100+ Free Atestace Ortopedie a traumatologie Practice Questions

Musculoskeletal Trauma & Fractures

Comprehensive fracture care, biomechanics of osteosynthesis, and polytrauma resuscitation based on AO Trauma principles and ČSOT guidelines: AO/OTA classification, Perren's strain theory (absolute stability with interfragmentary compression and primary bone healing vs relative stability with splinting/bridging and secondary endochondral callus healing), polytrauma damage control orthopaedics (DCO vs early total care, lethal triad of hypothermia, acidosis, and coagulopathy), open fracture management (Gustilo-Anderson classification, emergent debridement within 6 hours, systemic antibiotic protocols, staged soft tissue closure), acute compartment syndrome (pathophysiology, measurement of intracompartmental pressure, delta pressure <= 30 mmHg threshold, emergency two-incision four-compartment fasciotomy of the leg and volar/dorsal forearm releases), proximal femoral fractures (Garden and Pauwels classifications, cannulated lag screw fixation vs dynamic hip screw vs unipolar/bipolar hemiarthroplasty vs total hip arthroplasty), pertrochanteric and reverse obliquity fractures (AO 31-A, cephalomedullary intramedullary nailing vs extramedullary implants, tip-apex distance < 25 mm), subtrochanteric fractures and deforming muscular forces (iliopsoas flexion, abductor abduction, adductor shortening), diaphyseal femoral and tibial nailing (reamed intramedullary nailing, infrapatellar vs suprapatellar semi-extended entry portals), distal femur fractures (AO 33, lateral locking plates, coronal Hoffa shear fractures), tibial plateau fractures (Schatzker classification, Luo three-column classification, medial column and posteromedial shearing fractures requiring direct posterior approaches), distal tibial pilon fractures (staged protocol: spanning external fixation followed by delayed definitive open reduction and internal fixation after soft tissue wrinkle sign appears), ankle fractures (Lauge-Hansen mechanism-based classification, Danis-Weber classification, syndesmotic injury assessment, Hook test, syndesmotic screw vs flexible suture button fixation), calcaneal fractures (Sanders CT classification, Essex-Lopresti joint depression vs tongue-type, Bohler's angle restoration), talar neck fractures (Hawkins classification, risk of avascular necrosis, Hawkins sign of subchondral radiolucency indicating intact vascularity), pelvic ring disruptions (Young-Burgess classification, anteroposterior compression, lateral compression, vertical shear, emergency pelvic binder placement over the greater trochanters, preperitoneal pelvic packing, supra-acetabular external fixator, C-clamp in vertical instability), acetabular fractures (Judet-Letournel classification, five elementary and five associated types, Judet 45° obturator and iliac oblique radiographic projections), fracture nonunion (hypertrophic vascular nonunion requiring rigid mechanical stabilization vs atrophic oligotrophic nonunion requiring biological augmentation and bone grafting), and critical-sized bone defect reconstruction using the Masquelet induced membrane technique.

Arthroplasty & Joint Reconstruction

Adult joint reconstruction, elective arthroplasty, tribology, and complication management: total hip arthroplasty (THA) surgical approaches (direct anterior Hueter approach utilizing the tensor fasciae latae and sartorius internervous interval, direct lateral transgluteal Hardinge approach with superior gluteal nerve considerations, posterolateral Moore approach with short external rotator repair), acetabular cup orientation (Lewinnek safe zone: 40° ± 10° inclination, 15° ± 10° anteversion, and modern spinopelvic mobility concepts: stiff spine syndrome, high pelvic tilt, hypermobility, and compensatory cup adjustment), femoral offset restoration, abductor lever arm mechanics, leg length discrepancy prevention and correction, bearing surface tribology (cross-linked polyethylene wear, ceramic-on-ceramic squeaking and stripe wear, modular taper fretting corrosion and trunnionosis / ALTR), femoroacetabular impingement (cam vs pincer morphology, alpha angle > 55°, crossover sign, arthroscopic osteochondroplasty and labral refixation), avascular necrosis of the femoral head (Ficat-Arlet and Steinberg staging, core decompression with or without biological adjuncts vs THA), total knee arthroplasty (TKA) alignment paradigms (mechanical alignment with neutral mechanical axis vs kinematic alignment restoring constitutional anatomy), gap balancing vs measured resection techniques, component kinematics (cruciate-retaining CR vs posterior-stabilized PS vs constrained condylar CCK), unicompartmental knee arthroplasty (UKA: Kozinn and Scott criteria, medial unicompartmental osteoarthritis, intact ACL requirement, correctable deformity), patellofemoral arthroplasty, shoulder arthroplasty (anatomic total shoulder arthroplasty vs reverse total shoulder arthroplasty RTSA, Grammont principles: medializing and distalizing the center of rotation to recruit anterior and posterior deltoid fibers, Walch glenoid morphology classification), periprosthetic joint infection (PJI: 2018 International Consensus Meeting / MSIS diagnostic criteria, major criteria of sinus tract or two positive identical cultures, minor criteria including elevated synovial WBC > 3,000/μL, PMN% > 70%, synovial alpha-defensin, serum CRP and ESR, debridement, antibiotics, and implant retention DAIR indications in acute postoperative or acute hematogenous infections < 3–4 weeks with stable components vs one-stage and two-stage revision arthroplasty with articulating or static antibiotic-loaded PMMA bone cement spacers), periprosthetic fractures (Vancouver classification for periprosthetic femoral fractures around THA stems: Type A trochanteric, Type B shaft around/just distal to stem subdivided into B1 well-fixed stem, B2 loose stem with adequate bone stock, B3 loose stem with severe bone deficiency, Type C well distal to stem, and Lewis-Rorabeck classification for periprosthetic knee fractures).

Pediatric Orthopaedics & Deformities

Pediatric musculoskeletal disorders, developmental deformities, neuromuscular pathology, and pediatric trauma: Developmental Dysplasia of the Hip (DDH: clinical screening with Barlow and Ortolani tests, universal ultrasound screening in the Czech Republic according to Graf classification: Type I normal alpha angle >= 60°, Type II physiological immaturity/dysplasia alpha 43°–59°, Type III eccentric subluxation alpha < 43°, Type IV total dislocation, treatment algorithms: Pavlik harness dynamic splinting, Frejka pillow, closed reduction with arthrogram and spica cast, open reduction via anterior or medial Ludloff approach, pelvic osteotomies including Salter redirectional osteotomy, Dega and Pemberton acetabuloplasties, and femoral varus derotation shortening osteotomy), Slipped Capital Femoral Epiphysis (SCFE: adolescent demographic, endocrine predispositions, radiographic Trethowan sign with Klein's line, Southwick slip angle, Loder classification into stable vs unstable based on weight-bearing ability, urgent surgical management with in situ single central cannulated screw fixation under fluoroscopic control to prevent avascular necrosis and chondrolysis), Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the capital femoral epiphysis, Waldenström radiographic stages, Herring lateral pillar classification: Group A no lateral pillar involvement, Group B > 50% height maintained, Group C < 50% height, concept of containment: non-weight-bearing, abduction braces, femoral varus osteotomy or Salter pelvic osteotomy to maintain femoral head within acetabulum), Congenital Talipes Equinovarus / Clubfoot (pathoanatomy: CAVE deformity — cavus, adduction, varus, equinus, Dimeglio and Pirani scoring systems, standard Ponseti method of gentle serial corrective manipulations and long-leg plaster casts with primary abduction around the talar head, percutaneous Achilles tenotomy under local anesthesia in > 90% of cases to correct residual equinus, followed by foot abduction brace / Steenbeek bar protocol until 4–5 years of age to prevent relapse), Congenital Muscular Torticollis, Blount disease (tibia vara, Langenskiöld radiographic stages, Langenskiöld osteotomy vs guided growth with tension band plates), pediatric physeal fractures (Salter-Harris classification: Type I through V, risk of premature physeal closure, formation of transphyseal bony bridges, Langenskiöld bridge resection with fat graft interposition, temporary hemiepiphysiodesis for angular deformity correction using eight-plates / tension-band plates), and flexible flatfoot vs rigid flatfoot with tarsal coalition (calcaneonavicular coalition with 'anteater nose' sign on oblique radiograph, talocalcaneal coalition with C-sign on lateral radiograph).

Spine Pathology & Surgery

Degenerative spinal pathology, spinal deformities, spinal trauma, infections, and neurosurgical spine stabilization: lumbar disc herniation (pathophysiology, radiculopathy, neurological localization: L4 root with diminished patellar reflex, tibialis anterior weakness, medial foot sensation; L5 root with extensor hallucis longus weakness, dorsal foot sensation; S1 root with diminished Achilles reflex, gastrocnemius weakness, lateral foot sensation; distinction between traversing and exiting nerve roots in paracentral vs far-lateral foraminal disc herniations), lumbar spinal stenosis and neurogenic intermittent claudication (shopping cart sign, relief with forward flexion increasing canal diameter vs vascular claudication, indications for open or tubular decompression and instrumented fusion), cauda equina syndrome (surgical emergency characterized by bilateral sciatica, lower extremity motor weakness, saddle anesthesia in the perineal region, and urinary retention / overflow incontinence, requiring urgent MRI and decompression within 24–48 hours to preserve sphincter and neurological function), cervical spondylotic myelopathy (CSM: pathomechanics of static compression and dynamic cord injury, upper motor neuron signs: hyperreflexia, positive Hoffman sign, inverted radial reflex, clonus, positive Babinski sign, gait ataxia, modified Japanese Orthopaedic Association mJOA score, surgical indications: anterior cervical discectomy and fusion ACDF, anterior cervical corpectomy and fusion ACCF, posterior cervical laminoplasty vs laminectomy and instrumented fusion), cervical radiculopathy (Spurling test, manual traction relief), spondylolisthesis (Wiltse-Newman classification: dysplastic, isthmic with pars interarticularis defect / spondylolysis displaying Scotty dog with collar on oblique radiographs, degenerative, traumatic, pathologic; Meyerding grading: Grade I < 25%, Grade II 25–50%, Grade III 50–75%, Grade IV 75–100%, Grade V spondyloptosis), adult spinal deformity and spinopelvic sagittal alignment (pelvic incidence PI, pelvic tilt PT, sacral slope SS, fundamental equation PI = PT + SS, target sagittal balance: PI-LL mismatch < 10°, sagittal vertical axis SVA < 50 mm, pelvic tilt PT < 20°, spinal osteotomies: Schwab Grade II Ponte / Smith-Petersen osteotomy vs Grade III pedicle subtraction osteotomy PSO vs Grade IV vertebral column resection VCR), subaxial cervical spine trauma (AO Spine subaxial classification, SLIC score, unilateral and bilateral facet dislocations, protocol for awake closed skull-traction reduction vs pre-reduction MRI in obtunded patients to rule out herniated disc prior to reduction), upper cervical spine trauma (Jefferson burst fracture of C1 atlas: Rule of Spence lateral mass displacement > 7 mm indicating transverse atlantal ligament disruption, Anderson-D'Alonzo classification of odontoid peg fractures: Type I tip, Type II waist with high nonunion risk > 30% especially with displacement > 5 mm, angulation > 10°, or age > 65 treated with anterior odontoid screw fixation vs posterior C1-C2 fusion, Type III body with cancellous bone healing, Hangman fracture of C2 axis pedicles: Levine-Edwards classification), thoracolumbar trauma (AO Spine thoracolumbar classification, TLICS score: injury morphology, integrity of posterior ligamentous complex PLC, neurological status, operative threshold >= 5 points), pyogenic spondylodiscitis (Staphylococcus aureus predominant pathogen, elevated CRP/ESR, MRI with T1 hypointense and T2 hyperintense disc/vertebra with gadolinium enhancement, blood cultures and CT-guided biopsy, 6-week targeted antibiotic therapy, indications for urgent anterior/posterior debridement and stabilization), and osteoporotic vertebral compression fractures (conservative management, percutaneous vertebroplasty vs balloon kyphoplasty).

Sports Medicine, Arthroscopy & Bone Tumors

Knee and shoulder sports medicine, ligamentous reconstructive surgery, arthroscopic procedures, musculoskeletal oncology, and bone pathology: anterior cruciate ligament (ACL) injuries (mechanism of noncontact valgus pivot-shift, Lachman test, pivot shift test, graft options: bone-patellar tendon-bone BPTB with bone-to-bone healing, quadrupled hamstrings semitendinosus/gracilis, quadriceps tendon graft, indications for concurrent lateral extra-articular tenodesis LET or anterolateral ligament ALL reconstruction in high-risk patients with high-grade pivot shift, hyperlaxity, or revision scenarios), posterior cruciate ligament (PCL) injuries (posterior drawer test, Godfrey sag test, dial test at 30° and 90° of knee flexion to differentiate isolated PCL injury from combined posterolateral corner PLC injury: isolated PLC shows > 10° external rotation asymmetry at 30° only, combined PCL + PLC shows asymmetry at both 30° and 90°), meniscal pathology (vascular zones: red-red peripheral, red-white intermediate, white-white avascular zone, meniscal preservation paradigms, inside-out vs outside-in vs all-inside repair techniques, meniscal root tears: extruded meniscus, loss of hoop stress transmission equivalent to total meniscectomy, transtibial pullout repair, meniscal ramp lesions in ACL tears), cartilage restoration techniques (microfracture for small focal defects < 2 cm², osteochondral autograft transfer system OATS for full-thickness defects with subchondral involvement, autologous chondrocyte implantation ACI/MACI for large full-thickness chondral defects > 3–4 cm²), patellofemoral instability (recurrent lateral patellar dislocation, predisposing anatomical risk factors: trochlear dysplasia, patella alta with Caton-Deschamps index > 1.2, elevated tibial tuberosity-trochlear groove TT-TG distance > 20 mm on CT/MRI, medial patellofemoral ligament MPFL reconstruction and medializing/distalizing tibial tubercle osteotomy Fulkerson/Elmslie-Trillat), shoulder instability (anterior glenohumeral dislocation, classic Bankart labral tear, bony Bankart fracture, Hill-Sachs compression fracture of posterosuperior humeral head, on-track vs off-track Hill-Sachs lesion concept based on glenoid track measurement: off-track lesions engage anterior glenoid rim and cause recurrent instability, requiring Latarjet coracoid transfer with triple biomechanical effect: bone block augmentation, sling effect of conjoined tendon, and capsule repair, ISIS instability severity index score > 3–4 favoring Latarjet over arthroscopic Bankart repair, posterior dislocation with reverse Hill-Sachs McLaughlin lesion), rotator cuff pathology (subacromial impingement, Neer stages, cuff tear classifications: Bateman, Patte retraction stages 1–3, Goutallier fatty degeneration grades 0–4 on CT/MRI, repair biomechanics: margin convergence, suture-bridge double-row repair, massive irreparable tears: superior capsular reconstruction SCR vs tendon transfers including latissimus dorsi or lower trapezius transfer vs reverse total shoulder arthroplasty RTSA in cuff tear arthropathy / Hamada classification), Musculoskeletal Oncology: primary bone and soft tissue tumors, Enneking staging system (surgical grade G, local extent T, metastasis M), biopsy principles (longitudinal incision in line with definitive surgical approach, rigorous hemostasis, avoiding contamination of anatomical compartments), Osteosarcoma (most common primary malignant bone tumor in children/young adults, metaphyseal predilection in distal femur and proximal tibia, radiographic presentation with bone destruction, Codman's reactive triangle, sunburst periosteal reaction, standard treatment protocol: neoadjuvant chemotherapy with MAP regimen — methotrexate, doxorubicin/adriamycin, cisplatin, followed by wide limb-sparing resection and prosthetic endoprosthetic reconstruction, and adjuvant chemotherapy), Ewing sarcoma (small round blue cell tumor, neuroectodermal origin, diaphyseal predilection, characteristic cytogenetic translocation t(11;22)(q24;q12) producing EWSR1-FLI1 fusion transcript, membranous CD99 / MIC2 positivity, onion-skin lamellated periosteal reaction on radiographs, multimodal management: intensive induction chemotherapy, local control with wide resection or radiotherapy, and maintenance chemotherapy), Chondrosarcoma (malignant cartilaginous matrix-producing tumor, adults > 40–50 years, pelvis, proximal femur, scapula, radiographic ring-and-arc chondroid calcifications, endosteal scalloping > two-thirds cortical thickness, profound chemoresistance and radioresistance, requiring wide surgical excision with negative histological margins), Giant Cell Tumor of Bone (GCTB: benign but locally aggressive osteolytic tumor, epiphyseal-metaphyseal subarticular location in skeletally mature young adults with closed physes, multinucleated osteoclast-like giant cells and stromal cells overexpressing RANK ligand RANKL, medical therapy with Denosumab RANKL monoclonal antibody inhibitor, surgical treatment with intralesional extended curettage with high-speed burr and chemical adjuvants like liquid nitrogen, phenol, or PMMA bone cement reconstruction), Aneurysmal Bone Cyst (ABC: osteolytic expansile lesion, fluid-fluid levels on MRI, USP6 gene rearrangement, curettage and bone grafting), Unicameral Bone Cyst (UBC: fallen leaf sign on radiograph), Osteoid Osteoma (nocturnal pain relieved by aspirin/NSAIDs, radiolucent nidus < 1.5 cm surrounded by dense cortical sclerosis, percutaneous CT-guided radiofrequency ablation RFA as treatment of choice), and metastatic bone disease (breast, prostate, lung, kidney, thyroid, Mirels scoring system to predict impending pathological fracture: site, size > 2/3 cortical diameter, nature lytic vs blastic, and functional pain; score >= 8 indicates prophylactic surgical fixation).