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2. Trauma MCQs

Practice Set 353 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 7041

Topic: 2. Trauma

A 25-year-old cyclist sustains a completely displaced midshaft clavicle fracture with 2.5 cm of shortening. Compared to nonoperative management, what is the primary advantage of open reduction and internal fixation (ORIF) for this specific injury pattern?

. Decreased risk of nonunion
. Decreased risk of deep infection
. Improved long-term cosmetic appearance
. Decreased risk of adhesive capsulitis
. Elimination of the need for any postoperative immobilization

Correct Answer & Explanation

. Decreased risk of nonunion

Explanation

For completely displaced and significantly shortened (>2 cm) midshaft clavicle fractures, operative fixation significantly decreases the risk of nonunion and symptomatic malunion compared to nonoperative sling immobilization.

Question 7042

Topic: 2. Trauma

A 7-year-old boy falls from the monkey bars. Radiographs demonstrate a fracture of the ulnar shaft with an anterior dislocation of the radial head (Bado Type I Monteggia variant). What is the preferred initial management?

. Open reduction of the radial head and rigid ulnar plating
. Closed reduction and long arm casting in supination and flexion
. Closed reduction and long arm casting in pronation and extension
. Flexible intramedullary nailing of the ulna without addressing the radius
. Sling immobilization and early range of motion

Correct Answer & Explanation

. Closed reduction and long arm casting in supination and flexion

Explanation

In pediatric Bado Type I Monteggia fractures, closed reduction of the ulnar fracture typically allows spontaneous reduction of the radial head. The most stable position to maintain reduction is in a long arm cast with the elbow flexed to roughly 100 degrees and the forearm supinated.

Question 7043

Topic: 2. Trauma

An 82-year-old community-dwelling woman with severe osteoporosis presents with a highly comminuted, intra-articular distal humerus fracture. She is a low-demand patient but requires her arms for basic transfers. What is the most appropriate surgical intervention?

. Total elbow arthroplasty
. ORIF with dual orthogonal plating
. ORIF with parallel plating
. Hemiarthroplasty of the elbow
. External fixation

Correct Answer & Explanation

. Total elbow arthroplasty

Explanation

Total elbow arthroplasty (TEA) is the treatment of choice for comminuted, intra-articular distal humerus fractures in low-demand, elderly patients with poor bone quality. TEA provides predictable pain relief and allows for immediate weight-bearing for transfers.

Question 7044

Topic: 2. Trauma

A 28-year-old man suffers a severe fall on an outstretched hand, resulting in a comminuted radial head fracture, diffuse forearm pain, and distal radioulnar joint (DRUJ) tenderness. If the radial head is surgically excised without replacement, what is the most likely complication?

. Proximal migration of the radius
. Posterior interosseous nerve palsy
. Heterotopic ossification of the anconeus
. Nonunion of the proximal ulna
. Avascular necrosis of the scaphoid

Correct Answer & Explanation

. Proximal migration of the radius

Explanation

This presentation describes an Essex-Lopresti injury, which involves a radial head fracture, tear of the interosseous membrane, and DRUJ disruption. Excision of the radial head without prosthetic replacement leads to catastrophic proximal radial migration and ulnocarpal impaction.

Question 7045

Topic: 2. Trauma

During open reduction and internal fixation of a midshaft clavicle fracture, the surgeon inadvertently plunges the drill bit deep to the clavicle and the subclavius muscle. Which neurovascular structure is at greatest risk of direct injury in this immediate anatomic region?

. Subclavian vein
. Subclavian artery
. Suprascapular nerve
. Brachial plexus roots
. Internal jugular vein

Correct Answer & Explanation

. Subclavian vein

Explanation

The subclavian vein is the most superficial and anterior neurovascular structure located directly posterior to the subclavius muscle and the middle third of the clavicle, making it highly vulnerable to plunging drills or excessively long screws.

Question 7046

Topic: 2. Trauma

A 65-year-old woman sustains a 4-part proximal humerus fracture and undergoes shoulder hemiarthroplasty. Which of the following technical factors is most critical for restoring forward elevation and predicting a good long-term functional outcome?

. Restoration of absolute humeral length
. Anatomic reduction and healing of the tuberosities
. Use of a cemented rather than press-fit stem
. Retroversion of the humeral stem to exactly 40 degrees
. Repair of the subscapularis directly to the metal stem

Correct Answer & Explanation

. Anatomic reduction and healing of the tuberosities

Explanation

Healing of the tuberosities in anatomic or near-anatomic position is the single most important prognostic factor for functional return (particularly forward elevation) following hemiarthroplasty for a proximal humerus fracture.

Question 7047

Topic: 2. Trauma

A 32-year-old man undergoes superior plating for a completely displaced midshaft clavicle fracture. Postoperatively, he notes a localized area of numbness over the anterosuperior aspect of his chest wall, directly inferior to the surgical incision. Which nerve was most likely injured during the exposure?

. Supraclavicular nerve branches
. Axillary nerve
. Long thoracic nerve
. Suprascapular nerve
. Medial pectoral nerve

Correct Answer & Explanation

. Supraclavicular nerve branches

Explanation

The supraclavicular nerves cross directly over the clavicle. Incisions for clavicle ORIF frequently traumatize or divide these branches, leading to a common complication of postoperative numbness just inferior to the incision.

Question 7048

Topic: 2. Trauma

An 82-year-old woman with advanced osteoporosis presents with a severely comminuted intra-articular distal humerus fracture (AO/OTA type 13-C3). She lives independently but uses a walker. Which surgical treatment provides the most reliable early return to function while minimizing the risk of reoperation for fixation failure?

. Total elbow arthroplasty
. Open reduction and internal fixation with orthogonal plating
. Open reduction and internal fixation with parallel locked plating
. Hinged external fixation
. Closed reduction and percutaneous pinning

Correct Answer & Explanation

. Total elbow arthroplasty

Explanation

Total elbow arthroplasty is the preferred treatment for elderly, lower-demand patients with osteoporotic, highly comminuted intra-articular distal humerus fractures. It allows immediate postoperative mobilization and avoids the high complication rates of ORIF in poor bone.

Question 7049

Topic: 2. Trauma

A 55-year-old woman undergoes volar locked plating for a displaced distal radius fracture. Six months later, she presents with a sudden, painless inability to actively flex the interphalangeal joint of her thumb.

What is the most likely cause of this complication?

. Extensor pollicis longus rupture due to dorsal screw prominence
. Flexor pollicis longus rupture due to prominent volar hardware
. Delayed median nerve palsy
. Unrecognized acute compartment syndrome sequelae
. Adhesion of the flexor digitorum profundus tendons

Correct Answer & Explanation

. Flexor pollicis longus rupture due to prominent volar hardware

Explanation

Flexor pollicis longus (FPL) rupture is a well-documented complication of volar plating for distal radius fractures. It is typically caused by plate placement distal to the watershed line, resulting in attrition of the FPL tendon over the prominent hardware.

Question 7050

Topic: 2. Trauma

A 7-year-old boy falls from the monkey bars and sustains a Bado Type I Monteggia fracture equivalent. What is the classic anatomic deformity seen in a typical Bado Type I injury?

. Anterior dislocation of the radial head with an apex-anterior fracture of the ulnar diaphysis
. Posterior dislocation of the radial head with an apex-posterior fracture of the ulnar diaphysis
. Lateral dislocation of the radial head with a metaphyseal ulnar fracture
. Anterior dislocation of the radial head with a midshaft radius fracture
. Proximal radioulnar joint dislocation with a distal radius fracture

Correct Answer & Explanation

. Anterior dislocation of the radial head with an apex-anterior fracture of the ulnar diaphysis

Explanation

Bado Type I Monteggia fractures are the most common variant, characterized by an anterior dislocation of the radial head and a diaphyseal fracture of the ulna with anterior angulation.

Question 7051

Topic: 2. Trauma
A 45-year-old woman falls on her outstretched hand and sustains a coronal shear fracture of the distal humerus. The fracture fragment includes the capitellum and a significant medial extension that encompasses most of the trochlea. What is the correct classification for this fracture pattern?
. Kocher-Lorenz fracture
. Hahn-Steinthal (Type I) fracture
. McKee modification (Type IV) capitellar fracture
. Bryan and Morrey Type III fracture
. Essex-Lopresti fracture

Correct Answer & Explanation

. McKee modification (Type IV) capitellar fracture

Explanation

A Type IV capitellum fracture (McKee modification) describes a coronal shear fracture that involves the capitellum and extends medially to include a significant portion of the trochlea. This typically requires an extensile exposure for fixation.

Question 7052

Topic: 2. Trauma

A 34-year-old man presents with a high-energy multitrauma including a displaced scapular neck fracture. Which of the following radiographic parameters is an accepted indication for operative fixation of the scapula?

. Medialization of the glenoid by 5 mm
. Glenopolar angle of 40 degrees
. Scapular body displacement of 5 mm
. Glenopolar angle of less than 22 degrees
. Isolated coracoid fracture with 2 mm displacement

Correct Answer & Explanation

. Glenopolar angle of less than 22 degrees

Explanation

A glenopolar angle of less than 20 to 22 degrees causes severe medialization and distalization of the glenoid, leading to poor functional outcomes and rotator cuff dysfunction. This is a primary indication for ORIF of a scapular neck/body fracture.

Question 7053

Topic: 2. Trauma

Which of the following scenarios is considered an absolute indication for operative internal fixation of a Galeazzi fracture?

. Dorsal angulation of the radius in a pediatric patient
. Any Galeazzi fracture pattern occurring in an adult patient
. A distal third radius fracture without DRUJ disruption
. An associated nondisplaced ulnar styloid fracture
. Presentation delayed by 48 hours

Correct Answer & Explanation

. Any Galeazzi fracture pattern occurring in an adult patient

Explanation

A Galeazzi fracture consists of a distal radius shaft fracture with disruption of the distal radioulnar joint. In adults, these injuries are highly unstable and require absolute operative internal fixation of the radius.

Question 7054

Topic: 2. Trauma

According to Hertel's criteria, which of the following radiographic findings is the strongest predictor of humeral head ischemia in the setting of a proximal humerus fracture?

. Metaphyseal head extension (calcar length) of less than 8 mm
. Greater tuberosity displacement of 5 mm
. Intact medial hinge
. Varus angulation of 15 degrees
. Lesser tuberosity fracture

Correct Answer & Explanation

. Metaphyseal head extension (calcar length) of less than 8 mm

Explanation

Hertel established that a short calcar segment (<8 mm), a disrupted medial hinge, and complex fracture patterns are the most reliable predictors of ischemia to the humeral head.

Question 7055

Topic: 2. Trauma

A 6-year-old child sustains an extension-type Monteggia fracture-dislocation. Which of the following neurological deficits is most commonly associated with this injury?

. Inability to flex the interphalangeal joint of the thumb
. Numbness in the small finger
. Inability to extend the metacarpophalangeal joints
. Weakness in wrist flexion
. Numbness over the deltoid

Correct Answer & Explanation

. Inability to extend the metacarpophalangeal joints

Explanation

The posterior interosseous nerve (PIN) is most commonly injured in Monteggia fractures due to stretching of the nerve by the anteriorly dislocated radial head. This presents as weakness in extending the metacarpophalangeal joints and thumb.

Question 7056

Topic: 2. Trauma

A 22-year-old cyclist sustains a midshaft clavicle fracture. Which of the following is a widely accepted relative indication for open reduction and internal fixation?

. Displacement of 5 mm
. Shortening greater than 2 cm with 100% displacement
. Associated grade I acromioclavicular joint sprain
. Injury to the non-dominant arm
. Presence of a skin abrasion over the fracture

Correct Answer & Explanation

. Shortening greater than 2 cm with 100% displacement

Explanation

Significant shortening (>2 cm) and 100% displacement are strong relative indications for operative fixation of clavicle fractures. Nonoperative management in these cases is associated with higher rates of nonunion and decreased shoulder strength.

Question 7057

Topic: 2. Trauma

During surgical exposure for a comminuted intra-articular distal humerus fracture via an olecranon osteotomy, what is the ideal configuration of the osteotomy to maximize stability upon repair?

. Transverse straight cut
. Oblique cut from proximal-dorsal to distal-volar
. Step-cut
. Chevron-shaped osteotomy with the apex pointing distally
. Curved osteotomy matching the trochlear notch

Correct Answer & Explanation

. Chevron-shaped osteotomy with the apex pointing distally

Explanation

A chevron-shaped osteotomy with the apex pointing distally provides optimal interdigitation and maximized rotational stability when repaired with a tension band or plate construct.

Question 7058

Topic: 2. Trauma

A 30-year-old man presents to the emergency department following a high-speed motor vehicle collision. Radiographs reveal an isolated, minimally displaced fracture of the scapular body. What is the most appropriate initial management?

. Open reduction and internal fixation with plates
. Sling immobilization and early range of motion
. Shoulder spica cast application
. External fixation
. Excision of the fractured scapular body

Correct Answer & Explanation

. Sling immobilization and early range of motion

Explanation

The vast majority of extra-articular scapular body fractures heal well with nonoperative management. A sling for comfort followed by early range of motion is the standard of care for minimally displaced fractures.

Question 7059

Topic: Upper Extremity Trauma

A 28-year-old man falls onto his shoulder and is diagnosed with a Type V acromioclavicular (AC) joint injury. Which of the following best describes the anatomic disruption characteristic of this injury type?

. AC ligaments torn, coracoclavicular ligaments intact
. AC and coracoclavicular ligaments torn with <100% superior clavicular displacement
. AC and coracoclavicular ligaments torn with >100% superior clavicular displacement through the deltotrapezial fascia
. AC and coracoclavicular ligaments torn with posterior clavicle displacement into the trapezius
. AC and coracoclavicular ligaments torn with inferior clavicle displacement under the coracoid

Correct Answer & Explanation

. AC and coracoclavicular ligaments torn with >100% superior clavicular displacement through the deltotrapezial fascia

Explanation

A Type V AC joint injury features disruption of both the AC and CC ligaments along with the deltotrapezial fascia, resulting in severe superior displacement of the clavicle by greater than 100% to 300% relative to the acromion.

Question 7060

Topic: 2. Trauma

A 24-year-old man presents with a 9-month history of wrist pain after a fall. MRI shows a scaphoid nonunion with avascular necrosis (AVN) of the proximal pole. What is the most appropriate surgical management?

. Non-vascularized iliac crest bone graft and screw fixation
. Vascularized pedicled bone graft and internal fixation
. Proximal row carpectomy
. Scaphoid excision and four-corner fusion
. Radial styloidectomy

Correct Answer & Explanation

. Vascularized pedicled bone graft and internal fixation

Explanation

Proximal pole AVN with nonunion is an indication for vascularized bone grafting (e.g., 1,2 ICSRA pedicled graft). Non-vascularized grafts have an unacceptably high failure rate when the proximal pole is ischemic.

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