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2. Trauma MCQs

Practice Set 359 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 7161

Topic: 2. Trauma

A 6-year-old boy falls onto his outstretched arm and sustains a lateral condyle fracture of the humerus. Radiographs show a displacement of 4 mm. Which of the following is the most appropriate management?

. Long arm cast in supination
. Closed reduction and long arm cast
. Closed reduction and percutaneous pinning with arthrogram
. Open reduction and internal fixation
. Skeletal traction

Correct Answer & Explanation

. Long arm cast in supination

Explanation

Lateral condyle fractures displaced >2 mm have a high risk of nonunion and subsequent cubitus valgus due to the pull of the extensor origin. Open reduction and internal fixation is the standard of care for >2 mm displacement.

Question 7162

Topic: 2. Trauma

A 6-year-old boy sustains a Bado Type I Monteggia fracture-dislocation. If a neurologic deficit is present upon initial examination, which of the following nerve branches is most likely affected?

. Anterior interosseous nerve
. Posterior interosseous nerve
. Ulnar nerve
. Superficial radial nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

A Bado Type I Monteggia lesion involves an anterior dislocation of the radial head. The posterior interosseous nerve (PIN) is at the highest risk of injury due to its proximity to the radial neck.

Question 7163

Topic: 2. Trauma
A 10-year-old boy has a painful, swollen knee after falling off his bicycle. Examination reveals no other injuries. Radiographs are shown in Figures 35a and 35b. Initial management of this fracture should consist of
. open reduction and internal fixation.
. arthroscopic reduction and internal fixation.
. closed reduction following evacuation of the hemarthrosis and casting in extension if reduction is adequate.
. closed reduction and casting in 90 degrees of flexion.
. excision of the fragment.

Correct Answer & Explanation

. closed reduction following evacuation of the hemarthrosis and casting in extension if reduction is adequate.

Explanation

The radiographs show a minimally displaced fracture of the tibial eminence, which is classified as a McKeever type II injury. In a number of studies, it has been found that most of these fractures will reduce with extension of the knee. This is often made easier with evacuation of the hemarthrosis. The position of knee immobilization is controversial, with some authors preferring full extension and others preferring 20 degrees of flexion. Flexion to 90 degrees will further displace the fragment. If the fragment does not reduce or if the patient has a McKeever type III or IV injury, reduction and internal fixation are required. This can be done with either an open or an arthroscopic procedure. Excision of the fragment is not indicated.

Question 7164

Topic: 2. Trauma

A 4-year-old boy falls off monkey bars and sustains a displaced lateral condyle fracture of the humerus. Which of the following complications is most specifically associated with a failure of this fracture to unite?

. Cubitus varus and median nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Radioulnar synostosis
. Avascular necrosis of the trochlea
. Compartment syndrome

Correct Answer & Explanation

. Cubitus varus and median nerve palsy

Explanation

Lateral condyle fractures are intra-articular and prone to nonunion because the fracture site is bathed in synovial fluid. Nonunion leads to a progressive cubitus valgus deformity, which can stretch the ulnar nerve and cause tardy ulnar nerve palsy years later.

Question 7165

Topic: 2. Trauma

A 3-year-old boy sustains an isolated, closed, length-stable diaphyseal femur fracture after a low-energy fall. He has no other injuries. What is the preferred treatment?

. Immediate early spica casting
. Flexible intramedullary nailing
. Rigid antegrade locked intramedullary nail
. Open reduction and plate fixation
. External fixation

Correct Answer & Explanation

. Immediate early spica casting

Explanation

For children 6 months to 5 years of age with closed, isolated, length-stable femur fractures (<2-3 cm of shortening), early spica casting is the gold standard treatment with excellent clinical outcomes.

Question 7166

Topic: 2. Trauma

Which of the following is the most pathognomonic radiographic sign of non-accidental trauma (child abuse) in an infant?

. Clavicle fracture
. Linear skull fracture
. Spiral fracture of the tibia (toddler's fracture)
. Classic metaphyseal lesion (corner or bucket-handle fracture)
. Transverse femur fracture

Correct Answer & Explanation

. Clavicle fracture

Explanation

The classic metaphyseal lesion (CML), also known as a corner fracture or bucket-handle fracture, is highly specific for non-accidental trauma. It results from violent pulling or twisting of an infant's extremity.

Question 7167

Topic: 2. Trauma

An 8-year-old boy falls on an outstretched hand and sustains an isolated plastic deformation of the ulna. On careful examination, he is unable to supinate his forearm and has pain at the elbow. What must be ruled out radiographically?

. Supracondylar humerus fracture
. Radial head dislocation (Monteggia equivalent)
. Distal radius physeal arrest
. Olecranon apophysitis
. Galeazzi fracture

Correct Answer & Explanation

. Supracondylar humerus fracture

Explanation

Plastic deformation of the ulna can act similarly to a true ulnar fracture in a Monteggia lesion. It forces a change in forearm length, frequently resulting in a concomitant radial head dislocation that must be identified and reduced.

Question 7168

Topic: 2. Trauma

A 6-year-old boy falls from the monkey bars and sustains a lateral condyle fracture of the distal humerus. Radiographs show a Milch Type II fracture with 3 mm of displacement. What is the most appropriate management?

. Long arm cast for 4 weeks
. Long arm cast for 6 weeks with weekly radiographs
. Closed reduction and long arm casting
. Closed reduction and percutaneous pinning
. Open reduction and internal fixation

Correct Answer & Explanation

. Long arm cast for 4 weeks

Explanation

Lateral condyle fractures displaced > 2 mm require open reduction and internal fixation to ensure anatomic reduction of the articular surface and physis. This minimizes the risk of nonunion, malunion, and progressive cubitus valgus with tardy ulnar nerve palsy.

Question 7169

Topic: Upper Extremity Trauma
A 7-year-old boy sustains a forearm injury. Radiographs show a plastic deformation of the ulna and an anterior dislocation of the radial head. According to the Bado classification, what type of Monteggia lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Galeazzi equivalent

Correct Answer & Explanation

. Type I

Explanation

A Bado Type I Monteggia fracture involves an anterior dislocation of the radial head with a fracture (or plastic deformation in children) of the ulnar diaphysis. It is the most common type of Monteggia lesion in the pediatric population.

Question 7170

Topic: 2. Trauma

A 2-year-old boy is brought to the emergency department after tripping and falling while running on a carpet. Radiographs demonstrate a spiral fracture of the middle third of the femoral shaft. There are no signs of non-accidental trauma. What is the most appropriate treatment?

. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. Early spica casting
. External fixation
. Open reduction and plate fixation

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

In children ages 6 months to 5 years with isolated, length-stable or minimally shortened diaphyseal femur fractures, early spica casting is the gold standard treatment. It is associated with high union rates and minimal complications.

Question 7171

Topic: 2. Trauma

A 5-year-old boy undergoes open reduction and internal fixation for a displaced lateral condyle fracture of the humerus. Which of the following is the most common complication of this fracture despite anatomic reduction?

. Avascular necrosis of the trochlea
. Cubitus varus
. Nonunion
. Lateral spur formation (prominence)
. Premature physeal closure of the medial epicondyle

Correct Answer & Explanation

. Avascular necrosis of the trochlea

Explanation

Lateral spur formation, or lateral condylar overgrowth, is the most common complication following a lateral condyle fracture. Nonunion and cubitus valgus are more severe but less common.

Question 7172

Topic: 2. Trauma

A 2-year-old child presents with a sudden onset of limping and refusal to bear weight on the right leg. There is no history of significant trauma. Physical exam shows mild tenderness over the distal tibia. Initial AP and lateral radiographs are normal. What is the most appropriate initial management?

. Immediate MRI of the tibia
. Bone scan
. Long leg cast and follow-up radiographs in 10-14 days
. Reassurance and ibuprofen
. Aspiration of the ankle joint

Correct Answer & Explanation

. Immediate MRI of the tibia

Explanation

This clinical presentation is classic for a toddler's fracture (undisplaced spiral fracture of the distal tibia), which often does not appear on initial radiographs. Immobilization in a cast or splint with repeat imaging in 10-14 days to identify periosteal reaction is the standard of care.

Question 7173

Topic: 2. Trauma

A 10-year-old boy sustains a completely displaced Salter-Harris II fracture of the proximal humerus. What is the most acceptable management for this injury?

. Open reduction and internal fixation with plates and screws
. Closed reduction and percutaneous pinning
. Sling and swathe immobilization without reduction
. Shoulder spica cast
. External fixation

Correct Answer & Explanation

. Open reduction and internal fixation with plates and screws

Explanation

The proximal humerus has massive remodeling potential, contributing to 80% of humeral growth. Therefore, even completely displaced fractures in young children (under 11) can typically be managed conservatively with a sling and swathe, yielding excellent functional results.

Question 7174

Topic: 2. Trauma

An 8-year-old boy sustains a mid-diaphyseal both-bone forearm fracture. What is the maximum acceptable angulation that will still allow for functional remodeling without significant loss of forearm rotation?

. 15 degrees
. 25 degrees
. 35 degrees
. 45 degrees
. 55 degrees

Correct Answer & Explanation

. 15 degrees

Explanation

In children younger than 9 years, up to 15 degrees of angulation and complete displacement are generally acceptable in midshaft forearm fractures due to robust remodeling potential. Greater angulation risks a clinically significant loss of pronation and supination.

Question 7175

Topic: 2. Trauma

A 6-year-old girl falls on an outstretched arm and sustains a lateral condyle fracture of the distal humerus with 3 mm of displacement. If this fracture goes untreated, what is the most likely late complication?

. Cubitus varus and tardy radial nerve palsy
. Cubitus valgus and tardy ulnar nerve palsy
. Volkmann ischemic contracture
. Avascular necrosis of the radial head
. Myositis ossificans

Correct Answer & Explanation

. Cubitus varus and tardy radial nerve palsy

Explanation

Displaced lateral condyle fractures (>2 mm) require surgical fixation. Nonunion is a common complication of untreated or inadequately treated fractures, which leads to progressive cubitus valgus and subsequent tardy ulnar nerve palsy.

Question 7176

Topic: 2. Trauma

A 13-year-old boy sustains a Salter-Harris II fracture of the proximal humerus. Radiographs show 40 degrees of apex anterior angulation and 50% translation. What is the most appropriate treatment?

. Sling and swath immobilization
. Closed reduction and percutaneous pinning
. Open reduction and internal fixation with plates
. Flexible intramedullary nailing
. Skeletal traction

Correct Answer & Explanation

. Sling and swath immobilization

Explanation

The proximal humerus physis provides 80% of the longitudinal growth of the humerus, offering immense remodeling potential. In a 13-year-old, up to 45 degrees of angulation and 50% translation are acceptable and can be managed non-operatively with a sling.

Question 7177

Topic: Pelvic & Acetabular Trauma

A 5-year-old female with residual acetabular dysplasia requires a pelvic osteotomy to improve anterolateral femoral head coverage. The surgeon plans an incomplete pericapsular osteotomy that hinges on the triradiate cartilage. Which procedure is being described?

. Salter innominate osteotomy
. Pemberton osteotomy
. Dega osteotomy
. Chiari osteotomy
. Shelf procedure

Correct Answer & Explanation

. Salter innominate osteotomy

Explanation

The Pemberton osteotomy is an incomplete pericapsular cut that hinges on the triradiate cartilage, effectively reducing acetabular volume and improving anterolateral coverage. In contrast, the Salter osteotomy hinges at the pubic symphysis.

Question 7178

Topic: Pelvic & Acetabular Trauma

A 4-year-old child undergoes a Salter innominate osteotomy for the treatment of DDH. Which of the following biomechanical changes occurs as a direct result of this specific osteotomy?

. Medialization of the joint center
. Lateralization and distalization of the joint center
. Decreased anterior coverage
. Reduction in overall acetabular volume
. Hinging at the triradiate cartilage

Correct Answer & Explanation

. Medialization of the joint center

Explanation

The Salter osteotomy is a complete innominate cut that redirects the entire acetabulum to provide anterolateral coverage. Because it hinges at the pubic symphysis, it biomechanically lateralizes and distalizes the joint center, often lengthening the limb slightly.

Question 7179

Topic: 2. Trauma

A 4-year-old boy sustains a completely displaced, isolated, midshaft femur fracture after a fall from a playground structure. He weighs 18 kg (40 lbs). What is the most appropriate initial treatment?

. Pavlik harness
. Rigid locked intramedullary nailing
. Elastic stable intramedullary nailing (ESIN)
. External fixation
. Immediate hip spica cast

Correct Answer & Explanation

. Pavlik harness

Explanation

For children under 5 years old and weighing less than 50 lbs, an early or immediate hip spica cast is the treatment of choice for closed, isolated midshaft femur fractures.

Question 7180

Topic: 2. Trauma

A 10-year-old boy weighing 40 kg sustains a closed, length-stable transverse midshaft femur fracture. Which of the following is the most appropriate surgical treatment?

. Spica casting
. Plate osteosynthesis
. Flexible intramedullary nailing
. Trochanteric entry rigid intramedullary nail
. External fixation

Correct Answer & Explanation

. Spica casting

Explanation

Flexible intramedullary nailing is the standard of care for length-stable femur fractures in children aged 5 to 11 years who weigh less than 50 kg (110 lbs).

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