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2. Trauma MCQs

Practice Set 31 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 601

Topic: 2. Trauma

Review the clinical image

. A 40-year-old male arrives in the trauma bay in hemorrhagic shock following a high-energy crush injury. The AP radiograph demonstrates an "open book" pelvic fracture with wide symphyseal diastasis. What is the most critical initial orthopaedic intervention to control hemodynamics?

. Application of a pelvic binder centered over the greater trochanters
. Immediate open reduction and internal fixation of the symphysis pubis
. Application of a pelvic binder centered over the iliac crests
. Immediate administration of intravenous tranexamic acid
. Emergent retrograde urethrogram

Correct Answer & Explanation

. Application of a pelvic binder centered over the greater trochanters

Explanation

In a hemodynamically unstable patient with an open book (APC) pelvic ring injury, the application of a pelvic binder centered precisely over the greater trochanters reduces pelvic volume, promoting tamponade of venous bleeding.

Question 602

Topic: 2. Trauma

Which of the following is not a complication of macrodactyly surgery:

. Nerve injury
. Bony malunion
. Decreased sensation
. Joint laxity
. Infection

Correct Answer & Explanation

. Nerve injury

Explanation

Complications of macrodactyly surgery include poor healing of flaps secondary to devascularization or undue tension, nerve injury or decreased sensation, infection, stiffness, bony nonunion or malunion, and failure of the epiphysiodesis.

Question 603

Topic: 2. Trauma

A 25-year-old male sustains a displaced basicervical femoral neck fracture. Biomechanically, which of the following is the most appropriate fixation method?

. Three parallel cancellous screws
. Sliding hip screw (SHS) with or without a derotation screw
. Unipolar hemiarthroplasty
. Spanning external fixator

Correct Answer & Explanation

. Sliding hip screw (SHS) with or without a derotation screw

Explanation

Basicervical femoral neck fractures are extracapsular and behave biomechanically like intertrochanteric fractures. A sliding hip screw (SHS) provides superior biomechanical stability compared to cancellous screws, which have a high failure rate in this pattern.

Question 604

Topic: 2. Trauma
A 30-year-old male sustains an anteroposterior compression (APC) Type III pelvic ring injury following a high-speed motor vehicle collision. He is hemodynamically unstable. The primary source of life-threatening retroperitoneal hemorrhage in pelvic fractures is most commonly from:
. The superior gluteal artery
. The internal pudendal artery
. The presacral venous plexus and bleeding cancellous bone
. The external iliac vein

Correct Answer & Explanation

. The presacral venous plexus and bleeding cancellous bone

Explanation

While arterial bleeding (e.g., from branches of the internal iliac) can occur and is severe, approximately 80-90% of pelvic hemorrhage originates from the low-pressure presacral venous plexus and exposed cancellous bone at the fracture sites.

Question 605

Topic: Pelvic & Acetabular Trauma

In an APC-II (Anteroposterior Compression type II) pelvic ring injury, which of the following ligaments remains intact, thereby preventing complete vertical instability?

. Anterior sacroiliac ligament
. Sacrotuberous ligament
. Sacrospinous ligament
. Posterior sacroiliac ligament
. Symphyseal ligament

Correct Answer & Explanation

. Posterior sacroiliac ligament

Explanation

In APC-II injuries, the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments tear, causing rotational instability. The posterior sacroiliac ligament remains intact, maintaining vertical stability of the pelvis.

Question 606

Topic: 2. Trauma
A 45-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels Type III). What is the primary biomechanical rationale for augmenting standard inverted-triangle cannulated screw fixation with a medially placed anti-glide plate?
. Reduces rotational instability of the femoral head
. Neutralizes the extreme vertical shear forces at the fracture site
. Prevents anterior cortex comminution and subsequent varus collapse
. Enhances revascularization of the femoral head via medial circumflex vessels
. Accelerates secondary bone healing and endochondral ossification

Correct Answer & Explanation

. Neutralizes the extreme vertical shear forces at the fracture site

Explanation

Pauwels Type III fractures possess a steep angle (>50 degrees), subjecting them to high vertical shear forces that lead to failure of simple screw constructs. A medial buttress or anti-glide plate specifically neutralizes these shear forces.

Question 607

Topic: 2. Trauma

A 30-year-old male with a closed tibial shaft fracture develops disproportionate pain out of proportion to the injury. He complains of severe paresthesias in the first dorsal web space of the foot. Which fascial compartment of the leg is most likely experiencing critically elevated tissue pressures?

. Anterior compartment
. Lateral compartment
. Superficial posterior compartment
. Deep posterior compartment
. Tibialis posterior compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

The deep peroneal nerve courses through the anterior compartment of the leg and provides sensation exclusively to the first dorsal web space. Paresthesias in this distribution are a hallmark of impending anterior compartment syndrome.

Question 608

Topic: 2. Trauma

A 12-year-old boy presents with a pathologic fracture through a radiolucent lesion in the proximal humerus.

The "fallen leaf" sign is seen. What is the most appropriate initial management after the fracture has healed?

. En bloc resection
. Curettage and bone grafting
. Observation without intervention
. Aspiration and intralesional steroid injection
. Radiation therapy

Correct Answer & Explanation

. Aspiration and intralesional steroid injection

Explanation

The "fallen leaf" sign is pathognomonic for a unicameral bone cyst (UBC). First-line treatment for active, symptomatic UBCs often involves aspiration and intralesional injection of methylprednisolone or bone marrow.

Question 609

Topic: 2. Trauma

In a patient with a displaced midshaft clavicle fracture, which of the following is considered an absolute indication for operative fixation?

. Displacement greater than 1 cm
. Comminution
. Skin tenting without ischemia
. Open fracture
. Shortening of 1.5 cm

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, associated neurovascular injury, and severe skin compromise causing ischemia. Displacement and shortening are relative indications.

Question 610

Topic: 2. Trauma

Pseudoaneurysms differ from true aneurysms in that:

. Pseudoaneurysms are expansile.
. Pseudoaneurysms occur secondary to trauma.
. Pseudoaneurysms have a fibrous wall.
. Pseudoaneurysms frequently occur in the ulnar artery.

Correct Answer & Explanation

. Pseudoaneurysms occur secondary to trauma.

Explanation

Pseudoaneurysms occur secondary to penetrating trauma and have a fibrous wall, compared to true aneurysms that have all the elements of an arterial wall.

Question 611

Topic: 2. Trauma

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal air in the joint but no joint dislocation or fracture, and there is no neurovascular deficit. All of the following are appropriate steps in the management of this patient except:

. Injection of tetanus toxoid
. C losure of the wound
. Exploration for air in the joint
. Admitting the patient for observation and intravenous antibiotics
. Splinting

Correct Answer & Explanation

. Injection of tetanus toxoid

Explanation

Human bite wounds on the hand are typically found over the MP joint. The mechanism of injury is a clenched-fist blow to the mouth. Oral flora enters the wound, which often communicates with the joint. Eikenella corrodens is frequently cultured from human bite wounds, but the most common pathogen is staphylococcus aureus. Appropriate treatment includes the administration of tetanus toxoid, exploration if there is air in the joint or frank infection, observation, intravenous antibiotics, arm elevation, and splinting. All bites over joints should be assumed to penetrate and require formal incision and drainage.

Question 612

Topic: 2. Trauma

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. After cultures are taken, the next important step in treatment is:

. Debridement in the emergency department and suture
. Single dose intravenous (IV) antibiotics and discharge on oral antibiotics with follow-up instructions
. Admit and administer IV antibiotics
. Patient work up for human immunodeficiency virus
. None of the above

Correct Answer & Explanation

. Admit and administer IV antibiotics

Explanation

A patient with a human bite must be admitted for IV antibiotics and observation. If left untreated, human bites are commonly infected by a mixed flora of organisms. Therefore, they must be treated diligently.C orrect Answer: Admit and administer IV antibiotics

Question 613

Topic: 2. Trauma
An otherwise healthy man has Dupuytren's disease, which involves his small finger with 40° proximal interphalangeal joint involvement. The preferred surgery in this patient is:
. Partial fasciectomy
. Arthrodesis
. Arthroplasty
. Osteotomy
. Fasciotomy with skin grafting

Correct Answer & Explanation

. Partial fasciectomy

Explanation

A partial fasciectomy is the preferred surgery in this situation. It is recommended that involved fascial cords be resected rather than performing prophylactic fasciectomies. Care must be taken to preserve the neurovascular bundles. Arthrodesis, arthroplasty, and osteotomies are salvage procedures meant for recurrent disease. Fasciotomy has been recommended for elderly patients who cannot tolerate a long operation.

Question 614

Topic: 2. Trauma

A 45-year-old male sustains a severe, closed highly comminuted tibial pilon fracture (OTA/AO 43-C3) with massive soft tissue swelling and fracture blisters. What is the most appropriate initial management?

. Immediate open reduction and internal fixation (ORIF)
. Primary amputation
. Spanning external fixation with delayed ORIF
. Intramedullary nailing
. Closed reduction and long leg cast

Correct Answer & Explanation

. Spanning external fixation with delayed ORIF

Explanation

In high-energy pilon fractures with severe soft tissue compromise, immediate ORIF carries an unacceptably high risk of wound breakdown and infection. A staged approach using spanning external fixation followed by delayed ORIF is the standard of care.

Question 615

Topic: Pelvic & Acetabular Trauma
A patient sustains an anteroposterior compression type III (APC-III) pelvic ring injury. Which of the following ligamentous structures is completely disrupted in this injury pattern, distinguishing it from an APC-II injury?
. Anterior sacroiliac ligament
. Sacrospinous ligament
. Sacrotuberous ligament
. Posterior sacroiliac ligament
. Symphyseal ligament

Correct Answer & Explanation

. Posterior sacroiliac ligament

Explanation

An APC-III injury involves complete disruption of both the anterior and posterior sacroiliac ligaments, leading to complete pelvic instability. An APC-II injury disrupts the anterior SI, sacrospinous, and sacrotuberous ligaments but spares the strong posterior SI ligaments.

Question 616

Topic: 2. Trauma

A 75-year-old female undergoes closed reduction and percutaneous pinning for a displaced femoral neck fracture. Six months later, radiographs confirm a nonunion. Which vascular supply was most likely disrupted at the time of the initial injury, contributing to this outcome?

. Artery of the ligamentum teres
. Medial femoral circumflex artery (MFCA)
. Lateral femoral circumflex artery (LFCA)
. Inferior gluteal artery
. Pudendal artery

Correct Answer & Explanation

. Medial femoral circumflex artery (MFCA)

Explanation

The medial femoral circumflex artery (MFCA) provides the predominant blood supply to the adult femoral head via the lateral epiphyseal artery. Disruption of this vessel in displaced femoral neck fractures significantly increases the risk of avascular necrosis and nonunion.

Question 617

Topic: Pelvic & Acetabular Trauma
In the Young-Burgess classification, an anteroposterior compression type III (APC III) pelvic ring injury is characterized by the complete disruption of which of the following posterior structures?
. Anterior sacroiliac ligaments only
. Sacrotuberous and sacrospinous ligaments only
. Anterior sacroiliac, sacrotuberous, and sacrospinous ligaments
. Posterior sacroiliac ligaments only
. Anterior and posterior sacroiliac, sacrotuberous, and sacrospinous ligaments

Correct Answer & Explanation

. Anterior and posterior sacroiliac, sacrotuberous, and sacrospinous ligaments

Explanation

APC III injuries involve complete disruption of the pubic symphysis anteriorly and all posterior stabilizing structures. This includes both the anterior and posterior sacroiliac ligaments, as well as the sacrotuberous and sacrospinous ligaments, leading to complete spinopelvic instability.

Question 618

Topic: 2. Trauma

A "Segond fracture" seen on an anteroposterior radiograph of the knee is considered pathognomonic for an anterior cruciate ligament (ACL) tear. This fracture represents an avulsion of which of the following structures?

. Biceps femoris tendon
. Iliotibial band
. Anterolateral ligament
. Popliteus tendon
. Lateral collateral ligament

Correct Answer & Explanation

. Anterolateral ligament

Explanation

The Segond fracture is a cortical avulsion off the proximal lateral tibia. It specifically represents an avulsion of the anterolateral capsule, predominantly involving the anterolateral ligament (ALL).

Question 619

Topic: 2. Trauma

Which of the following fixation methods promotes fracture healing primarily through intramembranous ossification (primary bone healing)?

. Intramedullary nailing of a femur fracture
. Bridge plating of a comminuted tibial shaft fracture
. Absolute stability via compression plating of a radius fracture
. Plaster cast immobilization of a pediatric both-bone forearm fracture
. External fixation of a distal radius fracture

Correct Answer & Explanation

. Absolute stability via compression plating of a radius fracture

Explanation

Primary bone healing occurs without a cartilaginous intermediate (callus) under conditions of absolute stability and intimate cortical contact. Compression plating achieves this, allowing direct osteoclastic tunneling and osteoblastic bone formation.

Question 620

Topic: 2. Trauma
A 30-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels type III). What is the primary biomechanical rationale for using a sliding hip screw with a derotation screw rather than three parallel cancellous screws for fixation?
. Decreased risk of avascular necrosis
. Better resistance to vertical shear forces
. Improved rotational control
. Preservation of the lateral femoral wall
. Minimization of abductor weakness

Correct Answer & Explanation

. Better resistance to vertical shear forces

Explanation

Pauwels type III fractures have a high vertical angle, subjecting them to massive shear forces during weight-bearing. A fixed-angle device like a sliding hip screw provides superior resistance to vertical shear compared to multiple cancellous screws.

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