2. Trauma MCQs

In the initial resuscitation of a hemodynamically unstable patient with an anteroposterior compression (APC) pelvic ring injury, what is the correct anatomical landmark for the placement of a circumferential pelvic binder?

Following open reduction and internal fixation of ankle fractures, early mobilization in a removable cast demonstrated:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9.5 lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as a clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age. You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MCP) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is in an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The X-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent. The diagnosis of this boy's condition is:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9.5 lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as a clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age. You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MCP) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is in an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The X-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent. The level of the lesion in this boy's case is:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9.5 lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as a clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age. You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MCP) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is in an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The X-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent. Appropriate surgical management in this case should be:

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9.5 lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as a clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age. You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MCP) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is in an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The X-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner Syndrome and the grasp reflex is absent. Which of the following set of investigations is most appropriate in this case?

An 18-month-old boy is brought to your office for a clawing deformity of his right hand. The parents inform you that he was born full term after a difficult delivery complicated by shoulder dystocia. The boy weighed 9.5 lbs at birth. The child had a brief episode of apnea with an APGAR score of 5 at birth and needed resuscitation and admission to the neonatal intensive care unit. Parents recall having noted a bump on his right clavicle, which was tender and was diagnosed as a clavicle fracture. They also noticed a week later that the child did not flex the fingers of his right hand. The neonatologist had informed them that the fracture is managed conservatively and the absence of finger flexion is due to the fracture and shall recover. They were warned that the recovery can be prolonged and can take up to 2 years. The boy has grown well and has achieved his milestones on time. His immunization is complete for his age. You find a healthy, playful boy who tends to use his left hand to reach for objects. His right hand has extension at all the metacarpophalangeal (MCP) joints of the fingers while his proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are flexed. His thumb is in an adducted position and it is difficult to passively bring it to full abduction. There is obvious wasting of the hand and forearm. The child is able to move the arm well with no abnormalities noticed at the shoulder, elbow, and the wrist. The X-ray of his chest shows a healed clavicle fracture with no evidence of diaphragmatic paralysis. There is no evidence of Horner syndrome and the grasp reflex is absent. The goal of reconstructive surgery in this boy should include all of the following EXCEPT:

An anteroposterior compression (APC) type III pelvic ring injury involves complete disruption of the anterior ring and posterior sacroiliac complex. Which specific posterior ligamentous structure disruption distinguishes an APC II from an APC III injury?

During surgical exposure for a displaced proximal humerus fracture, preservation of the primary blood supply to the humeral head is critical. Recent anatomical studies indicate which artery provides the majority of the blood supply to the humeral head?

A 45-year-old male sustains a high-energy Schatzker IV tibial plateau fracture with a distinct posteromedial shear fragment. Which surgical approach is most appropriate to mechanically buttress this specific fragment?

A 45-year-old male sustains a high-energy Schatzker VI bicondylar tibial plateau fracture with a displaced posteromedial coronal shear fragment. Which surgical approach and fixation strategy is most appropriate for addressing this specific posteromedial fragment?

How many weeks following open reduction and internal fixation of a right ankle fracture can patients resume driving with normal braking times:

When using external fixation in the treatment of tibial pilon fractures, distal transfixation wires:

Incisions made through blood-filled fracture blisters have:

When using external fixation in the treatment of tibial pilon fractures, distal transfixation wires:

The clinical variable found to be associated with a higher risk of complications following open reduction and internal fixation of unstable ankle fractures in diabetic patients was:

Urgent closed reduction of ankle fracture-dislocations using intraarticular lidocaine injection:

In a vertical shear pelvic ring injury, which muscle group is primarily responsible for the cephalad migration of the unstable hemipelvis?

A 45-year-old sustains a high-energy Schatzker type IV (medial) tibial plateau fracture. Which surgical approach is most frequently indicated to directly buttress the primary fracture fragment?

A 28-year-old male has an atrophic midshaft femoral nonunion 9 months after initial statically locked intramedullary nailing. Infection has been ruled out. What is the most appropriate surgical intervention?