Remediation:
A. In closed dislocation of the MCP joint, the volar plate is most commonly interposed, blocking reduction. While the flexor digitorum superficialis can be interposed, it is not the most common structure.
B. In closed dislocation of the MCP joint, the volar plate is most commonly interposed, blocking reduction. The reduction maneuver involves exaggeration of the deformity, not simply longitudinal traction.
C. In closed dislocation of the MCP joint, the volar plate is most commonly interposed, blocking reduction. The dorsal capsule usually does not block reduction.
D. In closed dislocation of the MCP joint, the volar plate is most commonly interposed, blocking reduction. The radial collateral ligament usually does not block reduction.

Remediation:
A. Improving the knee flexion contractures is the best way to address the described crouch gait.
B. A patient at age 16 is too skeletally mature to allow correction with this method.
C. Passive ankle dorsiflexion to 1°with the knees extended shows that the gastrocnemius muscles are not unduly tight.
D. Hinged ankle-foot orthoses will not improve the knee flexion contractures.

Remediation:
A. A type-1 bunionette is characterized by prominence of the fifth metatarsal head without angular deformity of the fifth metatarsal or an increase in the fourth/fifth intermetatarsal angle.
B. A type-2 bunionette has a characteristic lateral bowing of the fifth metatarsal on anteroposterior radiographs.
C. A type-3 bunionette is characterized by divergence between the fourth and fifth metatarsals (i.e., an increased fourth/fifth intermetatarsal angle) without lateral bowing of the metatarsal.

Remediation:
A. Ollier disease is not typically heritable. While some mutations have been identified in these patients, these are most often thought to represent mosaicism of a somatic mutation.
B. Polyostotic fibrous dysplasia may be seen in some syndromes, including McCune-Albright syndrome (polyostotic fibrous dysplasia, café-au-lait spots, and endocrinopathies) and Mazabraud syndrome (polyostotic fibrous dysplasia, intramuscular myxomas). Fibrous dysplasia is associated with GNAS mutations, although it is not typically heritable.
C. Multiple hereditary exostoses represents a heritable condition whereby numerous osteochondromas develop throughout the skeleton. This is inherited in autosomal dominant fashion and is associated with the EXT genes.
D. Chondrosarcoma may be seen in patients with multiple hereditary exostoses, Ollier disease, and Maffucci syndrome. However, none of these are known to be heritable.
E. The Ewing sarcoma family of tumors are commonly associated with EWS-FLI1 mutations; these are not known to be inherited in an autosomal dominant pattern.

Remediation:

A. A subanalysis of patients in the SPORT trial who underwent primary versus revision discectomy found there were no significant differences between the groups in operative time, blood loss, dural or nerve root injuries, or postoperative hematomas.
B. A subanalysis of patients in the SPORT trial who underwent primary versus revision discectomy found the revision group to have a significantly higher overall complication rate, longer length of hospital stay, and higher rates of wound infection.
C. A subanalysis of patients in the SPORT trial who underwent primary versus revision discectomy found there were no significant differences between the groups in operative time, blood loss, dural or nerve root injuries, or postoperative hematomas.
D. A subanalysis of patients in the SPORT trial who underwent primary versus revision discectomy found there were no significant differences between the groups in operative time, blood loss, dural or nerve root injuries, or postoperative hematomas.

Remediation:

A. The patient still has discomfort, so an injection with a corticosteroid or local anesthetic would be appropriate.
B. Something should be changed as the current treatment is not providing results. A corticosteroid injection is the next likely step.
C. There is rarely any indication for surgery for an iliac crest contusion. Healing and return to play is individual for each patient.
D. A computed tomography scan is unlikely to change management since a fracture has already been excluded.

Remediation:
A. The patient has an anterior glenoid fracture. The Judet approach is used for accessing the scapular body and the posterior glenoid.
B. This patient has an anterior glenoid fracture, which is best accessed by an anterior shoulder operative approach.
C. A deltoid split approach is used for proximal humeral exposure and would not allow access to the glenoid fracture seen in the computed tomography scan.
D. The patient has an anterior glenoid fracture. An arthroscopy into the joint can be used to assist in reduction of the fracture, but subacromial arthroscopy will not be of benefit in this case.

Remediation:
A. A Bado type-1 fracture is characterized by an anterior angulation of the ulnar fracture with anterior dislocation of the radial head. This Monteggia lesion is the most common form in the pediatric population and is thought to result from a fall on an extended and hyperpronated arm.
B. A Bado type-2 fracture is characterized by posterior angulation of the ulnar fracture and posterior dislocation of the radial head. This Monteggia lesion is the most common type seen in the adult population.
C. A Bado type-3 fracture is a proximal ulnar metaphyseal fracture with lateral dislocation of the radial head. This type has the lowest incidence in the adult population and has been associated with a primary adduction force.
D. A Bado type-4 fracture is an anterior dislocation of the radial head and fracture of the radial and ulnar shafts. Bado type-3 fractures are the least common type seen in adults.

Remediation:

A. A lateral unloading brace would increase joint pressures on the medial compartment of the knee and is not recommended.
B. Bracing leads to a substantial overall lowering of antagonist muscle co-contractions on both the medial and lateral sides of the joint. This results in decreased joint compression.
C. A neutral brace setting results in the best overall improvements in the pain and knee function scores. Pain relief may result from diminished muscle co-contractions rather than medial compartment unloading.
D. Data suggest that when a brace is worn for the treatment of medial compartment knee osteoarthritis, pain relief is due to reduced muscle co-contractions, mediated by the brace mechanically stabilizing the knee.

Remediation:
A. Charcot arthropathy is a joint pathology associated with a neurological condition such as syringomyelia, neurosyphilis, or diabetic neuropathy. It is most commonly seen in the foot or the ankle in a patient with diabetic arthropathy but may present in the hip. Radiographic findings include femoral head resorption as well as bony debris in the acetabulum. It is important to rule out infectious etiology in these patients.
B. This patient presents with Charcot arthropathy of the hips. Charcot arthropathy is a joint pathology associated with a neurological condition such as syringomyelia, neurosyphilis, or diabetic neuropathy. It is most commonly seen in the foot or the ankle in a patient with diabetic arthropathy but may rarely present in the hip. Radiographic findings include femoral head resorption as well as bony debris in the acetabulum. In this patient with normal serum inflammatory markers and a negative joint aspiration, septic arthritis is unlikely.
C.  While severe hip dysplasia can present with femoral head resorption on imaging, there is typically a long-standing history of deformity and it is not usually associated with any neurological deficits. In addition, the bony debris and hypertrophy seen on these images are more commonly associated with Charcot arthropathy.
D. Osteoarthritis of the hip does not usually present with femoral head resorption, bony debris, and limb shortening as with this patient. In addition, this patient's history of syphilis and neurological deficits suggest a diagnosis of Charcot arthropathy.