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2. Trauma MCQs

Practice Set 19 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 361

Topic: 2. Trauma
A 4-year-old girl is diagnosed with infantile Blount disease, classified as Langenskiöld stage IV. What is the most appropriate definitive treatment?
. Knee-ankle-foot orthosis (KAFO) bracing
. Guided growth with tension band plates
. Proximal tibial osteotomy
. Epiphysiodesis of the lateral proximal tibia
. Observation as spontaneous resolution is expected

Correct Answer & Explanation

. Proximal tibial osteotomy

Explanation

Langenskiöld stage IV infantile Blount disease involves advanced depression of the medial tibial plateau and is unlikely to respond to bracing or guided growth alone. Proximal tibial realignment osteotomy (often with elevation of the medial plateau) is indicated to prevent progressive deformity and joint degeneration.

Question 362

Topic: 2. Trauma

A 5-year-old child sustains a minimally displaced fracture of the lateral humeral condyle. The fracture is managed non-operatively in a cast but progresses to a delayed nonunion. If left untreated, this nonunion is most likely to result in which of the following long-term complications?

. Cubitus varus and tardy radial nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Volkmann ischemic contracture
. Heterotopic ossification of the brachialis
. Premature closure of the medial epicondyle physis

Correct Answer & Explanation

. Cubitus valgus and tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle fracture typically leads to progressive cubitus valgus deformity. Over time, the valgus angulation stretches the ulnar nerve, commonly resulting in a tardy ulnar nerve palsy.

Question 363

Topic: 2. Trauma

A 13-year-old girl sustains a juvenile Tillaux fracture. Which of the following best describes the anatomical basis and mechanism of this specific fracture pattern?

. Avulsion of the anteromedial distal tibia by the deltoid ligament due to eversion
. Avulsion of the anterolateral distal tibia by the anterior inferior tibiofibular ligament due to external rotation
. Shear fracture of the medial malleolus due to supination-adduction
. Compression fracture of the posterolateral tibia by the fibula due to axial loading
. Avulsion of the posterior tibial margin by the posterior inferior tibiofibular ligament

Correct Answer & Explanation

. Avulsion of the anterolateral distal tibia by the anterior inferior tibiofibular ligament due to external rotation

Explanation

A juvenile Tillaux fracture occurs due to external rotation of the foot, where the anterior inferior tibiofibular ligament (AITFL) avulses the anterolateral aspect of the distal tibial epiphysis. This pattern occurs because the medial and central aspects of the distal tibial physis close before the lateral aspect.

Question 364

Topic: 2. Trauma

A 3-year-old boy sustains an isolated midshaft femur fracture after a low-energy fall. Examination reveals 1.5 cm of shortening. What is the most appropriate definitive management?

. Open reduction and internal fixation with a compression plate
. Intramedullary nailing using an antegrade rigid nail
. Flexible intramedullary nailing (TENs)
. Spica cast application
. Skeletal traction for 6 weeks

Correct Answer & Explanation

. Spica cast application

Explanation

For children aged 6 months to 5 years with a femur fracture and acceptable shortening (typically <2 cm), a Spica cast is the gold standard of treatment. Rigid nailing in this age is contraindicated due to the risk of avascular necrosis.

Question 365

Topic: 2. Trauma

A 3-year-old child sustains an isolated spiral fracture of the midshaft femur. There is no suspicion of non-accidental trauma, and shortening is less than 2 cm. Which of the following is the standard of care for definitive treatment?

. Flexible intramedullary nails
. Rigid antegrade intramedullary nailing
. Immediate hip spica cast
. External fixation
. Open reduction and internal fixation with a plate

Correct Answer & Explanation

. Immediate hip spica cast

Explanation

For a preschool-aged child (under 5 years) with a typical isolated closed femur shaft fracture and acceptable shortening, early hip spica casting is the gold standard treatment with excellent remodeling potential.

Question 366

Topic: 2. Trauma

A 9-year-old girl is incidentally found to have a discoid lateral meniscus on MRI after mild knee trauma. She denies any popping, catching, or mechanical symptoms. What is the most appropriate management?

. Immediate total meniscectomy
. Partial meniscectomy (saucerization)
. Observation
. Meniscal repair with inside-out technique
. High tibial osteotomy

Correct Answer & Explanation

. Observation

Explanation

An asymptomatic discoid meniscus without a tear should be managed with observation alone. Surgical intervention, such as saucerization, is only indicated if the patient develops persistent symptoms, pain, or mechanical locking due to a tear.

Question 367

Topic: 2. Trauma

A 22-year-old soccer player sustains a twisting injury to the knee. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This finding is most highly associated with a tear of which structure?

. Posterior cruciate ligament
. Medial collateral ligament
. Lateral meniscus
. Anterior cruciate ligament
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral tibial plateau and is considered pathognomonic for an anterior cruciate ligament (ACL) tear. It represents an avulsion of the anterolateral ligament or lateral capsular attachments.

Question 368

Topic: Pelvic & Acetabular Trauma

A 40-year-old man is involved in a high-speed motor vehicle collision. Pelvic radiographs show an anteroposterior compression (APC) Type II injury, with widening of the pubic symphysis of 3.5 cm and widening of the anterior sacroiliac joints. Which ligaments are classically disrupted in this specific injury pattern?

. Anterior sacroiliac, sacrotuberous, and sacrospinous ligaments
. Posterior sacroiliac and iliolumbar ligaments
. Anterior and posterior sacroiliac ligaments
. Sacrospinous ligament only
. Inguinal and lacunar ligaments

Correct Answer & Explanation

. Anterior sacroiliac, sacrotuberous, and sacrospinous ligaments

Explanation

In an APC II pelvic ring injury, there is disruption of the symphysis pubis, the anterior sacroiliac ligaments, and the pelvic floor ligaments (sacrotuberous and sacrospinous). The posterior sacroiliac ligaments remain intact, providing vertical stability.

Question 369

Topic: 2. Trauma

A 55-year-old man sustains a tibial plateau fracture following a varus-directed force to the knee. Radiographs reveal a medial tibial plateau fracture with depression (Schatzker Type IV). What is the most critical associated soft-tissue risk with this specific injury pattern?

. Common peroneal nerve palsy
. Rupture of the patellar tendon
. Injury to the popliteal artery
. Avulsion of the anterior tibial artery
. Tear of the superficial medial collateral ligament

Correct Answer & Explanation

. Injury to the popliteal artery

Explanation

Schatzker Type IV fractures (medial plateau) are typically caused by high-energy varus forces and are highly associated with knee subluxation or dislocation. Consequently, they carry a high risk of injury to the popliteal artery and common peroneal nerve.

Question 370

Topic: 2. Trauma

A 32-year-old male is admitted after sustaining a closed tibial shaft fracture. He complains of worsening leg pain out of proportion to his injury. On examination, passive plantar flexion of the toes elicits excruciating pain in the anterolateral aspect of the leg. Which fascial compartment is most likely experiencing critically elevated pressures?

. Anterior compartment
. Lateral compartment
. Superficial posterior compartment
. Deep posterior compartment
. Peroneal compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

The anterior compartment of the leg contains the extensor hallucis longus and extensor digitorum longus. Passive plantar flexion stretches these muscles, eliciting severe pain characteristic of acute anterior compartment syndrome.

Question 371

Topic: 2. Trauma
A 28-year-old male sustains a high-energy motor vehicle collision resulting in a displaced, vertical femoral neck fracture (Pauwels Type III). What is the most biomechanically stable surgical fixation strategy for this specific fracture pattern?
. Three cannulated screws in an inverted triangle configuration
. Sliding hip screw combined with a derotation screw
. Unipolar hemiarthroplasty
. Total hip arthroplasty
. Standard piriformis-entry intramedullary nail

Correct Answer & Explanation

. Sliding hip screw combined with a derotation screw

Explanation

Pauwels Type III fractures are highly vertical and subject to massive shear forces. A sliding hip screw with a derotation screw (or a proximal femoral locking plate) provides superior biomechanical stability against shear compared to standard cannulated screws.

Question 372

Topic: 2. Trauma

A 40-year-old male is brought to the emergency department after severe pelvic trauma and is hemodynamically unstable. A pelvic binder is ordered to reduce pelvic volume. At what specific anatomical landmark should the binder be centered for optimal effectiveness?

. Iliac crests
. Anterior superior iliac spines
. Greater trochanters
. Pubic symphysis
. Subtrochanteric femur

Correct Answer & Explanation

. Greater trochanters

Explanation

Pelvic binders must be centered directly over the greater trochanters to effectively compress the pelvic ring. Placement higher up (e.g., iliac crests) can paradoxically widen the pelvis in certain open-book fracture patterns.

Question 373

Topic: 2. Trauma

A 3-year-old boy presents to the emergency department with an isolated, closed, midshaft femur fracture after a fall from a playground structure. There is 1.5 cm of shortening on radiographs. What is the most appropriate definitive management?

. Immediate hip spica cast application
. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. External fixation
. Open reduction and plate fixation

Correct Answer & Explanation

. Immediate hip spica cast application

Explanation

In children younger than 5 years old with isolated femur fractures and less than 2 cm of shortening, a hip spica cast is the gold standard treatment. Flexible nailing is generally reserved for children aged 5 to 11 years.

Question 374

Topic: 2. Trauma

A 25-year-old man sustains a closed tibia fracture. Four hours post-injury, he complains of excruciating pain that is worsened by passive stretch of his toes. Which of the following pressure measurements is the generally accepted threshold for performing an emergency fasciotomy?

. Absolute compartment pressure > 15 mmHg
. Absolute compartment pressure > 20 mmHg
. Delta P (Diastolic blood pressure minus compartment pressure) < 30 mmHg
. Delta P (Mean arterial pressure minus compartment pressure) < 40 mmHg
. Absolute compartment pressure > 25 mmHg

Correct Answer & Explanation

. Delta P (Diastolic blood pressure minus compartment pressure) < 30 mmHg

Explanation

A delta P (diastolic blood pressure minus intracompartmental pressure) of less than 30 mmHg is the accepted threshold indicating inadequate tissue perfusion and the need for urgent fasciotomy.

Question 375

Topic: 2. Trauma

A 22-year-old man falls on an outstretched hand and sustains a fracture of the proximal pole of the scaphoid. Why is this specific fracture pattern at a high risk for avascular necrosis (AVN) and nonunion?

. The proximal pole lacks ligamentous attachments.
. The blood supply enters distally and flows in a retrograde fashion.
. The proximal pole is primarily composed of cortical bone.
. The fracture hematoma is contained within the joint capsule.
. The intrinsic blood supply enters exclusively from the volar radiocarpal ligaments.

Correct Answer & Explanation

. The blood supply enters distally and flows in a retrograde fashion.

Explanation

The major blood supply to the scaphoid comes from the dorsal carpal branch of the radial artery, which enters distally and flows proximally. Proximal pole fractures disrupt this retrograde blood supply, leading to high rates of AVN.

Question 376

Topic: 2. Trauma

A 24-year-old soccer player sustains a twisting injury to his knee. Radiographs reveal an avulsion fracture of the anterolateral tibial plateau (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which structure?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Lateral meniscus
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is a cortical avulsion off the anterolateral tibia caused by the anterolateral ligament and capsule. It is highly associated with and considered pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 377

Topic: 2. Trauma
A trauma patient presents with an open-book pelvic fracture (APC Type III) and hemodynamic instability. When applying a pelvic binder for temporary stabilization, over which anatomic landmark should it be centered to be most effective?
. Over the iliac crests
. Over the greater trochanters
. Over the lower lumbar spine
. Over the mid-abdomen
. Over the proximal femur diaphysis

Correct Answer & Explanation

. Over the greater trochanters

Explanation

To effectively close the pelvic ring and reduce intrapelvic volume, a pelvic binder must be centered directly over the greater trochanters of the femurs. Placing it higher over the iliac crests is less effective and can paradoxically open the pelvis further.

Question 378

Topic: 2. Trauma

A 32-year-old man presents with a closed tibial shaft fracture following a motorcycle accident. He complains of severe pain out of proportion to the injury. Which of the following pressure measurements is most indicative of the need for an emergent fasciotomy?

. Absolute compartment pressure of 20 mmHg
. Diastolic blood pressure minus compartment pressure less than 30 mmHg
. Mean arterial pressure minus compartment pressure less than 40 mmHg
. Systolic blood pressure minus compartment pressure less than 30 mmHg
. Absolute compartment pressure of 25 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure less than 30 mmHg

Explanation

A delta pressure (diastolic blood pressure minus compartment pressure) of less than 30 mmHg is the most reliable indicator for diagnosing acute compartment syndrome and necessitates emergent fasciotomy. Absolute pressure readings are less reliable due to variations in systemic blood pressure.

Question 379

Topic: Pelvic & Acetabular Trauma
A 28-year-old man is brought in after a high-speed motor vehicle collision. He is hypotensive (BP 80/40 mmHg) and tachycardic. Pelvic radiographs show an anteroposterior compression (APC) type III injury with completely disrupted sacroiliac joints bilaterally. A pelvic binder has been applied. FAST exam is negative. What is the most appropriate next step to manage his hemodynamics?
. CT abdomen and pelvis with IV contrast
. Exploratory laparotomy
. Preperitoneal pelvic packing or angioembolization
. Application of an external fixator in the emergency department
. Administration of tranexamic acid and wait for response

Correct Answer & Explanation

. Preperitoneal pelvic packing or angioembolization

Explanation

In a hemodynamically unstable patient with a mechanically unstable pelvic ring injury and a negative FAST exam, the bleeding is likely retroperitoneal. Preperitoneal pelvic packing or pelvic angiography with embolization are the appropriate emergent interventions to control venous and arterial hemorrhage.

Question 380

Topic: 2. Trauma
A 32-year-old man sustains a displaced, Pauwels type III femoral neck fracture after a motor vehicle collision. Which of the following fixation constructs provides the most biomechanically stable construct for this specific fracture pattern?
. Three parallel cancellous screws
. Dynamic hip screw with a derotation screw
. Intramedullary nail
. Hemiarthroplasty
. Total hip arthroplasty

Correct Answer & Explanation

. Dynamic hip screw with a derotation screw

Explanation

Correct Answer: B. Pauwels type III fractures have a vertical shear pattern, making them highly unstable. A sliding hip screw (dynamic hip screw) with a derotation screw provides superior biomechanical stability against vertical shear forces compared to multiple cancellous screws.

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