APll:TOTEAEIO nANEnlI:THMIO 0EI:/NIK!

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e· oreonAlt.lKH K/\INIKH ARISTOTLE UNIVERSITY OF TI-IESSALONIKI
MEYeYNTHl:: nEPIK/\HI: nAfIAt.OCTOY/\OI: 2nd ORTHOPAEDIC DEPARTMENT
KA0HTTfl"HI: OPeOnAlt. IKHI: CHAIRMAN: PERICLES PAPADOPOULOS
r .N.0ooaaAOVb('l1~ «f.rENNHMATAI:» PROFESSOR OF ORTHOPAEDICS
E9vucft~ Aµ,)vr)~ 41 , T.K. 54635, 0&aaw..ovlKT) "G.GENNIMATAS" HOSPITAL
T11)..: 2310-963220 4 I Ethnikis Aminis Str, 54635 Thessaloniki, Greece
Fax: 2310-992S23 Tel: 0030 2310-963220
Fax: 0030 2310-992523

QUESTIONS

1. 1. A 70-year-old right-hand dominant female presents to your office complaining of continued right
shoulder pain 12 weeks after falling from a ladder, despite participating in a rigorous physical
therapy program. She was initially reduced in the emergency department and her injury films are
shown in Figures A and B. On exam, she has weakness on active elevation and external rotation, but
full passive range of motion and intact sensation. New radiographs reveal no acute osseous
abnormalities and a concentric reduction. What is best next step and which diagnosis will most likely
be revealed?

a. Right upper extremity electromyography; axillary nerve palsy

b. MRI brachia! plexus; axillary nerve palsy
c. MRI cervical spine; C5 and C6 nerve root radiculopathy
~ MRI right shoulder; rotator cuff tear

2. When performing a routine reverse shoulder arthroplasty, which technique would increase the
moment of the deltoid compared to the native, rotator cuff-deficient shoulder?

a. Using a glenosphere with 10-degree inferior tilt

b. Switching to a humeral prosthesis with a smaller neck-shaft angle
c. Switching to a short-stemmed humeral component
d. Placing the glenosphere more inferiorly
3. A latissimus dorsi tendon transfer is indicated for
which of the following clinical scenarios?

@ A 30-year-old carpenter with MRI findings depicted

in Figure A
b. A 70-year-old carpenter with MRI findings depi
cted in Figure A
c. A 30-year-old carpenter with MRI findings depi
cted in Figure B
d. A 70-year-old carpenter with MRI findings depi
cted in Figure B
4. What nerve is at risk with overdrilling the glen
oid during a SLAP repair?

a. Axillary
~ Upper subscapular
c. Radial
(P. Supraspinatus
5. A 17-y~ar-old basketball player presents to .
fall dunng a game 2 months ago. Immedia!e~u~il~c~ with _Pe:si~tent shoulder soreness following a
s~oulder, which resolved his pain and allow~ hi owing ~s mc1dent, a teammate manipulated the
Figure A, what structure is tom what . th m to firush the game. His current MRI shown in
contribute to stability? ' is e eponym for this lesion, and at what position does it most

Anterior-inferior labrum, Bankart lesion, external rotation with shoulder abducted at 45°
Anterior-superior labrum, HAGL lesion, internal rotation with shoulder abducted at 90°
c. Posterior-inferior labrum, GLAD lesion, internal rotation with shoulder abducted at 45°
d. Anterior-inferior labrum, Bankart lesion, external rotation with shoulder abducted at 90°

6. 73-year-old man with a history of a left shoulder hemiarthroplasty 10 years ago sustains a fall and
presents the emergency room with acute pain and weakness in his left shoulder. He undergoes
successful closed reduction of the left shoulder. On routine follow up 3 months later, he is still
unable to elevate his arm beyond 30 degrees despite rigorous physical therapy. New radiographs
depict anterosuperior escape. What is the structure likely injured and what is the treatment that would
result in the most predictable outcome?

~ Rotator cuff; Isolated rotator cuff repair

/ 15_ Rotator cuff; Rotator cuff repair and conversion to anatomic total shoulder arthroplasty
® Rotator cuff; Conversion to a reverse total shoulder arthroplasty
d. Labrum; Conversion to anatomic total shoulder arthroplasty

7. A 69-year-old patient presents with a periprosthetic reverse total shoulder arthroplasty fracture. A
deltopectoral approach is used for open reduction and internal fixation of the fracture. Which of the
following is the most likely complication that might occur when cable fixation is placed 4 cm
inferior to the insertion of the latissimus dorsi?

a. Iatrogenic median nerve injury

b. Axillary nerve neurapraxia
c. Subscapularis tendon injury
 d. Iatrogenic radial nerve injury

8. In what tendons pathology is the comma sign found?

a. Axillary Long head of biceps tear

b. Supraspinatus tendon tear
c. Subscapularis tendon tear
d. Pectoralis major tear

9. 21-year-old collegiate volleyball player is noted to have we~ess_ in external rot~tii°~~ d- isolat~d
atrophy of the infraspinatus on physical examination as seen m Figure A. _An axia nnage is
shown in Figure B. This clinical condition is most likely caused by compression of the:

a. Axillary nerve at the triangular space

b. Suprascapular nerve in the suprascapular notch
c. Suprascapular nerve in the spinoglenoid notch
d. Axillary nerve in the quadrangular space

10. An anteromedial facet fracture of the coronoid process leads to:

@ Posteromedial rotatory instability
=b. Posterolateral rotatory instability
~ Lateral instability
~ -Medial Instability

11. A 45-year-old male presents with an acute inability to extend his thumb, four months after he was
treated with cast immobilization for a minimally-displaced distal radius fracture. What is the most
appropriate treatment at this time?

~ Primary repair of extensor pollicus longus

(~ Extensor indicis proprius transfer to extensor pollicis longus
c. Extensor pollicis brevis transfer to extensor pollicus longus
d. Extensor carpi radialis longus transfer to extensor pollicus longus
e. Occupational therapy for strengthening
 r . . .c-.
12. A 40- yea r-ol d ma le pre sen ts to you c1iruc 1or eva lua fo f 8 months of left shoulder pain and
I n o
wea kne ss afte r a fall whi le skii ng MRI tud ' · p· .
I . · s 1es are shown
. m igur e A. Wh ich of the following
· hly p b bl . thi
Ph ys1ca exa m find mg s wou ld be hig ro a em s patient?

ulder compared to the right sho uld er

a. Inc reas ed pas sive flexion of the left sho ulder
left shoulder com par ed to the righ t sho
b. Inc reas ed active internal rotation of the er
shoulder compared to the righ t sho uld
c. Inc reas ed pas sive extension of the left ulder
ed pas sive exte rna l rota tion of the left shoulder com par ed to the righ t sho
d. Inc reas

ma bay following a mo tor

Fig ure A is the rad iog rap h of a 42- year-old female who presents to the trau ogenic injury
13. ORIF through a pos teri or approach. Iatr
isio n. She sub seq uen tly und ergo es
vehicle coll
ly with this approach?
to whi ch nerve in Figure B is mo st like

Cl
-
Cl

ct

Cl

a. A
b. B

~
C
D
e. E
14. Figure A is the postoperative radiograph of an 82-year-old female who was treated
cephalomedually nail for a left intertrochanteric hip fracture. Which of the following is
common complication following use of this device?
th:~\)
.

'II\.

a. Anterior perforation of distal femur

@ Breakage of the screw
c. Implant cutout
d. Implant breakage
e. Nonunion

15. A 45-year-old female barista' from Portland fell off her skateboard and sustained a closed distal
radius fracture. The patient undergoes open reduction internal fixation (ORIF). Post-operatively she
is given a prescription with the goal of mitigating a potential adverse outcome. Which of the
following has evidence to support its utility in this clinical situation?

a. Alendronate 700mg once per week for 3 months

b. Alendronate 70mg once per week for 3 months
A Vitamin C 300mg once daily for 50days
(g) Vitamin C 500mg once daily for 50days
e. Vitamin C 1500mg once daily for 30days

16. What muscles are responsible for the most common deformity after antegrade intramedullary nailing
for a subtrochanteric femur fracture?

@ Hip abductors and iliopsoas muscle

b. Hip internal rotators and iliopsoas muscle
c. Quadriceps and iliopsoas muscle
d. Hamstring and iliopsoas muscle
e. Quadriceps and hip adductors
 t the injury
17. A 2l-y~ar- ?ld foo ball player is tackled as he falls onto an outstretched arm. He sustains
order did his
~h_own m Figure A. He undergoes successful operative treatment of his injury. In which
mJury occur?

a. LCL > anterior capsule > MCL

b. LCL > MCL > anterior capsule
c. anterior capsule > MCL > LCL
.@ MCL > anterior capsule > LCL
e. MCL > LCL > anterior capsule

wound
18. A 37-year-old male presents overnight to your busy trauma hospital after sustaining a gunshot
with
to the right forearm. He is neurovascularly intact. Given the bony defect, you decide to proceed
respect to
a two-stage Masquelet technique for reconstruction. Which of the following is true with
this surgical technique?

a It is an acceptable method for management of large articular bony defects

r
b. Iliac crest bone graft (ICBG) has been shown to be superior to reamer irrigator aspirato
(RIA) bone grafting
@ The ideal timing of stage 2 reconstruction is 8 weeks after stage 1
d. The induced membrane prevents the resorption of the bone graft placed during stage 2
n of
e. Antibiotics should not be included in the cement spacer due to disruptio
pseudomembrane formation

reveals a
19. A 62-year-old man slips on ice and sustains an elbow dislocation. Post-reduction imaging
the most
highly comminuted radial head fracture and coronoid fracture through its base. What is
appropriate treatment?

a. Early passive range-of-motion in a hinged elbow brace

b. Application of a static spanning external fixator for 6 weeks
t and
c. Radial head excision, coronoid excision, and repair of the lateral ulnar collateral ligamen
medial collateral as needed
of the
d. Radial head excision, open reduction internal fixation of the coronoid, and repair
lateral ulnar collateral ligament and medial collateral as needed
~ Radial head replacement, open reduction internal fixation of the coronoid, and repair of the
V lateral ulnar collateral ligament and medial collateral as needed
 20. A 3O-year-old female falls onto her outstretched arm and sustains the.
injury shown in Figures A
.
. . ~I.\.
B . After mtra-art1cu1ar l"d
0 0 •
• e m·,iecti"on her elbow range of motion 1s
1 ocam 30 -95 extens10n/flex.ion
~ , . . . ,
450 supination 650 pronation. There is no wrist tenderness and the radius pull
' test is symme tric to
the contralateral forearm. What is the most appropnate. t?
treatmen ·

a. Sling and early elbow range of motion

@ Internal fixation with a periarticular plate via the extensor carpi ulnaris / ancone
us approach
c. Radial head arthroplasty via the brachialis / pronator teres approach
d. Internal fixation with headless compression screws via the brachialis
/ pronator teres
approach
e. Fragment excision via the extensor carpi ulnaris / anconeus approach

21. A 65-year-old female sustains a fall onto her outstretched right hand. The
injury is closed and she is
neurovascularly intact. There is no median nerve paresthesias. Radiographs are
shown in Figures A
and B. What is the next best step in management ofthis patient?

a. Admit for acute carpal tunnel syndrome monitoring

~ Place into rigid splint and follow-up in clinic
c. Admit for acute open reduction/internal fixation
d. Place into removable soft splint and follow-up in clinic
e. Place into rigid splint and schedule for outpatient open reduction/internal
fixation
 I
22 · A 30-year-old wo~an falls onto an outstretched arm while rollerblading. She presents to the
emergency room with the elbow deformity shown in Fi8!JI~ A2 0n physical examination she is
unable to_ range her elbo~. She is distally neurovascularly ·intact. Her radiograph is shown in Figure z

--
B. What 1s the next step m management of this patient?

a.
b.
Closed reduction, splinting & early active ROM
Closed reduction, splinting & early passive ROM
c. Open reduction and surgical repair of the lateral collateral ligament complex
d. Closed reduction, acute surgical repair of the lateral collateral ligament complex
e. Closed reduction, hinged external fixator

23. A 74-year-old female sustains a displaced intracapsular femoral neck fracture. Which of the
following is TRUE regarding the long-term differences between possible treatment options for this
injury?

a. Patients undergoing total hip arthroplasty are more likely to experience persistent pain than
those undergoing internal fixation
@:) Patients undergoing total hip arthroplasty are less likely to require reoperation than those
undergoing internal fixation
c. There is no difference in functional outcome scores between internal fixation and total hip
arthroplasty
d. Patients undergoing internal fixation perform activities of daily living better than those
undergoing total hip arthroplasty
e. Mortality rates are higher following total hip arthroplasty than internal fixation

24. A 74-year-old female falls from a standing height and sustains a proximal humerus fracture. The
occurrence of this injury most increases her risk of subsequently sustaining which of the following
fractures in the future?

a. Distal humerus fracture

b. Distal radius fracture
c. Distal fibula fracture
d. Hip fracture
e. Sacral fracture

25. When utilizing the pectoralis major tendon as a reference for restoring humeral height during
shoulder hemiarthroplasty, at what level cephalad to the proximal edge of the tendon should the top
of the prosthesis sit?

a. 1.4 cm
b. 2.8cm
c. 5.6cm
d. 6.5 cm
e. 4.2 cm
26. Which of the following factors MOST places the knee at risk of patellar maltracking in total knee
arthroplasty?

a. Thickness of patellar resection

b. Cruciate retaining component
c. Medial placement of patellar component
d. Preoperative patellar tilt
e. Lateral placement of patellar component

27. A 62-year-old female Zumba instructor presents to your clinic reporting progressive left knee pain
and effusion that has been present for the past few months. Pain is exacerbated by weightbearing and
physical exam is significant only for TIP over the medial joint line. A radiograph and MRI are
shown in Figures A-B. Which of the following statements regarding management of this pathology is
true?

a. Unicompartmental knee arthroplasty (UKA) demonstrates reliable long-term outcomes when

performed for this condition
b. UK.A is appropriate for the spontaneous (but not secondary) form of this condition
c. UK.A performed for this condition is associated greater failure rates than for osteoarthritis
d. The most common cause of failure following UKA for this condition is from tibial stress
fractures
e. Total knee arthroplasty (TKA) is indicated for this patient due to high failure rates associated
with UKA when performed for this condition

28. A 65-year-old male presents with a painful right total knee arthroplasty, which was performed ten
years ago. CRP is 15 mg/L. Knee aspiration reveals a purulent fluid with 3,100 WBC's ~th 83%
PMN's. Culture results are pending. Which of the following is the best management option?

a. Physical therapy, ice, and follow-up evaluation in 2 weeks

b. Repeat aspiration if cultures are positive
c. Oral antibiotics
d. Intravenous antibiotics
e. Surgical explant of the components
, L}Uring total knee replacement with the tri 1 •
29· . t"gh . fl . a components m place, the knee achieves full extension
but expenences 1 tness m ex1on with nl • •
. ? a range to o y 90 degrees. What 1s the most appropnate
action.

a. Resect more proximal tibia

b. Downsize the femoral component
c. Addition of a distal femoral augment
d. Downsize the tibial polyethylene insert
e. Resect more distal femur

30. A 22-year-old female sustained a lateral patellar dislocation while playing intramural soccer. This is
her third dislocation in the last 6 months. She completed 6 weeks of physical therapy following her
first dislocation. You recommend reconstruction of her medial patellofemoral ligament (MPFL)
given her recurrent instability. Where should your femoral tunnel be located when looking at Figure
A?

a. A
b. B
C. C
d. D
e. E

31. Which of the following is true of the medial meniscus when compared to the lateral meniscus?

a. More anterior translation with extension and less posterior movement with flexion
b. Less anterior translation with extension and less posterior movement with flexion
c. More posterior translation with extension
d. More anterior translation with flexion
e. Fewer capsular attachments to the meniscus periphery
32. A 62-year-old woman with a valgus knee as seen in Figures A ~d B ':ho underwe?t ~ Primary tota,\
knee arthroplasty with a tourniquet presents 5 hours postoperatively _wi~ severe pain_ m the extrenuty
and inability to dorsiflex or plantarflex the ankle. Narcotic pain med1cat1on does not 1ID.prove her
symptoms. The knee is flexed and the bandage is loosened and she is re-examined one hour later. On
examination, the patient is unable to dorsiflex or plantarflex the foot and the pulses are asymmetric.
What is the next most appropriate step in management?

a. Serial neurologic examinations and EMG in 3 months

b. Pain service consultation for adductor canal block
c. Return to the OR for peroneal nerve exploration
d. Vascular surgery consultation
e. Thrombectomy

33. A young athlete sustains an isolated meniscal tear and undergoes arthroscopy. The surgeon performs
a meniscal repair. Which of the following factors is most important in determining healing rates?
a. Days from injury to repair
b. Medial versus lateral meniscus
c. Width of the meniscal rim
d. Use of growth hormone
e. Dominant versus non-dominant leg

34. During anterior cruciate ligament reconstruction, a graft that is tight inflexion but lax in extension
may be due to which technical error?
a. Femoral tunnel is too posterior
b. Femoral tunnel is too anterior
c. Femoral tunnel placed at 12:00 position
d. Tibial tunnel is too anterior
e. Tibial tunnel is too media
 ,41l of the following are intraoperative techni
Jf•artf1rop1asty EXCEPT: ques to treat a flexion contracture in total knee

a. Resect osteophytes
b. Release posterior capsule
c. Resect more distal femur
d. Downsize the femoral component
e. Tenotomize the hamstrings

36. Which view offers the best view for CMC joint?
a. Brewerton
b. Roberts
c. Zanca
d. Canale

37. Acceptable angulation in little finger neck fractures is:

a 10°-15°
b. 30°-40°
c. 50°-60°
d. No angulation is acceptable

38. Excision of a large hook of the hamate fracture can lead to:
a Decreased grip strength
b. Instability
c. Ulnar nerve neuropathy in Guyon' s canal
d. All of the above

39. The most common mechanism of injury in scaphoid fractures is:

a. Axial load across a hyper-palmarflexed, supinated and ulnarly-deviated wrist
b. Axial load across a hyper-dorsiflexed, supinated and ulnarly-deviated wrist
c. Axial load across a hyper-palmarflexed, pronated and ulnarly-deviated wrist
d. Axial load across a hyper-dorsiflexed, pronated and ulnarly-deviated wrist

40. Risk factors for scaphoid nonunion are all EXCEPT for:
a. Vertical oblique fracture pattern
b. Displacement> 1mm
c. Youngage
d. Nicotine use

41. Which of the following statements regarding the Space of Poirier is NOT true?
a. It is between the volar radioscaphocapitate ligament and volar long radiolunate ligament
b. It is a central weak area of the wrist and with wrist palmar flexion this area increases
c. In perilunate dislocations, this space allows the distal carpal row to separate from the lunate
d. In lunate dislocations, the lunate escapes into this space

42. In CMC arthrodesis, the joint is fused in:

a. 35° radial abduction, 30° palmar abduction and 15° supination
b. 35° radial abduction, 30° palmar abduction and 15° pronation
c. 25° radial abduction, 15° palmar abduction and 15° supination
d. 25° radial abduction, 15° palmar abduction and 15° pronation
I
 43. What is the most appropriate treatment for a patient who suffers from MCP hyperextension
deformity of 30° after CMC arthritis?
a. No surgical intervention
b. Percutaneous pinning ofMCP in 25-35° flexion
c. Volar capsulodesis or sesamoidesis
d. MCP fusion

44. Which of the following statements regarding the Carpal tunnel syndrome is true?
a. Acute CTS following ORIF of a distal radius fracture is initially treated conservatively.
b. Pinch strength returns in 6 months.
c. Grip strength is expected to return to 100% preoperative levels by 6 weeks postop.
d. The rate of continued symptoms at 1+ year is 20% in severe CTS.

45. A patient with inability of performing an·"OK" sign suffers from:

a. Anterior interosseous nerve compressive neuropathy
b. Cubital tunnel syndrome
c. Pronator syndrome
d. Carpal tunnel syndrome

46. Pronator syndrome and Carpal tunnel syndrome have both:

a. Paresthesia in thumb, index, middle finger.and radial half of ring finger.
b. Sensory disturbances over the distribution of palmar cutaneous branch of the median nerve.
c. Night symptoms.
d. All of the above.

47. Sensory deficit to the ulnar 1-1/2 digits and the dorsum of the hand can be caused by:
a. Cubital tunnel syndrome
b. Ulnar tunnel syndrome (Guyon's canal)
c. Pronator syndrome
d. All of the above

48. Nerve palsy after elbow arthroscopy accounts for 1-5%. Which is the most common nerve palsy?
a. Radial nerve palsy
b. Nerve palsy of the medial antebrachial cutaneous and median nerves
c. Transient ulnar nerve palsy
d. PIN palsy

49. A 40-year-old male patient suffers from deep aching pain in proximal forearm which increases
during lifting activities . There is pain with resisted forearm supination and with resisted third-finger
extension. He hasn't any sensory manifestations. Which is the most probable diagnosis?
a. Lateral epicondylitis (tennis elbow)
b. Medial epicondylitis (golfer's elbow)
c. Radial tunnel syndrome
d. Cubital tunnel syndrome

50. Which of the following statements regarding distal biceps avulsion is FALSE?
a. There is loss of 50% sustained supination strength.
b. The "Hook test" has nearly 100% sensitivity and specificity.
c. "Reverse Popeye sign" is usually seen.
d. Radial nerve or PIN injury is the most common complication