Shoulder and Elbow Self-Scored Self-Assessment Examination 2025 (AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Your Source for Lifelong Orthopaedic Learning)

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




Question 1 of 100
Which ligamentous structure attaches to the fracture fragment?
1- Lateral ulnar collateral ligament
2- Radial collateral ligament
3- Posterior medial collateral ligament (MCL)
4- Anterior MCL


PREFERRED RESPONSE: 4- Anterior MCL



Question 2 of 100
The bony landmark is known as the
1- crista supinatoris.
2- sublime tubercle.
3- radial notch.
4- coronoid.


PREFERRED RESPONSE: 2- sublime tubercle.


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


Question 3 of 100
The critical weight-bearing portion of the elbow joint that is damaged in this fracture is the
1- anteromedial coronoid facet.
2- posteromedial olecranon facet.
3- coronoid.
4- radial notch.


PREFERRED RESPONSE: 1- anteromedial coronoid facet.



Question 4 of 100
Treatment of this fracture should consist of
1- closed reduction, limited immobilization (1-2 weeks), and early functional rehabilitation.
2- limited immobilization in a long-arm cast (4 weeks) and early functional rehabilitation.
3- open reduction and internal fixation.
4- open reduction, capsular repair, and suture fixation of the bony fragment and ligament.


PREFERRED RESPONSE: 3- open reduction and internal fixation.
DISCUSSION
Varus posteromedial rotatory instability is a complex injury pattern that starts with varus stress
resulting in a fracture of the anteromedial coronoid. The anterior MCL attaches to the sublime
tubercle, which is part of the anteromedial coronoid facet. The posterior MCL attaches to the
posterior medial aspect of the ulna. The radial collateral and lateral ulnar collateral attach to the
ulna at the crista supinatoris. The bony landmark is the sublime tubercle; as noted above, the crista
supinatoris is lateral on the ulna. The radial notch is also lateral and is the articulation between the
proximal ulna and proximal radius. The anteromedial coronoid facet is part of the coronoid, which
extends more lateral and anterior than the anteromedial facet. The anteromedial facet represents
the critical weight-bearing portion of the ulnohumeral joint. Damage to this structure causes
posteromedial subluxation that often results in severe progressive arthritis. The coronoid is the
larger structure of which the anteromedial coronoid facet is a portion. The posteromedial coronoid
facet does not appear to be critical in weight bearing. The radial notch is not associated with
increased stress with weight bearing. The treatment of displaced fractures of this structure is open
reduction and internal fixation utilizing buttress plating. Closed treatment is acceptable only for
nondisplaced fractures with appropriate radiographic follow-up. Suture fixation is not advocated
because of inadequate strength.
RECOMMENDED READINGS


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




Question a5 aof a100
Figures a5a athrough a5d aare athe aradiographs aof aa a55-year-old ahealthy awoman awho afell adown
aa aflight aof asteps awhile asleepwalking. aWhen athe asurgeon areplace athe aradial ahead, athe aelbow
adislocates aposteriorly aat a60 adegrees aof aflexion aas ait ais abrought aout afrom afull aflexion. aWhat
ais athe abest anext astep?




1- Only arepair athe alateral acollateral aligament a(LCL)
2- Do anothing afurther aand aplace athe aelbow ain a90 adegrees aof aflexion
3- Repair athe aposterior aband aof athe amedial acollateral aligament a(MCL)
4- Repair athe acoronoid aand areassess afor astability

PREFERRED aRESPONSE: a4- aRepair athe acoronoid aand areassess afor astability
DISCUSSION


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