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 adislocations ahave aa ahigh arate aof avascular ainjuries a(15% ato a40%). aAll apatients apresenting awith
aknee adislocations ashould abe aurgently areduced. aUse aof aABI a(range a0.9-1.1) awill aallow aidentification aof
apatients awith asubtle avascular ainjury. aThis acan aalso abe aused aas aa ascreening atool afor afurther aworkup
aincluding aangiography.
Question a5 aof a100
Two afemoral ashaft afractures aare ashown ain aFigure a1. aEach ais afixed aidentically awith athe asame
aintramedullary anail aand ainterlocking ascrews. aThe afracture agap astrain ais ahigher ain
A. A.
B. B.
C. neither; athe astrain ais aidentical ain aA aand aB.
D. neither; athe astrain ais adependent aon afemur alength.
R: aA
Fracture agap astrain ais adefined aas adeformation aof agranulation atissue awithin athe afracture agap awhen aa
agiven aforce ais aapplied. aNormal astrain ais athe achange ain alength a(Δ al) adivided aby athe aoriginal alength a(l)
awhen aa agiven aload ais aapplied. aThe aamount aof adeformation athat aa atissue acan atolerate awhile afunctioning
avaries agreatly. aIntact abone ahas aa anormal astrain atolerance aof a2% a(before ait afractures), awhereas
agranulation atissue ahas aa astrain atolerance aof a100%. aBony abridging abetween athe adistal aand aproximal
acallus acan aonly aoccur awhen alocal astrain a(ie, adeformation) ais aless asevere athan athe aforming abone acan
atolerate. aTherefore, atreatment aof afractures amust aoptimize athe astrain aenvironment ato aenable ahealing.
Comminution, aas ashown ain aB, aresults ain adistribution aof athe amotion abetween amultiple afracture
afragments. aAs aa aresult, aeach afracture agap aexperiences aless amotion aand astrain ais adecreased. aIn asimple
afracture apatterns aas ashown ain aA, asmall aamounts aof amotion aor aeven aa asmall afracture agap aresults ain aa
ahigh-strain aenvironment. aStrain ais adependent aupon athe alength aof athe afracture agap abut anot aon athe
alength aof athe abone.
Question a6 aof a100
A a31-year-old aman asustained aan aunstable aclosed aleft aposterior ahip adislocation ain aa amotorcycle
aaccident. aA apostreduction aradiograph ais ashown ain aFigure a1. a3-D aCT ascans aare ashown ain
aFigures a2 aand a3. aWhat ais athe aoptimal asurgical aapproach athat awill aallow afor athe amost
aappropriate atreatment?
a a
A. Surgical adislocation
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 adislocations ahave aa ahigh arate aof avascular ainjuries a(15% ato a40%). aAll apatients apresenting awith
aknee adislocations ashould abe aurgently areduced. aUse aof aABI a(range a0.9-1.1) awill aallow aidentification aof
apatients awith asubtle avascular ainjury. aThis acan aalso abe aused aas aa ascreening atool afor afurther aworkup
aincluding aangiography.
Question a5 aof a100
Two afemoral ashaft afractures aare ashown ain aFigure a1. aEach ais afixed aidentically awith athe asame
aintramedullary anail aand ainterlocking ascrews. aThe afracture agap astrain ais ahigher ain
A. A.
B. B.
C. neither; athe astrain ais aidentical ain aA aand aB.
D. neither; athe astrain ais adependent aon afemur alength.
R: aA
Fracture agap astrain ais adefined aas adeformation aof agranulation atissue awithin athe afracture agap awhen aa
agiven aforce ais aapplied. aNormal astrain ais athe achange ain alength a(Δ al) adivided aby athe aoriginal alength a(l)
awhen aa agiven aload ais aapplied. aThe aamount aof adeformation athat aa atissue acan atolerate awhile afunctioning
avaries agreatly. aIntact abone ahas aa anormal astrain atolerance aof a2% a(before ait afractures), awhereas
agranulation atissue ahas aa astrain atolerance aof a100%. aBony abridging abetween athe adistal aand aproximal
acallus acan aonly aoccur awhen alocal astrain a(ie, adeformation) ais aless asevere athan athe aforming abone acan
atolerate. aTherefore, atreatment aof afractures amust aoptimize athe astrain aenvironment ato aenable ahealing.
Comminution, aas ashown ain aB, aresults ain adistribution aof athe amotion abetween amultiple afracture
afragments. aAs aa aresult, aeach afracture agap aexperiences aless amotion aand astrain ais adecreased. aIn asimple
afracture apatterns aas ashown ain aA, asmall aamounts aof amotion aor aeven aa asmall afracture agap aresults ain aa
ahigh-strain aenvironment. aStrain ais adependent aupon athe alength aof athe afracture agap abut anot aon athe
alength aof athe abone.
Question a6 aof a100
A a31-year-old aman asustained aan aunstable aclosed aleft aposterior ahip adislocation ain aa amotorcycle
aaccident. aA apostreduction aradiograph ais ashown ain aFigure a1. a3-D aCT ascans aare ashown ain
aFigures a2 aand a3. aWhat ais athe aoptimal asurgical aapproach athat awill aallow afor athe amost
aappropriate atreatment?
a a
A. Surgical adislocation
