AAOS Shoulder and Elbow Self-Assessment Examination | Latest 2025/2026 Self-Scored Practice Test & Answer Guide | American Academy of Orthopaedic Surgeons

SHOULDER AND ELBOW SELF-
SCORED SELF-ASSESSMENT
EXAMINATION
AAOS 2025

,Shoulder and Elbow Self-Scored Self-Assessment Examination 2025 Ahmed Altaei


CLINICAL SITUATION FOR QUESTIONS 1 THROUGH 4 I I I I I I




A 55-year-old man falls on his outstretched arm and sustains the injury shown in the 3-dimensional CT
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scans in Figures 1a and 1b.
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Question 1 of 100 I I I




Which ligamentous structure attaches to the fracture fragment?
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1- Lateral ulnar collateral ligament
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2- Radial collateral ligament
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3- Posterior medial collateral ligament (MCL) I I I I


4- Anterior MCL I




PREFERRED RESPONSE: 4- Anterior MCL I I I I




Question 2 of 100 I I I




The bony landmark is known as the
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1- crista supinatoris.
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2- sublime tubercle. I


3- radial notch. I


4- coronoid.


PREFERRED RESPONSE: 2- sublime tubercle. I I I I




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,Shoulder and Elbow Self-Scored Self-Assessment Examination 2025 Ahmed Altaei


Question 3 of 100 I I I




The critical weight-bearing portion of the elbow joint that is damaged in this fracture is the
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1- anteromedial coronoid facet. I I


2- posteromedial olecranon facet. I I


3- coronoid.
4- radial notch. I




PREFERRED RESPONSE: 1- anteromedial coronoid facet. I I I I I




Question 4 of 100 I I I




Treatment of this fracture should consist of
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1- closed reduction, limited immobilization (1-2 weeks), and early functional rehabilitation.
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2- limited immobilization in a long-arm cast (4 weeks) and early functional rehabilitation.
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3- open reduction and internal fixation.
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4- open reduction, capsular repair, and suture fixation of the bony fragment and ligament.
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PREFERRED RESPONSE: 3- open reduction and internal fixation. I I I I I I I




DISCUSSION
Varus posteromedial rotatory instability is a complex injury pattern that starts with varus stress
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resulting in a fracture of the anteromedial coronoid. The anterior MCL attaches to the sublime
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tubercle, which is part of the anteromedial coronoid facet. The posterior MCL attaches to the
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posterior medial aspect of the ulna. The radial collateral and lateral ulnar collateral attach to the
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ulna at the crista supinatoris. The bony landmark is the sublime tubercle; as noted above, the crista
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supinatoris is lateral on the ulna. The radial notch is also lateral and is the articulation between the
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proximal ulna and proximal radius. The anteromedial coronoid facet is part of the coronoid, which
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extends more lateral and anterior than the anteromedial facet. The anteromedial facet represents
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the critical weight-bearing portion of the ulnohumeral joint. Damage to this structure causes
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posteromedial subluxation that often results in severe progressive arthritis. The coronoid is the
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larger structure of which the anteromedial coronoid facet is a portion. The posteromedial coronoid
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facet does not appear to be critical in weight bearing. The radial notch is not associated with
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increased stress with weight bearing. The treatment of displaced fractures of this structure is open
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reduction and internal fixation utilizing buttress plating. Closed treatment is acceptable only for
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nondisplaced fractures with appropriate radiographic follow-up. Suture fixation is not advocated
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because of inadequate strength.
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RECOMMENDED READINGS I




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, Shoulder and Elbow Self-Scored Self-Assessment Examination 2025 Ahmed Altaei


• Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G. The effect of anteromedial
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facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J
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Bone Joint Surg Am. 2009 Jun;91(6):1448-58. doi: 10.2106/JBJS.H.00222.
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• Sanchez-Sotelo J, O'Driscoll SW, Morrey BF. Anteromedial fracture of the coronoid process of the
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ulna. J Shoulder Elbow Surg. 2006 Sep-Oct;15(5):e5-8. Epub 2006 Jul 26. Erratum in: J Shoulder
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Elbow Surg. 2007 Jan-Feb;16(1):127. PubMed PMID: 16979044.
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Question 5 of 100 I I I




Figures 5a through 5d are the radiographs of a 55-year-old healthy woman who fell down a flight of
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steps while sleepwalking. When the surgeon replace the radial head, the elbow dislocates
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posteriorly at 60 degrees of flexion as it is brought out from full flexion. What is the best next step?
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1- Only repair the lateral collateral ligament (LCL)
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2- Do nothing further and place the elbow in 90 degrees of flexion
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3- Repair the posterior band of the medial collateral ligament (MCL)
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4- Repair the coronoid and reassess for stability
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PREFERRED RESPONSE: 4- Repair the coronoid and reassess for stability
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DISCUSSION



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