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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5211_Библиотеки_им_академика_М_И_Перельмана
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Tim Brock and Rishi Dhir
(a) (b)
Figure 15.2 (a) Anteroposterior (AP)
and (b) lateral radiographs of the
right tibia
Figure 15.3 Lateral
radiograph finger
Figure 15.4 (a) Lateral radiograph calcaneum and (b) sagittal CT
view calcaneum
A. A reduced angle of Gissane indicates collapse
of the posterior facet
B. An enlarged Böhler’s angle indicates collapse
of the posterior facet
C. Sanders classification is based on the number
of articular fragments on the sagittal CT image
D. The sustentaculum tali (anteromedial) frag-
ment is referred to as the ‘ constant fragment’
E. Double density sign seen on lateral radio-
graphs indicates a superiorly displaced calcaneus fracture/dislocation
5. Regarding radiology for Lisfranc injuries,
which of the following is false?
A. The ‘fleck sign’ is pathognomic and indicates
avulsion of the Lisfranc ligament
B. The ‘step off sign’ is caused by dorsal dis-
placement of the 2nd metatarsal relative to
the cuboid
C. The gap between the 2nd metatarsal and
medial cuneiform is <2mm
D. The medial border of the cuboid should nor-
mally line up with the medial border of the
4th metatarsal on the oblique view
E. The medial edge of the 2nd metatarsal
should normally line up with the medial
edge of the middle cuneiform on the AP
radiograph
6. Which of the following is incorrect concerning
Lisfranc joint anatomy?
A. The 2nd tarsometatarsal joint produces the
so-called ‘keystone’ in the ‘Roman Arch’
B. The dorsal ligaments are stronger than the
plantar ligaments
C. There is no intermetatarsal ligament between
the 1st and 2nd metatarsals
314
Trauma I Structured SBA
D. The Lisfranc ligament runs from the first cunei-
form to the medial base of the 2nd metatarsal
E. The Lisfranc joint is formed by the five meta-
tarsals that articulate with the three cuneiform and cuboid bones
7. Which mode of plating should be ideally used
for the distal radius fracture pattern seen in
Figure 15.5?
Figure 15.5 Lateral
radiograph distal radius
A. Buttress
B. Neutralisation
C. Bridging
D. Locking
E. Compression
8. Which of the following techniques mainly produces
healing by a high strain fracture environment?
A. Overdrilling the near cortex to 3.5mm and
the far cortex to 2.5mm in a Weber B ankle
fracture
B. Using a partially threaded cancellous screw in
a transverse medial malleolar fracture
C. Drilling an eccentric hole in an LCP plate
D. Using an articulated compression device
E. Using hybrid fixation for a periarticular frac-
ture with metaphyseal comminution
9. Regarding the injury shown in Figure 15.6,
indications for urgent surgical treatment do
NOT include which of the following?
Figure 15.6
Lateral radiograph
supracondylar
fracture elbow
A. Absent radial pulse
B. Threaten ed skin viability
C. Capillary refill time of 5 seconds
D. Displacement greater than 100%
E. Pale hand
10. A 53-year-old male fell down 12 flights of steps
onto his right elbow. His radiographs are shown
in Figure 15.7.
Regarding his injury, which of the following is
NOT a technical objective to achieve maximal
fixation and stability?
(a) (b)
Figure 15.7 (a) Anteroposterior (AP)
radiograph and (b) lateral radiographs
fractured distal right humerus
315
Tim Brock and Rishi Dhir
A. Every screw in the distal fragments should
pass through a plate
B. The screws in the distal fragments should
lock together by interdigitation, creating a
fixed-angle structure
C. Plates should be strong enough and stiff
enough to resist breaking or bending
D. Each screw should be as long as possible
E. Lag screw to be used outside the plate to fix
fracture fragments
11. A 24-year-old male sustains a type II odontoid
fracture following a diving injury.
Regarding anterior pin placemen t for a Halo
device, which of the following is true?
A. If the pins are placed more laterally, then there
is a risk of injury to the orbicularis muscle
B. Should be placed 2cm above the lateral one-
third of the eyebrow
C. Should be placed below the equator of the skull
D. Should be placed medial to the supraorbital
nerve
E. The supraorbital nerve exits the skull at the
level of the frontal sinus
Regarding fixation of radial head fractures,
which of the following is correct?
A. Kocher’s approach is in the interval between
triceps and brachioradialis
B. PIN palsy causes weakness of wrist extension
and abduction
C. Supination should be performed to protect
the posterior interosseus nerve
D. The capsule should not be dissected too far
posteriorly, as the PIN runs over the back of
the posterolateral portion of the elbow
capsule
E. The safe zone of fixation is between the radial
styloid and Lister’s tubercle
14. A 30-year-old patient falls off his motorbike and
sustains the injury shown in Figure 15.8. He has
a blood pressure of 90/60 and pulse of 110 on
arrival in ED.
12. A 26-year-old male patient fell directly on his
right shoulder with the arm in an outstretched
and overhead position. Pain and swelling were
immediate and were associated with a ‘step
deformity’. The patient had limited right shoulder
range of motion (ROM), strength and function.
Regarding this injury, which of the following
statements is correct?
A. Type II injuries involve rupture of the AC
ligament and a CC ligament sprain
B. Type III injuries involve posterior displace-
ment of the lateral clavicle through the
trapezius
C. Type IV injuries involve rupture of both AC
and CC ligaments with increased CC distance
of 25–100%
D. Type VI injuries involve increased CC dis-
tance from 100–300% of contralateral side
E. Type V injuries involve inferior dislocation of
the lateral clavicle
13. A 20-year-old right-handed man sustained a displaced comminuted radial head fracture
following a traffic accident.
Figure 15.8 Anteroposterior (AP) radiograph pelvis
Which of the following would initial management NOT include?
A. Administer tranexamic acid
B. Apply an external fixator
C. Apply a pelvic binder
D. Give FFP and cryoprecipitate
E. Initiate a massive transfusion protocol
15. A 45-year-old woman has sustained a talar neck
fracture following a motor vehicle accident. She
has been added to the trauma list for ORIF. The
CT1 on call at the time of admission has read up
that the possibility of AVN developing in this
fracture is high.
316
Trauma I Structured SBA
The blood supply to the talar neck does NOT
include which of the following?
A. Anterior tibial artery
B. Artery to tarsal canal
C. Deltoid branches
D. Lateral plantar artery
E. Peroneal artery
16. A toddler was brought to the ED with irritability.
In an investigation of non-accidental injury,
which of the following has a high specificity
for NAI?
A. Complex skull fractures
B. Digital fractures
C. Femoral fracture in an ambulatory child
D. Metaphyseal fracture (junction of metaphysis
and physis)
E. Vertebral body fractures
17. A 30-year-old, right hand-dominant man sus-
tained an isolated injury to the right wrist after
a fall from a height of approximately 15 feet. The
patient reported that he fell on his outstretched
hand with the wrist in extension. The right wrist
was painful, swollen and tender to palpation. The
hand was neurovascularly intact with no sensory
deficit in the distribution of the median nerve.
His radiographs are shown in Figure 15.9.
In the pathoanatomy of the injury, which of the
following lists the events in the correct order?
A. Failure of lunocapitate ligament – failure of
scapholunate ligament – failure of
lunotriquetral ligament – lunate dislocates into
carpal tunnel
B. Failure of lunotriquetral ligament – failure of
lunocapitate ligament – failure of scapholunate
ligament – lunate dislocates into carpal tunnel
C. Failure of lunotriquetral ligament – failure of
scapholunate ligament – failure of lunocapitate ligamen t – lunate dislocates into carpal
tunnel
D. Failure of scapholunate ligament – failure of
lunocapitate ligament – failure of lunotriquetral ligament – lunate dislocates into carpal
tunnel
E. Failure of scapholunate ligament – failure of
lunotriquetral l igament- failure of lunocapitate ligamen t – lunate dislocates into carpal
tunnel
18. An 18-year-old tennis player attended the orthopaedic clinic complaining of radial-sided wrist
pain after a fall on an outstretched hand.
Radiographs have shown a displaced waist of
scaphoid fracture.
Regarding the volar approach to the scaphoid,
which of the following statement is false?
A. It is indicated in distal pole fractures
B. It is indicated in humpback flexion
deformities
C. It is indicated in proximal pole fractures
D. It is indicated in waist fractures
E. It utilises the interval between FCR and the
radial artery
(a)
Figure 15.9 (a) Anteroposterior (AP)
and (b) lateral radiographs right wrist
(b)
317
Tim Brock and Rishi Dhir
(a) (b)
Figure 15.10 (a) Anteroposterior (AP) and (b) lateral radiograph child’s elbow
19. Which of the following is NOT a content of the
anterior compartment of the leg?
A. Extensor digitorum longus
B. Extensor hallucis longus
C. Peroneus longus
D. Peroneus tertius
E. Tibialis anterior
20. A 6-year-old boy falls off a trampoline onto his
left elbow and sustains the injury noted on radiographs shown in Figure 15.10.
Regarding the elbow fracture, which of the
following statements is correct?
A. May be associated with wasting of the first
dorsal interosseus
B. Minimally displaced fractures (<2mm gap)
should be treated with open reduction
internal fixation
C. The external oblique view is the most accur-
ate view to show fracture displacement
D. The fracture fragment most often lies
anterolateral
E. When fixed with K-wires, 2mm K-wires
should be used
21. A 46-year-old motorcyclist sustains an isolated
closed injury (Figure 15.11) after falling off his
motorbike at high speed.
Regarding the initial management of this
injury, which of the following is correct?
A. Intramedullary nailing has better disability
ratings at 6 months
B. Intramedullary nailing is more cost-effective
compared with locking plates
Figure 15.11
Anteroposterior (AP) and lateral
radiographs tibia
C. Recovery rates for IM nailing and locking
plates are equivalent
D. There is a statistically higher infection rate
when using lockin g plates compared with
intramedullary nailing
E. There is no difference in further surgery
between IM nailing and locking plates
22. Principles of elastic (TENS) nails include all of
the following except which?
A. They can be used for comminuted forearm
fractures
B. Nail diameter should be no more than 40% of
the isthmus of the medullary canal
C. They should be pre-bent to three times the
diameter of the isthmus
318
Trauma I Structured SBA
D. The apex of the bow of the elastic nail should
be at the level of the fracture
E. The entry point for the nail should be
2.5–3cm proximal to the physis
23. Which of the following increases the pull-out
strength of a screw in bone?
A. Decrease the cortex thickness
B. Decrease the outer diameter
C. Decrease the thread density (increased dis-
tance between threads)
D. Increase the inner diameter
E. Increase the outer diameter
24. Undisplaced distal radius fractures are most
associated with the rupture of which structure?
A. Extensor digitorum communis
B. Extensor indicis proprius
C. Extensor pollicis longus
D. Flexor pollicis brevis
E. Flexor pollicis longus
25. A 30-year-old patient sustains an epileptic fit and
attends the ED complaining of severe right
shoulder pain. An anteroposterior (AP) shoulder
radiograph is shown in Figure 15.12. It is irreducible in the ED.
C. Rotational osteotomy
D. Subscapularis transfer +/– lesser tubero sity
E. Emergency closed reduction under GA
26. A 35-year-old man is found 6 hours after sustain-
ing a comminuted fracture of his right tibia secondary to a high-velocity gunshot wound. He hasa
systolicBP of 90 butresponds wellto fluids. He has
a weak dorsalis pedis pulse but good capillary refill.
What is his MESS value?
A. 5
B. 6
C. 7
D. 8
E. 9
27. Paediatric fractures occur through which layer
of the physis ?
A. Maturation zone
B. Primary spongiosa
C. Proliferative zone
D. Reserve zone
E. Zone of provisional calcification
28. A 25-year-old male was resuscitated after coming
off a motorbike at 50mph. He sustained an open
humerus fracture, femur and tibia fracture and
spinal fracture. His ISS score was 20. After he
was resuscitated initially, the trauma team
wanted to plan for fixation of his injuries.
In the Early Appropriate Care (EAC) protocol
which of the following is incorrect regarding
fracture fixation?
A. Base excess should be >5.5mmol/L
B. Definitive fixation should be performed
within 36 h of injury
C. Lactate should be <4mmol/L
D.
Patients should respond to resuscitation with
pressor support
E. pH should be >7.25
Figure 15.12 Anteroposterior (AP) radiograph right shoulder
Which of the following is NOT a recommended
treatment option?
A. Femoral head allograft reconstruction
B. Reverse shoulder arthroplasty
29. A 74-year-old man falls downstairs while intoxi-
cated and attends ED complaining of neck pain.
Plain lateral radiograph cervical spine is shown
in Figure 15.13. He is awake and alert.
Which of the following is the most appropriate
initial management following resuscitation?
A. Closed reduction in Gardner–Wells tongs
with serial traction
319
Tim Brock and Rishi Dhir
Figure 15.13 Lateral
radiograph cervical spine
B. Immediate anterior discec tomy and fusion
C. Halo application
D. MRI and urgent neurosurgical consult
E. Immediate posterior discectomy and fusion
30. An 80-year-old male presented to the ED with
neck pain following a mechanical fall at home.
Coronal CT image cervical spin is shown in
Figure 15.14.
surgical treatment in elderly patients (65–85
years)
D. The complication rate of non-surgical and
surgical treatment of type II fractures in the
elderly is higher
E. Type II fractures sit in a watershed area and
have a greater risk of non-union
31. A 35-year-old male came off a motorbike.
Following resuscitation, he complained of weakness in both legs and lower back pain. Clinical
examination revealed bruising and swelling over
his lumbar spine with M3 power in both legs and
bilateral paraesthesia. Sagittal CT imaging is
shown in Figure 15.15.
Figure 15.14 Coronal CT scan cervical spine
Which of the following statements is false in
elderly patients with this injury pattern?
A. Anterior screw fixation is indicated with
transverse or posterior oblique fracture lines
B. Posterior fusion has higher union rates than
anterior fixation in type II fractures
C. Surgical stabilisation of type II fractures
improves survival compared with non-
320
Figure 15.15 Sagittal CT image lumbar spine
What is the most appropriate management
following initial resuscitation?
A. Mobilise with a spinal brace with flexion and
extension views at 6 weeks
B. Mobilise with physiotherapy with no brace
with flexion and extension views at 6 weeks
C. Prolonged bed rest with full spinal
precautions
D. Surgical decompression
E. Surgical stabilisation
(a) (b)
Trauma I Structured SBA
Figure 15.16 (a) Anteroposterior (AP)
radiograph right humerus and (b) clinical
photograph upper limb
32. A 33-year-old male falls down a flight of stairs,
sustaining an injury to his right upper arm.
Anteroposterior (AP) radiograph is shown in
Figure 15.16(a) and clinical photograph is shown
in Figure 15.16(b). The injury is isolated. On
clinical examination, he is unable to dorsiflex
his wrist and extend his fingers at the MCPJs.
The most appropriate next step in management
would be which of the following?
A. Coaptation splint followed by functional brace
B. Humeral nailing
C. Open reduction, internal fixation and explor-
ation of the median nerve
D. Open reduction, internal fixation and explor-
ation of the radial nerve
E. Urgent nerve conduction studies and MRI
upper limb
33. A 41-year-old woman undergoes a radial head
fixation for a Mason II radial head fracture. The
Kaplan approach is used.
Post-operatively, what complication is most
likely?
A. Inability to abduct the fingers
B. Inability to extend the wrist in radial
deviation
C. Inability to extend the wrist in ulnar
deviation
D. Inability to flex the wrist in radial deviation
E. Inability to flex the wrist in ulnar deviation
34. A77-year-oldwomanresidentofanursinghome
with limited functional ability falls onto concrete
sustaining a closed injury. She has radiographs
performed, which confirm the injury (Figure
15.17).
Figure 15.17 Lateral
radiograph elbow
What is themost appropriate managementoption?
A. Total elbow replacement
B. Tension-band wiring of the olecranon
C. Conservative treatment
D. Open reduction, internal fixation w ith
locking plate
E. Excision and triceps advancement
35. A 31-year-old man falls off his motor bike. sus-
taining the isolated inju ry shown in Figure 15.18.
He is neurovascularly intact and is initially resuscitated in the ED.
What is the most appropriate definit ive
management?
A. Closed reduction, examination under anaes-
thetic and early range of motion
B. Radial head arthroplasty and coronoid open
reduction internal fixation
321
Tim Brock and Rishi Dhir
Figure 15.18 Lateral radiograph elbow
C. Radial head arthroplasty, coronoid open
reduction internal fixation and lateral collateral ligament repair
D. Radial head fixation and coronoi d open
reduction internal fixation
E. Radial head fixation, coronoid open reduc-
tion internal fixation and medial collateral
ligament repair
D. Sling immobilisation and early mobilisation
E. Total shoulder replacement
37. A 39-year-old motorcyclist presents with con-
tinuing residue discomfort 4 months after intramedullary nailing of a midshaft tibial fracture.
Inflammatory markers are normal. Radiographs
are shown in Figure 15.20.
36. A 63-year-old golfer falls awkwardly onto his left
shoulder. He is neurovascularly intact.
Anteroposterior (AP) radi ograph demonstrates
a three-part fracture of the proximal humerus
involving the surgical neck and the greater tuberosity (Figure 15.19). There is posterior and
superior displacement of the greater tuberosity
by 1cm.
Figure 15.19
Anteroposterior radiograph
(AP) shoulder
What is the most appropriate treatment?
A. Hemiarthroplasty
B. Open reduction and internal fixation
C. Reverse polarity total shoulder arthroplasty
Figure 15.20 (a) Anteroposterior (AP) and (b) lateral radiographs
right tibia
What is the next appropriate treatment?
A. Dynamisation of the tibial nail
B. Exchange tibial nailing
C. Functional bracing and observation
D. Low-intensity pulsed ultrasound
E. Nail removal and open reduction internal
fixation
38. A 26-year-old cyclist falls over his handlebars at
high speed. Following initial resuscitation, he is
found to have the injury shown in Figure 15.21.
In the consent process, what statement is incorrect with regard to non-operative versus operative management?
A. Return to sport is quicker with operative
management
B. There is a higher re-operative rate with
operative management
322
Figure 15.21 Lateral radiograph clavicle
C. There is a hi gher symptomatic mal-union
rate in non-operative management
D. There is better short-term function with
operative management
E. There is no difference between non-union
rates
39. A 26-year-old undergoes scapula fixation
following polytrauma via a Judet approach. He
awakes with deep posterior shoulder pain and
weakness with abduction.
During the approach, where is the nerve most
likely to be damaged?
A. By inadvertently dissecting inferior to teres
minor
B. During exposure of the posterior deltoid
muscle belly
C. During retraction of infraspinatus
D. During retraction of teres minor
E. Inadvertently dissecting out the quadrangular
space
40. A 7-year-old girl falls off a climbing frame, sustaining the injury shown in Figure 15.22. She
sustains a neurological injury.
Figure 15.22 Lateral
radiograph elbow
Trauma I Structured SBA
Based on her injury, what muscle(s) are most
likely to be deficient?
A. 4th and 5th lumbricals
B. Abductor digiti minimi
C. Abductor pollicis longus
D. Extensor pollicis lon gus
E. Pronator quadratus
41. A 16-year-old male sustains the injury to his hip
shown in Figure 15.23 following a motor vehicle
accident. There is no neurovascular deficit and
no other associated injuries. The on-call registrar
is able to reduce the hip in the ED under
sedation.
Figure 15.23 Anteroposterior (AP) radiograph hip
What is the next step in management?
A. Abduction brace
B. CT scan of pelvis
C. MRI scan of pelvis
D. Protected weight bearing
E. Skeletal traction
42. A 23-year-old man is brought into ED after a fall
from a height of 6 feet. Following resuscitation,
an anteroposterior (AP) radiograph demonstrates an isolated closed injury (Figure 15.24).
Which of the following is false in the management of this injury?
A. A Leadbetter manoeuvre may be performed
to aid reduction
B. Open reduction relies on an internervous
plane between the superior gluteal and femoral nerves
C. Quality of reduction is the most important
factor in influencing outcome
323
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