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2. Trauma MCQs

Practice Set 332 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 6621

Topic: 2. Trauma

Which of the following accurately describes the fundamental biomechanical principle of a locked plating construct when compared to a conventional non-locked compression plate?

. It relies entirely on friction between the plate and bone for stability
. It severely increases periosteal blood supply disruption
. It functions as a single fixed-angle construct independent of plate-to-bone contact
. It requires perfect anatomic contouring to the bone to maintain fracture reduction
. It utilizes a higher screw thread pitch to improve cortical bone purchase

Correct Answer & Explanation

. It functions as a single fixed-angle construct independent of plate-to-bone contact

Explanation

Locked plating systems function as fixed-angle constructs because the screw heads lock directly into the threaded holes of the plate. This design eliminates the requirement for plate-to-bone friction, preserving the periosteal blood supply and negating the need for exact plate contouring.

Question 6622

Topic: 2. Trauma

During a lateral approach to the fibula for a distal third fracture, the surgeon identifies the intermuscular septum between the lateral and anterior compartments. Which nerve resides immediately deep to the fascia in the anterior compartment, traveling with the anterior tibial artery?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Deep peroneal nerve

Explanation

The deep peroneal nerve travels in the anterior compartment of the leg alongside the anterior tibial artery. It runs immediately deep to the extensor digitorum longus and tibialis anterior muscles.

Question 6623

Topic: 2. Trauma

When performing a two-incision four-compartment fasciotomy of the leg, the lateral incision is used to release the anterior and lateral compartments. The surgeon must identify and protect the superficial peroneal nerve. What is the anatomic course of this nerve relative to the muscular compartments?

. It courses within the anterior compartment and pierces the interosseous membrane.
. It courses within the lateral compartment before piercing the crural fascia in the distal third of the leg.
. It courses within the superficial posterior compartment deep to the gastrocnemius.
. It runs immediately along the anterior aspect of the interosseous membrane.
. It courses within the deep posterior compartment and crosses medially.

Correct Answer & Explanation

. It courses within the lateral compartment before piercing the crural fascia in the distal third of the leg.

Explanation

The superficial peroneal nerve courses within the lateral compartment of the leg, supplying the peroneus longus and brevis. It typically pierces the crural fascia in the distal third of the leg to provide sensory innervation to the dorsum of the foot.

Question 6624

Topic: 2. Trauma

During a four-compartment fasciotomy for acute compartment syndrome of the leg, the deep posterior compartment must be adequately released. Which of the following muscles is NOT contained within the deep posterior compartment?

. Flexor hallucis longus
. Flexor digitorum longus
. Tibialis posterior
. Popliteus
. Plantaris

Correct Answer & Explanation

. Plantaris

Explanation

The deep posterior compartment of the leg contains the tibialis posterior, flexor hallucis longus, flexor digitorum longus, and popliteus muscles. The plantaris is located in the superficial posterior compartment alongside the gastrocnemius and soleus.

Question 6625

Topic: Pelvic & Acetabular Trauma

During an anterior intrapelvic (modified Stoppa) approach to the acetabulum, the obturator nerve is visualized before it exits the pelvis. In relation to the deep pelvic musculature, what is the expected path of the obturator nerve as it heads toward the obturator canal?

. Superficial to the obturator internus fascia
. Between the obturator internus and levator ani
. Above the superior gemellus
. Inferior to the piriformis
. Piercing directly through the obturator externus

Correct Answer & Explanation

. Superficial to the obturator internus fascia

Explanation

Within the true pelvis, the obturator nerve courses along the lateral pelvic wall, running superficial to the obturator internus fascia, before exiting the pelvis via the obturator canal to enter the medial thigh.

Question 6626

Topic: 2. Trauma

During a posterior approach to the humerus for fracture plating, the radial nerve is identified in the spiral groove. At approximately what distance proximal to the olecranon fossa does the nerve cross the posterior humerus?

. 5 to 7 cm
. 10 to 12 cm
. 14 to 15 cm
. 18 to 20 cm
. 22 to 25 cm

Correct Answer & Explanation

. 14 to 15 cm

Explanation

The radial nerve lies in the spiral groove, crossing the posterior humerus from medial to lateral approximately 14 to 15 cm proximal to the olecranon fossa and 20 cm proximal to the medial epicondyle.

Question 6627

Topic: Upper Extremity Trauma

The anterior bundle of the medial collateral ligament (AMCL) of the elbow is the primary restraint to valgus stress. Where is its primary insertion on the proximal ulna?

. Olecranon tip
. Sublime tubercle
. Supinator crest
. Coronoid tip
. Radial notch

Correct Answer & Explanation

. Sublime tubercle

Explanation

The anterior bundle of the elbow MCL originates on the anteroinferior aspect of the medial epicondyle and inserts on the sublime tubercle of the proximal ulna.

Question 6628

Topic: 2. Trauma

A 45-year-old man undergoes a fasciotomy for chronic exertional compartment syndrome of the lateral leg. During the procedure, a nerve that pierces the deep fascia to become subcutaneous is at high risk of injury. Approximately where does this nerve typically exit the deep fascia?

. 10 to 12 cm proximal to the lateral malleolus
. 2 to 3 cm proximal to the lateral malleolus
. Posterior to the fibular head
. Between the medial and lateral heads of the gastrocnemius
. At the level of the anterior ankle joint

Correct Answer & Explanation

. 10 to 12 cm proximal to the lateral malleolus

Explanation

The superficial peroneal nerve typically pierces the deep fascia of the lateral compartment approximately 10 to 12 cm proximal to the tip of the lateral malleolus. It then divides into medial and intermediate dorsal cutaneous nerves to supply sensation to the dorsum of the foot.

Question 6629

Topic: 2. Trauma

A patient undergoes a four-compartment fasciotomy of the leg. The deep posterior compartment is released to decompress its contents. Which of the following neurovascular structures is contained within the deep posterior compartment?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Peroneal artery
. Saphenous nerve

Correct Answer & Explanation

. Peroneal artery

Explanation

The deep posterior compartment of the leg contains the tibialis posterior, flexor hallucis longus, and flexor digitorum longus muscles. It also encases the posterior tibial and peroneal arteries along with the tibial nerve.

Question 6630

Topic: 2. Trauma

The blood supply to the scaphoid predominantly enters at which location, making proximal pole fractures particularly susceptible to nonunion?

. Volar aspect of the proximal pole
. Dorsal ridge at the waist of the scaphoid
. Volar aspect of the distal pole
. Scapholunate interosseous ligament
. Radioscaphocapitate ligament

Correct Answer & Explanation

. Dorsal ridge at the waist of the scaphoid

Explanation

Approximately 70% to 80% of the scaphoid's blood supply is retrograde, entering through the dorsal ridge at the waist via branches of the radial artery. Proximal pole fractures disrupt this flow, leading to a high rate of avascular necrosis and nonunion.

Question 6631

Topic: 2. Trauma

A patient sustains a high-energy distal tibia fracture. During a minimally invasive percutaneous plate osteosynthesis (MIPPO) via an anterolateral approach, which nerve is most at risk of iatrogenic injury as it pierces the deep fascia of the leg?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve pierces the deep fascia of the lateral compartment approximately 10 to 12 cm proximal to the lateral malleolus. It crosses the anterolateral distal tibia, making it highly vulnerable during percutaneous anterolateral plating.

Question 6632

Topic: 2. Trauma

A 28-year-old runner presents with chronic exertional compartment syndrome requiring fasciotomy of the lateral leg compartment. During the fascial release, which nerve is at greatest risk of iatrogenic injury as it exits the deep fascia to become subcutaneous in the distal third of the leg?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve courses within the lateral compartment of the leg and pierces the crural fascia to become subcutaneous approximately 10-12 cm proximal to the lateral malleolus. It is at high risk of iatrogenic injury during lateral compartment fasciotomies or the placement of anterolateral ankle arthroscopy portals.

Question 6633

Topic: 2. Trauma

A patient develops compartment syndrome of the leg following a highly comminuted tibial shaft fracture. Decompression of the deep posterior compartment is essential. Which muscle is located within this specific compartment?

. Gastrocnemius
. Soleus
. Tibialis anterior
. Flexor hallucis longus
. Peroneus brevis

Correct Answer & Explanation

. Flexor hallucis longus

Explanation

The deep posterior compartment of the leg contains the tibialis posterior, flexor hallucis longus (FHL), and flexor digitorum longus (FDL).

Question 6634

Topic: 2. Trauma

During a fasciotomy for acute compartment syndrome of the leg, a double-incision technique is used. Which nerve is most at risk of injury during the distal extent of the lateral incision used to decompress the anterior and lateral compartments?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve exits the lateral compartment to become subcutaneous in the distal third of the leg, placing it at significant risk of iatrogenic injury during the distal portion of a lateral fasciotomy incision.

Question 6635

Topic: 2. Trauma

When placing an iliosacral screw for a zone II sacral fracture, the surgeon must aim to keep the screw within the "safe zone" of the S1 vertebral body. The superior boundary of this safe zone is defined by which structure?

. L5 nerve root
. S1 nerve root
. S2 nerve root
. Sacral ala
. Iliac vessels

Correct Answer & Explanation

. L5 nerve root

Explanation

The upper boundary of the S1 safe zone for iliosacral screw placement is the L5 nerve root, which courses over the sacral ala. The anterior boundary is the iliac vessels, and the inferior boundary is the S1 neuroforamen.

Question 6636

Topic: 2. Trauma

During a four-compartment fasciotomy of the leg for compartment syndrome, failure to adequately release the deep posterior compartment is a common cause of poor outcomes. Which nerve courses within this compartment and is at risk if ischemia persists?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Tibial nerve

Explanation

The tibial nerve runs within the deep posterior compartment of the leg alongside the posterior tibial vessels. Ischemia in this compartment leads to weakness in toe flexion and loss of plantar sensation.

Question 6637

Topic: 2. Trauma

A 30-year-old male undergoes a fasciotomy for acute compartment syndrome of the leg. The deep posterior compartment is released. Which of the following structures is found within this compartment?

. Superficial peroneal nerve
. Tibial nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve

Correct Answer & Explanation

. Tibial nerve

Explanation

The deep posterior compartment of the leg contains the tibialis posterior, flexor digitorum longus, flexor hallucis longus, and the tibial nerve.

Question 6638

Topic: 2. Trauma

A surgeon is fixing a displaced scaphoid waist fracture using a volar approach. Blood supply to the scaphoid is primarily provided by branches of which artery?

. Ulnar artery
. Anterior interosseous artery
. Radial artery
. Deep palmar arch
. Superficial palmar arch

Correct Answer & Explanation

. Radial artery

Explanation

The scaphoid is predominantly supplied by dorsal branches of the radial artery, which enter distally and flow in a retrograde fashion.

Question 6639

Topic: Upper Extremity Trauma

During reconstruction of the coracoclavicular (CC) ligaments for an acromioclavicular joint separation, anatomic placement is crucial. Which of the following best describes the normal anatomic orientation of the CC ligaments?

. The conoid ligament is lateral and anterior to the trapezoid ligament
. The conoid ligament is medial and posterior to the trapezoid ligament
. The trapezoid ligament is medial and posterior to the conoid ligament
. The trapezoid ligament is medial and anterior to the conoid ligament
. The conoid and trapezoid ligaments share a single footprint on the clavicle

Correct Answer & Explanation

. The conoid ligament is medial and posterior to the trapezoid ligament

Explanation

The conoid ligament attaches posteromedially on the clavicle at the conoid tubercle, acting primarily to resist superior displacement. The trapezoid ligament attaches anterolaterally on the trapezoid line and resists axial compression.

Question 6640

Topic: Upper Extremity Trauma

Superior capsular reconstruction (SCR) is considered for younger patients with massive, irreparable posterosuperior rotator cuff tears. The primary biomechanical goal of this procedure is to prevent which of the following?

. Anterior translation of the humeral head
. Superior migration of the humeral head
. Posterior subluxation of the humeral head
. Acromioclavicular joint arthritis
. Inferior displacement of the glenoid

Correct Answer & Explanation

. Superior migration of the humeral head

Explanation

Superior capsular reconstruction utilizes a graft to replace the deficient superior capsule. The primary biomechanical goal is to depress the humeral head, preventing superior migration and restoring normal glenohumeral kinematics to allow the deltoid to function effectively.

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