Menu

2. Trauma MCQs

Practice Set 120 of 640

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 2381

Topic: 2. Trauma

When performing an anterolateral approach to the distal tibia for the definitive fixation of a pilon fracture, which nerve is at the highest risk of iatrogenic injury during the superficial dissection?

. Deep peroneal nerve
. Saphenous nerve
. Sural nerve
. Superficial peroneal nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve courses through the anterolateral aspect of the distal leg and crosses the ankle joint. It is at significant risk during the superficial surgical dissection of the anterolateral approach to the distal tibia.

Question 2382

Topic: 2. Trauma

A 25-year-old male sustains a closed, transverse midshaft humerus fracture. Nonoperative management with a functional fracture brace (Sarmiento) is planned. According to established criteria, what is the maximum acceptable coronal plane deformity (varus/valgus) to proceed with bracing?

. 10 degrees
. 20 degrees
. 30 degrees
. 40 degrees
. 50 degrees

Correct Answer & Explanation

. 20 degrees

Explanation

The acceptable parameters for functional bracing of a humeral shaft fracture are less than 20 degrees of anterior bowing, less than 30 degrees of varus/valgus angulation, and less than 3 cm of shortening. Deformities within these limits are generally well-tolerated functionally and cosmetically.

Question 2383

Topic: 2. Trauma

Following open reduction and internal fixation of a distal humerus intra-articular fracture utilizing a Chevron olecranon osteotomy, the patient develops a complication related specifically to the osteotomy site. Which complication is most common?

. Triceps rupture
. Olecranon nonunion
. Symptomatic hardware requiring removal
. Ulnar nerve entrapment at the osteotomy site
. Heterotopic ossification of the olecranon bursa

Correct Answer & Explanation

. Symptomatic hardware requiring removal

Explanation

While olecranon nonunion can occur, the most common complication specifically associated with an olecranon osteotomy is symptomatic hardware (e.g., K-wires or tension band wiring) that often necessitates secondary surgery for hardware removal.

Question 2384

Topic: 2. Trauma

A 55-year-old diabetic male undergoes definitive fixation of a severe open pilon fracture. Two weeks postoperatively, he presents with a 6 cm by 6 cm soft tissue defect over the anteromedial distal third of the tibia with exposed bone and hardware. What is the most reliable method for soft tissue coverage in this region?

. Split-thickness skin graft
. Local soleus muscle flap
. Local gastrocnemius muscle flap
. Free tissue transfer (e.g., anterolateral thigh or latissimus dorsi flap)
. Reverse sural artery flap

Correct Answer & Explanation

. Free tissue transfer (e.g., anterolateral thigh or latissimus dorsi flap)

Explanation

The distal third of the tibia lacks adequate local muscle bulk for rotational flaps. Significant soft tissue defects with exposed bone or hardware in this area typically require free tissue transfer for durable and reliable coverage.

Question 2385

Topic: 2. Trauma

In the surgical treatment of proximal humerus fractures using proximal humeral locking plates, what is the most frequently reported hardware-related complication?

. Plate breakage
. Primary screw back-out
. Intra-articular screw penetration (screw cutout)
. Axillary nerve entrapment by the plate
. Nonunion at the plate-bone interface

Correct Answer & Explanation

. Intra-articular screw penetration (screw cutout)

Explanation

Intra-articular screw penetration, often due to varus collapse of the humeral head or avascular necrosis post-fixation, is the most common hardware-related complication of locked plating in the proximal humerus.

Question 2386

Topic: Lower Extremity Trauma

A meta-analysis comparing intramedullary nailing (IMN) versus dynamic compression plating (DCP) for humeral shaft fractures shows similar rates of union. However, intramedullary nailing is associated with a significantly higher incidence of which complication?

. Radial nerve palsy
. Deep infection
. Shoulder pain and impingement
. Elbow stiffness
. Refracture after hardware removal

Correct Answer & Explanation

. Shoulder pain and impingement

Explanation

Intramedullary nailing of the humerus, particularly with antegrade insertion, is associated with a significantly higher rate of shoulder morbidity, including pain, stiffness, and rotator cuff pathology, compared to plate fixation.

Question 2387

Topic: 2. Trauma

Which of the following scenarios represents an absolute indication for operative internal fixation of an acute humeral shaft fracture?

. Associated primary radial nerve palsy
. Transverse fracture pattern in a 20-year-old
. Brachial artery injury requiring vascular repair
. Fracture angulation of 15 degrees in the coronal plane
. Obesity with a BMI of 35

Correct Answer & Explanation

. Brachial artery injury requiring vascular repair

Explanation

Absolute indications for operative stabilization of a humeral shaft fracture include an associated vascular injury requiring repair, open fractures, floating elbow, and compartment syndrome. Primary radial nerve palsy alone is a relative, not absolute, indication.

Question 2388

Topic: 2. Trauma

A 28-year-old male undergoes successful ORIF of a severe pilon fracture with anatomic restoration of the joint surface. Five years later, he develops symptomatic ankle osteoarthritis. What is the primary etiologic factor for the development of post-traumatic arthritis in this patient?

. Retained intra-articular hardware
. Chronic syndesmotic instability
. Initial articular cartilage damage sustained at the time of impact
. Avascular necrosis of the talar dome
. Subclinical deep infection

Correct Answer & Explanation

. Initial articular cartilage damage sustained at the time of impact

Explanation

Even with perfect anatomic reduction, pilon fractures have a high rate of post-traumatic arthritis. This is primarily due to the irreversible damage sustained by the articular cartilage chondrocytes at the moment of the high-energy axial impact.

Question 2389

Topic: 2. Trauma

According to the principles of parallel plating for distal humerus fractures outlined by O'Driscoll, how should the screws traversing the distal articular fragments be oriented to maximize biomechanical stability?

. They should be placed in a divergent pattern from the medial epicondyle
. They should interdigitate and capture fragments from both sides to create a fixed-angle arch
. They should be inserted perpendicular to the articular surface into the olecranon fossa
. They should only engage the capitellum to avoid the trochlear groove
. They should cross the fracture line and engage the contralateral plate hole

Correct Answer & Explanation

. They should interdigitate and capture fragments from both sides to create a fixed-angle arch

Explanation

O'Driscoll's principles of parallel plating emphasize that the distal screws should interlock or interdigitate, capturing the articular fragments from both the medial and lateral columns to create a robust, stable structural arch.

Question 2390

Topic: 2. Trauma

In the context of a pilon fracture, the 'Volkmann fragment' refers to the posterior malleolar component. This fragment is rigidly attached to the fibula via which ligamentous structure?

. Anterior inferior tibiofibular ligament
. Posterior inferior tibiofibular ligament
. Calcaneofibular ligament
. Superficial deltoid ligament
. Deep transverse fascial band

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament

Explanation

The Volkmann fragment is the posterolateral articular fragment of the tibial plafond. It is strongly attached to the distal fibula by the Posterior Inferior Tibiofibular Ligament (PITFL), often moving in concert with the fibula during reduction.

Question 2391

Topic: 2. Trauma

A 68-year-old female presents with a complex, comminuted intra-articular distal humerus fracture (AO/OTA 13-C3) after a fall. Pre-operative CT scans confirm significant articular involvement and displacement of both medial and lateral columns. The surgical team plans for open reduction and internal fixation (ORIF) via a posterior approach. Given the need for extensive exposure to achieve anatomical reduction and stable fixation, which of the following triceps management techniques is most appropriate and why?

. A. Triceps-splitting approach, as it is the most direct and least invasive.
. B. Bryan-Morrey triceps-sparing approach, reflecting the triceps-periosteal flap laterally for broad exposure while preserving triceps continuity.
. C. Olecranon osteotomy, as it provides the widest exposure of the distal humerus articular surface and trochlea.
. D. A medial paratricipital approach, as it avoids the ulnar nerve and provides good access to the medial column.
. E. A lateral paratricipital approach, as it provides excellent access to the capitellum and radial head.
. F. A medial paratricipital approach, as it avoids the ulnar nerve and provides good access to the medial column.

Correct Answer & Explanation

. C. Olecranon osteotomy, as it provides the widest exposure of the distal humerus articular surface and trochlea.

Explanation

Correct Answer: CExplanation:The case describes a complex, comminuted intra-articular distal humerus fracture (AO/OTA 13-C3) requiring extensive exposure for anatomical reduction and stable fixation. The text explicitly states that the 'Olecranon Osteotomy' provides the 'most extensive access' and 'unparalleled exposure of the distal humerus articular surface and trochlea' for complex distal humerus fractures. This technique allows for direct visualization and reconstruction of the articular surface and both columns.A. Triceps-splitting approach:While direct, the text notes this approach 'can compromise triceps integrity and potentially limit exposure compared to the other methods,' making it less ideal for complex intra-articular fractures requiring extensive visualization.B. Bryan-Morrey triceps-sparing approach:This technique, involving lateral reflection of the triceps-periosteal flap, 'provides excellent visualization of the posterior distal humerus' and preserves triceps continuity. It is a strong option for many distal humerus fractures, but the question emphasizes thewidestexposure for acomplex, comminuted intra-articularfracture, for which the olecranon osteotomy is superior.D. A medial paratricipital approach:This is not a standard posterior approach described in the text for complex distal humerus fractures. The Kocher posterior approach involves managing the triceps and explicitly identifies the ulnar nerve as being at high risk, often requiring transposition.E. A lateral paratricipital approach:This is not a standard posterior approach described in the text for complex distal humerus fractures. Lateral approaches (like Kaplan) are typically for radial head/capitellum.

Question 2392

Topic: 2. Trauma

A 55-year-old male undergoes ORIF of a complex distal humerus fracture via a Kocher posterior approach with an olecranon osteotomy. Post-operatively, he develops a significant elbow flexion contracture despite aggressive physical therapy. After 9 months, with radiographic evidence of fracture healing and HO maturation, he is scheduled for an open capsular release. Which of the following prophylactic measures would have been most appropriate to consider immediately post-operatively to mitigate the risk of heterotopic ossification (HO)?

. A. Early, aggressive passive range of motion beyond the stable arc of fixation.
. B. Administration of high-dose systemic corticosteroids for 6 weeks.
. C. Prophylactic administration of NSAIDs (e.g., Indomethacin) or selective radiation therapy.
. D. Prolonged immobilization in a posterior splint for 8-12 weeks.
. E. Immediate surgical exploration and debridement of any suspected HO formation.

Correct Answer & Explanation

. C. Prophylactic administration of NSAIDs (e.g., Indomethacin) or selective radiation therapy.

Explanation

Correct Answer: CExplanation:The text explicitly lists 'Heterotopic Ossification (HO)' as a potential complication for both approaches, with 'Prophylaxis' including 'NSAIDs (Indomethacin) post-op, radiation therapy (selective cases).' This directly addresses the question of mitigating HO risk immediately post-operatively.A. Early, aggressive passive range of motion beyond the stable arc of fixation:While early controlled motion is crucial for preventing stiffness, 'aggressive' motion, especially beyond the stable arc, can compromise fixation and potentially exacerbate inflammation, which can contribute to HO.B. Administration of high-dose systemic corticosteroids for 6 weeks:Corticosteroids are not a standard prophylactic measure for HO in elbow surgery and carry significant side effects.D. Prolonged immobilization in a posterior splint for 8-12 weeks:Prolonged immobilization is a known risk factor for elbow stiffness and contracture, which the patient already developed, and does not prevent HO. Modern elbow rehabilitation emphasizes early controlled motion.E. Immediate surgical exploration and debridement of any suspected HO formation:Surgical excision of HO is typically performed after maturation (6-12 months post-injury) if it significantly limits motion, not immediately post-operatively for suspected formation.

Question 2393

Topic: 2. Trauma

A 28-year-old male presents with a displaced, unstable radial head fracture (Mason Type II) after a fall onto an outstretched hand. The surgeon plans for ORIF via the Kaplan anterolateral approach. During pre-operative planning, which imaging modality is considered essential for delineating fracture lines, comminution, fragment displacement, and articular involvement, especially for complex intra-articular fractures?

. A. Plain radiographs (AP, lateral, oblique views) only.
. B. Magnetic Resonance Imaging (MRI) only, for soft tissue assessment.
. C. Computed Tomography (CT) scan, often with 3D reconstructions.
. D. Ultrasound, for dynamic assessment of ligamentous stability.
. E. Arthrography, to visualize intra-articular loose bodies.

Correct Answer & Explanation

. C. Computed Tomography (CT) scan, often with 3D reconstructions.

Explanation

Correct Answer: CExplanation:Under 'Pre-Operative Planning & Patient Positioning - General Principles for Elbow Surgery - Imaging,' the text states: 'Computed Tomography (CT) Scan: Essential for complex intra-articular fractures (distal humerus, radial head, capitellum) to delineate fracture lines, comminution, fragment displacement, and articular involvement. 3D reconstructions are invaluable for pre-operative templating and surgical simulation.' This directly supports the use of CT for a displaced radial head fracture.A. Plain radiographs (AP, lateral, oblique views) only:While standard, the text indicates CT is 'essential' forcomplexintra-articular fractures, implying radiographs alone are often insufficient.B. Magnetic Resonance Imaging (MRI) only:The text notes MRI is 'Less common for acute fractures, but useful for assessing ligamentous injuries (e.g., LUCL, UCL) or soft tissue pathology in chronic conditions,' not primarily for acute fracture morphology.D. Ultrasound:Not mentioned as an essential pre-operative imaging modality for fracture assessment in this context.E. Arthrography:Not mentioned as an essential pre-operative imaging modality for fracture assessment in this context.

Question 2394

Topic: 2. Trauma

A 78-year-old female with severe rheumatoid arthritis sustains an intra-articular distal humerus fracture (AO/OTA 13-C3). Which of the following is the most established advantage of total elbow arthroplasty (TEA) over open reduction internal fixation (ORIF) in this specific patient population?

. Lower lifetime rate of implant revision surgery.
. Lower rate of post-operative ulnar nerve palsies.
. Improved early functional outcomes and range of motion.
. Elimination of the lifelong lifting restriction.
. Decreased risk of deep surgical site infection.

Correct Answer & Explanation

. Improved early functional outcomes and range of motion.

Explanation

TEA provides more predictable early range of motion and functional recovery in elderly patients with rheumatoid arthritis compared to ORIF, which carries a high risk of fixation failure in osteoporotic bone. However, TEA imposes permanent lifetime lifting restrictions.

Question 2395

Topic: 2. Trauma

A 45-year-old female sustains an isolated, displaced coronal plane fracture of the lateral femoral condyle (Hoffa fracture). Which of the following fixation strategies provides the most biomechanically stiff construct for this specific fracture pattern?

. Anterior-to-posterior oriented fully threaded cortical screws
. Posterior-to-anterior oriented partially threaded cancellous lag screws
. Lateral-to-medial oriented partially threaded cancellous lag screws
. Anteroposterior sliding hip screw with a derotational pin
. Lateral locked plating without independent lag screws

Correct Answer & Explanation

. Posterior-to-anterior oriented partially threaded cancellous lag screws

Explanation

Hoffa fractures are coronal shear fractures of the femoral condyle. Posterior-to-anterior (PA) oriented lag screws have been shown biomechanically to provide superior stability compared to anterior-to-posterior (AP) screws because they are directed perpendicular to the fracture plane.

Question 2396

Topic: 2. Trauma

A 72-year-old male sustains a severely comminuted olecranon fracture. The surgeon elects to perform fragment excision and triceps advancement. To prevent postoperative elbow instability, what is the maximum percentage of the olecranon that can generally be excised, provided the radial head and collateral ligaments are intact?

. 25 percent
. 50 percent
. 75 percent
. 90 percent
. 100 percent

Correct Answer & Explanation

. 50 percent

Explanation

Up to 50 percent of the proximal olecranon can be safely excised in elderly or low-demand patients with comminuted fractures without compromising stability. This is contingent upon the anterior bundle of the medial collateral ligament and the radial head remaining anatomically intact.

Question 2397

Topic: 2. Trauma

When utilizing a direct posteromedial approach to treat a displaced posteromedial shear fragment of a tibial plateau fracture, the surgeon develops the superficial interval to access the posterior capsule. Which anatomical structures define this interval?

. Lateral head of gastrocnemius and biceps femoris
. Medial head of gastrocnemius and semimembranosus
. Popliteus and soleus
. Tibialis anterior and extensor hallucis longus
. Sartorius and gracilis

Correct Answer & Explanation

. Medial head of gastrocnemius and semimembranosus

Explanation

The posteromedial approach to the tibial plateau typically utilizes the interval between the medial head of the gastrocnemius and the semimembranosus (pes anserinus). Retracting the gastrocnemius laterally and the pes tendons medially provides direct visualization of the posteromedial bone fragment.

Question 2398

Topic: 2. Trauma

A 40-year-old male sustains a high-energy Schatzker IV tibial plateau fracture. Imaging reveals a significant posteromedial metaphyseal and articular fragment that is displaced. Which surgical approach provides the most direct access to place a buttress plate specifically on this posteromedial fragment?

. Anterolateral approach
. Direct Anterior approach
. Posteromedial approach
. Posterolateral approach
. Medial parapatellar approach

Correct Answer & Explanation

. Posteromedial approach

Explanation

The posteromedial approach allows direct visualization and biomechanically optimal buttress plating of the posteromedial fragment in a Schatzker IV fracture. The dissection utilizes the interval between the medial head of the gastrocnemius and the semimembranosus.

Question 2399

Topic: 2. Trauma

A 28-year-old male sustains a high-energy distal femur fracture. CT imaging reveals a coronal plane fracture of the lateral femoral condyle (Hoffa fracture). If evaluating fixation strategies for this specific fracture pattern, which of the following provides the greatest biomechanical stability?

. Anterior-to-posterior positional screws
. Posterior-to-anterior lag screws
. Medial-to-lateral lag screws
. Lateral-to-medial positional screws
. Proximal-to-distal lag screws

Correct Answer & Explanation

. Posterior-to-anterior lag screws

Explanation

Biomechanical studies show that posterior-to-anterior (PA) lag screw placement provides superior stability and a higher load to failure for lateral Hoffa fractures compared to anterior-to-posterior screws. However, PA screws require a more technically demanding posterior exposure.

Question 2400

Topic: 2. Trauma

A 35-year-old male sustains a high-energy injury resulting in a proximal tibia fracture. Clinical exam reveals an intact neurovascular status and no signs of compartment syndrome. What is the most appropriate initial imaging study to fully characterize the fracture pattern and guide surgical planning, especially considering potential articular involvement?

. A. Standard AP and lateral radiographs of the knee only
. B. AP and lateral radiographs of the entire tibia, including knee and ankle
. C. Computed Tomography (CT) scan of the proximal tibia with sagittal and coronal reconstructions
. D. Magnetic Resonance Imaging (MRI) of the knee
. E. Long-leg alignment films

Correct Answer & Explanation

. C. Computed Tomography (CT) scan of the proximal tibia with sagittal and coronal reconstructions

Explanation

Correct Answer: CThe case emphasizes that CT scans areessential for all suspected intra-articular involvement and for complex meta-diaphyseal fractures. CT provides detailed information on fracture morphology, fragment size, comminution, and helps in planning reduction strategies (e.g., identifying blocking screw trajectories, assessing articular step-off). Sagittal and coronal reconstructions are particularly useful. While plain radiographs (Option B) are crucial for initial assessment, they often underestimate the extent of articular involvement and comminution in proximal tibia fractures. MRI (Option D) is excellent for soft tissue injuries (ligaments, menisci) but is not the primary imaging modality for detailed bone fracture morphology in the acute setting. Long-leg alignment films (Option E) are helpful for overall limb alignment but are not typically performed acutely for fracture characterization. Standard AP and lateral radiographs of the knee only (Option A) are insufficient as they do not show the entire tibia or ankle, which is necessary for assessing overall alignment and planning nail length.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page