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2. Trauma MCQs

Practice Set 363 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 7241

Topic: 2. Trauma

A 25-year-old female marathon runner presents with insidious onset groin pain. Radiographs are normal, but an MRI reveals a focal fracture line involving the superior (tension) aspect of the femoral neck without displacement. What is the most appropriate management?

. Non-weight bearing with crutches for 6 weeks
. Core decompression of the femoral head
. In situ fixation with cannulated screws
. Sliding hip screw fixation
. Physical therapy focusing on abductor strengthening

Correct Answer & Explanation

. Non-weight bearing with crutches for 6 weeks

Explanation

Tension-sided femoral neck stress fractures have a high propensity for completion and displacement. They are managed operatively with in situ percutaneous cannulated screw fixation to prevent catastrophic displacement and subsequent avascular necrosis.

Question 7242

Topic: 2. Trauma

In an 80-year-old patient with multiple medical comorbidities, surgical intervention for a displaced femoral neck fracture within 48 hours of admission has been shown to primarily decrease the risk of:

. Avascular necrosis of the femoral head
. Nonunion of the fracture
. Systemic complications and overall 1-year mortality
. Postoperative deep surgical site infection
. Heterotopic ossification

Correct Answer & Explanation

. Avascular necrosis of the femoral head

Explanation

Early surgery (within 24-48 hours) for hip fractures in the elderly is associated with fewer systemic complications (e.g., pneumonia, pressure ulcers, DVT) and a decreased 1-year mortality rate. It does not reliably decrease AVN or nonunion in this population.

Question 7243

Topic: 2. Trauma

Which of the following is the strongest predictive factor for nonunion after closed reduction and internal fixation of a displaced femoral neck fracture in a 60-year-old patient?

. Patient age
. Time to surgery greater than 12 hours
. Degree of initial fracture displacement and quality of reduction
. Choice of cannulated screws versus a sliding hip screw
. Presence of osteoporosis

Correct Answer & Explanation

. Patient age

Explanation

The quality of the surgical reduction and the initial degree of fracture displacement are the most critical determinants of successful healing. Poor reduction (varus malalignment) significantly increases the risk of nonunion and hardware failure.

Question 7244

Topic: 2. Trauma

A 45-year-old man with end-stage renal disease on hemodialysis presents with a displaced femoral neck fracture. If internal fixation is chosen over arthroplasty, the surgeon must be aware of an exceptionally high risk for which complication?

. Nonunion and avascular necrosis due to renal osteodystrophy
. Rapid hardware integration leading to difficult future extraction
. Hypertrophic ossification of the hip capsule
. Acute deep infection from the hemodialysis access site
. Premature fusion of the greater trochanteric apophysis

Correct Answer & Explanation

. Nonunion and avascular necrosis due to renal osteodystrophy

Explanation

Patients with chronic renal failure and renal osteodystrophy have very poor bone healing potential. Internal fixation of displaced femoral neck fractures in this population is associated with an unacceptably high rate of nonunion, hardware failure, and AVN, often making arthroplasty the preferred choice even in younger patients.

Question 7245

Topic: 2. Trauma

When utilizing three cannulated screws for the fixation of a non-displaced femoral neck fracture, the optimal biomechanical configuration of the screws is:

. A base-superior triangle with the inferior screw in the center of the neck
. An inverted triangle with the inferior screw resting strictly on the femoral calcar
. A linear vertical configuration
. Three diverging screws starting from the greater trochanter
. A transverse alignment across the basicervical region

Correct Answer & Explanation

. A base-superior triangle with the inferior screw in the center of the neck

Explanation

The optimal configuration for three cannulated screws is an inverted triangle. The inferior screw should run adjacent to and be supported by the calcar (inferior cortex of the neck) to provide maximum cortical support and resist varus displacement.

Question 7246

Topic: 2. Trauma

A 30-year-old man involved in a motorcycle accident sustains a comminuted midshaft femur fracture and an ipsilateral, non-displaced femoral neck fracture. What is the most appropriate sequence and method of fixation?

. Retrograde intramedullary nailing of the shaft followed by cannulated screw fixation of the neck
. Fixation of the femoral neck first, followed by fixation of the femoral shaft
. Antegrade piriformis entry nailing to address both fractures simultaneously
. Non-operative management of the neck and plating of the shaft
. External fixation of the shaft and non-operative management of the neck

Correct Answer & Explanation

. Retrograde intramedullary nailing of the shaft followed by cannulated screw fixation of the neck

Explanation

In ipsilateral femoral neck and shaft fractures, the priority is anatomic reduction and fixation of the femoral neck to prevent displacement and AVN. This is typically done first (e.g., with screws), followed by shaft fixation (e.g., retrograde nail or plate).

Question 7247

Topic: 2. Trauma

A healthy 35-year-old man sustains a displaced femoral neck fracture. When counseling the patient on the risk of avascular necrosis (AVN), which of the following is considered the most significant determining factor?

. Time to surgery greater than 6 hours
. Presence of an intracapsular hematoma
. Initial degree of fracture displacement
. Use of a sliding hip screw versus cancellous screws
. Failure to perform a capsulotomy

Correct Answer & Explanation

. Time to surgery greater than 6 hours

Explanation

The initial degree of fracture displacement is the most critical factor predicting the development of AVN in young patients with femoral neck fractures. While urgent reduction and fixation are recommended, initial displacement dictates the extent of irreversible vascular injury to the retinacular vessels.

Question 7248

Topic: 2. Trauma

A 28-year-old female marathon runner complains of progressively worsening anterior groin pain. MRI reveals a stress fracture on the superior aspect of the femoral neck involving 60% of the neck width. What is the most appropriate management?

. Strict non-weight bearing with crutches for 6 weeks
. Core decompression
. In situ fixation with cannulated screws
. Proximal femoral osteotomy
. Pulsed electromagnetic field therapy

Correct Answer & Explanation

. Strict non-weight bearing with crutches for 6 weeks

Explanation

Tension-sided (superior) femoral neck stress fractures have a high risk of completion and displacement, requiring prophylactic operative fixation. Compression-sided (inferior) fractures involving less than 50% of the neck can often be managed non-operatively.

Question 7249

Topic: 2. Trauma

Which of the following fracture patterns of the proximal femur is biomechanically best treated with a sliding hip screw (SHS) rather than multiple parallel cancellous screws?

. Garden I femoral neck fracture
. Garden II femoral neck fracture
. Basicervical femoral neck fracture
. Subcapital femoral neck fracture
. Impacted valgus femoral neck fracture

Correct Answer & Explanation

. Garden I femoral neck fracture

Explanation

Basicervical femoral neck fractures are considered extracapsular and lack the inherent stability of true transcervical fractures. They are subject to significant shear forces and are best treated with a sliding hip screw or cephalomedullary nail to prevent fixation failure.

Question 7250

Topic: 2. Trauma
A 45-year-old man presents with a painful nonunion of a femoral neck fracture 9 months after fixation with 3 cancellous screws. Radiographs show a vertical fracture line (Pauwels type III) with varus collapse, but MRI confirms a viable femoral head. What is the best surgical option?
. Total hip arthroplasty
. Bipolar hemiarthroplasty
. Valgus-producing proximal femoral osteotomy
. Revision fixation with a sliding hip screw
. Vascularized fibular graft

Correct Answer & Explanation

. Valgus-producing proximal femoral osteotomy

Explanation

A valgus intertrochanteric osteotomy reorients the vertical fracture line to a more horizontal position, converting shear forces into compressive forces. This promotes healing of the nonunion while preserving the native, viable femoral head in a young patient.

Question 7251

Topic: 2. Trauma
A 35-year-old man sustains a displaced, vertically oriented (Pauwels type III) femoral neck fracture. Which of the following fixation constructs offers the greatest biomechanical stability for this specific fracture pattern?
. Three parallel cannulated screws in an inverted triangle
. Three parallel cannulated screws in a standard triangle
. A sliding hip screw with an anti-rotation screw
. A standard length cephalomedullary nail
. Two fully threaded cancellous screws

Correct Answer & Explanation

. A sliding hip screw with an anti-rotation screw

Explanation

Pauwels type III fractures experience high shear forces due to their vertical orientation. A sliding hip screw with a derotation screw provides superior biomechanical stability compared to multiple cancellous screws for this fracture pattern.

Question 7252

Topic: 2. Trauma

A 28-year-old woman sustains a non-displaced femoral neck fracture. She undergoes in situ fixation with three cannulated screws. What is the most significant factor predicting the development of osteonecrosis (AVN) of the femoral head in this patient?

. Initial degree of fracture displacement
. Number of screws utilized
. Use of a capsulotomy
. Timing of surgery within 12 hours
. Thread length of the screws

Correct Answer & Explanation

. Initial degree of fracture displacement

Explanation

The initial degree of fracture displacement is the most critical prognostic factor for the development of osteonecrosis following a femoral neck fracture. Capsulotomy and timing have not been consistently proven to alter AVN rates in non-displaced fractures.

Question 7253

Topic: 2. Trauma

An 80-year-old man falls and sustains a basicervical femoral neck fracture. Which of the following fixation methods is biomechanically most appropriate for this fracture pattern?

. Three parallel cannulated cancellous screws
. Two fully threaded cancellous screws
. A sliding hip screw
. A unipolar hemiarthroplasty
. A resurfacing arthroplasty

Correct Answer & Explanation

. Three parallel cannulated cancellous screws

Explanation

Basicervical femoral neck fractures are biomechanically unstable and behave similarly to intertrochanteric fractures. They are best treated with a sliding hip screw or cephalomedullary nail rather than multiple cancellous screws.

Question 7254

Topic: 2. Trauma

You are reviewing a radiograph of a 62-year-old female who sustained a fall. The radiograph reveals a Garden I femoral neck fracture. Which of the following best describes the classical radiographic appearance of this fracture type?

. Complete, non-displaced fracture
. Incomplete, valgus-impacted fracture
. Complete, partially displaced fracture
. Complete, fully displaced fracture
. Basicervical shear fracture

Correct Answer & Explanation

. Complete, non-displaced fracture

Explanation

In the Garden classification of femoral neck fractures, a Garden I fracture is classically described as an incomplete, valgus-impacted fracture on the anteroposterior radiograph.

Question 7255

Topic: 2. Trauma
A 25-year-old man sustains a displaced transcervical femoral neck fracture. Which of the following fixation constructs provides the greatest biomechanical stability for this high-shear fracture pattern?
. Three parallel cannulated screws
. Sliding hip screw with a derotation screw
. Two crossed cannulated screws
. Dynamic condylar screw
. Proximal femoral nail

Correct Answer & Explanation

. Sliding hip screw with a derotation screw

Explanation

In young adults with displaced, high-shear femoral neck fractures (Pauwels III), a sliding hip screw with a derotation screw provides superior biomechanical stability compared to parallel cannulated screws. This construct better resists vertical shear forces and decreases the rate of nonunion.

Question 7256

Topic: 2. Trauma

A 30-year-old male presents with a nondisplaced femoral neck fracture. Which of the following is the most compelling rationale for performing a hip capsulotomy during surgical fixation?

. To allow direct visualization of the fracture reduction
. To decompress the intracapsular hematoma and improve femoral head perfusion
. To prevent heterotopic ossification
. To facilitate precise placement of a sliding hip screw
. To reduce the risk of postoperative deep vein thrombosis

Correct Answer & Explanation

. To allow direct visualization of the fracture reduction

Explanation

The primary rationale for capsulotomy in young patients with femoral neck fractures is to decompress the intracapsular hematoma. This reduces elevated intra-articular pressure, which may improve residual blood flow to the femoral head and theoretically reduce the risk of avascular necrosis.

Question 7257

Topic: 2. Trauma

A 45-year-old man underwent closed reduction and percutaneous pinning for a displaced femoral neck fracture 8 months ago. He now complains of progressive groin pain. Radiographs reveal varus collapse and fracture nonunion with a viable femoral head on MRI. What is the most appropriate definitive management?

. Core decompression
. Total hip arthroplasty
. Valgus intertrochanteric osteotomy
. Revision internal fixation with a sliding hip screw
. Bipolar hemiarthroplasty

Correct Answer & Explanation

. Core decompression

Explanation

In a young patient with a femoral neck nonunion and a viable femoral head, a valgus intertrochanteric osteotomy is the treatment of choice. It converts shear forces into compressive forces, promoting fracture healing and preserving the native joint.

Question 7258

Topic: 2. Trauma

When utilizing three parallel cannulated screws for the fixation of a femoral neck fracture, what configuration provides the maximum biomechanical stability?

. An inverted triangle configuration with screws placed centrally
. An apex distal triangle spread widely against the cortices
. An apex proximal triangle spread widely against the cortices
. Three screws placed linearly along the calcar
. Two anterior screws and one posterior screw

Correct Answer & Explanation

. An inverted triangle configuration with screws placed centrally

Explanation

The most biomechanically stable construct for cannulated screw fixation of a femoral neck fracture is an apex-distal (inverted) triangle. The screws should be spread as far apart as possible, resting against the inferior, anterior, and posterior cortices to maximize cortical support.

Question 7259

Topic: 2. Trauma



Which of the following vessels is the principal source of blood supply to the weight-bearing dome of the femoral head, and is most at risk in a displaced intracapsular femoral neck fracture?

. Artery of the ligamentum teres
. Lateral epiphyseal artery from the medial femoral circumflex artery
. Inferior metaphyseal artery from the lateral femoral circumflex artery
. Ascending branch of the lateral femoral circumflex artery
. Medial epiphyseal artery from the obturator artery

Correct Answer & Explanation

. Artery of the ligamentum teres

Explanation

The medial femoral circumflex artery (MFCA) gives rise to the lateral epiphyseal artery, which provides the majority of the blood supply to the weight-bearing dome of the femoral head. This ascending vessel is frequently disrupted or kinked in displaced femoral neck fractures.

Question 7260

Topic: 2. Trauma

A 78-year-old man presents with a displaced femoral neck fracture. He is on clopidogrel for a drug-eluting stent placed 2 years ago. Cardiology clears him for surgery. What is the optimal timing for his hemiarthroplasty to minimize mortality?

. Wait 5-7 days for clopidogrel to wash out
. Proceed with surgery within 24-48 hours
. Delay surgery for 72 hours and transfuse platelets
. Proceed with surgery immediately only if an epidural is used
. Wait 14 days for complete endothelialization

Correct Answer & Explanation

. Wait 5-7 days for clopidogrel to wash out

Explanation

Delaying hip fracture surgery beyond 48 hours is associated with significantly increased 30-day and 1-year mortality. Current guidelines recommend proceeding with surgery within 24-48 hours, even in patients taking clopidogrel, as the benefits of early mobilization outweigh the risks of bleeding.

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