Page 110 South African Orthopaedic Journal 
http://journal.saoa.org.za

SAOJ
SOUTH AFRICAN ORTHOPAEDIC JOURNAL

CPD QUESTIONNAIRE. MAY/JUNE 2020 VOL 19 NO 2

Short-term results following two-stage revision for peripros-
thetic joint infection (Du Plessis J, Greeff R, Singh V, Fang N, 
Frey CT)
1. According to the host classification by McPherson, which of 

the following scenarios represent a type C host?
a. A 73-year-old male with hypertension and gout, presenting with 

a draining sinus two months after total hip arthroplasty A

b. An 84-year-old female with diabetes and chronic obstructive 
pulmonary disease presents with an active draining sinus for 
four months following total knee arthroplasty

B

c. A 54-year-old male with HIV infection for the last two years 
and on antiretrovirals. His CD4 count is 300 and viral load 
undetectable. He presents three weeks following total hip 
arthroplasty with pain and erythema

C

d. A 74-year-old female with previous bicolumnar plating of a tibial 
plateau fracture through two incisions presents with wound 
breakdown following total knee arthroplasty two weeks ago

D

e. A 62-year-old male with chronic alcoholism develops a draining 
sinus four weeks following total hip arthroplasty for avascular 
necrosis

E

2. Which of the following do not represent an increased risk of 
reinfection following a two-stage revision at one year? 

a. Type C host A

b. Pus found at reimplantation stage B

c. Positive frozen section at time of reimplantation C
d. Positive alpha defensin at reimplantation D

e. Limited debridement E
3. The current gold standard for the management of  

Tsukayama 4 periprosthetic joint infection includes:
a. Two-stage revision with explant and antibiotic cement spacer, 

six weeks targeted antibiotics, two weeks antibiotic-free period 
and reimplantation when no signs of infection

A

b. Single stage revision with thorough debridement and empiric 
antibiotics for six weeks B

c. Thorough debridement with antibiotics and implant retention 
(DAIR) followed by six weeks of antibiotics C

d. Wound debridement followed by six weeks of targeted antibiotics D

e. Explant and debridement followed by arthrodesis E

Low dislocation rates achieved when using dual mobility cup 
hip implants for femur neck fractures (Erasmus LJ, Fourie FF, 
Van der Merwe JF)
4. Which of the following is not a risk factor for hip dislocation 

after total hip arthroplasty?
a. Dementia A

b. Alcohol abuse B

c. Age older than 60 years C
d. Psychiatric disorders D
e. Neuromuscular disorders E

5. Which of the following is true regarding dual mobility cups:
a. Has three articulations A
b. Has two articulations B
c. Only available in cemented options C

d. Only available in non-cemented options D
e. None of the above E

6. The study in this journal looking at dual mobility cups used 
for femur neck fractures found (at one year after surgery) a 
dislocation rate of:

a. 0% A

b. 1.3% B

c. 2.2% C

d. 4.3% D

e. 8.5% E
Percutaneous intra-articular tranexamic acid following total 
knee arthroplasty without drainage to reduce blood loss 
(Gericke E, De Beer J, Deacon M, Marais LC)
7. Which of the following methods of administrating 

tranexamic acid are preferred, considering outcome and 
possible side effects?

a. Intravenous A
b. Intra-articular B
c. Oral C
d. Topical D
e. Inconclusive E
8. Blood loss is a common and challenging complication in 

total knee replacement and has been reported to range 
from:

a. <300 ml A

b. 300–500 ml B

c. 500–700 ml C
d. 700–1 700 ml D
e. >1 700 ml E
9. Regarding the biomechanical effect of tranexamic acid 

reducing blood loss, which is the most appropriate 
statement?

a. Clot formation at the surgical site is promoted due to prevention 
of the formation of plasmin by blocking the conversion of 
plasminogen to plasmin

A

b. Tranexamic acid is a synthetic antifibrinolytic, blocking 
plasminogin directly B

c. Fibrin degradation and breakdown of clots are prevented 
due to prevention of the formation of plasmin by blocking the 
conversion of plasminogen to plasmin

C

d. Tranexamic acid has a higher coagulation effect given 
intravenously D

e. Tranexamic acid potency to reduce blood loss is due to the 
high concentration that is achieved at the target location E

The use of three-dimensional models in tibial plateau fractures 
(Joubert JA)

10. According to the author, can we improve the reliability of 
tibial plateau fracture classification by utilising a 3D printed 
model (in addition to 3D CT scans)? 

a. Yes, for both the Hohl and Moore and the Schatzker classification 
systems A

b. No, 3D printed models do not improve the reliability of fracture 
classification B

c. Yes, but only when using the Schatzker classification C

d. Yes, but only when using the Hohl and Moore classification D

e. No, except for the AO classification system E



Page 112 South African Orthopaedic Journal 
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11. Taking into consideration that this is a level 4 study, are 
3D printed models useful when managing tibial plateau 
fractures?

a. Yes, because the reliability of classification is improved A
b. Yes, the use of 3D models resulted in decreased length of 

hospital stay and less surgical blood loss B

c. No, 3D printed model manufacturing only contributes to patient 
radiation exposure C

d. Yes, observers found 3D models superior to 3D CT in terms of 
spatial awareness and one’s ability to estimate how much bone 
graft is required

D

e. No, 3D printed model use resulted in more patients theoretically 
receiving surgical management than needed E

Correlation of Soft tissue Projection in Injured NEcks (CSPINE): 
Prevertebral soft tissue measurement in paediatric cervical 
spine trauma (McCaul J, Horn A, McCaul M, Dix-Peek S)

12. A 10-year-old female falls off her bunk bed and presents to 
your emergency department with a distal radius fracture. 
Which statement is correct?

a. C-spine injuries are common in the paediatric population and 
therefore this patient should definitely have a full C-spine X-ray 
series

A

b. Intubation will significantly increase the appearance of the soft 
tissue shadow on the upper part of the C-spine on lateral X-ray B

c. In children, the lower C-spine is much more likely to be injured 
than the upper C-spine C

d. Soft tissue swelling on lateral C-spine X-ray correlates well with 
bony injury D

e. Soft tissue swelling on lateral C-spine X-ray cannot be measured 
as a ratio of vertebral body width E

13. In this patient, you suspect that the prevertebral soft tissue 
is swollen by its appearance on the lateral C-spine X-ray. 
Which of the following measurements would alert you to the 
possibility of injury and prompt further investigation (e.g. CT 
scan or MRI)?

a. The soft tissue in front of the C6 vertebral body is 65% of the 
width of the C7 vertebral body A

b. The soft tissue in front of C2 is more than 20% of the C3 
vertebral body B

c. The soft tissue in front of the C6 vertebral body is more than 
55% of the width of the C7 vertebral body C

d. The soft tissue in front of the C2 vertebral body is 38% of the 
width of the C7 vertebral body D

e. The soft tissue in front of the C2 vertebral body is more than 
55% of the width of the C7 vertebral body E

14. You apply the CSPINE rule to interpret her X-ray. This rule 
has a sensitivity of about 33–45% and a specificity of around 
82–93%. This means:

a. It is a good screening tool A
b. It will have a good positive predictive value as C-spine injury has 

a high prevalence B

c. It is useful to rule in the chance of cervical spine injury C
d. It has a low false negative rate D
e. It is useful to rule out the chance of cervical spine injury E
Epidemiology of paediatric and adolescent fractures admitted 
to a South African provincial hospital (Strydom S, Hattingh C, 
Ngcelwane M, Ngcoya N)

15. Which of the following is not a risk factor to identify child 
abuse?

a. Unplanned pregnancy A

b. Children less than 5 years of age B

c. Unemployed parents C
d. Femur fracture in children less than 1 year of age D
e. Multiple fractures in different stages of healing E

16. Which of the following strategies may best decrease the 
number of children admitted with fractures?

a. Better gun control A
b. Improved playground supervision at school B
c. Build pedestrian sidewalks in communities C
d. Home traction treatment of femur fractures D
e. Enforce the use of child seats in cars E

17. Regarding PVAs in children, which of the following 
statements is true?

a. Most fractures occur in the upper limbs A
b. Educational programmes have not been proven to reduce the 

incidence B

c. Most accidents occur at night C
d. The majority occur in pre-school children D
e. These children tend to suffer more severe injuries E
The risk of early complications in patients with hand infections 
(Verhoef H, Marais LC, Ryan PV, Rollinson PD)

18. The following are all independent risk factors for development 
of early complications in hand infections, except:

a. Polymicrobial infections A
b. Human bites B
c. Diabetes mellitus with HBA1C 7.8% C
d. HIV infection with CD4 count 180 cells/mm3 D
e. Diabetes mellitus with HBA1C 10.1% E

19. Regarding the bacteriology of hand infections, which one of 
the following statements is correct?

a. Polymicrobial infections are found more frequently than isolated 
S. aureus infections in HIV-positive patients A

b. Polymicrobial infections are found more frequently than isolated 
S. aureus infections in diabetic patients B

c. S. epidermidis is the most frequently isolated organism C
d. Eikenella corrodens is the most frequently isolated organism in 

HIV-positive patients D

e. HIV-positive patients and poorly controlled diabetic patients 
are more likely to be affected by polymicrobial infections than 
patients who are HIV negative and non-diabetic

E

Management of femur neck fractures in young adults under 
the age of 60 years (Blake CA, Van Staden GF, Van der Merwe 
JF, Matshidza S)

20. The most important aspect of hip-preserving surgery in young 
adults under the age of 60 years with femur neck fractures is:

a. Capsulotomy A
b. Surgical timing B
c. Open reduction C
d. Quality of reduction and fixation D
e. Choice of internal fixation E

21. Which surgical implant should be avoided in Pauwels type 3 
fractures?

a. Cannulated screws A
b. Proximal femoral locking plate B
c. Dynamic hip screw C

d. Cephalomedullary device D
e. Hybrid plate E

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