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Dr Mohammed Hutaif
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ORTHOPEDIC MCQS BANK OITE 99

Orthopedics MCQ online
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ORTHOPEDIC MCQS BANK OUTE 99

  • 99.1 Examination of a 60-year-old man who has a painful flatfoot deformity reveals
  • no demonstrable function of the posterior tibial tendon. Neither the hindfoot
  • valgus nor the forefoot pronation is passively correctable, and management
  • consisting of shoe modification and use of an insert has failed to provide relief.
  • Treatment should now include
  • 1- reconstruction of the posterior tibial tendon and a medial displacement
  • calcaneal osteotomy.
  • 2- reconstruction of the posterior tibial tendon and lengthening of the lateral
  • column of the foot.
  • 3- osteotomy of the talar neck and reconstruction of the calcaneonavicular
  • (spring) ligament.
  • 4- triple arthrodesis and Achilles tendon lengthening.
  • 5- medial closing wedge osteotomy of the navicular and calcaneus.

 

  • Question 99.1
  • Answer = 4
  • Reference(s)
  • Mann RA: Flatfoot in adults, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 757‑784. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 269‑282.

 

  • 99.2 Which of the following structures is most likely to be injured during application of a
  • halo ring when the anterior pins are inserted too far anteriorly?
  • 1- Temporal artery
  • 2- Greater auricular nerve
  • 3- Supratrochlear nerve
  • 4- Supraorbital nerve
  • 5- Frontal sinus

 

  • Question 99.2
  • Answer = 4
  • Reference(s)
  • Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 593‑599. Botte MJ, Byrne TP, Abrams RA, et al: Halo skeletal fixation: Techniques of application and prevention of complications. J Am Acad Orthop Surg 1996;4:44‑53.

 

  • 99.3 Examination of a 16-year-old girl reveals a scoliosis that measures 38° from T4-
  • T12 and 30° from T12-L4. The patient is 4 years postmenarche, and she denies
  • any history of pain. Management should consist of
  • 1- a brace worn for 22 hours a day.
  • 2- nighttime bracing only.
  • 3- observation.
  • 4- surgical correction of the thoracic curve only.
  • 5- surgical correction of both curves.

 

  • Question 99.3
  • Answer = 3
  • Reference(s)
  • Bradford DS, Moe JH, Lonstein JE (eds): Moe's Textbook of Scoliosis and Other Spinal Deformities, ed 3. Philadelphia, PA, WB Saunders, 1995, pp 357‑364.

 

  • 99.4 Follow-up of patients who have had hip arthroplasties with large diameter
  • uncemented femoral stems that are diaphyseal locking most commonly
  • reveals which of the following physiologic responses in bone?
  • 1- Proximal bone hypertrophy
  • 2- Proximal bone loss
  • 3- Diaphyseal bone loss
  • 4- Acetabular bone loss
  • 5- Acetabular bone hypertrophy

 

  • Question 99.4
  • Answer = 2
  • Reference(s)
  • Bobyn JD, Glassman AH, Goto H, et al: The effect of stem stiffness on femoral bone resorption after canine porous‑coated total hip arthroplasty. Clin Orthop 1990;261:196‑213. Engh CA, Bobyn JD: The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop 1988;231:7‑28.

 

  • 99.5 Figure 1 shows the radiograph of a 14-year-old boy
  • who sustained an injury to the foot in a motor vehicle
  • accident. Examination reveals gross swelling and
  • tenderness without skin injury. Diminished sensation
  • is noted in the first web space, and the dorsalis pedis
  • pulse is not readily palpable. Plantar compartment
  • pressure measures 60 mm Hg, and the patient has a
  • blood pressure of 140/75 mm Hg. Management
  • should include
  • 1- elevation of the extremity and a repeat compartment
  • pressure measurement in 2 hours.
  • 2- compartment release via a medial approach.
  • 3- closed reduction and casting.
  • 4- application of a compression pump.
  • 5- an arteriogram.
  • Figure 1

 

  • Question 99.5
  • Answer = 2
  • Reference(s)
  • Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 255‑268. Anderson RB: Lisfrancs fracture‑dislocation, in Pfeffer GB (ed): Current Practice of Foot and Ankle Surgery. New York, NY, McGraw‑Hill, 1993, pp 140‑150.

 

  • 99.6 A 32-year-old woman with a history of recurrent anterior glenohumeral
  • dislocations undergoes an open Bankart repair that results in a postoperative
  • neurologic deficit. Examination reveals intact rhomboids, infraspinatus, and
  • biceps. The deltoid is weak; however, there is no scapular winging. What is the
  • most likely location of the brachial plexus injury?
  • 1- Upper trunk
  • 2- Middle trunk
  • 3- Lower trunk
  • 4- Posterior cord
  • 5- Lateral cord

 

  • Question 99.6
  • Answer = 4
  • Reference(s)
  • Bach BR Jr, O'Brien SJ, Warren RF, et al: An unusual neurological complication of the Bristow procedure: A case report. J Bone Joint Surg 1988;70A:458‑460. Jobe CM: Gross anatomy of the shoulder, in Rockwood CA Jr, Matsen FA III (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1990, pp 34‑97.

 

  • 99.7 To enhance the successful use of a halo vest in a 2-year-old child, management
  • should include
  • 1- the use of more than four cranial pins.
  • 2- the use of smaller diameter pins.
  • 3- placement of pins within the temporal area.
  • 4- avoidance of pin placement lateral to the midorbital line.
  • 5- retorquing of the pins every 3 days.

 

  • Question 99.7
  • Answer = 1
  • Reference(s)
  • Mubarak SJ, Camp JF, Vuletich W, et al: Halo application in the infant. J Pediatric Orthop 1989;9:612‑614.

 

  • 99.8 Figure 2 shows the plain AP radiograph of a 20-year-old man who has had a painful swelling in his left wrist for the past 4 months. A bone scan shows a solitary lesion. A radiograph and CT scan of the chest are normal. Prior to biopsy, what is the most likely diagnosis?
  • 1- Telangiectatic
  • osteosarcoma
  • 2- Chondromyxoid fibroma
  • 3- Aneurysmal bone cyst
  • 4- Giant cell tumor
  • 5- Chondroblastoma
  • Figure 2

 

  • Question 99.8
  • Answer = 4
  • Reference(s)
  • Sheth DS, Healey JH, Sobel M, et al: Giant cell tumor of the distal radius. J Hand Surg 1995;20A:432‑440. Vander Griend RA, Funderburk CH: The treatment of giant‑cell tumors of the distal part of the radius. J Bone Joint Surg 1993;75A:899‑908.

 

  • 99.9 The amount of stress shielding (osteopenia) that occurs in the proximal femur
  • following noncemented total hip arthroplasty appears to be most strongly
  • influenced by which of the following femoral component design parameters?
  • 1- Distal extent of femoral component porous coating
  • 2- Stiffness of the femoral component
  • 3- Amount of head offset
  • 4- Presence or absence of a collar
  • 5- Degree of proximal fit and fill

 

  • Question 99.9
  • Answer = 2
  • Reference(s)
  • Turner TM, Sumner DR, Urban RM, et al: Maintenance of proximal cortical bone with the use of a less stiff femoral component in hemiarthroplasty of the hip without cement: An investigation in a canine model at six months and two years. J Bone Joint Surg. 1997;79A:1381‑1390. Bobyn JD, Mortimer ES, Glassman AH, et al: Production and avoiding stress shielding: Laboratory and clinical observations of noncemented total hip arthroplasty. Clin Orthop 1992;274:79‑96.

 

  • 99.10 A 65-year-old man has a persistent limp after undergoing right total hip
  • arthroplasty 6 months ago; however, he denies having any pain. Examination
  • shows that he lurches to the right during weightbearing on the right limb when
  • not using a cane. Which of the following hip muscle groups should be
  • strengthened to improve the abnormality in the patient's gait?
  • 1- Abductors
  • 2- Adductors
  • 3- Extensors
  • 4- External rotators
  • 5- Flexors

 

  • Question 99.10
  • Answer = 1
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389‑426. Menon PC, Griffiths WE, Hook WE, et al: Trochanteric osteotomy in total hip arthroplasty: Comparison of 2 techniques. J Arthroplasty 1998;13:92‑96.

 

  • 99.11 A 37-year-old man sustained a posterior hip dislocation with a femoral head fracture
  • below the fovea (Pipkin I) as the result of a fall off a roof. After undergoing closed
  • reduction under general anesthesia, the hip is now stable in flexion and
  • adduction. Radiographs and a CT scan confirm anatomic reduction of the femoral
  • head fragment and concentric reduction of the hip. Management should now include
  • 1- open reduction and internal fixation through an anterior approach.
  • 2- open reduction and internal fixation through a posterior approach.
  • 3- mobilization with protected weightbearing.
  • 4- skeletal traction for 8 weeks, followed by protected weightbearing.
  • 5- excision of the femoral head fragment.

 

  • Question 99.11
  • Answer = 3
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 281‑286. Yang RS, Tsuang YH, Hang YS, et al: Traumatic dislocation of the hip. Clin Orthop 1991;265:218‑227. DeLee JC: Fractures and dislocations of the hip, in Rockwood CA Jr, Green DP (eds): Fractures in Adults, ed 4. Philadelphia, PA, Lippincott‑Raven, pp 1659‑1803.

 

  • 99.12 A 34-year-old machinist who underwent a distal interphalangeal joint level
  • amputation of the long finger has difficulty grasping his tools because of a
  • paradoxical extension of the long finger with grip. What is the most likely cause
  • of this problem?
  • 1- Quadriga effect
  • 2- Lumbrical plus finger
  • 3- Intrinsic contracture
  • 4- Loss of profundus tendon to finger
  • 5- Profundus tendon adhesions

 

  • Question 99.12
  • Answer = 2
  • Reference(s)
  • Parkes A: The "lumbrical plus" finger. J Bone Joint Surg 1971;538:236‑239.

 

  • 99.13 Which of the following is considered the primary indication for surgery for
  • patients with hallux valgus?
  • 1- Cosmetic appearance
  • 2- Split-size shoe requirements
  • 3- An intermetatarsal angle of greater than 15° between the first and second
  • metatarsals
  • 4- Symptoms that persist despite nonsurgical management
  • 5- Arthritic changes in the first metatarsophalangeal joint

 

  • Question 99.13
  • Answer = 4
  • Reference(s)
  • Coughlin M: Hallux valgus. J Bone Joint Surg 1996;78A:932‑966. Mann RA: Decision‑making in bunion surgery, in Greene WB (ed): Instructional Course Lectures XXXIX. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 3-13.

 

  • 99.14 A woman who was adopted, and therefore does not know her family history,
  • give birth to a son with classic hemophilia. The woman herself has no clotting
  • disorders. What is the risk that her future offspring will have this condition?
  • 1- 1:1
  • 2- 1:2
  • 3- 1:4
  • 4- 1:8
  • 5- Less than 1:10,000

 

  • Question 99.14
  • Answer = 3
  • Reference(s)
  • Greene WB: Hematology, in Morrissey RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 342‑392.

 

  • 99.15 What intercarpal arthrodesis procedure is associated with the highest rate of
  • nonunion?
  • 1- Scapholunate
  • 2- Scaphocapitolunate
  • 3- Capitolunate
  • 4- Capitohamate-lunatotriquetral
  • 5- Lunatotriquetral

 

  • Question 99.15
  • Answer = 1
  • Reference(s)
  • Larsen CF, Jacoby RA, McCabe SJ: Nonunion rates of limited carpal arthrodesis: A meta-analysis of the literature. J Hand Surg 1997;22A:66‑73. Siegel JM, Ruby LK: A critical look at intercarpal arthrodesis: Review of the literature. J Hand Surg 1996;21A:717‑723.

 

  • 99.16 Which of the following radiographic signs suggests significant elbow trauma in
  • a 3-year--old child?
  • 1- Axial line of the radius bisects the capitellar ossification center (AP view).
  • 2- Axial line of the humerus bisects the capitellar ossification center (AP view).
  • 3- Axial line of the radius bisects the capitellar ossification center (lateral view).
  • 4- Anterior humeral line bisects the capitellar ossification center (lateral view).
  • 5- Anterior fat pad sign is visible (lateral view).

 

  • Question 99.16
  • Answer = 2
  • Reference(s)
  • Rockwood CA Jr, Wilkins KE, Beaty JH: Fractures in Children, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 560, 664‑666.

 

  • 99.17 Which of the following is considered the most common primary carcinoma to
  • metastasize to bones distal to the elbow and knee?
  • 1- Breast
  • 2- Prostate
  • 3- Kidney
  • 4- Lung
  • 5- Thyroid

 

  • Question 99.17
  • Answer = 4
  • Reference(s)
  • Lombardi RM, Amadio PC: Acrometastases, in Sim FH (ed): Diagnosis and Management of Metastatic Bone Disease: A Multidisciplinary Approach. New York, NY, Raven Press, 1988, pp 237‑243. Leeson MC, Makley JT, Carter JR: Metastatic skeletal disease distal to the elbow and knee. Clin Orthop 1986;206:94‑99.

 

  • 99.18 What role does fatigue play in the production of a muscle strain injury?
  • 1- Reduces the ability to absorb energy
  • 2- Causes failure at shorter muscle lengths
  • 3- Decreases the ability to elongate
  • 4- Decreases stiffness
  • 5- Decreases the force to failure

 

  • Question 99.18
  • Answer = 1
  • Reference(s)
  • Mair SD, Seaver AV, Glisson RR, et al: The role of fatigue in susceptibility to acute musclestrain injury. Am J Sports Med 1996;24:137‑143. Garrett WE Jr, Safran MR, Seaber AV, et al: Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 1987;15:448‑454.

 

  • 99.19 A 45-year-old man is struck by a motor vehicle and sustains the closed injury shown in Figure 3a. Surgical stabilization of the fracture is performed the night of the injury. A postoperative radiograph is shown in Figure 3b. What is the most frequently observed complication following this method of management of the fracture?
  • 1- Malunion
  • 2- Nonunion
  • 3- Neurologic injury
  • 4- Osteomyelitis
  • 5- Wound healing problems
  • Figure 3A
  • B

 

  • Question 99.19
  • Answer = 5
  • Reference(s)
  • Wyrsch B, McFerran MA, McAndrew M, et al: Operative treatment of fractures of the tibial plafond: A randomized, prospective study. J Bone Joint Surg 1996;78A:1646‑1657. Bonar SK, Marsh JL: Tibial plafond fractures: Changing principles of treatment. J Am Acad Orthop Surg 1994;2:297‑305.

 

  • 99.20 In planning for revision of a unicondylar knee arthroplasty to a total knee
  • arthroplasty, the most common problem that should be anticipated is
  • 1- contracture of the patellar tendon.
  • 2- increased collateral ligament laxity.
  • 3- tibiofemoral malalignment.
  • 4- bone loss.
  • 5- limited exposure.

 

  • Question 99.20
  • Answer = 4
  • Reference(s)
  • Padgett DE, Stern SH, Insall JN: Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg 1991;73A:186‑190. Gill T, Schemitsch EH, Brick GW, et al: Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop 1995;321:10‑18.

 

  • 99.21 Which of the following cell types is most commonly found in the interface
  • membrane about aseptically loosened femoral implants?
  • 1- Macrophage
  • 2- Fibroblast
  • 3- T-lymphocyte
  • 4- B-lymphocyte
  • 5- Plasma cell

 

  • Question 99.21
  • Answer = 1
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389‑426. Horowitz SM, Doty SB, Lane JM, et al: Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption. J Bone Joint Surg 1993;75A:802‑813.

 

  • 99.22 An otherwise healthy 58-year-old woman reports the acute onset of medial knee pain
  • 3 months ago. She denies any history of trauma. Examination shows tenderness just
  • below the medial jointline, a negative McMurray's sign, trace effusion, and a range of
  • motion of 0° to 120°. Plain radiographs show well-maintained joint spaces and a faint
  • lucent area in the subchondral region of the medial tibial plateau without collapse. A
  • bone scan shows increased uptake only in the medial tibial plateau. The MRI scan
  • shows osteonecrosis of the medial tibial plateau. The joint surface is congruent.
  • Management should include
  • 1- nonsteroidal anti-inflammatory drugs.
  • 2- synthetic hyaluronate injections.
  • 3- arthroscopic debridement.
  • 4- high tibial osteotomy.
  • 5- osteochondral allograft.

 

  • Question 99.22
  • Answer = 1
  • Reference(s)
  • Ahlback S, Bauer GC, Bohne WH: Spontaneous osteonecrosis of the knee. Arthritis Rheum 1968;11:705‑733. Ahuja SC, Bullough PG: Osteonecrosis of the knee: A clinicopathological study in twenty eight patients. J Bone Joint Surg 1978;60A:191‑197. Lotke PA, Ecker ML, Alavi A: Painful knees in older patients: Radionuclide diagnosis of possible osteonecrosis with spontaneous resolution. J Bone Joint Surg 1977;59A:617‑621.

 

  • 99.23 Radiographs of an 8-year-old girl who reports neck pain following a motor
  • vehicle accident reveal that the odontoid process is translated forward 50%
  • because of a fracture at its base. Neurologic examination is normal. Treatment
  • should consist of
  • 1- skeletal traction for 4 weeks, followed by application of a Minerva cast.
  • 2- posterior fusion of the atlas to the axis using wire fixation.
  • 3- reduction and fixation using an anterior screw from the body into the dens.
  • 4- closed reduction and application of a Philadelphia collar.
  • 5- closed reduction and halo vest immobilization.

 

  • Question 99.23
  • Answer = 5
  • Reference(s)
  • Jones ET, Hensinger RN: Injuries of the cervical spine, in Rockwood CA Jr, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 1023‑1061.

 

  • 99.24 An otherwise healthy 79-year-old woman has had deteriorating fine motor function in her hands for the past 6 months when she is knitting or buttoning buttons. She also reports neck pain and stiffness and diminished sensation in the left hand. Examination reveals a broad-based gait, bilateral dysdiadochokinesia, weakness in the interossei of the left hand, a positive left Hoffman sign, and bilateral up-going toes. Figures 4a and 4b show the lateral radiograph and sagittal T,-weighted MRI scan. What is the most likely diagnosis?
  • 1- Syringomyelia
  • 2- Pathologic fracture of C4 with incomplete spinal cord injury
  • 3- Amyotrophic lateral sclerosis
  • 4- Multiple sclerosis
  • 5- Cervical spondylotic myelopathy
  • Fig. 4A
  • B

 

  • Question 99.24
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 593‑601. Nurick S: The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:101‑108.

 

  • 99.25 Which of the following signal sequences describes the MRI scan
  • characteristics of normal tendons?
  • 1- Low on TI-weighted images and low on T2-weighted images
  • 2- Low on T1-weighted images and high on T2-weighted images
  • 3- High on T1-weighted images and low on T2 -weighted images
  • 4- High on T1-weighted images and moderate on T2 -weighted images
  • 5- High on T1-weighted images and high on T2 weighted images

 

  • Question 99.25
  • Answer = 1
  • Reference(s)
  • Moser RP, Madewell JE: Radiologic evaluation of soft‑tissue tumors, in Enzinger FM, Weiss SW (eds): Soft Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 39‑88. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 81‑87.

 

  • 99.26 A 45-year-old woman has shoulder pain after being struck by a car, and radiographs
  • reveal a comminuted fracture of the scapular neck and body. Eight hours after the
  • injury, the patient reports shortness of breath. What is the most likely diagnosis?
  • 1- Fat embolism
  • 2- Pulmonary embolus
  • 3- Arrhythmia
  • 4- Pulmonary contusion
  • 5- Pericardial effusion

 

  • Question 99.26
  • Answer = 4
  • Reference(s)
  • Zdravkovic D, Damholt VV: Comminuted and severely displaced fractures of the scapula. Acta Orthop Scand 1974;45:60‑65. Leung KS. Lam TP, Poon KM: Operative treatment of displaced intra‑articular glenoid fractures. Injury 1993;24:324‑328. Thompson DA, Flynn TC, Miller PW, et al: The significance of scapular fractures. J Trauma 1985 ;25:974‑977.

 

  • 99.27 Posterolateral rotatory instability of the elbow is the result of injury to the
  • 1- annular ligament.
  • 2- radial collateral ligament.
  • 3- accessory collateral ligament.
  • 4- lateral ulnar collateral ligament.
  • 5- flexor-pronator complex.

 

  • Question 99.27
  • Answer = 4
  • Reference(s)
  • Miller C, Savoie FH: Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg 1994;2:261‑269. O'Driscoll SW, Bell DF, Morrey BF: Posterolateral rotatory instability of the elbow. J Bone Joint Surg 1991;73A:440‑446.

 

  • 99.28 Which of the following muscles is expected to return to function last following a
  • radial neurapraxia (Saturday night palsy)?
  • 1- Extensor digitorum communis
  • 2- Abductor pollicis longus
  • 3- Extensor pollicis brevis
  • 4- Extensor pollicis longus
  • 5- Extensor indicis

 

  • Question 99.28
  • Answer = 5
  • Reference(s)
  • Boilseau Grant JC: Grant's Atlas of Anatomy, ed 6. Baltimore, MD, Williams & Wilkins, 1972, p 10.

 

  • 99.29 Examination of a 5‑month‑old infant with a clubfoot reveals that all aspects of
  • the deformity are partially, but not fully correctible. The child has had no prior
  • treatment. Initial management should include
  • 1‑ electrical stimulation of the leg muscles.
  • 2‑ manipulation and serial long leg casts.
  • 3‑ use of a Denis Browne bar and reverse last shoes.
  • 4‑ posteromedial release.
  • 5‑ complete subtalar release.

 

  • Question 99.29
  • Answer = 2
  • Reference(s)
  • Ponseti IV: Treatment of congenital clubfoot. J Bone Joint Surg 1992;74A:448‑454.

 

  • 99.30 A 21-year-old patient reports chronic lateral ankle discomfort that worsens with
  • activity. Examination reveals tenderness along the course of the peroneal tendon,
  • posterior to the distal fibula. Resisted eversion testing confirms gross subluxation
  • of the peroneal tendon. Standing hindfoot alignment approximates 5° of valgus.
  • In addition to repair of the superior peroneal retinaculum, management should
  • include
  • 1- repair of any associated longitudinal tears of the peroneus brevis.
  • 2- repair of the inferior extensor retinaculum.
  • 3- a Dwyer osteotomy of the calcaneus.
  • 4- tenodesis of the peroneus longus and peroneus brevis tendons distal to the
  • fibula.
  • 5- decompression and rerouting of the superficial peroneal nerve.

 

  • Question 99.30
  • Answer = 1
  • Reference(s)
  • Sobel M, Mizel MS: Peroneal tendon injury, in Pfeffer GB (ed): Current Practice of Foot and Ankle Surgery. New York, NY, McGraw‑Hill, 1993, pp 30‑48. Davis WH, Sobel M, Deland J, et al: The superior peroneal retinaculum: An anatomic study. Foot Ankle Int 1994;15:271‑275.

 

  • 99.31 When a patient sustains a traumatic nerve injury that results in axonotmesis,
  • an electromyogram will most likely reveal denervation activity with
  • fibrillation changes and positive sharp waves at what time following injury?
  • 1- Immediately
  • 2- Within 3 days
  • 3- 3 to 7 days
  • 4- 7 to 14 days
  • 5- 2 to 5 week

 

  • Question 99.31
  • Answer = 5
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 325‑396.

 

  • 99.32 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.33 A 77-year-old man reports neck pain after a fall at home. Neurologic
  • examination reveals 3/5 strength in the right triceps, finger extensors, and
  • interossei, 2/5 strength in the left triceps, finger extensors, and interossei,
  • and 4/5 strength throughout the lower extremities. Which of the following
  • conditions best describes the patient's injury?
  • 1- Central cord syndrome
  • 2- Anterior cord syndrome
  • 3- Complete spinal cord injury
  • 4- Bilateral C7 root injuries
  • 5- Right C7 and left C8 root injuries

 

  • Question 99.33
  • Answer = 1
  • Reference(s)
  • Bohlman HH, Ducker TB: Spine and spinal cord injuries, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 972‑1005. Schneider RC, Cherry G, Pantk H: The syndrome of acute central cervical spinal cord injury: Special reference to the mechanisms involved in hyperextension injuries of the cervical spine. J Neurosurg 1954;11:546‑577.

 

  • 99.34 A 10-lb, 10-oz male infant with limb-length discrepancy was born at 40
  • weeks, and delivery was uneventful. Examination reveals normal facial
  • features, except for prominent ear creases and tongue enlargement. There
  • is a slight pectus excavatum; however, the upper extremities are normal.
  • Examination of the lower extremities shows asymmetrical range of motion
  • and full abduction of the hips; however, the entire left lower extremity is
  • approximately 1 cm longer and appears larger in girth. The skin appears
  • thicker with no other cutaneous markings. In addition to
  • orthoroentgenograms of the lower extremities and radiographs of the
  • spine, management should include
  • 1- a vascular surgery consultation.
  • 2- an ophthalmology consultation.
  • 3- an ultrasound of the abdomen, chromosome studies, and serum glucose levels.
  • 4- chromosome studies, and urine keratin sulfate, chondroitin sulfate, and
  • hyaluronidase levels.
  • 5- serum thyroid levels.

 

  • Question 99.34
  • Answer = 3
  • Reference(s)
  • Ballock RT, Wiesner GL, Myers MT, et al: Hemihypertrophy: Concepts and controversies. J Bone Joint Surg 1997;79A:1731‑1738. Beckwith JB: Macroglossia, omphalocele, adrenal cytomegaly, gigantism, and hyperplastic visceromegaly. Birth Defects 1969;5:188‑196. Weidemann HR: Complexe malformatif famialial hernia ombilicale et macroglossie: Un "syndrome nouveau"? J Genet Hem 1964;13:223‑232.

 

  • 99.35 A 38-year-old patient with type I diabetes
  • mellitus sustains the ankle injury shown in
  • Figure 6. Examination reveals palpable pulses,
  • but there is diminished sensation in a stocking
  • distribution. Moderate swelling is present;
  • however, the skin is intact. Management should
  • consist of
  • 1- closed reduction and application of a nonweightbearing short leg cast for 2 months.
  • 2- open reduction and internal fixation, followed by use of an ankle-foot orthosis.
  • 3- open reduction and internal fixation, followed by nonweightbearing immobilization for 1 month.
  • 4- open reduction and internal fixation, followed by nonweightbearing immobilization for 4 to 6 months.
  • 5- primary ankle arthrodesis using a retrograde intramedullary nail device.
  • Figure 6

 

  • Question 99.35
  • Answer = 4
  • Reference(s) Holmes GB Jr, Hill N: Fractures and dislocations of the foot and ankle in diabetics associated with Charcot joint changes. Foot Ankle Int 1994;15:182‑185.

 

  • 99.36 Which of the following conditions will most likely eventually develop in a
  • newborn girl with achondroplasia?
  • 1- Degenerative disease of the hips
  • 2- Spinal stenosis
  • 3- Atlantoaxial instability
  • 4- Cardiomyopathy
  • 5- Patellar subluxation

 

  • Question 99.36
  • Answer = 2
  • Reference(s)
  • Bassett GS: The osteochondrodysplasias, in Morrissey RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 203­223.

 

  • 99.37 A 25-year-old man is struck by a motor vehicle and sustains an injury to the right
  • lower extremity. Radiographs show a posterior dislocation of the knee; however,
  • examination reveals that the limb is neurologically intact. Initial management of the
  • limb should include
  • 1- application of an above-knee splint.
  • 2- application of an external fixator.
  • 3- an arteriogram.
  • 4- closed reduction of the knee dislocation.
  • 5- open reduction of the knee dislocation.

 

  • Question 99.37
  • Answer = 4
  • Reference(s)
  • Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 1724‑1729. Good L, Johnson RJ: The dislocated knee. J Am Acad Orthop Surg 1995;3:284‑292.

 

  • 99.38 A patient with a unilateral transtibial (below-knee) prosthesis reports
  • lateral knee pain with prolonged weightbearing. Examination reveals a
  • broad-based gait, evidence of increased pressure on the skin over the
  • lateral aspect of the knee, and medial wear on the sole of the shoe on the
  • prosthetic side. The most likely problem is that the prosthetic
  • 1- limb is too short.
  • 2- limb is too long.
  • 3- socket is too flexed.
  • 4- foot is too outset.
  • 5- heel is too firm.

 

  • Question 99.38
  • Answer = 4
  • Reference(s)
  • Bowker JH, Michael JW (eds): Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles, ed 2. St Louis, MO, CV Mosby, 1992, pp 470474. Czerniecki JM: Rehabilitation in limb deficiency: 1. Gait and motion analysis. Arch Phys Med Rehabil 1996;77:S3‑S8.

 

  • 99.39 Examination of a 12-year-old boy with Duchenne's muscular dystrophy
  • who recently began using a wheelchair reveals a progressive left
  • thoracolumbar scoliosis that measures 31° (sitting). In addition, the patient
  • has a Risser sign of 1. Sagittal alignment of the spine is normal except for
  • mild exaggeration of lumbar lordosis. Pulmonary function tests (vital
  • capacity and forced expiratory volume) are 50% of predicted normal
  • values, and cardiac function is good. There is no pelvic obliquity, and
  • sitting balance is good. The hips show flexion contractures of 10°
  • bilaterally. Management should include
  • 1- supportive wheelchair seating, including lateral trunk supports.
  • 2- full-time bracing with a thoracolumbosacral orthosis.
  • 3- posterior spinal subcutaneous rod insertion without fusion.
  • 4- posterior spinal fusion with instrumentation.
  • 5- anterior spinal epiphysiodesis and posterior spinal fusion with instrumentation.

 

  • Question 99.39
  • Answer = 4
  • Reference(s)
  • Mubarak SJ, Morin WD, Leach J: Spinal fusion in Duchenne muscular dystrophy: Fixation and fusion to the sacropelvis? J Pediatr Orthop 1993;13:752‑757. Smith AD, Koreska J, Moseley CF: Progression of scoliosis in Duchenne muscular dystrophy. J Bone Joint Surg 1989;71A:1066‑1074.

 

  • 99.40 When performing a posterior approach to the shoulder, it is important to
  • note that the axillary nerve passes into the field immediately inferior to the
  • 1- teres major.
  • 2- teres minor.
  • 3- latissimus dorsi.
  • 4- infraspinatus.
  • 5- deltoid.

 

  • Question 99.40
  • Answer = 2
  • Reference(s)
  • Hoppenfeld S, deBoer P: Surgical Exposures in Orthopaedics. Philadelphia, PA, JB Lippincott, 1984, pp 42‑44.

 

  • 99.41 A 67-year-old man underwent primary total knee arthroplasty 8 years ago.
  • He now reports a painful, swollen knee for the past 4 months after
  • sustaining a perforated diverticulum that resulted in peritonitis. Aspirate of
  • the knee shows Enterococcus faecalis. Plain radiographs show lucency
  • about erosive lytic changes in the proximal medial tibia. Management
  • should consist of
  • 1- arthroscopic debridement.
  • 2- open debridement and polyethylene exchange.
  • 3- open debridement with primary exchange.
  • 4- open debridement with staged exchange.
  • 5- resection arthroplasty.

 

  • Question 99.41
  • Answer = 4
  • Reference(s)
  • Rand JA: Evaluation and management of infected total knee arthroplasty. Semin Arthroplasty 1994;5:178‑182. Cuckler JM, Star AM, Alavi A, et al: Diagnosis and management of the infected total joint. arthroplasty. Orthop Clin North Am 1991;22:523‑530.

 

  • 99.42 What is the major difference in the clinical presentation of fat embolism syndrome and
  • pulmonary embolism?
  • 1- Degree of hypoxia
  • 2- Respiratory rate
  • 3- Interval between injury and symptoms
  • 4- Need for mechanical ventilation
  • 5- Hematuria

 

  • Question 99.42
  • Answer = 3
  • Reference(s)
  • Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 443‑470.

 

  • 99.43 A 75-year-old man has a destructive lesion of the proximal femur with
  • soft-tissue extension. A technetium bone scan shows no other lesions, and a CT scan of the chest is negative. A needle biopsy of the soft-tissue component shows high-grade chondrosarcoma. According to the staging system of the Musculoskeletal Tumor Society, the stage of the lesion is
  • 1- IB.
  • 2- IIB.
  • 3- III.
  • 4- 2.
  • 5- 3.

 

  • Question 99.43
  • Answer = 2
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, p 198. Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106‑120.

 

  • 99.44 A 19-year-old college football player who sustained a turf toe injury returned
  • to activity after 8 weeks of rest. After 2 days of running activity, he now
  • reports pain directed to the hallux metatarsophalangeal (MTP) joint.
  • Examination reveals generalized swelling and dorsal tenderness at the MTP
  • joint. An AP radiograph of the injured left foot with a comparison view of the
  • right is shown in Figure 7. What is the most likely diagnosis?
  • 1- Occult fracture of the metatarsal head
  • 2- Collateral ligament tear
  • 3- Incompetent plantar sesamoid complex
  • 4- Overuse with reactive synovitis
  • 5- Acute hallux rigidus
  • Figure 7

 

  • Question 99.44
  • Answer = 3
  • Reference(s)
  • Rodeo SA, O'Brien S, Warren RF, et al: Turf toe: An analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 1990;18:280‑285. Adelaar RS (ed): Disorders of the Great Toe. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 1‑22.

 

  • 99.45 Following bony stabilization, what is the recommended sequence of soft-tissue
  • repair in digital replantation?
  • 1- Arteries, veins, tendons, and nerves
  • 2- Arteries, tendons, veins, and nerves
  • 3- Veins, arteries, nerves, and tendons
  • 4- Tendons, arteries, nerves, and veins
  • 5- Tendons, nerves, arteries, and veins

 

  • Question 99.45
  • Answer = 4
  • Reference(s)
  • Urbaniak JR: Replantation, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1085‑1102. Wright PE II, Jobe MT: Microsurgery, in Crenshaw AH (ed): Campbell's Operative Orthopaedics, ed 8. St Louis, MO, Mosby, 1992, pp 2501‑2603.

 

  • 99.46 The development of plantar fasciitis is frequently associated with which of
  • the following conditions?
  • 1- Equinovarus deformity
  • 2- Contracture of the Achilles tendon
  • 3- Plantar spur on the calcaneus
  • 4- Previous fracture of the calcaneus
  • 5- Plantar fibromatosis

 

  • Question 99.46
  • Answer = 2
  • Reference(s)
  • Furey JG: Plantar fasciitis: The painful heel syndrome. J Bone Joint Surg 1975;57A:672‑673 Graham CE: Painful heel syndrome: Rationale of diagnosis and treatment. Foot Ankle 1983;3:261‑267.

 

  • 99.47 A 3-year-old boy with a myelomeningocele and a T 10 neurologic level is
  • beginning to have difficulty with positioning his lower extremities in the leg-
  • rests of his wheelchair. In a sitting position, the knees can be passively flexed
  • to 10° only. Treatment of the lower extremities should include
  • 1- posterior transfer of the rectus femoris to the semitendinosis.
  • 2- quadricepsplasty with anterior knee capsulotomy.
  • 3- supracondylar distal femoral flexion osteotomy.
  • 4- release of the direct head of the rectus femoris.
  • 5- serial casting with passive stretching exercises.

 

  • Question 99.47
  • Answer = 2
  • Reference(s)
  • Tachdjian MO: The neuromuscular system, in Tachdjian MO (ed): Pediatric Orthopedics. Philadelphia, PA, WB Saunders, 1990, pp 1820‑1821.

 

  • 99.48 Figure 8 shows the AP radiograph of the sacroiliac joints of a 29-year-old man who has had increasing lower back pain and stiffness for the past 4 months. Management consisting of exercise and nonsteroidal anti-inflammatory drugs has provided only minimal relief. Examination reveals decreased lumbar mobility in all directions, normal sensibility, and no weakness. The most useful physical finding for confirming the diagnosis is
  • 1- a positive straight leg raising test.
  • 2- limitation of chest expansion to 1" or less.
  • 3- the presence of urethritis.
  • 4- bilateral tightness of the hamstrings.
  • 5- unilateral absence of the Achilles reflex.
  • Figure 8

 

  • Question 99.48
  • Answer = 2
  • Reference(s)
  • Frymoyer JW (ed): The Adult Spine: Principles and Practice. Philadelphia, PA, WB Saunders, 1992, pp 699‑705. El‑Khoury GY, Kathol MH, Brandser EA: Seronegative spondyloarthropathies. Radiol Clin North Am 1996;34:343‑357.

 

  • 99.49 What structure is innervated by the posterior primary ramus of a lumbar spinal nerve?
  • 1- Facetjoint
  • 2- Annulus fibrosus
  • 3- Nucleus pulposus
  • 4- Anterior longitudinal ligament
  • 5- Posterior longitudinal ligament

 

  • Question 99.49
  • Answer = 1
  • Reference(s)
  • Parke WW: Applied anatomy of the spine, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 35‑87. Dupuis PR: The anatomy of the lumbosacral spine, in Kirkaldy‑Willis WH (ed): Managing Low Back Pain. New York, NY, Churchill Livingston, 1998, pp 29‑48.

 

  • 99.50 The use of a pneumatic antishock garment (PASG) is absolutely
  • contraindicated in a patient with a
  • 1- fracture of the pelvis.
  • 2- fracture of the proximal femur.
  • 3- fracture of the lumbar spine.
  • 4- rupture of the diaphragm.
  • 5- traumatic amputation of the lower limb.

 

  • Question 99.50
  • Answer = 4
  • Reference(s)
  • Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 138‑139. Tile M (ed): Fractures of the Pelvis and Acetabulum, ed 2. Baltimore, MD, Williams and Wilkins, 1995, pp 47‑48.

 

  • 99.51 A 35-year-old executive jammed his index finger against the wall while playing
  • squash. Examination reveals tenderness over the dorsum of the distal
  • interphalangeal joint, a lack of active distal interphalangeal joint extension, and the
  • fingertip is held flexed at about 45 degrees. Radiographs show no evidence of
  • fracture, and the joint is reduced. Management should consist of
  • 1- direct surgical repair of the extensor tendon.
  • 2- arthrodesis of the distal interphalangeal joint.
  • 3- buddy taping the distal aspect of the finger to the adjacent digit, followed by
  • early active motion.
  • 4- splinting of the distal interphalangeal joint in slight hyperextension for 6
  • weeks.
  • 5- splinting of the distal interphalangeal joint for 3 weeks, followed by
  • aggressive therapy for mobilization of the joint.

 

  • Question 99.51
  • Answer = 4
  • Reference(s)
  • Cranford GP: The molded polyethylene splint for mallet finger deformities. J Hand Surg 1984;9A:231‑237.

 

  • 99.52 Balance between the dorsiflexors and the plantarflexors in the normal ankle
  • is the result of
  • 1- equal strength between these structures.
  • 2- central nervous system control.
  • 3- location of the tendon insertion sites relative to the axis of ankle motion.
  • 4- the difference in nerve action potentials between the tibial and peroneal
  • nerves.
  • 5- the position of the extrinsic tendons as they cross the ankle joint.

 

  • Question 99.52
  • Answer = 2
  • Reference(s)
  • Plattner P, Mann RA: Disorders of tendons, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 805‑835. Silver RL, de la Garza J, Rang M: The myth of muscle balance: A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg 1985;67B:432‑437.

 

  • 99.53 Figures 9a and 9b show the sagittal and axial T,-weighted MRI scans of a 36-year-old woman who reports pain in the neck and right arm. Examination will most likely reveal which of the following physical findings?
  • 1- Decreased triceps reflex
  • 2- Decreased brachioradialis reflex
  • 3- Decreased biceps reflex
  • 4- Increased triceps reflex
  • 5- Increased scapulohumeral reflex
  • Fig. 9A
  • B

 

  • Question 99.53
  • Answer = 1
  • Reference(s)
  • Simeone FA: Cervical disk disease with radiculopathy, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 553‑560. Hoppenfeld S: Physical Examination of the Spine and Extremities. New York, NY, Appleton‑Century‑Crofts, 1976, pp 105‑127.

 

  • 99.54 A 12-year-old boy who is struck by a car sustains a Salter-Harris type II
  • fracture of the proximal humerus that is displaced 60% and angulated 35°,
  • apex lateral. Management should consist of
  • 1- closed reduction and application of a shoulder spica cast.
  • 2- closed reduction and pin fixation.
  • 3- open reduction and pin fixation.
  • 4- open reduction and tension band wire fixation.
  • 5- immobilization of the fracture in a sling and swathe.

 

  • Question 99.54
  • Answer = 5
  • Reference(s)
  • Larsen CF, Kiaer T, Lindequist S: Fractures of the proximal humerus in children: Nine‑year follow‑up of 64 unoperated on cases. Acta Orthop Scand 1990;61:255‑257.

 

  • 99.55 A 21-year-old laborer sustains the injury shown in Figure 10. Management
  • should consist of
  • 1- closed reduction and casting with the wrist in flexion.
  • 2- closed reduction and casting with the wrist in extension.
  • 3- open reduction and internal fixation with a volar plate.
  • 4- open reduction and internal fixation with a dorsal plate.
  • 5- external fixation.
  • Figure 10

 

  • Question 99.55
  • Answer = 3
  • Reference(s)
  • Zoubos AB, Babis GC, Korres DS, et al: Surgical treatment of 35 volar Barton fractures: No need for routine decompression of the median nerve. Acta Orthop Scand 1997;275:65‑68. Mehara AK, Rastogi S, Bhan S, et al: Classification and treatment of volar Barton fractures. Injury 1993;24:55‑59. Keating JF, Court‑Brown CM, McQueen MM: Internal fixation of volar‑displaced distal radial fractures. J Bone Joint Surg 1994;76B:401‑405.

 

  • 99.56 Revision hip arthroplasty using impaction bone grafting in conjunction with a collarless
  • polished, tapered femoral stem is most commonly associated with which of the following intraoperative and/or postoperative complications?
  • 1- Proximal femur fracture and subsidence of the femoral component
  • 2- Hypotension secondary to embolic bone and cement particles
  • 3- Lack of bone incorporation and remodeling
  • 4- Accelerated polyethylene wear
  • 5- Osteolytic bone destruction

 

  • Question 99.56
  • Answer = 1
  • Reference(s)
  • Meding JB, Ritter MA, Keating EM, et al: Impaction bone‑grafting before insertion of a femoral stem with cement in revision total hip arthroplasty: A minimum two‑year follow‑up study. J Bone Joint Surg 1997;79A:1834‑1841.

 

  • 99.57 Which of the following procedures is considered proper initial management of
  • an amputated part?
  • 1- Place the part in dry sterile gauze and then against the patient's body to
  • keep it warm.
  • 2- Place the part in a saline or lactated Ringer's solution ice bath.
  • 3- Wrap the part in gauze moistened with saline or lactated Ringer's
  • solution, then place it in a plastic bag and place the bag on ice.
  • 4- Wrap the part in gauze, then place it in a plastic bag immersed in an ice
  • and saline bath.
  • 5- Wash the part in any available warm, clean nontoxic fluid to clear
  • debris, then place it in dry sterile gauze.

 

  • Question 99.57
  • Answer = 3
  • Reference(s)
  • Urbaniak JR: Replantation, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1085‑1102.

 

  • 99.58 Which of the following procedures provides optimal soft-tissue coverage for the
  • wound shown in Figure 11?
  • 1- Soleus muscle rotation and split-thickness skin graft
  • 2- Medial gastrocnemius muscle rotation and split-thickness skin graft
  • 3- Local fasciocutaneous rotation flap
  • 4- Rectus abdominis free microvascular transfer and split-thickness skin graft
  • 5- Free microvascular transfer of the fascial cutaneous lateral arm flap
  • Figure 11

 

  • Question 99.58
  • Answer = 4
  • Reference(s)
  • Gorman PW, Barnes CL, Fischer TJ, et al: Soft‑tissue reconstruction in severe lower extremity trauma: A review. Clin Orthop 1989;243:57‑64.

 

  • 99.59 Which of the following design parameters has the most favorable impact on
  • polyethylene wear rate following total knee replacement?
  • 1- Grit-blast surface finish on the tibial tray
  • 2- Increased medial-lateral articular surface conformity
  • 3- Heat-pressed polyethylene surface finish
  • 4- Titanium counterface-bearing surface
  • 5- Carbon-fiber inclusion within the polyethylene

 

  • Question 99.59
  • Answer = 2
  • Reference(s)
  • Bartel DL, Bucknell VL, Wright TM: The effect of conformity, thickness, and material on stresses in ultra‑high molecular weight components for total joint replacement. J Bone Joint Surg 1998;68A:1041‑1051. Li S, Burstein AH: Ultra‑high molecular weight polyethylene: The material and its use in total joint implants. J Bone Joint Surg 1994;76A:1080‑1090.

 

  • 99.60 A 2-year-old boy is evaluated for delay of walking. History reveals that the
  • patient was delivered 2 months premature by caesarean section secondary to
  • placenta previa hemorrhage. He required 1 week of intubation and was
  • discharged on phenobarbital for control of seizures. The parents have asked
  • about the child's potential for ambulation. Which of the following factors have
  • negative prognostic findings for walking ability?
  • 1- Persistent Moro reflex, extensor thrust, and absence of the parachute response
  • 2- Persistent Moro reflex, absence of the asymmetric tonic neck reflex, and absence
  • of the parachute response
  • 3- Persistent Babinski reflex, presence of the asymmetric tonic neck reflex, and
  • absence of Moro reflex
  • 4- Extensor thrust, persistent Babinski reflex, and presence of the parachute response
  • 5- Foot placement reaction, absence of the asymmetric tonic neck reflex, and
  • presence of the parachute response

 

  • Question 99.60
  • Answer = 1
  • Reference(s)
  • Bleck EE (ed): Orthopaedic management in cerebral palsy in clinics in developmental medicine. London, England, Mackeith Press, 1987, vol 99/100, pp 1‑485.

 

  • 99.61 A 20-year-old student sustains the closed tibia fracture shown in Figures 12a and 12b. Examination reveals no signs of compartment syndrome, and initial management consists of application of a long leg cast. Postreduction radiographs are shown in Figures 12c and 12d. Management should now include
  • 1- continued casting, followed by a
  • functional brace.
  • 2- continued casting until union is
  • achieved.
  • 3- open reduction and plate
  • fixation.
  • 4- external fixation.
  • 5- a reamed tibial nail.
  • Fig. 12 A & B
  • C & D

 

  • Question 99.61
  • Answer = 1
  • Reference(s)
  • Sarmiento A, Sharpe FE, Ebramzadeh E, et al: Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop 1995;315:8‑24.

 

  • 99.62 A 27-year-old man has had activity-related lateral ankle pain for the past 2 months.
  • He denies any history of trauma. Examination reveals a mild cavovarus foot
  • posture with peroneal tendinitis. Modification of the patient's shoe wear should
  • include a
  • 1- SACH modification to the sole of the shoe.
  • 2- medial heel wedge with lateral forefoot posting.
  • 3- lateral heel flare with lateral posting of an accommodative insole.
  • 4- custom-molded arch support with shock-absorbing properties.
  • 5- cushion insole in a shoe that is modified with an offset rocker sole.

 

  • Question 99.62
  • Answer = 3
  • Reference(s)
  • Janisse DJ: Footwear prescriptions. Foot Ankle Int 1997;18:526‑527.

 

  • 99.63 Figure 13 shows the AP radiograph of both knees of a 55-year-old man who reports an acute exacerbation of right knee pain for the past 36 hours. Examination reveals a palpable effusion, moderate warmth, and pain on range of motion. A synovial fluid aspiration will most likely show
  • 1- a WBC greater than 100,000/mm'.
  • 2- gram-negative intracellular diplococcus.
  • 3- positive birefringent crystals.
  • 4- negative birefringent crystals.
  • 5- elevated complement levels.
  • Figure 13

 

  • Question 99.63
  • Answer = 3
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 219‑276.

 

  • 99.64 Which of the following findings should prompt emergent surgical
  • management in a patient with an isolated posterior hip dislocation?
  • 1- Fragments of bone in the fovea
  • 2- Unstable fracture-dislocation
  • 3- Femoral head fracture
  • 4- Nonconcentric reduction
  • 5- Irreducible dislocation

 

  • Question 99.64
  • Answer = 5
  • Reference(s)
  • Dreinhofer KE, Schwarzkopf SR, Haas NP, et al: Isolated traumatic dislocation of the hip: Long‑term results in 50 patients. J Bone Joint Surg 1994;76B:6‑12. Thompson VP, Epstein HC: Traumatic dislocation of the hip: A survey of two hundred and four cases covering a period of twenty‑one years. J Bone Joint Surg 1951;33A:746‑778. Tornetta P III, Hamid R: Hip dislocation: Current treatment regimens. J Am Acad Orthop Surg 1997;5:27‑36.

 

  • 99.65 Three-point bending produces a predominantly transverse fracture because
  • 1- a compression crack begins at the fulcrum.
  • 2- bone is weaker in tension than in compression.
  • 3- bone is weaker in compression than in tension.
  • 4- the forces are equally resolved between tension and compression.
  • 5- the forces are resolved into pure tension.

 

  • Question 99.65
  • Answer = 2
  • Reference(s)
  • Alms M: Fracture mechanics. J Bone Joint Surg 1961;43B:162‑166. Wright TM, Hayes WC: Mechanics of fracture and fracture propagation, in Owen R, Goodfellow J, Bullough P (eds): Scientific Foundations of Orthopaedics and Traumatology. Philadelphia, PA, WB Saunders, 1980, pp 252‑258.

 

  • 99.66 A patient with lumbar spinal stenosis has difficulty walking. What physical examination finding would suggest co-existing cervical myelopathy?
  • 1- Weakness of the gastrocsoleus muscle groups
  • 2- Positive straight leg raising test
  • 3- Plantar extensor responses
  • 4- Diminished ankle reflexes
  • 5- Intact bulbocavemosus reflex

 

  • Question 99.66
  • Answer = 3
  • Reference(s)
  • Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 75‑86.

 

  • 99.67 A 6-year-old girl sustains a closed greenstick fracture of the proximal tibial
  • metaphysis, and management consists of a long leg cast with the knee in
  • extension, with anatomic reduction. Examination of the leg 6 months after
  • cast removal reveals that the leg has grown into a valgus position.
  • Radiographs show the mechanical axis of the limb to be in 12° of valgus
  • (opposite limb, 2°). Management should now include
  • 1- a knee-ankle-foot orthosis.
  • 2- tibial osteotomy.
  • 3- femoral osteotomy.
  • 4- tibial and femoral hemiepiphysiodesis.
  • 5- observation.

 

  • Question 99.67
  • Answer = 5
  • Reference(s)
  • Heinrich SD: Fractures of the shaft of the tibia and fibula, in Rockwood CA Jr, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 1331‑1376.

 

  • 99.68 Femoral nerve palsy following total hip replacement is most commonly associated with
  • 1- errant placement of acetabular retractors.
  • 2- leg lengthening.
  • 3- protruding acetabular component fixation screws.
  • 4- intrapelvic cement extrusion.
  • 5- prolonged intraoperative hip extension.

 

  • Question 99.68
  • Answer = 1
  • Reference(s)
  • Shaw JA, Greer RB III: Complications of total hip replacement, in Epps CH Jr (ed): Complications in Orthopaedic Surgery, ed 3. Philadelphia, PA, JB Lippincott, 1994, pp 1013‑1056. Simmons C Jr, Izant TH, Rothman RH, et al: Femoral neuropathy following total hip arthroplasty: Anatomic study, case reports, and literature review. J Arthroplasty 1991;6:S57 S66.

 

  • 99.69 A 35-year-old woman has increasing pain in the lateral aspect of the proximal
  • forearm and elbow that is exacerbated by forceful wrist extension and
  • supination. She also reports vague dorsal wrist and hand discomfort.
  • Examination reveals tenderness in the proximal extensor muscle mass, and
  • discomfort is increased with resisted wrist and finger extension. Management
  • consisting of use of a tennis elbow band and nonsteroidal anti--inflammatory
  • drugs has failed to provide relief. Radiographs of the elbow are normal. The
  • diagnosis is most likely to be confirmed by
  • 1- a bone scan.
  • 2- an arthrogram.
  • 3- an MRI scan of the elbow and proximal forearm.
  • 4- electrodiagnostic testing.
  • 5- injection of the radial tunnel.

 

  • Question 99.69
  • Answer = 5
  • Reference(s)
  • Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 221‑231. Eversmann WW Jr: Entrapment and compression neuropathies, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1341‑1385.

 

  • 99.70 A 13-month-old infant is scheduled to undergo surgical treatment of
  • developmental hip dislocation. Which of the following procedures can be
  • performed through an anterior (Smith-Peterson) approach to the hip, but not
  • through the anteromedial approach to the hip?
  • 1- Iliopsoas tenotomy
  • 2- Release of the transverse acetabular ligament
  • 3- Release of the hourglass capsular constriction
  • 4- Imbrication of the lax portion of the hip capsule
  • 5- Excision of the hypertrophied ligamentum teres

 

  • Question 99.70
  • Answer = 4
  • Reference(s)
  • Morcuende JA, Meyer MD, Dolan LA, et al: Long‑term outcome after open reduction through an anteromedial approach for congenital dislocation of the hip. J Bone Joint Surg 1997;79A:810‑817. Gabuzda GM, Renshaw TS: Reduction of congenital dislocation of the hip. J Bone Joint Surg 1992;74A:624‑631.

 

  • 99.71 The purpose of obtaining informed consent during clinical research on pediatric
  • patients is to make sure that the child's guardian is
  • 1- notified of the outcome following completion of the study.
  • 2- unable to withdraw consent once participation in a study has begun.
  • 3- aware that the child's name and photograph may be used when the research is published.
  • 4- aware of potential risks that may result from participation in a research protocol.
  • 5- aware of whether the child is receiving the experimental treatment or a placebo.

 

  • Question 99.71
  • Answer = 4
  • Reference(s)
  • Riecken HW, Ravich R: Informed consent to biomedical research in Veterans Administration Hospitals. JAMA 1982;248:344‑348. Brahams D: Randomized trials and informed consent. Lancet 1988;2:1033‑1034. Grodin MA, Alpert JJ: Children as participants in medical research. Pediatr Clin North Am 1988;35:1389‑1401.

 

  • 99.72 The female athlete triad consists of
  • 1- menstrual dysfunction, stress fractures, and anemia.
  • 2- menstrual dysfunction, disordered eating, and decreased bone mineral density.
  • 3- menstrual dysfunction, muscle cramping, and anemia.
  • 4- anemia, weight loss, and muscle cramping.
  • 5- amenorrhea, bulimia, and anemia.

 

  • Question 99.72
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 107‑122.

 

  • 99.73 A common purpose of using meta-analysis as a research tool is to
  • 1- increase the validity of multiple similar research projects by averaging poorly designed studies with well-designed studies.
  • 2- provide a chronologic summary of existing literature on a single research topic.
  • 3- obtain prospective agreement among investigators at multiple institutions.
  • 4- enhance sample size by statistically integrating the findings of multiple similar research projects.
  • 5- compare the findings of one research project with historical controls from previous similar projects.

 

  • Question 99.73
  • Answer = 4
  • Reference(s)
  • Haher TR, Merola A, Zipnick RI, et al: Meta‑analysis of surgical outcome in adolescent idiopathic scoliosis: A 35‑year English literature review of 11,000 patients. Spine 1995;20:1575‑1584. Keller RB: Outcomes research in orthopaedics. J Am Acad Orthop Surg 1993;1:122‑129.

 

  • 99.74 Which of the following benign lesions may occasionally metastasize to the
  • lungs?
  • 1- Nonossifying fibroma
  • 2- Osteofibrous dysplasia
  • 3- Chondromyxoid fibroma
  • 4- Chondroblastoma
  • 5- Periosteal chondroma

 

  • Question 99.74
  • Answer = 4
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, p 221.

 

  • 99.75 Figure 14 shows the clinical
  • photograph of a 4-year-old boy
  • who sustained a traumatic
  • amputation of his dominant
  • thumb 10 weeks ago. One
  • third of the proximal phalanx
  • remains and has good soft-
  • tissue coverage. Which of the
  • following procedures will
  • best improve function of the
  • thumb?
  • Figure 14
  • 1- Modified nail wrap-around flap
  • 2- Amputation of the remaining thumb and index pollicization
  • 3- Bone lengthening of the metacarpal by distraction
  • 4- Osteocutaneous fibula microvascular transfer
  • 5- Second toe microvascular transfer

 

  • Question 99.75
  • Answer = 5
  • Reference(s)
  • Valauri FA, Bunke HJ: Thumb and finger reconstruction by toe‑to hand transfer. Hand Clinic 1992;8:551‑574. Kay SP, Wiberg M: Toe to hand transfer in children. Brit JHS 1996;21B:723‑734.

 

  • 99.76 Adequate decompression of the medial and lateral plantar nerves during a tarsal
  • tunnel release requires
  • 1- release of the medial half of the plantar fascia.
  • 2- release of the deep fascia of the abductor hallucis muscle.
  • 3- release of the inferior extensor retinaculum.
  • 4- release of the quadratus plantae fascia.
  • 5- resection of a plantar exostosis of the calcaneus, when present.

 

  • Question 99.76
  • Answer = 2
  • Reference(s)
  • Bailie DS, Kelikian AS: Tarsal tunnel syndrome: Diagnosis, surgical technique, and functional outcome. Foot Ankle Int 1998;19:65‑72. Takakura Y, Kitada C, Sugimoto K, et al: Tarsal tunnel syndrome: Causes and results of operative treatment. J Bone Joint Surg 1991;73B:125‑128.

 

  • 99.77 Examination of an 8-year-old child with a congenital 6-cm femoral
  • discrepancy reveals a significantly greater than normal anterior translation of
  • the tibia with a Lachman's test. The most likely clinical implication of this
  • finding is that the patient may have
  • 1- knee instability that limits participation in sports.
  • 2- patellofemoral instability.
  • 3- premature knee degeneration.
  • 4- anterior tibial subluxation during lengthening.
  • 5- a meniscal tear at a young age.

 

  • Question 99.77
  • Answer = 4
  • Reference(s)
  • Insall JN, Windsor RE, Scott WN, et al (eds): Surgery of the Knee, ed 2. New York, NY; Churchill Livingston, 1993, pp 1203‑1213.

 

  • 99.78 Figures 15a and 15b show the AP and lateral plain radiographs of the lumbar spine of a 42-year-old man who has low back pain. What is the most likely diagnosis?
  • 1- Spondylolisthesis
  • 2- Ankylosing spondylitis
  • 3- Segmental instability
  • 4- Diffuse idiopathic skeletal hyperostosis
  • 5- Lumbar spondylosis
  • Fig. 15A
  • B

 

  • Question 99.78
  • Answer = 2
  • Reference(s)
  • Simpson JM, Booth RE: Arthritis of the spine, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 515‑545. Resnick D, Shal SR, Robins JM: Diffuse idiopathic skeletal hyperostosis (DISH): Forestier's disease with extraspinal manifestations. Radiology 1975;115:513‑520. Boachie‑Adjei O, Bullough PG: Atlas of spinal diseases. New York, NY, Gower Medical Publishing, 1988, pp 98‑117.

 

  • 99.79 A 51-year-old woman with rheumatoid arthritis is suddenly unable to actively
  • extend her ring and little fingers on her dominant hand. What is the most likely
  • diagnosis?
  • 1- Volar subluxation of the extensor tendons at the level of the metacarpal heads
  • 2- Posterior interosseous nerve compression at the elbow
  • 3- Intrinsic contractures preventing active extension
  • 4- Attritional ruptures of the extensor tendons at the wrist
  • 5- Cervical radiculopathy

 

  • Question 99.79
  • Answer = 4
  • Reference(s)
  • Leslie BM: Rheumatoid extensor tendon ruptures. Hand Clin 1989;5:191‑202.

 

  • 99.80 The risk of adult respiratory distress syndrome, fat embolism, or pneumonia
  • developing in patients with femoral fractures and thoracic injury is greatest
  • with the use of
  • 1- reamed intramedullary nailing.
  • 2- nonreamed intramedullary nailing.
  • 3- plating.
  • 4- delayed stabilization.
  • 5- external fixation.

 

  • Question 99.80
  • Answer = 4
  • Reference(s)
  • Bosse MJ, MacKenzie EJ, Riemer BL, et al: Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate: A comparative study. J Bone Joint Surg 1997;79A:799‑809. Bucholz RW, Jones A: Fractures of the shaft of the femur. J Bone Joint Surg 1991;73A:1561‑1566.

 

  • 99.81 Examination of the radiographs of a 15-year-old football player that were
  • obtained to rule out scoliosis reveal an isthmic spondylolisthesis. The
  • studies show a 10° lumbar scoliosis, along with a 26% forward slip of L5
  • on S 1 because of pars defects in L5. The patient reports no pain, and
  • neurologic examination is normal. Management should include
  • 1- posterior spinal fusion of L5 to S 1.
  • 2- repair of the pars defects, without fusing to an adjacent level.
  • 3- brace treatment until the patient reaches maturity.
  • 4- no further participation in football or contact sports
  • 5- no treatment or restrictions unless symptoms develop.

 

  • Question 99.81
  • Answer = 5
  • Reference(s)
  • Hensinger RN: Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg 1989;71A:1098‑1107.

 

  • 99.82 The etiology of senile osteoporosis is best supported by which of the
  • following current hypotheses?
  • 1- Uncoupling of bone formation and resorption
  • 2- Insufficient dietary calcium
  • 3- Inability to absorb calcium in the small intestine
  • 4- Osteoclast overactivity
  • 5- Excessive endogenous estrogen

 

  • Question 99.82
  • Answer = 1
  • Reference(s)
  • Parfitt AM, Mundry GR, Roodman GD, et al: A new model for the regulation of bone resorption, with particular reference to the effects of bisphosphonates. J Bone Miner Res 1996;11:150‑159. Simon SR (ed): Orthopaedic Basic Science. Rosemont IL, American Academy of Orthopaedic Surgeons, 1994, pp 127‑184. Kleerekoper M, Alvioli LV: Evaluation and treatment of postmenopausal osteoporosis, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, ed 2. New York, NY, Raven Press, pp 223‑229.

 

  • 99.83 The development of osteonecrosis of the femoral head following treatment of
  • femoral shaft fractures in adolescents has been most strongly linked to which
  • of the following factors?
  • 1- Excessive time from injury to stabilization
  • 2- Fat embolization from reaming for an intramedullary nail
  • 3- Intramedullary nailing from a starting point in the piriformis fossa
  • 4- Retrograde flexible nail fixation extending up the femoral neck
  • 5- Pressure on the femoral head from over-lengthening at the fracture site

 

  • Question 99.83
  • Answer = 3
  • Reference(s)
  • Hughes LO, Beaty JH: Fractures of the head and neck of the femur in children. J Bone Joint Surg 1994;76A:283‑292.

 

  • 99.84 What part of the meniscus has the highest incidence of degenerative tears?
  • 1- Anterior horn of the medial meniscus
  • 2- Anterior horn of the lateral meniscus
  • 3- Posterior horn of the lateral meniscus
  • 4- Posterior horn of the medial meniscus
  • 5- Middle and posterior horns of the lateral meniscus

 

  • Question 99.84
  • Answer = 4
  • Reference(s)
  • Bernstein J, Lane JM: Metabolic bone disorders of the spine, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 1381‑1427. Riggs BL, Melton LJ: Involutional osteoporosis. N Engl J Med 1986;314:1676‑1681.

 

  • 99.85 Figure 16 shows the lateral radiograph of the lumbosacral spine of a 24-year-old woman who has pain in the back and leg. The pain in the leg is most likely caused by compression of which of the following nerve roots?
  • 1- L3
  • 2- L4
  • 3- L5
  • 4- S 1
  • 5- S2
  • Fig. 16
  • Fig. 16

 

  • Question 99.85
  • Answer = 3
  • Reference(s)
  • Lauerman WC, Cain JE: Isthmic spondylolisthesis in the adult. J Am Acad Orthop Surg 1996;4:201‑208. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 633‑638.

 

  • 99.86 Figure 17 shows the current radiographs of a 55-year-old woman who sustained a closed humeral fracture 6 months ago, and management consisted of application of a functional brace. Examination reveals good elbow function and some mild shoulder pain; however, she has gross motion and pain at the fracture site when the brace is off. Management should now include
  • 1- closed reduction and flexible intramedullary nailing.
  • 2- open reduction and internal fixation with a plate and bone graft.
  • 3- open reduction and a reamed antegrade locked nail.
  • 4- continued bracing and observation.
  • 5- continued bracing and electrical stimulation.
  • Figure 17

 

  • Question 99.86
  • Answer = 2
  • Reference(s)
  • Epps CH Jr: Nonunion of the humerus, in Bassett FH III (ed): Instructional Course Lectures XXXVII. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1988, pp 161‑166.

 

  • 99.87 Examination of a 28-year-old woman who sustained a displaced oblique distal
  • diaphyseal humerus fracture in a fall reveals that she is neurologically intact. After
  • undergoing manipulation and casting, the patient is unable to extend her wrist or
  • fingers. Management should now consist of
  • 1- repeat manipulation and casting.
  • 2- observation.
  • 3- electrodiagnostic studies.
  • 4- olecranon pin traction and close monitoring for return of function.
  • 5- surgical exploration of the radial nerve.

 

  • Question 99.87
  • Answer = 5
  • Reference(s)
  • Garcia A, Maleck BH: Radial nerve injuries in fractures of the shaft of the humerus. Am J Surg 1960;99:625‑627. Pollock FH, Drake D, Bovill EG, et al: Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg 1981;63A:239‑243.

 

  • 99.88 Compared with patients who have other conditions, patients with sickle
  • cell disease experience what complication more frequently following total
  • hip arthroplasty?
  • 1- Heterotopic ossification
  • 2- Dislocation
  • 3- Loosening
  • 4- Fracture
  • 5- Deep vein thrombosis

 

  • Question 99.88
  • Answer = 3
  • Reference(s)
  • Acurio MT, Friedman RJ: Hip arthroplasty in patient with sickle‑cell hemoglobinopathy. J Bone Joint Surg 1992;74B:367‑371. Clarke HJ, Jinnah RH, Brooker AF, et al: Total replacement of the hip for avascular necrosis in sickle cell disease. J Bone Joint Surg 1989;71B:465‑470. Callaghan JJ, Dennis DA, Paprosky WG, et al (ed): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 79‑86.

 

  • 99.89 A 25-year-old man sustains
  • the injury shown in Figures
  • 18a and 18b. In addition to
  • open reduction and plate
  • stabilization of the radial
  • fracture, management should
  • include
  • 1- cross-pinning of the distal
  • radioulnar joint.
  • 2- repair of the triangular
  • fibrocartilage complex.
  • 3- arthrodesis of the distal radioulnar
  • joint.
  • 4- assessment of distal radioulnar joint
  • stability.
  • 5- immobilization in a long arm cast
  • in supination.
  • Figure 18 A & B

 

  • Question 99.89
  • Answer = 4
  • Reference(s)
  • Rockwood CA, Green DP, Bucholz RW, et al: Fractures of the shafts of the radius and ulna, in Fractures in Adults. Philadelphia, PA, Lippincott‑Raven, 1996. Strehle J, Gerber C: Distal radioulnar joint function after Galeazzi fracture‑dislocations treated by open reduction and internal plate fixation. Clin Orthop 1993;293:240‑245.

 

  • 99.90 The parents of a 2-year-old boy report that he has been irritable and has refused to walk
  • for the past 5 days. Examination reveals mild tenderness and paraspinous muscle spasm
  • in the lumbar area. The patient has a temperature of 99.5°F (37.5°C), and laboratory
  • studies show a WBC of 8,200/mm' (normal 3,500 to 10,500/mm') with normal
  • differential and an erythrocyte sedimentation rate of 60 mm/hr (normal up to 20 mm/hr).
  • Plain radiographs of the spine are normal, but a technetium bone scan shows increased
  • uptake at the L2-3 interspace. Management consisting of 1 week of bed rest and IV
  • oxacillin allows the child to ambulate without discomfort, but repeat radiographs of the
  • spine show progressive narrowing of the L2-3 disk space with erosion of adjacent end
  • plates. Management should now include
  • 1- a CT-guided needle biopsy of the L2-3 disk.
  • 2- an MRI scan of the lumbar spine.
  • 3- a tuberculin skin test.
  • 4- changing the IV antibiotic to vancomycin.
  • 5- transition to oral dicloxacillin.

 

  • Question 99.90
  • Answer = 5
  • Reference(s)
  • Atar D, Lehman WB, Grant AD: Diskitis in children. Orthop Rev 1992;21:931‑933. Crawford AH, Kucharzyk DW, Ruda R, et al: Diskitis in children. Clin Orthop 1991;266:70 79. Szalay EA, Green NE, Heller RM, et al: Magnetic resonance imaging in the diagnosis of childhood diskitis. J Pediatr Orthop 1987;7:164‑167.

 

  • 99.91 A 49-year-old woman with diabetes
  • mellitus sustained an ankle fracture 2
  • years ago. Despite the use of serial
  • casting, a double upright brace, and
  • protected weightbearing, she now
  • reports recurrent ulcerations over the
  • heel and lateral hindfoot. Examination
  • reveals normal circulation and no
  • evidence of active infection. Figure 19
  • shows an AP radiograph of the ankle.
  • Management should now include
  • 1- below-knee amputation.
  • 2- Syme's amputation.
  • 3- conversion to a polypropylene patellar tendon-bearing brace with a lateral T-strap.
  • 4- tibiotalocalcaneal arthrodesis.
  • 5- a clam-shell ankle-foot orthosis.
  • Figure 19

 

  • Question 99.91
  • Answer = 4
  • Reference(s)
  • Papa J, Myerson M, Girard P: Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg 1993;75A:1056‑1066.

 

  • 99.92 Figure 20 shows the clinical
  • photograph of a 54-year-old farmer
  • who caught the wedding ring on his
  • nondominant ring finger in a manure
  • spreader drive belt. Examination
  • reveals an amputation through the
  • distal phalanx and complete skin loss
  • from the midaspect of the proximal
  • phalanx. Active flexion and extension
  • are present. Treatment should consist of
  • 1- skeletal shortening and closure.
  • 2- replantation of the amputated part.
  • 3- split-thickness skin grafting and early
  • motion.
  • 4- coverage with a pedicle groin flap.
  • 5- microvascular great toe fasciocutaneous
  • wrap-around transfer.
  • Figure 20

 

  • Question 99.92
  • Answer = 1
  • Reference(s)
  • Urbaniak JR, Evans JP, Bright DS: Microvascular management of ring avulsion injuries. J Hand Surg 1981;6:25‑30.

 

  • 99.93 Examination of a patient with long-standing juvenile rheumatoid arthritis will most likely reveal what abnormality of the cervical spine?
  • 1- Os odontoideum
  • 2- Subaxial subluxation
  • 3- Spontaneous ankylosis
  • 4- Scoliosis
  • 5- Torticollis

 

  • Question 99.93
  • Answer = 3
  • Reference(s)
  • Simpson JM, Booth RE: Arthritis of the spine, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 515‑545. Ansell BM: The cervical spine in post‑pubertal patients with rheumatoid arthritis of juvenile onset. Ann Rheum Dis 1956;15:40‑44.

 

  • 99.94 Which of the following conditions most often occurs after open reduction and
  • internal fixation of a displaced posterior wall acetabular fracture?
  • 1- Nerve palsy
  • 2- Infection
  • 3- Osteonecrosis
  • 4- Arthritis
  • 5- Hip instability

 

  • Question 99.94
  • Answer = 4
  • Reference(s)
  • Letoumel E, Judet R: Fractures of the Acetabulum, ed 2. New York, NY, Springer‑Verlag, 1993. Matta JM: Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg 1996;78A:1632 1645.

 

  • 99.95 In which of the following pediatric neoplasms can involvement of the
  • synovium result in arthralgias?
  • 1- Ewing's tumor
  • 2- Osteosarcoma
  • 3- Eosinophilic granuloma
  • 4- Leukemia
  • 5- Chondrosarcoma

 

  • Question 99.95
  • Answer = 4
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, pp 127‑128. Silverstein MN, Kelly PJ: Leukemia with osteoarticular symptoms and signs. Ann Intern Med 1963;59:637‑645.

 

  • 99.96 Which of the following material combinations has the lowest coefficient of
  • friction?
  • 1- Steel/steel
  • 2- High-density polyethylene/steel
  • 3- High-density polyethylene/cobalt chrome
  • 4- High-density polyethylene/titanium
  • 5- Hyaline cartilage/hyaline cartilage

 

  • Question 99.96
  • Answer = 5
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 447‑486.

 

  • 99.97 A 35-year-old woman with rheumatoid arthritis is unable to extend her middle
  • finger. She also reports pain, swelling, and mild restriction of motion of the wrist
  • and finger metacarpophalangeal (MCP) joints. Examination reveals that the middle
  • finger MCP joint is held in 60° of flexion. When the finger is passively extended,
  • the patient can then actively hold the finger in full extension. Appropriate surgical
  • treatment should consist of
  • 1- intrinsic releases.
  • 2- side-to-side extensor tenodesis.
  • 3- extensor hood reconstruction.
  • 4- flexor sheath tenosynovectomy.
  • 5- radial nerve decompression.

 

  • Question 99.97
  • Answer = 3
  • Reference(s)
  • Burton RI: Extensor tendons: Late reconstruction, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1955‑1988. McCoy FJ, Winsky AJ: Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg 1969;44:142‑146.

 

  • 99.98 Figure 21a shows the initial radiographs of a patient before undergoing a
  • surgical procedure for neurofibromatosis. Figure 21 b shows the
  • radiograph of the progressive deformity 10 months after the procedure.
  • What is the most probable cause for the deformity?
  • 1- Residual cord compression because of a retained neurofibroma
  • 2- Paralysis of the erector spine muscles
  • 3- Postlaminectomy instability
  • 4- Degenerative disk disease
  • 5- Central nervous system neurofibroma
  • Fig. 21A
  • B

 

  • Question 99.98
  • Answer = 3
  • Reference(s)
  • Tumors involving the cervical spine, in The Cervical Spine, ed 2. Philadelphia, PA, JB Lippincott, 1989, pp 723‑774.

 

  • 99.99 In an adult, management of an isolated Gustilo type II open distal one third
  • femoral shaft fracture that ends 7 cm from the joint should include
  • 1- an external fixator.
  • 2- an unreamed femoral nail.
  • 3- a reamed femoral nail.
  • 4- a femoral plate.
  • 5- provisional stabilization with a femoral external fixator, followed by
  • conversion to a femoral nail.

 

  • Question 99.99
  • Answer = 3
  • Reference(s)
  • Brumback RJ, Ellison PS Jr, Poka A, et al: Intramedullary nailing of open fractures of the femoral shaft. J Bone Joint Surg 1989;71A:1324‑1331. Lhowe DW, Hansen ST: Immediate nailing of open fractures of the femoral shaft. J Bone Joint Surg 1988;70A:812‑820. Winquist RA: Locked femoral nailing. J Am Acad Orthop Surg 1994;1:95‑105. Tornetta P III, Tiburzi D: The treatment of femoral shaft fractures using intramedullary interlocked nails with and without intramedullary reaming: A preliminary report. J Orthop Trauma 1997;11:89‑92.

 

  • 99.100 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.101 Examination of a 7-year-old child with hemiplegic cerebral palsy and an
  • equinovarus foot reveals that the ankle can be brought to neutral only by
  • flexing the knee. The varus can be corrected passively. Electromyography
  • results obtained during gait study show continuous firing of the
  • gastrocnemius-soleus complex and posterior tibialis muscle. Treatment
  • should consist of
  • 1- Achilles tendon lengthening and a Dwyer calcaneal osteotomy.
  • 2- Achilles tendon lengthening and a split anterior tibia] transfer.
  • 3- Achilles tendon lengthening and a split posterior tibial transfer.
  • 4- Achilles tendon tenotomy.
  • 5- posterior tibial tendon lengthening.

 

  • Question 99.101
  • Answer = 3
  • Reference(s)
  • Renshaw TS, Green NE, Griffin PP, et al: Cerebral palsy: Orthopaedic management, in Pritchard DJ (ed): Instructional Course Lectures 45. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 475‑490.

 

  • 99.102 The anti-inflammatory action of corticosteroids is mediated by
  • 1- decreasing cell membrane permeability.
  • 2- blocking cyclooxygenase.
  • 3- inhibiting lipoxygenase.
  • 4- inhibiting phospholipase Az.
  • 5- suppressing leukocyte chemotactic mediators.

 

  • Question 99.102
  • Answer = 4
  • Reference(s)
  • Fadale PD, Wiggins ME: Corticosteroid injections: Their use and abuse. J Am Acad Orthop Surg 1994;2:133‑140. Leadbetter WB: Corticosteroid injection therapy in sports injuries, in Leadbetter WB, Buckwalter JA, Gordon SL (eds): Sports‑Induced Inflammation: Clinical and Basic Science Concepts. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 527‑545.

 

  • 99.103 Figures 22a and 22b show the AP and lateral radiographs, and Figures 22c
  • and 22d show the sagittal and axial MRI scans of the lumbar spine of a
  • 53-year-old man who has had pain in the back and left thigh for the past 2
  • months. The pathologic fracture seen at L2 is most likely secondary to
  • 1- giant cell tumor.
  • 2- osteoporosis.
  • 3- vertebral osteomyelitis.
  • 4- Charcot spine.
  • 5- metastatic disease.

 

  • Question 99.103 Images
  • D
  • B
  • Fig. 22A
  • B
  • C

 

  • Question 99.103
  • Answer = 5
  • Reference(s)
  • Harrington KD: Metastatic tumors of the spine: Diagnosis and treatment. J Am Acad Orthop Surg 1993;1:76‑86. An HS, Vaccaro AR, Dolinskas CA, et al: Differentiation between spinal tumors and infections with magnetic resonance imaging. Spine 1991;16:S334‑S338. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy Of Orthopaedic Surgeons, 1996, pp 657‑666.

 

  • 99.104 Which of the following devices provides the best prophylactic
  • stabilization of an impending pathologic fracture caused by a lytic defect
  • in the mid-diaphysis of the femur?
  • 1- Plate and screws alone
  • 2- Plate and screws with cement
  • 3- Rush rod with cement
  • 4- Ender's rods with cement
  • 5- Locked intramedullary nail

 

  • Question 99.104
  • Answer = 5
  • Reference(s)
  • Peabody TD, Finn HA: Femoral diaphysis and distal femur, in Simon MA, Springfield D (eds): Surgery for Bone and Soft‑Tissue Tumors. Philadelphia, PA, Lippincott‑Raven, 1998, pp 705‑711. Kunec J, Lewis R: Closed intramedullary rodding of pathologic fractures with supplemental cement. Clin Orthop 1984;188:183.

 

  • 99.105 An 80-year-old woman sustains a minimally displaced proximal humerus
  • fracture. To improve her functional outcome, management should consist of
  • 1- proximal humeral replacement.
  • 2- supervised early motion within 2 weeks.
  • 3- internal fixation with a tension band, followed by immediate physical therapy.
  • 4- immobilization until fracture healing is complete.
  • 5- functional bracing.

 

  • Question 99.105
  • Answer = 2
  • Reference(s)
  • Koval KJ, Gallagher MA, Marsicano JG, et al: Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg 1997;79A:203‑207.

 

  • 99.106 Figure 23 shows the radiograph of a 60-year-old man who has had a painful
  • prosthetic hip for the past 6 months. What is the primary cause of the
  • radiographic findings?
  • 1- Loosening of the acetabular component
  • 2- Loosening of the femoral component
  • 3- Prosthesis-associated neoplasm
  • 4- Polyethylene wear debris
  • 5- Infection
  • Figure 23

 

  • Question 99.106
  • Answer = 4
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389‑426. Schmalzried TP, Jasty M, Harris WH: Periprosthetic bone loss in total hip arthroplasty: Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg 1992;74A:849‑863.

 

  • 99.107 Following closed reduction, the injury shown in Figure 24 remains unstable.
  • Management should now include
  • 1- cast immobilization.
  • 2- external fixation.
  • 3- percutaneous pinning.
  • 4- arthrodesis.
  • 5- ligamentous reconstruction.
  • Figure 24

 

  • Question 99.107
  • Answer = 5
  • Reference(s)
  • Simonian PT, Trumble TE: Traumatic dislocation of the thumb carpometacarpal joint: Early ligamentous reconstruction versus closed reduction and pinning. J Hand Surg 1996;21B:802-806. Chen VT: Dislocation of the carpometacarpal joint of the thumb. J Hand Surg 1987;12B:246‑251.

 

  • 99.108 Sprengel's deformity (congenital elevation of the scapula) is most commonly
  • associated with
  • 1- neurofibromatosis.
  • 2- syndactyly of the ipsilateral hand.
  • 3- pseudarthrosis of the clavicle.
  • 4- Klippel-Feil syndrome.
  • 5- aplastic anemia.

 

  • Question 99.108
  • Answer = 4
  • Reference(s)
  • Greitemann B, Rondhuis JJ, Karbowski A: Treatment of congenital elevation of the scapula: 10 (2‑18) year follow‑up of 37 cases of Sprengel's deformity. Acta Orthop Scand 1993;64:365‑368.

 

  • 99.109 Which of the following is the correct sequence of nerve fiber failure in a
  • neurapraxia?
  • 1- Motor, proprioceptor, touch, temperature, pain
  • 2- Motor, pain, temperature, touch, proprioceptor
  • 3- Pain, temperature, touch, proprioceptor, motor
  • 4- Temperature, pain, touch, proprioceptor, motor
  • 5- Touch, temperature, pain, proprioceptor, motor

 

  • Question 99.109
  • Answer = 1
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL„ American Academy of Orthopaedic Surgeons, 1994, pp 325‑396.

 

  • 99.110 Restoration of maximal forearm rotation during treatment of a both-bone
  • fracture of the forearm in an adult depends on the
  • 1- timing of the surgery.
  • 2- use of an indirect reduction technique.
  • 3- use of a volar approach to the radius.
  • 4- initiation of early motion.
  • 5- restoration of a normal radial bow.

 

  • Question 99.110
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 269‑281. Schemitsch EH, Richards RR: The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg 1992:74A:1068‑1078.

 

  • 99.111 During a primary decompressive laminectomy for spinal stenosis, a linear
  • 2-cm dural tear with leakage of spinal fluid is noted. Management of the
  • tear should consist of
  • 1- primary watertight repair.
  • 2- placement of a subarachnoid drain.
  • 3- repair with a cadaveric dural patch.
  • 4- inside-out placement of a muscle patch.
  • 5- use of fibrin glue and Gelfoam.

 

  • Question 99.111
  • Answer = 1
  • Reference(s)
  • Marshall LF: Cerebrospinal fluid leaks: Etiology and repair, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 1892‑1898. Wiesel SW: Neurological complications in lumbar laminectomy, in Garfin SR (ed): Complications of Spine Surgery. Baltimore, MD, Williams and Wilkins, 1989, pp 65‑74.

 

  • 99.112 Figures 25a and 25b show the AP and lateral radiographs, and Figures 25c and 25d show the T1- and T2-weighted MRI scans of a 42-year-old man who has a painful mass of the ankle. Figure 25e shows a histopathologic specimen. What is the most likely diagnosis?
  • 1- Aneurysmal bone cyst
  • 2- Giant cell tumor
  • 3- Hemangioma
  • 4- Osteomyelitis
  • 5- Intraosseous ganglion
  • Figures 25:
  • A
  • B
  • C
  • D
  • E

 

  • Question 99.112
  • Answer = 5
  • Reference(s)
  • Bauer TW, Dorfman HD: Intraosseous ganglion: A clinicopathologic study of 11 cases. Am J Surg Pathol 1982:6:207‑213. Helwig U, Lang S, Baczynski M, et al: The intraosseous ganglion: A clinical Pathological report on 42 cases. Arch Orthop Trauma Surg 1994;114:14‑17.

 

  • 99.113 A 31-year-old man who is involved
  • in a head-on motor vehicle accident
  • sustains the injury shown in Figure
  • 26a. Figure 26b shows the CT scan
  • obtained after closed reduction. The
  • most critical factor in minimizing the
  • risk of osteonecrosis of the
  • weightbearing surface of the femoral
  • head is the
  • 1- interval between injury and reduction of the
  • dislocation.
  • 2- surgical approach chosen for internal
  • fixation of the fracture.
  • 3- type of internal fixation used for the fracture
  • 4- presence of other musculoskeletal injuries.
  • 5- size of the femoral head fracture fragment.
  • Figures 26A & B

 

  • Question 99.113
  • Answer = 1
  • Reference(s)
  • Epstein HC: Posterior fracture‑dislocations of the hip: Long‑term follow‑up. J Bone Joint Surg 1974;56A:1103‑1129. Browner BD, Jupiter JB. Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 1369‑1384.

 

  • 99.114 A 14-year-old boy has acute pain and swelling in the anterior knee as the
  • result of tripping while playing soccer. Radiographs show a fracture that
  • passes proximally and posteriorly across the physis, and the proximal
  • articular surface of the tibia is displaced 7 mm at the articular surface.
  • Management should include
  • 1- closed reduction under a hematoma block and a long leg cylinder cast with the
  • knee in extension.
  • 2- closed reduction under a hematoma block and a range of motion brace set at 0° to
  • 30° of flexion.
  • 3- closed reduction under general anesthesia and smooth pin fixation.
  • 4- open reduction under general anesthesia and screw fixation.
  • 5- open reduction under general anesthesia, epiphysiodesis of the remaining proximal
  • tibial physis, and a long leg cylinder cast with the knee in extension.

 

  • Question 99.114
  • Answer = 4
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL., American Academy of Orthopaedic Surgeons, 1996, pp 437‑452.

 

  • 99.115 A 17-year-old high school football player sustains a burner or stinger after
  • tackling another player. Examination immediately following the injury will
  • most likely reveal weakness of the
  • 1- infraspinatus, teres minor, and trapezius muscles.
  • 2- deltoid, biceps, and spinatus muscles.
  • 3- triceps, wrist, and finger extension muscles.
  • 4- latissimus dorsi and rhomboid muscles.
  • 5- finger flexor and interossei muscles.

 

  • Question 99.115
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 653‑671. Torg SS, Gennarelli TA: Head and cervical spine injuries, in DeLee JC, Drez D (eds): Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, PA, WB Saunders, 1994, pp 417‑462.

 

  • 99.116 Figures 27a and 27b show the MRI scan and clinical photograph of a
  • young woman who has a dumbbell-shaped lesion. What is the most likely
  • diagnosis?
  • 1- Desmoid tumor
  • 2- Scleroderma
  • 3- Sarcoidosis
  • 4- Neurofibromatosis
  • 5- Marfan syndrome
  • B
  • Fig. 27A

 

  • Question 99.116
  • Answer = 4
  • Reference(s)
  • Verbiest H: The Cervical Spine, ed 2. Philadelphia, PA, JB Lippincott, 1989, pp 723‑774.

 

  • 99.117 A 38-year-old woman was treated surgically for a transverse patellar
  • fracture 4 months ago. The fracture is healed and the hardware is intact;
  • however, she now reports severe diffuse pain. Although she gained 60° of
  • flexion soon after surgery and her pain was tolerable in the early
  • postoperative period, she now has continuous and severe searing pain that
  • coincides with the initiation of physical therapy to increase knee motion.
  • Examination reveals that the knee is cool to touch with a small effusion,
  • moderate edema, and no palpable hardware. Radiographs show a healed
  • well-reduced fracture with diffuse osteopenia. Management should consist
  • of
  • 1- arthroscopic lysis of adhesions.
  • 2- arthroscopic irrigation and debridement.
  • 3- ionophoresis.
  • 4- a sympathetic block.
  • 5- neuroma resection.

 

  • Question 99.117
  • Answer = 4
  • Reference(s)
  • Cooper DE, DeLee JC: Reflex sympathetic dystrophy of the knee. J Am Acad Orthop Surg 1994;2:79‑86. Lindenfeld TN, Bach BR Jr, Wojtys EM: Reflex sympathetic dystrophy and pain dysfunction in the lower extremity, in Springfield D (ed): Instructional Course Lectures 46. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 261‑268.

 

  • 99.118 Which of the following soft-tissue tumors has the following MRI scan
  • signal characteristics: high signal on T,-weighted images and intermediate
  • to high signal on T2-weighted images?
  • 1- Synovial sarcoma
  • 2- Extra-abdominal desmoid tumor
  • 3- Malignant fibrous histiocytoma
  • 4- Lipoma
  • 5- High-grade pleomorphic liposarcoma

 

  • Question 99.118
  • Answer = 4
  • Reference(s)
  • Moser RP, Madewell JE: Radiologic evaluation of soft tissue tumors, in Enzinger FM, Weiss SW (eds): Soft Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 39‑88. Sim FH, Frassica FJ, Frassica DA: Soft‑tissue tumors: Diagnosis, evaluation, And management. J Am Acad Orthop Surg 1994;2:202‑211. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 81‑87.

 

  • 99.119 Figure 28 shows the current radiograph of a 22-year-old male basketball player who has had pain for the past 3 months despite undergoing nonsurgical treatment of a fracture of the proximal aspect of the fifth metatarsal. Based on the radiographic findings, which of the following structures has been injured?
  • 1- Intramedullary nutrient artery
  • 2- Peroneal sleeve
  • 3- Metaphyseal vessels
  • 4- Interossei muscles
  • 5- Abductor digiti minimi muscle
  • Figure 28

 

  • Question 99.119
  • Answer = 1
  • Reference(s)
  • Torg JS, Balduini FC, Zelko RR, et al: Fractures of the base of the fifth metatarsal distal to the tuberosity: Classification and guidelines for nonsurgical and surgical management. 1Bone Joint Surg 1984;66A:209‑214. Dameron TB Jr: Fractures of the proximal fifth metatarsal: Selecting the best Treatment option. J Am Acad Orthop Surg 1995;3:1 10‑1 14.

 

  • 99.120 A 13-year-old girl sustained an ankle fracture playing basketball 1 year ago, and
  • management consisted of a cast. She now reports fatigue and pain in the ankle on
  • walking and has been unable to return to sports. Radiographs reveal an 18°varus
  • deformity of the distal tibia and 1.5 cm of shortening when compared with the other
  • side The distal tibial physis is symmetrically closed, but the distal fibular growth plate
  • remains open. Management should now include
  • 1- a shoe orthotic with a 1-cm lift.
  • 2- distal fibular epiphysiodesis.
  • 3- gradual angular correction of the tibia with fibular shortening.
  • 4- a one-stage opening wedge angular correction of the tibia, distal fibular osteotomy,
  • and distal fibular epiphysiodesis.
  • 5- a one-stage closing wedge osteotomy and distal fibular epiphysiodesis.

 

  • Question 99.120
  • Answer = 4
  • Reference(s)
  • Takakura Y, Takaoka T, Tanaka Y, et al: Results of opening wedge osteotomy for the treatment of a posttraumatic varus deformity of the ankle. J Bone Joint Surg 1998;80A:213-218.

 

  • 99.121 Medial dislocation of the long head of the biceps is most commonly associated
  • with injury of which of the following structures?
  • 1- Coracoacromial ligament
  • 2- Anteroinferior glenohumeral ligament
  • 3- Subscapularis tendon
  • 4- Pectoralis major tendon
  • 5- Latissimus dorsi tendon

 

  • Question 99.121
  • Answer = 3
  • Reference(s)
  • Walch G, Nove‑Josserand L, Boileau P, et al: Subluxations and dislocations of the tendon of the long head of the biceps. 1 Shoulder Elbow Surg 1998;7:100‑108. Burkhead WZ Jr: The biceps tendon, in Rockwood CA Jr, Matsen FA III (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1990, pp 799‑830.

 

  • 99.122 Radiographs of the arm of a 25-year-old man reveal a fracture of the
  • proximal third of the ulna and a posterolaterally dislocated radial head. The
  • patient reports weakness of the hand. Examination will most likely reveal
  • 1- weakness of power pinch.
  • 2- weakness of flexion of the interphalangeal joint of the thumb.
  • 3- mild clawing of the ulnar digits.
  • 4- extension of the wrist in radial deviation.
  • 5- an inability to oppose the thumb.

 

  • Question 99.122
  • Answer = 4
  • Reference(s)
  • Bruce HE, Harvey JP, Wilson JC Jr: Monteggia fractures. J Bone Joint Surg 1974;56A:1563 1576. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, II„ American Academy of Orthopaedic Surgeons, 1996, pp 269‑281. Rockwood CA, Green DP, Bucholz RW, et al: Fractures of the shafts of the radius and ulna, in Fractures in Adults. Philadelphia, PA, Lippincott‑Raven, 1996, pp 869‑928.

 

  • 99.123 Which of the following imaging studies most accurately assesses the healing
  • of a spondylolytic lesion in a young athlete?
  • 1- AP, lateral, and oblique radiographs of the lumbar spine
  • 2- Flexion and extension radiographs
  • 3- MRI scan
  • 4- CT scan
  • 5- Technetium bone scan

 

  • Question 99.123
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 699‑706. Congeni J, McCulloch J, Swanson K: Lumbar spondylolysis: A study of natural Progression in athletes. Am J Sports Med 1997;25:248‑253.

 

  • 99.124 A morbidly obese 28-year-old man
  • sustains the vertically stable pelvic
  • fracture shown in Figure 29.
  • Treatment should consist of
  • 1- anterior external fixation.
  • 2- a posterior pelvic clamp.
  • 3- open reduction and internal fixation with an
  • anterior plate alone.
  • 4- open reduction and internal fixation with an
  • anterior plate and posterior sacral iliac
  • screws.
  • 5- open reduction and internal fixation with
  • posterior sacral iliac screws alone.
  • Figure 29

 

  • Question 99.124
  • Answer = 3
  • Reference(s)
  • Tornetta P III, Dickson K, Matta JM: Outcome of rotationally unstable pelvic ring injuries treated operatively. Clin Orthop 1996;329:147‑151. Pohlemann T, Bosch U, Gansslen A, et al: The Hannover experience in management of pelvic fractures. Clin Orthop 1994;305:69‑80.

 

  • 99.125 A 4-year-old girl with Larsen's syndrome ambulates with a knee-ankle-foot
  • orthosis. Following bilateral clubfoot releases 6 months ago, the child has had
  • progressive difficulty in walking endurance. Examination reveals a recurrence
  • of equinus. Management should now include
  • 1- serial casting of the feet.
  • 2- imaging studies of the cervical spine.
  • 3- bilateral Achilles tendon lengthening.
  • 4- supramalleolar closing wedge osteotomies.
  • 5- botulinum toxin injection into the gastrocnemius.

 

  • Question 99.125
  • Answer = 2
  • Reference(s)
  • Micheli LJ, Hall JE, Watts HG: Spinal instability in Larsen's syndrome: Report of three cases. J Bone Joint Surg 1976;58A:562‑565.

 

  • 99.126 The development of a hallux varus deformity after bunion surgery is most
  • commonly related to
  • 1- undercorrection of the intermetatarsal angle.
  • 2- inadequate repair of the lateral capsule of the metatarsophalangeal joint.
  • 3- the development of osteonecrosis of the metatarsal head.
  • 4- excessive resection of the medial eminence of the metatarsal head.
  • 5- failure to restore the sesamoids to their normal position.

 

  • Question 99.126
  • Answer = 4
  • Reference(s)
  • Mann RA, Coughlin MJ: Adult hallux valgus, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 284‑294. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 141‑162.

 

  • 99.127 The most frequently occurring complication following total hip surgery in patients
  • with ankylosing spondylitis is
  • 1- loosening.
  • 2- wound dehiscence.
  • 3- dislocation.
  • 4- heterotopic ossification.
  • 5- infection.

 

  • Question 99.127
  • Answer = 4
  • Reference(s)
  • Walker LG, Sledge CB: Total hip arthroplasty in ankylosing spondylitis. Clin Orthop 19911262:198‑204. Callaghan JJ. Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 79‑86.

 

  • 99.128 Which of the following is considered the most important factor in avoiding
  • infection in the management of open tibial fractures?
  • 1- A 72-hour course of antibiotics
  • 2- Use of antibiotics in the irrigant fluid
  • 3- Adequate wound extension and tissue debridement
  • 4- Immediate rigid skeletal stability
  • 5- Soft-tissue coverage between 14 and 21 days

 

  • Question 99.128
  • Answer = 3
  • Reference(s)
  • Sanders R, Swiontkowski M, Nunley J, et al: The management of fractures with soft‑tissue disruptions. J Bone Joint Surg 1993;75A:778‑789. Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 316‑320. Norris BL, Kellam JF: Soft‑tissue injuries associated with high‑energy extremity trauma: Principles of management. J Am Acad Orthop Surg 1997;5:37‑46.

 

  • 99.129 A 4-year-old girl has feet that turn in, and examination reveals a foot-
  • progression angle of 25° internal. In the prone position, the feet are normal,
  • the thigh-foot angle is 10° internal, and the hips internally rotate 75° and
  • externally rotate 15°. Management should consist of
  • 1- twister cables.
  • 2- a Denis Browne bar.
  • 3- proximal femoral osteotomy.
  • 4- distal femoral osteotomy.
  • 5- observation.

 

  • Question 99.129
  • Answer = 5
  • Reference(s)
  • Staheli LT: Rotational problems in children, in Schafer M (ed): Instructional Course Lectures 43. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 199‑209.

 

  • 99.130 A patient with the myelographic findings shown in Figure 30 would most likely have difficulty with which of the following activities?
  • 1- Walking in a mall
  • 2- Pushing a cart in a grocery store
  • 3- Sitting
  • 4- Lying down
  • 5- Swimming
  • Fig. 30

 

  • Question 99.130
  • Answer = 1
  • Reference(s)
  • Lumbar spinal stenosis, in Weinstein JN, Wiesel SW (eds): The Lumbar Spine. Philadelphia, PA, The International Society for the Study of the Lumbar Spine, 1990, pp 546‑611.

 

  • 99.131 A child with pseudoachondroplasia, an autosomal-dominant condition, is born to parents of average stature. Two years later, they have another child with the same condition. What is the most likely explanation for this condition?
  • 1- High levels of radiation in the locality
  • 2- Consanguinity in the family's ancestry
  • 3- Germline mosaicism
  • 4- Lyon hypothesis
  • 5- Phenomenon of anticipation

 

  • Question 99.131
  • Answer = 3
  • Reference(s)
  • Cole WG: Genetic aspects of orthopaedic diseases, in Morrissey RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 117‑136.

 

  • 99.132 Figures 31a and 31b show the radiograph and biopsy specimen of a
  • 57-year-old man with no history of trauma who has had painful swelling of
  • the distal phalanx of the little finger for the past 2 months. What is the
  • most likely diagnosis?
  • 1- Osteomyelitis
  • 2- Epidermal inclusion cyst
  • 3- Metastatic lung carcinoma
  • 4- Metastatic kidney carcinoma
  • 5- Metastatic prostate carcinoma
  • Figure 31A
  • Figure 31B

 

  • Question 99.132
  • Answer = 3
  • Reference(s)
  • Lombardi RM, Amadio PC: Acrometastases, in Sim FH (ed): Diagnosis and Management of Metastatic Bone Disease: A Multidisciplinary Approach. New York, NY, Raven Press, 1988, pp 237‑243. Kerin R: Metastatic tumors of the hand: A review of the literature. J Bone Joint Surg 1983;65A:1331‑1335.

 

  • 99.133 A 34-year-old man sustains an open proximal tibia fracture with the loss of
  • a 5-cm x 5-cm area of skin over the fracture site anteromedially. The
  • rotational muscle flap that should be used to obtain coverage of the fracture
  • is based on which of the following arteries?
  • 1- Popliteal
  • 2- Sural
  • 3- Anterior tibial
  • 4- Posterior tibial
  • 5- Peroneal

 

  • Question 99.133
  • Answer = 2
  • Reference(s)
  • Pico R, Luscher NJ, Rometsch M, et al: Why the denervated gastrocnemius muscle flap should be encouraged‑ Ann Plast Surg 1991;26:312‑324.

 

  • 99.134 A patient is pain-free and walks without ambulatory aids after undergoing
  • routine total knee arthroplasty 6 weeks ago. Examination reveals an extensor
  • lag of 15°, with passive motion of 0° to 110° without pain. Management
  • should consist of
  • 1- nonsteroidal anti-inflammatory drugs.
  • 2- quadriceps strengthening exercises.
  • 3- continuous passive motion.
  • 4- arthroscopic debridement.
  • 5- revision to a thinner tibial tray.

 

  • Question 99.134
  • Answer = 2
  • Reference(s)
  • Gotlin RS, Hershkowitz S, Juris PM, et al: Electrical stimulation effect on extensor leg and length of hospital stay after total knee arthroplasty. Arch Phys Med Rehabil 1994;75:957 959.

 

  • 99.135 Examination of a 1-year-old boy reveals that he is unable to bend his right
  • knee. The parents state that the child was normal at birth; however, he was
  • quite sick as an infant and required prolonged antibiotic treatment for sepsis.
  • They also report that the child began to walk at age 10 months and has a
  • dimple on the upper thigh. What is the most likely diagnosis?
  • 1- Larsen's syndrome
  • 2- Cerebral palsy hemiplegia
  • 3- Arthrogryposis
  • 4- Congenital dislocation of the knee
  • 5- Infantile quadriceps fibrosis

 

  • Question 99.135
  • Answer = 5
  • Reference(s)
  • Sengupta S: Pathogenesis of infantile quadriceps fibrosis and its correction by proximal release. J Pediatr Orthop 1985;5:187‑191.

 

  • 99.136 Which of the following factors best predicts an increased risk for development of
  • a foot ulcer in a diabetic patient?
  • 1- History of a previous foot ulcer
  • 2- History of type I diabetes mellitus for more than 10 years
  • 3- History of poor glucose control
  • 4- Inability to detect a 5.07 Semmes-Weinstein filament on the plantar surface of the
  • foot
  • 5- An ankle-brachial index of less than 0.5

 

  • Question 99.136
  • Answer = 1
  • Reference(s)
  • McDermott JE (ed): The Diabetic Foot. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 1‑12. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL„ American Academy of Orthopaedic Surgeons, 1994, pp 133‑140.

 

  • 99.137 What percent of circulating blood volume must be lost in a healthy 25-year-old man
  • with acute hemorrhage before a sustained decrease in systolic blood pressure occurs?
  • 1- 5%
  • 2- 20%
  • 3- 35%
  • 4- 50%
  • 5- 65%

 

  • Question 99.137
  • Answer = 3
  • Reference(s)
  • Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 137‑138. Peitzman AB, Billiar TR, Harbrecht BG, et al: Hemorrhagic shock. Curr Probl Surg 1995;32:925‑1002.

 

  • 99.138 The genetic defect in the congenital type of spondyloepiphyseal dysplasia
  • involves
  • 1- sulfate transport enzyme.
  • 2- fibrillin.
  • 3- type II collagen.
  • 4- fibroblast growth factor receptor protein.
  • 5- alpha-L iduronidase.

 

  • Question 99.138
  • Answer = 3
  • Reference(s)
  • Dietz FR, Mathews KD: Update on the genetic bases of disorders with orthopaedic manifestations. J Bone Joint Surg 1996;78A:1583‑1598.

 

  • 99.139 Figure 32 shows the clinical photograph of a 27-year-old woman who
  • sustained a close- range shotgun injury to the hand. Examination reveals no
  • fractures or major neurovascular deficits. Wound closure should consist of
  • 1- serial dressing changes, wound contraction, and epithelialization.
  • 2- a split-thickness skin graft.
  • 3- a tubed groin flap.
  • 4- a flag flap from the index finger.
  • 5- a posterior interosseous island flap.
  • Figure 32

 

  • Question 99.139
  • Answer = 5
  • Reference(s)
  • Mazzer N, Barbieri CH, Cortez M: The posterior interosseous forearm island flap for skin defects in the hand and elbow: A prospective study of 51 cases. J Hand Surg 1996;21B:237 243. Buchler U, Frey HP: Retrograde posterior interosseous flap. J Hand Surg 1991;16A:283‑292.

 

  • 99.140 The most likely obstacle to closed reduction of the injury shown in Figures
  • 33a and 33b is the
  • 1- posterior tibial tendon.
  • 2- tibialis anterior tendon.
  • 3- extensor digitorum brevis.
  • 4- talar neck fracture.
  • 5- talar head buttonholed through the
  • extensor retinaculum.
  • Figure 33A
  • B

 

  • Question 99.140
  • Answer = 1
  • Reference(s)
  • DeLee JC, Curbs R: Subtalar dislocation of the foot. J Bone Joint Surg 1982; 64A:433‑437. Saltzman C, Marsh JL: Hindfoot dislocations: When are they not benign? J Am Acad Orthop Surg 1997;5:192‑198. Waldrop J, Ebraheim NA, Shapiro P, et al: Anatomical considerations of posterior tibialis tendon entrapment in irreducible lateral subtalar dislocation. Foot Ankle 1992;13:458‑461.

 

  • 99.141 Examination of a radiograph obtained prior to revision arthroplasty reveals a 2-cm
  • inflammatory lytic lesion in the ilium surrounding a fixation screw. At the time of
  • surgery, the acetabular component is found to be stable. Treatment of the lesion
  • should include
  • 1- filling the bony void with acrylic cement.
  • 2- revision of the acetabular component with a cemented polyethylene component.
  • 3- exchange of the acetabular component with an oversized noncemented
  • component.
  • 4- exchange of the modular polyethylene liner only with bone grafting of the
  • osteolytic defect.
  • 5- exchange of the acetabular component with a protrusio shell for supplemental
  • fixation.

 

  • Question 99.141
  • Answer = 4
  • Reference(s)
  • Maloney WJ, Herzwurm P, Paprosky W, et al: Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg 1997;79A:1628‑1634.

 

  • 99.142 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.143 Examination of a 23-year-old motorcyclist who was struck by a car reveals
  • a systolic blood pressure of 90 mm/Hg and a pulse rate of 140/min. Initial
  • assessment reveals a normal chest radiograph, a grade II open tibia fracture
  • without vascular injury, a negative diagnostic peritoneal tap, microscopic
  • hematuria, a hemoglobin level of 6 g/dL (normal 12 to 15.5 g/dL), and a
  • rotationally unstable pelvic fracture with symphyseal widening. In addition
  • to appropriate fluid resuscitation, the next step in management should
  • include
  • 1- a laparotomy.
  • 2- angiography.
  • 3- external fixation of the pelvis.
  • 4- irrigation and debridement of the open tibia.
  • 5- open reduction and internal fixation of the symphysis.

 

  • Question 99.143
  • Answer = 3
  • Reference(s)
  • Poka A, Libby EP: Indications and techniques for external fixation of the pelvis. Clin Orthop 1996;329:54‑59. Olson SA, Pollak AN: Assessment of pelvic ring stability after injury: Indications for surgical stabilization. Clin Orthop 1996;329:15‑27. Ghanayem AJ, Stover MD, Goldstein JA, et al: Emergent treatment of pelvic fractures: Comparison of methods for stabilization. Clin Orthop 1995;318:75‑80.

 

  • 99.144 A 6-year-old boy sustains a closed fracture of the radius and ulna at the
  • junction of the middle and distal one third of the bones. The fracture is
  • completely displaced with 40° of apex volar angulation. Manipulation under a
  • hematoma block obtains a reduction, and radiographs show approximately
  • 60% apposition of the fracture ends with no appreciable angulation.
  • Management should now include
  • 1- remanipulation under general anesthesia, followed by splinting in neutral.
  • 2- remanipulation under IV sedation, followed by splinting in neutral.
  • 3- a long arm molded cast with the forearm in pronation.
  • 4- closed reduction under general anesthesia with percutaneous intramedullary
  • nailing.
  • 5- open reduction and internal fixation with dynamic compression plates.

 

  • Question 99.144
  • Answer = 3
  • Reference(s)
  • Price CT, Scott DS, Kurzner ME, et al: Malunited forearm fractures in children. J Pediatr Orthop 1990;10:705‑712. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 259‑267.

 

  • 99.145 A 73-year-old woman has had aching pain in the right ankle region for the past 4 months. Results of serum and urine protein electrophoresis show normal migration. Figures 34a through 34c show the plain lateral radiograph of the talus, sagittal T,-weighted MRI scan, and biopsy specimen. What is the most likely diagnosis?
  • 1- Metastatic carcinoma
  • 2- Lymphoma
  • 3- Multiple myeloma
  • 4- Fibrosarcoma
  • 5- Malignant fibrous histiocytoma

 

  • Question 99.145
  • Answer = 2
  • Reference(s)
  • Baar J, Burkes RL, Bell R, et al: Primary non‑Hodgkin's lymphoma of bone: A clinicopathologic study. Cancer 1994;73:1194‑1199. Huvos AG: Skeletal manifestations of malignant lymphomas and leukemias, in Huvos AG (ed): Bone Tumors: Diagnosis, Treatment, and Prognosis, ed 2.Philadelphia, PA, WB Saunders, 1991, pp 625‑637.

 

  • 99.146 A 45-year-old woman has pain in the metatarsophalangeal (MTP) joint of the
  • great toe with all weightbearing activities. Management consisting of shoe
  • modification and an insert has failed to provide relief. Examination of the joint
  • reveals a 45-degree arc of motion with pain in full flexion. Radiographs show
  • minimal degenerative changes, with dorsal and medial osteophytes on the
  • metatarsal head. Treatment should now include
  • 1- resection arthroplasty of the MTP joint.
  • 2- a Silastic implant of the MTP joint.
  • 3- arthrodesis of the MTP joint.
  • 4- dorsiflexion osteotomy of the base of the proximal phalanx.
  • 5- excision of the osteophytes and dorsal one third of the metatarsal head.

 

  • Question 99.146
  • Answer = 5
  • Reference(s)
  • Mann RA, Clanton TO: Hallux rigidus: Treatment by cheilectomy. J Bone Joint Surg 1988;70A:400‑406. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle.Rosemont IL, American Academy of Orthopaedic Surgeons, 1994, pp 141‑162.

 

  • 99.147 What is the most likely mechanical cause of recurrent dislocations in a patient who
  • underwent a total hip replacement through an anterolateral approach 4 months ago?
  • 1- Stem placed in excessive valgus
  • 2- Stem placed in excessive varus
  • 3- Excessively anteverted acetabular cup
  • 4- Horizontally tilted acetabular cup
  • 5- Vertically tilted acetabular cup

 

  • Question 99.147
  • Answer = 3
  • Reference(s)
  • Krushell RJ, Burke DW, Harris WH: Elevated‑rim acetabular components: Effect on range of motion and stability in total hip arthroplasty. J Arthroplasty 1991;6:553‑558. Money BF: Instability after total hip arthroplasty. Orthop Clin North Am 1992;23:237‑248.

 

  • 99.148 What is the first stage of fracture healing?
  • 1- Remodeling
  • 2- Soft callus formation
  • 3- Hard callus formation
  • 4- Periosteal reaction
  • 5- Inflammation

 

  • Question 99.148
  • Answer = 5
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 277‑323.

 

  • 99.149 A 61-year-old man has permanent radial nerve palsy following excision of a
  • tumor. Which of the following sets of transfers will provide the best
  • function?
  • 1- Flexor carpi ulnaris to extensor digitorum communis and palmaris longus to
  • extensor pollicis longus
  • 2- Flexor carpi ulnaris to extensor carpi radialis brevis, flexor carpi radialis to extensor
  • digitorum communis, and flexor digitorum sublimis to extensor carpi ulnaris
  • 3- Ring flexor digitorum sublimis to extensor digitorum communis, flexor carpi
  • radialis to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis
  • 4- Palmaris longus to extensor carpi radialis brevis, pronator teres to extensor pollicis
  • longus, and ring flexor digitorum sublimis to extensor digitorum communis
  • 5- Pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor
  • digitorum communis, and palmaris longus to extensor pollicis longus

 

  • Question 99.149
  • Answer = 5
  • Reference(s)
  • Green DP: Radial nerve palsy, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1401‑1417.

 

  • 99.150 Figures 35a and 35b show the AP and lateral radiographs of a 75-year-old
  • woman who fell and injured her dominant left elbow. What is the most
  • appropriate treatment?
  • 1- Hinged elbow distractor
  • 2- Open reduction and internal fixation with
  • a figure-of-8 tension band
  • 3- Open reduction and internal fixation with
  • a 3.5 dynamic compression plate
  • 4- Closed reduction and cast immobilization
  • 5- Closed reduction and early range of motion
  • Figure 35A
  • B

 

  • Question 99.150
  • Answer = 3
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 405‑413. Jupiter JB, Kellam JF: Diaphyseal fractures of the forearm, in Browner BD. Jupiter JB, Levine AM (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 1421 1454.

 

  • 99.151 Figure 36 shows the radiograph of the long
  • finger of a 72-year-old woman who has had
  • pain and swelling in the distal aspect of her
  • finger for 1 week. Specimens obtained on
  • aspiration will most likely reveal
  • 1- gram-positive cocci in chains.
  • 2- gram-negative bacillus.
  • 3- many polymorphonuclear neutrophil leukocytes, but
  • no organisms.
  • 4- tapered negative birefringent crystals noted by
  • polarized microscopy.
  • 5- blunt positive birefringent crystals noted by
  • polarized microscopy.
  • Figure 36

 

  • Question 99.151
  • Answer = 4
  • Reference(s)
  • Resnik CS, Miller BW, Gelberman RH, et al: Hand and wrist involvement in calcium pyrophosphate dihydrate crystal deposition disease. J Hand Surg 1983;8:856‑863.

 

  • 99.152 Radiographs of a 14-year-old boy who has back pain and a hunched back
  • reveal wedging of T7 to T10, and an overall kyphosis of 61°. On
  • hyperextension radiographs, the curve corrects to 39°. The iliac apophyses
  • have just started to ossify. Management of the pain and deformity should
  • include
  • 1- a corrective thoracolumbosacral orthosis worn 22 hours per day.
  • 2- a thoracolumbosacral orthosis (Charleston-type) worn at night only.
  • 3- posterior spinal fusion with segmental instrumentation.
  • 4- anterior and posterior fusion with posterior segmental instrumentation.
  • 5- anterior fusion and anterior instrumentation.

 

  • Question 99.152
  • Answer = 1
  • Reference(s)
  • Lowe TG: Scheuermann disease. J Bone Joint Surg 1990;72A:940‑945. Bradford DS. Moe JH, Montalvo FJ, et al: Scheuermann's kyphosis and roundback deformity: Results of Milwaukee brace treatment. J Bone Joint Surg 1974:56A:740‑758.

 

  • 99.153 Figures 37a and 37b show the
  • radiographs of the arm of a 19-year-
  • man. Examination reveals a 2-cm
  • posterior wound and a radial nerve
  • palsy. In addition to irrigation and
  • debridement of the open fracture and
  • exploration of the radial nerve,
  • management should include
  • 1- antegrade intramedullary nailing.
  • 2- retrograde intramedullary nailing.
  • 3- plating through an anterolateral approach.
  • 4- plating through a posterior approach.
  • 5- closed reduction and splinting, followed by
  • application of a fracture brace.
  • Figures 37A & B

 

  • Question 99.153
  • Answer = 4
  • Reference(s)
  • Sarmiento A, Kinman PB, Galvin EG, et al: Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg 1977;59A:596‑601. Zagorski JB, Latta LL, Zych GA, et al: Diaphyseal fractures of the humerus: Treatment with prefabricated braces. J Bone Joint Surg 1988;70A:607‑610.

 

  • 99.154 Chance-type fractures of the lumbar spine are usually the result of what
  • type of injury?
  • 1- Axial loading
  • 2- Axial rotation
  • 3- Hyperextension
  • 4- Hyperflexion
  • 5- Flexion-distraction

 

  • Question 99.154
  • Answer = 5
  • Reference(s)
  • Garfm SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 197‑218.

 

  • 99.155 The lytic destructive bone lesions in metastatic breast carcinoma are usually
  • caused by which of the following cells?
  • 1- Macrophages
  • 2- Stromal fibroblasts
  • 3- Osteoclasts
  • 4- Mast cells
  • 5- Langerhans' cells

 

  • Question 99.155
  • Answer = 3
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, p 176.

 

  • 99.156 Which of the following factors most strongly influences the risk of subsesquent
  • femoral head collapse in osteonecrosis of the femoral head?
  • 1- Etiology of osteonecrosis
  • 2- Location of the necrosis in the femoral head
  • 3- Size of the area of necrosis
  • 4- Duration of involvement
  • 5- Age of the patient

 

  • Question 99.156
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL., American Academy of Orthopaedic Surgeons, 1996, pp 389‑426. Steinberg ME, Hayken GD, Steinberg DR: A new method for evaluation and staging of avascular necrosis of the femoral head, in Arlet J, Ficat RP, Hungerford DS (eds): Bone Circulation. Baltimore, MD, Williams and Wilkins, 1984, pp 390‑403.

 

  • 99.157 Figures 38a through 38c show the plain radiograph and coronal T,- and
  • T2-weighted MRI scans of a 30-year-old man who has a painful lump over the distal deltoid on the lateral aspect of his arm. The mass is marginally excised, and a histologic section at the periphery of the mass is shown in Figure 38d. Management should include
  • 1- observation.
  • 2- serial follow-up staging studies.
  • 3- radiation therapy.
  • 4- wide reexcision, followed by radiation therapy.
  • 5- chemotherapy.
  • Figures 38:
  • A
  • B
  • C
  • D

 

  • Question 99.157
  • Answer = 1
  • Reference(s)
  • Enzinger FH, Weiss SW: Osseous soft tissue tumors, in Enzinger FM, Weiss SW (eds): Soft Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 1013‑1037. Huvos AG: Miscellaneous tumors of soft tissue and bone, in Huvos AG (ed): Bone Tumors. Diagnosis, Treatment and Prognosis, ed 2. Philadelphia, PA, WB Saunders, 1991, pp 745­ 753.

 

  • 99.158 A 48-year-old man has a painful hallux valgus deformity that has failed to respond
  • to nonsurgical management. A standing AP radiograph of the foot shows an
  • intermetatarsal angle of 20° and a hallux valgus angle of greater than 40°. Which
  • of the following procedures will most likely result in the greatest amount of patient
  • satisfaction?
  • 1- Keller arthroplasty
  • 2- Distal first metatarsal osteotomy
  • 3- Arthrodesis of the first metatarsophalangeal joint
  • 4- Double-stemmed Silastic implant arthroplasty
  • 5- Distal soft-tissue reconstruction and a proximal metatarsal osteotomy

 

  • Question 99.158
  • Answer = 5
  • Reference(s)
  • Coughlin MJ: Hallux valgus, in Springfield D (ed): Instructional Course Lectures 46. Rosemont IL., American Academy of Orthopaedic Surgeons, 1997, pp 357‑391. Mann RA: Decision‑making in bunion surgery, in Greene WB (ed): Instructional Course Lectures XXXIX. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 3 13.

 

  • 99.159 Which of the following veins is at risk if screws are placed in the
  • anterosuperior quadrant of an acetabular component in total hip
  • arthroplasty?
  • 1- Common iliac
  • 2- Superior gluteal
  • 3- Femoral
  • 4- Internal iliac
  • 5- External iliac

 

  • Question 99.159
  • Answer = 5
  • Reference(s)
  • Wasielewski RC, Crossett LS, Rubash HE: Neural and vascular injury in total hip arthroplasty. Orthop Clin North Am 1992;23:219‑235. Callaghan JJ. Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 163‑170.

 

  • 99.160 A 17-year-old high school student reports activity-related pain in her
  • dominant shoulder. Examination reveals hyperlaxity of the joints, and the
  • pain is reproduced with Neer's impingement sign. Inferior traction results in a
  • sulcus sign with a sensation of instability. Initial management should consist of
  • 1- arthroscopic anterior acromioplasty.
  • 2- arthroscopic glenoid labral debridement.
  • 3- open Bankart repair.
  • 4- exercises to strengthen the shoulder.
  • 5- an inferior capsular shift.

 

  • Question 99.160
  • Answer = 4
  • Reference(s)
  • Burkhead WZ Jr, Rockwood CA Jr: Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg 1992;74A:890‑896. Neer CS II, Foster CR: Inferior capsular shift for involuntary inferior and Multidirectional instability of the shoulder: A preliminary report. J Bone Joint Surg 1980;62A:897‑908.

 

  • 99.161 A 42-year-old woman has had persistent aching pain in her right arm for the past 9 months that now awakens her from sleep. Management consisting of oral narcotics has failed to provide relief. Figures 39a and 39b show the plain radiographs of the right humerus, and Figure 39c shows the biopsy specimen. What is the most likely diagnosis?
  • 1- Chondrosarcoma
  • 2- Ewing's sarcoma
  • 3- Enchondroma
  • 4- Osteosarcoma
  • 5- Malignant fibrous histiocytoma

 

  • Question 99.161
  • Answer = 1
  • Reference(s)
  • Unni KK: Chondrosarcoma (primary, secondary, dedifferentiated, and clear cell), in Unni KK (ed): Dahlin's Bone Tumors: General Aspects and Data on 11,087 cases, ed 5. Philadelphia, PA, Lippincott‑Raven, 1996, pp 71‑108. Huvos AG: Chondrosarcoma including spindle‑cell (dedifferentiated) and Myxoid chondrosarcoma: Mesenchymal chondrosarcoma, in Huvos AG (ed): Bone Tumors: Diagnosis, Treatment, and Prognosis, ed 2. Philadelphia, PA, WB Saunders, 1991, pp 343­ 393.

 

  • 99.162 Figure 40 shows the radiograph of a 23-year-old woman who sustained an
  • L1 fracture and isolated vertebral trauma from a fall while skiing.
  • Examination reveals that she is neurologically intact. Which of the
  • following conditions is considered an absolute indication for surgical
  • intervention?
  • 1- Canal compromise of 60% noted on a CT scan
  • 2- Epidural hematoma on an MRI scan
  • 3- Severe low back pain despite IV narcotics
  • 4- Progressive weakness of ankle dorsiflexion and plantarflexion
  • 5- Pronounced flank ecchymosis
  • Fig. 40

 

  • Question 99.162
  • Answer = 4
  • Reference(s)
  • Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 197‑217.

 

  • 99.163 A 40-year-old former professional athlete who is 6'5" and weighs 240 lb has
  • a painful 15° valgus deformity of the left knee with isolated lateral
  • compartment degenerative changes. Treatment should include
  • 1- unicompartmental replacement.
  • 2- distal femoral varus-producing osteotomy.
  • 3- proximal tibial varus-producing osteotomy.
  • 4- total knee replacement.
  • 5- knee arthrodesis.

 

  • Question 99.163
  • Answer = 2
  • Reference(s)
  • Edgerton BC. Mariam EM, Money BF: Distal femoral varus osteotomy for painful gems valgum: A five‑to‑ ll‑year follow‑up study. Clin Orthop 1993;288:263‑269. Healy WL, Anglen JO. Wasilewski SA, et al: Distal femoral vans osteotomy. J Bone Joint Surg 1988;70A:102‑109.

 

  • 99.164 When the diameter of a spinal instrumentation rod is increased from 4 mm
  • to 5 mm, the rod's ability to resist a bending moment is increased by
  • approximately what percent?
  • 1-10%
  • 2- 25%
  • 3- 50%
  • 4- 100%
  • 5- 300%

 

  • Question 99.164
  • Answer = 4
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, II„ American Academy of Orthopaedic Surgeons, 1994, pp 397‑446. Nordin M, Frankel VH: Basic Biomechanics of the Musculoskeletal System, ed 2. Philadelphia, PA, Lea and Febiger, 1989, pp 3‑30.

 

  • 99.165 A 28-year-old man involved in a motorcycle accident sustains a
  • pneumothorax, a closed fracture of the femur, and closed displaced fractures
  • of the ipsilateral humerus, radius, and ulna. Management of the femoral
  • fracture consists of internal fixation. Management of the humeral and forearm
  • fractures should consist of
  • 1- skeletal traction.
  • 2- closed reduction and plaster immobilization.
  • 3- open reduction and internal fixation of all fractures.
  • 4- external fixation of all fractures.
  • 5- internal fixation of the humeral fracture and immobilization of the forearm
  • fractures.

 

  • Question 99.165
  • Answer = 3
  • Reference(s)
  • Bone LB, Chapman MW: Initial management of the patient with multiple injuries, in Greene WB (ed): Instructional Course Lectures XXXIX. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 557‑563. Simpson NS, Jupiter JB: Complex fracture patterns of the upper extremity. Clin Orthop 1995;318:43‑53.

 

  • 99.166 Figures 41a through 41c show the axial T~- and T,-weighted MRI scans and the biopsy specimen of a 53-year-old patient who has a painless soft-tissue mass over the posterior aspect of the left proximal thigh. A radiograph and CT scan of the chest and a bone scan are normal.
  • Management should consist of
  • 1- radiation therapy and
  • chemotherapy.
  • 2- radiation therapy and wide
  • excision.
  • 3- radiation therapy and
  • debulking.
  • 4- wide excision alone.
  • 5- marginal excision alone.
  • Figures 41:
  • A
  • B
  • C

 

  • Question 99.166
  • Answer = 2
  • Reference(s)
  • Chang AE, Sondak VK: Clinical evaluation and treatment of soft tissue tumors,in Enzinger FM, Weiss SW (eds): Soft‑Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 17‑38. O'Connor MI, Gunderson LL, Edmonson JH: Multimodality management of malignant soft­ tissue tumors, in Simon MA, Springfield D (eds): Surgery for Bone and Soft‑Tissue Tumors. Philadelphia, PA, Lippincott‑Raven, 1998, pp 567‑575.

 

  • 99.167 Figure 42 shows the plain radiograph of a 32-year-old man who fell onto
  • his left shoulder while skiing. Examination reveals mobility and
  • prominence of the midshaft clavicle, and mild ipsilateral shoulder ptosis.
  • Management should consist of
  • 1- a figure-of-8 harness.
  • 2- open reduction and internal fixation with a plate and screws.
  • 3- open reduction and internal fixation with a cannulated intramedullary screw.
  • 4- a shoulder abduction cast.
  • 5- manipulative closed reduction and a sling.
  • Figure 42

 

  • Question 99.167
  • Answer = 1
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 191‑197. Craig EV: Fractures of the clavicle, in Rockwood CA Jr, Matsen FA III, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 42882.

 

  • 99.168 Which of the following variables will most likely prevent the development of
  • posttraumatic osteoarthrosis in surgically treated patients with displaced
  • complex acetabular fractures?
  • 1- Ilioinguinal surgical approach
  • 2- Reduction and fixation within 5 days
  • 3- Anatomic reduction
  • 4- Presence of three or fewer intra-articular fracture lines
  • 5- Presence of fracture lines in the weightbearing dome

 

  • Question 99.168
  • Answer = 3
  • Reference(s)
  • Letournel E, Judet R: Fractures of the Acetabulum, ed 2. New York, NY, Springer‑Verlag, 1993. Matta JM: Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg 1996;78A:1632 1645.

 

  • 99.169 Figures 43a and 43b show the sagittal and axial MRI cans of L4-L5 of a 31-year-old woman who reports back pain and sciatica. Which of the following neurologic abnormalities would be most consistent with these studies?
  • 1- Diminished ankle jerk
  • 2- Diminished knee jerk
  • 3- Presence of plantar extensor response
  • 4- Weakness of the iliopsoas
  • 5- Weakness of the extensor hallucis longus
  • B
  • Fig. 43A
  • B

 

  • Question 99.169
  • Answer = 5
  • Reference(s)
  • Wisnesk RJ, Garfm SR, Rothman RH: Lumbar disc disease, in Rothman RH, Simeone FA (eds): The Spine, ed 3. Philadelphia, PA, WB Saunders, 1992, pp 681‑746. Hoppenfeld S: Physical Examination of the Spine and Extremities. New York, NY, Appleton‑Century‑Crofts, 1976, pp 237‑263.

 

  • 99.170 Instability of the distal tibiofibular syndesmosis in a patient with an intact
  • fibula is best demonstrated preoperatively by
  • 1- a positive squeeze test.
  • 2- a medial clear space of 3 mm with the ankle in plantarflexion.
  • 3- a medial malleolar fracture with 2 mm of displacement.
  • 4- a tibiofibular clear space of 6 mm.
  • 5- pain on abduction stress testing.

 

  • Question 99.170
  • Answer = 4
  • Reference(s)
  • Amendola A: Controversies in diagnosis and management of syndesmosis injuries of the ankle. Foot Ankle 1992;13:44‑50. Vander Griend R, Michelson JD, Bone LB: Fractures of the ankle and the distal part of the tibia, in Springfield D (ed): Instructional Course Lectures 46. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 311‑321.

 

  • 99.171 What is the main cause of poor results following an amputation at the midfoot or
  • hindfoot level?
  • 1- Heel pad instability
  • 2- Valgus deformity
  • 3- Dorsiflexion deformity
  • 4- Equinus deformity
  • 5- Malleolar prominence

 

  • Question 99.171
  • Answer = 4
  • Reference(s)
  • Wagner FW Jr: A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems, in Cooper RR (ed): Instructional Course Lectures XXVIII. St Louis, MO, CV Mosby, 1979, pp 143‑165. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 697‑704.

 

  • 99.172 A patient with a transverse patella fracture undergoes open reduction and
  • fixation with lag screws and a tension band wire. What is the principal
  • action of the wire during knee flexion?
  • 1- Resists distracting forces of the quadriceps
  • 2- Enhances compression of the articular surface
  • 3- Prevents distal screw thread cut-out
  • 4- Prevents displacement of longitudinal fracture lines
  • 5- Prevents anterior fracture distraction from three-point bending forces

 

  • Question 99.172
  • Answer = 5
  • Reference(s)
  • Berg EE: Open reduction and internal fixation of displaced transverse patella fractures with figure‑of‑eight wiring through parallel cannulated compression screws. J Orthop Trauma 1977;11:573‑576. Nakumara S, et al: Advancement of the tibial tuberosity: A biomechanical study. J Bone Joint Surg 1985;67B:255‑260.

 

  • 99.173 Figures 44a and 44b show the radiographs obtained 10 weeks after open
  • reduction and internal fixation of an open type II fracture-dislocation of
  • the talar neck. Based on the radiographs, which of the following
  • complications has most likely occurred?
  • 1- Nonunion of the talar neck
  • 2- Infection of the distal tibial metaphysis
  • 3- Osteonecrosis of the talar body
  • 4- Segmental collapse of the talar body
  • 5- Subtalar arthrosis
  • Figures 44A & B

 

  • Question 99.173
  • Answer = 3
  • Reference(s)
  • Daniels TR, Smith JW: Talar neck fractures. Foot Ankle 1993;14:225‑234. Hawkins LG: Fractures of the neck of the talus. J Bone Joint Surg 1970;52A:991‑1002.

 

  • 99.174 Which of the following complications of total joint arthroplasty occurs more
  • frequently in patients with psoriatic arthritis than in patients with other diagnoses?
  • 1- Heterotopic ossification
  • 2- Intraoperative bleeding
  • 3- Infection
  • 4- Joint contracture
  • 5- Dislocation

 

  • Question 99.174
  • Answer = 3
  • Reference(s)
  • Menon TJ, Wroblewski BM: Chamley low‑friction arthroplasty in patients with psoriasis. Clin Orthop 1983;176:127‑128. Stem SH, Insall JN, Windsor RE, et al: Total knee arthroplasty in patients with psoriasis. Clin Orthop 1989;248:108‑110. Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 79‑86.

 

  • 99.175 The extracellular matrix of meniscal cartilage is composed primarily of
  • which of the following types of collagen?
  • 1- I
  • 2- II
  • 3- III
  • 4- IV
  • 5- V

 

  • Question 99.175
  • Answer = 1
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 3‑23.

 

  • 99.176 Figure 45 shows the AP radiograph of the pelvis of a 42-year-old woman who
  • reports the insidious onset of anterior pelvic pain over the past 2 years. History
  • reveals that she had a hysterectomy 7 years ago. Examination reveals localized
  • tenderness over the symphysis pubis, and laboratory studies show an erythrocyte
  • sedimentation rate of 2 mm/hr (normal up to 20 mm/hr). Microscopic examination of
  • the involved area would most likely reveal
  • 1- osteomyelitis.
  • 2- osteomalacia.
  • 3- osteonecrosis.
  • 4- neoplasia.
  • 5- chronic inflammation.
  • Figure 45

 

  • Question 99.176
  • Answer = 5
  • Reference(s)
  • Grace JN, Sim FH, Shives TC, et al: Wedge resection of the symphysis pubis for the treatment of osteitis pubis. J Bone Joint Surg 1989;71A:358‑364.

 

  • 99.177 A 72-year-old man reports a progressive increase in pain in his right hip, where he has had very mild aching pain for several years. Figure 46a shows the plain AP radiograph of the pelvis, and Figures 46b and 46c show the coronal T,- and T,-weighted MRI scans. A biopsy specimen from the femoral neck region is shown in Figure 46d. What is the most likely diagnosis?
  • 1- Dedifferentiated chondrosarcoma
  • 2- Telangiectatic osteosarcoma
  • 3- Pagetoid osteosarcoma
  • 4- Metastatic carcinoma
  • 5- Bone infarct-associated osteosarcoma

 

  • Question 99.177
  • Answer = 3
  • Reference(s)
  • Hadjipavlou A, Lander P. Srolovitz, et al: Malignant transformation in Paget disease of bone. Cancer 1992;70:2802‑2808. Unni KK: Osteosarcoma, in Unni KK (ed): Dahlin's Bone Tumors: General Aspects and Data on 11,087 cases, ed 5. Philadelphia, PA, Lippincott‑Raven, 1996, pp 143‑183.

 

  • 99.178 The occurrence of delayed union or nonunion after statically locked
  • unreamed nailing of an acute tibia fracture is most often the result of
  • 1- valgus malalignment.
  • 2- rotational malalignment.
  • 3- varus malalignment.
  • 4- lengthening of the tibia.
  • 5- shortening of the tibia.

 

  • Question 99.178
  • Answer = 4
  • Reference(s)
  • Bone L, Kassman S, Stegeman P, et al: Prospective study of union rate of open tibial fractures treated with locked, unreamed, intramedullary nails. J Orthop Trauma 1994;8:45 49.

 

  • 99.179 Figures 47a and 47b show the postreduction radiographs of a 30-year-old
  • man who sustained a left elbow dislocation after falling from a ladder.
  • Examination after reduction reveals that the elbow is unstable when
  • extended beyond the 50° flexed position. Examination under anesthesia
  • reveals valgus and posterolateral rotatory instability. After repair of the
  • avulsed lateral ligament complex, the elbow is stable through a full arc of
  • flexion. Additional management should include
  • 1- a hinged elbow fixator.
  • 2- medial ligament repair.
  • 3- open reduction and internal fixation of the coronoid fracture.
  • 4- early range of motion.
  • 5- immobilization until the ligament heals.
  • Figures 44
  • A
  • B

 

  • Question 99.179
  • Answer = 4
  • Reference(s)
  • Cohen MS, Hastings H II: Acute elbow dislocation: Evaluation and management. J Am Acad Ortho Surg 1998;6:15‑23. Money BF: Current concepts in the treatment of the radial head, the olecranon, and the coronoid. J Bone Joint Surg 1995;77A:316‑327.

 

  • 99.180 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.181 Third-generation bisphosphonates exert most of their effect by
  • 1- increasing osteoblast production of primary spongiosa.
  • 2- increasing osteoclast resorptive fronts.
  • 3- decreasing osteoblast production of secondary spongiosa.
  • 4- decreasing osteoclast resorption.
  • 5- inhibiting matrix vesicle dissolution.

 

  • Question 99.181
  • Answer = 4
  • Reference(s)
  • Chestnut CH III, Harris ST: Short‑term effect of alendronate on bone mass and bone remodeling in postmenopausal women. Osteoporos Int 1993;3:S17‑S19. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149‑165.

 

  • 99.182 A 42-year-old man with a history of poliomyelitis has had progressively worsening
  • shoulder pain and stiffness for the past 6 years. He ambulates with crutches.
  • Examination reveals 130° of active forward elevation, 20° of active external rotation,
  • and passive internal rotation to L3. Radiographs are shown in Figures 48a and 48b. What
  • is the most appropriate surgical treatment?
  • 1- Humeral head replacement
  • 2- Distal clavicle resection
  • 3- Shoulder arthrodesis
  • 4- Total shoulder replacement
  • 5- Arthroscopic debridement
  • Figures 48
  • B
  • A

 

  • Question 99.182
  • Answer = 1
  • Reference(s)
  • Levine WN, Djurasovic M, Glasson JM, et al: Hemiarthroplasty for glenohumeral osteoarthritis: Results correlated to degree of glenoid wear. J Shoulder Elbow Surg 1997;6:449‑454. Matsen FA III, Rockwood CA Jr, Wirth MA, et al: Glenohumeral arthritis and Its management, in Rockwood CA Jr, Matsen FA 111, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 840‑964.

 

  • 99.183 Figures 49a and 49b show the lateral flexion extension radiographs of a woman who has
  • dynamic spondylolisthesis. She reports a decrease in symptoms after undergoing an
  • isolated nerve root block at the involved L4-L5 foramen. Symptom improvement would
  • most likely show decreased pain in the
  • 1- buttock.
  • 2- anteromedial leg.
  • 3- posterior heel.
  • 4- lateral calf.
  • 5- dorsal foot.
  • Fig. 49A
  • B

 

  • Question 99.183
  • Answer = 2
  • Reference(s)
  • Lumbar and lumbosacral spondylolisthesis, in Weinstein JN, Wiesel SW (eds): The Lumbar Spine. Philadelphia, PA, The International Society for the Study of the Lumbar Spine, 1990, pp 471‑545.

 

  • 99.184 Figure 50 shows the radiograph of a 20-year-old man who sustained a
  • closed, twisting injury to the ankle. Examination reveals mild swelling, and
  • the foot is neurovascularly intact. The mortise is easily reduced with closed
  • manipulation. Management should include
  • 1- placement of a syndesmotic screw.
  • 2- plate fixation of the fibula.
  • 3- immobilization in a long leg cast.
  • 4- repair of the deltoid ligament.
  • 5- temporary transarticular pin fixation.
  • Figure 50

 

  • Question 99.184
  • Answer = 1
  • Reference(s)
  • Vander Griend RA, Michelson JD, Bone LB: Fractures of the ankle and the distal part of the tibia. Instructional Course Lecture. J Bone Joint Surg 1996;78A:1772‑1783. Boden BD, Labropoulos PA, McCowin P, et al: Mechanical considerations for the syndesmotic screw: A cadaver study. J Bone Joint Surg 1989;71A:1548‑1555.

 

  • 99.185 An 80-year-old man sustains a femoral neck fracture secondary to metastatic disease.
  • Management should include
  • 1- cannulated screws.
  • 2- crutches with protected weightbearing.
  • 3- a sliding hip compression screw.
  • 4- a primary prosthetic replacement.
  • 5- an intramedullary nail with head fixation.

 

  • Question 99.185
  • Answer = 4
  • Reference(s)
  • Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 97‑108. Sim FH: Metastatic bone disease of the pelvis and femur, in Eilert RE (ed): Instructional Course Lectures XLI. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1992, pp 317‑327.

 

  • 99.186 The table shown below depicts the results of a diagnostic test (T) and the
  • actual disease status (D).
  • Disease Status (D)
  • Positive Negative
  • Positive a b
  • Test Result (T) Negative c d
  • The sensitivity of the test is defined by which of the following ratios?
  • 1- a/ (a+c)
  • 2- d/ (b+d) d+d
  • 3- a/ (a+b) a
  • 4- d/ (c+d)
  • 5- c/ (b+d)

 

  • Question 99.186
  • Answer = 1
  • Reference(s)
  • Szabo RM: Principles of epidemiology for the orthopaedic surgeon. J Bone Joint Surg 1998;80A:111‑120.

 

  • 99.187 Which of the following factors is most responsible for the development of
  • symptomatic hindfoot valgus in a patient with rheumatoid arthritis?
  • 1- Insufficiency of the posterior tibial tendon
  • 2- Contracture of the peroneal muscles
  • 3- Weightbearing
  • 4- Loss of articular cartilage in the subtalar joint
  • 5- Lateral compression fracture of the os calcis

 

  • Question 99.187
  • Answer = 1
  • Reference(s)
  • Graves SC, Mann RA, Graves KO: Triple arthrodesis in older adults: Results after long‑term follow‑up. J Bone Joint Surg 1993;75A:355‑362. Kelley WN. Harris ED, Ruddy S, et al (eds): Textbook of Rheumatology. Philadelphia, PA, WB Saunders, 1989, p 820.

 

  • 99.188 A 12-year-old girl sustained several puncture wounds to her palm from cat bites. Twenty-four hours later the hand is swollen, erythematous, and painful. What organism is most likely associated with this infection?
  • 1- Eikenella corrodens
  • 2- Proteus mirabilis
  • 3- Streptococcus
  • 4- Staphylococcus aureus
  • 5- Pasteurella multocida

 

  • Question 99.188
  • Answer = 5
  • Reference(s)
  • Arons MS, Fernando L, Polayes IM: Pasteurella multocida: The major cause of hand infections following domestic animal bites. J Hand Surg 1982;7A:47‑52. Lucas GL, Bartlett DH: Pasteurella multocida infection in the hand. Plast Reconstr Surg 1981;67:49‑53.

 

  • 99.189 Which of the following is considered the most common presenting symptom in a patient with a high-grade primary malignant bone tumor?
  • 1- Weight loss
  • 2- Fatigue
  • 3- Fever
  • 4- Pain
  • 5- Malaise

 

  • Question 99.189
  • Answer = 4
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, p 197.

 

  • 99.190 The single proton emission computed tomography (SPECT) bone scans shown in Figures 51a through 51c show the axial, coronal, and sagittal views. These findings are most consistent with which of the following conditions?
  • 1- Pars defect at L5
  • 2- Pars defect at L5 and a degenerative disk at LS-S 1
  • 3- Normal study results
  • 4- Plasmacytoma of L5
  • 5- Anterior compression fracture of L3
  • Fig. 51A
  • B
  • C

 

  • Question 99.190
  • Answer = 2
  • Reference(s)
  • Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 173‑182.

 

  • 99.191 With respect to component fixation, fatigue failure of a prosthetic femoral
  • component is generally associated with
  • 1- a loose component.
  • 2- stable stem fixation distally.
  • 3- first-generation cement technique.
  • 4- inadequate cement mantle surrounding the distal stem.
  • 5- varus component orientation.

 

  • Question 99.191
  • Answer = 2
  • Reference(s)
  • Woolson ST, Milbauer JP, Bobyn JD, et al: Fatigue failure of a forged cobalt‑chromium molybdenum femoral component inserted with cement: A report of ten cases. J Bone Joint Surg 1997;79A:1842‑1848.

 

  • 99.192 Figure 52a shows the radiograph of a 32-year-old man who sustained a
  • humerus fracture 3 weeks ago. A follow-up examination reveals no
  • shoulder pain, and the patient is neurologically intact. Current radiographs
  • of the shoulder are shown in Figures 52b and 52c. Management of the
  • shoulder should include
  • 1- open reduction. 2- closed reduction.
  • 3- closed reduction and pinning of the humeral neck.
  • 4- closed reduction of the acromioclavicular joint.
  • 5- observation.
  • Figures 52A
  • B
  • C

 

  • Question 99.192
  • Answer = 5
  • Reference(s)
  • Pritchett JW: Inferior subluxation of the humeral head after trauma or surgery. J Shoulder Elbow Surg 1997;6:356‑359.

 

  • 99.193 Which of the following organisms can produce gas gangrene and may
  • necessitate open amputation above the level of the infection?
  • 1- Pseudomonas aeruginosa
  • 2- Staphylococcus aureus methicillin-resistant
  • 3- Staphylococcus aureuscoagulase-negative
  • 4- Clostridium perfringens
  • 5- Group D enterococcus

 

  • Question 99.193
  • Answer = 4
  • Reference(s)
  • DeHaven KE, Evarts CM: The continuing problem of gas gangrene: A review and report of illustrative cases. J Trauma 1971;11:983‑991. Lagaard SW, McElfresh EC, Premer RF: Gangrene of the upper extremity in Diabetic patients. J Bone Joint Surg 1989;71A:257‑264.

 

  • 99.194 Radiographs of a 6-year-old girl who has a swollen elbow as the result of a
  • fall reveal that the radial head is completely separated from the metaphysis by
  • a Salter type I fracture. It is rotated 90°, resting distal to the capitellum, while
  • the line of the radial shaft points to the capitellum. The rest of the elbow is
  • normal radiographically. Management should include
  • 1- accepting the position, followed by early range of motion exercises.
  • 2- excising the radial head, followed by early range of motion exercises.
  • 3- replacing the dislocated radial head with a silicone spacer.
  • 4- open reduction and internal fixation of the radial head.
  • 5- open reduction of the radial head and reconstruction of the annular ligament.

 

  • Question 99.194
  • Answer = 4
  • Reference(s)
  • Wilkins KE: Fractures and dislocations of elbow region, in Rockwood CA Jr, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 653‑995.

 

  • 99.195 An active 22-year-old ballet dancer has a symptomatic bunion deformity with
  • pain primarily over the medial eminence when dancing. Examination reveals
  • that the metatarsophalangeal joint motion is normal, and the valgus deformity
  • is passively correctable. The patient has a hallux valgus angle of 35° and an
  • intermetatarsal angle of 14°. Management should include
  • 1- a distal soft-tissue procedure and a proximal metatarsal osteotomy.
  • 2- a distal metatarsal osteotomy.
  • 3- use of a bunion pad and toe spacers.
  • 4- use of a stiff-soled shoe and a custom insert.
  • 5- excision only of the symptomatic medial eminence.

 

  • Question 99.195
  • Answer = 3
  • Reference(s)
  • Hamilton WG: Foot and ankle injuries in dancers, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, CV Mosby, 1993, pp 1241‑1276. Quirk R: Ballet injuries, in Baxter DE (ed): The Foot and Ankle in Sport. St Louis, MO, Mosby, 1995, pp 287‑303.

 

  • 99.196 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.197 In the treatment of open diaphyseal tibia fractures, the use of nonreamed
  • statically locked nails compared with external fixation results in a lower rate of
  • 1- deep infection.
  • 2- union.
  • 3- amputation.
  • 4- malunion.
  • 5- hardware failure.

 

  • Question 99.197
  • Answer = 4
  • Reference(s)
  • Santoro V, Henley M, Benirschke S, et al: Prospective comparison of unreamed interlocked IM nails versus half‑pin external fixation in open tibia fractures. Toronto, ON, Proc Orthop Trauma Assn, 1990, p 78. Tometta P III, Bergman M, Watnik N, et al: Treatment of grade‑IIIB open tibial fractures: A prospective randomized comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg 1994;76B:13‑19.

 

  • 99.198 Figures 53a and 53b show the radiographs of a 45-year-old man who fell
  • onto his outstretched hand 6 months ago. At that time, he reported that he
  • felt the elbow dislocate and spontaneously reduce. Management consisted
  • of a long arm cast for 4 weeks, followed by extensive physical therapy. The
  • patient now reports elbow pain and a catching sensation with forearm
  • rotation. Examination reveals 30° to 130° of motion. The pivot-shift test is
  • positive on examination under anesthesia. Treatment should now include
  • 1- radial head excision.
  • 2- lateral ligament reconstruction.
  • 3- contracture release.
  • 4- open reduction and internal fixation of the coronoid.
  • 5- medial collateral ligament reconstruction.
  • Figures 53
  • B
  • A

 

  • Question 99.198
  • Answer = 2
  • Reference(s)
  • O'Driscoll SW, Bell DF, Mosey BF: Posterolateral rotatory instability of the elbow. J Bone Joint Surg 1991;73A:440‑446. Regan W, Morrey BF: Fractures of the coronoid process of the ulna. J Bone Joint Surg 1989;71 A:1348‑1354.

 

  • 99.199 A hyperextension injury to the metatarsophalangeal joint of the great toe most
  • commonly results in a tear of the
  • 1- intersesamoid ligament.
  • 2- insertion of the plantar plate on the proximal phalanx.
  • 3- adductor hallucis tendon.
  • 4- medial and accessory collateral ligaments.
  • 5- flexor hallucis brevis insertion on the proximal phalanx.

 

  • Question 99.199
  • Answer = 2
  • Reference(s)
  • Clanton TO, Schon LC: Athletic injuries to the soft tissues of the foot and ankle, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp1191‑1200. Lutter LD, Mize] MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 141‑162.

 

  • 99.200 Which of the following soft-tissue sarcomas most commonly shows
  • prominent mineralization within the lesion on plain radiographs?
  • 1- Rhabdomyosarcoma
  • 2- Liposarcoma
  • 3- Epithelioid sarcoma
  • 4- Synovial sarcoma
  • 5- Angiosarcoma

 

  • Question 99.200
  • Answer = 4
  • Reference(s)
  • Moser RP, Madewell JE: Radiologic evaluation of soft‑tissue tumors, in Enzinger FM, Weiss SW (eds): Soft‑Tissue Tumors, ed 3. St Louis, MO. Mosby, 1995, pp 39‑88.

 

  • 99.201 What is the maximum percent contact between two fracture fragments that overlap
  • by 50% on both AP and lateral radiographic views?
  • 1- 2.5%
  • 2- 10%
  • 3- 25%
  • 4- 50%
  • 5- 75%

 

  • Question 99.201
  • Answer = 3
  • Reference(s)
  • Rockwood CA, Green DP (eds): Fractures in Adults, ed 2. Philadelphia, PA, JB Lippincott, 1984, pp 1‑167.

 

  • 99.202 Figure 54 shows the preoperative radiograph of a 44-year-old man who
  • sustained a severe closed tibial plafond fracture as the result of a fall. What
  • complication is most commonly associated with open fixation of this type
  • of fracture?
  • 1- Failure of fixation
  • 2- Nonunion
  • 3- Neurologic injury
  • 4- Soft-tissue problems
  • 5- Osteomyelitis
  • Figure 54

 

  • Question 99.202
  • Answer = 4
  • Reference(s)
  • Dillin L, Slabaugh P: Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma 1986;26:1116‑1119. Ovadia DN, Beals RK: Fractures of the tibial plafond. J Bone Joint Surg 1986;68A:543‑551. Mast JW, Spiegel PG, Pappas JN: Fractures of the tibial pilon. Clin Orthop 1988;230:68‑82.

 

  • 99.203 A 12-year-old girl who is referred for evaluation of scoliosis reports that she
  • has some low back pain intermittently; however, it does not keep her from
  • participating in her usual activities. Neurologic examination is normal. Plain
  • radiographs show a right thoracic curve of 23°. Management should include
  • 1- an MRI scan of the cervical spine.
  • 2- an MRI scan of the thoracolumbar spine.
  • 3- a bone scan of the spine with single proton emission computed tomography.
  • 4- a CT scan of the lumbar spine.
  • 5- follow-up in 4 months, or sooner if pain worsens.

 

  • Question 99.203
  • Answer = 5
  • Reference(s)
  • Ramirez N, Johnsston CE II, Browne RH: The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg 1995;77A:364‑368. Schwend RM, Hennrikus W, Hall JE, et al: Childhood scoliosis: Clinical indications for magnetic resonance imaging. J Bone Joint Surg 1995;77A:46‑53.

 

  • 99.204 A 21-year-old man who was thrown from a car sustains a closed midshaft
  • tibia fracture and a severe closed head injury. Management of the tibia
  • consists of a well-molded long leg cast with an anatomic reduction. Six
  • weeks after the accident, the head injury resolves and the patient is first able
  • to cooperate with a physical examination. With the cast removed, the patient
  • is unable to extend his ankle or toes, and he reports numbness over the
  • dorsum of the foot. What is the most likely diagnosis?
  • 1- Anterior tibial artery injury
  • 2- Tibial nerve injury
  • 3- Superficial peroneal nerve injury
  • 4- Residual from the head injury
  • 5- Residual from a compartment syndrome

 

  • Question 99.204
  • Answer = 5
  • Reference(s)
  • Hak D, Johnson EE: The use of the unreamed nail in tibial fractures with concomitant preoperative or intraoperative elevated compartment pressure or compartment syndrome. J Orthop Trauma 1994;8:203‑211. Triffitt PD, Konig D, Harper WM, et al: Compartment pressures after closed tibial shaft fracture: Their relation to functional outcome. J Bone Joint Surg 1992;74B:195‑198.

 

  • 99.205 At higher rates of loading, bone absorbs more energy prior to failure
  • because
  • 1- the modulus of elasticity decreases.
  • 2- bone is anisotropic.
  • 3- bone is viscoelastic.
  • 4- bone deforms plastically.
  • 5- bone is stronger in compression than in tension.

 

  • Question 99.205
  • Answer = 3
  • Reference(s)
  • Albright JA: Bone: Physical properties, in Albright JA, Brand RA (eds): The Scientific Basis of Orthopaedics. Appleton and Lange, 1987, pp 213‑240. Wright TM, Hayes WC: Mechanics of fracture and fracture propagation, in Owen R, Goodfellow J, Bullough P (eds): Scientific Foundations of Orthopaedics and Traumatology. Philadelphia, PA, WB Saunders, 1980, pp 252‑258. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 397‑446.

 

  • 99.206 A 32-year-old woman sustains a closed Lisfranc (tarsometatarsal) fracture-
  • dislocation. Management consisting of closed reduction results in a 5-mm
  • offset remaining at the first metatarsocuneiform joint. Management should
  • now include
  • 1- a below-knee nonweightbearing cast.
  • 2- a below-knee walking cast.
  • 3- a bulky dressing and early range of motion.
  • 4- in situ percutaneous pinning.
  • 5- open reduction and internal fixation.

 

  • Question 99.206
  • Answer = 5
  • Reference(s)
  • Adelaar RS: The treatment of tarsometatarsal fracture‑dislocation, in Greene WB (ed): Instructional Course Lectures XXXDC. Park Ridge, 1L, American Academy of Orthopaedic Surgeons, 1990, pp 141‑145. Trevino SG, Kodros S: Controversies in tarsometatarsal injuries. Orthop Clin North Am 1995;26:229‑238.

 

  • 99.207 Figures 55a through 55c show the AP radiograph and T,- and T,-weighted axial MRI scans of an 8-year old boy who has a painless mass in the right antecubital space. The mass increases in size with activity and then decreases after activity. Gross blood is obtained during a needle biopsy. Management should include
  • 1- wide resection.
  • 2- observation.
  • 3- open incisional biopsy.
  • 4- CT scan-guided core biopsy.
  • 5- radiation therapy.
  • Figures 55:
  • A
  • B
  • C

 

  • Question 99.207
  • Answer = 2
  • Reference(s)
  • Palmieri TJ: Vascular tumors of the hand and forearm. Hand Clin 1987;3:225‑240. Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill‑Livingston, 1993, pp 2283‑2286.

 

  • 99.208 What factor, in addition to the injury severity score, is most useful to
  • predict mortality in a patient with blunt multiple injuries?
  • 1- Age of the patient
  • 2- The fourth highest abbreviated injury score
  • 3- Bilateral skeletal injury
  • 4- Mechanism of injury
  • 5- Field intubation

 

  • Question 99.208
  • Answer = 1
  • Reference(s)
  • Baker SP, O'Neill B, Haddon W Jr, et al: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187‑196. Bone LB: Emergency treatment of the injured patient, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 127‑145.

 

  • 99.209 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 99.210 Which of the following imaging studies best evaluates acute traumatic
  • injuries of the sternoclavicular joint?
  • 1- MRI scan
  • 2- CT scan
  • 3- Apical lordotic radiograph
  • 4- Tri-spiral tomography
  • 5- Fluoroscopy

 

  • Question 99.210
  • Answer = 2
  • Reference(s)
  • Wirth MA, Rockwood CA Jr: Acute and chronic traumatic injuries of the stemoclavicular joint. J Am Acad Orthop Surg 1996;4:268‑278.

 

  • 99.211 Which of the following findings is commonly seen in late-onset
  • (adolescent) tibia vara (Blount's disease?)
  • 1- Elongation (overgrowth) of the proximal fibula
  • 2- Varus deformity of the ipsilateral distal femur
  • 3- Lateral subluxation of the patella
  • 4- Lateral subluxation of the knee (tibiofemoral) joint
  • 5- Mechanical axis of the lower extremity (center of femoral head to center of ankle)
  • passes lateral to the center of the knee joint.

 

  • Question 99.211
  • Answer = 2
  • Reference(s)
  • Kline SC, Bostrum M, Griffin PP: Femoral varus: An important component in late‑onset Blount's disease. J Pediatr Orthop 1992;12:197‑206. Beskin JL, Burke SW, Johnston CE 11, et al: Clinical basis for a mechanical etiology in adolescent Blount's disease. Orthopedics 1986;9:365‑370.

 

  • 99.212 Which of the following antibiotics is contraindicated in patients who
  • require oral anticoagulants?
  • 1- Trimethoprim
  • 2- Clindamycin
  • 3- Ciprofloxacin
  • 4- Aminoglycoside
  • 5- Erythromycin

 

  • Question 99.212
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 149‑161.

 

  • 99.213 A 45-year-old man who underwent open reduction and internal fixation of a femoral
  • neck fracture with cannulated screws now has a femoral neck nonunion without
  • osteonecrosis. Treatment should now include
  • 1- a sliding hip screw.
  • 2- a bipolar prosthesis.
  • 3- repeat fixation with screws and bone graft.
  • 4- a varus-producing intertrochanteric osteotomy.
  • 5- a valgus-producing intertrochanteric osteotomy.

 

  • Question 99.213
  • Answer = 5
  • Reference(s)
  • Marti RK, Schuller HM, Raaymakers EL: Intertrochanteric osteotomy for nonunion of the femoral neck. J Bone Joint Surg 1989;71B:782‑787. Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 109‑115.

 

  • 99.214 A 63-year-old retired factory worker who underwent humeral arthroplasty for
  • glenohumeral osteoarthritis 6 years ago now reports shoulder pain. What is the
  • most likely diagnosis?
  • 1- Humeral component loosening
  • 2- Rotator cuff tear
  • 3- Glenoid arthritis
  • 4- Glenohumeral instability
  • 5- Proximal humeral stress fracture

 

  • Question 99.214
  • Answer = 3
  • Reference(s)
  • Petersen SA, Hawkins RJ: Revision of failed total shoulder arthroplasty. Orthop Clin North Am 1998;29:519‑533. Cofield RH, Edgerton BC: Total shoulder arthroplasty: Complications and revision surgery, in Greene WB (ed): Instructional Course Lectures XXXIX. Park Ridge, IL, American Academy of Orthopaedic Surgeons. 1990, pp 449‑462. Cofield RH, Frankle MA, Zuckerman JD: Humeral head replacement for Glenaliumeral arthritis. Semin Arthroplasty 1995;6:214‑221.

 

  • 99.215 A 16-year-old high school football player is injured after being tackled.
  • Examination reveals medial clavicle swelling, respiratory stridor, and
  • jugular vein distention. A CT scan with aortogram shows no vascular
  • injury. What is the most likely diagnosis?
  • 1- Posterior sternoclavicular joint dislocation
  • 2- Anterior sternoclavicular joint dislocation
  • 3- First rib fracture
  • 4- Medial clavicular physeal fracture
  • 5- Sternomanubrial dislocation

 

  • Question 99.215
  • Answer = 4
  • Reference(s)
  • Wirth MA, Rockwood CA Jr: Acute and chronic traumatic injuries of the sternoclavicular joint. J Am Acad Orthop Surg 1996;4:268‑278.

 

  • 99.216 Examination of a 30-year-old recreational basketball player who jammed his
  • ring finger during a game reveals fusiform swelling and pain at the proximal
  • interphalangeal (PIP) joint. The patient has difficulty initiating PIP extension
  • from a position of full flexion, and there is weak extension against resistance.
  • Radiographs are normal. Management should consist of
  • 1- a dynamic PIP joint extension splint for 6 weeks.
  • 2- a static PIP joint extension splint for 6 weeks.
  • 3- buddy taping of the ring finger to the long finger.
  • 4- immediate controlled mobilization.
  • 5- open repair of the central slip.

 

  • Question 99.216
  • Answer = 2
  • Reference(s)
  • Newport ML: Extensor tendon injuries. J Am Acad Orthop Surg 1997;5:59‑66. Lovett WL, McCalla MA: Management and rehabilitation of extensor tendon injuries. Orthop Clin North Am 1983;14:811‑826.

 

  • 99.217 Which of the following conditions is most frequently encountered when performing
  • total knee arthroplasty in patients who have previously undergone a high tibial
  • valgus producing closing wedge osteotomy?
  • 1- Patella alta
  • 2- Patella infera
  • 3- Medial collateral laxity
  • 4- Medial tibial compartment bone deficiency
  • 5- Posterior cruciate ligament laxity

 

  • Question 99.217
  • Answer = 2
  • Reference(s)
  • Katz MM, Hungerford DS, Krackow KA, et al: Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg 1987;69A:225‑233. MOMMA, Alexander N, Krackow KA, et al: Total knee axthroplasty after failed high tibial osteotomy. Orthop Clin North Am 1994;25:515‑525.

 

  • 99.218 A 32-year-old carpenter has an anteriorly dislocated sternoclavicular joint in
  • his dominant shoulder after falling from a scaffold 4 weeks ago. Management
  • should consist of
  • 1- closed reduction with percutaneous threaded pin fixation.
  • 2- closed reduction with application of a figure-of-8 cast.
  • 3- open reduction with screw fixation.
  • 4- open reduction with sternoclavicular capsular repair.
  • 5- sling protection until the patient's symptoms subside.

 

  • Question 99.218
  • Answer = 5
  • Reference(s)
  • Wirth MA, Rockwood CA Jr: Acute and chronic traumatic injuries of the stemoclavicular joint. J Am Acad Orthop Surg 1996;4:268‑278.

 

  • 99.219 Examination of a 6-month-old infant with unilateral dislocation of the hip is
  • most likely to reveal
  • 1- symmetric gluteal creases.
  • 2- a positive Ortolani sign.
  • 3- a positive result on Barlow maneuver.
  • 4- asymmetry of abduction.
  • 5- pain on passive motion of the hip.

 

  • Question 99.219
  • Answer = 4
  • Reference(s)
  • Tachdjian MO (ed): Pediatric Orthopedics, ed 2. Philadelphia, PA, WB Saunders, 1996, pp 326‑327.

 

  • 99.220 A 19-year-old martial arts student has had pain, swelling, and a snapping
  • sensation in the metacarpophalangeal joint of the long finger for the past
  • week. Examination reveals full active extension of the joint, accompanied by
  • slight ulnar deviation of the finger. What structure has most likely been
  • injured?
  • 1- Central extensor tendon
  • 2- Junctura tendinum between the index and long fingers
  • 3- Radial sagittal band
  • 4- Radial slip of the flexor digitorum superficialis
  • 5- Lumbrical to the long finger

 

  • Question 99.220
  • Answer = 3
  • Reference(s)
  • Inoue G, Tamura Y: Dislocation of the extensor tendons over the metacarpophalangeal joints. J Hand Surg 1996;21A:464‑469. Koniuch MP, Peimer CA, VanGorder T, et al: Closed crush injury of the metacarpophalangealjoint. J Hand Surg 1987;12A:750‑757.

 

  • 99.221 A 17-year-old boy steps into a hole, forcing his ankle into dorsiflexion and
  • inversion. Examination will most likely reveal damage to which of the
  • following ligaments?
  • 1- Anterior talofibular
  • 2- Posterior talofibular
  • 3- Posterior tibiofibular
  • 4- Calcaneofibular
  • 5- Deltoid

 

  • Question 99.221
  • Answer = 4
  • Reference(s)
  • Conlin FD, Johnson PG, Sinning JE Jr: The etiology and repair of rotary ankle instability. Foot Ankle 1989;10:152‑155. Karlsson J, Lansinger O: Lateral instability of the ankle joint. Clin Orthop 1992;276:253 261. Lassiter TE Jr, Malone TR, Garrett WE Jr: Injury to the lateral ligaments of the ankle. Orthop Clin North Am 1989;20:629‑640.

 

  • 99.222 Examination of a 13-year-old girl reveals scoliosis of 75° from the second to
  • the fourth thoracic vertebrae. Radiographs shown in Figures 56a and 56b
  • reveal a focal kyphosis of 66° at the same level. The intervertebral foramenae
  • are enlarged. Neurologic examination is normal. What is the most likely
  • diagnosis?
  • 1- Marfan syndrome
  • 2- Ehlers-Danlos syndrome
  • 3- Spinal muscular atrophy
  • 4- Idiopathic scoliosis
  • 5- Neurofibromatosis
  • Figures 56
  • A
  • B

 

  • Question 99.222
  • Answer = 5
  • Reference(s)
  • Sirois JL 111. Drennan JC: Dystrophic spinal deformities in neurofibromatosis. J Pediatr Orthop 1990;10:522‑526.

 

  • 99.223 A 10-year-old child is brought to the operating room for curettage and bone grafting of a large nonossifying fibroma of the distal femur. During the surgical approach, it becomes apparent that the wrong side has been exposed in error. After wound closure, the next step in management should consist of
  • 1- treatment of the correct site, followed by an explanation to the parents by the
  • surgeon.
  • 2- treatment of the correct site, followed by an explanation to the parents by a
  • representative of the risk management committee.
  • 3- rescheduling the surgery with another surgeon.
  • 4- a percutaneous injection on the other side to avoid another incision.
  • 5- an explanation to the parents that it was the nurse's responsibility to check for
  • correct sidedness, followed by treatment of the correct side as planned.

 

  • Question 99.223
  • Answer = 1
  • Reference(s)
  • American Academy of Orthopaedic Surgeons policy statement on wrong‑site surgery. September 1997. (Refer to Web Site)

 

  • 99.224 The occurrence of periprosthetic fractures of the acetabulum during total hip
  • arthroplasty is generally associated with
  • 1- the creation of multiple cement fixation holes.
  • 2- the use of screws for acetabular component fixation.
  • 3- an underreamed acetabulum.
  • 4- medialization of the cup.
  • 5- threaded acetabular components.

 

  • Question 99.224
  • Answer = 3
  • Reference(s)
  • Callaghan JJ: Periprosthetic fractures of the acetabulum during and following total hip arthroplasty, in Cannon WD Jr (ed): Instructional Course Lectures 47. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 231‑235.

 

  • 99.225 A 30-year-old patient who underwent an endoscopic plantar fascia release several
  • months ago now reports pain in the medial arch of the foot with weightbearing and
  • progressive flattening of the foot. What is the most likely diagnosis?
  • 1- Surgical injury to the medial plantar nerve
  • 2- Excessive release of the plantar fascia
  • 3- Degeneration of the posterior tibial tendon
  • 4- Inadequate release of the abductor hallucis fascia
  • 5- Late rupture of the proximal quadratus plantae aponeurosis

 

  • Question 99.225
  • Answer = 2
  • Reference(s)
  • Palumbo RC, Kodrois SA, Baxter DE: Endoscopic plantar fasciotomy: Indications, techniques, and complications. Sports Med Arthroscopy Review 1994;2:317‑322. Daly PJ, Kitaoka HB, Chao EY: Plantar fasciotomy for intractable plantar fasciitis: Clinical results and biomechanical evaluation. Foot Ankle 1992;13:188‑195.

 

  • 99.226 A 6-year-old boy who fell down the stairs at home sustained the injury shown in Figures
  • 57a and 57b. Examination reveals that the forearm compartments are soft, but there is no
  • active extension of the interphalangeal joint of the thumb. Initial management should
  • include
  • 1- closed reduction of the ulna and
  • radiocapitellar joint.
  • 2- closed reduction of the ulna and
  • radiocapitellar joint, and exploration
  • of the radial nerve.
  • 3- closed reduction of the ulna and
  • radiocapitellar joint, and percutaneous
  • insertion of a transcapitellar Kirschner
  • wire.
  • 4- open reduction of the ulna with
  • compression plating, closed reduction
  • of the radiocapitellar joint, and
  • exploration of the radial nerve.
  • 5- percutaneous intramedullary nailing of
  • the ulna with repair of the annular ligament.
  • Figures 57
  • A
  • B

 

  • Question 99.226
  • Answer = 1
  • Reference(s)
  • Wiley JJ, Galey JP: Monteggia injuries in children. 1 Bone Joint Surg 1985;67B:728‑731. Olney BW, Menelaus MB: Monteggia and equivalent lesions in childhood. J Pediatr Orthop 1989;9:219‑223.

 

  • 99.227 Examination of a 2-year-old boy reveals bowed legs, enlarged wrists, and
  • alopecia. Laboratory studies reveal low levels of serum calcium and phosphate
  • and elevated levels of parathormone and 1,25-dihydroxy vitamin D.
  • Radiographs of the upper and lower extremities show bowing of the femur and
  • tibia, with cupping of the metaphysis and widening of the physis. What is the
  • most likely diagnosis?
  • 1- Vitamin D-dependent rickets (type II)
  • 2- Tumor-induced rickets
  • 3- Nutritional rickets
  • 4- Hypophosphatasia
  • 5- Renal osteodystrophy

 

  • Question 99.227
  • Answer = 1
  • Reference(s)
  • Liverman UA, Marx SJ: Vitamin D‑dependent rickets, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Philadelphia, PA, Lippincott‑Raven, 1996, pp 311‑315.

 

  • 99.228 After undergoing elective anterior cruciate ligament reconstruction, a patient is now
  • questioning the fact that allograft was used instead of autograft. The medical record
  • documents that the benefits and the potential disadvantages of using allograft were
  • discussed with the patient. This situation is an example of
  • 1- fraud.
  • 2- informed consent.
  • 3- criminal negligence.
  • 4- misrepresentation.
  • 5- conflict of interest.

 

  • Question 99.228
  • Answer = 2
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 25‑29.

 

  • 99.229 In addition to serving as a carrier for factor VIII, von Willebrand factor
  • also serves to
  • 1- promote platelet binding to vessel walls.
  • 2- stimulate calmoduliu degradation.
  • 3- increase platelet production.
  • 4- prolong platelet circulation time.
  • 5- cause activation of profactor VII.

 

  • Question 99.229
  • Answer = 1
  • Reference(s)
  • Greene WB: Hematologic disorders, in Morrissey RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott‑Raven, 1996, pp 345­ 353.

 

  • 99.230 The presence of a Homer's sign (ptosis, meiosis, and anhydrosis) most
  • likely indicates a severe injury to the brachial plexus at the
  • 1- C5-6 preganglionic level.
  • 2- C5-6 postganglionic level.
  • 3- C6-7 preganglionic level.
  • 4- C8-T1 preganglionic level.
  • 5- C8-T1 postganglionic level.

 

  • Question 99.230
  • Answer = 4
  • Reference(s)
  • Bonney A: Prognosis in traction lesions of the brachial plexus. J Bone Joint Surg 1959;41B:4‑35. Hentz VR: Microneural Reconstruction of the Brachial Plexus, in Green DP (ed): Operative Hand Surgery. New York, NY, Churchill Livingston, 1993, pp 1223‑1252.

 

  • 99.231 Examination of a 10-year-old girl who uses a wheelchair reveals multiple
  • cafe-au-lait spots with painless bowing deformities of both lower extremities.
  • Figure 58 shows the radiograph of the right femur. The patient should also be
  • evaluated for which of the following conditions?
  • 1- Malignant degeneration
  • 2- Endocrinopathy
  • 3- Neurofibromas
  • 4- Congenital tibial pseudarthrosis
  • 5- Macrodactyly
  • Figure 58

 

  • Question 99.231
  • Answer = 2
  • Reference(s)
  • Lee PA, Van Dop C, Migeon CJ: McCune‑Albright syndrome: Long‑term follow‑up. JAMA 1986;256:2980‑2984. Zaleske DJ, Doppelt SH, Mankin HJ: Metabolic and endocrine abnormality of the immature skeleton, in Lovell WW, Winter RB (eds): Pediatric Orthopaedics, ed 2. Philadelphia, PA, JB Lippincott, 1986, pp 81‑145.

 

  • 99.232 Following total hip arthroplasty, the use of low molecular weight heparin rather
  • than adjusted dose warfarin in deep venous thrombosis (DVT) prophylaxis may
  • result in an increased incidence of which of the following complications?
  • 1- DVT in the calf
  • 2- DVT in the thigh
  • 3- Bleeding at the surgical site
  • 4- Fatal pulmonary embolus
  • 5- Postphlebitic syndrome

 

  • Question 99.232
  • Answer = 3
  • Reference(s)
  • Francis CW, Pellegrini VD Jr, Totterman S, et al: Prevention of deep‑vein thrombosis after total hip arthroplasty: Comparison of warfarin and dalteparin. J Bone Joint Surg 1997;79A:1365‑1372.

 

  • 99.233 A 53-year-old woman with no history of injury or foot surgery has had forefoot
  • pain for the past 6 months, and nonsurgical management has failed to provide
  • relief. Examination reveals a mild asymptomatic hallux valgus and bunion
  • deformity, with tenderness about the second metatarsophalangeal joint. Anterior
  • drawer (vertical stress) testing of the second toe is positive. Radiographs are
  • normal. Surgical treatment should include
  • 1- an oblique diaphyseal osteotomy of the second metatarsal with shortening.
  • 2- isolated correction of the hallux valgus and bunion deformity.
  • 3- a flexor to extensor tendon transfer at the second toe.
  • 4- a basilar dorsiflexion osteotomy of the second metatarsal.
  • 5- a collateral ligament reconstruction.

 

  • Question 99.233
  • Answer = 3
  • Reference(s)
  • Gazdag A, Cracchiolo A III: Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. Foot Ankle 1998;19:137‑143. Thompson FM, Deland IT: Flexor tendon transfer for metatarsophalangeal instability of the second toe. Foot Ankle 1993;14:385‑388.

 

  • 99.234 A 25-year-old competitive runner who has progressive pain in the medial arch
  • of the foot with radiation of pain to the medial three toes reports that the pain
  • is worse with the use of a medial arch-supporting orthosis. Examination
  • reveals tenderness along the medial plantar arch, and both active and passive
  • eversion of the heel increase the medial arch pain. What is the most likely
  • diagnosis?
  • 1- Rupture of the medial band of the plantar fascia
  • 2- Compression of the medial plantar nerve
  • 3- Tendinitis of the posterior tibial tendon
  • 4- Early arthritis of the naviculocuneiform joint
  • 5- Avulsion of the peroneus longus tendon

 

  • Question 99.234
  • Answer = 2
  • Reference(s)
  • Baxter DE: Functional nerve disorders, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 559‑573. Murphy PC, Baxter DE: Nerve entrapment of the foot and ankle in runners. Clin Sports Med 1985;4:753‑763. Baxter DE: Functional nerve disorders, in Baxter DE (ed): The Foot and Ankle in Sports. St Louis, MO, Mosby, 1995, pp 9‑22.

 

  • 99.235 Figures 59a through 59c show the radiograph and biopsy specimens of an
  • 11-year-old child who has distal thigh pain. What is the most likely diagnosis?
  • 1- Nonossifying fibroma
  • 2- Aneurysmal bone cyst
  • 3- Intraosseous ganglion
  • 4- Periosteal chondroma
  • 5- Telangiectatic osteosarcoma
  • Figures 59:
  • A
  • B
  • C

 

  • Question 99.235
  • Answer = 2
  • Reference(s)
  • Vergel De Dios AM, Bond JR, Shives TC, et al: Aneurysmal bone cyst: A clinicopathologic study of 238 cases. Cancer 1992;69:2921‑2931. Martinez V, Sissons HA: Aneurysmal bone cyst: A review of 123 cases including primary lesions and those secondary to other bone pathology. Cancer 1988;61:2291‑2304.

 

  • 99.236 Examination of a 14-year-old boy who reports a sudden increase in back pain
  • for the past week reveals that he walks stiffly and cannot bend forward to
  • touch his toes. Neurologic examination and plain radiographs of the spine are
  • normal. An MRI scan shows a disk herniation at the L4-5 level. No
  • congenital spinal stenosis is seen. Management should consist of
  • 1- diskectomy through a posterior approach.
  • 2- diskectomy through an anterior approach.
  • 3- diskectomy and posterior fusion.
  • 4- percutaneous endoscopic diskectomy.
  • 5- nonsurgical management for 4 to 6 weeks.

 

  • Question 99.236
  • Answer = 5
  • Reference(s)
  • DeOrio JK, Bianco AJ Jr: Lumbar disc excision in children and adolescents. J Bone Joint Surg 1982;64A:991‑996.

 

  • 99.237 Perpetrators of family abuse are commonly members of what demographic group?
  • 1- Elderly
  • 2- Women
  • 3- Adults who were formerly abused as children
  • 4- Lower socioeconomic groups
  • 5- Uneducated

 

  • Question 99.237
  • Answer = 3
  • Reference(s)
  • Raff MS (ed): What You Can Do About Family Violence. Chicago, IL, AMA Department of Communication Services, 1992, pp 26‑27.

 

  • 99.238 Surgical intervention in the form of spinal fusion offers more predictable results for relief of back pain in a patient with
  • 1- an MRI scan showing a single-level degenerative disk.
  • 2- an MRI scan showing a three-level degenerative disk.
  • 3- a diskogram showing a degenerative disk with concordant pain at a single level.
  • 4- a diskogram showing a degenerative disk with concordant pain at three levels.
  • 5- a diskogram showing a degenerative disk at a single level with discordant pain.

 

  • Question 99.238
  • Answer = 3
  • Reference(s)
  • Garf‑in SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 121‑126.

 

  • 99.239 A football player with a neck injury is placed on a rigid spine board to
  • minimize the risk of injury during transport. In preparation for transport, the
  • most appropriate course of action is to
  • 1- leave both the shoulder pads and helmet in place.
  • 2- leave the shoulder pads in place and remove the helmet.
  • 3- leave the shoulder pads in place, remove the helmet, and apply a Philadelphia
  • collar.
  • 4- remove both the shoulder pads and helmet.
  • 5- remove both the shoulder pads and helmet and apply a soft cervical collar.

 

  • Question 99.239
  • Answer = 1
  • Reference(s)
  • Swenson TM, Lauerman WC, Blanc RO, et al: Cervical spine alignment in the immobilized football player: Radiographic analysis before and after helmet removal. Am J Sports Med 997;25:226‑230. Herzenberg JE, Hensinger RN, Dedrick DK, et al: Emergency transport and positioning of young children who have an injury of the cervical spine: The standard backboard may be hazardous. J Bone Joint Sung 1989;71A:15‑22.

 

  • 99.240 Figure 60a shows the radiograph of an 8-year-old boy who sustained a closed Salter type
  • 11 fracture of the distal radius 2 days ago. Examination at the time of injury revealed
  • moderate wrist edema, and the neurovascular examination was intact both before and
  • after reduction of the fracture and application of a long arm cast. The final reduction is
  • shown in Figure 60b. The patient now reports severe tingling numbness in the
  • distribution of the median nerve. Examination reveals slight swelling of the hand but no
  • pain with passive motion of the digits. Motor function in the abductor pollicis brevis is
  • intact. Management should now include
  • 1- elevating the extremity consistently.
  • 2- bivalving the cast and wrapping it with an elastic bandage.
  • 3- removing the cast and measuring compartment pressures in the forearm.
  • 4- removing the cast and performing emergent surgery for carpal tunnel release.
  • 5- removing the cast and immobilizing the fracture with the wrist in 20° of flexion.
  • answer
  • back
  • Figures 60
  • A
  • B

 

  • Question 99.240
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Paley D, McMurtry RY: Median nerve compression by volarly displaced fragments of the distal radius. Clin Orthop 1987;215:139‑147. Cooney WP III, Dobyns JH, Linscheid RL: Complications of Colles' fractures. J Bone Joint Surg 1980;62A:613‑619.

 

  • 99.241 A 30-year-old man fell from a scaffold onto his outstretched hand.
  • Radiographs of the elbow reveal a markedly comminuted fracture of the
  • radial head. Six months after undergoing radial head resection, the patient
  • reports ipsilateral wrist pain and weakness of grip. What is the most likely
  • cause of the pain?
  • 1- Posttraumatic arthritis of the elbow
  • 2- Entrapment of the posterior interosseous nerve
  • 3- Nonunion of an unrecognized scaphoid fracture
  • 4- Proximal migration of the radius
  • 5- Compression of the median nerve at the elbow
  • answer
  • back

 

  • Question 99.241
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Edwards G, Jupiter JB: The Essex‑Lopresti lesion revisited. Clin Orthop 1988;234:61‑66. Hotchkiss RN: Displaced fractures of the radial head: Internal fixation or excision? J Am Acad Orthop Surg 1997;5:1‑10.

 

  • 99.242 Which of the following structures are considered the primary joint stabilizers
  • against valgus (radial deviation) stress when the metacarpophalangeal joint of
  • the thumb is tested in extension?
  • 1- Adductor pollicis and dorsal capsule
  • 2- Adductor pollicis and volar plate
  • 3- Proper and accessory ulnar collateral ligaments
  • 4- Volar plate and accessory ulnar collateral ligament
  • 5- Dorsal capsule and proper ulnar collateral ligament
  • answer
  • back

 

  • Question 99.242
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Heyman P, Gelberman RH, Duncan K, et al: Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint: Biomechanical and prospective clinical studies on the usefulness of valgus stress testing. Clin Orthop 1993;292:165‑171.

 

  • 99.243 A 12-year-old boy has pain at rest and at night over the proximal tibia. Plain radiographs show a 6-mm lucent area in the cortex surrounded by sclerotic bone. What is the most likely diagnosis?
  • 1- High-grade osteosarcoma
  • 2- Periosteal osteosarcoma
  • 3- Osteoblastoma
  • 4- Osteoid osteoma
  • 5- Osteofibrous dysplasia
  • answer
  • back

 

  • Question 99.243
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiological Correlation. Philadelphia, PA, WB Saunders, 1998, pp 200‑202.

 

  • 99.244 The parents of a 20-month-old girl who has no history of trauma report that she cries
  • when she walks. Examination reveals that the child will not stand and has
  • ecchymosis and tenderness over the proximal right leg. She also has ecchymosis over
  • the lateral aspect of the left shoulder. Plain radiographs show a nondisplaced Salter
  • type II fracture of the proximal tibia. After applying a long leg cast, management
  • should include
  • 1- a follow-up examination of the cast the next day.
  • 2- office follow-up in 2 weeks.
  • 3- office follow-up in 6 weeks.
  • 4- outpatient referral to protective services.
  • 5- immediate referral to protective services.
  • answer
  • back

 

  • Question 99.244
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Green NE: Child abuse, in Green NE, Swiontowski MF (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1994, pp 517‑532.

 

  • 99.245 Which of the following is considered the main advantage of using a posterior
  • interosseous flap compared with a radial forearm flap?
  • 1- No major artery is sacrificed.
  • 2- A segment of attached bone can be included.
  • 3- A larger area can be resurfaced.
  • 4- Sensory restoration can be provided.
  • 5- The vascular pedicle is longer.
  • answer
  • back

 

  • Question 99.245
  • Answer = 1
  • back to this question
  • Reference(s)
  • Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 309‑316. Lister GD: Skin flaps, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingston, 1993, pp 1741‑1822.
  • next question

 

  • 99.246 A 30-year-old man who underwent an open Bankart procedure 2 months ago
  • for recurrent anterior glenohumeral dislocations has now sustained a
  • redislocation as the result of a fall. Examination reveals weakness on lift-off
  • testing. Which of the following is considered the most likely finding at surgical
  • reexploration?
  • 1- Failure to repair the rotator cuff interval
  • 2- Ruptured biceps tendon
  • 3- Untreated multidirectional instability
  • 4- Glenoid deficiency
  • 5- Subscapularis disruption
  • answer
  • back

 

  • Question 99.246
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Gerber C, Krushell RJ: Isolated rupture of the tendon of the subscapularis muscle: Clinical features in 16 cases. J Bone Joint Surg 1991;73B:389‑394. Greis PE, Dean M. Hawkins RJ: Subscapularis tendon disruption after Bankart Reconstruction for anterior instability. J Shoulder Elbow Surg 1996:5:219‑222.

 

  • answer
  • back
  • Figures 61
  • B
  • A
  • 99.247 A 16-year-old girl who ski races sustains a high-energy injury to the right knee after landing from a
  • jump with her knees deeply flexed. An accurate clinical picture is difficult to assess because of pain
  • and swelling. Figures 61a and 61b show the T1- weighted sagittal and coronal MRI scans. Based on
  • the MRI scans, which of the following structures have been injured?
  • 1- Anterior cruciate and lateral collateral ligaments and biceps tendon
  • 2- Anterior cruciate and medial collateral ligaments, quadriceps tendon, and lateral meniscus
  • 3- Anterior cruciate and medial collateral ligaments, patellar tendon, and lateral meniscus
  • 4- Posterior cruciate and lateral collateral ligaments and biceps tendon
  • 5- Posterior cruciate ligament, patellar tendon, and lateral meniscus

 

  • Question 99.247
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Levakos Y, Sherman MF, Shelboume KD. et al: Simultaneous rupture of the anterior cruciate ligament and the patellar tendon: Six case reports. Am J Sports Med 1996;24:498‑503. Rae PJ, Davies DR: Simultaneous rupture of the ligamentum patellae, medial collateral, and anterior cruciate ligaments. Am J Sports Med 1991;19:529‑530.

 

  • 99.248 Which of the following processes produces both fusion defects and a subsurface
  • white band in ultrahigh molecular weight polyethylene?
  • 1- Gamma sterilization in air
  • 2- Gamma sterilization in nitrogen
  • 3- Gamma sterilization in argon
  • 4- Ethylene oxide sterilization in air
  • 5- Ethylene oxide sterilization in argon
  • answer
  • back

 

  • Question 99.248
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Rimnac CM, Klein RW, Betts F, et al: Post‑irradiation aging of ultra‑high molecular weight polyethylene. J Bone Joint Surg 1994;76A:1052‑1056. Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 35‑41.

 

  • 99.249 Figure 62 shows the biopsy specimen of a 35-year-old migrant farm worker who has a mildly painful, 2-cm x 3-cm soft-tissue mass on the medial aspect of the foot that has been slowly enlarging for the past 6 months. He denies any history of injury. Examination reveals chronic drainage from several small sinus tracts. The remainder of the foot examination and
  • radiographic studies are normal.
  • Management should consist of
  • 1- below-knee amputation.
  • 2- wide local excision and skin graft.
  • 3- radiation therapy.
  • 4- antituberculous drug therapy.
  • 5- antifungal drug therapy.
  • Figure 62
  • answer
  • back

 

  • Question 99.249
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • McGinnis MR, Fader RC: Mycetoma: A contemporary concept. Infect Dis Clin North Am 1988;2:939‑954. Frierson JG, Pfeffinger LL: Infections of the foot, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 859‑876.

 

  • 99.250 An otherwise healthy 9-year-old child undergoing ear surgery awakens from general
  • anesthesia with torticollis. Management consists of application of a soft cervical collar,
  • but despite full-time use of the collar for 5 days, the torticollis fails to resolve. A CT
  • scan, with one transaxial image, is shown in Figure 63.
  • Treatment should now consist of
  • 1- application of a rigid cervical collar.
  • 2- application of chin-halter traction.
  • 3- application of a halo vest.
  • 4- manipulation of the cervical spine under general anesthesia.
  • 5- C1-C2 in situ posterior spinal fusion.
  • answer
  • back
  • Figure 63

 

  • Question 99.250
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Phillips WA. Hensinger RN: The management of rotatory atlanto‑axial subluxation in children. J Bone Joint Surg 1989;71A:664‑668. Fielding JW, Hawkins RJ: Atlanto‑axial rotatory fixation: Fixed rotatory subluxation of the atlanto‑axial joint. J Bone Joint Surg 1977;59A:37‑44.

 

  • 99.251 Figures 64a and 64b show the plain frog lateral radiograph and axial MRI scan of a 7- year-old child who has had left groin pain and a limp for the past 3 months. A biopsy reveals an aneurismal bone cyst. Management should include
  • 1- observation with serial
  • radiographs.
  • 2- hip spica casting.
  • 3- curettage and bone grafting.
  • 4- curettage and cementation.
  • 5- en bloc wide excision.
  • answer
  • Figure 64 A
  • Figure 64 B
  • back

 

  • Question 99.251
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Vergel De Dios AM, Bond JR, Shives TC, et al: Aneurysmal bone cyst: A clinicopathologic study of 238 cases. Cancer 1992;69:2921‑2931. Unni KK: Conditions that commonly simulate primary neoplasms of bone, in Unni KK (ed): Dahlin's Bone Tumors: General Aspects and Data on 11,087 cases, ed 5. Philadelphia, PA, Lippincott‑Raven, 1996, pp 382‑390.

 

  • 99.252 An 18-year-old female gymnast has had right shoulder pain for the past 6
  • months. Examination reveals 180° of active forward elevation, 90° of active
  • external rotation, passive internal rotation to T4, and pain with all motion. The
  • left shoulder has 2+ translation in all directions, and there is elbow
  • hyperextension. What is the next step in management?
  • 1- Examination under anesthesia
  • 2- Arthroscopic evaluation
  • 3- Capsular shift
  • 4- Physical therapy
  • 5- Corticosteroid injection
  • answer
  • back

 

  • Question 99.252
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Neer CS II: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: A preliminary report. J Bone Joint Surg 1980:62A:897‑908. Schenk T, Brems JJ: Multidirectional instability of the shoulder: Pathophysiology, diagnosis, and management. J Am Acad Orthop Surg 1998;6:65‑72.

 

  • 99.253 A 32-year-old man has an L2 paraplegia after sustaining a fracture at the
  • thoracolumbar junction. To enable the patient to stand using a knee-ankle-
  • foot orthosis and without using crutches, the body weight line must pass
  • 1- through the hip and knee joints.
  • 2- anterior to the hip and knee joints.
  • 3- posterior to the hip and knee joints.
  • 4- anterior to the hip joint and posterior to the knee joint.
  • 5- posterior to the hip joint and anterior to the knee joint.
  • answer
  • back

 

  • Question 99.253
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Bowker JH, Michael JW (eds): Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles. St Louis, MO, CV Mosby, 1992, pp 359‑361. Bunch WH, Keagy R, Kritter AE, et al (eds): Atlas of Orthotics. St Louis, MO, CV Mosby, 1985, pp 101‑103.

 

  • 99.254 What section of the meniscus is considered to be the most important
  • secondary restraint to anterior translation of the tibia?
  • 1- Anterior horn of the medial meniscus
  • 2- Anterior horn of the lateral meniscus
  • 3- Posterior horn of the lateral meniscus
  • 4- Posterior horn of the medial meniscus
  • 5- Middle and posterior horns of the lateral meniscus
  • answer
  • back

 

  • Question 99.254
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 3‑23. McConville OR, Kipnis JM, Richmond JC, et al: The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction. Arthroscopy 1993;4:431‑439.

 

  • 99.255 Which of the following is considered a radiographic sign of a stable (ingrown)
  • extensively porous-coated femoral component?
  • 1- Spot welds
  • 2- Calcar hypertrophy
  • 3- Component subsidence
  • 4- Distal bone pedestal formation
  • 5- Reactive lines around the prosthesis
  • answer
  • back

 

  • Question 99.255
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Engh CA, Massin P, Suthers KE: Roentgenographic assessment of the biologic fixation of porous‑surfaced femoral components. Clin Orthop 1990;257:107‑128. Zicat B, Engh CA, Gokcen E: Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg 1995;77A:432‑439.

 

  • 99.256 A 60-year-old woman falls on her outstretched arm and sustains an anterior
  • subcoracoid shoulder dislocation. After undergoing closed reduction, she is
  • unable to raise the arm. Which of the following conditions is most likely
  • responsible for this problem?
  • 1- Labral detachment
  • 2- Supraspinatus tear
  • 3- Subscapularis tear
  • 4- Dislocated long head of biceps
  • 5- Axillary nerve injury
  • answer
  • back

 

  • Question 99.256
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Neviaser RJ, Neviaser TJ, Neviaser JS: Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient. J Bone Joint Surg 1988;70A:1308‑1311. Hawkins RJ, Bell RH, Hawkins RH, et al: Anterior dislocation of the shoulder in the older patient. Clin Orthop 1986;206:192‑195.

 

  • 99.257 Figures 65a and 65b show the hematoxylin-eosin stains of the biopsy specimen, and Figures 65c and 65d show the T1 and T2 weighted axial MRI scans of a 36-year-old woman who has a painless mass in the posterior thigh. Management should include
  • 1- marginal excision.
  • 2- wide excision.
  • 3- wide excision and radiation therapy.
  • 4- radiation therapy alone.
  • 5- amputation.
  • answer
  • Figures 65:
  • A
  • B
  • C
  • D
  • back

 

  • Question 99.257
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Enzinger FM, Weiss SW (eds): Soft‑Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 829‑842. White NB: Neurilemomas of the extremities. J Bone Joint Surg 1967;49A:1605‑1610.

 

  • 99.258 Figure 66 shows the MRI scan of a 40-year-old roofer who has shoulder pain
  • and is unable to raise his arm after falling 10 feet from a ladder onto his right
  • elbow 24 hours ago. Examination reveals a palpable defect under the deltoid
  • and an external rotation lag. Management should consist of
  • 1- sling immobilization for 6 weeks.
  • 2- arthroscopic acromioplasty.
  • 3- physical therapy.
  • 4- biceps tenodesis.
  • 5- rotator cuff repair.
  • answer
  • back
  • Figure 66

 

  • Question 99.258
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Bassett RW, Cofield RH: Acute tears of the rotator cuff: The timing of surgical repair. Clin Orthop 1983;175:18‑24. Matsen FA III, Arnetz CT, Lippitt SB: Rotator cuff, in Rockwood CA Jr, Matsen FA III, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 755 839.

 

  • 99.259 Which of the following techniques for measuring bone mass exposes the
  • patient to the highest dose of radiation?
  • 1- Single emission photon X-ray absorptiometry (SXA)
  • 2- Dual emission X-ray absorptiometry (DXA)
  • 3- Radionucleotide imaging
  • 4- Radiographic absorptiometry (RA)
  • 5- Vertebral quantitative computed tomography
  • answer
  • back

 

  • Question 99.259
  • Answer =5
  • back to this question
  • next question
  • Reference(s)
  • Einhorn TA: Evaluation and treatment methods for metabolic bone disease. Contemp Orthop 1987;14:21‑34. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 119‑132.

 

  • 99.260 Examination of a 55-year-old man who sustained a right shoulder injury 3 months ago
  • reveals acromioclavicular and greater tuberosity tenderness. He has active shoulder
  • elevation of 120° and active external rotation of 20°. He reports pain with active and
  • passive shoulder motion and with stretching, but no pain with manual muscle testing.
  • MRI scans are shown in Figures 67a and 67b. Management should include
  • 1- manipulation under anesthesia.
  • 2- arthroscopic acromioplasty.
  • 3- physical therapy
  • 4- corticosteroid injection.
  • 5- rotator cuff repair.
  • answer
  • back
  • Figures 67
  • B
  • A

 

  • Question 99.260
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Warner JP, Greis, PE: The treatment of stiffness of the shoulder after repair of the rotator cuff, in Cannon WD (ed): Instructional Course Lectures, Volume 47. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 67‑76. Harryman DT, Lazarus MD, Rozencwaig R: The stiff shoulder, in Rockwood CA Jr, Matsen FA IIl, Wirth MA, (et al): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 1064‑1112.

 

  • 99.261 Treatment to minimize posterior sag following posterior cruciate ligament
  • reconstruction consists of immobilization at which of the following flexion
  • angles?
  • 1- 0°
  • 2- 30°
  • 3- 45°
  • 4- 70°
  • 5- 90°
  • answer
  • back

 

  • Question 99.261
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Harrier CD, Holier J: Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998;26:471‑482. Clancy WG Jr, Shelboume KD, Zoellner GB, et al: Treatment of knee joint Instability secondary to rupture of the posterior cruciate ligament: Report of a new procedure. J Bone Joint Surg 1983;65A:310‑322.

 

  • 99.262 Figures 68a through 68c show the radiographs of the foot and ankle of a 29-year-old man who fell from a height of 10 feet. Management should include
  • 1- closed reduction and casting.
  • 2- closed reduction and early motion.
  • 3- closed reduction and percutaneous pinning.
  • 4- open reduction and internal fixation.
  • 5- open reduction and fragment excision.
  • answer
  • back
  • Figures 52
  • B
  • C
  • A

 

  • Question 99.262
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Canale ST, Kelly FB Jr: Fractures of the neck of the talus: Long‑term evaluation of seventy one cases. J Bone Joint Surg 1978;60A:143‑156. Frawley PA, Hart JA, Young DA: Treatment outcome of major fractures of the talus. Foot Ankle 1995;16:339‑345. Sangeorzan BJ, Wagner UA, Harrington RM, et al: Contact characteristics of the subtalar joint: The effect of talar neck misalignment. J Orthop Res 1992;10:544‑551.

 

  • 99.263 Figures 69a and 69b show the radiographs of the lower and upper
  • extremities of an otherwise healthy 9-month-old infant who is irritable and
  • has mild diffuse tenderness in all four extremities. He takes no medication
  • or vitamin supplements. The infant has a temperature of 100.4°F (38.0°C),
  • and laboratory studies show a WBC of 9,400/mm' (normal 3,500 to 10,500/mm')
  • and an erythrocyte sedimentation rate of 68 mm/hr
  • (normal up to 20 mm/hr). Management should include
  • 1- a skeletal survey and consultation with protective services.
  • 2- needle aspiration of bone, followed by IV antibiotics.
  • 3- oral naproxen sodium.
  • 4- open biopsy of the tibia.
  • 5- IV prostaglandin-E2.
  • answer
  • back
  • Figures 69
  • A
  • B

 

  • Question 99.263
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Thometz JG, DiRaimondo CA: A case of recurrent Caffey's disease treated with naproxen. Clin Orthop 1996;323:304‑309. Letts M, Pang E, Simons J: Prostaglandin‑induced neonatal periostitis. J Pediatr Orthop 1994;14:309‑813.

 

  • 99.264 In technetium-99 bone scans, the radiopharmaceutical is most likely
  • deposited on the
  • 1- red blood cells.
  • 2- polymorphonuclear cells.
  • 3- osteoid.
  • 4- osteoblasts.
  • 5- osteoclasts.
  • answer
  • back

 

  • Question 99.264
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Alazraki N: Bone imaging by radionuclide techniques, in Resnick D, Niwayama A (eds): Diagnosis of Bone and Joint Disorders. Philadelphia, PA, WB Saunders, 1981, pp 639‑678. Nuclear imaging, in Sim FH (ed): Diagnosis and Management of Metastatic Bone Disease: A Multidisciplinary Approach. New York, NY, Raven Press, 1988.

 

  • 99.265 Item deleted after statistical review
  • (and no answer or references cited)
  • next question
  • back

 

  • 99.266 Item deleted after statistical review
  • (and no answer or references cited)
  • next question
  • back

 

  • 99.267 Figures 71a and 71b show the plain AP radiograph and coronal TI-weighted MRI scan of a 75-year-old patient who has had progressively worsening pain in the left hip for the past 6 months. Figure 71c shows the incisional biopsy specimen. Staging studies show localized disease. Surgical treatment should include
  • 1- prophylactic fixation.
  • 2- curettage and cementation.
  • 3- curettage and bone grafting.
  • 4- en bloc wide excision.
  • 5- hemipelvectomy.
  • answer
  • Figures 71:
  • B
  • A
  • back

 

  • Question 99.267
  • Answer = 4
  • back to this question
  • Reference(s)
  • Unni KK: Chondrosarcoma (primary, secondary, dedifferentiated, and clear cell), in Unni KK (ed): Dahlin's Bone Tumors: General Aspects and Data on 11,087 cases, ed 5. Philadelphia, PA, Lippincott‑Raven, 1996, pp 71‑108.
  • next question

 

  • 99.268 Which of the following rehabilitation exercises produces the least amount of
  • strain in the anterior cruciate ligament?
  • 1- Squatting with body weight
  • 2- Isometric quadriceps contraction at 15°
  • 3- Active range of motion from 90 to 35°
  • 4- Active range of motion with a 45 Newton-weight boot
  • 5- Simultaneous quadriceps and hamstring contraction at 15°
  • answer
  • back

 

  • Question 99.268
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Beynnon BD, Fleeting BC, Johnson RJ, et al: Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med 1995:23:24‑34. Beynnon BD, Johnson RJ, Fleeting BC, et al: The effect of functional knee bracing on the anterior cruciate ligament in the weightbearing and nonweightbearing knee. Am J Sports Med 1997;25:353‑359.

 

  • 99.269 What part of the patellar articular surface is in contact with the femoral
  • trochlea when the knee is flexed to 90°?
  • 1- Proximal third
  • 2- Middle third
  • 3- Distal third
  • 4- The odd facets
  • 5- Median ridge
  • answer
  • back

 

  • Question 99.269
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Goodfellow J. Hungerford DS, Woods C: Patello‑femoral joint mechanics and pathology: 2. Chondromalacia patellae. J Bone Joint Surg 1976;5813:291‑299. Fulkerson JP, Hungerford DS: Disorders of the Patellofemoral Joint. Baltimore, MD, 1990, pp 31‑35.

 

  • 99.270 In patients over age 60 years who have asymptomatic shoulders, the combined
  • incidence of partial- and full-thickness tears of the rotator cuff on MRI scans
  • is closest to what percent?
  • 1- 15%
  • 2- 35%
  • 3- 55%
  • 4- 75%
  • 5- 95%
  • answer
  • back

 

  • Question 99.270
  • Answer = 3
  • back to this question
  • Reference(s)
  • Sher JS, Uribe JW, Posada A, et al: Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg 1995;77A:10‑15.
  • next question

 

  • 99.271 Successful healing of a meniscal repair is most likely associated with which
  • of the following tear patterns?
  • 1- Radial tear
  • 2- Parrot beak tear
  • 3- Vertical tear in the red-red zone
  • 4- Vertical tear in the red-white zone
  • 5- Vertical tear in the white-white zone
  • answer
  • back

 

  • Question 99.271
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Rosenberg TD, Scott SM, Coward DB, et al: Arthroscopic meniscal repair evaluated with repeat arthroscopy. Arthroscopy 1986;2:14‑20. Tenuta JJ, Arciero RA: Arthroscopic evaluation of meniscal repairs: Factors that effect healing. Am J Sports Med 1994;22:797‑802.

 

  • 99.272 A 62-year-old man undergoes a suture-to-bone surgical technique to repair a
  • full-thickness supraspinatus tear that extends 3.0 cm across its insertion. Two
  • weeks later, the skin sutures are removed. Physical therapy for this patient
  • should include
  • 1- lifting weights that do not exceed 5 lb.
  • 2- lifting the weight of the arm only while standing.
  • 3- passive elevation and external rotation of the shoulder.
  • 4- ultrasound and phonophoresis.
  • 5- performing internal and external rotation stretching only.
  • answer
  • back

 

  • Question 99.272
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Brems JJ: Rotator cuff tears: Mobilization and tissue coverage, in Craig EV (ed): The Shoulder. New York, NY, Raven Press, 1995, pp 35‑54. Cofield RH: Rotator cuff disease of the shoulder. J Bone Joint Surg 1985;67A:974‑979.

 

  • 99.273 Which of the following mechanisms is most likely to result in graft failure 4
  • weeks after anterior cruciate ligament reconstruction with a patellar tendon
  • graft?
  • 1- Loss of fixation
  • 2- Midsubstance graft rupture
  • 3- Notch impingement
  • 4- Stretching of the graft
  • 5- Tear at the bone-tendon interface
  • answer
  • back

 

  • Question 99.273
  • Answer = 1
  • back to this question
  • End
  • Reference(s)
  • Kurosaka M, Yoshiya S, Andrish JT: A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 1987;15:225‑229.

 

  • 99.274 Which of the following is the most probable mechanism of pain relief when
  • transcutaneous electrical nerve stimulation (TENS) is used?
  • 1- Increase in oxygen delivery
  • 2- Release of endogenous opiates
  • 3- Decrease of type A sensory nerve conduction
  • 4- Inhibition of sympathetic vasoconstriction
  • 5- Enhancement of neuromuscular reeducation
  • answer
  • back

 

  • Question 99.274
  • Answer = 2
  • back to this question
  • Reference(s)
  • Wolff G, Grana WA: Knee rehabilitation. Sports Med Arthros Rev 1996;4:2‑7. Singer KM: Electrical stimulation in sports medicine, in DeLee JC, Drez D (eds): Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, PA, WB Saunders, 1994, pp 213‑227.
  • next question

 

  • 99.275 Figure 72 shows the AP radiograph of a 2-year-old African-American girl who has
  • diffuse tenderness and swelling of both feet. The patient has a temperature of 100.4°F
  • (38.0°C), and laboratory studies show an erythrocyte sedimentation rate of 35 mm/hr
  • (normal up to 20 mm/hr), a hemoglobin level of 8.5 g/dL (normal 12 to 15.5 g/dL), and
  • a peripheral WBC of 9,200/mm' (normal 3,500 to 10,500/mm'). Management should
  • include
  • 1- IV antibiotics.
  • 2- a triple-phase technetium bone scan.
  • 3- a blood transfusion.
  • 4- hydration and sickle cell preparation.
  • 5- open biopsy of the right third metatarsal.
  • answer
  • back
  • Figure 72

 

  • Question 99.275
  • Answer = 4
  • back to this question
  • End of 1999 Exam
  • Reference(s)
  • Onuba O: Bone disorders in sickle‑cell disease. Int Orthop 1993;17:397‑399. Tachdjian M (ed): Pediatric Orthopedics, ed 2. Philadelphia, PA, WB Saundars, 1996, pp 1139‑1146.
Dr. Mohammed Hutaif

About the Author: Prof. Dr. Mohammed Hutaif

Vice Dean of the Faculty of Medicine at Sana'a University and a leading consultant in orthopedic and spinal surgery. Learn more about my expertise and achievements.

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