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 sdislocations shave sa shigh srate sof svascular sinjuries s(15% sto s40%). sAll spatients spresenting swith
sknee sdislocations sshould sbe surgently sreduced. sUse sof sABI s(range s0.9-1.1) swill sallow sidentification sof
spatients swith ssubtle svascular sinjury. sThis scan salso sbe sused sas sa sscreening stool sfor sfurther sworkup
sincluding sangiography.
Question s5 sof s100
Two sfemoral sshaft sfractures sare sshown sin sFigure s1. sEach sis sfixed sidentically swith sthe ssame
sintramedullary snail sand sinterlocking sscrews. sThe sfracture sgap sstrain sis shigher sin
A. A.
B. B.
C. neither; sthe sstrain sis sidentical sin sA sand sB.
D. neither; sthe sstrain sis sdependent son sfemur slength.
R: sA
Fracture sgap sstrain sis sdefined sas sdeformation sof sgranulation stissue swithin sthe sfracture sgap swhen sa
sgiven sforce sis sapplied. sNormal sstrain sis sthe schange sin slength s(Δ sl) sdivided sby sthe soriginal slength s(l)
swhen sa sgiven sload sis sapplied. sThe samount sof sdeformation sthat sa stissue scan stolerate swhile sfunctioning
svaries sgreatly. sIntact sbone shas sa snormal sstrain stolerance sof s2% s(before sit sfractures), swhereas sgranulation
stissue shas sa sstrain stolerance sof s100%. sBony sbridging sbetween sthe sdistal sand sproximal scallus scan sonly
soccur swhen slocal sstrain s(ie, sdeformation) sis sless ssevere sthan sthe sforming sbone scan stolerate. sTherefore,
streatment sof sfractures smust soptimize sthe sstrain senvironment sto senable shealing.
Comminution, sas sshown sin sB, sresults sin sdistribution sof sthe smotion sbetween smultiple sfracture
sfragments. sAs sa sresult, seach sfracture sgap sexperiences sless smotion sand sstrain sis sdecreased. sIn ssimple
sfracture spatterns sas sshown sin sA, ssmall samounts sof smotion sor seven sa ssmall sfracture sgap sresults sin sa
shigh-strain senvironment. sStrain sis sdependent supon sthe slength sof sthe sfracture sgap sbut snot son sthe slength
sof sthe sbone.
Question s6 sof s100
A s31-year-old sman ssustained san sunstable sclosed sleft sposterior ship sdislocation sin sa smotorcycle
saccident. sA spostreduction sradiograph sis sshown sin sFigure s1. s3-D sCT sscans sare sshown sin sFigures
s2 sand s3. sWhat sis sthe soptimal ssurgical sapproach sthat swill sallow sfor sthe smost sappropriate
streatment?
s s
A. Surgical sdislocation
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 sdislocations shave sa shigh srate sof svascular sinjuries s(15% sto s40%). sAll spatients spresenting swith
sknee sdislocations sshould sbe surgently sreduced. sUse sof sABI s(range s0.9-1.1) swill sallow sidentification sof
spatients swith ssubtle svascular sinjury. sThis scan salso sbe sused sas sa sscreening stool sfor sfurther sworkup
sincluding sangiography.
Question s5 sof s100
Two sfemoral sshaft sfractures sare sshown sin sFigure s1. sEach sis sfixed sidentically swith sthe ssame
sintramedullary snail sand sinterlocking sscrews. sThe sfracture sgap sstrain sis shigher sin
A. A.
B. B.
C. neither; sthe sstrain sis sidentical sin sA sand sB.
D. neither; sthe sstrain sis sdependent son sfemur slength.
R: sA
Fracture sgap sstrain sis sdefined sas sdeformation sof sgranulation stissue swithin sthe sfracture sgap swhen sa
sgiven sforce sis sapplied. sNormal sstrain sis sthe schange sin slength s(Δ sl) sdivided sby sthe soriginal slength s(l)
swhen sa sgiven sload sis sapplied. sThe samount sof sdeformation sthat sa stissue scan stolerate swhile sfunctioning
svaries sgreatly. sIntact sbone shas sa snormal sstrain stolerance sof s2% s(before sit sfractures), swhereas sgranulation
stissue shas sa sstrain stolerance sof s100%. sBony sbridging sbetween sthe sdistal sand sproximal scallus scan sonly
soccur swhen slocal sstrain s(ie, sdeformation) sis sless ssevere sthan sthe sforming sbone scan stolerate. sTherefore,
streatment sof sfractures smust soptimize sthe sstrain senvironment sto senable shealing.
Comminution, sas sshown sin sB, sresults sin sdistribution sof sthe smotion sbetween smultiple sfracture
sfragments. sAs sa sresult, seach sfracture sgap sexperiences sless smotion sand sstrain sis sdecreased. sIn ssimple
sfracture spatterns sas sshown sin sA, ssmall samounts sof smotion sor seven sa ssmall sfracture sgap sresults sin sa
shigh-strain senvironment. sStrain sis sdependent supon sthe slength sof sthe sfracture sgap sbut snot son sthe slength
sof sthe sbone.
Question s6 sof s100
A s31-year-old sman ssustained san sunstable sclosed sleft sposterior ship sdislocation sin sa smotorcycle
saccident. sA spostreduction sradiograph sis sshown sin sFigure s1. s3-D sCT sscans sare sshown sin sFigures
s2 sand s3. sWhat sis sthe soptimal ssurgical sapproach sthat swill sallow sfor sthe smost sappropriate
streatment?
s s
A. Surgical sdislocation
