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2. Trauma MCQs

Practice Set 370 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 7381

Topic: 2. Trauma

A 22-year-old college basketball player sustains an acute fracture at the metaphyseal-diaphyseal junction of the 5th metatarsal (Jones fracture). To ensure the highest likelihood of union and rapid return to play, what is the treatment of choice?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Open reduction and plate fixation
. Primary excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Non-weight bearing in a short leg cast for 6 weeks

Explanation

Due to the watershed blood supply at the metaphyseal-diaphyseal junction of the 5th metatarsal, Jones fractures in high-level athletes are best treated with intramedullary screw fixation to decrease nonunion risk and expedite return to play.

Question 7382

Topic: Upper Extremity Trauma

A 28-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate superior displacement of the distal clavicle by 150% relative to the acromion. Which ligaments must be completely disrupted in this injury pattern?

. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Both acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament
. Sternoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular ligaments only

Explanation

A Type III or greater acromioclavicular (AC) joint separation features complete disruption of both the AC ligaments and the coracoclavicular (CC) ligaments, leading to significant superior clavicle displacement.

Question 7383

Topic: 2. Trauma

A 35-year-old man feels a pop in his knee while jumping. He cannot actively extend his knee, and radiographs reveal patella alta. What is the optimal timing and rationale for surgical repair?

. Within 2 weeks to prevent quadriceps contracture and patellar retraction
. After 4 weeks to allow acute soft tissue swelling to subside
. Delayed 6 weeks to allow scar tissue to form for better suture purchase
. Immediately in the emergency department to prevent compartment syndrome
. Nonoperative management with extension bracing is the treatment of choice

Correct Answer & Explanation

. Within 2 weeks to prevent quadriceps contracture and patellar retraction

Explanation

Acute patellar tendon ruptures should ideally be repaired within 2 weeks. Delayed repair increases the risk of severe quadriceps contracture and proximal patellar migration, severely complicating surgical reduction.

Question 7384

Topic: Pelvic & Acetabular Trauma

A 5-year-old child with residual developmental dysplasia of the hip undergoes a Pemberton osteotomy. Unlike a Salter osteotomy, the Pemberton osteotomy hinges on which of the following anatomic structures to achieve acetabular redirection?

. Pubic symphysis
. Sacroiliac joint
. Triradiate cartilage
. Ischial tuberosity
. Greater sciatic notch

Correct Answer & Explanation

. Pubic symphysis

Explanation

The Pemberton osteotomy is an incomplete pericapsular osteotomy that hinges on the flexible triradiate cartilage in children. In contrast, the Salter osteotomy is a complete innominate osteotomy that hinges on the pubic symphysis.

Question 7385

Topic: Upper Extremity Trauma

An 18-month-old girl presents with a painless limp. Examination reveals a positive Galeazzi sign and limited abduction of the right hip. Radiographs confirm a developmental dislocation of the right hip. What is the most appropriate initial surgical management?

. Pavlik harness application
. Closed reduction and spica casting
. Open reduction with or without pelvic/femoral osteotomy
. Shelf arthroplasty
. Trochanteric advancement

Correct Answer & Explanation

. Pavlik harness application

Explanation

In children over 18 months of age with a completely dislocated hip, open reduction is generally required. Pelvic and/or femoral osteotomies are frequently added to correct secondary bony dysplasia and stabilize the joint.

Question 7386

Topic: 2. Trauma

A 6-year-old boy undergoes crossed-pin fixation (one lateral, one medial) for a displaced supracondylar humerus fracture. Postoperatively, he exhibits clawing of the ring and small fingers and numbness over the volar aspect of the fifth digit. The most likely etiology of this deficit is:

. Direct trauma from the initial fracture displacement
. Compartment syndrome of the deep flexor compartment
. Iatrogenic injury during placement of the medial pin
. Brachial artery vasospasm
. Entrapment in the lateral fracture site

Correct Answer & Explanation

. Direct trauma from the initial fracture displacement

Explanation

Ulnar nerve injury is the most common iatrogenic nerve injury during crossed-pin fixation of supracondylar fractures, typically caused by the medial pin. Failing to protect the nerve through a mini-open incision increases this risk.

Question 7387

Topic: 2. Trauma

A 35-year-old male presents with numbness in his small and ring fingers, along with intrinsic muscle weakness in his dominant hand. He reports a history of an elbow fracture treated non-operatively with a cast when he was 5 years old. Examination reveals significant valgus carrying angle at the elbow. Which of the following pediatric fracture patterns is most likely responsible for this late presentation?

. Medial epicondyle fracture
. Supracondylar humerus fracture
. Olecranon fracture
. Lateral condyle fracture
. Radial neck fracture

Correct Answer & Explanation

. Medial epicondyle fracture

Explanation

Pediatric lateral condyle fractures have a high risk of nonunion if displaced and treated non-operatively. A nonunion leads to progressive cubitus valgus deformity, which eventually causes stretching of the ulnar nerve and a tardy ulnar nerve palsy years later.

Question 7388

Topic: 2. Trauma

An 8-year-old, 32 kg boy sustains an isolated, length-stable midshaft transverse femur fracture and undergoes treatment with titanium elastic nails. Which of the following is the most frequently encountered complication specific to this fixation method in this age group?

. Avascular necrosis of the femoral head
. Symptomatic hardware at the distal insertion site
. Nonunion requiring bone grafting
. Leg length discrepancy of greater than 2.5 cm
. Profound rotational malalignment

Correct Answer & Explanation

. Avascular necrosis of the femoral head

Explanation

The most common complication following the use of flexible intramedullary nails for pediatric femur fractures is soft tissue irritation and pain at the distal insertion site near the knee, often requiring nail removal once the fracture has healed.

Question 7389

Topic: 2. Trauma

A 6-year-old boy sustains a completely displaced, extension-type supracondylar humerus fracture.

He presents with an absent radial pulse but a well-perfused, pink hand. After closed reduction and percutaneous pinning, the hand remains pink, but the radial pulse remains non-palpable. Doppler signals are audible at the wrist. What is the most appropriate management?

. Immediate surgical exploration of the brachial artery
. Remove the pins and re-reduce the fracture
. Admission for close observation and elevation
. Perform a prophylactic fasciotomy
. Immediate CT angiography of the upper extremity

Correct Answer & Explanation

. Immediate surgical exploration of the brachial artery

Explanation

A 'pink, pulseless' hand following adequate reduction and pinning of a supracondylar humerus fracture indicates adequate collateral circulation. The standard of care is admission and close clinical observation for 24-48 hours rather than immediate surgical exploration.

Question 7390

Topic: 2. Trauma

A 12-year-old boy presents with right elbow deformity and a history of a fracture at age 4 that was treated non-operatively. Examination reveals severe cubitus valgus and numbness extending to the palmar aspect of the small finger and ulnar half of the ring finger. This condition most likely resulted from nonunion of which of the following fractures?

. Medial epicondyle fracture
. Lateral condyle fracture
. Supracondylar humerus fracture
. Radial neck fracture
. Olecranon fracture

Correct Answer & Explanation

. Medial epicondyle fracture

Explanation

Nonunion of a lateral condyle fracture leads to progressive cubitus valgus. This angular deformity chronically stretches the ulnar nerve, resulting in tardy ulnar nerve palsy.

Question 7391

Topic: 2. Trauma

A 3-year-old boy is brought to the emergency department after a fall while running, resulting in a closed spiral fracture of the femoral shaft. Non-accidental trauma has been definitively ruled out. What is the most appropriate definitive treatment?

. Intramedullary nailing using a rigid trochanteric entry nail
. Plate osteosynthesis
. External fixation
. Early spica casting
. Flexible intramedullary nailing

Correct Answer & Explanation

. Intramedullary nailing using a rigid trochanteric entry nail

Explanation

For children between 6 months and 5 years of age with an isolated, low-energy femoral shaft fracture and acceptable shortening (<2 cm), early hip spica casting is the gold standard of treatment.

Question 7392

Topic: 2. Trauma

A 6-year-old boy sustains a completely displaced, overriding fracture of the distal third of the radius and ulna. Closed reduction under conscious sedation achieves 15 degrees of dorsal angulation and 1 cm of bayonet apposition in a well-molded long-arm cast. What is the most appropriate next step?

. Attempt closed reduction again to improve apposition
. Perform open reduction and internal fixation
. Pin the fracture percutaneously
. Accept the reduction and observe in the current cast
. Proceed with flexible intramedullary nailing

Correct Answer & Explanation

. Attempt closed reduction again to improve apposition

Explanation

In children under 9 years of age, complete displacement (bayonet apposition) of a distal third forearm fracture is perfectly acceptable as long as angulation is less than 15-20 degrees, due to massive remodeling potential. Attempting further reduction is unnecessary.

Question 7393

Topic: 2. Trauma

A 2-year-old boy sustains a closed, isolated midshaft femur fracture. He is treated with early spica casting. Which of the following acceptable radiographic parameters is correct for this age group?

. Up to 30 degrees of varus/valgus angulation
. Up to 30 degrees of anterior/posterior angulation
. Up to 15 mm of shortening
. Perfect anatomical alignment is required
. Up to 25 mm of shortening

Correct Answer & Explanation

. Up to 30 degrees of varus/valgus angulation

Explanation

In children aged 2 to 10 years, up to 15 mm of shortening is acceptable and expected to correct via overgrowth. Up to 15 degrees of varus/valgus and 20 degrees of anteroposterior angulation are generally acceptable limits.

Question 7394

Topic: 2. Trauma

A 9-year-old girl sustains a Delbet Type II (transcervical) femoral neck fracture after falling from a tree. She is treated with urgent open reduction and internal fixation with cannulated screws. Which of the following complications occurs at the highest rate in this specific injury pattern?

. Nonunion
. Avascular necrosis (AVN)
. Premature physeal closure
. Chondrolysis
. Infection

Correct Answer & Explanation

. Nonunion

Explanation

Pediatric femoral neck fractures carry a high risk of avascular necrosis (AVN). Delbet Type I (transepiphyseal) and Type II (transcervical) have the highest rates of AVN, with Type II occurring at a rate of 30-50%.

Question 7395

Topic: 2. Trauma

A 6-year-old girl sustains a closed fracture of the distal third of the radius and ulna. Following closed reduction and casting, the radiographs show 15 degrees of apex volar angulation. What is the most appropriate management?

. Immediate open reduction and internal fixation
. Immediate closed manipulation to achieve anatomical alignment
. Observation and continuation of casting
. Intramedullary flexible nailing
. Application of an external fixator

Correct Answer & Explanation

. Immediate open reduction and internal fixation

Explanation

In a child under 9 years of age with a distal third both-bone forearm fracture, up to 15-20 degrees of angulation is acceptable. The high remodeling potential near the rapidly growing distal physes makes observation and continuation of casting appropriate.

Question 7396

Topic: 2. Trauma

A 5-year-old boy falls on an outstretched hand and sustains a lateral condyle fracture of the distal humerus. Initial radiographs show 1 mm of displacement, and he is placed in a long arm cast. At 1-week follow-up, radiographs show 3 mm of displacement. What is the most appropriate management?

. Continue cast immobilization for 3 more weeks
. Closed reduction and percutaneous pinning (CRPP)
. Open reduction and internal fixation (ORIF)
. Observation with no further immobilization
. Application of a hinged elbow brace

Correct Answer & Explanation

. Continue cast immobilization for 3 more weeks

Explanation

Lateral condyle fractures displaced > 2 mm are at high risk for nonunion and cubitus valgus deformity because the fracture fragment is bathed in synovial fluid and subject to the pull of the extensor origin. ORIF is indicated to ensure precise anatomic reduction of the articular surface.

Question 7397

Topic: 2. Trauma

An 18-month-old girl is brought to the clinic for a waddling gait. Examination shows restricted hip abduction on the left side and a positive Galeazzi sign. Radiographs confirm a dislocated left hip with a dysplastic acetabulum (acetabular index 38 degrees). What is the most appropriate initial surgical management?

. Pavlik harness application
. Closed reduction and spica casting
. Open reduction with femoral shortening osteotomy and pelvic osteotomy
. Open reduction and spica casting without osteotomies
. Observation until age 4 to allow spontaneous remodeling

Correct Answer & Explanation

. Pavlik harness application

Explanation

In children older than 18 months with a completely dislocated hip, closed reduction is rarely successful and carries a high risk of avascular necrosis. Open reduction combined with a femoral shortening osteotomy (to reduce tension) and a pelvic osteotomy (to address significant dysplasia) is typically required.

Question 7398

Topic: 2. Trauma

A 10-year-old boy sustains a Salter-Harris II fracture of the distal femur. It is treated with closed reduction and percutaneous pinning. Which of the following is the most common complication associated with this specific injury?

. Compartment syndrome
. Nonunion
. Growth arrest (premature physeal closure)
. Osteonecrosis of the femoral condyles
. Deep vein thrombosis

Correct Answer & Explanation

. Compartment syndrome

Explanation

Distal femur physeal fractures have a notoriously high rate of growth arrest (up to 50%). This occurs because the undulating nature of the distal femoral physis leads to severe crushing of the physeal germinal cells during fracture displacement.

Question 7399

Topic: 2. Trauma

During closed reduction and spica casting for a 9-month-old girl with DDH, the hip reduces at 40 degrees of abduction and re-dislocates at 20 degrees of abduction. The safe zone of Ramsey is 20 to 60 degrees. What is the primary risk of immobilizing the hip in excessive abduction (>60 degrees)?

. Immediate re-dislocation
. Sciatic nerve palsy
. Avascular necrosis of the femoral head
. Progressive acetabular dysplasia
. Femoral shaft fracture

Correct Answer & Explanation

. Immediate re-dislocation

Explanation

Immobilization of a dysplastic hip in extreme abduction (greater than 60 degrees) significantly increases the risk of avascular necrosis (AVN). The extreme position compresses the extracapsular vessels (medial circumflex femoral artery) against the margin of the acetabulum.

Question 7400

Topic: 2. Trauma

A 7-year-old girl sustains a both-bone forearm fracture. Closed reduction is performed in the emergency department. Which of the following post-reduction radiographic parameters is considered unacceptable and requires surgical fixation or remanipulation?

. 10 degrees of mid-shaft angulation
. 15 degrees of distal-third angulation
. 100% translation (bayonet apposition) of the radius shaft
. Loss of the normal radial bow resulting in a straight radius
. 10 degrees of malrotation

Correct Answer & Explanation

. 10 degrees of mid-shaft angulation

Explanation

In pediatric both-bone forearm fractures, maintaining the radial bow is critical for preserving functional forearm pronation and supination. While minor angulation and complete translation can remodel adequately in a 7-year-old, loss of the radial bow will cause a permanent mechanical block to rotation.

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