an outgrowth of cartilage-capped bone near the growth plate.

Question 40

Which nerve is at risk during surgical fixation of a proximal fibula fracture?

Explanation

The common fibular (peroneal) nerve wraps around the neck of the fibula, making it highly susceptible to injury during fractures or surgical procedures in this region.

Question 41

What is the most effective long-term treatment for osteoarthritis?

Explanation

While conservative treatments can manage symptoms, joint replacement (arthroplasty) is the most effective long-term treatment for severe, end-stage osteoarthritis, providing significant pain relief and improved function.

Question 42

What is the initial management for an acute Achilles tendon rupture?

Explanation

Initial management for an acute Achilles tendon rupture involves immobilization of the ankle in plantarflexion to approximate the tendon ends, followed by prompt orthopedic evaluation to determine if surgical or non-surgical treatment is best.

Question 43

Which of the following is most indicative of a disc herniation with nerve root compression?

Explanation

Radicular pain (sciatica) that radiates down the leg below the knee into specific dermatomal patterns is a classic symptom of nerve root compression due to disc herniation.

Question 44

Which condition is characterized by avascular necrosis of the femoral head in children aged 4-8 years?

Explanation

Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the femoral head in children, typically affecting boys between 4 and 8 years of age.

Question 45

Which type of fracture pattern is commonly seen in osteoporotic bone?

Explanation

Compression fractures, particularly in the vertebral bodies, are very common in osteoporotic bone due to axial loading on weakened bone.

Question 46

Which of the following describes the function of the subacromial bursa?

Explanation

The subacromial bursa is a fluid-filled sac that acts as a cushion, reducing friction between the rotator cuff tendons (especially supraspinatus) and the overlying acromion during shoulder movement.

Question 47

Which of the following is an indication for surgical intervention in scoliosis?

Explanation

Surgical intervention (spinal fusion) is generally indicated for progressive scoliosis with a Cobb angle exceeding 45-50 degrees in a growing adolescent, as these curves are likely to continue progressing even after skeletal maturity and can lead to significant deformity and potential cardiopulmonary compromise.

Question 48

The fibular collateral ligament (FCL) serves as the primary restraint to varus instability. Its contribution to varus restraint is most pronounced at what degree of knee flexion?

Explanation

The FCL is the primary restraint to varus stress at 30 degrees of knee flexion. At full extension (0 degrees), the posterior cruciate ligament and the posterior capsule act as critical secondary stabilizers.

Question 49

During an anatomical medial patellofemoral ligament (MPFL) reconstruction, the femoral attachment (Schottles point) is identified radiographically. It is properly located:

Explanation

Schottles point is defined radiographically as 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior extension of Blumensaats line.

Question 50

Which of the following radiographic parameters is considered the most reliable and reproducible for diagnosing a syndesmotic injury on standard AP and mortise ankle radiographs?

Explanation

A tibiofibular clear space greater than 5 mm, measured on both AP and mortise views, is the most reliable radiographic parameter for detecting syndesmotic diastasis. It is less dependent on rotation than tibiofibular overlap.

Question 51

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. Compared to operative management, utilizing a non-operative treatment plan with early functional rehabilitation is associated with:

Explanation

Recent high-level evidence demonstrates that non-operative management using early functional rehabilitation protocols yields equivalent re-rupture rates compared to surgical repair, while avoiding surgical complications.

Question 52

A complete posterior root tear of the medial meniscus severely disrupts the hoop stresses of the meniscus. Biomechanically, the resulting knee joint contact pressures are most similar to which of the following conditions?

Explanation

A complete medial meniscus posterior root tear renders the meniscus functionally incompetent, leading to altered kinematics and contact pressures that are essentially equivalent to a total medial meniscectomy.

Question 53

A patient presents to the trauma bay with a knee dislocation that has just been reduced. The physical examination is notable for an Ankle-Brachial Index (ABI) of 0.85. What is the most appropriate next step in management?

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for an intimal tear or occlusion of the popliteal artery. CT angiography is the recommended next step to definitively evaluate the vascular status before potential intervention.

Question 54

A 22-year-old professional soccer player sustains an acute Jones fracture (Zone 2 fracture of the proximal fifth metatarsal). To optimize and expedite return to play, what is the recommended treatment?

Explanation

Intramedullary screw fixation is highly recommended for elite athletes with acute Jones fractures to significantly decrease the time to return to play and reduce the risk of nonunion associated with conservative management.

Question 55

A Segond fracture is a pathognomonic radiographic sign commonly associated with an anterior cruciate ligament (ACL) tear. This fracture represents a cortical avulsion of which anatomical structure?

Explanation

The Segond fracture is a cortical avulsion fracture off the proximal anterolateral tibia. It is widely considered to represent an avulsion of the anterolateral ligament (ALL) and the associated anterolateral capsular structures.

Question 56

When evaluating a pediatric patient with poorly localized knee pain, an MRI is obtained. The most common anatomical location for osteochondritis dissecans (OCD) of the knee is the:

Explanation

The classic and most frequent location for osteochondritis dissecans (OCD) lesions in the knee is the lateral aspect of the medial femoral condyle.

Question 57

A collegiate runner complains of reproducible bilateral anterolateral leg pain after 15 minutes of running. To confirm the diagnosis of chronic exertional compartment syndrome, intracompartmental pressure testing is performed. Which baseline resting pressure meets the diagnostic Pedowitz criteria?

Explanation

According to the Pedowitz criteria, a resting baseline pressure greater than or equal to 15 mm Hg is diagnostic for chronic exertional compartment syndrome. Alternatively, a 1-minute post-exercise pressure of 30 mm Hg or higher is also diagnostic.

Question 58

A 19-year-old female athlete undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Compared to a hamstring autograft, the BTB graft is most frequently associated with which postoperative complication?

Explanation

The use of a bone-patellar tendon-bone (BTB) autograft is most commonly associated with increased donor site morbidity, specifically anterior knee pain and discomfort when kneeling, compared to soft tissue grafts.

Question 59

An athlete reports a snapping sensation at the posterolateral ankle with active dorsiflexion and eversion. Clinical examination reveals anterior subluxation of the peroneal tendons. This condition is primarily associated with insufficiency of the:

Explanation

Peroneal tendon subluxation or dislocation is primarily caused by an injury, avulsion, or insufficiency of the superior peroneal retinaculum (SPR), which restrains the tendons within the retromalleolar groove.

Question 60

According to established treatment algorithms for osteochondral lesions of the talus (OCL), which of the following lesions is best suited for arthroscopic microfracture or bone marrow stimulation as the primary surgical intervention?

Explanation

Arthroscopic microfracture is generally recommended as the primary surgical treatment for symptomatic, contained osteochondral lesions of the talus that are less than 1.5 cm squared in total area.

Question 61

The anterior talofibular ligament (ATFL) functions as the primary restraint to anterior translation of the talus within the ankle mortise. It achieves its maximum tension and primary restraining function when the ankle is in what position?

Explanation

The ATFL is oriented vertically and becomes tightest when the ankle is in plantarflexion, making it the primary restraint to anterior talar translation in this position.

Question 62

A patient is evaluated for a suspected posterior cruciate ligament (PCL) injury following a dashboard injury. An isolated, complete tear of the PCL without posterolateral corner (PLC) involvement will classically demonstrate which dial test result?

Explanation

An isolated PCL injury typically presents with increased external rotation at 90 degrees of flexion but normal rotation at 30 degrees. Combined PCL and PLC injuries demonstrate increased external rotation at both 30 and 90 degrees.

Question 63

A 24-year-old basketball player presents with chronic patellar tendinopathy (jumpers knee) failing 6 months of eccentric strengthening protocols. What is the characteristic MRI finding confirming this diagnosis?

Explanation

Patellar tendinopathy classically presents on MRI as focal thickening and increased T2 signal at the proximal origin of the patellar tendon, located at the inferior pole of the patella.

Question 64

Meniscal healing potential is highly dependent on its vascular supply. In adults, the well-vascularized zone of the meniscus extends approximately how far from the peripheral capsular attachment?

Explanation

In adults, only the peripheral 10% to 30% of the meniscus (the red-red zone) receives direct blood supply from the perimeniscal capillary plexus, giving this region the highest healing potential for repairs.

Question 65

Which of the following physical examination tests is most sensitive for diagnosing a syndesmotic ankle sprain?

Explanation

The external rotation stress test has the highest sensitivity for syndesmotic injury. The squeeze test has high specificity but low sensitivity.

Question 66

In anterior cruciate ligament (ACL) anatomy, the anteromedial (AM) bundle and posterolateral (PL) bundle exhibit which of the following biomechanical behaviors?

Explanation

The AM bundle is tightest in flexion, providing primary restraint to anterior translation at 90 degrees. The PL bundle is tightest in extension and provides primary rotational stability.

Question 67

A 22-year-old football player sustains a non-contact knee injury. MRI reveals an isolated complete tear of the posterolateral corner (PLC). Which of the following physical exam findings is most expected?

Explanation

An isolated PLC injury results in increased external rotation (greater than 10 degrees compared to the contralateral side) at 30 degrees of flexion. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 68

Which of the following is considered the most common complication following surgical repair of an acute Achilles tendon rupture when compared to nonoperative management?

Explanation

Operative management of Achilles tendon ruptures has a historically lower re-rupture rate but carries a significantly higher risk of wound complications and iatrogenic nerve injury, specifically to the sural nerve.

Question 69

Placing the femoral attachment of a medial patellofemoral ligament (MPFL) graft too proximal and anterior to its anatomic origin will result in:

Explanation

A femoral tunnel placed too proximal and anterior results in an MPFL graft that tightens excessively in knee flexion. This non-anatomic placement restricts flexion and dramatically increases medial patellofemoral articular contact pressures.

Question 70

During rehabilitation following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, closed kinetic chain exercises are preferred early on because they:

Explanation

Closed kinetic chain exercises promote co-contraction of the quadriceps and hamstrings. This increases axial compressive forces across the joint and minimizes anterior tibial shear, protecting the healing graft.

Question 71

The primary restraint to valgus stress of the knee at 30 degrees of flexion is the:

Explanation

The superficial MCL is the primary restraint to valgus stress, providing nearly 80% of the resisting force at 30 degrees of knee flexion.

Question 72

A 25-year-old runner presents with chronic anterior leg pain that worsens with exercise. Intracompartmental pressure testing is performed. Which of the following measurements is most diagnostic for chronic exertional compartment syndrome (CECS)?

Explanation

Modified Pedowitz criteria for CECS include a resting pressure > 15 mm Hg, a 1-minute post-exercise pressure > 30 mm Hg, or a 5-minute post-exercise pressure > 20 mm Hg.

Question 73

In a patient with an acute "turf toe" injury, the primary pathoanatomic disruption involves the:

Explanation

Turf toe is a forced hyperextension injury of the first MTP joint. It results in a sprain or tear of the plantar plate and the associated plantar capsuloligamentous complex.

Question 74

The arterial blood supply to the meniscus of the knee in an adult is limited primarily to the:

Explanation

The adult meniscus is relatively avascular, receiving its blood supply from the medial and lateral geniculate arteries. These vessels only penetrate the peripheral 10% to 30%, often referred to as the "red-red" zone.

Question 75

Which of the following is the most appropriate initial management for an isolated, acute Grade III tear of the medial collateral ligament (MCL) in a professional athlete?

Explanation

Isolated acute Grade III MCL injuries have excellent healing potential without surgery. They are typically treated nonoperatively with a hinged knee brace, early range of motion, and progressive weight-bearing.

Question 76

A 28-year-old soccer player sustains an inversion ankle sprain and later develops chronic lateral ankle instability. Which of the following surgical procedures utilizes the peroneus brevis tendon to reconstruct the lateral ligaments, but is associated with restricted subtalar motion?

Explanation

The Chrisman-Snook procedure is a non-anatomic tenodesis using a split peroneus brevis tendon to reconstruct the ATFL and CFL. It is known to restrict subtalar motion and alter normal biomechanics compared to anatomic repairs.

Question 77

When repairing a massive, chronic patellar tendon rupture, the patella is often found to be proximally migrated. Which of the following indices is most commonly used on a lateral radiograph to quantify patellar height?

Explanation

The Insall-Salvati ratio compares the length of the patellar tendon to the greatest diagonal length of the patella on a lateral radiograph. A ratio greater than 1.2 indicates patella alta.

Question 78

A 16-year-old gymnast presents with knee pain, and radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomic location for an OCD lesion in the knee?

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common site for osteochondritis dissecans of the knee, accounting for roughly 70% of cases.

Question 79

During a posterior cruciate ligament (PCL) reconstruction, the surgeon must protect the neurovascular bundle located posterior to the capsule. The most anterior structure of this bundle at the level of the joint line is the:

Explanation

From anterior to posterior at the level of the knee joint line, the popliteal artery is the most anterior structure. It sits directly posterior to the joint capsule, making it highly vulnerable during PCL surgery.

Question 80

The medial meniscus is injured more frequently than the lateral meniscus in the adult knee. This is primarily because the medial meniscus:

Explanation

The medial meniscus has a firm attachment to the deep portion of the MCL and the joint capsule. This rigid fixation makes it less mobile and more susceptible to tearing from shearing forces than the lateral meniscus.

Question 81

A "Jones fracture" refers specifically to a fracture of the fifth metatarsal located at the:

Explanation

A true Jones fracture occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal. This specific anatomical area is a vascular watershed zone, predisposing these fractures to delayed union or nonunion.

Question 82

Which bundle of the anterior cruciate ligament (ACL) is responsible for primarily resisting anterior tibial translation when the knee is in near-full extension?

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension. It serves as the primary restraint to both anterior tibial translation and rotatory loads when the knee is near full extension.

Question 83

A patient presents to the emergency department with an obviously deformed, dislocated knee following a high-velocity trauma. The foot is cool and pulseless. The immediate first step in management is:

Explanation

In the setting of an acute, unreduced knee dislocation with vascular compromise, immediate closed reduction must be performed first. This restores anatomic alignment and often relieves tension or kinking of the popliteal artery.

Question 84

High ankle sprains (syndesmotic injuries) typically require a longer return-to-play timeframe compared to lateral ankle sprains. Which mechanism of injury is classically responsible for an isolated syndesmotic sprain?

Explanation

Syndesmotic injuries are classically caused by a forced dorsiflexion and external rotation mechanism. This motion forces the wider anterior dome of the talus into the mortise, spreading the distal tibiofibular joint.

Question 85

During posterior cruciate ligament (PCL) reconstruction using an Achilles tendon allograft, at what degree of knee flexion should the graft typically be tensioned to restore normal knee kinematics?

Explanation

The PCL is typically tensioned at 90 degrees of knee flexion where it normally experiences maximum tension. Tensioning in full extension can lead to over-constraint and limited functional knee flexion.

Question 86

A 35-year-old male sustains an acute Achilles tendon rupture. Compared to conservative management with an accelerated functional rehabilitation protocol, surgical repair is statistically associated with which of the following outcome profiles?

Explanation

Current meta-analyses indicate that surgical repair of acute Achilles ruptures slightly decreases the re-rupture rate compared to functional bracing but significantly increases the risk of complications such as wound breakdown and infection.

Question 87

A posterior root tear of the medial meniscus in a 50-year-old patient typically results in biomechanical alterations most closely resembling which of the following scenarios?

Explanation

A posterior root tear effectively abolishes the hoop stresses of the meniscus, leading to extrusion under load. Biomechanically, this distributes tibiofemoral contact pressures in a manner nearly identical to a total meniscectomy.

Question 88

A patient presents with a traumatic multi-ligamentous knee dislocation (KD-III) that reduced spontaneously. Pedal pulses are palpable and symmetric. The ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?

Explanation

An ABI less than 0.90 following a knee dislocation is highly suspicious for a vascular injury, even if pedal pulses are palpable. CT angiography is definitively indicated to evaluate for an intimal tear or popliteal artery occlusion.

Question 89

Which of the following radiographic parameters on a standard AP or Mortise view of the ankle is considered the most reliable indicator of a syndesmotic injury?

Explanation

A tibiofibular clear space greater than 5 mm measured on AP or mortise views 1 cm proximal to the joint line is the most reliable radiographic parameter for diagnosing a syndesmosis injury. Tibiofibular overlap is highly dependent on ankle rotation.

Question 90

When performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the anatomic femoral attachment (Schöttle's point) is best described radiographically as being located:

Explanation

Anatomically, Schöttle's point is located in the saddle between the medial epicondyle and adductor tubercle. Radiographically, it is located roughly 1 mm anterior to the posterior femoral cortical line and 2.5 mm distal to the posterior origin of the medial femoral condyle.

Question 91

A 14-year-old elite baseball pitcher presents with chronic lateral elbow pain and catching. Imaging reveals an advanced osteochondral defect (OCD) of the capitellum. The vulnerability of the capitellum to avascular necrosis is primarily due to its blood supply, which consists of:

Explanation

The capitellum is supplied by limited intraosseous vessels derived from end arteries entering posteriorly. This lack of collateral circulation makes the capitellum extremely susceptible to ischemic injury and osteochondritis dissecans from repetitive valgus-extension overload.

Question 92

The most common significant complication specifically associated with surgical repair of a type II Superior Labrum Anterior Posterior (SLAP) tear in an overhead throwing athlete is:

Explanation

Postoperative stiffness, particularly loss of external rotation in abduction, is the most common complication following SLAP repairs. This stiffness profoundly limits the "late cocking" phase required in overhead throwing athletes.

Question 93

Which structural component of the ulnar collateral ligament (UCL) complex of the elbow is the primary restraint to valgus stress between 30 and 120 degrees of flexion?

Explanation

The anterior bundle of the ulnar collateral ligament is the primary restraint to valgus stress at the elbow from roughly 30 to 120 degrees of flexion. The posterior bundle functions primarily as a secondary restraint.

Question 94

During hip arthroscopy, establishing the anterior portal places a specific neural structure at significant risk if placed incorrectly. Which nerve is most susceptible to direct injury during this step?

Explanation

The anterior portal is typically made lateral to the intersection of a sagittal line drawn distally from the ASIS and a transverse line from the greater trochanter. The lateral femoral cutaneous nerve (LFCN) is the primary structure at risk.

Question 95

Which of the following clinical scenarios represents an absolute indication for acute surgical repair of a proximal hamstring avulsion injury?

Explanation

Acute surgical repair is indicated for complete 3-tendon avulsions (biceps femoris, semitendinosus, and semimembranosus) that are retracted greater than 2 cm. Most 1- or 2-tendon tears with minimal retraction can be managed conservatively.

Question 96

Based on the Pedowitz criteria, a diagnosis of chronic exertional compartment syndrome (CECS) of the leg is confirmed if the intra-compartmental pressure measured 5 minutes post-exercise strictly exceeds:

Explanation

The accepted Pedowitz criteria for diagnosing CECS include a resting pressure ≥ 15 mmHg, a 1-minute post-exercise pressure ≥ 30 mmHg, or a 5-minute post-exercise pressure ≥ 20 mmHg.

Question 97

A 40-year-old male sustains a severe acute knee injury while landing from a jump. Lateral radiographs demonstrate patella baja. Based on this finding, which of the following physical examination findings is most likely to be present?

Explanation

Patella baja, or an abnormally low-riding patella, is indicative of a quadriceps tendon rupture, which allows the intact patellar tendon to pull the patella inferiorly. This injury is characterized by a palpable gap at the superior pole of the patella.

Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 50

Orthopedic Prometric MCQs - Chapter 3 Part 50

Chapter Index