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2. Trauma MCQs

Practice Set 352 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 7021

Topic: 2. Trauma

When surgically treating an adult intercondylar distal humerus fracture (AO Type 13-C), what is the optimal plate configuration required for stable internal fixation to allow early range of motion?

. Single lateral locking plate
. Two plates placed in orthogonal (90-90) or parallel configuration
. Single medial reconstruction plate
. Transverse percutaneous pinning
. Flexible intramedullary nailing

Correct Answer & Explanation

. Two plates placed in orthogonal (90-90) or parallel configuration

Explanation

Dual plating (either parallel or orthogonal) is the standard of care for bicolumnar distal humerus fractures in adults, providing adequate biomechanical stability to permit early elbow mobilization.

Question 7022

Topic: Upper Extremity Trauma

A 35-year-old woman falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. During the standard surgical protocol for this injury, which of the following structures is typically addressed or repaired last?

. Coronoid process
. Radial head
. Lateral collateral ligament (LCL)
. Medial collateral ligament (MCL)
. Common extensor origin

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

The standard surgical algorithm for a terrible triad injury proceeds from deep to superficial and anterior to posterior: coronoid fixation, radial head fixation/replacement, followed by LCL repair. The MCL is typically only addressed if the elbow remains unstable after the lateral and anterior structures are stabilized.

Question 7023

Topic: 2. Trauma

A 30-year-old man sustains a closed, completely displaced spiral fracture of the distal third of the humerus (Holstein-Lewis fracture). In the emergency department, his radial nerve function is intact. Following a closed reduction and application of a coaptation splint, he loses the ability to extend his wrist and fingers. What is the most appropriate next step in management?

. Immediate surgical exploration and fixation
. Observation and physical therapy for 3 months
. Electromyography (EMG) at 6 weeks
. High-resolution ultrasound of the radial nerve
. Conversion to a functional fracture brace

Correct Answer & Explanation

. Immediate surgical exploration and fixation

Explanation

A secondary radial nerve palsy that develops after a closed reduction attempt of a humeral shaft fracture is an absolute indication for surgical exploration. This clinical presentation suggests the nerve has become entrapped within the fracture fragments.

Question 7024

Topic: 2. Trauma

A 40-year-old man sustains a highly comminuted radial head fracture from a high-energy fall. An isolated radial head excision is performed. Three months later, he develops progressive proximal migration of the radius and severe ulnar-sided wrist pain. Which associated injury was most likely missed at the initial presentation?

. Triangular fibrocartilage complex (TFCC) tear
. Interosseous membrane tear
. Scapholunate ligament dissociation
. Lunotriquetral ligament tear
. Ulnar collateral ligament tear of the elbow

Correct Answer & Explanation

. Interosseous membrane tear

Explanation

An Essex-Lopresti lesion involves a radial head fracture combined with a longitudinal tear of the interosseous membrane and disruption of the distal radioulnar joint (DRUJ). Excising the radial head in this setting removes the remaining restraint to proximal radial migration, leading to ulnar impaction.

Question 7025

Topic: 2. Trauma

A 25-year-old cyclist sustains a closed, midshaft clavicle fracture after a fall over the handlebars. Which of the following radiographic findings is considered the strongest indication for operative fixation to prevent symptomatic nonunion?

. 1 cm of shortening
. 100 percent displacement with 2.5 cm of shortening
. A nondisplaced inferior butterfly fragment
. Angulation of 15 degrees in the coronal plane
. Extension of the fracture into the medial third

Correct Answer & Explanation

. 100 percent displacement with 2.5 cm of shortening

Explanation

Displacement greater than 100% and shortening greater than 2 cm are strong indications for ORIF of a midshaft clavicle fracture. Non-operative management of fractures with these characteristics carries a significantly higher risk of nonunion and symptomatic malunion.

Question 7026

Topic: 2. Trauma

A 32-year-old construction worker sustains a Galeazzi fracture-dislocation after being struck by a heavy beam. Which of the following accurately defines this specific injury pattern?

. Proximal ulnar shaft fracture with radial head dislocation
. Distal radial shaft fracture with disruption of the distal radioulnar joint (DRUJ)
. Proximal radial fracture with DRUJ disruption
. Ulnar shaft fracture with radiocapitellar dislocation
. Intra-articular distal radius fracture with radiocarpal dislocation

Correct Answer & Explanation

. Distal radial shaft fracture with disruption of the distal radioulnar joint (DRUJ)

Explanation

A Galeazzi fracture-dislocation is characterized by a fracture of the distal third of the radial shaft accompanied by a disruption of the distal radioulnar joint (DRUJ). In adults, this unstable injury requires operative fixation of the radius.

Question 7027

Topic: 2. Trauma

A 29-year-old man is struck on the forearm with a blunt object, resulting in an isolated, non-displaced midshaft ulnar fracture ('nightstick' fracture). Angulation is less than 5 degrees. What is the most appropriate treatment for this injury?

. Long arm cast immobilization for 6 weeks
. Immediate ORIF with a 3.5-mm compression plate
. Functional brace and early range of motion
. External fixation
. Short arm cast immobilization for 8 weeks

Correct Answer & Explanation

. Functional brace and early range of motion

Explanation

Isolated, non-displaced or minimally displaced ulnar shaft fractures (<50% displacement, <10 degrees angulation) are highly stable. They are best treated non-operatively with a functional brace and early range of motion to prevent stiffness and promote healing.

Question 7028

Topic: 2. Trauma

A 45-year-old male is struck on the forearm with a heavy pipe. Radiographs reveal an isolated fracture of the proximal third of the ulnar shaft combined with an anterior dislocation of the radial head. What is the appropriate eponymous designation for this specific injury pattern?

. Galeazzi fracture
. Monteggia fracture
. Colles fracture
. Barton fracture
. Essex-Lopresti fracture

Correct Answer & Explanation

. Monteggia fracture

Explanation

A Monteggia fracture-dislocation is defined as a fracture of the ulnar shaft associated with a dislocation of the radial head. This is distinct from a Galeazzi fracture, which is a distal radius shaft fracture with a distal radioulnar joint (DRUJ) dislocation.

Question 7029

Topic: 2. Trauma

A 22-year-old man has a symptomatic scaphoid nonunion. MRI demonstrates avascular necrosis (AVN) of the proximal pole, and CT shows structural collapse (humpback deformity). Which of the following is the most appropriate surgical option to achieve union?

. Free medial femoral condyle vascularized bone graft
. 1,2 Intercompartmental supraretinacular artery (ICSRA) pedicled graft
. Non-vascularized distal radius bone graft
. Proximal row carpectomy
. Four-corner arthrodesis

Correct Answer & Explanation

. Free medial femoral condyle vascularized bone graft

Explanation

For a scaphoid nonunion with proximal pole AVN and structural collapse, a free vascularized bone graft (such as from the medial femoral condyle) provides both the necessary blood supply and structural support. The 1,2 ICSRA graft is less effective in the setting of severe structural collapse and proximal pole AVN.

Question 7030

Topic: 2. Trauma

A 65-year-old woman sustains a 4-part proximal humerus fracture. Understanding the vascular anatomy is critical for predicting avascular necrosis. According to recent quantitative anatomical studies, which vessel provides the dominant blood supply to the articular segment of the humeral head?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Suprascapular artery
. Subscapular artery
. Thoracoacromial artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent studies (e.g., Hettrich et al.) have demonstrated that the posterior humeral circumflex artery provides the vast majority (approximately 64%) of the blood supply to the humeral head. This updated the classic teaching that the anterior humeral circumflex artery was the dominant supplier.

Question 7031

Topic: 2. Trauma

A 25-year-old man sustains a closed, displaced distal-third spiral fracture of the humeral shaft (Holstein-Lewis fracture). His neurovascular examination in the emergency department is entirely normal. Following closed reduction and placement of a coaptation splint, he develops a complete, dense wrist drop. What is the most appropriate next step in management?

. Observation and repeat examination in 2 weeks
. Immediate surgical exploration of the radial nerve
. Electromyography (EMG) at 3 weeks
. Change the splint to a functional fracture brace
. Ultrasound evaluation of the radial nerve

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve

Explanation

A secondary (post-reduction) radial nerve palsy in the setting of a humeral shaft fracture is an absolute indication for immediate surgical exploration. The nerve may be entrapped within the fracture site following the reduction maneuver.

Question 7032

Topic: 2. Trauma

A 30-year-old man requires open reduction and internal fixation of a transverse olecranon fracture using tension band wiring. To successfully convert distracting forces at the posterior cortex into compressive forces at the articular surface, the figure-of-eight wire must be placed on which aspect of the olecranon?

. Anterior cortex
. Posterior cortex to act as a tension band
. Intramedullary down the ulnar shaft
. Directly through the articular cartilage
. Transversely across the coronoid process

Correct Answer & Explanation

. Posterior cortex to act as a tension band

Explanation

The biomechanical principle of tension band wiring relies on placing the fixation (wire) on the tension side (dorsal/posterior aspect of the olecranon). Upon active flexion by the triceps, the distracting forces are converted into compressive forces at the articular surface.

Question 7033

Topic: Upper Extremity Trauma

A 29-year-old competitive weightlifter feels a sudden "pop" in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness with internal rotation. MRI confirms a pectoralis major rupture. What is the most common anatomical location of this tear in this patient population?

. Muscle belly
. Sternal origin
. Clavicular origin
. Musculotendinous junction
. Humeral insertion (tendon avulsion)

Correct Answer & Explanation

. Humeral insertion (tendon avulsion)

Explanation

In weightlifters, pectoralis major ruptures almost exclusively occur as avulsions of the tendon from its insertion on the proximal humerus. These injuries typically require surgical repair to restore strength and cosmesis.

Question 7034

Topic: 2. Trauma

A 24-year-old man presents with a scaphoid waist fracture nonunion 9 months after injury. MRI reveals avascular necrosis of the proximal pole. What is the most appropriate surgical graft choice to promote healing in this setting?

. Percutaneous screw fixation alone
. Non-vascularized iliac crest bone graft
. Vascularized bone graft (e.g., 1,2-ICSRA or Medial Femoral Condyle)
. Proximal row carpectomy
. Scaphoid excision and four-corner fusion

Correct Answer & Explanation

. Vascularized bone graft (e.g., 1,2-ICSRA or Medial Femoral Condyle)

Explanation

When avascular necrosis of the proximal pole is present in a scaphoid nonunion, non-vascularized grafts have high failure rates. A vascularized bone graft, such as the 1,2-ICSRA or medial femoral condyle (MFC) graft, is indicated to revascularize the pole and achieve union.

Question 7035

Topic: 2. Trauma

A 40-year-old man sustains a closed spiral fracture of the middle third of the humerus. On initial exam, neurological function is intact. Immediately following a closed reduction and splinting, he loses active wrist and finger extension and sensation in the first dorsal web space. What is the most appropriate next step in management?

. Functional fracture brace and clinical observation for 3 months.
. Immediate surgical exploration of the radial nerve and rigid fixation.
. Electromyography (EMG) at 3 weeks to determine severity.
. Loosening of the splint and re-evaluation in 2 weeks.
. Early tendon transfers to restore wrist and finger extension.

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve and rigid fixation.

Explanation

A secondary radial nerve palsy that develops immediately after closed manipulation or reduction of a humeral shaft fracture is an absolute indication for surgical exploration, as the nerve may be entrapped in the fracture site.

Question 7036

Topic: 2. Trauma

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

. Displacement greater than 2 cm
. Comminution with a Z-deformity
. Associated scapular neck fracture (floating shoulder)
. Open fracture with exposed bone
. 100% displacement without bony contact

Correct Answer & Explanation

. Open fracture with exposed bone

Explanation

While severe displacement, complete lack of bony contact, and a floating shoulder are relative indications for surgery, an open clavicle fracture is an absolute indication for immediate operative debridement and fixation.

Question 7037

Topic: 2. Trauma

According to the Bado classification, which of the following characterizes a Type I Monteggia lesion?

. Fracture of the ulnar diaphysis with posterior dislocation of the radial head
. Fracture of the ulnar metaphysis with lateral dislocation of the radial head
. Fracture of the proximal ulna with anterior dislocation of the radial head
. Fractures of both the proximal radius and ulna with anterior dislocation of the radial head
. Fracture of the radial shaft with DRUJ disruption

Correct Answer & Explanation

. Fracture of the proximal ulna with anterior dislocation of the radial head

Explanation

A Bado Type I Monteggia fracture is characterized by a fracture of the proximal or middle third of the ulna with an anterior dislocation of the radial head. It is the most common type.

Question 7038

Topic: 2. Trauma

A 35-year-old woman undergoes tension-band wiring for a transverse, non-comminuted olecranon fracture. What is the most common complication associated with this specific surgical technique?

. Ulnar nerve palsy
. Symptomatic hardware prominence requiring removal
. Nonunion of the fracture site
. Heterotopic ossification
. Loss of forearm pronation

Correct Answer & Explanation

. Symptomatic hardware prominence requiring removal

Explanation

Symptomatic hardware prominence is the most common complication of tension-band wiring for olecranon fractures, occurring in up to 80% of patients and often requiring secondary surgery for hardware removal.

Question 7039

Topic: 2. Trauma

When evaluating a displaced 4-part proximal humerus fracture for the risk of avascular necrosis, which of the following provides the primary arterial supply to the humeral head?

. Arcuate branch of the anterior circumflex humeral artery
. Posterior circumflex humeral artery
. Thoracoacromial artery
. Suprascapular artery
. Profunda brachii artery

Correct Answer & Explanation

. Posterior circumflex humeral artery

Explanation

Recent perfusion studies demonstrate that the posterior circumflex humeral artery provides the majority (up to 64%) of the blood supply to the humeral head, challenging older concepts that emphasized the anterior circumflex artery.

Question 7040

Topic: 2. Trauma

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

. 15 mm of shortening
. Z-type displacement
. Skin tenting without ischemia
. Open fracture
. Concomitant closed head injury

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for ORIF of a clavicle fracture include open fractures, neurovascular compromise, and severe skin tenting with impending necrosis. Displacement and shortening are considered relative indications.

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