Page 63South African Orthopaedic Journal 
http://journal.saoa.org.za

SAOJ
SOUTH AFRICAN ORTHOPAEDIC JOURNAL

CPD QUESTIONNAIRE. NOVEMBER 2019 VOL 18 NO 4

Assessment of elbow functional outcome after closed reduction 
and percutaneous pinning of displaced supracondylar humerus 
fractures in children (Rutarama A, Firth GB)

1. Regarding functional outcomes of closed reduction and 
percutaneous pinning of Gartland grade 3 supracondylar 
humerus fractures in children, most children gain good 
functional outcome and range of motion by:

a. 3 weeks A

b. 6 weeks B

c. 12 weeks C

d. 24 weeks D

e. 36 weeks E

2. In uncomplicated as opposed to complicated supracondylar 
humerus fractures in children, the role of physiotherapy 
versus no physiotherapy on functional outcome after closed 
reduction and percutaneous pinning at one-year follow-up 
is as follows:

a. Better outcome A

b. Poor outcome B

c. Same outcome C

d. Guarded outcome D

e. Early to assess outcome E

3. The Paediatric Outcome Data Collection Instrument (PODCI) 
to assess functional outcomes after closed reduction and 
percutaneous pinning of supracondylar humerus fracture in 
children is important because: 

a. Anatomical outcome is less important than clinical outcomes A

b. Anatomical outcomes do not necessarily equate to clinical 
outcomes

B

c. Anatomical outcomes equate to clinical outcomes C

d. Anatomical outcomes are more important than clinical 
outcomes

D

e. Anatomical outcomes somehow equate to clinical outcomes E

Antegrade flexible intramedullary nailing through the greater 
trochanter in paediatric femur shaft fractures (Rosin RC,  
Rasool MN, Sibanda W, Rollinson PD)

4. The incidence of femoral shaft fractures in South Africa is 
estimated to be:

a. 0.50 per 100 children per year A

b. 0.45 per 100 children per year B

c. 0.30 per 100 children per year C

d. 0.25 per 100 children per year D

e. 0.10 per 100 children per year E

5. The articulo-trochanteric distance is defined as the distance 
between two lines perpendicular to the anatomical axis of 
the femur through the following points:

a. The tip of the greater trochanter and the tip of the lesser 
trochanter

A

b. The tip of the greater trochanter and the highest extent of the 
femoral head

B

c. The tip of the greater trochanter and the lateral border of the 
acetabulum

C

d. The tip of the greater trochanter and the contralateral tip of the 
greater trochanter

D

e. The tip of the greater trochanter and the centre of the femoral 
head

E

6. It is recommended that flexible intramedullary nailing 
should not be used in children older than:

a. 13 years A

b. 6 years B

c. 10 years C

d. 15 years D

e. 11 years E

‘Out with the old and in with the new’ – a retrospective review 
of paediatric craniocervical junction fixation: indications, 
techniques and outcomes (Swan AK, Dunn RN)

7. Which of the following screw fixation options is not 
commonly used for the C2 vertebra?

a. C2 translaminar screw fixation A

b. C2 lateral mass screw fixation B

c. C2 pars screw fixation C

d. C2 pedicle screw fixation D

e. None of the above E

8. Which of the following biomechanical statements is true?

a. Primary motion at the occipitocervical joint is rotation A

b. Primary motion at the atlanto-axial joint is in the sagittal plane B

c. The craniocervical junction is the most significant transitional 
zone in children younger than 8 years

C

d. The sublaminar wiring technique is biomechanically superior to 
Magerl's TASF in resisting rotation

D

e. The cervical facet joints are more vertically oriented in 
paediatric patients

E

9. Which statement regarding Magerl's TASF and the Harms 
techniques is true?

a. Magerl's TASF has a significantly higher risk of vertebral artery 
injury than the Harms technique

A

b. The C2 nerve root is encountered during the surgical 
approach for the Harms technique

B

c. Obesity, barrel chest and kyphosis are relative 
contraindications for the Harms technique

C

d. The risk of vertebral artery injury is approximately 7% for both 
techniques

D

e. The Harms technique requires the reduction of the C1–C2 
joints to be used

E



Page 64 South African Orthopaedic Journal 
http://journal.saoa.org.za

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Circular frames of the humerus: salvage surgery case series 
(Pretorius HS, Strauss K, Ferreira N, Lamberts RP)

10. What method was used in this case to minimise pin loosening 
with insertion?

a. 90° orthogonal drilling A

b. Water cooling with drilling B

c. Pin inserted on power C

d. Touch technique applied D

e. Drill sleeves not used due to cumbersome design E

11. Of the 12 cases that are described, 83% went on to union. 
What adjunct was used to facilitate union?

a. Bone grafting A

b. Distraction B

c. Stable frame fixation C

d. Compression D

e. Concertina technique E

12. The classification system for pin-site infection that is used 
to evaluate and manage all pin and wire complications is 
known as the:

a. Olsen criteria A

b. Checketts and Otterburn classification B

c. Cierny and Mader classification C

d. Gustilo and Anderson classification D

e. Henderson classification E

Grip strength following total wrist arthrodesis using the  
same hand as reference: a prospective study (Koch O,  
Alexander AN, Olorunju S, McLoughlin HA, Le Roux TL)

13. Standard grip strength measurement is done with a Jamar 
dynamometer in which unit(s)?

a. kg A

b. mmHg B

c. cm3 C

d. lb D

e. kg and lb E

14. Aetiology contribution to a decrease in grip strength is:

a. SNAC A

b. SLAC B

c. Primary OA of the wrist C

d. Secondary OA after infection of the wrist joint D

e. All of the above E

15. A total wrist fusion:

a. Improves power grip from the starting value A

b. Is a suitable option for a high demand patient with OA of the 
wrist B

c. Provides pain relief C

d. Should remain in the skill set of the orthopaedic surgeon D

e. All of the above E

Communicating about prognosis with regard to osteosarcoma 
in a South African cross-cultural clinical setting: strategies 
and challenges (Brown O, Goliath V, Van Rooyen RM, Aldous 
C, Marais LC)

16. At the study site, healthcare professionals are expected to:
a. Allow sufficient time for cultural practices to be completed 

before discussing prognosis A

b. Communicate diagnostic, treatment and prognostic 
information urgently B

c. Communicate diagnostic and prognostic information in a 
staged approach C

d. Always respect patients’ occasional need for ambiguity about 
prognosis D

e. Allow patients sufficient time to come to terms with the diagnosis 
of osteosarcoma before communicating prognosis E

17. The limitations of this study include the following:

a. The researcher could have triangulated the data-gathering 
procedure A

b. The sample was too big to make meaningful interpretations B
c. The researcher could have mixed the professionals across 

cultural groups C

d. The researcher should have used random sampling D
e. A and C E

18. Participants found the following most challenging:
a. Disclosing a palliative amputation A
b. Disclosing prognosis B
c. Feeling incompetent with regard to disclosing prognosis despite 

adequate training C

d. Deciding who should disclose prognosis D
e. Giving patients time frames for survival E
Current concepts in the management of open tibia fractures 
(Manjra MA, Basson T, Du Preez G, Du Toit J, Ferreira N)

19. Choose the most correct answer with regard to the 
management of open tibial fractures:

a. Negative pressure wound therapy is an excellent strategy for 
definitive wound therapy A

b. The single biggest predictor of infection in open tibia fractures is 
the use of Gram-negative antibiotic cover B

c. Antibiotic cover should be continued for five days post wound 
coverage C

d. Wound cultures obtained at debridement should guide 
antibiotic therapy D

e. Low pressure saline is effective as a lavage solution E
20. All the statements below regarding open tibial fractures are 

correct except:
a. Local antibiotic beads are a useful and effective adjunct to 

intravenous therapy
A

b. Primary wound closure should be performed where this can be 
done safely

B

c. HIV status guides management irrespective of CD4 count C
d. For Gustilo-Anderson III fractures, circular external fixation 

appears to provide the lowest infection rates when compared 
to intramedullary nailing

D

e. Definitive soft tissue management should be achieved within 
seven days

E

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