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2. Trauma MCQs

Practice Set 266 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 5301

Topic: 2. Trauma

A 30-year-old man has pain in the left arm after a motor vehicle accident. His neurovascular examination is intact, and radiographs are shown in Figures 25a and 25b. What is the best course of management?

. Closed reduction and cast immobilization for 4 weeks, followed by therapy directed at regaining motion
. Open reduction and internal fixation of the olecranon fracture, functional bracing of the humeral fracture, and therapy directed at regaining motion initiated at 2 weeks after surgery
. Open reduction and internal fixation of the olecranon and humeral fractures, followed by therapy directed at regaining motion
. Open reduction and internal fixation of the olecranon and humeral fractures, and splint immobilization for 4 weeks followed by therapy directed at regaining motion
. Open reduction and internal fixation of the olecranon fracture, functional bracing of the humeral fracture, and therapy directed at regaining motion initiated at 4 weeks after surgery

Correct Answer & Explanation

. Open reduction and internal fixation of the olecranon and humeral fractures, followed by therapy directed at regaining motion

Explanation

The floating elbow is best managed with early open reduction and internal fixation of the humeral and forearm fractures, followed by early range of motion. These fractures predispose the elbow to stiffness, and early range of motion is recommended. Solomon HB, Zadnik M, Eglseder WA: A review of outcomes in 18 patients with floating elbow. J Orthop Trauma 2003;17:563-570.

Question 5302

Topic: 2. Trauma

Figures 9a and 9b show the radiographs of a 28-year-old woman who sustained a head injury and a closed injury, without soft-tissue compromise, to her right lower extremity in a motor vehicle accident. Appropriate management of the foot injury should include

. external fixation with a circular frame.
. open reduction and internal fixation with screws.
. closed reduction and percutaneous pinning.
. closed reduction and cast immobilization.
. amputation.

Correct Answer & Explanation

. open reduction and internal fixation with screws.

Explanation

The displaced talar neck fracture should be treated with open reduction and internal fixation using screws. Closed reduction and casting will not maintain position, and percutaneous pinning is not able to maintain reduction to allow union. External fixation and amputation are not necessary for this injury unless there is severe soft-tissue loss.

Question 5303

Topic: 2. Trauma

A 47-year-old patient has had persistent pain and weakness after undergoing a reamed intramedullary nailing for a midshaft humerus fracture 8 months ago. There is no evidence of infection. Radiographs are shown in Figures 19a and 19b. Management should consist of

. electrical stimulation.
. retrograde nailing with multiple unreamed flexible nails to prevent further loss of shoulder function.
. leaving the same nail in place but adding cancellous bone graft.
. exchange nailing with over-reaming and dynamic locking.
. open reduction and plate fixation with autograft and rod removal.

Correct Answer & Explanation

. open reduction and plate fixation with autograft and rod removal.

Explanation

Compression plating remains the treatment of choice for most established humeral nonunions. Autograft is felt to be superior to allograft. Electrical stimulation has not been found to improve healing rates in patients with nonunion after intramedullary nailing. Retrograde nailing with flexible nails gives inadequate rotational control to promote healing in this patient. Adding cancellous graft alone will not stabilize the nonunion site. Dynamic locking has been successful only in the lower extremity because the bone can be loaded axially. McKee MD, Miranda MA, Riemer BL, et al: Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma 1996;10:492-499.

Question 5304

Topic: 2. Trauma

A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. A current radiograph is shown in Figure 40. What is the best treatment option?

Hip & Knee Reconstruction 2007 Practice Questions: Set 3 (Solved) - Figure 14

. Bed rest and non-weight-bearing for 6 to 8 weeks
. Component retention and open reduction and internal fixation
. Proximal femoral replacement prosthesis
. Revision arthroplasty with a long cemented stem
. Revision arthroplasty with a long porous-coated cylindrical stem

Correct Answer & Explanation

. Revision arthroplasty with a long porous-coated cylindrical stem

Explanation

The patient has sustained a Vancouver B2 periprosthetic femoral fracture (a femoral fracture that occurs around or just distal to a loose stem, with adequate proximal bone stock). The stem is no longer fixed to proximal bone; therefore, retention of the femoral component is not recommended. Nonsurgical management is contraindicated because of the high risk of nonunion and malunion with significant component settling in the distal fragment and leg shortening. Revision femoral arthoplasty must attain distal fixation in adequate host bone, which is usually successful with a porous-coated cylindrical stem. Parvizi J, Rapuri VR, Purtill JJ, et al: Treatment protocol for proximal femoral periprosthetic fractures. J Bone Joint Surg Am 2004;86:8-16.

Question 5305

Topic: 2. Trauma

A 25-year-old semiprofessional football player sustains a hyperextension injury to the left foot. He is unable to bear weight. Examination reveals tenderness along the midfoot with swelling and plantar ecchymosis. Radiographs are negative. What is the next step in evaluation of this patient?

Trauma 2009 Practice Questions: Set 1 (Solved) - Figure 8

. CT
. MRI
. Standing radiographs
. Measurement of compartment pressures
. Bone scan

Correct Answer & Explanation

. Standing radiographs

Explanation

The patient has a suspected Lisfranc sprain based on the plantar ecchymosis. The first step in diagnosis is a dynamic radiographic study. This should include a physician-assisted midfoot stress examination or standing weight-bearing radiographs to evaluate for displacement. There is no evidence of compartment syndrome, and a bone scan, CT, and MRI are expensive tests that are not warranted. Early JS: Fractures and dislocations of the midfoot and forefoot, in Bucholz R, Heckman JD, Court-Brown CM (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott Williams and Wilkins, 2006, pp 2337-2400.

Question 5306

Topic: 2. Trauma

In Figure 14, the primary fracture line in a calcaneal fracture is best depicted by which of the following schematics?

Trauma Board Review 2000: High-Yield MCQs (Set 2) - Figure 5

. A
. B
. C
. D
. E

Correct Answer & Explanation

. A

Explanation

The schematic labeled A best depicts the primary fracture line in a calcaneal fracture. The primary fracture line in an axial-loading fracture of the calcaneus occurs from superior-lateral to inferior-medial. This fracture line separates the calcaneus into sustentacular and tuberosity fragments and typically enters the subtalar joint through the posterior facet. Although additional fracture lines typically occur, the primary fracture line is almost always present. If surgical reduction is planned, reducing the primary fracture is always a key step. Macey LR, Benirschke SK, Sangeorzan BJ, Hansen ST: Acute calcaneal fractures: Treatment option and results. J Am Acad Orthop Surg 1994;2:36-43.

Question 5307

Topic: 2. Trauma

A 25-year-old man is brought to the emergency department following a motor vehicle accident. Extrication time was 2 hours, and in the field he had a systolic blood pressure by palpation of 90 mm Hg. Intravenous therapy was started, and on arrival in the emergency department he has a systolic blood pressure of 90 mm Hg with a pulse rate of 130. Examination reveals a flail chest and a femoral diaphyseal fracture. Ultrasound of the abdomen is positive. The trauma surgeons take him to the operating room for an exploratory laparotomy. At the conclusion of the procedure, he has a systolic pressure of 100 mm Hg with a pulse rate of 110. Oxygen saturation is 90% on 100% oxygen, and he has a temperature of 95.0 degrees F (35 degrees C). What is the recommended treatment of the femoral fracture at this time?

. Reamed intramedullary nail
. Unreamed intramedullary nail
. Percutaneous plate fixation
. Skeletal traction
. External fixation

Correct Answer & Explanation

. External fixation

Explanation

This is a "borderline trauma" patient where serious consideration for damage control orthopaedic surgery is required. His prolonged hypotension, abdominal injury, and chest injury put him at higher risk for serious postinjury complications. Further surgery, such as definitive fracture fixation, adds metabolic load and injury to his system. It is prudent to consider femoral fracture stabilization with an external fixator until he is physiologically recovered as evidenced by a normal base excess and/or lactate acid levels, as well as all other parameters of resuscitation. A borderline patient has been described as polytrauma with an ISS > 20 and thoracic trauma (AIS > 2); polytrauma and abdominal/pelvic trauma (Moore > 3) and hemodynamic shock (initial BP < 90 mm Hg); ISS > 40; bilateral lung contusions on radiographs; initial mean pulmonary arterial pressure > 24 mm Hg; pulmonary artery pressure increase during intramedullary nailing > 6 mm Hg. Factors that worsen the situation following surgery include multiple long bones and truncal injury (AIS > 2), estimated surgery time of more than 6 hours, arterial injury and hemodynamic instability, and exaggerated inflammatory response (eg, Il-6 > 800 pg/mL). It is incumbent on the orthopaedic surgeon who is a member of the trauma team to make sure that he or she is aware of these factors and guides the team to the best patient care. Pape HC, Hildebrand F, Pertschy S, et al: Changes in the management of femoral shaft fractures in polytrauma patients: From early total care to damage control orthopaedic surgery. J Trauma 2002;53:452-461.

Question 5308

Topic: 2. Trauma

A 21-year-old football player who sustained a direct blow to the posterior hindfoot while making a cut is unable to bear weight on the injured foot. Examination reveals tenderness and swelling of the great toe metatarsophalangeal (MTP) joint. Radiographs are shown in Figures 9a and 9b. What is the most likely diagnosis?

. Dislocation of the great toe MTP joint
. Rupture of the volar plate
. Fracture of the lateral sesamoid
. Fracture of the lateral sesamoid and rupture of the plantar plate
. Subluxation of the sesamoids

Correct Answer & Explanation

. Fracture of the lateral sesamoid and rupture of the plantar plate

Explanation

Turf toe occurs in collision and contact sports in which the athlete pushes off to accelerate or change direction and there is hyperextension of the great toe MTP joint. Typically, there is also axial loading of the posterior hindfoot, which increases the hyperextension of the MTP joint. The most common presentation is pain and swelling of the MTP joint and inability to hyperextend the joint without significant symptoms. With significant force, fractures of the sesmoids and plantar soft tissues can occur. The radiographs do not show a dislocation of the great toe MTP joint because it is concentrically located on both radiographs. However, the radiographs show a fracture of the lateral sesamoid or a diastasis of a bipartite lateral sesamoid. The medial sesamoid is also proximal indicating a rupture of the plantar (volar) plate. Therefore, the most likely diagnosis is a fracture of the lateral sesamoid with rupture of the plantar plate leading to proximal migration of the proximal fragment of the lateral sesamoid and the medial sesamoid. Rodeo SA, et al: Diastasis of bipartite sesamoids of the first metatarsophalangeal joint. Foot Ankle 1993;l4:425-434.

Question 5309

Topic: 2. Trauma

A 20-year-old collegiate football player sustains an injury to his left foot 3 weeks before the start of the fall season. Examination reveals localized tenderness over the lateral midfoot and normal foot alignment. Radiographs are shown in Figures 28a through 28c. What is the treatment of choice?

. Intramedullary screw fixation
. Onlay bone graft
. Application of a walking boot with weight bearing as tolerated
. Application of a short leg cast with weight bearing as tolerated
. Application of a short leg cast and non-weight-bearing

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Due to the relatively high incidence of delayed union and nonunion associated with this mildly displaced Jones-type fracture, and the temporal proximity to his playing season, intramedullary screw fixation is the treatment of choice in this collegiate athlete to best ensure healing and expedite his return to football. If nonsurgical management were elected, application of a non-weight-bearing short leg cast would be appropriate since a higher likelihood of healing is expected with it versus a short leg walking cast. The risk of recurrent fracture of fractures that heal with nonsurgical management has reportedly been high (approximately 30%). Quill GE: Fractures of the proximal fifth metatarsal. Orthop Clin North Am 1995;26:353-361. Torg JS, Balduini FC, Zelko RR, et al: Fractures of the base of the fifth metatarsal distal to the tuberosity: Classification and guidelines for nonsurgical and surgical management. J Bone Joint Surg Am 1984;66:209-214.

Question 5310

Topic: 2. Trauma

A 16-year-old girl sustained the injury shown in Figure 7a. CT scans are shown in Figures 7b through 7d. The results of treatment of this injury have been shown to most correlate with which of the following factors?

. Surgical approach
. Location of the transverse fracture
. Timing of surgery
. Accuracy of reduction
. Use of skeletal traction

Correct Answer & Explanation

. Accuracy of reduction

Explanation

The patient has a very low T-type acetabular fracture; however, the head is not congruent under the dome so surgical reduction is necessary. The anterior and posterior columns are displaced and will move independent from each other. The extended iliofemoral is the only approach allowing for visualization and reduction of each column. A combined anterior and posterior approach may also be used. The timing of surgery should be within the first 3 weeks of injury to optimize chances of obtaining an accurate reduction because this is an important factor in determining outcome. Letournel E, Judet R (eds): Fractures of the Acetabulum, ed 2. Berlin, Germany, Springer-Verlag, 1991.

Question 5311

Topic: 2. Trauma

A 28-year-old woman who is training for the New York Marathon reports pain in the posteromedial aspect of her right ankle. Examination reveals tenderness just posterior to the medial malleolus. Radiographs are normal. An MRI scan is shown in Figure 3. What is the most likely diagnosis?

Foot & Ankle 2000 Practice Questions: Set 1 (Solved) - Figure 7

. Posterior tibial tendinitis
. Osteoid osteoma
. Posterior ankle impingement
. Tibial stress fracture
. Flexor hallucis longus tendinitis

Correct Answer & Explanation

. Tibial stress fracture

Explanation

Any of the above conditions is credible with a limited history. The MRI scan unequivocally shows the stress fracture in the distal tibia. Most tibial stress fractures can be managed with rest and immobilization. Boden BP, Osbahr DC: High risk stress fractures: Evaluation and treatment. J Am Acad Orthop Surg 2000;8:344-353.

Question 5312

Topic: 2. Trauma

In an effort to reduce costs, a limited MRI sequence is planned to detect a possible occult hip fracture. What is the anticipated fracture signal?

. Bright on T1 and T2
. Dark on T1 and T2
. Dark on T1, bright on T2
. Bright on T1, dark on T2
. Enhancement by gadolinium

Correct Answer & Explanation

. Dark on T1, bright on T2

Explanation

At present, radiologists perform multiple MRI images to rule out all possible diagnoses. The ability to specify the anticipated changes on MRI should become more important as a means of reducing costs. MRI is sensitive to changes in free water (or hemorrhage) and thus this will appear dark on T1 and bright on T2. Miller MD: Review of Orthopaedics, ed 3. Philadelphia PA, WB Saunders, 2000, p 116.

Question 5313

Topic: 2. Trauma

An 8-year-old boy sustains injuries to his head, abdomen, and left lower extremity after being struck by a truck. In the emergency department, his mental status deteriorates and he is intubated after assessment reveals a Glasgow Coma Scale score of 3; the score subsequently improves to 10. A CT scan reveals a right parietal intracranial hemorrhage, and an abdominal ultrasound reveals free fluid. Prior to an emergency laparotomy, the swollen left thigh is evaluated. Radiographs reveal a transverse fracture of the mid-diaphysis. Management of the fracture should consist of

Orthopedic Surgery Board Review 2026 | High-Yield MCQs - Set 10 - Figure 34

. immediate application of a hip spica cast.
. insertion of a distal femoral traction pin and placement into 90-90 traction.
. closed reduction and stabilization using retrograde flexible intramedullary nails.
. insertion of an antegrade reamed interlocking intramedullary nail.
. closed reduction and transcutaneous pin fixation supplemented by a long leg cast.

Correct Answer & Explanation

. closed reduction and stabilization using retrograde flexible intramedullary nails.

Explanation

The prognosis for a young patient with a head injury is more favorable compared to that for adults. Full neurologic recovery generally occurs. Spasticity may occur within a few days after injury, which can lead to fracture displacement if immediate spica casting or traction is used. Early surgical stabilization will reduce problems with shortening and malunion and will facilitate transportation of the child for diagnostic tests. Surgery may be performed when it is best for the patient, either on the day of injury or later if time is needed for stabilization. In this patient, the fracture is ideally suited to stabilization using flexible intramedullary nails. Heinrich and associates' report of 78 diaphyseal femur fractures stabilized with flexible intramedullary nails included 14 patients with an associated closed head injury. All fractures healed, and there were no major complications. Tolo VT: Management of the multiply injured child, in Rockwood CA, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 83-95.

Question 5314

Topic: Upper Extremity Trauma

A 28-year-old hockey player has a shoulder deformity after being checked into the boards. Examination reveals that swelling has improved, but there is tenderness along the distal clavicle. Radiographs reveal a grade II acromioclavicular joint separation. Initial management should consist of

. a sling, ice, and isometric exercises.
. a glenohumeral cortisone injection.
. surgical repair of the coracoclavicular ligaments.
. chin-ups and latissimus pull-down exercises.
. cross-chest stretches.

Correct Answer & Explanation

. a sling, ice, and isometric exercises.

Explanation

The most common shoulder injury in hockey players is to the acromioclavicular joint. Early rest and control of pain and inflammation is the preferred management. Surgery is reserved for patients with significant coracoclavicular disruption that has failed to respond to nonsurgical management. Cross-chest stretches and overhead exercises may increase symptoms. A cortisone injection within the glenohumeral joint will have little effect. Nuber GW, Bowen MK: Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 1997;5:11-18.

Question 5315

Topic: 2. Trauma

A 35-year-old man sustained the closed injury shown in Figure 52 in his dominant extremity. Neurologic function is normal. Treatment should consist of

Upper Extremity 2008 Practice Questions: Set 5 (Solved) - Figure 6

. functional bracing.
. a sling and swathe.
. intramedullary nail fixation.
. open reduction and internal fixation.
. iliac crest bone graft.

Correct Answer & Explanation

. functional bracing.

Explanation

Functional bracing has been demonstrated to have a very high rate of healing without any functional limitations in a large series of patients. Surgery is reserved for "floating elbows," open injuries, neurovascular injuries, and those fractures that go on to nonunion. Sarmiento A, Zagorski JB, Zych GA, et al: Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 2000;82:478-486.

Question 5316

Topic: 2. Trauma

Figure 33 shows the radiograph of a 28-year-old avid golfer who has chronic right wrist pain. Management should consist of

Sports Medicine Board Review 2004: High-Yield MCQs (Set 4) - Figure 2

. cast immobilization.
. splinting with a bone stimulator.
. excision of the fracture fragment.
. arthroscopically assisted percutaneous fixation.
. trephination of the fibrous union.

Correct Answer & Explanation

. excision of the fracture fragment.

Explanation

The patient's chronic symptoms are associated with a fracture of the base of the hook of the hamate; therefore, the treatment of choice is simple excision of the fracture fragment, with reasonable expectations of functional return. Acute fractures may be difficult to treat because of the high incidence of nonunion, but once nonunion is discovered, nonsurgical management usually is unsuccessful. Bone grafting may be a surgical alternative, but successful outcomes with percutaneous fixation or trephination of the fibrous union have not been reported. Geissler WB: Carpal fractures in athletes. Clin Sports Med 2001;20:167-188.

Question 5317

Topic: 2. Trauma

A 35-year-old man is brought to the emergency department following a motorcycle accident. He is breathing spontaneously and has a systolic blood pressure of 80 mm Hg, a pulse rate of 120/min, and a temperature of 98.6 degrees F (37 degrees C). Examination suggests an unstable pelvic fracture; AP radiographs confirm an open book injury with vertical displacement on the left side. Ultrasound evaluation of the abdomen is negative. Despite administration of 4 L of normal saline solution, he still has a systolic pressure of 90 mm Hg and a pulse rate of 110. Urine output has been about 20 mL since arrival 35 minutes ago. What is the next best course of action?

. Continued resuscitation with fluids and blood
. Ongoing resuscitation and pelvic angiography
. Application of an external fixator in the emergency department
. A pelvic binder and continued resuscitation
. A pelvic binder, skeletal traction, and continued resuscitation

Correct Answer & Explanation

. A pelvic binder, skeletal traction, and continued resuscitation

Explanation

The patient is at risk for a pelvic vascular injury and major hemorrhage. This type of complication of pelvic trauma is highest in motorcyclists. Once it is recognized that the pelvic ring has opened, it is important to close that ring to tamponade any venous bleeding with a pelvic binder and to add a skeletal traction pin to the limb on the involved side. This will correct any translational displacement. The noninvasive pelvic binders or sheets are easy to apply and are very effective. They do not compromise future care and allow the surgeons access to the abdomen. External fixation or pelvic resuscitation clamps require a certain amount of skill to apply and are not always available. If the pelvic stabilization does not improve the hemodynamic parameters in 10 to 15 minutes, angiography is necessary.

Question 5318

Topic: 2. Trauma

Figure 22 shows the radiograph of a 7-year-old boy who underwent retrograde elastic nailing of a femoral shaft fracture. What is the most common problem following this procedure?

Pediatrics 2007 Practice Questions: Set 3 (Solved) - Figure 2

. Unacceptable shortening
. Osteonecrosis of the femoral head
. Malunion
. Persistent pain and irritation at the nail insertion site
. Rotational malalignment

Correct Answer & Explanation

. Persistent pain and irritation at the nail insertion site

Explanation

Several large clinical studies have shown that the most common problem after elastic nailing of a femoral shaft fracture is persistent pain and irritation at the nail insertion site. Unacceptable shortening and malunion are very rare in a 7-year-old patient. Rotational malalignment also is unusual. Osteonecrosis has been reported in solid antegrade nailing but not with elastic nailing of femoral shaft fractures in skeletally immature patients. Flynn JM, Luedtke LM, Ganley TJ, et al: Comparison of titanium elastic nails with traction and a spica cast to treat femoral fractures in children. J Bone Joint Surg Am 2004;86:770-777. Flynn JM, Hresko T, Reynolds RA, et al: Titanium elastic nails for pediatric femur fractures: A multicenter study of early results with analysis of complications. J Pediatr Orthop 2001;21:4-8.

Question 5319

Topic: 2. Trauma

A right-handed 20-year-old college baseball pitcher has had a 6-month history of vague right elbow pain while pitching. Examination reveals full flexion of the elbow and a loss of only a few degrees of full extension. The elbow is stable, but palpation reveals tenderness over the olecranon. Plain radiographs are inconclusive. MRI and CT scans are shown in Figures 20a and 20b. Management should consist of

. repair of a triceps tendon avulsion.
. arthroscopy of the elbow for removal of loose bodies.
. arthroscopic removal of a posteromedial olecranon osteophyte.
. internal fixation of an olecranon stress fracture.
. rest, rehabilitation, and resumption of pitching when the fracture is healed.

Correct Answer & Explanation

. rest, rehabilitation, and resumption of pitching when the fracture is healed.

Explanation

The patient has a stress fracture of the olecranon that occurs with repetitive throwing motions. If the fracture is not displaced, the initial treatment of choice is rest and rehabilitation to maintain elbow motion, followed by aggressive strengthening at 6 to 8 weeks. A light throwing program generally can begin at 8 to 12 weeks. Complete recovery may require 3 to 6 months. If the fracture is displaced or if nonsurgical management fails, surgery is indicated for internal fixation of the stress fracture. Azar FM, Wilk KE: Nonoperative treatment of the elbow in throwers. Oper Tech Sports Med 1996;4:91-99.

Question 5320

Topic: 2. Trauma

A 30-year-old woman who runs approximately 30 miles a week has had right hip and groin pain for the past 3 weeks. Examination reveals an antalgic gait, limited motion of the right hip, and pain, especially with internal and external rotation. Plain radiographs are normal, and an MRI scan is shown in Figure 21. Management should consist of

Sports Medicine Board Review 2001: High-Yield MCQs (Set 2) - Figure 25

. immediate internal fixation of the right femoral neck stress fracture.
. non-weight-bearing crutch ambulation until symptoms resolve, followed by a gradual resumption of activities.
. ultrasound therapy to promote fracture healing.
. a metabolic work-up.
. a bone scan to look for other stress fractures.

Correct Answer & Explanation

. non-weight-bearing crutch ambulation until symptoms resolve, followed by a gradual resumption of activities.

Explanation

A stress fracture of the hip is a relatively common problem in endurance sports. These fractures are classified as compression-side, tension-side, and displaced femoral neck fractures. The MRI scan shows a compression-side stress fracture. Compression-side fractures usually occur in the inferior or calcar area of the proximal femur, and non-weight-bearing crutch ambulation for 6 to 7 weeks will most likely result in healing. Once the patient is walking without pain or a limp, activities can be slowly increased. Because tension-side fractures have a high risk of displacement, treatment should consist of immediate internal fixation. Griffin LY (ed): Orthopaedic Knowledge Update: Sports Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 239-253.

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