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2. Trauma MCQs

Practice Set 13 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 241

Topic: 2. Trauma

A 14-year-old boy sustains a distal femur Salter-Harris II fracture following a football tackle. Which of the following is the most common significant complication associated with this specific injury pattern at this location?

. Nonunion
. Growth arrest
. Compartment syndrome
. Avascular necrosis
. Deep vein thrombosis

Correct Answer & Explanation

. Growth arrest

Explanation

Distal femur physeal fractures have a high risk of growth arrest (up to 50%), even in Salter-Harris I and II patterns. This is due to the undulating nature of the distal femoral physis, which leads to severe crushing of the germinal layer during displacement.

Question 242

Topic: 2. Trauma

A 5-year-old child presents with a 'pink, pulseless' hand after a severely displaced extension-type supracondylar humerus fracture. After prompt closed reduction and percutaneous pinning, the hand remains well-perfused (pink) but the radial pulse is still non-palpable. What is the next best step in management?

. Immediate arterial exploration
. Observation and hospital admission
. Release of the pins and re-reduction
. Prophylactic forearm fasciotomy
. CT angiography

Correct Answer & Explanation

. Observation and hospital admission

Explanation

A pink, pulseless hand after adequate closed reduction and pinning indicates sufficient collateral perfusion. The standard of care is close observation, as the pulse often returns spontaneously within a few days.

Question 243

Topic: 2. Trauma

A 5-year-old boy sustains a lateral condyle fracture of the distal humerus. Initial radiographs show 3 mm of displacement.

What is the most appropriate management?

. Long arm cast in supination
. Closed reduction and percutaneous pinning
. Open reduction and internal fixation
. Skeletal traction
. Observation in a sling

Correct Answer & Explanation

. Open reduction and internal fixation

Explanation

Lateral condyle fractures of the humerus with >2 mm of displacement require open reduction and internal fixation. This is essential to ensure anatomic reduction of the articular surface and to minimize risks of nonunion or tardy ulnar nerve palsy.

Question 244

Topic: 2. Trauma

A 13-year-old baseball pitcher presents with acute medial elbow pain after throwing a pitch. Radiographs show an avulsion fracture of the medial epicondyle. What is the primary mechanism of injury?

. Varus stress with extensor traction
. Valgus stress with flexor-pronator mass traction
. Direct posterior blow to the olecranon
. Hyperextension with joint subluxation
. Axial load with rapid supination

Correct Answer & Explanation

. Valgus stress with flexor-pronator mass traction

Explanation

The medial epicondyle is the origin of the flexor-pronator mass and the ulnar collateral ligament. Avulsion fractures typically occur from sudden or repetitive valgus stress combined with intense traction from the flexor-pronator musculature.

Question 245

Topic: 2. Trauma

Which of the following commonly used statements regarding the pelvis in patients with bladder exstrophy is true:

. The forces across the hip joints are increased in patients with bladder exstrophy.
. Athletic ability is significantly compromised in patients with bladder exstrophy.
. Significant limp persists throughout life in patients with bladder exstrophy.
. The pelvis is more vulnerable to fracture in patients with bladder exstrophy.
. Urinary continence is not possible in patients with bladder exstrophy.

Correct Answer & Explanation

. The forces across the hip joints are increased in patients with bladder exstrophy.

Explanation

In patients with bladder exstrophy, computerized modeling shows that the forces across the hip are increased by approximately 30%. However, limp is not significant and the pelvis is not more prone to fracture. Most patients can be made continent through surgery.

Question 246

Topic: Lower Extremity Trauma

Which of the following statements describes the growth plate biomechanics of the distal femur:

. The collateral ligaments protect the distal femur.
. The posterior cruciate ligament protects the distal femur.
. The anterior cruciate ligaments protect the distal femur.
. The patellar ligament protects the distal femur.
. The distal femur is not protected by any ligaments.

Correct Answer & Explanation

. The distal femur is not protected by any ligaments.

Explanation

Whereas the the proximal tibial physis is protected by the collateral ligaments and tibial tubercle epiphysis, the distal femoral physis is vulnerable to injury because it is not protected by any ligaments.

Question 247

Topic: 2. Trauma

A 200-lb 13-year-old boy sustained a fracture while playing football. His radiographs are presented (Slide 1). Which of the following treatments should be attempted first:

. Closed reduction and internal fixation
. Open reduction and screw fixation
. Open reduction and plate fixation
. External fixation
. Arthroscopically assisted reduction and internal fixation

Correct Answer & Explanation

. Closed reduction and internal fixation

Explanation

The radiographs show a Salter II fracture with a large metaphyseal fragment. A high likelihood exists for successful closed reduction, and the metaphyseal fragment should allow rigid fixation. This patient received closed reduction and was internally fixed with three percutaneous 7.3-mm screws (Slide 2). He did not require a cast.

Question 248

Topic: 2. Trauma

An 8-year old girl with fibrous dysplasia fractures her femur (Slide). Which of the following procedures is the best treatment option:

. Femoral traction followed by spica cast
. C urettage, bone graft, and spica cast
. Allograft strut and spica cast
. External fixation
. Hip screw with long side plate

Correct Answer & Explanation

. Hip screw with long side plate

Explanation

This lesion requires mechanical support because it is vulnerable to malunion and further deformity. Bone graft would be rapidly reabsorbed and has no lasting value in this patient. A screw with a long side plate that extends well into normal bone is the best treatment option.

Question 249

Topic: 2. Trauma

A 14-year-old boy sustains an avulsion of the tibial tubercle while playing basketball. The fracture extends vertically into the joint, crossing the proximal tibial articular surface. He is at greatest risk for which of the following complications:

. Peroneal nerve injury
. Tibial nerve injury
. Popliteal artery disruption
. Anterior leg compartment syndrome
. Femoral nerve palsy

Correct Answer & Explanation

. Anterior leg compartment syndrome

Explanation

Fracture of the tibial tubercle has been reported to lead to compartment syndrome, presumably due to bleeding from the geniculate vessels and the exposed bone. This would not be expected from such a proximal fracture, but orthopedic surgeons should be aware of the possible association.

Question 250

Topic: 2. Trauma
A neonate sustains a clavicle fracture during birth. Sclerae are distinctly blue, and radiographs show osteopenia but no severe long bone bowing. By age 2, the child has had minimal fractures and is ambulatory. This presentation best fits which Sillence type of osteogenesis imperfecta?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

Sillence Type I OI is the most common and mildest form, characterized by distinctly blue sclerae, mild-to-moderate bone fragility, normal teeth, and minimal or no long bone deformity. Type II is perinatally lethal, while III is severe and progressively deforming.

Question 251

Topic: Pelvic & Acetabular Trauma



Which of the following statements regarding the pelvic anatomy in patients with classic bladder exstrophy is correct?

. The pubic symphysis is closed but dysplastic
. There is internal rotation of the posterior ilium
. The acetabulum is retroverted
. The pubic rami are internally rotated
. The sacrum is typically completely absent

Correct Answer & Explanation

. The acetabulum is retroverted

Explanation

In classic bladder exstrophy, the anterior pelvic ring is open. The bony pelvis is characterized by external rotation of the posterior ilium, external rotation of the pubic rami, and profound retroversion of the acetabulum, leading to an out-toeing gait.

Question 252

Topic: 2. Trauma

A 10-year-old girl has a projected limb length discrepancy of 3.5 cm at skeletal maturity due to overgrowth following a previous femur fracture. What is the most appropriate treatment option?

. Permanent use of a shoe lift
. Epiphysiodesis of the longer leg at the appropriate skeletal age
. Distraction osteogenesis femoral lengthening of the shorter leg
. Acute femoral shortening osteotomy at skeletal maturity
. Observation until growth is completed

Correct Answer & Explanation

. Epiphysiodesis of the longer leg at the appropriate skeletal age

Explanation

For projected limb length discrepancies between 2 and 5 cm at skeletal maturity, the treatment of choice is typically a timed epiphysiodesis of the longer limb. Discrepancies >5 cm generally require lengthening procedures, while those <2 cm can be managed non-operatively.

Question 253

Topic: 2. Trauma

A 12-year-old boy sustains a distal diaphyseal femur fracture with a large butterfly fragment. He weighs 110 lb. Which of the following treatments is most appropriate and best able to preserve alignment:

. Flexible intramedullary nails
. Immediate hip spica cast
. Submuscular plate fixation
. Retrograde nail
. Traction for 1 week followed by functional cast-brace

Correct Answer & Explanation

. Submuscular plate fixation

Explanation

A large butterfly fragment as well as the age and weight of the patient have been demonstrated to decrease the chances of success in treating children with femur fractures using flexible intramedullary nails. For similar reasons, the fracture is not suitable for an immediate spica or traction followed by functional bracing. The retrograde nail is not indicated due to open physis. Submuscular plate fixation is the best option.C orrect Answer: Submuscular plate fixation

Question 254

Topic: 2. Trauma

Which of the following risks is associated with inserting a rigid femoral intramedullary nail through the piriformis fossa in a 10- to 14-year-old child:

. Obligatory varus deformity at the fracture
. Trochanteric overgrowth
. Avascular necrosis
. C hondrolysis
. Recurvatum

Correct Answer & Explanation

. Avascular necrosis

Explanation

Avascular necrosis is a risk if a nail is inserted through the piriformis fossa in a patient younger than 15 years of age with open physes.

Question 255

Topic: 2. Trauma

Which of the following has not shown a decrease in the success rate of flexible intramedullary nails for femur fractures in children:

. Age older than 10 years
. Weight more than 120 lbs
. Comminution
. Long oblique fracture pattern
. Transverse fracture pattern

Correct Answer & Explanation

. Transverse fracture pattern

Explanation

All of the factors, except for a transverse fracture pattern, have been shown to decrease the chances of success in treating children with femur fractures using flexible intramedullary nails.

Question 256

Topic: Lower Extremity Trauma

Which of the following is the best starting point for inserting a rigid femoral intramedullary nail in a 13-year-old boy:

. Piriformis fossa
. Medial to the tip of the greater trochanter
. Apex of the greater trochanter
. Between the tip and the growth plate of the greater trochanter
. Below the growth plate of the greater trochanter

Correct Answer & Explanation

. Medial to the tip of the greater trochanter

Explanation

Avascular necrosis is a risk if a nail is inserted near the piriformis fossa in a patient younger than 15 years old with open physes. The best way to avoid this risk is to insert the intramedullary nail just lateral to the tip of the greater trochanter.

Question 257

Topic: 2. Trauma

A patient had an elbow fracture that was openly reduced and internally fixed. The radiographs (Slide) from his first postoperative checkup are presented. Which of the following is a correct assessment:

. The fixation is adequate.
. The second pin should have been placed from the medial side.
. The two pins should have diverged in the proximal fragment.
. The pins should have been larger in diameter.
. The pins should have been buried under the skin.

Correct Answer & Explanation

. The two pins should have diverged in the proximal fragment.

Explanation

This patient has a lateral condyle fracture. This type of fracture has a tendency to spread unless adequate compression is maintained. Diverging pins in the proximal fragment is the most widely advocated strategy.

Question 258

Topic: 2. Trauma

Which of the following femur fractures is best treated with flexible intramedullary nails:

. A 12-year-old child, 45 kg, transverse fracture of the midshaft
. An 8-year-old child, 28 kg, midshaft fracture with grade 3 butterfly fragment
. An 8-year-old child, 55 kg, transverse fracture of the midshaft
. An 8-year-old child, 35 kg, oblique fracture 8 cm below the lesser trochanter
. A 4-year-old child, 20 kg, transverse midshaft fracture with 2 cm shortening

Correct Answer & Explanation

. An 8-year-old child, 55 kg, transverse fracture of the midshaft

Explanation

Age older than 10 years, weight greater than 50 kg, and length-unstable fractures are associated with poor results after insertion of flexible intramedullary nails. The subtrochanteric region is defined in children as 10% femur length below the lesser trochanter. Children age 5 and younger are best treated with immediate spica cast.

Question 259

Topic: 2. Trauma
A 17-month-old toddler sustained a femur fracture (Slide) in a fall from a height. Which of the following is the best treatment method:
. Pavlik harness
. Spica cast
. Femoral skeletal traction
. External fixation
. Flexible intramedullary nails

Correct Answer & Explanation

. Spica cast

Explanation

This toddler's fracture shows minimal shortening. Spica cast treatment is ideal for fractures of the femur in children younger than school age because of their portability, overgrowth, remodeling, and lack of implant to remove. A Pavlik harness does not control a child beyond the age of a few months. Femoral skeletal traction, external fixation, and flexible intramedullary nails are more invasive than is warranted.

Question 260

Topic: 2. Trauma

A 2-year-old boy sustains a spiral midshaft femur fracture. He is otherwise healthy and no non-accidental trauma is suspected. What is the most appropriate initial management?

. Pavlik harness
. Spica cast
. Titanium elastic nails
. Submuscular plating
. Rigid intramedullary nail

Correct Answer & Explanation

. Spica cast

Explanation

Early spica casting is the gold standard for isolated femur fractures in children aged 6 months to 5 years. Overgrowth of 1 to 2 cm is expected and shortening up to 2 cm is considered acceptable.

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