Musculoskeletal Trauma Scored and
Recorded Self-Assessment Examination 2025
,Question 1 of 100
Figure 1 is the radiograph of a 40-year-old man who had a 15-foot fall and now has foot pain. Medical
history is significant for diabetes and smoking two packs a day. You determine that a sinus tarsi
approach is necessary for surgical reconstruction. During the approach what structure is most at risk?
A. Peroneal tendons
B. Sural nerve
C. Superficial peroneal nerve
D. Abductor digiti quinti
R: A
The radiograph depicts an intra-articular displaced calcaneus fracture. The sinus tarsi approach uses an
incision 1 cm distal to the tip of the lateral malleolus and 2-3 cm distal along the lateral foot. The peroneal
tendons must be mobilized and retracted to visualize the anterolateral process, critical angle of Gissane, and
the posterior facet. The sural nerve is 1 cm posterior to the fibula and runs toward the base of the fifth
metatarsal. This structure would be remote from the incision unless a more posterior incision is used. The
superficial peroneal nerve is anterior and not involved with the approach. The abductor digiti quinti is plantar
to this incision and would not be encountered.
Question 2 of 100
A 99-year-old woman sustains the injury shown in Figure 1 after falling from a standing position. What
is the most cost-effective treatment?
A. Three cannulated screws
B. Long intramedullary nail
C. Sliding hip screw
D. Short intramedullary nail
,R: C
Intertrochanteric hip fractures remain a common injury that orthopaedic surgeons manage. The optimal form
of surgical stabilization for these injuries has been a topic of debate over the years. Recent studies have
demonstrated equivalent outcomes between the use of sliding hip screws and intramedullary nails for stable
fracture patterns. Recent guidelines have suggested that the use of sliding hip screws for stable fracture
patterns can have a significant reduction in cost per case.
Question 3 of 100
A 26-year-old man is involved in a high-speed motorcycle accident. He sustains a grade IIIB open tibia
fracture. Examination reveals a large soft-tissue defect and an insensate foot. What is the expected
outcome in this scenario?
A. Equal functional outcome when limb salvage is compared with amputation
B. Worse functional outcome with limb salvage than with primary amputation
C. Better functional outcome when amputation is compared with limb salvage
D. Permanent loss of plantar sensation
R: A
The Lower Extremity Assessment Project data have shown that absent plantar sensation is not an indication
for primary amputation. When looking at a comparison between an insensate salvage group and a sensate
salvage group at 2 years follow-up, both groups had an equal proportion (55%) of normal plantar sensation
and more importantly, functionally both groups were equivalent. Absent plantar sensation at initial evaluation
is not prognostic for long-term plantar sensory status or functional outcome.
Question 4 of 100
Figure 1 is the radiograph of a 36-year-old male bicyclist who was struck by a car. After reduction,
what should be the next step in the evaluation?
A. Ankle brachial index (ABI)
B. Venous duplex ultrasonography
C. CT scan without contrast
D. Angiogram of the lower extremity
R: A
, Knee fdislocations fhave fa fhigh frate fof fvascular finjuries f(15% fto f40%). fAll fpatients fpresenting fwith fknee
fdislocations fshould fbe furgently freduced. fUse fof fABI f(range f0.9-1.1) fwill fallow fidentification fof fpatients
fwith fsubtle fvascular finjury. fThis fcan falso fbe fused fas fa fscreening ftool ffor ffurther fworkup fincluding
fangiography.
Question f5 fof f100
Two ffemoral fshaft ffractures fare fshown fin fFigure f1. fEach fis ffixed fidentically fwith fthe fsame
fintramedullary fnail fand finterlocking fscrews. fThe ffracture fgap fstrain fis fhigher fin
A. A.
B. B.
C. neither; fthe fstrain fis fidentical fin fA fand fB.
D. neither; fthe fstrain fis fdependent fon ffemur flength.
R: fA
Fracture fgap fstrain fis fdefined fas fdeformation fof fgranulation ftissue fwithin fthe ffracture fgap fwhen fa fgiven
fforce fis fapplied. fNormal fstrain fis fthe fchange fin flength f(Δ fl) fdivided fby fthe foriginal flength f(l) fwhen fa
fgiven fload fis fapplied. fThe famount fof fdeformation fthat fa ftissue fcan ftolerate fwhile ffunctioning fvaries
fgreatly. fIntact fbone fhas fa fnormal fstrain ftolerance fof f2% f(before fit ffractures), fwhereas fgranulation ftissue
fhas fa fstrain ftolerance fof f100%. fBony fbridging fbetween fthe fdistal fand fproximal fcallus fcan fonly foccur
fwhen flocal fstrain f(ie, fdeformation) fis fless fsevere fthan fthe fforming fbone fcan ftolerate. fTherefore,
ftreatment fof ffractures fmust foptimize fthe fstrain fenvironment fto fenable fhealing.
Comminution, fas fshown fin fB, fresults fin fdistribution fof fthe fmotion fbetween fmultiple ffracture ffragments.
fAs fa fresult, feach ffracture fgap fexperiences fless fmotion fand fstrain fis fdecreased. fIn fsimple ffracture
fpatterns fas fshown fin fA, fsmall famounts fof fmotion for feven fa fsmall ffracture fgap fresults fin fa fhigh-strain
fenvironment. fStrain fis fdependent fupon fthe flength fof fthe ffracture fgap fbut fnot fon fthe flength fof fthe fbone.
Question f6 fof f100
A f31-year-old fman fsustained fan funstable fclosed fleft fposterior fhip fdislocation fin fa fmotorcycle
faccident. fA fpostreduction fradiograph fis fshown fin fFigure f1. f3-D fCT fscans fare fshown fin fFigures f2
fand f3. fWhat fis fthe foptimal fsurgical fapproach fthat fwill fallow ffor fthe fmost fappropriate ftreatment?
f f
A. Surgical fdislocation
B. Watson-Jones fapproach
C. Smith-Peterson fapproach
Recorded Self-Assessment Examination 2025
,Question 1 of 100
Figure 1 is the radiograph of a 40-year-old man who had a 15-foot fall and now has foot pain. Medical
history is significant for diabetes and smoking two packs a day. You determine that a sinus tarsi
approach is necessary for surgical reconstruction. During the approach what structure is most at risk?
A. Peroneal tendons
B. Sural nerve
C. Superficial peroneal nerve
D. Abductor digiti quinti
R: A
The radiograph depicts an intra-articular displaced calcaneus fracture. The sinus tarsi approach uses an
incision 1 cm distal to the tip of the lateral malleolus and 2-3 cm distal along the lateral foot. The peroneal
tendons must be mobilized and retracted to visualize the anterolateral process, critical angle of Gissane, and
the posterior facet. The sural nerve is 1 cm posterior to the fibula and runs toward the base of the fifth
metatarsal. This structure would be remote from the incision unless a more posterior incision is used. The
superficial peroneal nerve is anterior and not involved with the approach. The abductor digiti quinti is plantar
to this incision and would not be encountered.
Question 2 of 100
A 99-year-old woman sustains the injury shown in Figure 1 after falling from a standing position. What
is the most cost-effective treatment?
A. Three cannulated screws
B. Long intramedullary nail
C. Sliding hip screw
D. Short intramedullary nail
,R: C
Intertrochanteric hip fractures remain a common injury that orthopaedic surgeons manage. The optimal form
of surgical stabilization for these injuries has been a topic of debate over the years. Recent studies have
demonstrated equivalent outcomes between the use of sliding hip screws and intramedullary nails for stable
fracture patterns. Recent guidelines have suggested that the use of sliding hip screws for stable fracture
patterns can have a significant reduction in cost per case.
Question 3 of 100
A 26-year-old man is involved in a high-speed motorcycle accident. He sustains a grade IIIB open tibia
fracture. Examination reveals a large soft-tissue defect and an insensate foot. What is the expected
outcome in this scenario?
A. Equal functional outcome when limb salvage is compared with amputation
B. Worse functional outcome with limb salvage than with primary amputation
C. Better functional outcome when amputation is compared with limb salvage
D. Permanent loss of plantar sensation
R: A
The Lower Extremity Assessment Project data have shown that absent plantar sensation is not an indication
for primary amputation. When looking at a comparison between an insensate salvage group and a sensate
salvage group at 2 years follow-up, both groups had an equal proportion (55%) of normal plantar sensation
and more importantly, functionally both groups were equivalent. Absent plantar sensation at initial evaluation
is not prognostic for long-term plantar sensory status or functional outcome.
Question 4 of 100
Figure 1 is the radiograph of a 36-year-old male bicyclist who was struck by a car. After reduction,
what should be the next step in the evaluation?
A. Ankle brachial index (ABI)
B. Venous duplex ultrasonography
C. CT scan without contrast
D. Angiogram of the lower extremity
R: A
, Knee fdislocations fhave fa fhigh frate fof fvascular finjuries f(15% fto f40%). fAll fpatients fpresenting fwith fknee
fdislocations fshould fbe furgently freduced. fUse fof fABI f(range f0.9-1.1) fwill fallow fidentification fof fpatients
fwith fsubtle fvascular finjury. fThis fcan falso fbe fused fas fa fscreening ftool ffor ffurther fworkup fincluding
fangiography.
Question f5 fof f100
Two ffemoral fshaft ffractures fare fshown fin fFigure f1. fEach fis ffixed fidentically fwith fthe fsame
fintramedullary fnail fand finterlocking fscrews. fThe ffracture fgap fstrain fis fhigher fin
A. A.
B. B.
C. neither; fthe fstrain fis fidentical fin fA fand fB.
D. neither; fthe fstrain fis fdependent fon ffemur flength.
R: fA
Fracture fgap fstrain fis fdefined fas fdeformation fof fgranulation ftissue fwithin fthe ffracture fgap fwhen fa fgiven
fforce fis fapplied. fNormal fstrain fis fthe fchange fin flength f(Δ fl) fdivided fby fthe foriginal flength f(l) fwhen fa
fgiven fload fis fapplied. fThe famount fof fdeformation fthat fa ftissue fcan ftolerate fwhile ffunctioning fvaries
fgreatly. fIntact fbone fhas fa fnormal fstrain ftolerance fof f2% f(before fit ffractures), fwhereas fgranulation ftissue
fhas fa fstrain ftolerance fof f100%. fBony fbridging fbetween fthe fdistal fand fproximal fcallus fcan fonly foccur
fwhen flocal fstrain f(ie, fdeformation) fis fless fsevere fthan fthe fforming fbone fcan ftolerate. fTherefore,
ftreatment fof ffractures fmust foptimize fthe fstrain fenvironment fto fenable fhealing.
Comminution, fas fshown fin fB, fresults fin fdistribution fof fthe fmotion fbetween fmultiple ffracture ffragments.
fAs fa fresult, feach ffracture fgap fexperiences fless fmotion fand fstrain fis fdecreased. fIn fsimple ffracture
fpatterns fas fshown fin fA, fsmall famounts fof fmotion for feven fa fsmall ffracture fgap fresults fin fa fhigh-strain
fenvironment. fStrain fis fdependent fupon fthe flength fof fthe ffracture fgap fbut fnot fon fthe flength fof fthe fbone.
Question f6 fof f100
A f31-year-old fman fsustained fan funstable fclosed fleft fposterior fhip fdislocation fin fa fmotorcycle
faccident. fA fpostreduction fradiograph fis fshown fin fFigure f1. f3-D fCT fscans fare fshown fin fFigures f2
fand f3. fWhat fis fthe foptimal fsurgical fapproach fthat fwill fallow ffor fthe fmost fappropriate ftreatment?
f f
A. Surgical fdislocation
B. Watson-Jones fapproach
C. Smith-Peterson fapproach
