Menu

2. Trauma MCQs

Practice Set 348 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 6941

Topic: 2. Trauma

A 35-year-old man sustains a high-energy, closed tibial pilon fracture. At presentation, there is massive soft tissue swelling and multiple clear fracture blisters over the medial ankle. What is the most appropriate initial orthopaedic management?

. Immediate definitive open reduction and internal fixation with dual plating
. Application of a spanning external fixator and delayed definitive fixation
. Primary below-knee amputation
. Closed reduction and application of a rigid fiberglass cast
. Immediate intramedullary nailing of the tibia

Correct Answer & Explanation

. Application of a spanning external fixator and delayed definitive fixation

Explanation

High-energy pilon fractures are frequently associated with severe soft tissue compromise. Standard of care involves initial application of a spanning external fixator, delaying definitive ORIF until soft tissues recover and the "wrinkle sign" appears.

Question 6942

Topic: 2. Trauma

When utilizing lag screws for the internal fixation of a transverse medial malleolus fracture, what is the optimal trajectory of the screws to maximize interfragmentary compression and avoid articular penetration?

. Parallel to the tibiotalar joint surface
. Perpendicular to the primary fracture line
. Directed inferiorly towards the medial clear space
. Directed horizontally to capture the anterior colliculus only
. Directed laterally into the fibular medullary canal

Correct Answer & Explanation

. Perpendicular to the primary fracture line

Explanation

According to AO principles of fracture management, lag screws provide maximum interfragmentary compression when inserted exactly perpendicular to the fracture plane. Directing them parallel to the joint runs the risk of poor compression or joint penetration depending on the fracture angle.

Question 6943

Topic: 2. Trauma

A 42-year-old roofer falls from a ladder and sustains a displaced intra-articular calcaneus fracture

. According to the Sanders classification, which of the following radiographic views is primary for determining the grade of the fracture?

. Lateral radiograph
. Coronal CT scan
. Harris axial view
. Sagittal CT scan
. Broden's view

Correct Answer & Explanation

. Coronal CT scan

Explanation

The Sanders classification of calcaneus fractures is based on the number and location of articular fracture lines through the posterior facet. This is best visualized and graded on the coronal CT image.

Question 6944

Topic: 2. Trauma

A 50-year-old male presents with a high-energy closed pilon fracture accompanied by severe soft tissue swelling, fracture blisters, and skin tenting. What is the most appropriate initial management step?

. Immediate open reduction and internal fixation of the tibia and fibula
. Spanning external fixation and delayed open reduction of the tibia
. Closed reduction and long leg casting
. Immediate intramedullary nailing of the tibia
. Primary arthrodesis of the tibiotalar joint

Correct Answer & Explanation

. Spanning external fixation and delayed open reduction of the tibia

Explanation

High-energy pilon fractures with severe soft tissue compromise require staged management. Temporary spanning external fixation allows soft tissues to recover before definitive internal fixation is performed, typically 10 to 21 days later.

Question 6945

Topic: 2. Trauma

A 28-year-old male undergoes ORIF for a displaced talar neck fracture. At 8 weeks postoperatively, an AP radiograph shows a subchondral radiolucent band in the talar dome. What does this finding indicate?

. Impending avascular necrosis of the talus
. Revascularization and intact blood supply to the talus
. Nonunion of the talar neck
. Osteomyelitis of the talar dome
. Rapidly progressive chondrolysis

Correct Answer & Explanation

. Revascularization and intact blood supply to the talus

Explanation

Hawkins sign is a subchondral radiolucent band in the talar dome seen 6-8 weeks post-injury. It represents subchondral atrophy from disuse in the presence of an intact blood supply, effectively ruling out avascular necrosis.

Question 6946

Topic: 2. Trauma

A 30-year-old male presents with a severely deformed ankle following a twisting injury. Closed reduction in the emergency department is unsuccessful. Radiographs show a posterior fracture-dislocation of the fibula behind the posterior tubercle of the distal tibia. What is the most likely diagnosis?

. Maisonneuve fracture
. Tillaux fracture
. Bosworth fracture-dislocation
. Wagstaffe-Le Fort fracture
. Cotton fracture

Correct Answer & Explanation

. Bosworth fracture-dislocation

Explanation

A Bosworth fracture-dislocation occurs when the proximal fragment of the fibula becomes irreducibly entrapped behind the posterior tubercle of the distal tibia. It strictly requires open reduction.

Question 6947

Topic: 2. Trauma

A 60-year-old patient with poorly controlled diabetes mellitus and severe peripheral neuropathy sustains a bimalleolar ankle fracture. To prevent fixation failure and Charcot arthropathy, what modification to standard surgical technique is recommended?

. Use of bioabsorbable screws to reduce infection risk
. Immediate full weight-bearing postoperatively to stimulate healing
. Use of robust fixation (e.g., multiple syndesmotic screws) and prolonged non-weight-bearing
. Single lag screw fixation of the fibula without a neutralization plate
. Primary subtalar arthrodesis

Correct Answer & Explanation

. Use of robust fixation (e.g., multiple syndesmotic screws) and prolonged non-weight-bearing

Explanation

Diabetic patients with neuropathy are at high risk for hardware failure, malunion, and Charcot arthropathy. Maximizing fixation strength (using multiple syndesmotic screws or stronger plates) and extending the non-weight-bearing period are critical.

Question 6948

Topic: 2. Trauma

A 38-year-old male complains of anterior ankle impingement and difficulty fitting into standard shoes 2 years after conservative treatment of a calcaneus fracture. Which of the following best describes the typical components of a calcaneal malunion?

. Increased heel height, varus angulation, and decreased width
. Decreased heel height, varus angulation, and increased width
. Increased heel height, valgus angulation, and increased width
. Decreased heel height, valgus angulation, and decreased width
. Cavus deformity with severe hindfoot valgus

Correct Answer & Explanation

. Decreased heel height, varus angulation, and increased width

Explanation

Calcaneal malunions characteristically present with a loss of heel height (causing anterior tibiotalar impingement), increased heel width (causing subfibular impingement), and varus deformity of the tuberosity.

Question 6949

Topic: 2. Trauma

A 35-year-old roofer falls and sustains an isolated vertical fracture of the medial malleolus. Which of the following Lauge-Hansen injury mechanisms is most likely responsible for this specific fracture pattern?

. Supination-External Rotation
. Pronation-External Rotation
. Supination-Adduction
. Pronation-Abduction
. Pronation-Adduction

Correct Answer & Explanation

. Supination-Adduction

Explanation

A vertical fracture of the medial malleolus is the hallmark of a Supination-Adduction (SAD) stage 2 injury. The talus impacts the medial malleolus, causing a vertical shear fracture, which is best treated biomechanically with an anti-glide plate.

Question 6950

Topic: Lower Extremity Trauma

When evaluating an ankle mortise radiograph for a suspected syndesmotic injury, the medial clear space (MCS) is a critical parameter. Which of the following conditions definitively describes an abnormal medial clear space indicative of deep deltoid ligament disruption?

. MCS > 2 mm
. MCS > 4 mm, or greater than the superior clear space
. MCS > tibiofibular clear space
. MCS > 6 mm with external rotation stress only
. MCS > tibiofibular overlap

Correct Answer & Explanation

. MCS > 4 mm, or greater than the superior clear space

Explanation

A medial clear space of greater than 4 mm, or an MCS that is wider than the superior clear space between the talar dome and tibial plafond, is considered abnormal and highly suggestive of a deep deltoid ligament tear and syndesmotic instability.

Question 6951

Topic: 2. Trauma

A 28-year-old marathon runner presents with vague, aching dorsal midfoot pain. A T1-weighted MRI reveals a linear hypointense signal in the central third of the navicular body consistent with a stress fracture. There is no displacement or cystic changes. What is the recommended initial management?

. Weight-bearing as tolerated in a stiff-soled shoe
. Weight-bearing in a CAM boot for 4 weeks
. Non-weight-bearing in a short leg cast for 6 to 8 weeks
. Immediate percutaneous screw fixation
. Extracorporeal shock wave therapy

Correct Answer & Explanation

. Non-weight-bearing in a short leg cast for 6 to 8 weeks

Explanation

The navicular is a high-risk stress fracture due to its watershed blood supply in the central third. The standard of care for a non-displaced navicular stress fracture without cystic changes is strict non-weight-bearing in a cast for 6 to 8 weeks.

Question 6952

Topic: 2. Trauma

Which of the following descriptions best localizes a true Jones fracture, which is known for its high risk of nonunion?

. Avulsion fracture at the insertion of the peroneus brevis
. Fracture at the metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal articulation
. Fracture of the proximal diaphyseal region distal to the fourth-fifth intermetatarsal articulation
. Intra-articular fracture of the base of the fifth metatarsal entering the cuboid articulation
. Stress fracture of the distal third of the fifth metatarsal shaft

Correct Answer & Explanation

. Fracture at the metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal articulation

Explanation

A true Jones fracture occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal and must involve the fourth-fifth intermetatarsal articulation (Zone 2). Fractures distal to this are diaphyseal stress fractures (Zone 3), and proximal are tuberosity avulsion fractures (Zone 1).

Question 6953

Topic: 2. Trauma

A patient sustains a supination-external rotation (SER) type IV ankle fracture. On the mortise radiograph, the medial clear space is measured. An abnormal medial clear space indicative of deep deltoid ligament rupture and lateral talar shift is generally defined as greater than what measurement?

. 2 mm
. 3 mm
. 4 mm
. 6 mm
. 8 mm

Correct Answer & Explanation

. 4 mm

Explanation

An abnormal medial clear space on an AP or mortise radiograph is widely defined as greater than 4 mm (or >5 mm in some literature, but 4 mm is a standard threshold indicating deep deltoid incompetence when compared to the superior clear space).

Question 6954

Topic: 2. Trauma
A 35-year-old roofer falls from a height and sustains a closed, displaced intra-articular calcaneus fracture (Sanders Type III). He undergoes ORIF via an extensile lateral approach. Which of the following is the most common complication associated with this surgical approach?
. Sural nerve injury
. Superficial peroneal nerve injury
. Wound dehiscence and edge necrosis
. Deep vein thrombosis
. Nonunion of the calcaneus

Correct Answer & Explanation

. Wound dehiscence and edge necrosis

Explanation

Wound complications, including edge necrosis, dehiscence, and infection, occur in up to 10-25% of cases utilizing the standard extensile lateral approach for calcaneus fractures.

Question 6955

Topic: 2. Trauma
A 28-year-old male sustains a Hawkins Type III talar neck fracture. Six weeks postoperatively, an AP radiograph of the ankle reveals a subchondral radiolucent band in the dome of the talus. What does this radiographic finding indicate?
. Onset of avascular necrosis
. Osteomyelitis of the talar dome
. Intact vascularity to the talar body
. Nonunion of the talar neck
. Post-traumatic osteoarthritis

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

The Hawkins sign (a subchondral radiolucent band) indicates active subchondral bone resorption. This physiologic process requires an intact blood supply, thereby effectively ruling out avascular necrosis of the talar body.

Question 6956

Topic: Lower Extremity Trauma

A 22-year-old skier presents with lateral ankle pain and a snapping sensation behind the lateral malleolus when circumducting the foot. Radiographs demonstrate a 'fleck sign' avulsed from the lateral malleolus. Which anatomic structure is compromised?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Superior peroneal retinaculum
. Inferior peroneal retinaculum
. Peroneus brevis tendon

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

The fleck sign represents a bony avulsion of the superior peroneal retinaculum from the posterolateral fibula. This injury commonly leads to peroneal tendon subluxation or dislocation.

Question 6957

Topic: 2. Trauma

A 20-year-old collegiate basketball player sustains an acute Zone II fracture of the proximal fifth metatarsal (Jones fracture). To minimize the risk of nonunion and allow early return to play, what is the treatment of choice?

. Non-weight-bearing cast for 6 weeks
. Walking boot for 4 weeks
. Intramedullary screw fixation
. Tension band wiring
. Primary excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Intramedullary screw fixation is recommended for acute Jones fractures in high-level athletes to decrease the high nonunion rate associated with conservative care and to accelerate the return to competitive sports.

Question 6958

Topic: 2. Trauma

A 25-year-old basketball player sustains a fifth metatarsal base fracture located strictly at the metaphyseal-diaphyseal junction (Zone 2). This specific fracture pattern has a notoriously high rate of delayed union and nonunion due to which of the following vascular characteristics?

. Robust retrograde flow from the distal diaphysis causing rapid callus resorption
. A vascular watershed area between the proximal metaphyseal and distal diaphyseal blood supplies
. Disruption of the purely periosteal blood supply to the tuberosity
. The presence of avascular cartilage at the cuboid articulation
. Dominant blood supply derived solely from the peroneus brevis tendon insertion

Correct Answer & Explanation

. A vascular watershed area between the proximal metaphyseal and distal diaphyseal blood supplies

Explanation

Zone 2 fractures (Jones fractures) occur at the metaphyseal-diaphyseal junction of the fifth metatarsal. This region is a vascular watershed area between the metaphyseal arterial supply and the distal nutrient artery, making it highly susceptible to nonunion.

Question 6959

Topic: 2. Trauma

A 38-year-old construction worker falls from a height and sustains a high-energy tibial plafond (pilon) fracture. On presentation, the leg is massively swollen with multiple fracture blisters over the ankle. What is the standard protocol for surgical management of this injury?

. Immediate definitive open reduction and internal fixation within 12 hours
. Temporary spanning external fixation, followed by delayed definitive fixation once soft tissues allow
. Closed reduction and long leg casting for 6 weeks, followed by definitive fixation
. Primary tibiotalar arthrodesis using a retrograde intramedullary nail
. Immediate intramedullary nailing with percutaneous lag screws

Correct Answer & Explanation

. Temporary spanning external fixation, followed by delayed definitive fixation once soft tissues allow

Explanation

High-energy pilon fractures are associated with profound soft tissue compromise. A staged approach using initial spanning external fixation allows the swelling and fracture blisters to resolve (typically 10-21 days), significantly reducing the high risk of catastrophic wound complications during definitive ORIF.

Question 6960

Topic: 2. Trauma

A 24-year-old professional soccer player presents with acute lateral foot pain after a cutting maneuver. Radiographs demonstrate a non-displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, extending into the fourth-fifth intermetatarsal articulation. What is the best management to ensure rapid return to sport and minimize nonunion risk?

. Rigid shoe insert and weight-bearing as tolerated
. Short leg cast, non-weight-bearing for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Zone 2 (Jones) fracture, which occurs in a watershed vascular area and has a high rate of nonunion. In elite athletes, early intramedullary screw fixation is recommended to reduce nonunion risk and expedite return to play.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page