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2. Trauma MCQs

Practice Set 33 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 641

Topic: 2. Trauma
In the treatment of a displaced vertical femoral neck fracture (Pauwels type III) in a 30-year-old patient, which internal fixation construct provides the most biomechanical stability against shear forces?
. Three parallel cancellous screws placed in an inverted triangle
. Dynamic hip screw with a derotational screw
. Proximal femoral nail
. Two parallel cancellous screws
. A single large-diameter fully threaded screw

Correct Answer & Explanation

. Dynamic hip screw with a derotational screw

Explanation

A sliding hip screw (DHS) with an anti-rotation screw provides superior biomechanical stability against the high shear forces seen in vertical (Pauwels III) femoral neck fractures compared to multiple parallel cancellous screws.

Question 642

Topic: Pelvic & Acetabular Trauma
In an anteroposterior compression type III (APC-III) pelvic ring injury, which of the following ligamentous structures is completely disrupted, distinguishing it from an APC-II injury?
. Symphyseal ligaments
. Sacrospinous ligament
. Anterior sacroiliac ligament
. Posterior sacroiliac ligament
. Iliolumbar ligament

Correct Answer & Explanation

. Posterior sacroiliac ligament

Explanation

An APC-II injury involves disruption of the symphysis, anterior SI, sacrospinous, and sacrotuberous ligaments but leaves the posterior SI ligaments intact. An APC-III injury includes complete disruption of the posterior SI ligaments, causing complete global pelvic instability.

Question 643

Topic: 2. Trauma
According to the Gustilo-Anderson classification, an open tibial shaft fracture with a 12 cm laceration, extensive soft tissue stripping, but adequate periosteal coverage of the bone fragment is classified as:
. Type II
. Type IIIA
. Type IIIB
. Type IIIC
. Type IV

Correct Answer & Explanation

. Type IIIA

Explanation

A Type IIIA open fracture involves extensive soft tissue damage (usually a wound >10 cm) but maintains adequate soft tissue or periosteal coverage of the fractured bone, thereby not requiring a free tissue transfer or rotational flap.

Question 644

Topic: 2. Trauma

When evaluating a patient for acute compartment syndrome of the lower leg, which measurement parameter is considered the most reliable threshold for indicating an emergent fasciotomy?

. Absolute compartment pressure > 20 mmHg
. Absolute compartment pressure > 25 mmHg
. Delta pressure (Diastolic blood pressure - compartment pressure) < 30 mmHg
. Delta pressure (Mean arterial pressure - compartment pressure) < 40 mmHg
. Delta pressure (Systolic blood pressure - compartment pressure) < 30 mmHg

Correct Answer & Explanation

. Delta pressure (Diastolic blood pressure - compartment pressure) < 30 mmHg

Explanation

The delta pressure, defined as the diastolic blood pressure minus the intracompartmental pressure, is the most accurate diagnostic parameter for compartment syndrome. A delta pressure of less than 30 mmHg strongly indicates the need for fasciotomy.

Question 645

Topic: 2. Trauma

A 45-year-old male presents with a severely displaced intra-articular distal tibia (pilon) fracture with significant soft tissue swelling and fracture blisters. What is the most appropriate initial management to minimize soft tissue complications while awaiting definitive fixation?

. Immediate open reduction and internal fixation with plates
. Spanning external fixation and elevation
. Intramedullary nailing
. Closed reduction and long leg cast
. Primary arthrodesis

Correct Answer & Explanation

. Spanning external fixation and elevation

Explanation

High-energy pilon fractures with severe soft tissue compromise are best managed initially with a spanning external fixator and elevation. Definitive open reduction and internal fixation is typically delayed until the wrinkle sign appears, indicating reduced soft tissue swelling.

Question 646

Topic: Pelvic & Acetabular Trauma
A 40-year-old male sustains an anteroposterior compression (APC) type III pelvic ring injury after a motorcycle crash. Anteroposterior pelvic radiographs reveal a pubic symphysis diastasis of 3.5 cm and widening of the sacroiliac joints bilaterally. Which of the following ligamentous structures is completely disrupted in this specific injury pattern?
. Sacrospinous ligament only
. Sacrotuberous ligament only
. Anterior sacroiliac, sacrotuberous, sacrospinous, and posterior sacroiliac ligaments
. Anterior sacroiliac ligament only
. Posterior sacroiliac ligament only with intact anterior structures

Correct Answer & Explanation

. Anterior sacroiliac, sacrotuberous, sacrospinous, and posterior sacroiliac ligaments

Explanation

APC Type III injuries involve complete symphyseal diastasis with complete disruption of both the anterior and posterior sacroiliac ligaments, as well as the sacrotuberous and sacrospinous ligaments. This extensive ligamentous failure results in complete global instability of the hemipelvis.

Question 647

Topic: 2. Trauma

The incidence of compartment syndrome following calcaneus fracture is:

. 5%
. 10%
. 15%
. 20%
. 30%

Correct Answer & Explanation

. 10%

Explanation

In a review article by Myerson, compartment syndrome was described to occur in 10% of calcaneal fractures. Of these, half will develop clawing, stiffness, or neurologic dysfunction. Diagnosis is confirmed by multistick invasive catheterization, especially the calcaneal compartment.

Question 648

Topic: 2. Trauma

Posterior antiglide plating of AO type B lateral malleolar fractures may be associated with:

. Early loss of fixation
. Greater wound healing complications
. Syndesmotic irritation
. Peroneal tendonitis or peroneal tendon lesions
. Greater risk for nonunion

Correct Answer & Explanation

. Peroneal tendonitis or peroneal tendon lesions

Explanation

Posterior antiglide plating is associated with an increased need for hardware removal (43%) and an increased incidence of peroneal tendon lesions. The highest risk for peroneal tendon lesions was with distal placement of the plate and a protruding screw head in the most distal hole.

Question 649

Topic: 2. Trauma

Superficial peroneal nerve injury following ankle fracture:

. Does not occur with nonoperative treatment
. Can best be avoided during open reduction internal fixation with a posterolateral approach to the fibula
. Did not ultimately affect the final AOFAS ankle-hindfoot score
. Occurs in fewer than 5% of operatively fixed fibula fractures
. Can best be avoided during open reduction internal fixation with an anterolateral approach to the fibula

Correct Answer & Explanation

. Can best be avoided during open reduction internal fixation with a posterolateral approach to the fibula

Explanation

One hundred twenty patients with ankle fractures were evaluated. Symptomatic superficial peroneal nerve injury was identified in 21% of patients who underwent open reduction internal fixation and 9% of nonoperatively treated patients. AOFAS scores were decreased in patients with symptomatic superficial peroneal nerve injury. No injuries to the superficial peroneal nerve occurred in patients who underwent surgery involving a posterolateral approach to the fibula.

Question 650

Topic: 2. Trauma

Varus malunion following talar neck fracture is best corrected by:

. Subtalar arthrodesis
. Rotational calcaneal osteotomy with a bone block
. Deltoid ligament release and lateral ligament reconstruction
. Talar neck osteotomy with lengthening or by triple arthrodesis
. Lateral column lengthening

Correct Answer & Explanation

. Talar neck osteotomy with lengthening or by triple arthrodesis

Explanation

The best way to address varus malunion in talar neck fractures and maintain motion is by talar neck osteotomy. However, there is a further possible risk of talar avascular necrosis with this procedure. The other acceptable treatment is a triple arthrodesis, although this eliminates all hindfoot motion.

Question 651

Topic: 2. Trauma
Gustilo-Anderson type I and type IIA open calcaneal fractures with a medial wound can be treated:
. With initial washout and subsequent open reduction internal fixation with a lateral plate once the soft tissues and swelling have stabilized
. With initial washout and external fixation only due to the risk of osteomyelitis
. With initial washout and late reconstruction once the soft tissue has healed to address the malunion
. Washout is unnecessary for type I and IIA open calcaneal fractures
. With immediate fasciotomy

Correct Answer & Explanation

. With initial washout and subsequent open reduction internal fixation with a lateral plate once the soft tissues and swelling have stabilized

Explanation

Forty-three open calcaneal fractures were studied, showing that open reduction internal fixation with plate and screws of type I and type IIA fractures with medial wounds had outcomes similar to closed injuries. Type IIIB open calcaneal fractures should undergo early flap coverage. Early internal fixation should be avoided in these injuries due to the high rates of osteomyelitis and amputation.

Question 652

Topic: 2. Trauma

Deep infection following open reduction internal fixation (ORIF) for tibial pilon fractures is most commonly associated with:

. Open fractures
. Postoperative wound dehiscence
. Anterior incision
. Medial and lateral plating
. Low energy injury

Correct Answer & Explanation

. Postoperative wound dehiscence

Explanation

Deep infection following ORIF of pilon fractures is correlated with postoperative wound dehiscence or skin slough but not with the presence of an open fracture in a series of 60 pilon fractures treated by ORIF.

Question 653

Topic: 2. Trauma

Talar body fractures are best classified by a fracture line:

. That extends superiorly into the trochlea
. That extends anywhere posterior to the talar neck
. That extends inferiorly, posterior to the lateral process
. That extends inferiorly, anterior to the lateral process
. That extends into the talar head

Correct Answer & Explanation

. That extends inferiorly, anterior to the lateral process

Explanation

Talar neck and body fractures can be difficult to distinguish, especially when they extend superiorly into the anteromedial aspect of the trochlea. These two fractures have a different prognosis. The authors recommend classification of these fractures based on the inferior fracture line; if anterior to lateral process of the talus, then it is a neck fracture; if posterior to lateral process of the talus, then it is a body fracture.

Question 654

Topic: 2. Trauma

The plantar ecchymosis sign is:

. An indication of possible compartment syndrome
. Related to a specific bacterial infection
. An indication of possible Lisfranc fracture or sprain
. Described as a sign of plantar fascia rupture
. Requires immediate fasciotomy

Correct Answer & Explanation

. An indication of possible Lisfranc fracture or sprain

Explanation

The plantar ecchymosis sign is described as an ecchymotic area on the plantar midfoot that is indicative of possible injury to the plantar tarsometatarsal ligaments.

Question 655

Topic: 2. Trauma

Delayed unions and nonunions of base of fifth metatarsal fractures have been demonstrated to heal by:

. Prolonged cast immobilization and non-weight bearing
. Pulsed electromagnetic fields
. C ontinued use of a fracture boot with protected weight-bearing
. Injection of demineralized bone matrix
. Rigid carbon fiber shoe inserts

Correct Answer & Explanation

. Pulsed electromagnetic fields

Explanation

Nine delayed unions and nonunions of the proximal fifth metatarsal were treated with pulsed electromagnetic fields. All fractures healed in a mean of 4 months (follow-up 39 months, no refractures).

Question 656

Topic: 2. Trauma

The strongest hardware configuration for fixation of talar neck fractures is:

. Two crossed screws from distal to proximal
. Two parallel screws inserted from distal to proximal
. One large screw from posterior to anterior
. Two parallel screws from posterior to anterior
. One oblique screw from distal to proximal

Correct Answer & Explanation

. Two parallel screws inserted from distal to proximal

Explanation

Biomechanical cadaveric testing of several screw configurations showed two parallel screws from proximal to distal as the strongest fixation. The screws can be inserted either open or percutaneously. All screw configurations were stronger than K-wire configurations.

Question 657

Topic: 2. Trauma
According to Sanders computed tomography (CT) classification for calcaneus fractures, a Sanders III fracture has:
. One fracture line in the posterior facet
. Two fracture lines in the posterior facet
. Three fracture lines in the posterior facet
. Four fracture lines in the posterior facet
. Five fracture lines in the posterior facet

Correct Answer & Explanation

. Two fracture lines in the posterior facet

Explanation

The Sanders CT classification is determined on coronal CT scans of the calcaneus at the level where the posterior facet is widest. A Sanders I is a nondisplaced fracture; Sanders II consists of a single fracture line splitting the posterior facet into two main fragments; Sanders III has two fracture lines with three main posterior facet fragments; and a Sanders IV has four or more articular fragments present.

Question 658

Topic: 2. Trauma

A 35-year-old male sustains a purely ligamentous Lisfranc injury. Compared to open reduction and internal fixation (ORIF), primary arthrodesis of the first, second, and third tarsometatarsal joints is associated with:

. Higher rates of hardware removal
. Decreased rate of reoperation
. Higher rate of post-traumatic osteoarthritis
. Lower patient-reported outcome scores
. Increased risk of compartment syndrome

Correct Answer & Explanation

. Decreased rate of reoperation

Explanation

Primary arthrodesis for purely ligamentous Lisfranc injuries yields similar or superior functional outcomes compared to ORIF. It significantly decreases the need for subsequent surgeries, such as symptomatic hardware removal or salvage fusion.

Question 659

Topic: Lower Extremity Trauma

When utilizing a posteromedial approach for open reduction and internal fixation of a Schatzker IV tibial plateau fracture, the surgical interval is developed between the medial head of the gastrocnemius and which of the following structures?

. Soleus
. Pes anserinus
. Semimembranosus
. Popliteus
. Tibialis posterior

Correct Answer & Explanation

. Pes anserinus

Explanation

The posteromedial approach to the proximal tibia utilizes the interval between the pes anserinus tendons anteriorly and the medial head of the gastrocnemius posteriorly. Retracting the gastrocnemius laterally safely protects the neurovascular bundle in the popliteal fossa.

Question 660

Topic: 2. Trauma

Which of the following is the most common complication associated with dual plating of a Schatzker VI bicondylar tibial plateau fracture using a single extensile anterior incision?

. Deep vein thrombosis
. Nonunion
. Wound necrosis and deep infection
. Popliteal artery injury
. Peroneal nerve palsy

Correct Answer & Explanation

. Wound necrosis and deep infection

Explanation

Single extensile anterior incisions for bicondylar tibial plateau fractures historically have high rates of wound breakdown and infection. Contemporary management favors dual incisions or staging with a spanning external fixator to allow soft tissue recovery.

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