2. Trauma MCQs

A 7-year-old child sustains a Bado Type I Monteggia equivalent lesion. Which of the following best describes the typical bony and ligamentous configuration of this injury?

A 5-year-old sustains a lateral condyle fracture of the humerus. Which of the following radiographic findings serves as an absolute indication for operative intervention (CRPP or ORIF)?

A 13-year-old boy is evaluated for progressive weakness and clawing of his right ring and small fingers over the past two years. He sustained a right elbow fracture at age 4 that was managed non-operatively. Physical examination reveals a significant cubitus valgus deformity. Which of the following pediatric elbow fractures is most strongly associated with this late complication?

A 5-year-old boy presents with an elbow injury. Radiographs reveal a displaced Milch Type II lateral condyle fracture. The surgeon recommends open reduction and internal fixation to prevent long-term sequelae. Which complication is most uniquely associated with nonunion of this specific pediatric fracture pattern?

A 60-year-old male presents with progressive medial knee pain and a noticeable bow-legged appearance. Full-length standing radiographs confirm a mechanical axis deviation of 25 mm medial to the center of the knee. Further analysis of the joint orientation angles reveals an mLDFA (Mechanical Lateral Distal Femoral Angle) of 96° and an MPTA (Medial Proximal Tibial Angle) of 87°. Based on Paley's principles, where is the primary source of the deformity located?

A 28-year-old patient presents with a history of a malunited tibial shaft fracture, now experiencing knee hyperextension and gait instability. A full-length lateral radiograph of the lower limb, as shown in the image, is obtained to assess sagittal plane alignment. The measurements reveal a Posterior Proximal Tibial Angle (PPTA) of 75° and an Anterior Distal Tibial Angle (ADTA) of 80°. Based on these findings and Paley's principles, what is the most likely interpretation?

A 40-year-old patient presents with a distal femoral valgus deformity. Pre-operative planning identifies the CORA within the distal femur, but due to concerns about hardware placement and proximity to the knee joint, the surgeon decides to perform the osteotomy 4 cm proximal to the CORA. However, the external fixator hinge is meticulously placed exactly at the CORA. According to Paley's Three Rules of Osteotomy, what is the expected outcome of this surgical approach?

A surgeon is planning a complex multiplanar deformity correction of the tibia. During the intraoperative phase, the surgeon uses fluoroscopy to verify the mechanical axis. Which of the following intraoperative techniques is explicitly mentioned in the case as an excellent way to verify the intraoperative Mechanical Axis Deviation (MAD)?

A 48-year-old male presents with a symptomatic varus knee deformity. A standardized 51-inch radiograph is obtained, and the following coronal plane measurements are recorded: Mechanical Lateral Distal Femoral Angle (mLDFA) = 88° and Medial Proximal Tibial Angle (MPTA) = 80°. . Based on these findings and Paley's principles, where is the primary source of the deformity located?

A 30-year-old patient presents with chronic knee pain, but no obvious bowing or knock-knee deformity is noted clinically. A standardized 51-inch standing radiograph is obtained. . The overall limb Mechanical Axis Deviation (MAD) is measured at 5 mm medial to the center of the knee (within normal physiological range). However, individual joint orientation angles reveal an mLDFA of 85° and an MPTA of 92°. What is the most accurate interpretation of these findings according to Paley's principles?

An orthopedic surgeon corrects a tibial malunion. The surgeon places both the osteotomy and the axis of rotation (hinge) proximal to the actual CORA. According to Paley's Osteotomy Rule 3, what effect will this have on the anatomical axis of the tibia?

A 16-year-old male presents with genu varum. A full-length standing radiograph reveals a mechanical axis deviation (MAD) of 45 mm medial to the center of the knee. The mechanical medial proximal tibial angle (mMPTA) is 87 degrees, and the mechanical lateral distal femoral angle (mLDFA) is 98 degrees. What is the primary source of the deformity?

When planning a lengthening over a nail (LON) for a 20-year-old male with a 5 cm post-traumatic femoral discrepancy, what is the primary advantage of this technique compared to classic external fixation lengthening?

A patient is undergoing distraction osteogenesis for a tibial defect. The distraction rate is set at 2.0 mm per day (0.5 mm every 6 hours). At the 4-week follow-up, radiographs show a radiolucent gap at the distraction site with poor regenerate bone formation. What is the most appropriate next step in management?

A 15-year-old male undergoes radiographic evaluation for symptomatic genu valgum. The mechanical lateral distal femoral angle (mLDFA) is measured at 80 degrees, and the mechanical medial proximal tibial angle (mMPTA) is measured at 87 degrees. What is the interpretation of these joint orientation angles?

A radiograph of a malunited tibial shaft fracture shows a 20-degree varus deformity on the AP view and a 15-degree procurvatum deformity on the lateral view. According to deformity planning principles, how is this complex angular deformity best conceptualized?

The 'lengthening over a nail' (LON) technique combines a classic intramedullary nail with an external fixator. What is the primary clinical advantage of this technique compared to standard Ilizarov lengthening alone?

A supracondylar femur fracture malunion is being corrected. The osteotomy and the axis of rotation are both intentionally placed proximal to the actual CORA. What is the expected outcome after angular correction?

A 45-year-old patient presents with severe varus deformity of the knee. The standing radiograph reveals a mechanical axis deviation (MAD) of 45 mm medially. The Joint Line Convergence Angle (JLCA) is measured at 8 degrees (apex lateral). What does this elevated JLCA most likely indicate?