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2. Trauma MCQs

Practice Set 350 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 6981

Topic: 2. Trauma

A 22-year-old collegiate track athlete presents with chronic midfoot pain. MRI confirms a stress fracture of the tarsal navicular. Which anatomic region of the navicular is considered an avascular watershed zone, predisposing it to nonunion?

. Medial third
. Lateral third
. Central third
. Dorsal articular margin
. Plantar tuberosity

Correct Answer & Explanation

. Central third

Explanation

The central third of the tarsal navicular has a tenuous blood supply, forming a vascular watershed area. This increases the risk of stress fractures and subsequent nonunion.

Question 6982

Topic: 2. Trauma

A professional soccer player sustains an acute Zone 2 fracture of the proximal 5th metatarsal (Jones fracture). He desires to return to play as safely and rapidly as possible. What is the most appropriate surgical management?

. Non-weight bearing cast for 6 weeks
. Plantar plate repair
. Intramedullary screw fixation
. Excision of the proximal fragment with peroneus brevis advancement
. Tension band wiring

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) involve the metaphyseal-diaphyseal junction, an area with limited blood supply. In high-level athletes, early IM screw fixation minimizes nonunion risk and accelerates return to play.

Question 6983

Topic: 2. Trauma

A patient with a severe crush injury to the foot develops compartment syndrome and requires emergent surgical release. How many distinct fascial compartments are recognized in the foot for the purpose of fasciotomy?

. Four
. Five
. Seven
. Nine
. Eleven

Correct Answer & Explanation

. Nine

Explanation

The foot contains nine distinct fascial compartments: medial, lateral, superficial central, three deep central, and three interosseous. All nine can be decompressed through a combined medial and dorsal approach or a dual dorsal approach.

Question 6984

Topic: 2. Trauma

When utilizing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, the viability of the full-thickness subperiosteal flap relies primarily on which artery?

. Medial plantar artery
. Lateral plantar artery
. Anterior tibial artery
. Lateral calcaneal artery
. Sural artery

Correct Answer & Explanation

. Lateral calcaneal artery

Explanation

The extensile lateral approach creates a full-thickness subperiosteal flap. Its viability relies primarily on the lateral calcaneal artery, which must be protected during the posterior dissection.

Question 6985

Topic: 2. Trauma
A 28-year-old male sustains a Hawkins type III talar neck fracture in a motor vehicle collision. He undergoes open reduction and internal fixation. At 8 weeks postoperatively, plain radiographs demonstrate a subchondral radiolucent band in the talar dome. What does this finding indicate?
. Impending nonunion
. Development of avascular necrosis
. Revascularization and intact blood supply
. Osteomyelitis
. Subchondral stress fracture

Correct Answer & Explanation

. Revascularization and intact blood supply

Explanation

A subchondral radiolucent band in the talar dome at 6 to 8 weeks is known as the Hawkins sign. It represents subchondral atrophy from disuse and indicates that the talus has an intact blood supply, making avascular necrosis unlikely.

Question 6986

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains an acute fifth metatarsal fracture in the metaphyseal-diaphyseal junction. He wishes to return to play as soon as possible. What is the most appropriate definitive treatment?

. Non-weight-bearing cast for 6-8 weeks
. Hard-soled shoe for comfort
. Intramedullary screw fixation
. Tension band wiring
. Plate and screw fixation

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Acute fractures of the metaphyseal-diaphyseal junction (Jones fractures) in high-level athletes are best treated with intramedullary screw fixation to decrease the time to union and lower the risk of nonunion compared to nonoperative management.

Question 6987

Topic: 2. Trauma

A 19-year-old cross-country runner complains of vague dorsal midfoot pain. Plain radiographs are negative, but an MRI demonstrates a nondisplaced incomplete stress fracture of the tarsal navicular. What is the most appropriate initial management?

. Continue running as tolerated in a stiff-soled shoe
. Weight-bearing in a CAM boot for 4 weeks
. Strict non-weight-bearing cast for 6 to 8 weeks
. Percutaneous screw fixation
. Open bone grafting

Correct Answer & Explanation

. Strict non-weight-bearing cast for 6 to 8 weeks

Explanation

Nondisplaced or incomplete navicular stress fractures have a high risk of nonunion due to the precarious blood supply of the central third of the navicular. The gold standard for initial treatment is strict non-weight-bearing in a cast for 6 to 8 weeks.

Question 6988

Topic: 2. Trauma

The Sanders classification for intra-articular calcaneus fractures is based on the number of articular fracture lines seen on which specific imaging view?

. Lateral plain radiograph
. Harris axial plain radiograph
. Broden view plain radiograph
. Sagittal CT scan
. Coronal CT scan

Correct Answer & Explanation

. Coronal CT scan

Explanation

The Sanders classification system evaluates intra-articular calcaneal fractures based on the number and location of primary fracture lines through the posterior facet as seen on the widest section of the coronal plane CT scan.

Question 6989

Topic: 2. Trauma

When fixing a vertical shear fracture of the medial malleolus (supination-adduction type), what is the optimal orientation of the lag screws?

. Perpendicular to the fracture line, parallel to the joint surface
. Parallel to the long axis of the tibia
. From anterior to posterior through the medial malleolus
. From distal-medial to proximal-lateral
. Parallel to the fracture line

Correct Answer & Explanation

. Perpendicular to the fracture line, parallel to the joint surface

Explanation

Vertical medial malleolus fractures require fixation placed perpendicular to the fracture line to achieve optimal interfragmentary compression. Screws are typically placed horizontally (parallel to the joint surface), often supplemented with an anti-glide plate.

Question 6990

Topic: 2. Trauma

A 45-year-old male sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling and fracture blisters. An external fixator is placed on the day of injury. What clinical sign indicates the soft tissues are ready for definitive open reduction and internal fixation?

. Epithelialization of all fracture blisters
. Return of palpable dorsalis pedis pulse
. Resolution of local erythema
. Appearance of skin wrinkles (the "wrinkle sign")
. Normalization of systemic white blood cell count

Correct Answer & Explanation

. Appearance of skin wrinkles (the "wrinkle sign")

Explanation

In staged management of high-energy pilon fractures, definitive fixation is delayed until soft tissue swelling resolves. The appearance of skin wrinkles (the "wrinkle sign") indicates that the edema has subsided sufficiently to allow safe surgical incisions and wound closure.

Question 6991

Topic: 2. Trauma

Which of the following patients with a displaced intra-articular calcaneus fracture is statistically most likely to have equivalent or worse outcomes with operative management compared to nonoperative treatment?

. A 35-year-old female office worker
. A 28-year-old male professional athlete
. A 40-year-old male who smokes heavily and is claiming workers' compensation
. A 50-year-old female with osteoporosis
. A 22-year-old male construction worker not claiming compensation

Correct Answer & Explanation

. A 40-year-old male who smokes heavily and is claiming workers' compensation

Explanation

The landmark study by Buckley et al. showed that patients who receive workers' compensation and heavy smokers tend to do poorly with surgery, often having outcomes equal to or worse than nonoperative treatment for intra-articular calcaneus fractures.

Question 6992

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal. He wishes to return to play as soon as safely possible. What is the recommended treatment?

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

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 (Jones) fractures in competitive athletes are best treated with intramedullary screw fixation to reduce the risk of nonunion and allow for a faster return to sport compared to non-operative management.

Question 6993

Topic: 2. Trauma

A 45-year-old female presents with a highly comminuted, displaced tibial pilon fracture and severe soft tissue swelling with fracture blisters.

What is the most appropriate initial step in her orthopedic management?

. Immediate definitive open reduction and internal fixation of the tibia
. Application of a spanning external fixator and delayed definitive fixation
. Closed reduction and application of a snug short-leg cast
. Primary tibiotalar arthrodesis
. Immediate intramedullary nailing of the tibia

Correct Answer & Explanation

. Application of a spanning external fixator and delayed definitive fixation

Explanation

High-energy pilon fractures with severe soft-tissue compromise are standardly treated with a staged protocol: initial spanning external fixation (with or without fibular fixation) to allow soft tissues to recover, followed by delayed definitive ORIF in 10-14 days.

Question 6994

Topic: 2. Trauma

During the evaluation of a rotational ankle fracture, a syndesmotic injury is suspected. Which of the following radiographic parameters on an AP or mortise radiograph is most diagnostic of syndesmotic instability?

. Tibiofibular overlap of 8 mm
. Tibiofibular clear space greater than 5 mm
. Medial clear space of 3 mm
. Talar tilt of 2 degrees
. Lateral malleolar shortening of 1 mm

Correct Answer & Explanation

. Tibiofibular clear space greater than 5 mm

Explanation

A tibiofibular clear space of greater than 5 mm on AP or mortise views is indicative of syndesmotic injury. The clear space is measured 1 cm proximal to the joint line.

Question 6995

Topic: 2. Trauma

A 38-year-old female sustains a trimalleolar ankle fracture. The posterior malleolus fracture involves 35% of the articular surface and is displaced. Current biomechanical evidence suggests that which method provides the most stable fixation for this fragment?

. Anterior-to-posterior percutaneous lag screws
. Direct posterolateral approach with buttress plating
. Closed reduction with a short leg cast
. Arthroscopic-assisted pinning
. Syndesmotic screw fixation alone

Correct Answer & Explanation

. Direct posterolateral approach with buttress plating

Explanation

Biomechanical studies have shown that fixing a posterior malleolus fracture via a direct posterolateral approach with antiglide/buttress plating is biomechanically superior to indirect anterior-to-posterior lag screws.

Question 6996

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains a fracture of the fifth metatarsal base located at the metaphyseal-diaphyseal junction. The fracture extends into the fourth-fifth intermetatarsal articulation. He wishes to return to play as soon as safely possible. What is the recommended treatment?

. Non-weight-bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Hook plate fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Jones fracture (Zone 2). In high-level or elite athletes, early intramedullary screw fixation is recommended to reduce the risk of nonunion and allow for a faster return to sport.

Question 6997

Topic: 2. Trauma

A 45-year-old man sustains a high-energy closed tibial pilon fracture. There is severe soft tissue swelling and fracture blisters over the medial and anterior ankle. What is the most appropriate initial management strategy?

. Immediate open reduction and internal fixation through an anterolateral approach
. Spanning external fixation and elevation until soft tissues permit delayed ORIF
. Percutaneous screw fixation of the articular surface
. Immediate circular fine-wire external fixation
. Open reduction and internal fixation with a medial plate

Correct Answer & Explanation

. Spanning external fixation and elevation until soft tissues permit delayed ORIF

Explanation

In high-energy pilon fractures with severe soft tissue compromise, staged management with a temporary spanning external fixator allows for soft tissue recovery before definitive ORIF. This significantly reduces the risk of wound complications and infection.

Question 6998

Topic: 2. Trauma

A 19-year-old track athlete presents with insidious onset of vague dorsal midfoot pain. Radiographs are normal, but an MRI confirms a stress fracture of the tarsal navicular without displacement. What is the initial treatment of choice?

. Weight-bearing in a walking boot for 4 weeks
. Non-weight-bearing in a short leg cast for 6 to 8 weeks
. Percutaneous screw fixation
. Open bone grafting
. Corticosteroid injection and modified activities

Correct Answer & Explanation

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

Explanation

The tarsal navicular has a tenuous blood supply, making stress fractures prone to nonunion. The gold standard for conservative management of non-displaced navicular stress fractures is strict non-weight-bearing in a cast for 6-8 weeks.

Question 6999

Topic: 2. Trauma

Which of the following intraoperative tests is most reliable for diagnosing latent syndesmotic instability following fixation of a lateral malleolus fracture?

. External rotation stress test or lateral hook (Cotton) test
. Anterior drawer test
. Talar tilt test
. Squeeze test
. Gravity stress test

Correct Answer & Explanation

. External rotation stress test or lateral hook (Cotton) test

Explanation

The external rotation stress test and the lateral hook (Cotton) test performed under direct vision or fluoroscopy intraoperatively are the most reliable methods to assess for syndesmotic instability after fibular fixation.

Question 7000

Topic: 2. Trauma

A 42-year-old man undergoes open reduction and internal fixation of a displaced intra-articular calcaneus fracture via an extensile lateral approach. Which of the following patient factors most significantly increases the risk of the most common postoperative complication associated with this approach?

. Diabetes mellitus
. Smoking
. Age greater than 40 years
. Body mass index > 30
. Use of a tourniquet for more than 90 minutes

Correct Answer & Explanation

. Smoking

Explanation

Wound healing complications, particularly apical edge necrosis, are the most common complication of the extensile lateral approach. Smoking is the most significant modifiable risk factor, increasing the wound complication rate markedly.

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