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2. Trauma MCQs

Practice Set 17 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 321

Topic: 2. Trauma

A 9-year-old boy sustains a pathologic fracture through a centrally located, expansile radiolucent lesion in the proximal humerus. Radiographs show a "fallen leaf" sign. After the fracture has healed, the lesion remains active and expansive. What is the most appropriate initial minimally invasive management?

. En bloc resection with allograft reconstruction
. Aspiration and intralesional corticosteroid injection
. Wide surgical margin excision
. Radiation therapy
. Prophylactic intramedullary nailing

Correct Answer & Explanation

. Aspiration and intralesional corticosteroid injection

Explanation

The "fallen leaf" sign is pathognomonic for a unicameral bone cyst (UBC). After allowing the fracture to heal, active UBCs are typically treated initially with aspiration and intralesional injection of corticosteroids or bone marrow aspirate.

Question 322

Topic: 2. Trauma

A 2-year-old girl refuses to bear weight on her right leg after tripping over a toy. Initial radiographs of the tibia and fibula are interpreted as normal. A bone scan demonstrates diffusely increased uptake in the distal third of the right tibia. What is the most likely diagnosis?

. Acute hematogenous osteomyelitis
. Non-accidental trauma
. Leukemia
. Toddler's fracture
. Transient synovitis

Correct Answer & Explanation

. Toddler's fracture

Explanation

A toddler's fracture is a subtle, nondisplaced spiral fracture of the distal tibia common in children aged 9 months to 3 years. Initial radiographs may appear normal, and treatment consists of simple immobilization.

Question 323

Topic: 2. Trauma

A 5-year-old boy sustains a lateral condyle fracture of the humerus. Which of the following long-term complications is most frequently associated with nonunion of this specific fracture pattern due to inadequate initial treatment?

. Progressive cubitus varus
. Progressive cubitus valgus and tardy ulnar nerve palsy
. Myositis ossificans of the brachialis
. Volkmann ischemic contracture
. Anterior interosseous nerve palsy

Correct Answer & Explanation

. Progressive cubitus valgus and tardy ulnar nerve palsy

Explanation

Lateral condyle fractures are intra-articular and highly prone to nonunion if displaced due to the pull of the extensor muscles and synovial fluid bathing the fracture. Nonunion typically leads to a progressive cubitus valgus deformity, which can subsequently cause tardy ulnar nerve palsy.

Question 324

Topic: Lower Extremity Trauma
A 4-year-old obese girl presents with severe, progressive bilateral genu varum. Radiographs show marked depression of the medial tibial plateau and a prominent medial metaphyseal beak. Given her age and progressive deformity (Langenskiöld stage III), what is the most appropriate surgical intervention?
. Medial distal femoral hemiepiphysiodesis
. Proximal tibial valgus osteotomy
. Observation with physical therapy
. Unilateral hinged knee brace
. Lateral tibial hemiepiphysiodesis

Correct Answer & Explanation

. Proximal tibial valgus osteotomy

Explanation

Infantile Blount disease in children older than 3 years with severe or progressive deformity (Langenskiöld stage III or higher) generally requires surgical correction. A proximal tibial valgus osteotomy is the gold standard to restore normal mechanical axis and relieve pressure on the medial physis.

Question 325

Topic: Pelvic & Acetabular Trauma

Which of the following iliac osteotomies provides the greatest freedom of mobilization of the acetabular segment:

. Salter osteotomy
. Pemberton osteotomy
. Steel osteotomy
. Chiari osteotomy
. Ganz osteotomy

Correct Answer & Explanation

. Ganz osteotomy

Explanation

Osteotomies that are made closest to the acetabulum provide the greatest freedom of mobilization. Of the choices provided, the Ganz or Bernese osteotomy is made closest to the acetabulum.

Question 326

Topic: Pelvic & Acetabular Trauma

The acetabular sourcil is best described as:

. The lateral articular border
. The teardrop
. The acetabular angle
. A degenerative osteophyte
. A cyst forming in hip dysplasia

Correct Answer & Explanation

. The lateral articular border

Explanation

The acetabular sourcil is a lateral articular border, which normally should be downsloping and below the dome of the acetabulum. In dysplastic hips, the femoral head pushes the acetabular sourcil up and gives it an upsloping shape.

Question 327

Topic: 2. Trauma

The greatest number of malpractice suits in pediatric orthopedics relates to which diagnosis:

. Fractures
. C ompartment syndromes
. Spinal deformities
. Tumors
. C ongenital anomalies

Correct Answer & Explanation

. Fractures

Explanation

The largest number of malpractice claims in pediatric orthopedics relates to fractures. This diagnosis accounts for 77% of all claims, in contrast to 57% for adults. However, the mean amount paid for each claim is lower than other diagnostic groups. Orthopedic surgeons should be aware of the issue when taking care of children with fractures.

Question 328

Topic: 2. Trauma

For a given femur fracture pattern and age, which method of treatment causes the longest time to union in children ages 6 to 12 years:

. Traction and cast
. Immediate hip spica
. External fixation
. Flexible nails
. Rigid nails

Correct Answer & Explanation

. External fixation

Explanation

External fixation produces the longest times to healing, presumably because of load-shielding. The fracture ends may also be distracted.

Question 329

Topic: 2. Trauma
According to the Bado classification, a Monteggia lesion consisting of a diaphyseal fracture of the ulna with posterior dislocation of the radial head is classified as:
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

Bado Type II Monteggia fractures are characterized by posterior or posterolateral dislocation of the radial head with an associated ulnar diaphyseal fracture. They are most commonly seen in adults.

Question 330

Topic: 2. Trauma

A 5-year-old sustains a lateral condyle fracture of the humerus. Which of the following complications is most highly associated with nonunion of this specific fracture?

. Cubitus varus
. Tardy ulnar nerve palsy
. Volkmann's ischemic contracture
. Anterior interosseous nerve palsy
. Avascular necrosis of the trochlea

Correct Answer & Explanation

. Tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle fracture leads to progressive cubitus valgus deformity. This increasing valgus stretches the ulnar nerve over time, leading to tardy ulnar nerve palsy years after the initial injury.

Question 331

Topic: 2. Trauma

An Essex-Lopresti fracture-dislocation is characterized by a radial head fracture, distal radioulnar joint (DRUJ) dislocation, and disruption of which of the following structures?

. Triangular fibrocartilage complex (TFCC) only
. Interosseous membrane
. Annular ligament
. Lateral collateral ligament of the elbow
. Biceps tendon

Correct Answer & Explanation

. Interosseous membrane

Explanation

An Essex-Lopresti injury is defined by a radial head fracture accompanied by disruption of the DRUJ and the interosseous membrane. This longitudinal instability requires radial head restoration to prevent proximal radial migration and chronic wrist pain.

Question 332

Topic: 2. Trauma
A pediatric patient sustains a Bado Type III Monteggia fracture-dislocation. What is the direction of the radial head dislocation in this specific injury pattern?
. Anterior
. Posterior
. Lateral
. Divergent
. Medial

Correct Answer & Explanation

. Lateral

Explanation

The Bado classification describes Monteggia fracture-dislocations based on the direction of radial head dislocation. A Type III injury features a lateral or anterolateral dislocation of the radial head along with a proximal ulnar metaphyseal fracture.

Question 333

Topic: 2. Trauma

According to the O'Driscoll classification, an anteromedial facet fracture of the coronoid is most commonly associated with which mechanism of injury?

. Varus posteromedial rotatory instability
. Valgus posterolateral rotatory instability
. Terrible triad mechanism
. Anterior olecranon fracture-dislocation
. Direct axial loading of the humerus

Correct Answer & Explanation

. Varus posteromedial rotatory instability

Explanation

Anteromedial facet fractures of the coronoid occur due to a varus posteromedial rotatory instability mechanism. This typically injures the LCL and causes the anteromedial coronoid facet to impact the medial trochlea.

Question 334

Topic: 2. Trauma

What is the most common complication following an intra-articular chevron olecranon osteotomy utilized for exposure in distal humerus fracture fixation?

. Ulnar nerve palsy
. Triceps rupture
. Symptomatic hardware requiring removal
. Nonunion of the osteotomy
. Heterotopic ossification

Correct Answer & Explanation

. Symptomatic hardware requiring removal

Explanation

The most frequent complication of an olecranon osteotomy is symptomatic hardware (typically tension band wire or prominent screws) at the proximal ulna, which often necessitates hardware removal once the osteotomy has healed.

Question 335

Topic: 2. Trauma
A coronal shear fracture of the distal humerus that extends medially to include the trochlea is classified as which type in the McKee modification of the Bryan and Morrey classification?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type IV

Explanation

McKee modified the Bryan and Morrey classification of capitellar fractures by adding Type IV, which is a coronal shear fracture that involves both the capitellum and the trochlea. It often requires extensile surgical exposure for anatomical fixation.

Question 336

Topic: 2. Trauma

Which of the following fracture types are most prone to nonunion or refracture in patients with osteogenesis imperfecta:

. Supracondylar humeral fractures
. Olecranon apophysis fractures
. Supracondylar femur fractures
. Tibial fractures
. C alcaneal fractures

Correct Answer & Explanation

. Olecranon apophysis fractures

Explanation

Unless they are internally fixed, olecranon fractures are notoriously prone to nonunion or refracture in patients with osteogenesis imperfecta. The remaining fractures can be treated nonoperatively with cast immobilization.

Question 337

Topic: 2. Trauma

Which of the following features differentiates a grade 2 open fracture from a grade 1 open fracture:

. Laceration larger than 1 mm
. Laceration larger than 1 cm
. Laceration larger than 1 in
. Associated neurologic injury
. Associated vascular injury

Correct Answer & Explanation

. Laceration larger than 1 cm

Explanation

A grade 2 open fracture is distinguished from a grade 1 open fracture by a laceration larger than 1 cm. Grade 3 open fractures are characterized by massive soft tissue damage, circulatory compromise, severe contamination, or marked instability. Grade 3A open fracture characteristics include extensive soft tissue lacerations but adequate skin to cover the bone. Grade 3B fractures show extensive soft tissue loss. Grade 3C open fractures demonstrate arterial injury and require repair.

Question 338

Topic: 2. Trauma

Which of the following features differentiates a grade 3B open fracture from a grade 3C open fracture:

. Presence of neurologic injury
. Presence of vascular injury requiring repair
. Presence of vascular injury not requiring repair
. Segmental bone loss
. Massive contamination

Correct Answer & Explanation

. Presence of vascular injury requiring repair

Explanation

Grade 3 injuries all have massive soft tissue damage. Grade 3C fractures have vascular injury requiring repair, whereas grade 3B fractures do not have vascular injury or do not require repair. An example of the latter is a severe open fracture of the distal tibia with laceration of the dorsalis pedis artery and a foot that is well perfused through its collaterals.

Question 339

Topic: 2. Trauma
A 6-year-old boy is receiving pharmacologic agents to assist in the reduction of a forearm fracture. Which of the following conditions is not necessary for him to be in 'conscious sedation'?
. His consciousness is fully normal.
. He can open his eyes to command.
. His airway reflexes are maintained.
. He maintains a patent airway.
. His vital signs are stable.

Correct Answer & Explanation

. His consciousness is fully normal.

Explanation

Under conscious sedation, a child must be able to open eyes to command, maintain a patent airway and reflexes, and have stable vital signs. However, consciousness is medically depressed by the drugs.

Question 340

Topic: 2. Trauma

A 10-year-old boy presents with a swollen knee after jumping. He is unable to perform a straight leg raise. Radiographs reveal a high-riding patella and a small fleck of bone at the inferior pole of the patella. What is the most appropriate management?

. Cylinder cast in extension for 4 weeks
. Hinged knee brace and early range of motion
. Open reduction and internal fixation
. Non-weight bearing with crutches for 6 weeks
. Arthroscopic fragment excision

Correct Answer & Explanation

. Open reduction and internal fixation

Explanation

This presentation is classic for a patellar sleeve fracture, representing a significant avulsion of the extensor mechanism in children. Because the cartilaginous component is much larger than the radiographic bony fleck, operative repair is required to restore the extensor mechanism.

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