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 ddislocations dhave da dhigh drate dof dvascular dinjuries d(15% dto d40%). dAll dpatients dpresenting dwith
dknee ddislocations dshould dbe durgently dreduced. dUse dof dABI d(range d0.9-1.1) dwill dallow didentification
dof dpatients dwith dsubtle dvascular dinjury. dThis dcan dalso dbe dused das da dscreening dtool dfor dfurther
dworkup dincluding dangiography.
Question d5 dof d100
Two dfemoral dshaft dfractures dare dshown din dFigure d1. dEach dis dfixed didentically dwith dthe dsame
dintramedullary dnail dand dinterlocking dscrews. dThe dfracture dgap dstrain dis dhigher din
A. A.
B. B.
C. neither; dthe dstrain dis didentical din dA dand dB.
D. neither; dthe dstrain dis ddependent don dfemur dlength.
R: dA
Fracture dgap dstrain dis ddefined das ddeformation dof dgranulation dtissue dwithin dthe dfracture dgap dwhen da
dgiven dforce dis dapplied. dNormal dstrain dis dthe dchange din dlength d(Δ dl) ddivided dby dthe doriginal dlength
d(l) dwhen da dgiven dload dis dapplied. dThe damount dof ddeformation dthat da dtissue dcan dtolerate dwhile
dfunctioning dvaries dgreatly. dIntact dbone dhas da dnormal dstrain dtolerance dof d2% d(before dit dfractures),
dwhereas dgranulation dtissue dhas da dstrain dtolerance dof d100%. dBony dbridging dbetween dthe ddistal dand
dproximal dcallus dcan donly doccur dwhen dlocal dstrain d(ie, ddeformation) dis dless dsevere dthan dthe dforming
dbone dcan dtolerate. dTherefore, dtreatment dof dfractures dmust doptimize dthe dstrain denvironment dto denable
dhealing.
Comminution, das dshown din dB, dresults din ddistribution dof dthe dmotion dbetween dmultiple dfracture
dfragments. dAs da dresult, deach dfracture dgap dexperiences dless dmotion dand dstrain dis ddecreased. dIn dsimple
dfracture dpatterns das dshown din dA, dsmall damounts dof dmotion dor deven da dsmall dfracture dgap dresults din da
dhigh-strain denvironment. dStrain dis ddependent dupon dthe dlength dof dthe dfracture dgap dbut dnot don dthe
dlength dof dthe dbone.
Question d6 dof d100
A d31-year-old dman dsustained dan dunstable dclosed dleft dposterior dhip ddislocation din da dmotorcycle
daccident. dA dpostreduction dradiograph dis dshown din dFigure d1. d3-D dCT dscans dare dshown din
dFigures d2 dand d3. dWhat dis dthe doptimal dsurgical dapproach dthat dwill dallow dfor dthe dmost
dappropriate dtreatment?
d d
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 ddislocations dhave da dhigh drate dof dvascular dinjuries d(15% dto d40%). dAll dpatients dpresenting dwith
dknee ddislocations dshould dbe durgently dreduced. dUse dof dABI d(range d0.9-1.1) dwill dallow didentification
dof dpatients dwith dsubtle dvascular dinjury. dThis dcan dalso dbe dused das da dscreening dtool dfor dfurther
dworkup dincluding dangiography.
Question d5 dof d100
Two dfemoral dshaft dfractures dare dshown din dFigure d1. dEach dis dfixed didentically dwith dthe dsame
dintramedullary dnail dand dinterlocking dscrews. dThe dfracture dgap dstrain dis dhigher din
A. A.
B. B.
C. neither; dthe dstrain dis didentical din dA dand dB.
D. neither; dthe dstrain dis ddependent don dfemur dlength.
R: dA
Fracture dgap dstrain dis ddefined das ddeformation dof dgranulation dtissue dwithin dthe dfracture dgap dwhen da
dgiven dforce dis dapplied. dNormal dstrain dis dthe dchange din dlength d(Δ dl) ddivided dby dthe doriginal dlength
d(l) dwhen da dgiven dload dis dapplied. dThe damount dof ddeformation dthat da dtissue dcan dtolerate dwhile
dfunctioning dvaries dgreatly. dIntact dbone dhas da dnormal dstrain dtolerance dof d2% d(before dit dfractures),
dwhereas dgranulation dtissue dhas da dstrain dtolerance dof d100%. dBony dbridging dbetween dthe ddistal dand
dproximal dcallus dcan donly doccur dwhen dlocal dstrain d(ie, ddeformation) dis dless dsevere dthan dthe dforming
dbone dcan dtolerate. dTherefore, dtreatment dof dfractures dmust doptimize dthe dstrain denvironment dto denable
dhealing.
Comminution, das dshown din dB, dresults din ddistribution dof dthe dmotion dbetween dmultiple dfracture
dfragments. dAs da dresult, deach dfracture dgap dexperiences dless dmotion dand dstrain dis ddecreased. dIn dsimple
dfracture dpatterns das dshown din dA, dsmall damounts dof dmotion dor deven da dsmall dfracture dgap dresults din da
dhigh-strain denvironment. dStrain dis ddependent dupon dthe dlength dof dthe dfracture dgap dbut dnot don dthe
dlength dof dthe dbone.
Question d6 dof d100
A d31-year-old dman dsustained dan dunstable dclosed dleft dposterior dhip ddislocation din da dmotorcycle
daccident. dA dpostreduction dradiograph dis dshown din dFigure d1. d3-D dCT dscans dare dshown din
dFigures d2 dand d3. dWhat dis dthe doptimal dsurgical dapproach dthat dwill dallow dfor dthe dmost
dappropriate dtreatment?
d d
