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2. Trauma MCQs

Practice Set 15 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 281

Topic: 2. Trauma

An 8-year-old girl is treated with titanium elastic nails for a transverse midshaft femur fracture. What is the most commonly reported complication associated with this treatment modality?

. Deep infection
. Nonunion
. Soft tissue irritation at the insertion site
. Avascular necrosis of the femoral head
. Refracture after implant removal

Correct Answer & Explanation

. Soft tissue irritation at the insertion site

Explanation

Soft tissue irritation and pain at the nail insertion site (usually the distal femur) is the most common complication of elastic nailing. It often necessitates premature removal of the implants once union is achieved.

Question 282

Topic: 2. Trauma

A 9-year-old boy sustains a length-unstable subtrochanteric femur fracture. What is the most appropriate surgical intervention to provide stable fixation and minimize complications?

. Flexible intramedullary nailing
. Rigid piriformis-entry intramedullary nailing
. Submuscular bridge plating
. External fixation
. Spica casting

Correct Answer & Explanation

. Submuscular bridge plating

Explanation

Submuscular bridge plating provides excellent stability for length-unstable or proximal/distal third pediatric femur fractures. Flexible nails often fail to maintain length and alignment in subtrochanteric fractures.

Question 283

Topic: 2. Trauma

A 5-year-old boy with a closed head injury (GCS 7) and a closed midshaft femur fracture is brought to the trauma bay. What is the primary advantage of early operative fixation of the femur in this polytraumatized child?

. It eliminates the risk of femoral overgrowth
. It prevents the development of fat embolism syndrome
. It facilitates nursing care and minimizes intracranial pressure spikes
. It allows for an accelerated rate of fracture healing
. It decreases the risk of compartment syndrome

Correct Answer & Explanation

. It facilitates nursing care and minimizes intracranial pressure spikes

Explanation

In pediatric polytrauma with head injury, early stabilization of major long bone fractures reduces pain and systemic stress. This facilitates mobilization, eases nursing care, and prevents spikes in intracranial pressure.

Question 284

Topic: 2. Trauma
Which of the following injury patterns has the highest incidence of avascular necrosis in the pediatric population?
. Delbet Type I (transepiphyseal) fracture
. Delbet Type II (transcervical) fracture
. Delbet Type III (cervicotrochanteric) fracture
. Delbet Type IV (intertrochanteric) fracture
. Isolated greater trochanteric apophyseal avulsion

Correct Answer & Explanation

. Delbet Type I (transepiphyseal) fracture

Explanation

Delbet Type I fractures (transepiphyseal separations) have the highest rate of AVN among pediatric proximal femur fractures, often exceeding 80-90% if associated with dislocation of the epiphysis.

Question 285

Topic: 2. Trauma

A 12-year-old, 80-kg male sustains a transverse midshaft femur fracture. Based on his age and weight, what is the most appropriate fixation strategy?

. Titanium elastic nails (TENs)
. Rigid lateral trochanteric entry intramedullary nail
. Hip spica cast
. Pavlik harness
. External fixation

Correct Answer & Explanation

. Rigid lateral trochanteric entry intramedullary nail

Explanation

This patient exceeds the weight limit (50 kg) and age recommendations for TENs. A rigid intramedullary nail using a lateral trochanteric entry point is the best option to provide stable fixation while minimizing AVN risk.

Question 286

Topic: 2. Trauma

A 3-year-old girl presents with an isolated closed spiral fracture of the femoral diaphysis. There are no signs of non-accidental trauma, and the injury occurred from a twisting fall at a playground. What is the most appropriate initial treatment?

. Submuscular bridge plating
. Flexible intramedullary nailing
. External fixation
. Early spica casting
. Open reduction and internal fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children under the age of 5 (or sometimes 6) with isolated femoral shaft fractures, early spica casting is the gold standard and provides excellent outcomes with low complication rates.

Question 287

Topic: 2. Trauma

An 11-year-old boy presents with a displaced Salter-Harris II fracture of the distal femur following a football tackle. Which of the following complications occurs with the highest frequency following this specific injury?

. Avascular necrosis
. Nonunion
. Compartment syndrome
. Physeal growth arrest
. Deep vein thrombosis

Correct Answer & Explanation

. Physeal growth arrest

Explanation

Distal femoral physeal fractures have an extremely high rate of growth arrest (up to 50%), even when nondisplaced or anatomically reduced. The undulations of the physis make it highly susceptible to damage.

Question 288

Topic: 2. Trauma

A 6-month-old infant is diagnosed with an unstable midshaft femur fracture. Which of the following is the most appropriate treatment option?

. Pavlik harness
. Titanium elastic nails
. Rigid intramedullary nail
. Submuscular plating
. External fixation

Correct Answer & Explanation

. Pavlik harness

Explanation

In infants under 6 months of age, isolated diaphyseal femur fractures are typically well-managed with a Pavlik harness, which provides adequate immobilization for rapid healing and simplifies diapering.

Question 289

Topic: 2. Trauma

An 8-year-old child sustains a highly comminuted midshaft femur fracture resulting from a gunshot wound. Soft tissues are viable but there is a 3 cm open wound laterally. Which of the following is the most appropriate fixation method?

. Immediate spica casting
. External fixation
. Flexible intramedullary nailing
. Rigid trochanteric-entry intramedullary nailing
. Open reduction and standard compression plating

Correct Answer & Explanation

. External fixation

Explanation

In the setting of a highly comminuted (length-unstable) fracture with an open wound (such as a gunshot wound), external fixation provides stable fixation, maintains length, and allows for ongoing wound care.

Question 290

Topic: 2. Trauma

A 10-year-old child treated with a hip spica cast for a femur fracture develops severe abdominal pain, nausea, and vomiting 2 days post-application. What is the most likely diagnosis?

. Appendicitis
. Superior mesenteric artery (SMA) syndrome
. Deep vein thrombosis
. Fat embolism syndrome
. Gastroenteritis

Correct Answer & Explanation

. Superior mesenteric artery (SMA) syndrome

Explanation

Superior mesenteric artery (SMA) syndrome, or cast syndrome, occurs when the third portion of the duodenum is compressed by the SMA following application of a body cast. Treatment involves splitting or adjusting the cast and decompression.

Question 291

Topic: 2. Trauma

A 2-year-old child is brought to the emergency department for refusal to walk. Radiographs show a nondisplaced spiral fracture of the distal third of the tibia. What is the classic mechanism for this injury?

. Direct blow to the anterior tibia
. Hyperextension of the knee
. Torsional force applied to the leg during walking or stumbling
. Crush injury from a heavy object
. Non-accidental trauma

Correct Answer & Explanation

. Torsional force applied to the leg during walking or stumbling

Explanation

This describes a 'toddler's fracture,' which typically occurs from a low-energy twisting or torsional force while learning to walk or stumbling. It is usually a benign, stable injury treated with a short leg cast or boot.

Question 292

Topic: 2. Trauma

A 10-year-old boy weighing 55 kg sustains a transverse midshaft femur fracture. Which of the following is the most significant risk factor for failure if treated with titanium elastic nails (TENs)?

. Age greater than 8 years
. Weight greater than 50 kg
. Midshaft fracture location
. Transverse fracture pattern
. Male sex

Correct Answer & Explanation

. Weight greater than 50 kg

Explanation

Weight over 50 kg (approx 110 lbs) and age over 10 years are associated with significantly higher rates of malunion and implant failure when using flexible intramedullary nails. Rigid fixation or submuscular plating is generally preferred in heavier patients.

Question 293

Topic: 2. Trauma

When treating a diaphyseal femur fracture in a 2-year-old child with an early spica cast, what is the optimal acceptable initial overriding (shortening) to allow for expected growth stimulation?

. 0 cm
. 1.5 to 2 cm
. 3.0 to 4.0 cm
. 4.5 to 5.0 cm
. Greater than 5 cm

Correct Answer & Explanation

. 1.5 to 2 cm

Explanation

In children aged 2 to 10 years, femoral fractures stimulate limb overgrowth due to hyperemia at the physes. An initial overriding of 1.5 to 2 cm is acceptable and optimal to compensate for this expected overgrowth.

Question 294

Topic: 2. Trauma

A 4-year-old girl sustains an injury in a motor vehicle accident. She sustained a femoral artery injury, which was repaired. Her pubic diastasis is 4.5 cm. A radiograph (Slide 1) and clinical photograph (Slide 2) are presented. Which of the following treatment options is recommended:

. Accept deformity; no weight bearing for 6 to 8 weeks
. Spica cast application
. Long leg cast application
. Pelvic sling
. Open reduction internal fixation

Correct Answer & Explanation

. Open reduction internal fixation

Explanation

This is an open-book injury due to direct frontal impact, which presumably also injured the femoral artery directly. A pubic diastasis .2.5 cm should be reduced. Open reduction and internal fixation is the preferred method to accomplish this, using either a wire or a plate. External fixation is also an acceptable option. Casts and sling are more likely to cause pressure sores or to be ineffective.

Question 295

Topic: 2. Trauma

Which of the following factors predicts an increased risk that a child sustaining a pelvis fracture will incur an unstable fracture:

. Whether the triradiate cartilages are open or closed
. C hilds body weight
. C hilds body mass index
. C hilds age
. Presence of associated injuries

Correct Answer & Explanation

. Whether the triradiate cartilages are open or closed

Explanation

The closure of the triradiate cartilage of the acetabulum is associated with a significant increase in the risk of an unstable pelvis fracture, as well as the need for surgical treatment. This seems to signal the change in bone plasticity from pediatric type to adult type.

Question 296

Topic: 2. Trauma

C hildren with unstable pelvis fractures have an increased risk of late pain and dysfunction if which of the following is present:

. Triradiate cartilages are closed
. Pelvic asymmetry >0.6 cm after reduction
. Pelvic asymmetry >1.1 cm after reduction
. Aspica cast is used
. Age is older than 8 years

Correct Answer & Explanation

. Pelvic asymmetry >1.1 cm after reduction

Explanation

Pediatric pelvis fractures are associated with an increased risk of late pain and dysfunction if the asymmetry after reduction is .1.1 cm.

Question 297

Topic: 2. Trauma
According to the Delbet classification, a transphyseal fracture of the pediatric proximal femur is considered type:
. I
. II
. III
. IV
. V

Correct Answer & Explanation

. IV

Explanation

According to the Delbet classification: Type I: Transphyseal fracture; Type II: Transcervical fracture; Type III: Basicervical fracture; Type IV: Intertrochanteric fracture.

Question 298

Topic: 2. Trauma

An 8-year-old boy presents with an asymptomatic bowing of his lower leg. Radiographs reveal a purely intracortical, expansile radiolucent lesion in the anterior diaphysis of the tibia. A biopsy confirms osteofibrous dysplasia. What is the most appropriate initial management?

. Immediate wide resection
. Curettage and bone grafting
. Observation with serial radiographs
. Radiotherapy
. Intramedullary nailing

Correct Answer & Explanation

. Observation with serial radiographs

Explanation

Osteofibrous dysplasia in young children is usually self-limiting and may spontaneously resolve after skeletal maturity; therefore, observation is the initial treatment of choice. Early surgery is associated with a very high recurrence rate and is reserved for severe deformity or impending fracture.

Question 299

Topic: 2. Trauma

An 8-year-old child sustains a mildly displaced pathologic fracture through a proximal humerus unicameral bone cyst. What is the most appropriate initial management?

. Immediate curettage and bone grafting
. Wide resection and fibular strut graft
. Immobilization in a sling to allow fracture healing
. Intralesional steroid injection
. Flexible intramedullary nailing

Correct Answer & Explanation

. Immobilization in a sling to allow fracture healing

Explanation

Pathologic fractures through a UBC should initially be treated non-operatively with simple immobilization (e.g., a sling) until the fracture heals. Interestingly, the cyst may sometimes heal spontaneously as the fracture calluses.

Question 300

Topic: Lower Extremity Trauma

A 12-year-old girl has genu valgum and requests correction. Radiographs reveal 12° valgus of the mechanical axis, with 2° arising in the distal femur and 3° arising in the proximal tibia. No evidence of other disorders are present. Recommended treatment includes:

. Observation
. Knee-ankle-foot orthosis worn at night
. Medial distal femur staple hemiepiphysiodesis
. Lateral opening wedge osteotomy of the distal femur
. Medial closing wedge osteotomy of the proximal tibia

Correct Answer & Explanation

. Medial distal femur staple hemiepiphysiodesis

Explanation

This patient has a significant amount of valgus. Valgus at the knee is evident when signaled by even a low number of degrees. The patient is at an age when medial distal femur staple hemiepiphysiodesis would be the best treatment for genu valgum. Medial distal femur staple hemiepiphysiodesis is a safe and effective procedure and is performed using small incisions, which allow for immediate ambulation.

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