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2. Trauma MCQs

Practice Set 155 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 3081

Topic: 2. Trauma

A 25-year-old patient presents with a severe valgus deformity of the proximal femur, characterized by a Lateral Proximal Femoral Angle (LPFA) of 75°. The surgeon plans a varus osteotomy to correct this. Which type of hardware is specifically highlighted in the text as providing unparalleled fixed-angle stability and resistance to bending for such periarticular deformities of the proximal femur?

. A standard locking compression plate (LCP).
. A dynamic hip screw (DHS).
. A blade plate.
. An intramedullary nail.
. A tension band plate.

Correct Answer & Explanation

. A blade plate.

Explanation

Correct Answer: CThe text specifically addresses the challenges of periarticular deformities, particularly in the proximal femur, due to massive bending forces. It states: 'The solid, one-piece chisel blade of theblade plateis driven deep into the metaphyseal bone, providing unparalleled fixed-angle stability of the proximal fragment. The massive cross-sectional area of the blade plate provides far greater resistance to bending and varus/valgus collapse than multiple individual screws.' The example provided in the text for a proximal femoral deformity (varus deformity with LPFA of 130° requiring valgus osteotomy) also mentions using a 120° angled blade plate.Options A (LCP) and B (DHS) are common implants but are not described as providing 'unparalleled fixed-angle stability' in the same context as blade plates for these specific high-bending force periarticular corrections. Option D (intramedullary nail) is typically for diaphyseal fractures or specific types of proximal femoral fractures, not primarily for angular deformity correction in this manner. Option E (tension band plate) is not a recognized specialized plate type for this specific application.

Question 3082

Topic: 2. Trauma

A surgeon is planning an opening wedge osteotomy for a patient with a distal femoral procurvatum deformity. The osteotomy is planned at the CORA. To optimize healing and prevent complications, which of the following strategies is most appropriate for managing the bone defect created by the opening wedge?

. A. Rely solely on the intact periosteum on the concave side for spontaneous healing, regardless of gap size.
. B. Perform an acute correction and avoid any bone grafting to minimize surgical time.
. C. Strongly consider bone grafting, especially with large gaps or in adult patients, using autogenous cancellous or structural grafts.
. D. Utilize a power saw for the osteotomy without irrigation to promote thermal osteogenesis.
. E. Intentionally create an angulation-translation (a-t) correction at the CORA to increase bone contact.

Correct Answer & Explanation

. C. Strongly consider bone grafting, especially with large gaps or in adult patients, using autogenous cancellous or structural grafts.

Explanation

Correct Answer: CThe case highlights that a primary challenge of the opening wedge osteotomy is the inherent risk of bone healing problems due to limited bone contact across the opening defect, potentially leading to nonunion. To prevent this, 'bone grafting should be strongly considered, especially when operating in diaphyseal regions or in adult patients with slower osteogenic potential.' Morcelled autogenous cancellous bone graft is preferred, and for large gaps requiring structural support, a tricortical iliac crest or fibular strut graft is recommended. Intramedullary reamings are also noted as an excellent source of graft.Option Ais incorrect. While periosteal integrity is important, relying solely on it for spontaneous healing is generally only successful with smaller opening wedge corrections, and not for large gaps or in adults.Option Bis incorrect. Acute correction of large deformities can stretch soft tissues and neurovascular structures, and avoiding bone grafting in opening wedges, especially in adults or large gaps, increases the risk of nonunion.Option Dis incorrect. The case explicitly warns that 'extreme care needs to be taken with copious irrigation to not thermally necrose (burn) the bone ends, which would severely impair healing' when using a power saw.Option Eis incorrect. The case states that if an a-t correction is performed exactly at the level of the CORA, an unwanted secondary translation deformity will result (violating Rule One). An a-t correction is typically chosen when the osteotomy is made at a level different from the CORA (Paley's Rule Two) to purposely improve bone contact, not when the osteotomy is at the CORA.

Question 3083

Topic: 2. Trauma

A surgeon performs a fixator-assisted nailing (FAN) of a severe distal femur deformity. Which of the following accurately describes the primary benefit of utilizing an external fixator during this technique?

. It is left in place for 3 months to provide long-term weight-bearing stability
. It perfectly maintains alignment during sequential reaming and nail insertion
. It gradually distracts the fracture postoperatively to stimulate endosteal healing
. It avoids the need for a femoral osteotomy entirely
. It replaces the need for distal interlocking screws

Correct Answer & Explanation

. It perfectly maintains alignment during sequential reaming and nail insertion

Explanation

Fixator-assisted nailing uses a temporary external fixator to acutely correct the deformity and maintain strict alignment. This allows the surgeon to safely ream the canal and insert the intramedullary nail without losing the correction.

Question 3084

Topic: Lower Extremity Trauma

A 45-year-old female presents with severe genu varum. Standing long-leg radiographs demonstrate a mechanical axis deviation (MAD) passing 30 mm medial to the knee center. The mechanical lateral distal femoral angle (mLDFA) is 88° and the medial proximal tibial angle (MPTA) is 87°. The joint line congruency angle (JLCA) is 7° (medial opening). What is the primary source of her varus deformity?

. Femoral diaphyseal bowing
. Proximal tibial metaphyseal varus
. Lateral compartment cartilage loss or lateral collateral ligament laxity
. Medial collateral ligament laxity
. Medial compartment cartilage loss or lateral collateral ligament laxity

Correct Answer & Explanation

. Lateral compartment cartilage loss or lateral collateral ligament laxity

Explanation

Normal mLDFA (85-90°) and MPTA (85-90°) exclude osseous deformities of the distal femur and proximal tibia. An abnormally high JLCA (>2°) in a varus knee suggests an intra-articular deformity, such as medial compartment cartilage loss or lateral collateral ligament laxity causing medial joint line opening.

Question 3085

Topic: 2. Trauma

When planning an Ilizarov frame application for tibial lengthening, stabilization of the distal tibiofibular joint is routinely recommended. What is the primary complication this step is intended to prevent?

. Fibular nonunion
. Equinus contracture of the ankle
. Proximal migration of the lateral malleolus and ankle valgus
. Anterior compartment syndrome
. Peroneal nerve palsy

Correct Answer & Explanation

. Proximal migration of the lateral malleolus and ankle valgus

Explanation

During tibial lengthening, soft tissue tension (especially from muscles attaching to the fibula) can cause the distal fibula to migrate proximally if the syndesmosis is not stabilized. This proximal migration leads to a secondary valgus deformity of the ankle joint.

Question 3086

Topic: 2. Trauma

A surgeon decides to use the Lengthening Over a Nail (LON) technique for a 25-year-old male requiring 5 cm of femoral lengthening. What is the principal advantage of this technique compared to classic external fixation lengthening?

. It eliminates the need for an external fixator completely.
. It allows for earlier weight-bearing during the distraction phase.
. It significantly reduces the time the external fixator must remain on the patient.
. It promotes faster endochondral ossification.
. It eliminates the risk of deep infection entirely.

Correct Answer & Explanation

. It significantly reduces the time the external fixator must remain on the patient.

Explanation

The primary advantage of LON is that once the desired length is achieved via the external fixator, the intramedullary nail is locked, allowing immediate removal of the external frame during the consolidation phase, greatly improving patient comfort.

Question 3087

Topic: Lower Extremity Trauma

A 50-year-old male with symptomatic knee osteoarthritis has a Mechanical Lateral Distal Femoral Angle (mLDFA) of 95° and a normal Medial Proximal Tibial Angle (MPTA) of 87°. The mechanical axis deviation (MAD) is lateral. What is the correct description of the primary deformity?

. Distal femoral valgus
. Distal femoral varus
. Proximal tibial valgus
. Proximal tibial varus
. Intra-articular varus

Correct Answer & Explanation

. Distal femoral varus

Explanation

Normal mLDFA is 85-90°. An mLDFA > 90° indicates a distal femoral varus deformity. Since the angle is measured on the lateral side, an angle greater than 90° means the distal femur is pointing medially (varus).

Question 3088

Topic: Lower Extremity Trauma

A patient with severe varus deformity of the knee presents with a Mechanical Axis Deviation (MAD) of 45 mm medial. The MPTA is 87 degrees, and the mLDFA is 88 degrees. The Joint Line Convergence Angle (JLCA) is measured at 8 degrees (apex lateral). What is the primary source of the varus deformity?

. Femoral shaft bowing
. Proximal tibial structural varus
. Intra-articular joint space narrowing and/or ligamentous laxity
. Distal tibial deformity
. Rotational malalignment of the femur

Correct Answer & Explanation

. Intra-articular joint space narrowing and/or ligamentous laxity

Explanation

The MPTA and mLDFA are within normal limits (average 87 and 88 degrees, respectively), ruling out osseous deformity. A JLCA greater than 2 degrees indicates that the deformity originates within the joint itself, such as from cartilage loss or ligamentous laxity.

Question 3089

Topic: Lower Extremity Trauma

A surgeon is evaluating the sagittal plane alignment of a tibia prior to deformity correction. What is the normal average Posterior Proximal Tibial Angle (PPTA), and what does it represent regarding the tibial plateau?

. 90 degrees, representing a perfectly orthogonal plateau.
. 81 degrees, representing approximately 9 degrees of posterior slope.
. 88 degrees, representing approximately 2 degrees of posterior slope.
. 75 degrees, representing approximately 15 degrees of posterior slope.
. 95 degrees, representing 5 degrees of anterior slope.

Correct Answer & Explanation

. 81 degrees, representing approximately 9 degrees of posterior slope.

Explanation

The normal average PPTA is 81 degrees. Since 90 degrees would be perfectly perpendicular to the anatomic axis, an 81-degree PPTA correlates with a normal 9-degree posterior slope of the tibial plateau.

Question 3090

Topic: Lower Extremity Trauma

A 45-year-old male presents with a valgus knee deformity. Standing long-leg radiographs demonstrate a mechanical axis deviation (MAD) lateral to the center of the knee. The Mechanical Lateral Distal Femoral Angle (mLDFA) is 81° and the Medial Proximal Tibial Angle (MPTA) is 88°. What is the primary anatomical source of the deformity?

. Proximal tibia
. Distal femur
. Intra-articular joint line convergence
. Combined femoral and tibial deformities
. Ligamentous laxity of the medial collateral ligament

Correct Answer & Explanation

. Distal femur

Explanation

Normal mLDFA is 87°-90° and normal MPTA is 85°-90°. An mLDFA of 81° is abnormally low, indicating a valgus deformity of the distal femur, while the tibia (MPTA) is normal.

Question 3091

Topic: Upper Extremity Trauma
A 25-year-old male presents to the emergency department after a direct fall onto the superior aspect of his right shoulder during a rugby match. He reports immediate severe pain and inability to lift his arm. On examination, there is marked superior displacement of the distal clavicle, significant tenting of the skin, and a palpable gap between the clavicle and acromion. The deltoid and trapezius muscles appear extensively stripped from the distal clavicle. Based on the clinical presentation and the provided image, which Rockwood classification best describes this injury?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type V

Explanation

The patient's presentation, including a direct fall, marked superior displacement of the distal clavicle, significant skin tenting, and extensive stripping of the deltoid and trapezius muscles, is characteristic of a Rockwood Type V AC joint separation. Type V represents a severe injury with complete tears of AC and CC ligaments, marked superior displacement of the clavicle (typically >100% of its height), and extensive stripping of the deltoid and trapezius from the distal clavicle.

Question 3092

Topic: Upper Extremity Trauma
A 40-year-old male presents with a painful right shoulder after falling directly onto his acromion. Radiographs reveal complete tears of both the acromioclavicular (AC) and coracoclavicular (CC) ligaments. The distal clavicle is superiorly displaced by approximately 75% of its height relative to the acromion, but an axillary lateral view confirms it remains within the sagittal contour of the acromion. The deltoid and trapezius muscle attachments appear largely intact. Which Rockwood classification best describes this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type III

Explanation

The description of complete tears of both AC and CC ligaments, with the clavicle superiorly displaced by 25% to 100% of its height and remaining within the sagittal contour of the acromion, is the classic definition of a Rockwood Type III AC joint separation.

Question 3093

Topic: Upper Extremity Trauma

A surgeon is performing an AC joint reconstruction using a suture-button system for coracoclavicular ligament reconstruction, as shown in the intraoperative image below. After achieving anatomical reduction of the clavicle, the sutures are tensioned and secured. What is the primary biomechanical principle by which this suture-button construct provides vertical stability to the AC joint?

. It directly repairs the torn acromioclavicular ligaments.
. It provides rigid bony fixation between the clavicle and acromion.
. It compresses the AC joint articular surfaces, promoting fusion.
. It approximates the clavicle to the coracoid process, functionally replacing the CC ligaments.
. It acts as a scaffold for the coracoacromial ligament transfer.

Correct Answer & Explanation

. It approximates the clavicle to the coracoid process, functionally replacing the CC ligaments.

Explanation

Correct Answer: DThe suture-button system for coracoclavicular (CC) ligament reconstruction works by passing strong suture tapes through tunnels drilled in the clavicle and coracoid. When tensioned, these sutures pull the clavicle inferiorly towards the coracoid process, thereby approximating the two structures and functionally replacing the torn CC ligaments. This restores vertical stability to the AC joint.Option A:While AC joint capsular repair may be performed concurrently, the suture-button construct itself is primarily for CC ligament reconstruction and vertical stability, not direct AC ligament repair.Option B:Suture-button systems provide dynamic stability, allowing for some micromotion, rather than rigid bony fixation between the clavicle and acromion. Rigid fixation between the clavicle and acromion alone has largely been abandoned due to high failure rates.Option C:The goal is to restore the normal anatomical relationship and stability, not to compress the articular surfaces for fusion. Fusion is not a desired outcome for acute AC joint reconstruction.Option E:While some historical techniques (e.g., Weaver-Dunn) involved coracoacromial ligament transfer, the suture-button system is a distinct method for CC ligament reconstruction and does not primarily act as a scaffold for other ligament transfers.

Question 3094

Topic: 2. Trauma

A 35-year-old male underwent surgical repair for a Rockwood Type V AC joint separation. A post-operative radiograph is provided below.

Based on the radiograph, which of the following statements best describes the primary fixation method used and its main purpose?

. A clavicle hook plate, primarily providing rigid horizontal stability.
. K-wires across the AC joint, primarily providing temporary vertical stability.
. A suture-button construct, primarily reconstructing the coracoclavicular ligaments for vertical stability.
. An AC joint plate, primarily providing direct AC joint compression.
. A tension band wiring technique, primarily stabilizing the acromion to the clavicle.

Correct Answer & Explanation

. A suture-button construct, primarily reconstructing the coracoclavicular ligaments for vertical stability.

Explanation

Correct Answer: CThe post-operative radiograph clearly shows a suture-button construct, characterized by small cortical buttons on the superior aspect of the clavicle and inferior aspect of the coracoid, connected by suture material (not directly visible but implied by the buttons). As detailed in the case, suture-button systems are increasingly popular for coracoclavicular (CC) ligament reconstruction, providing dynamic vertical stability by approximating the clavicle to the coracoid.Option A:A clavicle hook plate would appear as a plate with a hook extending under the acromion, which is not seen here. While it provides some stability, it's associated with higher irritation rates.Option B:K-wires would appear as thin metallic pins crossing the joint, which are absent in this image. K-wires are generally associated with high rates of migration and infection.Option D:An AC joint plate would be positioned directly over the AC joint, typically with screws into both the clavicle and acromion, which is not the primary construct shown.Option E:Tension band wiring is typically used for fractures, not primary ligamentous reconstruction of the AC joint in this manner.

Question 3095

Topic: Upper Extremity Trauma
A 35-year-old mountain biker falls off his bike and sustains a shoulder injury. Examination reveals a painful, non-reducible distal clavicle that is impaled posteriorly into the trapezius fascia. According to the Rockwood classification, what type of injury is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type IV

Explanation

A Rockwood Type IV AC joint injury involves posterior displacement of the distal clavicle into or through the trapezius fascia. It generally requires surgical reduction due to the irreducible nature of the clavicle.

Question 3096

Topic: 2. Trauma
A 40-year-old male sustains a severe shoulder trauma in a high-speed collision. Clinical examination shows a flattened shoulder contour, and radiographs demonstrate the distal clavicle is positioned inferior to the coracoid process, posterior to the conjoined tendon. Which Rockwood classification type is this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type VI

Explanation

A Rockwood Type VI injury involves inferior dislocation of the distal clavicle to a subcoracoid or subacromial position. This high-energy injury requires surgical reduction.

Question 3097

Topic: Upper Extremity Trauma

The classic Weaver-Dunn procedure for chronic AC joint instability involves resection of the distal clavicle and transfer of which ligament to the distal clavicle?

. Coracohumeral ligament
. Superior acromioclavicular ligament
. Coracoacromial (CA) ligament
. Conoid ligament
. Trapezoid ligament

Correct Answer & Explanation

. Coracoacromial (CA) ligament

Explanation

The Weaver-Dunn procedure transfers the coracoacromial (CA) ligament from its acromial attachment to the resected end of the distal clavicle. It is often augmented because the CA ligament is weaker than native CC ligaments.

Question 3098

Topic: Upper Extremity Trauma

A 28-year-old professional hockey player undergoes coracoclavicular (CC) ligament reconstruction for a chronic Type V acromioclavicular (AC) joint separation. To anatomically recreate the CC ligaments, the surgeon must place drill holes in the clavicle. Which of the following best describes the anatomic location of the conoid and trapezoid ligaments?

. Conoid is anterolateral, 4.5 cm from the distal clavicle; Trapezoid is posteromedial, 3.0 cm from the distal clavicle.
. Conoid is posteromedial, 4.5 cm from the distal clavicle; Trapezoid is anterolateral, 3.0 cm from the distal clavicle.
. Conoid is anterolateral, 3.0 cm from the distal clavicle; Trapezoid is posteromedial, 4.5 cm from the distal clavicle.
. Conoid is posteromedial, 3.0 cm from the distal clavicle; Trapezoid is anterolateral, 4.5 cm from the distal clavicle.
. Conoid and trapezoid both originate 4.5 cm from the distal clavicle in a single bundled footprint.

Correct Answer & Explanation

. Conoid is posteromedial, 4.5 cm from the distal clavicle; Trapezoid is anterolateral, 3.0 cm from the distal clavicle.

Explanation

The conoid ligament inserts posteromedially on the clavicle approximately 4.5 cm from the distal end. The trapezoid ligament inserts anterolaterally approximately 3.0 cm from the distal end.

Question 3099

Topic: Upper Extremity Trauma
A 45-year-old male falls directly on his shoulder and presents with intense pain. The axillary lateral radiograph reveals that the distal clavicle is displaced posteriorly into the trapezius muscle. Which Rockwood classification type is this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type IV

Explanation

A Rockwood Type IV AC joint separation is characterized by posterior displacement of the distal clavicle into or through the trapezius muscle fascia. This injury requires operative intervention.

Question 3100

Topic: 2. Trauma

A surgeon is repairing an acute AC joint separation using a suspensory cortical button construct placed through the clavicle and coracoid. Postoperatively, the patient experiences a sudden loss of reduction and anterior shoulder pain. Which of the following is the most common hardware-related mode of failure for this specific technique?

. Clavicular fracture
. Coracoid fracture
. Suture breakage
. Button migration through the clavicle
. Acromion fracture

Correct Answer & Explanation

. Coracoid fracture

Explanation

Coracoid fracture is a well-documented complication of suspensory fixation techniques. It is often related to eccentric drill hole placement, repetitive micro-motion, or using too large of a drill bit in the coracoid.

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