Remediation:
A. Elevated serum metal ion levels and chromium ion levels will typically be 5 times that of cobalt ion levels in trunnionosis.
B. Gram-negative rods are rare and highly virulent, and their presence is consistent with a periprosthetic joint infection rather than corrosion at the level of the trunnion.
C. A serum cobalt level of >1.6 ng/mL has been suggested as a threshold for trunnion corrosion.
D. Metal artifact reduction sequence magnetic resonance imaging is the gold standard for evaluation of trunnionosis, with the usual findings being a pseudotumor or soft-tissue destruction.
E. When there is concern for trunnionosis, a manual synovial fluid white blood-cell count is recommended to help determine the presence of an infection. When the manual synovial white blood-cell count is > 3,500/μL, there is a high suspicion for infection in isolation or in addition to mechanically assisted crevice corrosion.

Remediation:
A. The femoral component has been undersized. There is decreased posterior condylar offset causing flexion instability. Excessive posterior femoral resection occurred.
B. Resection of the tibia would affect both the flexion and the extension gaps. The patient has midflexion instability when navigating steps. Radiographs show the tibial resection is above the fibular head and appears appropriate.
C. The joint line does not appear to be substantially elevated.
D. Over-resection of the posterior condyles caused this technical error. The use of a CR knee did not affect this.
E. There is no evidence of heterotopic ossification.

Remediation:
A. The proximal phalanx appears to have been fused in a plantar-flexed position relative to the ground and parallel to the first metatarsal in the sagittal plane. This leads to painful rubbing at the tip of the first toe and overload of the first ray.
B. Tenderness and rubbing with shoe wear is most likely seen in a patient with a hallux MTP joint fusion in a dorsiflexed position. The radiograph shows fusion in a plantar-flexed position, which would cause pain at the tip of the toe and overload.
C. A painful prominence at the medial eminence would be most likely in a patient with a fusion in a valgus position that creates an iatrogenic bunion. The most common malunited fusions occur in the sagittal plane. The radiograph shows a fusion in a plantar-flexed position, which would cause pain at the tip of the toe and overload.
D. It would be difficult to identify a crossover toe on a lateral radiograph. Additionally, the second MTP joint does not show any deformity. The radiograph shows a fusion in a plantar-flexed position, which would cause pain at the tip of the toe and overload.

Remediation:
A. Topical antivirals would not treat the chronic paronychia. This patient has failed nonoperative management and is a candidate for a marsupialization.
B. Systemic antifungals would not outperform a topical corticosteroid with a chronic paronychia. This patient has failed nonoperative management and is a candidate for a marsupialization.
C. Marsupialization is the correct procedure for someone who has failed nonoperative management of a chronic paronychia.
D. Typically, there is nothing to drain in the chronic setting. This patient has failed nonoperative management and is a candidate for a marsupialization.
E. While removal of the nail plate may be needed at the time of marsupialization, there is no indication to remove and graft the nail bed in the setting of a chronic paronychia.

Remediation:
A. Tamoxifen is an estrogen-receptor blocker, particularly useful in estrogen-receptor- positive breast carcinoma, for example.
B. Denosumab is a monoclonal antibody against RANK-L, which is critical in osteoclastic bone resorption. This is utilized in osteoporosis, as well as in the management of skeletal metastases.
C. Selumetinib is a MEK inhibitor, acting within the RAS signaling pathway. This has shown some early promising results in the management of neurofibromatosis type 1.
D. Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF), and its use inhibits angiogenesis.

Remediation:
A. Spinopelvic fixation precludes the ability to ambulate.
B. Curve progression is halted by spinal fusion.
C. Curve progression is relatively inevitable and only halted by spinal fusion.
D. Posterior spinal fusion should be considered when sitting discomfort and care are issues, not at a particular curve magnitude. Age is a factor as fusion prior to age 8 can lead to thoracic insufficiency. Although fusion can be performed after age 8 years, a primary posterior spinal fusion approach prior to significant growth slowing may lead to crank-shafting and return of the spine deformity. If a fusion is absolutely required in this setting, anterior-posterior fusion would be necessary.

Remediation:
A. Core decompression is indicated in stage I and stage II disease. In these stages, there is an absence of humeral head collapse. Arthroplasty is indicated with collapse of the humeral head.
B. Total shoulder arthroplasty is indicated in advanced disease (stage IV or V) when humeral head collapse is seen.
C. Hemiarthroplasty is indicated with early collapse of the humeral head without glenoid involvement. In stage-II disease, there is no humeral head collapse.
D. Reverse total shoulder arthroplasty would be indicated in cases of advanced humeral head collapse with glenoid involvement in an elderly individual.

Remediation:
A. Prophylactic intraoperative local vancomycin powder has been shown to reduce the risk of surgical site infection in patients undergoing spine surgery, particularly for Staphylococcus aureus. Pseudomonas aeruginosa is more commonly associated with intravenous drug use. It is not covered by vancomycin.
B. Some studies have shown that the use of gram-positive perioperative antibiotics along with intrawound vancomycin powder are resulting in a shift toward gram-negative surgical site infections. Gram-negative infections can account for one-third of vertebral osteomyelitis cases.
C. Prophylactic intraoperative local vancomycin powder has been shown to reduce the risk of surgical site infection in patients undergoing spine surgery, particularly for Staphylococcus aureus.
D. Prophylactic intraoperative local vancomycin powder has been shown to reduce the risk of surgical site infection in patients undergoing spine surgery, particularly for Staphylococcus aureus. Propionibacterium acnes is associated with indolent implant-related infections with biofilms present.

Remediation:
A. Treatment of flexor digitorum profundus tendon avulsions depends on the type of injury. Complete avulsion of the FDP with loss of active flexion requires urgent surgery for the best outcomes.
B. Treatment of flexor digitorum profundus tendon avulsions depends on the type of injury. Complete avulsion of the FDP with loss of active flexion requires urgent surgery for the best outcomes.  Any delay will result in reduced chance of primary repair.
C. Same as A
D. Same as A

Remediation:
A. Plating has been associated with a higher failure rate for atypical femoral fractures when compared with intramedullary nailing. At the cellular level, bisphosphonates inhibit osteoclastic remodeling; thus, endochondral healing is the preferred treatment method. Intramedullary nailing accomplishes this goal while plating precludes endochondral repair.
B. Unless there is a contraindication, bisphosphonates are usually stopped in patients with atypical femoral fractures to help with fracture union.
C. A malreduction of 5° has been associated with implant failure.
D. Teriparatide is an analog of parathyroid hormone. It may be used as an adjunct treatment for an atypical femoral fracture.