LATEST ORTHOPAEDIC SURGERY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF ORTHOPAEDIC
SURGERY (ABOS) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 28-year-old male sustains a traumatic femoral
shaft fracture in a motorcycle accident. He is taken to
the operating room for intramedullary nailing within
24 hours. Intraoperatively, after reaming and nail
insertion, the patient becomes hypotensive, hypoxic,
and develops petechiae on his chest. Which of the
following is the most likely diagnosis?
A) Fat embolism syndrome
B) Pulmonary embolism
C) Anaphylactic reaction to anesthetic agents
D) Hemorrhagic shock
Correct answer: A
Rationale: Fat embolism syndrome (FES) occurs
when fat globules enter the pulmonary circulation,
typically following long bone fractures and
intramedullary reaming. The classic triad includes
respiratory distress, neurological changes, and
petechial rash. Pulmonary embolism (B) is less likely
,without DVT source; anaphylaxis (C) would present
with urticaria and bronchospasm; hemorrhagic
shock (D) would present earlier and without
petechiae.
2. A 45-year-old woman with a BMI of 38 and diabetes
presents with right hip pain. Radiographs show
severe osteoarthritis of the hip. Which perioperative
optimization step has been shown to most
significantly reduce the risk of periprosthetic joint
infection following total hip arthroplasty?
A) Preoperative chlorhexidine wipes the night before
surgery
B) Smoking cessation for 4 weeks prior to surgery
C) Optimization of glycemic control with HbA1c <7%
D) Preoperative nutritional supplementation with
protein
Correct answer: C
Rationale: Poorly controlled diabetes (HbA1c >7-8%)
is strongly associated with increased periprosthetic
joint infection risk. Optimizing glycemic control is one
of the most modifiable and impactful risk factors.
While smoking cessation (B) and nutrition (D) are
beneficial, glycemic control has the strongest
evidence for infection reduction in diabetic patients.
,3. A 72-year-old woman with osteoporosis falls onto
an outstretched hand and presents with wrist pain.
Radiograph reveals a dorsally displaced,
comminuted fracture of the distal radius with intra-
articular extension. What is the most appropriate
initial management?
A) Closed reduction and cast immobilization
B) Open reduction internal fixation with volar locking
plate
C) Percutaneous pinning
D) External fixation
Correct answer: B
Rationale: In elderly patients with osteoporotic bone
and intra-articular, comminuted distal radius
fractures, open reduction internal fixation (ORIF) with
a volar locking plate provides stable fixation allowing
early motion. Closed reduction (A) leads to loss of
reduction in comminuted fractures. External fixation
(D) is less commonly used for intra-articular
fractures.
4. A 16-year-old male basketball player presents with
insidious onset of anterior knee pain that worsens
with jumping and squatting. Physical examination
, reveals tenderness at the inferior pole of the patella
with a normal neurovascular exam. What is the most
likely diagnosis?
A) Patellofemoral stress syndrome
B) Osgood-Schlatter disease
C) Sinding-Larsen-Johansson syndrome
D) Patellar tendon rupture
Correct answer: C
Rationale: Sinding-Larsen-Johansson syndrome is an
apophysitis at the inferior pole of the patella (patellar
tendon insertion) seen in active adolescents.
Osgood-Schlatter (B) affects the tibial tubercle.
Patellofemoral stress syndrome (A) causes
peripatellar pain without focal tenderness. Patellar
tendon rupture (D) is acute and presents with
extensor lag.
5. A 35-year-old man sustains a gunshot wound to the
left thigh. On examination, he has a 2 cm wound with
no active bleeding. Distal pulses are palpable and
sensation is intact. X-ray shows a comminuted
midshaft femur fracture with a bullet fragment
retained in the soft tissues. What is the most
appropriate initial management?
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF ORTHOPAEDIC
SURGERY (ABOS) | COMPLETE EXAM Q&A
WITH RATIONALES
1. A 28-year-old male sustains a traumatic femoral
shaft fracture in a motorcycle accident. He is taken to
the operating room for intramedullary nailing within
24 hours. Intraoperatively, after reaming and nail
insertion, the patient becomes hypotensive, hypoxic,
and develops petechiae on his chest. Which of the
following is the most likely diagnosis?
A) Fat embolism syndrome
B) Pulmonary embolism
C) Anaphylactic reaction to anesthetic agents
D) Hemorrhagic shock
Correct answer: A
Rationale: Fat embolism syndrome (FES) occurs
when fat globules enter the pulmonary circulation,
typically following long bone fractures and
intramedullary reaming. The classic triad includes
respiratory distress, neurological changes, and
petechial rash. Pulmonary embolism (B) is less likely
,without DVT source; anaphylaxis (C) would present
with urticaria and bronchospasm; hemorrhagic
shock (D) would present earlier and without
petechiae.
2. A 45-year-old woman with a BMI of 38 and diabetes
presents with right hip pain. Radiographs show
severe osteoarthritis of the hip. Which perioperative
optimization step has been shown to most
significantly reduce the risk of periprosthetic joint
infection following total hip arthroplasty?
A) Preoperative chlorhexidine wipes the night before
surgery
B) Smoking cessation for 4 weeks prior to surgery
C) Optimization of glycemic control with HbA1c <7%
D) Preoperative nutritional supplementation with
protein
Correct answer: C
Rationale: Poorly controlled diabetes (HbA1c >7-8%)
is strongly associated with increased periprosthetic
joint infection risk. Optimizing glycemic control is one
of the most modifiable and impactful risk factors.
While smoking cessation (B) and nutrition (D) are
beneficial, glycemic control has the strongest
evidence for infection reduction in diabetic patients.
,3. A 72-year-old woman with osteoporosis falls onto
an outstretched hand and presents with wrist pain.
Radiograph reveals a dorsally displaced,
comminuted fracture of the distal radius with intra-
articular extension. What is the most appropriate
initial management?
A) Closed reduction and cast immobilization
B) Open reduction internal fixation with volar locking
plate
C) Percutaneous pinning
D) External fixation
Correct answer: B
Rationale: In elderly patients with osteoporotic bone
and intra-articular, comminuted distal radius
fractures, open reduction internal fixation (ORIF) with
a volar locking plate provides stable fixation allowing
early motion. Closed reduction (A) leads to loss of
reduction in comminuted fractures. External fixation
(D) is less commonly used for intra-articular
fractures.
4. A 16-year-old male basketball player presents with
insidious onset of anterior knee pain that worsens
with jumping and squatting. Physical examination
, reveals tenderness at the inferior pole of the patella
with a normal neurovascular exam. What is the most
likely diagnosis?
A) Patellofemoral stress syndrome
B) Osgood-Schlatter disease
C) Sinding-Larsen-Johansson syndrome
D) Patellar tendon rupture
Correct answer: C
Rationale: Sinding-Larsen-Johansson syndrome is an
apophysitis at the inferior pole of the patella (patellar
tendon insertion) seen in active adolescents.
Osgood-Schlatter (B) affects the tibial tubercle.
Patellofemoral stress syndrome (A) causes
peripatellar pain without focal tenderness. Patellar
tendon rupture (D) is acute and presents with
extensor lag.
5. A 35-year-old man sustains a gunshot wound to the
left thigh. On examination, he has a 2 cm wound with
no active bleeding. Distal pulses are palpable and
sensation is intact. X-ray shows a comminuted
midshaft femur fracture with a bullet fragment
retained in the soft tissues. What is the most
appropriate initial management?
