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2. Trauma MCQs

Practice Set 351 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 7001

Topic: 2. Trauma

A 22-year-old soccer player sustains an external rotation injury to his right ankle. Standard non-weight-bearing mortise and AP radiographs reveal no fractures and normal clear space parameters. However, the squeeze test is positive. What is the most appropriate next step to rule out a latent syndesmotic injury?

. Bilateral weight-bearing AP radiographs of the ankle
. Gravity external rotation stress radiograph
. Computed tomography (CT) of the ankle
. Diagnostic ultrasound of the anterior tibiofibular ligament
. Immediate arthroscopy of the ankle

Correct Answer & Explanation

. Gravity external rotation stress radiograph

Explanation

A gravity external rotation stress view (or manual external rotation stress view) is a highly reliable, low-cost method to reveal latent, dynamic syndesmotic instability when static, non-weight-bearing radiographs appear normal.

Question 7002

Topic: 2. Trauma

A 19-year-old Division I collegiate basketball player sustains an acute, non-displaced fracture of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction (Zone 2). To minimize the risk of nonunion and facilitate the most rapid return to play, which of the following is the best treatment option?

. Non-weight-bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Open reduction and internal fixation with a tension band construct
. Percutaneous intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Percutaneous intramedullary screw fixation

Explanation

Zone 2 (Jones) fractures in high-demand athletes are best treated with intramedullary screw fixation. This approach significantly decreases the nonunion rate and time to return to play compared to nonoperative cast immobilization.

Question 7003

Topic: 2. Trauma
An 8-week post-operative radiograph of a 32-year-old male who underwent open reduction and internal fixation for a Hawkins Type III talar neck fracture demonstrates a subchondral radiolucent band in the dome of the talus. What is the clinical significance of this radiographic finding?
. It indicates early-onset avascular necrosis of the talar body.
. It represents an active postoperative infection requiring debridement.
. It demonstrates intact vascularity to the talar body.
. It is a sign of an impending talar neck nonunion.
. It suggests rapid progression of post-traumatic subtalar arthritis.

Correct Answer & Explanation

. It demonstrates intact vascularity to the talar body.

Explanation

This finding is known as the Hawkins sign, which represents subchondral osteopenia. Its presence indicates that the talar body retains its blood supply and is undergoing normal hyperemic bone resorption, making avascular necrosis highly unlikely.

Question 7004

Topic: 2. Trauma

A 22-year-old elite basketball player sustains an acute, non-displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2). To minimize his time away from play and risk of nonunion, 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
. Percutaneous cross-pinning
. Primary excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) have poor blood supply and a high risk of nonunion. In high-level or competitive athletes, early intramedullary screw fixation is recommended to accelerate healing and return to sport.

Question 7005

Topic: 2. Trauma

A 38-year-old man sustains a severe, high-energy axial load injury to his distal tibia resulting in a highly comminuted, displaced intra-articular pilon fracture. The soft tissues are markedly swollen with early fracture blister formation. What is the most appropriate initial management?

. Immediate open reduction and internal fixation with dual plating
. Spanning external fixation and elevation until soft tissues permit definitive surgery
. Primary tibiotalar arthrodesis via an anterior approach
. Closed reduction and long leg cast application for 6 weeks
. Immediate minimally invasive intramedullary nailing

Correct Answer & Explanation

. Spanning external fixation and elevation until soft tissues permit definitive surgery

Explanation

High-energy pilon fractures are associated with significant soft-tissue envelopes that are prone to devastating complications like infection and necrosis if operated on acutely. The standard of care is a staged approach: initial spanning external fixation to allow soft-tissue recovery, followed by delayed definitive ORIF.

Question 7006

Topic: 2. Trauma

A 28-year-old man undergoes open reduction and internal fixation of a supination-external rotation type IV ankle fracture. Intraoperatively, after rigid fixation of the lateral malleolus, the Cotton test demonstrates 4 mm of lateral shift of the fibula relative to the tibia. What is the next most appropriate step in management?

. Deltoid ligament repair
. Syndesmotic fixation
. Posterior malleolus fixation
. Placement of an anterior inferior tibiofibular ligament internal brace alone
. Proceed to wound closure as this amount of translation is physiological

Correct Answer & Explanation

. Syndesmotic fixation

Explanation

A positive Cotton test (lateral pull on the fibula demonstrating >2-3 mm of syndesmotic widening) indicates syndesmotic instability after fibular fixation. Syndesmotic fixation (screws or suture buttons) is required to accurately restore and maintain the distal tibiofibular relationship.

Question 7007

Topic: 2. Trauma

In the treatment of a 4-part proximal humerus fracture with a shoulder hemiarthroplasty in an elderly patient, what is the most critical factor for achieving a good functional outcome?

. Restoring humeral head retroversion to exactly 40 degrees
. Anatomic healing of the greater and lesser tuberosities
. Utilizing a cemented humeral stem in all cases
. Achieving a tight closure of the rotator interval
. Resecting the coracoacromial ligament

Correct Answer & Explanation

. Anatomic healing of the greater and lesser tuberosities

Explanation

Anatomic reduction and secure healing of the tuberosities around the prosthesis is the most critical factor determining a successful functional outcome in proximal humerus hemiarthroplasty. Failure of tuberosity healing leads to poor active elevation and poor clinical results.

Question 7008

Topic: Upper Extremity Trauma

A 35-year-old man falls onto his shoulder. Radiographs show a 100% to 300% superior displacement of the clavicle relative to the acromion. Which ligaments are disrupted in this classic Type V acromioclavicular injury?

. Acromioclavicular (AC) ligaments only
. Coracoclavicular (CC) ligaments only
. Both AC and CC ligaments along with the deltotrapezial fascia
. Coracoacromial ligament only
. Sternoclavicular ligaments

Correct Answer & Explanation

. Both AC and CC ligaments along with the deltotrapezial fascia

Explanation

A Type V AC joint separation is characterized by severe superior displacement of the distal clavicle. This requires complete disruption of both the AC and CC ligaments, as well as significant tearing of the deltotrapezial fascia.

Question 7009

Topic: Upper Extremity Trauma

During the standard deltopectoral approach to the proximal humerus, the cephalic vein is identified. To minimize bleeding and preserve its main venous drainage, the cephalic vein should ideally be retracted in which direction?

. Medially with the pectoralis major
. Laterally with the deltoid
. Superiorly toward the clavicle
. Inferiorly toward the axilla
. It must be ligated in all cases

Correct Answer & Explanation

. Laterally with the deltoid

Explanation

The cephalic vein marks the deltopectoral interval. It is typically retracted laterally with the deltoid muscle to preserve its main venous tributaries from the deltoid, thereby minimizing bleeding.

Question 7010

Topic: 2. Trauma

A 30-year-old patient falls from a height, sustaining a displaced transverse fracture of the olecranon. The fracture is treated with tension band wiring. What is the most common complication of this procedure?

. Ulnar nerve palsy
. Nonunion
. Heterotopic ossification
. Prominent hardware requiring removal
. Post-traumatic arthritis

Correct Answer & Explanation

. Prominent hardware requiring removal

Explanation

The most common complication of tension band wiring for olecranon fractures is symptomatic hardware prominence. This frequently necessitates a second surgery for hardware removal after the fracture has united.

Question 7011

Topic: 2. Trauma

A 35-year-old male cyclist sustains a completely displaced midshaft clavicle fracture with 2.5 cm of shortening. According to prospective randomized trials, what is the primary benefit of operative fixation compared to nonoperative management for this specific injury?

. Lower incidence of thoracic outlet syndrome
. Decreased risk of nonunion and symptomatic malunion
. Decreased incidence of superficial infection
. Improved long-term range of motion in external rotation
. Elimination of the need for any postoperative immobilization

Correct Answer & Explanation

. Decreased risk of nonunion and symptomatic malunion

Explanation

In totally displaced, shortened (>2 cm) midshaft clavicle fractures, nonoperative management has historically been associated with a significantly higher rate of nonunion and symptomatic malunion. Operative fixation in these specific cases lowers these risks and often leads to earlier functional recovery.

Question 7012

Topic: Upper Extremity Trauma

A 28-year-old competitive weightlifter feels a tearing sensation in his anterior chest while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. Where is the most common anatomic location for this specific tendon rupture?

. Clavicular head at the musculotendinous junction
. Clavicular head at the humeral insertion
. Sternal head at the muscle belly
. Sternal head at the humeral insertion
. Sternal origin at the rib cage

Correct Answer & Explanation

. Sternal head at the humeral insertion

Explanation

Pectoralis major ruptures almost exclusively occur during eccentric loading activities like bench pressing. The most common site of failure is an avulsion of the sternal head tendon from its insertion on the proximal humerus.

Question 7013

Topic: 2. Trauma

Which of the following defines the specific pattern of injury known as the 'terrible triad' of the elbow?

. Olecranon fracture, radial head fracture, and medial collateral ligament tear
. Coronoid fracture, radial head fracture, and elbow dislocation
. Capitellum fracture, lateral ulnar collateral ligament tear, and elbow dislocation
. Radial head fracture, distal radioulnar joint disruption, and interosseous membrane tear
. Distal humerus fracture, coronoid fracture, and medial epicondyle avulsion

Correct Answer & Explanation

. Coronoid fracture, radial head fracture, and elbow dislocation

Explanation

The terrible triad of the elbow consists of an elbow dislocation, a radial head fracture, and a coronoid fracture. It is nearly always accompanied by a complete avulsion or tear of the lateral ulnar collateral ligament (LUCL) complex.

Question 7014

Topic: 2. Trauma

A 7-year-old boy falls on an outstretched arm and sustains a Monteggia fracture-dislocation. According to the Bado classification, what represents a Type I injury?

. Ulnar shaft fracture with anterior dislocation of the radial head
. Ulnar shaft fracture with posterior dislocation of the radial head
. Ulnar shaft fracture with lateral dislocation of the radial head
. Ulnar shaft fracture with an associated proximal radius fracture
. Radial shaft fracture with distal radioulnar joint dislocation

Correct Answer & Explanation

. Ulnar shaft fracture with anterior dislocation of the radial head

Explanation

The Bado classification categorizes Monteggia fractures based on the direction of radial head dislocation. Type I, the most common type in children, involves an anterior dislocation of the radial head with an associated ulnar diaphyseal fracture.

Question 7015

Topic: 2. Trauma

A 65-year-old female sustains a 4-part proximal humerus fracture. Which of the following radiographic and clinical findings is most predictive of humeral head ischemia and subsequent avascular necrosis?

. Valgus impaction of the humeral head
. Displacement of the greater tuberosity greater than 1 cm
. Metaphyseal extension of the humeral head segment less than 8 mm
. Intact medial periosteal hinge
. Concomitant surgical neck and greater tuberosity fractures

Correct Answer & Explanation

. Metaphyseal extension of the humeral head segment less than 8 mm

Explanation

According to Hertel's criteria, a short calcar length (metaphyseal extension < 8 mm) and a disrupted medial hinge are highly predictive of humeral head ischemia following proximal humerus fractures.

Question 7016

Topic: 2. Trauma

A 30-year-old man sustains a closed distal-third spiral humeral shaft fracture (Holstein-Lewis pattern). Clinical examination reveals an immediate, complete radial nerve palsy. What is the most appropriate initial management?

. Immediate open reduction internal fixation and nerve exploration
. Functional bracing and clinical observation
. External fixation
. Immediate electromyography (EMG)
. Intramedullary nailing without nerve exploration

Correct Answer & Explanation

. Functional bracing and clinical observation

Explanation

Closed humeral shaft fractures with primary radial nerve palsies are initially managed non-operatively with bracing. Over 80% of these palsies spontaneously recover.

Question 7017

Topic: 2. Trauma

A 30-year-old man sustains a Bado Type I Monteggia fracture. What is the most critical step in achieving and maintaining the anatomic reduction of the radial head?

. Anatomic reduction and rigid internal fixation of the ulnar shaft
. Open reduction and internal fixation of the radial head
. Primary reconstruction of the annular ligament
. Immobilization in 120 degrees of elbow flexion
. Closed reduction and percutaneous pinning of the radiocapitellar joint

Correct Answer & Explanation

. Anatomic reduction and rigid internal fixation of the ulnar shaft

Explanation

In Monteggia fractures, the primary requirement for reducing and stabilizing the dislocated radial head is achieving anatomic length and alignment of the ulna through rigid internal fixation.

Question 7018

Topic: 2. Trauma

Which of the following clinical scenarios is an absolute indication for operative fixation of an acute midshaft clavicle fracture?

. Shortening of 1.5 cm
. Z-deformity with superior displacement
. Open fracture
. Multifragmentary comminution
. Patient desire for rapid return to contact sports

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for open reduction and internal fixation of a clavicle fracture include open fractures, neurovascular compromise, and skin tenting causing impending necrosis.

Question 7019

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate superior displacement of the clavicle relative to the acromion by approximately 150%. Which ligaments are fully disrupted in this Type III acromioclavicular (AC) injury?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Coracoacromial and acromioclavicular ligaments
. Coracoacromial and coracoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

A Type III AC joint separation involves complete disruption of both the acromioclavicular ligaments and the coracoclavicular (conoid and trapezoid) ligaments.

Question 7020

Topic: 2. Trauma

A 45-year-old man sustains a diaphyseal fracture of the distal third of the radius with associated clinical disruption of the distal radioulnar joint (DRUJ). What is the standard of care for this Galeazzi fracture?

. Closed reduction and long arm casting in supination
. Open reduction and internal fixation of the radius with a compression plate
. Intramedullary nailing of the radius
. External fixation spanning the radiocarpal joint
. Percutaneous pinning of the DRUJ only

Correct Answer & Explanation

. Open reduction and internal fixation of the radius with a compression plate

Explanation

Galeazzi fractures in adults are highly unstable and necessitate open reduction and rigid internal fixation (plating) of the radius. Anatomic radial restoration is required to secondarily stabilize the DRUJ.

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