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2. Trauma MCQs

Practice Set 335 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 6681

Topic: 2. Trauma

A 4-year-old boy is treated with a hip spica cast for a transverse midshaft femur fracture. Which of the following describes the expected maximum amount of femoral overgrowth and the typical timeframe it peaks following the injury?

. 0.5 cm peaking at 6 months post-injury
. 1.0 cm peaking at 5 years post-injury
. 1.5 cm peaking at 18 to 24 months post-injury
. 2.5 cm peaking at 3 years post-injury
. 3.0 cm peaking at 5 years post-injury

Correct Answer & Explanation

. 1.5 cm peaking at 18 to 24 months post-injury

Explanation

Femoral overgrowth following a shaft fracture in young children averages 1 to 1.5 cm due to hyperemia stimulating the physes. This accelerated growth phase typically peaks around 18 to 24 months post-injury.

Question 6682

Topic: 2. Trauma

A 9-year-old girl weighing 48 kg (105 lbs) sustains a length-unstable, highly comminuted spiral fracture of the femoral shaft. Which of the following is the most appropriate surgical fixation method?

. Flexible titanium intramedullary nailing
. Closed reduction and spica casting
. Submuscular bridge plating
. Rigid piriformis-entry intramedullary nailing
. Skeletal traction followed by a cast brace

Correct Answer & Explanation

. Submuscular bridge plating

Explanation

Submuscular plating is ideal for length-unstable or comminuted femur fractures in older, heavier children (near 50 kg) where flexible nails have high failure rates. It preserves the fracture hematoma while providing rigid length and rotational control.

Question 6683

Topic: Pelvic & Acetabular Trauma

On an anteroposterior (AP) pelvis radiograph of a normal 6-month-old infant, the femoral head ossific nucleus should be located in the inferomedial quadrant formed by the intersection of which two radiographic lines?

. Shenton's and Perkin's lines
. Hilgenreiner's and Perkin's lines
. Klein's and Shenton's lines
. Wiberg's angle and Hilgenreiner's line
. Southwick's and Perkin's lines

Correct Answer & Explanation

. Hilgenreiner's and Perkin's lines

Explanation

Hilgenreiner's line (horizontal through triradiate cartilages) and Perkin's line (vertical from the lateral margin of the acetabulum) divide the hip into quadrants. In a normal hip, the ossific nucleus sits in the inferomedial quadrant.

Question 6684

Topic: Pelvic & Acetabular Trauma

A 4-year-old girl presents with a persistently subluxated right hip following previous treatment for DDH. A pelvic osteotomy is planned to improve anterolateral acetabular coverage. Which of the following osteotomies hinges at the triradiate cartilage and decreases the volume of the acetabulum?

. Salter osteotomy
. Pemberton osteotomy
. Steel triple osteotomy
. Chiari osteotomy
. Ganz (PAO) osteotomy

Correct Answer & Explanation

. Pemberton osteotomy

Explanation

The Pemberton osteotomy hinges at the flexible triradiate cartilage, allowing the acetabular roof to be hinged down, thus decreasing acetabular volume and improving anterolateral coverage. The Salter osteotomy hinges at the pubic symphysis and does not change acetabular volume.

Question 6685

Topic: Pelvic & Acetabular Trauma

An 18-month-old girl undergoes an open reduction for a chronically dislocated developmental dysplasia of the hip (DDH). Intraoperatively, there is significant acetabular dysplasia with a steep, shallow acetabulum. Which pelvic osteotomy is most appropriate to provide anterolateral coverage by redirecting the acetabulum without reducing its volume?

. Pemberton osteotomy
. Dega osteotomy
. Salter innominate osteotomy
. Chiari osteotomy
. Ganz periacetabular osteotomy

Correct Answer & Explanation

. Salter innominate osteotomy

Explanation

The Salter osteotomy is a complete, redirectional innominate osteotomy that hinges on the pubic symphysis, improving anterolateral coverage without changing the volume or shape of the acetabulum itself. Pemberton and Dega are incomplete, volume-reducing osteotomies.

Question 6686

Topic: Pelvic & Acetabular Trauma

A 4-year-old girl with residual acetabular dysplasia requires a pelvic osteotomy. The surgeon plans an incomplete transiliac osteotomy that hinges on the triradiate cartilage to decrease the volume and change the shape of the acetabulum. Which procedure is being described?

. Salter osteotomy
. Pemberton osteotomy
. Steel triple osteotomy
. Chiari osteotomy
. Bernese periacetabular osteotomy (PAO)

Correct Answer & Explanation

. Pemberton osteotomy

Explanation

The Pemberton osteotomy hinges on the open triradiate cartilage, allowing the surgeon to reshape the acetabulum and reduce its volume. In contrast, the Salter osteotomy hinges on the pubic symphysis and redirects the entire acetabular segment without altering its shape.

Question 6687

Topic: 2. Trauma

An 11-year-old basketball player reports that he felt a painful pop in the left knee when he stumbled while running. He is unable to bear weight on the extremity and cannot actively extend the knee against gravity. Examination reveals a large knee effusion. A lateral radiograph is shown in Figure 7. Management should consist of

. physical therapy for quadriceps strengthening exercises.
. a long leg cast with the knee fully extended.
. excision of the fragment.
. suture reattachment of the patellar tendon to the tibial tuberosity.
. open reduction and tension band fixation.

Correct Answer & Explanation

. open reduction and tension band fixation.

Explanation

The radiograph shows an avulsion fracture, or "sleeve fracture," of the distal pole of the patella. The distal fragment is much larger than it appears on the radiograph because it largely consists of cartilage; therefore, excision of the fragment is contraindicated. The treatment of choice is open reduction and tension band fixation to correct patella alta and restore the extensor mechanism. Maguire JK, Canale ST: Fractures of the patella in children and adolescents. J Pediatr Orthop 1993;13:567-571.

Question 6688

Topic: 2. Trauma

A 45-year-old man presents with progressive numbness in his ring and small fingers and weakness in hand grip. He reports a history of an elbow fracture as a young child that was treated in a cast. Radiographs reveal a severe cubitus valgus deformity. Which of the following pediatric injuries is most likely responsible for his current presentation?

. Nonunion of a lateral condyle fracture
. Malunion of a supracondylar humerus fracture
. Untreated medial epicondyle fracture
. Radial neck fracture
. Monteggia fracture-dislocation

Correct Answer & Explanation

. Nonunion of a lateral condyle fracture

Explanation

Nonunion of a lateral condyle fracture leads to a progressive cubitus valgus deformity. Over time, this causes stretch on the ulnar nerve, presenting decades later as tardy ulnar nerve palsy.

Question 6689

Topic: 2. Trauma

A 5-year-old child sustains a displaced lateral condyle fracture of the humerus that is missed and subsequently goes on to nonunion. Years later, which of the following is the most likely late clinical complication?

. Cubitus varus
. Cubitus valgus and tardy ulnar nerve palsy
. Radioulnar synostosis
. Radial nerve palsy
. Anterior interosseous nerve palsy

Correct Answer & Explanation

. Cubitus valgus and tardy ulnar nerve palsy

Explanation

Nonunion of a lateral condyle fracture typically results in a progressive cubitus valgus deformity. Over time, the valgus stretching of the medial elbow structures can lead to a tardy ulnar nerve palsy.

Question 6690

Topic: 2. Trauma

A 3-year-old girl sustains an isolated, closed spiral fracture of the middle third of the femoral shaft with 1.5 cm of shortening. What is the most appropriate definitive management?

. Pavlik harness application
. Early spica casting
. Flexible intramedullary nailing
. Rigid locked intramedullary nailing
. Plate osteosynthesis

Correct Answer & Explanation

. Early spica casting

Explanation

Early spica casting is the standard of care for isolated femoral shaft fractures in children aged 6 months to 5 years with acceptable shortening (< 2 cm). Flexible nailing is typically reserved for older children (ages 5-11).

Question 6691

Topic: 2. Trauma

An 11-year-old boy sustains a proximal humerus fracture with 60% translation. Management consists of a sling and observation due to the tremendous remodeling potential of this region. Approximately what percentage of longitudinal growth of the entire humerus is contributed by the proximal humeral physis?

. 20%
. 40%
. 60%
. 80%
. 100%

Correct Answer & Explanation

. 80%

Explanation

The proximal humerus physis contributes approximately 80% to the longitudinal growth of the humerus. This significant growth contribution explains the massive remodeling potential in children, allowing nonoperative treatment for highly displaced fractures.

Question 6692

Topic: 2. Trauma

A 5-year-old child sustains a displaced lateral condyle fracture of the distal humerus.

Following appropriate treatment with open reduction and internal fixation with pins, which of the following is the most common long-term complication?

. Nonunion
. Cubitus varus
. Lateral condylar overgrowth (spurring)
. Avascular necrosis of the trochlea
. Tardy ulnar nerve palsy

Correct Answer & Explanation

. Lateral condylar overgrowth (spurring)

Explanation

Lateral condylar overgrowth (spurring) is the most common complication following both operative and nonoperative treatment of lateral condyle fractures. Nonunion is a severe complication but is less common when appropriate operative reduction and fixation are achieved.

Question 6693

Topic: 2. Trauma

A 9-year-old boy weighing 110 lbs (50 kg) sustains a severely comminuted, length-unstable midshaft femoral fracture in a motor vehicle collision. Which of the following is the most appropriate definitive management?

. Immediate hip spica cast
. Titanium elastic nailing (TENs)
. Submuscular bridge plating
. External fixation
. Traction for 4 weeks followed by casting

Correct Answer & Explanation

. Submuscular bridge plating

Explanation

For pediatric patients older than 5 years and weighing more than 45 kg (100 lbs), titanium elastic nails have a high failure rate, especially in length-unstable patterns. Submuscular plating or a rigid lateral-entry intramedullary nail are the treatments of choice.

Question 6694

Topic: 2. Trauma

A 13-year-old boy sustains a midshaft both-bone forearm fracture. What is the maximum acceptable angular deformity in the sagittal plane to consider nonoperative management with a cast in this age group?

. < 10 degrees
. < 15 degrees
. < 20 degrees
. < 25 degrees
. < 30 degrees

Correct Answer & Explanation

. < 10 degrees

Explanation

In children older than 10 years, remodeling potential is significantly decreased. The acceptable angulation for a midshaft both-bone forearm fracture in this age group is typically less than 10 degrees.

Question 6695

Topic: 2. Trauma
A 6-year-old child sustains an isolated fracture of the proximal third of the 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

The Bado classification categorizes Monteggia fractures based on the direction of the radial head dislocation. Type I is anterior, Type II is posterior, Type III is lateral, and Type IV involves fractures of both the radius and ulna with an anterior radial head dislocation.

Question 6696

Topic: 2. Trauma

A 6-year-old boy presents with a completely displaced supracondylar humerus fracture. Upon examination, his hand is warm and pink, but the radial pulse is not palpable. What is the most appropriate initial management?

. Immediate exploration of the brachial artery
. Closed reduction and percutaneous pinning
. Arteriography to localize the arterial injury
. Observation and admission for compartment syndrome
. Open reduction and internal fixation

Correct Answer & Explanation

. Closed reduction and percutaneous pinning

Explanation

The initial management of a pink, pulseless hand associated with a supracondylar humerus fracture is urgent closed reduction and percutaneous pinning. Vascular status often returns to normal once the fracture is anatomically reduced and pinned.

Question 6697

Topic: 2. Trauma

A 5-year-old girl sustains a lateral condyle fracture of the humerus. Radiographs show 4 mm of displacement. What is the most common complication if this injury is treated with cast immobilization alone?

. Cubitus varus
. Nonunion
. Avascular necrosis of the trochlea
. Premature physeal closure
. Compartment syndrome

Correct Answer & Explanation

. Nonunion

Explanation

Lateral condyle fractures displaced >2 mm are highly prone to nonunion if treated non-operatively due to the pull of the common extensor origin and bathing of the fracture in synovial fluid. Operative fixation is indicated for displacement >2 mm.

Question 6698

Topic: 2. Trauma

A 3-year-old boy sustains a completely displaced, isolated midshaft femur fracture after a fall from a low playground structure. What is the most appropriate definitive management?

. Pavlik harness
. Early spica casting
. Flexible intramedullary nailing
. Rigid reamed intramedullary nailing
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 6 months to 5 years with an isolated femoral shaft fracture and less than 2 cm of shortening, early spica casting is the standard of care. Flexible intramedullary nails are typically reserved for older children, generally aged 5 to 11 years.

Question 6699

Topic: 2. Trauma

A 9-year-old boy falls on an outstretched hand and sustains a radial neck fracture. Which of the following is considered the upper limit of acceptable angulation for non-operative management in this age group?

. 15 degrees
. 30 degrees
. 45 degrees
. 60 degrees
. 75 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

In older children (around 10 years of age), up to 30 degrees of angulation is acceptable for radial neck fractures. In younger children, up to 45 degrees may remodel adequately, but 30 degrees is a standard threshold for intervention in a 9-year-old.

Question 6700

Topic: 2. Trauma

A 6-year-old boy sustains a midshaft both-bone forearm fracture. Which of the following fracture parameters has the LEAST potential for spontaneous remodeling?

. Volar angulation
. Dorsal angulation
. Rotational malalignment
. Bayonet apposition
. Metaphyseal translation

Correct Answer & Explanation

. Rotational malalignment

Explanation

In pediatric forearm fractures, rotational malalignment does not remodel significantly and must be corrected during reduction. Angulation in the plane of joint motion and bayonet apposition remodel very well in children under the age of 10.

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