Day 91A Abos Daily Mastery

Front 1

20yo falls from his bicycle. He requies orif. What best describes the injury shown in Figure A and B? 1-Coronoid fx; 2-Capitellum fx w/ extension ->trochlea; 3-Radial head & capitellum fx; 4-Isolated capitellum fx; 5-Trochlea fx

Back 1

lat xray "double bubble" sign representing fx-> trochlea & capitellum. Tx of choice; displaced Type IV & type 1 >2mm= ORIF vs excision; type 2 & 3 >2 m displaced :::ANS 2

Front 2

34yo presents an obvious deformity of LLE Fig A & B. He has no other injuries. Which Tx algorithms will ML lead to the best outcomest? 1- CR/Perc screw fem neck, ->reamed antegrade nail fem; 2-Reamed antegrade nail fem shaft -> OR/perc screw

Back 2

fem neck 3-Reamed retrograde naili fem shaft -> CR/perc screw fem neck; 4- OR/screw -> fem neck, -> reamed retrograde nail-> fem shaft 5- OR/screw fix-> fem neck,-> plating -> fem shaft:::Ans4

Front 3

22yo undergoes retrogradeIM nail Fig A. Which of the followg would place branches of the femoral N & deep femoral A at greatest risk during placement of the interlocking screw in Fig B? 1-A to P placement above lesser troch

Back 3

2-A to P placement below lesser troch 3-Lat to med placement above lesser troch 4-Lat to med placement below lesser troch 5Open placement w/ blunt dissection down to bn:::Ans2

Front 4

34yo is in a MVA & c/o several ortho injuries. Fig A shows a red line representating a fx of prox fem. This fx orientation is often present when found concomitantly w/ which orthopaedic injuries? 1-Ipsilateral acetabular fx;

Back 4

2-lumbar spine burst fx 3-Ipsilateral fem shaft fx
4-Ant-pos compression pelvic injury;5-Ipsilateral calcaneus fx:::Femoral neck < 10%, but frequently missed on initial eval. the pattern is typically nondisplaced, vertical, and basicervical:::3

Front 5

Which of the following factors is most associated w/ malrotation during antegrade or retrograde femoral nailing? 1-Surgeon experience; 2-Level of primary fx line; 3-Use of a piriformis starting portal
4-Fx comminution; 5-CR technique

Back 5

depending on the time of surgery, with significantly more malrotation during the night shift. Increased fracture comminution also significantly increased malrotation rates:::Ans4

Front 6

A 26-year-old male sustains a femoral shaft fracture treated with the implant shown in Figure A. Postoperatively, what muscular deficits can be expected at medium and long-term follow-up? 1-Weakness w/ hip abd & knee flex;

Back 6

2 Weakness w/ hip abd & knee ext; 3-Weakness w/ knee flex & knee ext; 4-Weakness w/ hip ER & hip abd; 5-Weakness w/ hip ER & hip flex::: Long term deficits weakness w/ knee extension (quadriceps) & hip abd (glutei muscles)Ans2

Front 7

26yo s/p MVA. W/u closed L fem shaft fx, & ipsilateral post wall fx. He undergoes IM nail-> fem & ORIF post wall. Tx'd w/ 25 mg indomethacin TID x 6 wks for HO prophylaxis. Which is true regarding this PO Tx protocol?

Back 7

1-incr rate fem shaft nonunion 2- no affect on the healing time of post wall fx 3-It is ass w/ a faster time to union; 4-Indomethacin is sup to rad tx prevention HO; 5-decr rate of rev. surgery needed when indomethacin is P/O:::incr risk of long-bone nonunion.Ans1

Front 8

P/o varus alignment of an unstable subtroch fem fx Tx w/ an IM nail has been shown to be related to which of the f/u factors? 1-Use of a piriformis entry nail through a greater troch entry portal; 2-Use of a greater troch entry nail through a piriformis

Back 8

entry portal 3-Use of a lat entry nail through a piriformis entry portal; 4-Use of a fem distractor device to obtain redtn; 5-Use of a fx table to obtain redtn:::advancement of the nail causes the two axes to become colinear, leading to varus,:::Ans1

Front 9

pts w/ ipsilateral fem neck & shaft fxs, what % of fem neck fxs are dx on a delayed basis?1-1%; 2-15%; 3-30%; 4-60%; 5-75%

Back 9

Ipsilateral fem neck & shaft fx occur in high Eng injuries, w/ a reported incidence of 2.5-9%. The dx of neck fx is delayed in 19%-31% of ptts.:::Ans3

Front 10

22 yo sustains the injury in Fig A. When placing an antegrade IM nail w/ manual traction, which of the following is T when compared to using a fx table? 1-Inc OR time; 2-Dec IR malrotation deform; 3-Incr ER malrotation deform;

Back 10

4-Incr pudendal N injury; 5-Inc need for revision::: 29) of the forty-two femora were ER by >10° vs (7%) of the 45 tx w/ manual tx:::Ans2

Front 11

33yo sustains the injury in Fig A. Compared to antegrade nail vs, retrograde nail has been shown to have an increased amount of which? 1-OR time;
2-Sx distal interlocking screws; 3Hip pain; 4-Union rate; 5-Final knee ROM

Back 11

retrograde nail= incr rate of sx distal interlocking screws, an inc rate of need for dynamization; longer union time, & less thigh pain than antegrade nail:::Ans2

Front 12

Which of the following has been shown to have similar biochemical and clinical characteristics as iliac crest autograft? 1-BMP-2; 2-BMP-7 + collagen matrix carrier; 3-Hydroxyapatite cement; 4-Platelet rich plasma w/ allograft cancellous bone carrier;

Back 12

5-Fem intramedullary reaming contents:::femoral intramedullary reaming debris =biochemical characteristics as iliac crest autograft. + osteogenic potential with viable cells while BMP's are osteoinductive cytokines:::Ans5

Front 13

A pt undergoes the tx Fig A for a displaced IT fem fx. With use of this construct, a starting point 3 mm ant to the center of the piriformis fossa has which benefits? 1-Improv placement of screws -> nail into the fem head; 2-Dec risk of varus

Back 13

3-Dec risk of jnt penetration; 4-Dec risk of AVN of fem head 5-Improved passage of nail through fem canal::: due to the fact that the hip is anteverted and the femoral neck arises from the anterior portion of the proximal femur. Therefore, by lead to a “straight” shot into the center of the femoral head.Ans5 (B)

Front 14

Pts who sustain b/l fem shaft fxs vs unilateral fem fx have higher rates of the following EXCEPT:1. closed head injury 1
2. mortality
3. thoracic injury
4. open skull fractures
5. pelvic fractures

Back 14

ans 3

Front 15

Which of the following is an advantage of computer-assisted navigation used to place medullary nail interlocking screws compared to a freehand techinque?

Back 15

1. Reduced fluoroscopy time 2. More reliable placement of interlocking screws through the nail
3. Reduced procedure time 4. Increased quality of fluoroscopic images 5. Improved accuracy of screw length:::1Ans

Front 16

the greatest amount of iatrogenic injury to the piriformis tendon is associated with which of the following?

Back 16

1. Antegrade piriformis entry femoral nailing
2. Antegrade greater trochanteric entry femoral nailing 3. Retrograde femoral nailing
4. External fixation of a femoral shaft fracture
5. Open reduction and internal fixation of an intertrochanteric fracture.ANs1

Front 17

A 32-year-old male sustains a closed head injury, a closed pelvic ring injury, as well as the bilateral open femoral fractures shown in Figures A-C. He remains borderline hypotensive with a base deficit of -4.9 after an exploratory laparatomy and splenectomy. After irrigation and debridement of his open fractures, what is the most appropriate treatment for this patient at this time?

Back 17

1. Bilateral retrograde femoral nailing and pelvic binder application
2. Bilateral retrograde femoral nailing and anterior pelvic external fixation
3. Bilateral antegrade femoral nailing and pelvic binder application
4. Bilateral femoral external fixation and anterior pelvic external fixation
5. Bilateral femoral plating and anterior pelvic external fixation Ans4