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2. Trauma MCQs

Practice Set 349 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 6961

Topic: 2. Trauma
A 30-year-old man underwent open reduction and internal fixation for a displaced Hawkins type III talar neck fracture. Six weeks postoperatively, an AP mortise radiograph reveals a distinct subchondral radiolucent band in the talar dome. What is the clinical significance of this radiographic finding?
. Avascular necrosis of the talar body
. Intact vascularity and bone resorption from disuse
. Impending talar dome collapse
. Nonunion of the talar neck
. Septic arthritis of the ankle joint

Correct Answer & Explanation

. Intact vascularity and bone resorption from disuse

Explanation

The subchondral radiolucent band, known as Hawkins sign, indicates subchondral osteopenia secondary to disuse. It is a highly reliable indicator that the talar body retains its blood supply, ruling out avascular necrosis.

Question 6962

Topic: 2. Trauma

A 45-year-old construction worker falls from a ladder, sustaining a severely displaced, high-energy OTA type 43-C pilon fracture. The ankle exhibits massive soft tissue swelling and multiple fracture blisters. What is the safest and most appropriate initial management?

. Immediate open reduction and internal fixation of the tibia and fibula
. Primary ankle arthrodesis
. Closed reduction and long leg cast
. Spanning external fixation and delayed definitive internal fixation
. Fibula plating alone with percutaneous tibial screw fixation

Correct Answer & Explanation

. Spanning external fixation and delayed definitive internal fixation

Explanation

High-energy pilon fractures with severe soft tissue compromise should be managed with a staged protocol. Initial spanning external fixation allows soft tissues to recover before definitive internal fixation, significantly reducing the risk of wound dehiscence and deep infection.

Question 6963

Topic: 2. Trauma

A 62-year-old patient with long-standing, poorly controlled diabetes mellitus and peripheral neuropathy sustains a displaced bimalleolar ankle fracture equivalent. When planning operative fixation, which technical modification is highly recommended to minimize the risk of catastrophic failure?

. Use of bioabsorbable implants
. Single unicortical syndesmotic screw fixation
. Augmented fixation with multiple syndesmotic screws and prolonged non-weight-bearing
. Early weight-bearing at 2 weeks postoperatively
. Avoidance of fibular plating

Correct Answer & Explanation

. Augmented fixation with multiple syndesmotic screws and prolonged non-weight-bearing

Explanation

Diabetic patients with neuropathy are at extremely high risk for hardware failure, nonunion, and Charcot neuroarthropathy following ankle fractures. Augmented fixation (e.g., locking plates, multiple syndesmotic screws, transarticular pins) and prolonged non-weight-bearing (often double the standard time) are essential.

Question 6964

Topic: 2. Trauma
A 30-year-old man falls from a height and sustains a Hawkins Type III talar neck fracture. Based on the classification and typical vascular disruption, what is the approximate historical risk of developing avascular necrosis (AVN) of the talar body?
. 0-10%
. 15-25%
. 30-40%
. 80-100%
. 5-10%

Correct Answer & Explanation

. 80-100%

Explanation

Hawkins Type III fractures involve a talar neck fracture with dislocation of both the subtalar and tibiotalar joints. This disrupts all three major blood supplies to the talar body, leading to an exceptionally high risk of AVN, historically reported as 80-100%.

Question 6965

Topic: 2. Trauma

A 21-year-old elite collegiate basketball player sustains an acute Zone 2 fracture of the proximal 5th metatarsal base (Jones fracture). To minimize the risk of nonunion and expedite his return to play, what is the recommended treatment?

. Short leg cast non-weight-bearing for 6 weeks
. Hard-soled shoe with weight-bearing as tolerated
. Intramedullary screw fixation
. Excision of the proximal pole fragment
. Lateral plating and bone grafting

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 base of the 5th metatarsal fractures (Jones fractures) have a high propensity for nonunion due to watershed vascularity. In high-level athletes, intramedullary screw fixation is recommended to significantly decrease nonunion rates and allow a faster return to sports.

Question 6966

Topic: 2. Trauma

A 20-year-old cross-country runner complains of vague, aching midfoot pain that worsens with activity. Plain radiographs are unremarkable, but an MRI demonstrates a nondisplaced stress fracture involving the central third of the navicular bone. What is the gold standard initial non-operative management?

. Weight-bearing as tolerated in a stiff-soled walking boot
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Immediate ORIF with headless compression screws
. Custom orthotics with a medial arch support and return to running as tolerated
. Extracorporeal shockwave therapy and immediate full weight-bearing

Correct Answer & Explanation

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

Explanation

Navicular stress fractures occur in the relatively avascular central third of the bone, placing them at high risk for nonunion. The gold standard non-operative treatment requires strict non-weight-bearing in a short leg cast for 6 to 8 weeks to allow adequate healing.

Question 6967

Topic: 2. Trauma
A 28-year-old sustains a Hawkins type III talus neck fracture. At 6 weeks post-injury, an AP radiograph of the ankle demonstrates the "Hawkins sign". Which of the following is true regarding this radiographic finding?
. It is a subchondral sclerotic band indicating avascular necrosis
. It is a subchondral lucency of the talar dome indicating intact vascularity
. It represents early post-traumatic arthritis of the tibiotalar joint
. It indicates a nonunion of the talar neck
. It represents a stress fracture of the talar dome

Correct Answer & Explanation

. It is a subchondral lucency of the talar dome indicating intact vascularity

Explanation

The Hawkins sign is a subchondral lucency of the talar dome typically seen 6-8 weeks post-injury. It indicates osteoclastic bone resorption, which requires an intact blood supply, thereby predicting a lower risk of avascular necrosis.

Question 6968

Topic: 2. Trauma
A 30-year-old man sustains a Hawkins type III talar neck fracture. Six weeks postoperatively, an anteroposterior mortise radiograph reveals a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?
. Avascular necrosis of the talar body
. Post-traumatic osteomyelitis
. Intact vascularity to the talar dome
. Talar neck nonunion
. Rapidly progressive chondrolysis

Correct Answer & Explanation

. Intact vascularity to the talar dome

Explanation

The presence of a subchondral radiolucent band, known as Hawkins sign, indicates active bone resorption. This requires an intact blood supply, thereby prognosticating a low risk for avascular necrosis.

Question 6969

Topic: 2. Trauma

A 45-year-old male sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling, marked ecchymosis, and early fracture blisters. What is the most appropriate initial management strategy?

. Immediate open reduction and internal fixation with dual plating
. Spanning external fixation and delayed open reduction internal fixation
. Immediate intramedullary nailing of the tibia
. Closed reduction and application of a circular cast
. Primary ankle arthrodesis using a hindfoot nail

Correct Answer & Explanation

. Spanning external fixation and delayed open reduction internal fixation

Explanation

High-energy pilon fractures have a high complication rate if fixed acutely. Staged management with spanning external fixation allows soft tissues to recover prior to definitive open reduction and internal fixation.

Question 6970

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He desires to return to play as safely and quickly as possible. What is the standard of care?

. Stiff-soled shoe with full weight-bearing for 6 weeks
. Non-weight-bearing short leg cast for 6 to 8 weeks
. Intramedullary screw fixation
. Tension band wiring of the proximal fragment
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 (Jones) fractures have a tenuous blood supply and higher risk of nonunion. Intramedullary screw fixation is recommended for elite athletes to minimize nonunion risk and expedite return to play.

Question 6971

Topic: 2. Trauma

A 40-year-old sustains a severe rotational ankle injury. The lateral radiograph shows the proximal fibular shaft fragment displaced and incarcerated posterior to the posterior tubercle of the tibia. What is this specific injury pattern called?

. Tillaux fracture
. Maisonneuve fracture
. Bosworth fracture-dislocation
. Cotton fracture
. Dupuytren fracture

Correct Answer & Explanation

. Bosworth fracture-dislocation

Explanation

A Bosworth fracture-dislocation involves entrapment of the proximal fibular fragment behind the posterolateral ridge of the tibia. This injury is characteristically irreducible by closed means and requires emergent open reduction.

Question 6972

Topic: 2. Trauma

A 20-year-old track athlete is diagnosed with an incomplete stress fracture in the central third of the tarsal navicular. What is the most appropriate initial non-operative management?

. Controlled ankle motion (CAM) boot with immediate weight-bearing as tolerated
. Carbon fiber shoe insert and running modification
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Extracorporeal shockwave therapy and continued training
. Ultrasound bone stimulation with full weight-bearing

Correct Answer & Explanation

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

Explanation

The central third of the navicular is a relative watershed area, placing these stress fractures at high risk for nonunion. Strict non-weight-bearing in a cast for 6-8 weeks is the gold standard conservative treatment.

Question 6973

Topic: 2. Trauma
A 28-year-old male sustains a Hawkins type III talar neck fracture. Six weeks post-operatively, a radiograph reveals a subchondral lucent band in the talar dome. What does this finding indicate?
. High likelihood of avascular necrosis (AVN)
. Intact vascularity to the talar body
. Nonunion of the talar neck
. Osteomyelitis
. Chondrolysis

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

The presence of subchondral radiolucency in the talar dome (Hawkins sign) at 6 to 8 weeks indicates intact vascularity and active bone resorption, meaning AVN is unlikely.

Question 6974

Topic: 2. Trauma

Following an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, what is the most common postoperative complication?

. Sural nerve transection
. Deep infection requiring amputation
. Wound healing issues at the apex of the incision
. Nonunion
. Flexor hallucis longus tethering

Correct Answer & Explanation

. Wound healing issues at the apex of the incision

Explanation

Wound healing complications at the apex of the L-shaped extensile lateral incision are the most common complication due to the precarious blood supply of the flap.

Question 6975

Topic: 2. Trauma

A 22-year-old collegiate athlete sustains an acute fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He wishes to return to play as soon as safely possible. What is the most appropriate management?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Plate and screw construct
. Primary bone grafting

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) in elite athletes are best treated with intramedullary screw fixation to decrease time to union and lower the risk of nonunion compared to nonoperative management.

Question 6976

Topic: 2. Trauma

A 32-year-old male sustains a Hawkins Type II talar neck fracture. At 8 weeks post-ORIF, AP radiographs reveal subchondral radiolucency in the talar dome. What does this finding indicate?

. Avascular necrosis is imminent
. Revascularization and intact blood supply
. Nonunion of the talar neck
. Infection of the talar body
. Chondrolysis of the tibiotalar joint

Correct Answer & Explanation

. Revascularization and intact blood supply

Explanation

Hawkins sign is a subchondral radiolucency of the talar dome, indicating intact vascularity and active resorption of subchondral bone. Its presence at 6 to 8 weeks strongly suggests the absence of avascular necrosis.

Question 6977

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains an acute fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal articulation. What is the most appropriate management?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Cross-pinning with Kirschner wires
. Excision of the proximal fragment and tendon advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This describes a Zone 2 (Jones) fracture. Due to the high rate of nonunion from a tenuous watershed blood supply and the patient's elite athletic status, early intramedullary screw fixation is the treatment of choice to expedite return to play.

Question 6978

Topic: 2. Trauma

A 45-year-old male presents with a high-energy closed severe pilon fracture with significant soft tissue swelling and fracture blisters. What is the standard staged protocol for managing this injury?

. Immediate definitive ORIF with dual plating
. Spanning external fixation with fibular fixation followed by delayed tibial ORIF
. Primary ankle arthrodesis
. Immediate intramedullary nailing of the tibia
. Closed reduction and percutaneous pinning of the articular surface

Correct Answer & Explanation

. Spanning external fixation with fibular fixation followed by delayed tibial ORIF

Explanation

Severe pilon fractures with massive soft tissue compromise are best treated with staged management. This involves immediate spanning external fixation to restore length and protect soft tissues, followed by definitive tibial ORIF once swelling resolves.

Question 6979

Topic: 2. Trauma

The Sanders classification for intra-articular calcaneus fractures is based on the number of fracture lines through which articular facet, as seen on a coronal CT scan?

. Anterior facet
. Middle facet
. Posterior facet
. Cuboid facet
. Talar dome

Correct Answer & Explanation

. Posterior facet

Explanation

The Sanders classification is determined by the number and location of primary fracture lines through the posterior articular facet of the calcaneus, utilizing coronal CT images at the widest point of the posterior facet.

Question 6980

Topic: 2. Trauma

A 30-year-old patient sustains a displaced talar neck fracture and undergoes open reduction and internal fixation. At 8 weeks post-operation, standard radiographs reveal a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

. Avascular necrosis of the talar body
. Intact vascularity to the talar body
. Deep postoperative infection
. Impending nonunion of the fracture site
. Hardware loosening

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

The Hawkins sign is a subchondral radiolucent band seen 6-8 weeks post-injury in the talar dome. It indicates subchondral bone resorption, confirming intact vascularity and absence of avascular necrosis.

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