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2. Trauma MCQs

Practice Set 329 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 6561

Topic: 2. Trauma

When utilizing a posterior approach with an olecranon osteotomy for open reduction and internal fixation of a highly comminuted intra-articular distal humerus fracture, a chevron osteotomy is often preferred over a transverse osteotomy because it:

. Prevents triceps tendon retraction
. Allows for immediate heavy weight bearing
. Increases the articular surface area of the radiocapitellar joint
. Provides inherent rotatory stability upon repair
. Avoids the need to isolate the ulnar nerve

Correct Answer & Explanation

. Provides inherent rotatory stability upon repair

Explanation

A chevron or V-shaped olecranon osteotomy provides inherent bony rotatory stability when reduced, and increases the surface area for healing compared to a simple transverse osteotomy. It facilitates anatomic restoration of the articular surface.

Question 6562

Topic: 2. Trauma

A 30-year-old man presents with a markedly displaced scapular body fracture following a high-speed motorcycle accident. Which of the following associated injuries is statistically most commonly seen in patients with this high-energy fracture?

. Brachial plexus root avulsion
. Subclavian artery intimal tear
. Ipsilateral rib fractures
. Tension pneumothorax
. Anterior glenoid labrum tear

Correct Answer & Explanation

. Ipsilateral rib fractures

Explanation

Scapula fractures generally require high-energy trauma, and associated injuries are present in over 80-90% of cases. Ipsilateral rib fractures are the most common associated injury, occurring in approximately 50% of patients.

Question 6563

Topic: 2. Trauma

A 32-year-old man sustains a spiral fracture of the distal third of the humeral shaft (Holstein-Lewis fracture). On presentation, he exhibits a complete inability to extend his wrist or digits. If surgical exploration is indicated, where is the radial nerve most likely to be entrapped or injured?

. Deep within the spiral groove of the proximal humerus
. As it pierces the lateral intermuscular septum
. At the level of the arcade of Frohse
. Between the brachialis and brachioradialis muscles
. Beneath the ligament of Struthers

Correct Answer & Explanation

. As it pierces the lateral intermuscular septum

Explanation

Holstein-Lewis fractures are spiral fractures of the distal one-third of the humerus. The radial nerve is at high risk of entrapment or laceration as it is tethered piercing the lateral intermuscular septum to pass from the posterior to the anterior compartment.

Question 6564

Topic: Upper Extremity Trauma
A 26-year-old hockey player sustains a direct downward blow to his shoulder. Radiographs demonstrate superior displacement of the clavicle relative to the acromion by approximately 200%. The coracoclavicular distance is more than twice that of the uninjured side. According to the Rockwood classification, what type of acromioclavicular injury is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

A Rockwood Type V acromioclavicular dislocation involves severe superior displacement of the clavicle (100% to 300%) relative to the acromion, accompanied by significant stripping of the deltotrapezial fascia. Type III involves up to 100% displacement, and Type IV is displaced posteriorly into the trapezius.

Question 6565

Topic: 2. Trauma

A 28-year-old man sustains a closed fracture of the distal third of the humeral shaft. On initial presentation, his radial nerve function is intact. Following closed reduction and splinting, he immediately loses the ability to actively extend his wrist and fingers. What is the most appropriate next step in management?

. Observation and electromyography (EMG) at 6 weeks
. Immediate surgical exploration and nerve release
. Application of a functional fracture brace
. Magnetic resonance imaging (MRI) of the humerus
. Casting the wrist in extension

Correct Answer & Explanation

. Immediate surgical exploration and nerve release

Explanation

A secondary radial nerve palsy that develops immediately after closed manipulation of a distal third humeral shaft fracture (Holstein-Lewis pattern) is an indication for immediate surgical exploration, as the nerve may be entrapped in the fracture site.

Question 6566

Topic: 2. Trauma

Which of the following is considered an absolute indication for operative fixation of an acute midshaft clavicle fracture?

. Displacement greater than 1 cm
. Shortening of 1.5 cm
. Open fracture
. Severe comminution
. Presence of a closed head injury

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for ORIF of a clavicle fracture include open fractures, neurovascular compromise, and severe skin tenting threatening skin necrosis. Displacement and shortening are relative indications.

Question 6567

Topic: 2. Trauma

A 30-year-old male sustains a Galeazzi fracture-dislocation. Following rigid open reduction and internal fixation of the radius, the distal radioulnar joint (DRUJ) is found to be irreducibly dislocated. What is the most likely interposed structure?

. Extensor carpi ulnaris (ECU) tendon
. Flexor carpi ulnaris (FCU) tendon
. Median nerve
. Extensor pollicis longus (EPL) tendon
. Extensor digiti minimi (EDM) tendon

Correct Answer & Explanation

. Extensor carpi ulnaris (ECU) tendon

Explanation

The extensor carpi ulnaris (ECU) tendon is the most common soft-tissue structure to block reduction of the DRUJ in a Galeazzi fracture-dislocation, requiring open exploration for removal.

Question 6568

Topic: 2. Trauma

Tension band wiring is most appropriate and biomechanically sound for which of the following olecranon fracture patterns?

. Transverse fracture with no comminution
. Oblique fracture exiting distal to the coronoid
. Highly comminuted fracture
. Monteggia fracture-dislocation
. Fracture involving only 10% of the articular surface

Correct Answer & Explanation

. Transverse fracture with no comminution

Explanation

Tension band wiring converts tension forces at the dorsal cortex into compression forces at the articular surface. This mechanism relies on an intact volar cortex to act as a buttress, making it ideal for simple transverse, non-comminuted fractures.

Question 6569

Topic: 2. Trauma

A 25-year-old cyclist falls and sustains a midshaft clavicle fracture. Which of the following is considered an absolute indication for immediate operative fixation of this injury?

. 1.5 cm of shortening.
. 100% displacement without skin tenting.
. Open fracture.
. Concomitant non-displaced scapular body fracture.
. Associated non-displaced rib fractures.

Correct Answer & Explanation

. Open fracture.

Explanation

Absolute indications for operative fixation of clavicle fractures include open fractures, neurovascular compromise, and severe skin tenting threatening to progress to an open fracture. Shortening of greater than 2 cm is generally considered a relative indication.

Question 6570

Topic: 2. Trauma

A 20-year-old man presents with anatomic snuffbox tenderness following a fall on an outstretched hand. Initial radiographs are negative, but an MRI confirms a non-displaced scaphoid waist fracture. What is the most appropriate definitive management?

. Long-arm thumb spica cast for 12 weeks.
. Short-arm thumb spica cast for 6-8 weeks.
. Immediate open reduction and internal fixation.
. Splinting for 2 weeks followed by physical therapy.
. Corticosteroid injection and immediate mobilization.

Correct Answer & Explanation

. Short-arm thumb spica cast for 6-8 weeks.

Explanation

Non-displaced scaphoid waist fractures can be successfully treated nonoperatively with a short-arm cast for 6-8 weeks. Operative fixation is generally reserved for displaced fractures, proximal pole fractures, or athletic patients desiring quicker return to play.

Question 6571

Topic: 2. Trauma

A 32-year-old man requires open reduction and internal fixation of a highly comminuted intercondylar distal humerus fracture (OTA type 13-C3). To provide the most extensive exposure to the articular surface, which surgical approach is preferred?

. Triceps-reflecting anconeus pedicle (TRAP) approach.
. Triceps-splitting approach.
. Chevron olecranon osteotomy.
. Paratricipital approach.
. Bryan-Morrey approach.

Correct Answer & Explanation

. Chevron olecranon osteotomy.

Explanation

A chevron olecranon osteotomy provides the widest exposure to the articular surface of the distal humerus, which is critical for restoring complex, comminuted intra-articular fractures. The osteotomy must be anatomically repaired at the end of the procedure.

Question 6572

Topic: 2. Trauma

A 25-year-old male cyclist sustains a midshaft clavicle fracture. Which of the following is considered an absolute indication for operative fixation?

. Shortening of 1.5 cm
. 100% displacement of the fracture fragments
. Z-deformity on the anteroposterior radiograph
. Impending skin necrosis (tenting)
. Comminution with a butterfly fragment

Correct Answer & Explanation

. Impending skin necrosis (tenting)

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, neurovascular compromise, and impending skin ischemia (tenting). Displacement, shortening, and comminution are considered relative indications.

Question 6573

Topic: Upper Extremity Trauma

During a coracoclavicular (CC) ligament reconstruction for a chronic Type V acromioclavicular joint separation, the surgeon must recreate the anatomical footprints. Which of the following accurately describes the native CC ligament anatomy?

. The conoid ligament is anterolateral to the trapezoid ligament
. The trapezoid ligament inserts approximately 4.5 cm from the distal clavicle
. The conoid ligament is located posteromedial to the trapezoid ligament
. The trapezoid ligament inserts into the base of the coracoid process
. Both ligaments merge into a single insertion on the acromion

Correct Answer & Explanation

. The conoid ligament is located posteromedial to the trapezoid ligament

Explanation

The conoid ligament is located posteromedial to the trapezoid ligament and inserts approximately 4.5 cm medial to the distal end of the clavicle. The trapezoid is anterolateral and inserts approximately 3 cm medial to the distal clavicle.

Question 6574

Topic: 2. Trauma

A 78-year-old female with long-standing rheumatoid arthritis sustains a severely comminuted intra-articular distal humerus fracture. Her bone quality is exceptionally poor. What is the preferred surgical treatment to maximize her early functional outcome?

. Closed reduction and percutaneous pinning
. Open reduction and internal fixation with dual orthogonal plates
. Total elbow arthroplasty
. Hemiarthroplasty of the distal humerus
. Olecranon osteotomy and tension band wiring

Correct Answer & Explanation

. Total elbow arthroplasty

Explanation

Total elbow arthroplasty is the preferred treatment for comminuted, intra-articular distal humerus fractures in elderly patients with pre-existing inflammatory arthritis and poor bone quality, allowing for immediate postoperative range of motion.

Question 6575

Topic: 2. Trauma

A patient presents with an anteromedial facet fracture of the coronoid process. This specific fracture pattern is the hallmark of varus posteromedial rotatory instability (VPMRI) of the elbow. Which ligamentous complex is consistently injured and requires evaluation in this setting?

. Anterior bundle of the medial collateral ligament (AMCL)
. Posterior bundle of the medial collateral ligament (PMCL)
. Lateral collateral ligament (LCL) complex
. Annular ligament
. Quadrate ligament

Correct Answer & Explanation

. Lateral collateral ligament (LCL) complex

Explanation

Anteromedial facet fractures of the coronoid are pathognomonic for varus posteromedial rotatory instability (VPMRI). This injury mechanism inherently involves a disruption of the lateral collateral ligament (LCL) complex, specifically avulsing from the lateral epicondyle.

Question 6576

Topic: Upper Extremity Trauma

A 40-year-old man underwent excision of a comminuted radial head fracture 6 weeks ago. He now presents with progressive ulnar-sided wrist pain and weakness. Radiographs demonstrate proximal migration of the radius. This complication is a result of an unrecognized injury to which structure?

. Triangular fibrocartilage complex (TFCC)
. Interosseous membrane
. Annular ligament
. Lateral ulnar collateral ligament
. Scapholunate interosseous ligament

Correct Answer & Explanation

. Interosseous membrane

Explanation

Proximal migration of the radius following radial head excision indicates an unrecognized disruption of the interosseous membrane, known as an Essex-Lopresti lesion. This results in longitudinal radioulnar dissociation and requires radial head replacement.

Question 6577

Topic: 2. Trauma
A 7-year-old boy sustains a Bado Type III Monteggia fracture-dislocation (lateral dislocation of the radial head with proximal ulnar fracture). Which of the following neurologic injuries is most commonly associated with this specific fracture pattern?
. Median nerve neurapraxia
. Ulnar nerve neurapraxia
. Posterior interosseous nerve (PIN) palsy
. Anterior interosseous nerve (AIN) palsy
. Musculocutaneous nerve palsy

Correct Answer & Explanation

. Posterior interosseous nerve (PIN) palsy

Explanation

Posterior interosseous nerve (PIN) palsy is the most common neurologic deficit associated with Monteggia fracture-dislocations, and it is particularly prevalent in Bado Type III (anterolateral/lateral radial head dislocation) injuries.

Question 6578

Topic: 2. Trauma

During open reduction and internal fixation of a Galeazzi fracture, rigid anatomic fixation of the radius has been achieved. What is the most appropriate intraoperative method to assess the stability of the distal radioulnar joint (DRUJ)?

. Ballottement of the lunate
. Assessment of ulnar head translation during full pronation and supination
. Application of an axial load to the radial shaft
. Varus stress testing of the elbow
. Obtaining a clenched fist radiograph

Correct Answer & Explanation

. Assessment of ulnar head translation during full pronation and supination

Explanation

Following stabilization of the radius in a Galeazzi fracture, the DRUJ must be evaluated. This is done by ranging the forearm through full supination and pronation while manually assessing for excessive anteroposterior translation of the ulnar head.

Question 6579

Topic: 2. Trauma

In the surgical management of a 'terrible triad' injury of the elbow, which of the following structures is typically repaired last to ensure adequate stability?

. Coronoid fracture
. Radial head
. Lateral collateral ligament (LCL)
. Medial collateral ligament (MCL)
. Anterior capsule

Correct Answer & Explanation

. Radial head

Explanation

The standard surgical algorithm for a terrible triad injury proceeds from deep to superficial: fixing the coronoid, then the radial head, and finally the LCL complex. The MCL is only repaired if the elbow remains unstable after LCL repair.

Question 6580

Topic: Upper Extremity Trauma
In an unreduced Type III acromioclavicular (AC) joint separation, which of the following ligaments provides the primary restraint against superior translation of the clavicle?
. Acromioclavicular ligaments
. Coracoacromial ligament
. Conoid ligament
. Trapezoid ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The conoid and trapezoid comprise the coracoclavicular (CC) ligaments. The conoid ligament is located posteromedially and acts as the primary restraint to superior translation of the clavicle.

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