100+ Free FC Orth(SA) Final Practice Questions

Explanation: Definitive soft tissue flap coverage for Gustilo Grade IIIB open tibial fractures should ideally be achieved within 48 to 72 hours (and certainly within 7 days per BOA/BAPRAS guidelines) of the initial injury. Early reconstruction significantly decreases deep infection rates, osteomyelitis, and flap failures compared to delayed coverage beyond 7 days.

Explanation: In lateral compression pelvic injuries with sacral disruption and persistent hemodynamic instability unresponsive to pelvic binding, the primary bleeding source is arterial (such as branches of the internal iliac artery like the superior gluteal or internal pudendal arteries). Immediate pelvic angiography and selective transcatheter embolization is the gold standard intervention.

Explanation: In young adults (<50 years) with displaced high-energy femoral neck fractures, joint preservation via urgent, anatomical open reduction and internal fixation (using a sliding hip screw with anti-rotation screw or parallel cannulated screws) within 6 hours is essential to decompress capsular hematoma and preserve the medial femoral circumflex arterial supply.

Explanation: High-energy bicondylar tibial plateau fractures (Schatzker VI) with severe soft tissue compromise are best treated with a staged protocol: immediate knee-spanning external fixation to restore length and alignment, followed by delayed definitive ORIF (typically 10 to 14 days later) once soft tissue swelling subsides and the positive wrinkle sign appears.

Explanation: Volar Barton fractures are volar marginal intra-articular fracture-dislocations of the distal radius. They are inherently unstable shear injuries that require anatomical open reduction and buttress fixation via a volar (Henry) approach using a anatomical volar locking plate.

Explanation: Atypical femoral fractures (AFF) associated with long-term bisphosphonate use are tension-side subtrochanteric or shaft fractures characterized by lateral cortical beaking and transverse orientation. A long cephalomedullary nail spanning the entire length of the femur is the implant of choice to protect the entire femoral shaft from secondary stress fractures.

Explanation: The extensile lateral approach (or modified sinus tarsi approach) provides comprehensive visualization of the posterior facet of the subtalar joint, calcaneocuboid joint, lateral calcaneal wall, and anterior process, enabling anatomical reduction and plate fixation in Sanders III fractures.

Explanation: Acute radial nerve palsy following closed mid-shaft humeral fractures is typically a neuropraxia or axonotmesis in over 85% of cases. Initial non-operative management with splinting, observation, and electrodiagnostic studies at 3-4 months is recommended before considering surgical exploration.

Explanation: In border-zone or unstable polytrauma patients with respiratory failure/ARDS, performing prolonged definitive reamed intramedullary nailing induces a secondary inflammatory insult ('second hit'). Damage Control Orthopaedics (DCO) using rapid temporary external fixation is indicated to minimize physiological stress.

Explanation: Acute compartment syndrome of the lower leg is a surgical emergency requiring immediate four-compartment decompression via two double incisions (anterolateral and posteromedial) to prevent irreversible muscular necrosis and nerve ischemia.