Henry Ford Macomb Orthopaedic Residency
July 29, 2011
Quiz 2
1. Figure 1 shows the radiograph of an 11-year-old boy who stubbed his great toe while playing soccer barefoot. He is
able to walk home despite a small amount of bleeding at the nail fold. Management should consist of
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A hard-soled shoe for 4 to 6 weeks.
Closed reduction and percutaneous pinning.
Burning a hole in the nail for relief of the impending hematoma.
Digital block and irrigation and debridement of the wound.
Repair of the extensor hallucis longus tendon injury and use of a hard-soled shoe
2. A 13-year-old boy hyperextends his knee while playing basketball and reports a pop that is followed by a rapid
effusion. A lateral radiograph is shown in Figure 4. Initial management consists of attempted reduction with
extension, with no change in position of the fragment. What is the next most appropriate step in management?
1.
2.
3.
4.
5.
A long leg cast in 90° of knee flexion for 6 weeks
Open reduction and internal fixation with a transphyseal 6.5-mm screw and washer
Arthroscopic anterior cruciate ligament reconstruction with hamstring tendons
Arthroscopic debridement and staged anterior cruciate ligament reconstruction when skeletally mature
Open reduction and internal fixation with suture or intra-epiphyseal screw placement
3. A 4-year-old girl sustains an isolated spiral femoral fracture after falling from her tricycle. Management
should consist of
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External fixation.
Plate fixation.
Skeletal traction for 5 weeks.
Immediate spica cast immobilization.
Flexible nailing with titanium nails
4. Examination of a 25-year-old man who was injured in a motor vehicle accident reveals a fracture-dislocation of
C5-6 with a Frankel B spinal cord injury. He also has a closed right femoral shaft fracture and a grade II open
ipsilateral midshaft tibial fracture. Assessment of his vital signs reveals a pulse rate of 45/min, a blood pressure of
80/45 mm Hg, and respirations of 25/min. A general surgeon has assessed the abdomen, and a peritoneal lavage is
negative. His clinical presentation is most consistent with what type of shock?
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Neurogenic
Hemorrhagic
Spinal
Septic
Hypovolemic
5. A 25-year-old student sustains the injury shown in Figures 13a through 13c after falling off a curb. Initial
management should consist of
1- Weight bearing as tolerated in a hard-soled shoe.
2- Weight bearing as tolerated in an ankle lacer.
3- Weight bearing as tolerated in a short leg cast.
4- non-weight-bearing in a hard-soled shoe.
5- non-weight-bearing in a short leg cast.
6. Figure 18a shows the initial lateral radiograph of a 6-year-old girl who sustained a fracture in a motor vehicle
accident and was treated in a cast 1 year ago. She now has the valgus deformity seen in Figure 18b. Treatment
should consist of
1- observation.
2- high tibial osteotomy.
3- MRI and assessment for growth arrest and bar excision.
4- stapling of the lateral tibial physis.
5- external fixation and hemichondrodiastasis.
7. A 7-year-old boy has a swollen and deformed right arm after falling off his bicycle. Radiographs reveal a
completely displaced posterolateral supracondylar humeral fracture. Examination reveals a warm, pink hand and
forearm but absent pulses. What is the next most appropriate step in management?
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Angiography
Immediate closed reduction and casting in extension
Surgical exploration and repair of the artery, followed by skeletal stabilization
Closed reduction and pinning, followed by reassessment of the vascular status
Magnetic resonance angiography (MRA)
8. A 13-year-old girl injures her ankle playing soccer. Radiographs reveal a displaced Tillaux fracture. CT scans
are shown in Figure 25. What is the most important consideration for appropriate management?
1- Joint congruity
2- Torn anterior tibiofibular ligament
3- Growth arrest leading to angular deformity
4- Growth arrest leading to limb-length discrepancy
5- Osteonecrosis of the talus
9. A 10-year-old girl has a midshaft both bone forearm fracture. After attempted closed reduction, alignment
consists of bayonet apposition, 10° of malrotation, and 8° of volar angulation. Management should now consist of
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Open reduction and plating of the radius to restore the radial bow.
Open reduction of the ulna and plating.
Closed reduction and nailing of the bones with flexible nails.
A long arm cast and follow-up of alignment in 5 days.
A short arm cast for 6 weeks.
10. A 42-year-old woman sustained a closed, displaced talar neck fracture in a motor vehicle accident. Which of
the following is an avoidable complication of surgical treatment?
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Posttraumatic arthritis of the subtalar joint
Posttraumatic arthritis of the ankle joint
Malunion of the talus
Osteonecrosis of the talus
Complex regional pain syndrome
11. Figure 35 shows the radiograph of a 12-year-old boy who fell off a snowmobile and landed on his left
shoulder. He has a closed injury. Management should consist of
1- a shoulder spica cast.
2- closed reduction and percutaneous pinning.
3- open reduction to remove the interposed soft tissue.
4- a shoulder sling, followed by repeat radiographs to document fracture position.
5- open reduction and internal fixation with a 90° blade plate.
12. A 5-year-old boy has a deformity of his right arm after falling from a jungle gym.
A radiograph is shown in Figure 37. Management should consist of
1- closed reduction of the ulna and transcapitellar pinning of the radial head.
2- closed reduction of the ulna and radial head dislocation.
3- closed reduction of the ulna and annular ligament repair.
4- open reduction of the radius and plating of the ulna.
5- open reduction of the ulna and immobilization in an extension cast.
13. Figure 38a shows the radiograph of a 12-year-old boy who underwent a reamed intramedullary nailing for a
closed femoral shaft fracture. One year after rod removal, he reports groin pain. A current radiograph is shown in
Figure 38b. The findings are most likely the result of
1- a torn ligamentum teres.
2- damage to the femoral neck.
3- damage to the lateral ascending vessels of the femoral neck.
4- unrecognized Perthes’ disease.
5- growth arrest of the proximal physis