DEX IOT DAY 3 TEST NEWEST 2024 ACTUAL EXAM 250 QUESTIONS AND CORRECT DETAILED
ANSWERS
Question 1
True or False: The Arthrex Trochanteric ES nail carries the same indications for use as the
Arthrex Short Trochanteric nail.
A) True
B) False
C) Only in elderly patients
D) Only for subtrochanteric fractures
E) None of the above
Correct Answer: A) True
Rationale: The Trochanteric ES (Excellence in Stability) nail is designed for the same
clinical indications as the standard short trochanteric nail, primarily intertrochanteric
fractures, offering a similar surgical approach and objective.
Question 2
Which of the following is NOT a standard classification for intertrochanteric fractures?
A) Stable 2-part fracture
B) Comminuted 4-part fracture
C) Reverse obliquity fracture
D) Spiral, valgus position fracture
E) Unstable 3-part fracture
Correct Answer: D) Spiral, valgus position fracture
Rationale: Intertrochanteric fractures are typically classified by stability and the number of
fragments (Evan’s or AO classification). A "spiral, valgus position fracture" is not a
standard descriptor for IT fractures.
Question 3
True or False: The Arthrex Trochanteric ES nail is indicated for subtrochanteric fractures that
extend deep into the femoral diaphysis.
A) True
B) False
Correct Answer: B) False
Rationale: While the ES nail can handle some proximal fractures, fractures extending into
the diaphysis require a long trochanteric nail to provide adequate intramedullary stability
across the entire length of the femur.
Question 4
Which region of the proximal femur is recognized as containing the strongest, most dense bone?
A) The greater trochanter tip
B) The femoral calcar
C) The lesser trochanter
, 2
D) The femoral neck mid-section
E) The fovea capitis
Correct Answer: B) The femoral calcar
Rationale: The calcar femorale is a thick plate of cortical bone that provides significant
structural support to the femoral neck, making it a critical landmark for hardware
purchase in hip fractures.
Question 5
The subtrochanteric region of the femur is defined as the area just inferior to the lesser
trochanter, extending distally approximately:
A) 1 cm
B) 2 cm
C) 5 cm
D) 10 cm
E) 15 cm
Correct Answer: C) 5 cm
Rationale: Anatomically and surgically, the subtrochanteric zone is generally considered the
5 cm area immediately below the inferior border of the lesser trochanter.
Question 6
In the Arthrex Trochanteric nail system, which of the following is TRUE regarding the
telescoping lag screw and the anti-rotation (AR) screw?
A) They must be used in separate surgeries.
B) The AR screw is only for long nails.
C) They can be used together in a "2-screw" construct.
D) The lag screw replaces the need for the nail.
E) They are incompatible.
Correct Answer: C) They can be used together
Rationale: The system allows for the simultaneous use of a telescoping lag screw and a
smaller anti-rotation screw to provide superior stability against rotational forces in
unstable fractures.
Question 7
Which type of femur fracture makes up 10-30% of all hip fractures, has a bimodal distribution
(20s and 60s), and is associated with long-term bisphosphonate use?
A) Intertrochanteric fracture
B) Femoral neck fracture
C) Subtrochanteric fracture
D) Greater trochanteric avulsion
E) Pipkin fracture
Correct Answer: C) Subtrochanteric fracture
, 3
Rationale: Subtrochanteric fractures are often high-energy in the young and low-
energy/atypical (bisphosphonate-related) in the elderly, making up a significant subset of
proximal femoral trauma.
Question 8
Which anatomic landmark is the ideal entry point (start point) for an Arthrex trochanteric nail?
A) Medial to the greater trochanter
B) Piriformis fossa
C) Tip of the greater trochanter
D) Lateral cortex of the shaft
E) Lesser trochanter
Correct Answer: C) Tip of the greater trochanter
Rationale: Modern trochanteric nails are designed with a lateral bend (valgus angle)
specifically intended to allow insertion through the tip of the greater trochanter.
Question 9
A fracture line that runs from the medial cortex (inferiorly) to the lateral cortex (superiorly) in
the trochanteric region is called a:
A) Stable IT fracture
B) Basicervical fracture
C) Reverse obliquity intertrochanteric fracture
D) Transverse shaft fracture
E) Comminuted subtrochanteric fracture
Correct Answer: C) Reverse obliquity intertrochanteric fracture
Rationale: Reverse obliquity fractures are highly unstable because the fracture line tends to
shift the femoral shaft medially; they are best treated with an intramedullary nail.
Question 10
Preoperative radiographs of an injured femur are used to establish which of the following?
A) Proper nail diameter
B) Expected amount of reaming
C) Lag screw angle and length
D) Trochanteric nail length
E) All of the above
Correct Answer: E) All of the above
Rationale: Thorough preoperative planning with X-rays (and sometimes templating the
contralateral side) is essential to ensure the correct implant size and strategy are selected
before the first incision.
Question 11
What is the most appropriate nail choice for a fracture classified as subtrochanteric?
ANSWERS
Question 1
True or False: The Arthrex Trochanteric ES nail carries the same indications for use as the
Arthrex Short Trochanteric nail.
A) True
B) False
C) Only in elderly patients
D) Only for subtrochanteric fractures
E) None of the above
Correct Answer: A) True
Rationale: The Trochanteric ES (Excellence in Stability) nail is designed for the same
clinical indications as the standard short trochanteric nail, primarily intertrochanteric
fractures, offering a similar surgical approach and objective.
Question 2
Which of the following is NOT a standard classification for intertrochanteric fractures?
A) Stable 2-part fracture
B) Comminuted 4-part fracture
C) Reverse obliquity fracture
D) Spiral, valgus position fracture
E) Unstable 3-part fracture
Correct Answer: D) Spiral, valgus position fracture
Rationale: Intertrochanteric fractures are typically classified by stability and the number of
fragments (Evan’s or AO classification). A "spiral, valgus position fracture" is not a
standard descriptor for IT fractures.
Question 3
True or False: The Arthrex Trochanteric ES nail is indicated for subtrochanteric fractures that
extend deep into the femoral diaphysis.
A) True
B) False
Correct Answer: B) False
Rationale: While the ES nail can handle some proximal fractures, fractures extending into
the diaphysis require a long trochanteric nail to provide adequate intramedullary stability
across the entire length of the femur.
Question 4
Which region of the proximal femur is recognized as containing the strongest, most dense bone?
A) The greater trochanter tip
B) The femoral calcar
C) The lesser trochanter
, 2
D) The femoral neck mid-section
E) The fovea capitis
Correct Answer: B) The femoral calcar
Rationale: The calcar femorale is a thick plate of cortical bone that provides significant
structural support to the femoral neck, making it a critical landmark for hardware
purchase in hip fractures.
Question 5
The subtrochanteric region of the femur is defined as the area just inferior to the lesser
trochanter, extending distally approximately:
A) 1 cm
B) 2 cm
C) 5 cm
D) 10 cm
E) 15 cm
Correct Answer: C) 5 cm
Rationale: Anatomically and surgically, the subtrochanteric zone is generally considered the
5 cm area immediately below the inferior border of the lesser trochanter.
Question 6
In the Arthrex Trochanteric nail system, which of the following is TRUE regarding the
telescoping lag screw and the anti-rotation (AR) screw?
A) They must be used in separate surgeries.
B) The AR screw is only for long nails.
C) They can be used together in a "2-screw" construct.
D) The lag screw replaces the need for the nail.
E) They are incompatible.
Correct Answer: C) They can be used together
Rationale: The system allows for the simultaneous use of a telescoping lag screw and a
smaller anti-rotation screw to provide superior stability against rotational forces in
unstable fractures.
Question 7
Which type of femur fracture makes up 10-30% of all hip fractures, has a bimodal distribution
(20s and 60s), and is associated with long-term bisphosphonate use?
A) Intertrochanteric fracture
B) Femoral neck fracture
C) Subtrochanteric fracture
D) Greater trochanteric avulsion
E) Pipkin fracture
Correct Answer: C) Subtrochanteric fracture
, 3
Rationale: Subtrochanteric fractures are often high-energy in the young and low-
energy/atypical (bisphosphonate-related) in the elderly, making up a significant subset of
proximal femoral trauma.
Question 8
Which anatomic landmark is the ideal entry point (start point) for an Arthrex trochanteric nail?
A) Medial to the greater trochanter
B) Piriformis fossa
C) Tip of the greater trochanter
D) Lateral cortex of the shaft
E) Lesser trochanter
Correct Answer: C) Tip of the greater trochanter
Rationale: Modern trochanteric nails are designed with a lateral bend (valgus angle)
specifically intended to allow insertion through the tip of the greater trochanter.
Question 9
A fracture line that runs from the medial cortex (inferiorly) to the lateral cortex (superiorly) in
the trochanteric region is called a:
A) Stable IT fracture
B) Basicervical fracture
C) Reverse obliquity intertrochanteric fracture
D) Transverse shaft fracture
E) Comminuted subtrochanteric fracture
Correct Answer: C) Reverse obliquity intertrochanteric fracture
Rationale: Reverse obliquity fractures are highly unstable because the fracture line tends to
shift the femoral shaft medially; they are best treated with an intramedullary nail.
Question 10
Preoperative radiographs of an injured femur are used to establish which of the following?
A) Proper nail diameter
B) Expected amount of reaming
C) Lag screw angle and length
D) Trochanteric nail length
E) All of the above
Correct Answer: E) All of the above
Rationale: Thorough preoperative planning with X-rays (and sometimes templating the
contralateral side) is essential to ensure the correct implant size and strategy are selected
before the first incision.
Question 11
What is the most appropriate nail choice for a fracture classified as subtrochanteric?
