This practice set contains high-yield board review questions covering key concepts in 2. Trauma. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.
Question 2181
Topic: 2. Trauma
A 35-year-old male is involved in a high-speed motorcycle collision and sustains an extra-articular scapular neck fracture. The decision is made to evaluate the glenopolar angle (GPA) on AP radiographs of the shoulder. A GPA less than which of the following values is generally considered a relative indication for surgical fixation due to severe rotational malalignment?
Correct Answer & Explanation
. 22 degrees
Explanation
The normal glenopolar angle is between 30 and 45 degrees. A GPA of less than 20 to 22 degrees indicates significant rotational malalignment of the glenoid and is a relative indication for operative fixation of a scapular neck fracture.
Question 2182
Topic: 2. Trauma
A 28-year-old carpenter falls from a ladder, sustaining a comminuted trans-olecranon fracture-dislocation. The surgeon decides against using tension band wiring for this injury. What is the primary mechanical reason tension band wiring is contraindicated in this specific fracture pattern?
Correct Answer & Explanation
. It can over-compress the comminution, leading to narrowing of the greater sigmoid notch
Explanation
Tension band wiring relies on dynamic compression across a simple transverse fracture. In comminuted fractures or fracture-dislocations, tension band wiring can over-compress the comminuted segments, thereby narrowing the greater sigmoid notch and preventing the trochlea from articulating congruently.
Question 2183
Topic: 2. Trauma
A 22-year-old male cyclist sustains a midshaft clavicle fracture. Which of the following clinical or radiographic findings is an absolute indication for open reduction and internal fixation?
Correct Answer & Explanation
. Open fracture
Explanation
Absolute indications for operative fixation of a clavicle fracture include an open fracture, neurovascular compromise, and symptomatic nonunion. Shortening, severe displacement, and skin tenting without ischemia are considered relative indications.
Question 2184
Topic: 2. Trauma
A 78-year-old female presents with an unstable intertrochanteric hip fracture after a ground-level fall. Radiographs demonstrate significant comminution of the posteromedial cortex. During preoperative planning, the orthopedic surgeon reviews the biomechanical principles of proximal femoral stability. Referring to the provided image of the proximal femur, which anatomical structure, when compromised by comminution, is a primary predictor of varus collapse and fixation failure in intertrochanteric fractures?
Correct Answer & Explanation
. C. Calcar femorale
Explanation
Correct Answer: CThe correct answer is C. The case explicitly states, 'The calcar femorale, a dense vertical plate of bone originating from the posteromedial aspect of the femoral shaft and extending into the posterior femoral neck, is a critical structural landmark. Loss of posteromedial support due to comminution of the calcar is a primary predictor of varus collapse and fixation failure in intertrochanteric fractures.' This structure provides crucial medial buttress support against varus collapse in intertrochanteric fractures.A. Wards triangle is a relative void in the trabecular network, becoming more prominent in osteoporotic bone, but its comminution is not described as the primary predictor of varus collapse in intertrochanteric fractures. It's more relevant to overall bone quality and screw purchase.B. The lateral tensile trabeculae are part of the internal architecture, but their disruption is not specifically highlighted as the primary predictor of varus collapse in the context of posteromedial comminution, which is the role of the calcar.D. The greater trochanter is an attachment site for abductor muscles; while its integrity is important for muscle function, its comminution is not the primary predictor of varus collapse in the same manner as the calcar femorale.E. The lesser trochanter is the insertion site for the iliopsoas. Its avulsion or comminution can indicate an unstable fracture pattern (e.g., reverse obliquity), but the loss of posteromedial support leading to varus collapse is specifically attributed to the calcar femorale in the case description.
Question 2185
Topic: 2. Trauma
A 35-year-old male sustains a Garden IV displaced femoral neck fracture after a high-energy motor vehicle accident. He is taken to the operating room for urgent open reduction and internal fixation. The surgical team is acutely aware of the high risk of avascular necrosis (AVN) in this type of injury. Which of the following arterial structures is considered the dominant contributor to the femoral head's blood supply and is most vulnerable to disruption in displaced femoral neck fractures?
Correct Answer & Explanation
. C. Medial circumflex femoral artery
Explanation
Correct Answer: CThe correct answer is C. The case states, 'The primary supply is derived from the medial circumflex femoral artery and the lateral circumflex femoral artery, which form an extracapsular arterial ring at the base of the femoral neck. The medial circumflex femoral artery is the dominant contributor, giving rise to the lateral epiphyseal artery via the retinacular vessels that ascend along the posterosuperior aspect of the femoral neck within the synovial reflection.' Displacement of femoral neck fractures tears or occludes these retinacular vessels, predisposing the femoral head to avascular necrosis.A. The lateral circumflex femoral artery contributes to the extracapsular ring but is not the dominant contributor to the femoral head's blood supply, especially via the critical retinacular vessels.B. The obturator artery contributes to the blood supply of the acetabulum and surrounding soft tissues but is not a primary direct supply to the femoral head itself.D. The artery of the ligamentum teres (foveal artery), a branch of the obturator artery, provides a minor and often inconsistent supply to the femoral head, particularly in adults, and cannot compensate for the loss of the retinacular vessels.E. The profunda femoris artery is a major artery of the thigh, giving rise to the circumflex femoral arteries, but it does not directly supply the femoral head. Its branches (medial and lateral circumflex) are the direct suppliers.
Question 2186
Topic: 2. Trauma
A 42-year-old active male presents with a femoral neck fracture following a fall from a ladder. Radiographs reveal a displaced fracture with a Pauwels angle of 70 degrees. The orthopedic surgeon notes this high angle as a significant concern for fixation failure. Based on the biomechanical principles discussed in the case, what is the primary implication of a high Pauwels angle on the fracture site?
Correct Answer & Explanation
. Increased shear forces, predisposing to nonunion
Explanation
The Pauwels classification, based on the angle of the fracture line relative to the horizontal, dictates the ratio of shear to compressive forces. High Pauwels angles inherently have higher shear forces, acting as a strong predictor for nonunion and fixation failure. A 70-degree angle is a Pauwels Type III, which is characterized by predominantly shear forces. High Pauwels angles lead to increased shear forces, not compressive forces. Increased compressive forces are associated with lower Pauwels angles (Type I) and are generally more favorable for healing. High Pauwels angles are associated with increased shear forces, which decrease stability and predispose to nonunion and failure. The Pauwels classification primarily relates to mechanical stability and the risk of nonunion, not directly to the risk of avascular necrosis. High shear forces at the fracture site make load sharing more challenging and increase the risk of implant failure.
Question 2187
Topic: 2. Trauma
A 68-year-old male presents with an unstable intertrochanteric hip fracture. During preoperative templating, the surgeon measures the lateral wall thickness on the anteroposterior radiograph, as shown in the image. The measurement is found to be 18 mm. Based on the case's guidelines, what is the most appropriate implant choice for this patient?
Correct Answer & Explanation
. C. Cephalomedullary nail
Explanation
Correct Answer: CThe correct answer is C. The case states, 'The lateral wall thickness must be measured on the anteroposterior radiograph; a thickness of less than twenty point five millimeters is a strong predictor of lateral wall fracture during sliding hip screw insertion, necessitating the use of a cephalomedullary nail.' With a lateral wall thickness of 18 mm (which is less than 20.5 mm), a cephalomedullary nail is indicated to prevent iatrogenic lateral wall fracture and subsequent construct failure.A. A sliding hip screw (SHS) is contraindicated in this scenario due to the thin lateral wall. Insertion of an SHS would likely lead to a lateral wall fracture, causing the proximal fragment to slide laterally, resulting in massive shortening and construct failure.B. Cannulated cancellous screws are typically used for femoral neck fractures, not intertrochanteric fractures, and would not provide adequate stability for an unstable intertrochanteric fracture.D. Hemiarthroplasty is rarely indicated for intertrochanteric fractures, typically reserved for femoral neck fractures in elderly patients or salvage situations with severe pre-existing osteoarthritis and highly comminuted osteoporotic bone.E. Total hip arthroplasty is also rarely indicated for intertrochanteric fractures, similar to hemiarthroplasty, and is primarily used for femoral neck fractures or severe osteoarthritis.
Question 2188
Topic: 2. Trauma
A 55-year-old male undergoes internal fixation with a sliding hip screw for a stable intertrochanteric fracture. Postoperatively, the surgeon reviews the fluoroscopic images and calculates the Tip Apex Distance (TAD). To minimize the risk of lag screw cutout, what is the critical threshold for the Tip Apex Distance that the surgeon should aim to achieve?
Correct Answer & Explanation
. C. Less than 25 mm
Explanation
Correct Answer: CThe correct answer is C. The case explicitly states, 'The concept of Tip Apex Distance, defined as the sum of the distance from the tip of the lag screw to the apex of the femoral head on both views, is critical. A Tip Apex Distance of less than twenty five millimeters has been definitively shown to minimize the risk of lag screw cutout.' This is further reinforced in the 'Summary of Key Literature and Guidelines' section, which highlights Baumgaertner et al.'s work establishing this threshold.A, B, D, E. These options represent incorrect thresholds. While a smaller TAD is generally better, the established critical threshold for minimizing cutout risk is specifically less than 25 mm, as per the seminal literature and guidelines referenced in the case.
Question 2189
Topic: 2. Trauma
An 82-year-old female, 3 months post-sliding hip screw fixation for an intertrochanteric fracture, presents with increasing groin pain and difficulty weight-bearing. Radiographs show the lag screw has migrated superiorly through the femoral head articular surface. The surgeon identifies this as implant cutout. Which of the following is NOT a primary predictor of implant cutout as described in the case?
Correct Answer & Explanation
. E. Early weight-bearing as tolerated
Explanation
Correct Answer: EThe correct answer is E. The case states, 'Implant cutout is the most common mode of mechanical failure, characterized by the migration of the lag screw through the superior articular surface of the femoral head. Predictors of cutout include a Tip Apex Distance greater than twenty five millimeters, varus malreduction, superior placement of the lag screw, and severe osteoporosis.' Conversely, the case advocates for 'early, safe mobilization' and 'weight-bearing as tolerated immediately following surgery,' noting that 'Restricting weight-bearing in the elderly is often impractical, leads to deconditioning, and does not significantly decrease the rate of mechanical failure.'A. A Tip Apex Distance (TAD) greater than 25 mm is a well-established primary predictor of cutout, as highlighted in the case.B. Varus malreduction shifts the weight-bearing axis medially and increases shear forces, drastically increasing the risk of cutout, as described in the case.C. Superior placement of the lag screw is explicitly listed as a predictor of cutout in the case, as it places the screw in a less dense, more vulnerable part of the femoral head.D. Severe osteoporosis significantly reduces bone mineral density and architectural integrity, decreasing the pullout strength of screws and increasing the risk of cutout, as mentioned in the case.
Question 2190
Topic: 2. Trauma
An 85-year-old male undergoes cephalomedullary nailing for an unstable intertrochanteric hip fracture. Postoperatively, the patient's family asks about the rehabilitation plan and long-term care. Based on the case's recommendations, which of the following statements represents the most appropriate post-operative management strategy?
Correct Answer & Explanation
. B. Immediate weight-bearing as tolerated, followed by a comprehensive osteoporosis evaluation and treatment.
Explanation
Correct Answer: BThe correct answer is B. The case strongly advocates for 'early, safe mobilization' and states, 'In the vast majority of cases, patients should be allowed weight-bearing as tolerated immediately following surgery.' It also emphasizes, 'Furthermore, a hip fracture is a sentinel event for severe osteoporosis. Secondary fracture prevention must be initiated prior to discharge. This includes a comprehensive endocrinology evaluation, dual energy x-ray absorptiometry scanning, and the initiation of appropriate pharmacological interventions...'A. Strict non-weight-bearing is generally not recommended for modern hip fracture fixation in appropriately selected patients, as it leads to deconditioning and does not significantly decrease mechanical failure rates.C. Limited toe-touch weight-bearing is often impractical and unnecessary. VTE prophylaxis is mandatory for a minimum of four weeks postoperatively, regardless of specific risk factors beyond the trauma itself.D. VTE prophylaxis is typically low molecular weight heparin or direct oral anticoagulants for a minimum of four weeks, not therapeutic anticoagulation for 6 months, unless there are specific indications for long-term therapeutic anticoagulation.E. Delayed mobilization is contrary to the recommended immediate weight-bearing as tolerated. Restricting weight-bearing does not significantly decrease the rate of mechanical failure and can lead to deconditioning.
Question 2191
Topic: 2. Trauma
A 28-year-old male sustains a high-energy segmental humeral shaft fracture with significant comminution and 4 cm of shortening. He is a polytrauma patient with associated pelvic and tibial fractures. He is hemodynamically stable. Which of the following is the MOST compelling indication for operative management of his humeral fracture via an anterolateral approach?
Correct Answer & Explanation
. The polytrauma status, facilitating nursing care and overall rehabilitation.
Explanation
Correct Answer: DWhile all the options represent valid considerations for operative management, the patient's polytrauma status is often the most compelling indication for early stabilization of long bone fractures, including the humerus. The teaching case lists 'Polytrauma Patient: Early stabilization facilitates nursing care, pulmonary toilet, and overall rehabilitation' as a key indication. In a polytrauma setting, early fracture stabilization helps reduce pain, minimizes blood loss, decreases the risk of fat embolism, and allows for easier patient mobilization, hygiene, and management of other injuries, ultimately improving overall outcomes.Option A is incorrectbecause while segmental fractures are often unstable and prone to nonunion, making them an indication for surgery, the polytrauma status often takes precedence in the acute decision-making process for overall patient management.Option B is incorrectbecause while young age and high functional demand are factors favoring operative management for faster recovery, they are not as acutely compelling as the polytrauma status in the immediate post-injury phase.Option C is incorrectbecause 4 cm of shortening does exceed the generally accepted non-operative limit of 2-3 cm, making it an indication for surgery. However, in a polytrauma patient, the systemic benefits of early stabilization are often prioritized.Option E is incorrectbecause comminuted fractures typically benefit from relative stability (bridging plates) rather than absolute stability, which is usually reserved for simple, transverse, or short oblique fractures with lag screw fixation. While comminution is an indication for operative fixation, the statement about absolute stability is incorrect, and the polytrauma status is a stronger overall indication.
Question 2192
Topic: 2. Trauma
A 72-year-old female with a history of osteoporosis sustains a comminuted humeral shaft fracture. She is scheduled for plate osteosynthesis via an anterolateral approach. The surgeon plans to use a locking compression plate (LCP). Which biomechanical principle is MOST relevant to the use of an LCP for this fracture pattern?
Correct Answer & Explanation
. LCPs function as internal fixators, providing relative stability and promoting indirect bone healing in comminuted fractures.
Explanation
Correct Answer: BThe teaching case states: 'Relative Stability: Achieved with bridging plates (locking or non-locking) for comminuted fractures, allowing for controlled motion at the fracture site to promote indirect bone healing.' It further clarifies: 'In comminuted fractures or osteoporotic bone, locking screws provide angular stability, creating a fixed-angle construct that acts as an internal fixator, primarily providing relative stability.'Option A is incorrectbecause absolute stability through interfragmentary compression is typically achieved with lag screws for simple, transverse, or short oblique fractures, not primarily with bridging LCPs for comminuted fractures.Option C is incorrectbecause the teaching case states: 'The anterolateral surface is mechanically advantageous for resisting bending forces.' It is also effective against torsional forces, but the statement incorrectly limits its advantage.Option D is incorrectbecause LCPs are designed to function as internal fixators with minimal plate-to-bone contact, preserving periosteal blood supply. Extensive periosteal stripping is generally avoided to preserve vascularity.Option E is incorrectbecause while LCPs provide stable fixation, the primary goal is to allow for early, safe mobilization and rehabilitation, not immediate full weight-bearing, especially in osteoporotic bone where construct failure is a risk.
Question 2193
Topic: 2. Trauma
A 22-year-old male sustains an open, comminuted humeral shaft fracture after a motor vehicle accident. He has no neurovascular deficits on presentation. Which of the following is an absolute contraindication to proceeding with immediate open reduction and internal fixation via an anterolateral approach?
Correct Answer & Explanation
. Active local infection at the surgical site, confirmed by purulent discharge.
Explanation
Correct Answer: CThe teaching case lists 'Absolute Contraindications: Active local infection at the surgical site (relative if debridement and staging are possible)' as a contraindication. Active infection at the surgical site is a critical concern that typically necessitates initial debridement and management of the infection before definitive internal fixation, as implanting hardware into an infected field carries a very high risk of chronic osteomyelitis and implant failure.Option A is incorrectbecause significant comminution is listed as arelativecontraindication if extensive soft tissue stripping is required, but it is not an absolute contraindication, especially for an open fracture that requires stabilization.Option B is incorrectbecause a history of smoking is a risk factor for nonunion but is not an absolute contraindication to surgery. It is a patient factor that needs to be managed, but not a reason to completely avoid surgery.Option D is incorrectbecause open fractures are a strong indication for operative management (debridement and stabilization), not a contraindication. While staging may be necessary, the open nature itself is not an absolute contraindication to operative intervention.Option E is incorrectbecause a patient's young age is not a contraindication; rather, it often supports operative management for faster recovery and return to high-demand activities. While intramedullary nailing is an alternative, it is not an absolute contraindication to plating.
Question 2194
Topic: 2. Trauma
A 40-year-old male undergoes an anterolateral approach for a mid-diaphyseal humeral fracture. During the initial superficial dissection, the surgeon identifies a prominent superficial vein coursing along the lateral aspect of the biceps. What is the MOST appropriate management of this vein during the approach?
Correct Answer & Explanation
. Carefully mobilize and retract the vein laterally to preserve venous drainage.
Explanation
Correct Answer: CThe teaching case states under 'Superficial Anatomy': 'Cephalic Vein: This superficial vein is a critical landmark, typically found coursing in the deltopectoral groove proximally and then along the lateral aspect of the biceps distally. It should be identified and carefully retracted laterally throughout the approach to minimize bleeding and preserve venous drainage.'Option A is incorrectbecause ligating a critical superficial vein like the cephalic vein, especially if it's prominent, can compromise venous drainage of the forearm and hand, leading to edema. Preservation is preferred.Option B is incorrectbecause the cephalic vein is typically lateral to the biceps. Retracting it medially would pull it across the surgical field and potentially put it at higher risk of injury or compromise its natural course.Option D is incorrectbecause dissecting deep to the vein would place it in the path of deeper dissection, increasing its risk of injury. It should be superficial to the main dissection plane.Option E is incorrectbecause the cephalic vein is a significant superficial vein. Ignoring it or assuming it will self-seal if transected is poor surgical practice and can lead to significant bleeding and post-operative complications.
Question 2195
Topic: 2. Trauma
A 32-year-old male presents to the emergency department after a high-energy motor vehicle accident with the injury shown in the clinical photograph. He is hemodynamically stable, and a full neurovascular exam reveals intact distal pulses and sensation. After initial ATLS protocol, the most appropriate next step in the management of this open fracture, prior to definitive surgical planning, is:
Correct Answer & Explanation
. Removal of gross contamination, wound photography, saline-soaked dressing, analgesia, splinting, IV antibiotics, and tetanus prophylaxis.
Explanation
Correct Answer: CThe case explicitly outlines the initial management for an open fracture in the emergency department. After ATLS principles, the specific steps for the open fracture include: performing a full neurovascular examination, removing any obvious contamination, photographing the wound, covering it with a saline-soaked swab, providing analgesia, splinting the limb, obtaining radiographs (if not already done), administering IV antibiotics as per local protocols (e.g., cefuroxime 1.5g IV), and assessing the need for tetanus prophylaxis. This comprehensive approach addresses immediate wound care, pain management, stabilization, and infection prevention.Option A:While early surgical debridement is important, the '6-hour rule' has been debunked by studies like LEAP, which found no difference in infection rates when managed within 6 or 24 hours. Immediate surgical debridement is not thenextstep after ATLS but rather the definitive surgical intervention, which requires prior preparation.Option B:Oral antibiotics are generally insufficient for open fractures, which require intravenous broad-spectrum antibiotics. While a sterile dressing is part of the management, it's not the complete initial picture.Option D:Direct wound closure is contraindicated in open fractures due to the high risk of trapping bacteria and increasing infection rates. The wound should be debrided and irrigated in the operating room before considering closure or coverage.Option E:While a vascular injury is a critical concern, the vignette states that a full neurovascular exam revealed intact distal pulses and sensation. Therefore, an immediate CT angiogram is not the most appropriatenextstep for this specific patient, although it would be indicated if vascular compromise was suspected. The immediate steps focus on wound care and systemic prophylaxis.
Question 2196
Topic: 2. Trauma
A 48-year-old construction worker sustains a Gustilo-Anderson Grade II open tibial shaft fracture after a fall from scaffolding. There is no evidence of vascular injury. Based on the current consensus and the LEAP study findings, what is the most appropriate timing for surgical debridement and stabilization?
Correct Answer & Explanation
. Within 24 hours of injury, ideally during daytime hours with combined orthopaedic and plastic surgery input.
Explanation
Correct Answer: BThe case explicitly states, 'The current consensus favours prudent early surgery within the first 24 hours. The old '6-hour rule' was based on animal experiments from the 1890s, and the well-known Lower Extremity Assessment Project (LEAP) study found no difference in infection rates when open fractures were managed within 6 hours or 24 hours.' It further recommends that, assuming no vascular injury, the injury is best managed during daytime hours with combined orthopaedic and plastic surgery input.Option A:This reflects the outdated '6-hour rule' which has been superseded by evidence from the LEAP study.Option C:Delaying surgery beyond 24 hours for an open fracture increases the risk of infection and is not recommended by current guidelines.Option D:Open fractures require surgical debridement and stabilization to prevent infection and promote healing, not just observation for infection.Option E:While urgent, the LEAP study and current guidelines allow for management within 24 hours, suggesting that it can be planned during daytime hours for optimal team availability, unless there's a vascular injury or heavy contamination (which are not present in this vignette).
Question 2197
Topic: 2. Trauma
A 28-year-old male sustains a high-energy open tibial fracture and undergoes surgical debridement and external fixation. Postoperatively, he remains obtunded due to associated head trauma. The nursing staff reports increasing pain medication requirements and a firm anterior compartment. To monitor for the most concerning postoperative complication in this patient, the orthopedic team decides to initiate continuous pressure monitoring. Which of the following findings would be diagnostic of early compartment syndrome in this context?
Correct Answer & Explanation
. A ΔP (diastolic blood pressure - intracompartmental pressure) persistently less than 30 mmHg.
Explanation
Patients who are unconscious or obtunded warrant continuous pressure monitoring with a slit catheter. Continuous pressure monitoring of the anterior compartment is a useful adjunct to clinical diagnosis, whereby the ΔP is calculated by subtracting the intracompartmental pressure from the diastolic blood pressure. A persistently low ΔP, that is, <30 mmHg, is diagnostic of early compartment syndrome.
Question 2198
Topic: 2. Trauma
A 55-year-old farmer sustains an open tibial fracture after being run over by a tractor. The wound is heavily contaminated with farmyard matter, and there is extensive soft tissue loss with exposed bone and periosteal stripping, but no arterial injury requiring repair. Based on the Gustilo and Anderson classification system, how would this injury be classified?
Correct Answer & Explanation
. Gustilo-Anderson Grade IIIb
Explanation
Gustilo-Anderson Grade IIIb is defined as an open fracture with extensive soft tissue loss and periosteal stripping. Additionally, heavy contamination and farmyard contamination automatically classify an injury as Grade III. The presence of farmyard contamination (automatic Grade III) and extensive soft tissue loss with periosteal stripping (specific to IIIb) leads to a classification of IIIb. The absence of an arterial injury requiring repair rules out IIIc.
Question 2199
Topic: 2. Trauma
Following thorough debridement of a Gustilo-Anderson Grade IIIb open tibial fracture, the wound bed reveals exposed bare bone and tendons without paratenon. According to the case discussion on soft tissue coverage, which of the following reconstructive options would be inappropriate for immediate application to this wound?
Correct Answer & Explanation
. Free flap
Explanation
The case explicitly states: 'Bare bone, exposed blood vessels, nerves and tendons (without paratenon) all are harmed by desiccation and do not support granulation tissues and STSG. These tissues should not be left exposed, and should be kept moist with appropriate dressings prior to definitive cover.' Therefore, a split-thickness skin graft (STSG) would be inappropriate for a wound with exposed bare bone and tendons without paratenon. Rotational muscle flaps (Gastrocnemius, Soleus) and various free flaps (including fasciocutaneous flaps like the sural artery flap) are all options on the reconstructive ladder designed to provide vascularized soft tissue coverage for complex defects involving exposed bone, vessels, nerves, or tendons, which cannot be covered by STSG.
Question 2200
Topic: 2. Trauma
A 22-year-old motorcyclist sustains a Gustilo-Anderson Grade IIIb open fracture of the middle third of the tibia. After initial debridement and stabilization with an external fixator, the plastic surgery team is consulted for definitive soft tissue coverage. Based on the reconstructive options discussed in the case, which flap is most appropriate for this specific defect location?
Correct Answer & Explanation
. Soleus rotational flap
Explanation
The case provides specific guidance for flap options based on the location of the tibial defect: 'Middle third tibial defect - Soleus rotational flap'. A Gastrocnemius rotational flap is indicated for proximal third tibial defects. A Latissimus dorsi free flap is typically used for large defects, not specifically for a middle third tibial defect when a local option is available. A Radial forearm free flap is indicated for smaller defects, but the soleus flap is a more direct and often preferred option for middle third tibial defects. A split-thickness skin graft (STSG) is inappropriate for a Grade IIIb fracture with extensive soft tissue loss and exposed bone, as STSG requires a healthy, vascularized wound bed capable of granulation, which is typically not present in such severe injuries.
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