1. Which of the following statements concerning the flexor digitorum profundus are TRUE?

 In addition to finger flexion, there is a secondary role as a weak supinator of the forearm.
 In the fingers, each of the four tendons divides into two slips that insert into the sides of the middle
phalanx.
 It originates from the anterior shaft of the ulna and adjoining interosseous membrane.
 The tendon to the index finger separates more proximally than those to the remaining three
fingers.
 The medial half of the muscle is innervated by the ulnar nerve.

2. The anterior interosseous nerve:

 Arises from the median nerve below supinator to supply the flexor carpi radialis, the palmaris
longus and the medial half of the flexor digitorum superficialis.
 Forms the terminal sensory branch of the radial nerve in the forearm.
 Arises from the median nerve below pronator teres to supply the flexor pollicis longus, the
pronator quadratus and the lateral half of the flexor digitorum profundus.
 Arises from the median nerve below pronator teres to supply the flexor pollicis longus, the
pronator quadratus and the medial half of the flexor digitorum profundus.
 Forms the terminal motor branch of the radial nerve in the forearm.

1. What percentage of axial load at the wrist occurs through the distal radius?

 20 per cent.
 40 per cent.
 60 per cent.
 80 per cent.
 100 per cent.

2. Which tendon most commonly ruptures as a complication of an undisplaced distal radius fracture?

 Flexor pollicis longus.

 Extensor pollicis longus.
 Extensor pollicis brevis.
 Abductor pollicis longus.
 Extensor indicis proprius.

1. Which ONE of the following parameters is within normal limits?

 Scapholunate angle of 80˚.

 Radiolunate angle of 22˚.
 Scapholunate interval of 2 mm.
 Radiocapitate angle of 15˚.
 Scapholunate angle of 20˚.
2. A 30-year-old man presents with a fracture of his scaphoid following a fall onto an outstretched hand.
Which one of the following statements is TRUE?

 An above elbow cast is the most appropriate method of treatment for an undisplaced fracture.
 A fracture through the waist of the scaphoid is most likely.
 Even with optimum treatment there is a 15% risk of non-union.
 Kienböck’s disease may ensue as a result of the fracture.
 This patient has an increased risk of developing Preiser’s disease.

1. A 45-year-old male mountain biker falls injuring his right thumb. There is swelling around the
metacarpophalangeal joint with localized tenderness to the ulnar aspect of the joint. No fractures are seen
on the radiographs. In extension, valgus stress produces 35° of flexion and with the joint in 30° of flexion
this increases to 45°. How should this injury be managed?

 Repair the volar plate.

 Repair the ulnar collateral ligament.
 Repair the adductor pollicis tendon avulsion.
 Reconstruct the ulnar collateral ligament using a palmaris longus graft.
 Cast thumb spica for 6 weeks.

2. What name is given to the vertical septa of the palm that divide it into compartments?

 Grayson’s ligaments.
 Septa Legueu and Juvara.
 Natatory cords.
 Malcolm’s septa.
 Clelland’s ligaments.

1. Which of the following features is associated with humeral head ischaemia after a proximal humerus
fracture?

 Dislocation of the glenohumeral joint

 Greater tuberosity displacement > 2 cm
 Length of metaphyseal head extension < 8 mm
 Maintenance of the medial periosteal hinge
 Valgus impaction of the humeral head

2. Which of the following is not an indication for fixation of a humeral shaft fracture?

 A patient with large breasts

 Distal third fractures
 Floating elbow
 Open fracture
 Rotator cuff injury
3. A 60-year-old woman slips, sustaining a comminuted intra-articular distal humeral fracture. Which of
the following represents the best fixation construct?

 Open reduction internal fixation with perpendicular third tubular plates

 Open reduction internal fixation with plating and an independent lag screw
 Open reduction internal fixation with plating and a lag screw through the plate
 Percutaneous lag screw fixation of major fragments
 Percutaneous wire fixation of major fragments

4. A 35-year-old man falls whilst playing basketball. He sustains a closed fracture dislocation of his right
elbow. The elbow is reduced in the emergency department. Radiographs and CT scan demonstrate a type
II coronoid fracture and a two-part Mason 4 radial head fracture. Which of the following is the most
appropriate management for the radial head element of this injury?

 Open reduction and internal fixation with buried compression screws •} a low-profile plate onto
the radial neck in the safe zone
 Radial head arthroplasty using a modular metal press-fit design with care not to over-stuff the
joint.
 Radial head excision and medial ulna collateral ligament repair
 Radial head excision and silicon interposition (Swanson) arthroplasty
 Trans-capitellar wire fixation of the radial head to the neck and immobilization in a cast for 4 weeks

5. Which of the following manoeuvres is most important when treating a Monteggia fracture dislocation

 Application of a dynamic external brace to allow for early range of movement exercises
 Obtaining a CT scan to identify the cause of the dislocation
 Open reduction and internal fixation of the proximal ulna fracture
 Reduction of the radius and temporary fixation with a K-wire
 Use of an unlocked nail to fix the ulna fracture

6. What would a fracture of the ulna with lateral dislocation of the radial head be classified as?

 Bado type I
 Bado type IIa
 Bado type IIb
 Bado type III
 Bado type IV

7. Which of the following is not a relative indication for the surgical management of glenoid and scapula
fractures?

 Angular deformity of the scapula body in the scapular Y view > 45°
 Displaced double disruption of the ‘superior shoulder suspensory complex’ (SSSC)
 Intra-articular step-off > 4 mm
 Medial displacement of the of the lateral border > 25 mm
 Reduction of the glenopolar angle to < 40°

8. A 25-year-old rugby player injures his right shoulder during a tackle. A deformity is noticed at his
acromioclavicular joint (ACJ). He is taken to accident and emergency (A&E) and diagnosed with a
Rockwood type V ACJ dislocation. Which of the following structures has/have been injured?
  Acromioclavicular ligament
 Conoid coracoclavicular ligament
 Deltotrapezial fascia
 Trapezoid ligament
 All of the above

9. Which of the following tests suggests a significant anterior bony lesion causing instability?

 Apprehension at 90° abduction and 90° external rotation

 Apprehension at 90° abduction and 45° external rotation
 Apprehension at 45° abduction and 45° external rotation
 Apprehension at 90° Forward flexion and 45° internal rotation
 Apprehension at 90° abduction and 45° internal rotation

1. When judging rotational alignment of the radius on an anteroposterior radiograph the radial tuberosity
should lie in which orientation in relation to the radial styloid?

 Facing anteriorly
 Facing away from the ulna
 Facing posteriorly
 Facing the ulna
 There is wide variation between individuals

2. When judging rotational alignment of the ulna on a lateral radiograph, which of the following is the
correct orientation of the ulnar styloid?

 180° to the coronoid

 90° lateral to the coronoid
 90° medial to the coronoid
 There is wide variation between individuals
 The same orientation as the coronoid

3. In a Galeazzi fracture, at a maximum of what distance from the lunate fossa of the distal radius does
the radius tends to fracture?

 2.5 cm
 5 cm
 7.5 cm
 10 cm
 12.5 cm

4. In the ‘normal’ wrist what is the relative transfer of load between the distal radius and distal ulna?

 80%:20%
 90%:10%
 70%:30%
 60%:40%
 50%:50%

5. Which structure is the chief stabilizer against longitudinal radioulnar migration after resection or
multifragmentary fracture of the radial head?
  Annular ligament
 Central band of the interosseous ligament
 Distal radioulnar joint
 Ulnohumeral articulation
 Volar radiocarpal ligaments

6. Which of the following has been shown to be the most common complication after a Colles’ fracture?

 CRPS
 Extensor pollicis longus (EPL) tendon rupture
 Flexor pollicis longus (FPL) tendon rupture
 Median nerve dysfunction
 Volkmann’s ischaemic contracture

7. A 24-year-old man falls playing football and injures his wrist. He plays on, but the pain increases during
the next 48 hours and he attends A&E. Radiographs show an undisplaced fracture of the waist of the
scaphoid. He is to be referred to the fracture clinic, but what is the most appropriate initial treatment?

 Immobilization in a Futuro type splint with thumb extension

 Immobilization in a simple forearm cast
 Immobilization in a scaphoid cast (thumb included)
 Immobilization in an above elbow cast
 Immobilization in a basic Futuro type splint

8. Which of the following is not typical of a perilunate dislocation?

 Caused by falling 5 m from a ladder

 Dorsal intercalated segment instability (DISI)
 Median nerve compression symptoms
 Swelling and loss of normal bony landmarks
 Widening of the scapholunate gap

9. A 38-year-old car mechanic has sustained an open fracture of the shaft of the fifth metacarpal of his
dominant hand. He has no comorbidities. Which of the following would be the most common cause of
infection?

 Closure under tension

 Early closure
 Extensive soft tissue dissection
 Failure to debride adequately
 Use of a blunt wire or repeated passing of wire

10. A 25-year-old barman sustains a fracture of the neck of his fifth metacarpal. He has an angulation of
50° on a lateral view but you decide to manage it non-operatively. Which of the following statements best
describes the rationale behind this approach?

 Malunion will be compensated by the relatively mobile fifth carpometacarpal joint

 The patient will compensate with movement at the proximal interphalangeal (PIP) joint
 These fractures have a good potential to remodel
  There will be compensation at the metacarpophalangeal (MCP) joint of the index and middle
fingers
 There will be compensation at the wrist joint

11. Which of the following carpal bones can be harvested for a PIP joint reconstruction?

 Capitate
 Hamate
 Scaphoid pole
 Trapezium
 Triquetral

12. Which finger is most commonly involved in fingertip injuries?

 Index
 Little
 Middle
 Ring
 Thumb

13. Which of the following is an indication for removal of the nail for nail bed injuries?

 Haematoma of 20% of the nail bed

 Haematoma of 30% of the nail bed
 Haematoma of 40% of the nail bed
 Haematoma of 50% of the nail bed
 Haematoma of 70% of the nail bed