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2. Trauma MCQs

Practice Set 325 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 6481

Topic: 2. Trauma

A 45-year-old male presents with a highly comminuted, isolated fracture of the scapular body following a high-energy fall. The glenoid and scapular neck are intact. What is the most appropriate primary treatment?

. Open reduction and internal fixation with dual plating
. Non-operative management with a sling and early range of motion
. Skeletal traction via an olecranon pin
. Excision of the comminuted body fragments
. Spica cast immobilization

Correct Answer & Explanation

. Non-operative management with a sling and early range of motion

Explanation

The vast majority of extra-articular scapular body fractures heal well with non-operative management (sling and early ROM) because they are highly vascularized and splinted by the surrounding robust musculature.

Question 6482

Topic: 2. Trauma

A 28-year-old male sustains a severe crush injury to the forearm and develops acute compartment syndrome. Emergent volar and dorsal fasciotomies are performed. To adequately decompress the 'mobile wad of Henry', the fascia over which of the following muscle groups must be released?

. Brachioradialis, extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB)
. Flexor carpi radialis, palmaris longus, and flexor carpi ulnaris
. Extensor digitorum communis and extensor digiti minimi
. Flexor pollicis longus and flexor digitorum profundus
. Pronator teres and pronator quadratus

Correct Answer & Explanation

. Brachioradialis, extensor carpi radialis longus (ECRL), and extensor carpi radialis brevis (ECRB)

Explanation

The mobile wad of Henry is a distinct compartment in the forearm that comprises three muscles: the brachioradialis, the ECRL, and the ECRB. It must be specifically released during dorsal forearm fasciotomy.

Question 6483

Topic: 2. Trauma

Which of the following radiographic findings in an acute midshaft clavicle fracture is the strongest independent predictor of nonunion with nonoperative management?

. Superior displacement of the distal fragment
. Shortening greater than 2 cm
. Presence of a butterfly fragment
. Z-type deformity
. Lack of cortical contact (100% displacement)

Correct Answer & Explanation

. Lack of cortical contact (100% displacement)

Explanation

Lack of cortical contact (complete displacement) is the strongest independent risk factor for nonunion in midshaft clavicle fractures. While shortening > 2cm is also a factor, complete displacement has been shown to be more predictive.

Question 6484

Topic: 2. Trauma

A 45-year-old male sustains a severe closed scapula fracture following a high-speed motorcycle accident. Which of the following radiographic parameters is considered an absolute indication for open reduction and internal fixation?

. Glenopolar angle of 20 degrees
. Medial/lateral displacement of 15 mm
. Angulation of 30 degrees
. Intra-articular step-off of 5 mm
. Coracoid fracture with 5 mm displacement

Correct Answer & Explanation

. Intra-articular step-off of 5 mm

Explanation

An intra-articular glenoid step-off of greater than 4-5 mm is an absolute indication for surgical fixation of a scapula fracture to prevent post-traumatic arthritis. A glenopolar angle < 22 degrees is considered a relative indication.

Question 6485

Topic: 2. Trauma

A 78-year-old female with severe rheumatoid arthritis presents with a highly comminuted, intra-articular distal humerus fracture. What is the primary advantage of total elbow arthroplasty (TEA) compared to open reduction and internal fixation (ORIF) in this patient?

. Lower lifetime risk of reoperation
. Immediate weight-bearing through the upper extremity
. Elimination of a post-operative lifting restriction
. More predictable restoration of functional range of motion
. Lower risk of ulnar nerve neuropathy

Correct Answer & Explanation

. More predictable restoration of functional range of motion

Explanation

In elderly patients with severe osteopenia and comminuted distal humerus fractures, TEA offers a more predictable restoration of functional range of motion and allows early mobilization. However, TEA patients require lifelong lifting restrictions.

Question 6486

Topic: 2. Trauma

A 35-year-old male sustains a closed scapula fracture following a motorcycle accident. Which of the following radiographic parameters is considered a strong indication for operative fixation of the scapular neck?

. Glenopolar angle of 35 degrees
. Medialization of the glenoid by 10 mm
. Glenopolar angle of 20 degrees
. Angulation of the scapular body of 20 degrees
. Coracoid fracture with 5 mm displacement

Correct Answer & Explanation

. Glenopolar angle of 20 degrees

Explanation

A glenopolar angle of less than 22 degrees is a widely accepted indication for operative intervention in scapula neck fractures. Other indications include >20mm of medialization or >40 degrees of angulation.

Question 6487

Topic: 2. Trauma

Which of the following factors is the most reliable independent predictor of nonunion in conservatively managed, completely displaced midshaft clavicle fractures?

. Patient age over 40 years
. Initial fracture shortening greater than 2 cm
. Associated single rib fracture
. Transverse fracture pattern without comminution
. Male sex

Correct Answer & Explanation

. Initial fracture shortening greater than 2 cm

Explanation

Initial fracture shortening greater than 2 cm is one of the strongest independent risk factors for nonunion in nonoperatively managed midshaft clavicle fractures. Lack of cortical apposition (100% displacement) and comminution also significantly increase the nonunion risk.

Question 6488

Topic: Upper Extremity Trauma

A 25-year-old cyclist falls directly onto his shoulder. Examination reveals skin tenting over a prominent distal clavicle. Radiographs show a 150% superior displacement of the clavicle relative to the acromion. What is the most appropriate management according to the Rockwood classification?

. Sling immobilization for 2 weeks followed by physical therapy
. Figure-of-eight brace
. Open reduction and coracoclavicular ligament reconstruction
. Distal clavicle excision alone
. Closed reduction and percutaneous pinning

Correct Answer & Explanation

. Open reduction and coracoclavicular ligament reconstruction

Explanation

This is a Rockwood Type V acromioclavicular joint dislocation, characterized by >100% superior displacement of the clavicle and disruption of the deltotrapezial fascia. Operative management with CC ligament reconstruction is indicated due to severe displacement and gross instability.

Question 6489

Topic: 2. Trauma
A 6-year-old boy sustains a fracture of the proximal ulna with an associated anterior dislocation of the radial head. According to the Bado classification, what type of Monteggia lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

A Bado Type I Monteggia fracture is defined by an anterior dislocation of the radial head combined with an anteriorly angulated fracture of the ulnar diaphysis. It is the most common Monteggia lesion encountered in the pediatric population.

Question 6490

Topic: Upper Extremity Trauma

When utilizing an olecranon osteotomy for open reduction and internal fixation of a complex intra-articular distal humerus fracture, which osteotomy configuration is associated with the highest biomechanical stability and lowest risk of articular step-off?

. Transverse osteotomy at the olecranon tip
. Apex-distal chevron osteotomy through the bare area
. Apex-proximal chevron osteotomy through the coronoid process
. Oblique osteotomy from dorsal to volar-distal
. Step-cut osteotomy through the olecranon fossa

Correct Answer & Explanation

. Apex-distal chevron osteotomy through the bare area

Explanation

An apex-distal chevron osteotomy directed through the non-articular bare area of the sigmoid notch provides excellent exposure, maximizes bony contact, and interlocks securely to prevent articular step-off during closure.

Question 6491

Topic: 2. Trauma

Which of the following accurately describes the primary blood supply to the scaphoid, predisposing proximal pole fractures to a high rate of nonunion?

. Volar branches of the radial artery entering distally
. Dorsal carpal branch of the radial artery entering distally
. Volar carpal branch of the ulnar artery entering proximally
. Interosseous branches from the deep palmar arch entering proximally
. Direct perforators from the anterior interosseous artery entering centrally

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery entering distally

Explanation

The primary blood supply to the scaphoid is retrograde, provided by the dorsal carpal branch of the radial artery which enters at the dorsal ridge near the distal pole. This retrograde flow makes proximal pole fractures highly susceptible to avascular necrosis and subsequent nonunion.

Question 6492

Topic: 2. Trauma

A 25-year-old male sustains a midshaft clavicle fracture. Which of the following combinations of radiographic findings most significantly increases his risk of nonunion if treated non-operatively?

. 50% displacement and an inferior butterfly fragment
. >100% displacement and >2 cm of shortening
. Distal third location and coracoclavicular ligament disruption
. Segmental fracture pattern with minimal displacement
. Apex superior angulation >15 degrees

Correct Answer & Explanation

. >100% displacement and >2 cm of shortening

Explanation

Risk factors for nonunion in midshaft clavicle fractures include completely displaced fractures (>100% translation), significant shortening (>2 cm), and severe comminution. Operative fixation in patients with these specific characteristics significantly decreases nonunion rates compared to conservative management.

Question 6493

Topic: 2. Trauma

A 45-year-old male is involved in a high-speed motor vehicle collision and sustains a scapular body fracture. Which of the following radiographic parameters is considered an absolute indication for open reduction and internal fixation?

. Glenopolar angle (GPA) of 35 degrees
. Intra-articular glenoid step-off > 4 mm
. Medialization of the lateral border by 10 mm
. Angulation of the scapular body of 25 degrees
. Concomitant nondisplaced distal third clavicle fracture

Correct Answer & Explanation

. Glenopolar angle (GPA) of 35 degrees

Explanation

Operative indications for scapula fractures include intra-articular glenoid displacement > 4 mm, a glenopolar angle < 22 degrees, or medialization > 20 mm. A glenopolar angle of 35 degrees is within normal limits.

Question 6494

Topic: 2. Trauma

An 82-year-old woman with severe rheumatoid arthritis and advanced osteoporosis sustains a highly comminuted, intra-articular distal humerus fracture (AO/OTA 13-C3). What is the most appropriate definitive management to maximize functional recovery and minimize reoperation?

. Long-arm casting for 6 weeks followed by progressive ROM
. Open reduction and internal fixation with dual orthogonal plates
. Total elbow arthroplasty
. Hemiarthroplasty of the distal humerus
. External fixation spanning the elbow joint

Correct Answer & Explanation

. Total elbow arthroplasty

Explanation

Total elbow arthroplasty (TEA) is the preferred treatment for highly comminuted, intra-articular distal humerus fractures in elderly patients with poor bone quality or pre-existing inflammatory arthritis. TEA allows for immediate range of motion and has lower reoperation rates compared to ORIF in this demographic.

Question 6495

Topic: 2. Trauma

A 19-year-old cyclist sustains a midshaft clavicle fracture after being thrown over the handlebars. Which of the following findings represents an absolute indication for open reduction and internal fixation?

. Shortening of 1 cm
. Fracture location in the middle third
. Open fracture
. Z-type deformity with comminution
. Inferior displacement of the distal fragment

Correct Answer & Explanation

. Open fracture

Explanation

Open fractures are an absolute indication for operative fixation of clavicle fractures. Other relative indications include significant displacement, shortening greater than 1.5 to 2 cm, and impending skin compromise.

Question 6496

Topic: 2. Trauma
A 7-year-old boy presents with a deformed forearm after a fall from monkey bars. Radiographs show an apex-volar angulated proximal ulnar shaft fracture and a posteriorly dislocated radial head. How is this specific injury pattern classified according to the Bado system?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

The Bado classification describes Monteggia fracture-dislocations. A Type II Bado lesion involves posterior angulation of the ulnar fracture with a posterior dislocation of the radial head.

Question 6497

Topic: 2. Trauma

A 24-year-old man presents with an open midshaft humerus fracture and an ipsilateral complete radial nerve palsy. What is the most appropriate management?

. Irrigation and debridement, external fixation, and nerve observation
. Irrigation and debridement, internal fixation, and nerve exploration
. Irrigation and debridement, functional bracing, and nerve exploration
. Intravenous antibiotics and functional bracing
. Irrigation and debridement, internal fixation, and nerve observation

Correct Answer & Explanation

. Irrigation and debridement, internal fixation, and nerve exploration

Explanation

An open humeral shaft fracture with an associated radial nerve palsy is an absolute indication for surgical exploration of the nerve. This should be performed at the time of fracture debridement and internal fixation.

Question 6498

Topic: Upper Extremity Trauma

A 32-year-old woman falls from a height and sustains a comminuted radial head fracture, which is excised. Postoperatively, she reports persistent, severe wrist pain. Examination reveals tenderness over the distal radioulnar joint (DRUJ) and positive ulnar variance. Which of the following is the most likely diagnosis?

. Monteggia fracture-dislocation
. Galeazzi fracture
. Essex-Lopresti lesion
. Terrible triad injury
. Scapholunate dissociation

Correct Answer & Explanation

. Essex-Lopresti lesion

Explanation

An Essex-Lopresti injury consists of a radial head fracture, rupture of the interosseous membrane, and DRUJ instability. Radial head excision in this setting leads to proximal migration of the radius and severe wrist pain, hence it should be avoided.

Question 6499

Topic: 2. Trauma

When evaluating a displaced 4-part proximal humerus fracture, preservation of the blood supply to the humeral head is a critical concern. Which of the following arteries provides the primary blood supply to the articular segment of the humeral head?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Suprascapular artery
. Thoracoacromial artery
. Subscapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent anatomic studies and quantitative assessments have shown that the posterior humeral circumflex artery provides the primary blood supply to the humeral head. This contradicts older literature that emphasized the anterolateral branch of the anterior humeral circumflex artery.

Question 6500

Topic: 2. Trauma

A 7-year-old boy falls on an outstretched arm and sustains a Bado Type I Monteggia fracture-dislocation. What is the defining characteristic of this injury?

. Proximal ulna fracture with anterior dislocation of the radial head
. Proximal ulna fracture with posterior dislocation of the radial head
. Proximal ulna fracture with lateral dislocation of the radial head
. Proximal radius fracture with distal radioulnar joint dislocation
. Proximal radius fracture with anterior dislocation of the ulnar head

Correct Answer & Explanation

. Proximal ulna fracture with anterior dislocation of the radial head

Explanation

A Bado Type I Monteggia fracture consists of a fracture of the proximal or middle third of the ulna with an anterior dislocation of the radial head. It is the most common type of Monteggia lesion in the pediatric population.

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