Fracture Fixation Fundamentals Question What are the four AO principles of fracture management? Answer Anatomical reduction, stable fixation, preservation of blood supply, and early mobilization. Question What is the main advantage of minimally invasive plate osteosynthesis (MIPO)? Answer It preserves blood supply while providing stable fracture fixation. Question What is the purpose of an interfragmentary lag screw? Answer To compress fracture fragments and improve stability. Question Why is fracture reduction performed before plate fixation? Answer Proper reduction restores anatomy and allows the implant to function as intended. Question Why is selecting the correct implant size important? Answer The right implant size improves stability, restores anatomy, and reduces the risk of fixation failure. Question What is the difference between absolute and relative stability? Answer Absolute stability eliminates fracture motion, while relative stability allows controlled micromotion to promote secondary bone healing. Question When is absolute stability preferred? Answer It is preferred for simple fracture patterns where direct bone healing is the goal. Question What type of bone healing occurs with relative stability? Answer Secondary bone healing through callus formation.
Screws, Drilling & Fixation Techniques Question What does a depth gauge measure? Answer It measures the correct screw length after drilling. Question Why is continuous irrigation recommended while drilling? Answer It helps reduce heat generation and minimizes the risk of thermal bone injury. Question What is the purpose of a drill guide? Answer It guides the drill accurately and helps protect surrounding soft tissues. Question Why are locking screws different from conventional screws? Answer Locking screws thread into the plate, creating a fixed-angle construct. Question What is the purpose of a load drill guide? Answer It creates axial compression across the fracture as the screw is tightened. Question What is the purpose of temporary K-wire fixation? Answer It maintains fracture reduction before definitive fixation. Question What is bicortical screw fixation? Answer The screw engages both the near and far cortices for improved stability. Question What is the purpose of a washer with a cancellous screw? Answer It increases the surface area and reduces the risk of the screw head sinking into bone. Question What is the purpose of a cannulated screw? Answer It is inserted over a guide wire for accurate placement. Question Why are guide wires important in orthopaedic surgery? Answer They help achieve precise implant positioning before definitive fixation.
Arthroscopy, ACL & Meniscus Question What is the primary role of the ACL? Answer The ACL limits anterior tibial translation and contributes to rotational stability of the knee. Question Why is preserving the meniscus important? Answer Preserving the meniscus helps maintain normal knee biomechanics and protects the articular cartilage. Question What is the purpose of a graft sizer during ACL reconstruction? Answer It measures the graft diameter to help prepare accurately sized bone tunnels. Question What is one advantage of an all-inside meniscus repair? Answer It allows secure repair while minimizing additional surgical exposure. Question What is the function of a cortical button in ligament reconstruction? Answer It suspends and secures the graft on the outer cortex of the bone. Question What is the purpose of a probe during arthroscopy? Answer It assesses tissue integrity, tear stability, and repair quality. Question Why is arthroscopic irrigation used throughout the procedure? Answer It maintains clear visualisation by removing blood and debris.
Instruments & Surgical Tools Question What is the purpose of a bone holding forceps? Answer It temporarily holds fracture fragments in the desired position during fixation. Question What is the purpose of a reduction clamp? Answer It temporarily holds fracture fragments in an anatomical position during fixation. Question Why is fluoroscopy important during fracture fixation? Answer It helps confirm reduction, implant position, and screw placement. Question Why should soft tissues be protected during drilling? Answer To avoid injury to nearby nerves, vessels, and tendons.
Implant & Bone Biology Question What is the difference between cortical and cancellous screws? Answer Cortical screws are designed for dense cortical bone, while cancellous screws are intended for softer cancellous bone. Question What is the advantage of titanium implants? Answer Titanium offers excellent biocompatibility, corrosion resistance, and a high strength-to-weight ratio. Question Bone quality should influence every decision. Answer Osteoporotic bone often requires different fixation strategies than healthy cortical bone. Question Implant position affects load sharing. Answer Proper implant placement distributes forces more evenly and reduces stress concentration.
Reduction & Soft-Tissue Principles Question Every screw should have a purpose. Answer Avoid placing unnecessary screws. Each screw should contribute to stability without compromising bone stock or future fixation options. Question Compression should be deliberate. Answer Apply compression only when the fracture pattern allows anatomical reduction. In comminuted fractures, excessive compression may shorten the bone. Question Reduction comes before fixation. Answer An implant should maintain a reduction, not create one. Accurate reduction before definitive fixation improves overall outcomes. Question Respect the soft tissues. Answer Successful fracture surgery depends as much on preserving soft tissues as it does on implant selection. Question Don't chase every small fragment. Answer Small comminuted fragments often heal through indirect reduction and preserved biology rather than extensive dissection. Question Restoration of alignment is just as important as fixation. Answer Correct length, rotation, and alignment are essential for restoring normal limb function. Question Not every fracture needs anatomical reduction. Answer In highly comminuted fractures, restoring alignment and preserving biology often produce better outcomes than extensive fragment dissection. Question Stability and biology must work together. Answer Excellent fixation without biology—or biology without stability—rarely produces the best result.
Planning & Implant Selection Question Good fixation starts with good planning. Answer Review imaging, understand the fracture pattern, and decide the fixation strategy before entering the OR (operating room). Question Every drill hole is permanent. Answer Plan screw placement carefully to preserve bone stock and avoid weakening the construct. Question Implant strength cannot compensate for poor technique. Answer Even the best implant performs poorly if reduction, screw placement, or surgical planning is inadequate. Question Fracture classification guides treatment—not just documentation. Answer Understanding the fracture pattern helps determine reduction strategy, implant selection, and expected healing. Question Good fixation starts before the first incision. Answer Careful preoperative planning often prevents intraoperative surprises and improves surgical efficiency. Question Locking screws don't replace good technique. Answer They improve construct stability but cannot compensate for poor reduction or incorrect implant placement. Question Think beyond today's surgery. Answer Plan fixation that allows fracture healing while preserving future treatment options if revision becomes necessary. Question The first screw sets the foundation. Answer Initial screw placement often determines plate position, fracture alignment, and overall construct stability.
Fixation, Technique & Outcomes Question Fluoroscopy is your second pair of eyes. Answer Confirm reduction, implant position, screw length, and joint penetration before completing fixation. Question Screw length is more than a measurement. Answer The correct screw length provides secure fixation while avoiding unnecessary prominence or soft-tissue irritation. Question Fracture healing begins in the operating room. Answer Careful tissue handling and stable fixation create the environment required for successful healing. Question A successful operation is judged by function, not just X-rays. Answer The ultimate goal is painless healing, restored alignment, and early return of function. Question Don't overtighten every screw. Answer Excessive torque can strip bone, reduce fixation strength, and make future implant removal more difficult. Question A plate should fit the bone—not force the bone to fit the plate. Answer Proper contouring restores anatomy while minimizing stress on both the implant and the bone. Question A shorter operation isn't always a better operation. Answer Surgical efficiency is valuable, but accuracy should never be sacrificed for speed. Question Fluoroscopy should answer questions—not create them. Answer Obtain clear orthogonal views before accepting reduction or final implant placement. Question Preserve bone stock whenever possible. Answer Every unnecessary drill hole weakens bone and may complicate future revision procedures.
