2. Trauma MCQs

A 72-year-old woman with diabetes sustains a displaced calcaneal tuberosity avulsion fracture with blanching of the overlying posterior heel skin. What is the most critical next step in management?

A 28-year-old skier sustains an acute dorsiflexion-inversion injury to his ankle. He reports a popping sensation behind the lateral malleolus. Radiographs reveal a small cortical avulsion fracture off the posterolateral ridge of the distal fibula. This 'fleck sign' is highly suggestive of which of the following injuries?

During an extensile lateral approach for the open reduction and internal fixation of a displaced intra-articular calcaneus fracture, careful full-thickness subperiosteal dissection is critical to prevent necrosis of the flap apex. The primary blood supply to the critical corner of this flap is derived from which of the following vessels?

A 20-year-old cross-country runner presents with 4 weeks of vague, aching dorsal midfoot pain that worsens with training. Radiographs are negative, but an MRI reveals bone marrow edema in the navicular. A subsequent CT scan confirms an incomplete, non-displaced stress fracture of the navicular body. What is the most appropriate initial management?

A 60-year-old male with poorly controlled diabetes and severe peripheral neuropathy sustains a closed, displaced bimalleolar ankle fracture. Which of the following surgical strategies is most appropriate to minimize the high risk of fixation failure and Charcot arthropathy in this patient?

A 40-year-old male sustains a high-energy tibial pilon fracture (OTA/AO 43-C3) in a motor vehicle collision. On arrival, there is massive soft tissue swelling, fracture blisters over the medial ankle, and threatened skin. What is the current gold standard sequence of management for this injury?

A 25-year-old soccer player sustains an external rotation ankle injury. Standard AP, mortise, and lateral radiographs are obtained to evaluate for a syndesmotic injury. Which of the following radiographic measurements is the most reliable and widely accepted indicator of syndesmotic widening?

A 45-year-old man presents with chronic lateral hindfoot pain and difficulty wearing shoes 18 months after non-operative management of a displaced intra-articular calcaneus fracture. Physical exam reveals a widened heel and restricted subtalar motion. What is the most likely cause of his lateral hindfoot pain?

A 25-year-old professional basketball player sustains a fracture of the fifth metatarsal. Radiographs show a transverse fracture at the metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal articulation. What zone does this represent, and what is the optimal treatment for this athlete?

A 19-year-old female track athlete presents with insidious onset of dorsal midfoot pain. CT scan reveals a complete stress fracture of the navicular with no displacement. What is the recommended initial management?

A 35-year-old man suffers a severe crush injury to the foot. Clinical exam is highly concerning for compartment syndrome. How many anatomically distinct osseofascial compartments are classically described in the foot?

A 22-year-old collegiate track athlete complains of vague dorsal midfoot pain that worsens with sprinting. Radiographs are negative. MRI reveals a stress fracture of the navicular involving the central third, and a subsequent CT scan shows an incomplete fracture line extending halfway across the bone. What represents the most reliable initial nonoperative treatment that minimizes nonunion risk?

A 21-year-old elite football player sustains a fracture of the fifth metatarsal. Radiographs show a fracture line located at the metaphyseal-diaphyseal junction, extending into the fourth-fifth intermetatarsal articulation. What is the diagnosis and the most appropriate treatment to ensure early return to play?

A 34-year-old male sustains a pronation-external rotation ankle fracture. After rigid fixation of the malleoli, the Cotton test is positive. Fixation is performed using a suture-button construct. According to biomechanical and clinical studies, what is the primary advantage of dynamic suture-button fixation over rigid static syndesmotic screw fixation?

A 35-year-old male sustains an ankle fracture-dislocation. Closed reduction in the emergency department is unsuccessful. Radiographs show a bimalleolar equivalent fracture with the fibula displaced posterior to the incisura fibularis of the tibia. What is the most likely anatomic structure preventing closed reduction?

A 20-year-old collegiate track athlete presents with insidious onset vague midfoot pain. MRI confirms a stress fracture in the central third of the tarsal navicular. The vulnerability of this area to fracture is primarily due to a watershed area of blood supply. Which arteries supply the medial and lateral poles of the navicular, creating this central avascular zone?

During the operative fixation of an intra-articular calcaneus fracture via an extensile lateral approach, the surgeon places a 'constant' screw from the lateral cortex directing medially to secure the tuberosity to the anteromedial (sustentacular) fragment. Which anatomical structure is tightly adherent to the inferior surface of the sustentaculum tali, serving as an important landmark but also at risk of injury from an overly long drill bit or screw?

A 30-year-old male sustains an external rotation injury to his ankle. Radiographs and intraoperative fluoroscopy reveal a syndesmotic disruption without a fibular fracture (purely ligamentous injury). Which of the following ligaments is typically the first to rupture in the sequence of a syndesmotic injury?

A 38-year-old male sustains a high-energy OTA/AO type 43-C3 pilon fracture. The surgeon plans a dual-incision approach. To minimize wound necrosis, the incisions should be based on distinct vascular angiosomes. While the anterolateral incision is based on the anterior tibial artery, what artery supplies the primary angiosome utilized for the standard posterolateral incision?