Remediation:
A. Intramedullary nail fixation has shown a time to union of 18 weeks compared with plate fixation, which has a time to union of approximately 22 weeks.
B. Plate fixation has demonstrated increased rates of implant removal in comparative studies.
C. Comparative studies have failed to demonstrate a difference in coronal or sagittal plane alignment between those patients treated with a plate or a nail.
D. Comparative studies have failed to demonstrate a difference in infection rate between those patients treated with a plate or a nail.
E. Although time to union has been shown to be slightly quicker in patients treated with an intramedullary nail, overall rate of union seems to be similar between those patients treated with a plate or an intramedullary nail.

Remediation:
A. A 1st MTP fusion would be more appropriate for a patient with a higher stage hallux rigidus. Her pain is over the dorsal prominence and occurs when wearing shoes.
B. This patient likely has grade 2 hallux rigidus. In a patient who has attempted and failed nonoperative treatment, the most appropriate surgery would be a cheilectomy.
C. A Keller procedure is reserved for elderly low-demand patients.
D. A cheilectomy is preferred to arthroplasty.

Remediation:
A. There is no role for prophylactic fusion. Ghiselli, et al. concluded that there was no need to routinely include the L5-S1 disc space if no symptoms were attributed to that level. They found that at an average of 7.3 years after isolated L4-L5 fusion, no patient required subsequent fusion for progressive symptomatic degeneration at the L5-S1 segment.
B. Inclusion of the healthy L5-S1 disc changes this to a 2-level fusion, which may increase (not decrease) the chance of adjacent segment disease (i.e., at L3-L4). Likewise, Ghiselli, et al. have shown that the natural history of the L5-S1 disc below an L4-L5 fusion is good.
C. Minimally invasive fusion techniques do not change the risk of long-term outcomes, other than perhaps a higher rate of nonunion. The primary benefit of minimally invasive surgery is experienced in the short-term, with reduced perioperative pain/disability for the first 3-6 months.
D. If anything, surgically altering the anatomy at the level adjacent to a fusion will increase (not decrease) the chance of adjacent segment disease (ASD). Adjacent level hypermobility that occurs following rigid fixation/fusion of a motion segment increases disc stress and increases the chance for ASD. Additional disruption of the posterior tension band/elements will only increase this risk.
E. Ghiselli, et al. concluded that there was no need to include to the L5-S1 disc space if no symptoms were attributed to that level. They found that at an average of 7.3 years after isolated L4-L5 fusion, there was no clinically significant adjacent segment disease."

Remediation:
A. Increasing the number of anchors alone has no biomechanical advantage. It is the number of suture limbs through the tendon that affects repair strength.
B. The number of anchor rows has not been shown to predict repair strength.
C. The number of suture limbs through the rotator cuff tendon best predicts repair strength.
D. There is no difference in repair strength between knotted and knotless repairs.

Remediation:
A. Gentle repositioning should be performed immediately to attempt to improve blood flow.
B. Pulseless supracondylar fractures should be monitored clinically as they are at risk for compartment syndrome.
C. Arterial repair should not be performed by someone without experience and comfort doing vascular surgery. A vascular surgeon should be employed for an injury requiring arterial exploration.
D. It would be appropriate to transfer the patient to a facility with vascular surgery capability, should that be required.

Remediation:
A. Genetic defect in type I collagen formation is characterized by osteopenia and excessive bone fragility; OI is inherited as autosomal dominant traits because of mutations in either the COL1A1 or COL1A2 genes that code for the α1 and α2 collagen chains, respectively.
B. The COL2A1 gene provides instructions for making one component of type II collagen, called the pro-alpha1(II) chain, which impacts cartilage, not bone.
C. The components of type III collagen, called pro-alpha1(III) chains, are produced from the COL3A1 gene. Type III collagen is found in the skin, lungs, intestinal walls, and the walls of blood vessels.
D. The components of type IV collagen, the alpha1(IV) chain, are produced from the COL4A1 gene. Type IV collagen is the main component of basement membranes, which are thin sheet-like structures that separate and support cells in many tissues.

Remediation:
A. A full-thickness skin graft is not a good option for durable and sensate coverage in this patient who is a manual laborer.
B. A first dorsal metacarpal artery flap (kite flap) is a local rotational flap based off of the first dorsal metacarpal artery. It is an excellent option for volar oblique defects of the thumb.
C. A Moberg advancement flap would be a reasonable option for transverse thumb tip amputations <2 cm. Volar oblique defects or defects >2 cm are not ideal for Moberg flaps.
D. A reverse radial forearm flap is most often used for coverage of dorsal hand defects or first web-space defects.

Remediation:
A. In a cadaveric study by Astion et al., fusion of the talonavicular joint essentially eliminated hindfoot motion.
B. The calcaneocuboid joint provides the least amount of composite hindfoot motion.
C. Fusion of the talocalcaneal (subtalar) joint does restrict overall hindfoot motion. However, this effect is less than that following a talonavicular fusion.
D. The tibiotalar joint provides plantar flexion and dorsiflexion but not inversion and eversion.

Remediation:
A. Improvements in pain and function have been shown 6 months to 1 year following injection of 100 to 150
B-D.  Same as A

Remediation:
A. This decrease in abductor moment arm can lead to instability and altered gait mechanics.
B. Raising the hip center 2 cm superolateral to the native acetabulum will reduce the abductor moment arm by 28%.
C. Raising the hip center 2 cm superolateral to the native acetabulum will decrease the abductor moment arm by 28%.
D. Raising the hip center will not affect the adductor moment arm.
E. Same as D