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2. Trauma MCQs

Practice Set 371 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 7401

Topic: 2. Trauma

A 3-year-old boy sustains a low-energy, isolated spiral fracture of the midshaft femur. Child abuse has been thoroughly ruled out. What is the gold standard of treatment for this injury?

. Titanium elastic nails
. Early spica casting
. Open reduction and internal fixation with a plate
. External fixation
. Skeletal traction for 3 weeks followed by casting

Correct Answer & Explanation

. Titanium elastic nails

Explanation

Early spica casting is the standard of care for isolated, low-energy diaphyseal femur fractures in children aged 6 months to 5 years. Operative fixation with flexible nails is generally reserved for older children, typically over 5 years of age.

Question 7402

Topic: 2. Trauma

An 8-year-old boy falls and sustains a closed diaphyseal both-bone forearm fracture. What is the maximum acceptable angulation in the middle third of the radius and ulna to allow for a satisfactory functional outcome with non-operative treatment?

. 0 degrees
. 5 degrees
. 15 degrees
. 25 degrees
. 30 degrees

Correct Answer & Explanation

. 0 degrees

Explanation

In children under 10 years old, up to 15 degrees of angulation and complete displacement in the middle third of the forearm are often acceptable due to robust remodeling potential. Beyond 15 degrees, closed reduction or operative fixation is typically required.

Question 7403

Topic: 2. Trauma

A 14-year-old boy sustains a twisting injury to his right ankle while sliding into a base. Radiographs reveal a Salter-Harris III fracture of the anterolateral aspect of the distal tibial epiphysis (Tillaux fracture). Which ligament is responsible for the avulsion of this fracture fragment?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Deltoid ligament
. Anterior inferior tibiofibular ligament
. Posterior inferior tibiofibular ligament

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

The Tillaux fracture is an avulsion of the anterolateral distal tibial epiphysis caused by an external rotation force. The fragment is avulsed by the anterior inferior tibiofibular ligament (AITFL).

Question 7404

Topic: 2. Trauma

A 3-year-old boy sustains an isolated, closed midshaft femur fracture after tripping. He weighs 14 kg (30 lbs). What is the most appropriate definitive management?

. Pavlik harness application
. Early spica cast application
. Flexible intramedullary nailing
. Rigid locked intramedullary nailing
. External fixation

Correct Answer & Explanation

. Pavlik harness application

Explanation

For children aged 6 months to 5 years presenting with an isolated femur fracture, early spica casting is the standard of care. Flexible nailing is typically reserved for older children (ages 5 to 11) or those with polytrauma.

Question 7405

Topic: 2. Trauma

A 9-year-old girl is evaluated for elbow and forearm pain after a fall. Radiographs reveal a displaced Bado Type I Monteggia fracture-dislocation. What is the characteristic radiographic pattern of this injury?

. Posterior dislocation of the radial head with an ulnar shaft fracture
. Anterior dislocation of the radial head with an ulnar shaft fracture
. Lateral dislocation of the radial head with an ulnar shaft fracture
. Radial shaft fracture with distal radioulnar joint dislocation
. Ulnar shaft fracture with distal radioulnar joint dislocation

Correct Answer & Explanation

. Posterior dislocation of the radial head with an ulnar shaft fracture

Explanation

A Bado Type I Monteggia fracture is characterized by an anterior dislocation of the radial head associated with a fracture of the ulnar shaft. It is the most common Monteggia fracture pattern seen in children.

Question 7406

Topic: 2. Trauma

An 8-year-old boy presents with a displaced fracture of the lateral condyle of the distal humerus. The fracture fragment is displaced 3 mm on the internal oblique radiograph. What is the most appropriate management?

. Long arm cast in full supination
. Long arm cast in full pronation
. Closed reduction and percutaneous pinning without joint visualization
. Open reduction and internal fixation
. Collar and cuff immobilization

Correct Answer & Explanation

. Long arm cast in full supination

Explanation

Lateral condyle fractures of the humerus that are displaced greater than 2 mm typically require open reduction and internal fixation. This ensures anatomic restoration of the articular surface and physis to prevent nonunion and cubitus valgus.

Question 7407

Topic: 2. Trauma

An 8-year-old boy sustains a closed midshaft both-bone forearm fracture. He is being considered for non-operative management with a long arm cast. What is the maximum acceptable angulation for this fracture location in this age group?

. 0 degrees
. 10 degrees
. 20 degrees
. 30 degrees
. 40 degrees

Correct Answer & Explanation

. 0 degrees

Explanation

In an 8-year-old child, the maximum acceptable angulation for a midshaft both-bone forearm fracture is 10 degrees. Distal third fractures may tolerate up to 15 degrees due to greater remodeling potential near the rapidly growing distal physis.

Question 7408

Topic: 2. Trauma

A 6-year-old child sustains a severely displaced type III supracondylar humerus fracture. Upon initial evaluation, the hand is pink but the radial pulse is absent. A satisfactory closed reduction and percutaneous pinning is performed. Following fixation, the hand remains pink but pulseless. What is the most appropriate management?

. Emergent exploration of the brachial artery
. Application of a warm compress and immediate arteriography
. Pin removal and extension of the elbow
. Fasciotomy of the forearm
. Observation and admission for close neurovascular monitoring

Correct Answer & Explanation

. Emergent exploration of the brachial artery

Explanation

A pink, pulseless hand after satisfactory reduction and pinning indicates adequate collateral perfusion. Observation is recommended, as most radial pulses return within a few days without surgical exploration.

Question 7409

Topic: 2. Trauma

A 10-year-old boy weighing 38 kg (84 lbs) sustains an isolated, closed, transverse midshaft femur fracture. Which of the following is the most appropriate definitive treatment?

. Immediate hip spica casting
. Pavlik harness application
. Flexible titanium intramedullary nails
. Rigid antegrade locked intramedullary nail
. Open reduction and internal fixation with a compression plate

Correct Answer & Explanation

. Immediate hip spica casting

Explanation

For children aged 5 to 11 years weighing less than 50 kg, flexible titanium intramedullary nailing is the standard of care for midshaft femur fractures. Rigid antegrade nailing risks avascular necrosis of the femoral head due to piriformis fossa or greater trochanter entry.

Question 7410

Topic: 2. Trauma

A 2-year-old boy is brought to the emergency department with an isolated spiral fracture of the femoral shaft. There are no signs of nonaccidental trauma and shortening is less than 2 cm. What is the most appropriate initial definitive management?

. Skeletal traction for 3 weeks
. Flexible intramedullary nailing
. Early hip spica casting
. External fixation
. Open reduction and internal fixation

Correct Answer & Explanation

. Skeletal traction for 3 weeks

Explanation

In a 2-year-old with an isolated femur fracture and acceptable shortening (<2 cm), early hip spica casting is the most appropriate and effective definitive management. Operative intervention is reserved for older children, multiple trauma, or open fractures.

Question 7411

Topic: 2. Trauma

A 2-year-old child presents with an isolated closed diaphyseal fracture of the left femur after a reported fall from a low bed. There are no signs of child abuse. What is the standard of care for definitive management?

. Pavlik harness
. Early spica casting
. Flexible intramedullary nailing
. External fixation
. Rigid intramedullary nailing

Correct Answer & Explanation

. Pavlik harness

Explanation

Early spica casting is the standard of care for isolated diaphyseal femur fractures in children aged 6 months to 5 years with less than 2 cm of shortening. Flexible nailing is typically reserved for children over age 5.

Question 7412

Topic: 2. Trauma

A 6-year-old boy sustains a closed, isolated midshaft fracture of the right femur after a fall from a playground structure. He has no other associated injuries. What is the current standard of care for definitive management?

. Immediate hip spica casting
. Skeletal traction for 3 weeks followed by spica casting
. Flexible intramedullary nailing
. Rigid antegrade locked intramedullary nailing
. Plate osteosynthesis

Correct Answer & Explanation

. Immediate hip spica casting

Explanation

For children aged 5 to 11 years with length-stable diaphyseal femur fractures, flexible intramedullary nailing (e.g., titanium elastic nails) is the standard of care. Rigid intramedullary nailing is contraindicated in this age group due to the risk of avascular necrosis and proximal femoral physeal arrest.

Question 7413

Topic: Pelvic & Acetabular Trauma

A 3-year-old girl presents with a painless waddling gait. Radiographs show a completely dislocated left hip with a false acetabulum and a dysplastic true acetabulum. She has had no prior treatment. What is the most appropriate surgical management?

. Closed reduction and spica casting
. Arthroscopic labral repair and capsulorrhaphy
. Open reduction alone
. Femoral varus derotational osteotomy alone
. Open reduction, femoral shortening osteotomy, and pelvic osteotomy

Correct Answer & Explanation

. Closed reduction and spica casting

Explanation

In children over 2 to 3 years of age with an untreated completely dislocated hip, the soft tissues are contracted and the acetabulum is dysplastic. Successful management typically requires an open reduction, a femoral shortening osteotomy (to relieve tension and prevent AVN), and a pelvic osteotomy (e.g., Salter or Dega) to provide anterior/lateral coverage.

Question 7414

Topic: 2. Trauma

A 6-year-old boy is evaluated for a displaced lateral condyle fracture of the humerus. If this fracture is managed non-operatively and progresses to nonunion, what is the most likely late clinical complication?

. Cubitus varus with median nerve palsy
. Cubitus valgus with tardy ulnar nerve palsy
. Volkmann's ischemic contracture
. Heterotopic ossification of the brachialis
. Avascular necrosis of the trochlea

Correct Answer & Explanation

. Cubitus varus with median nerve palsy

Explanation

Lateral condyle fractures are prone to nonunion because they are intra-articular and bathed in synovial fluid. A nonunion leads to progressive lateral growth arrest, resulting in cubitus valgus. This stretch on the medial side frequently causes a tardy ulnar nerve palsy years later.

Question 7415

Topic: 2. Trauma

An 8-year-old boy falls from a tree and sustains a Delbet Type II (transcervical) femoral neck fracture. Following prompt open reduction and internal fixation, what is the most significant complication he is at risk of developing?

. Nonunion
. Chondrolysis
. Osteonecrosis of the femoral head
. Premature closure of the greater trochanteric apophysis
. Heterotopic ossification

Correct Answer & Explanation

. Nonunion

Explanation

Pediatric femoral neck fractures, particularly transcervical (Delbet Type II) and transepiphyseal (Delbet Type I) fractures, carry a high risk of osteonecrosis (avascular necrosis) of the femoral head due to the disruption of the tenuous retinacular blood supply.

Question 7416

Topic: Pelvic & Acetabular Trauma

Which pelvic osteotomy for DDH provides primarily anterior and lateral coverage by hinging on the pubic symphysis without changing the shape of the acetabulum?

. Pemberton osteotomy
. Dega osteotomy
. Salter osteotomy
. Chiari osteotomy
. Shelf arthroplasty

Correct Answer & Explanation

. Pemberton osteotomy

Explanation

The Salter innominate osteotomy is a redirectional osteotomy that hinges at the pubic symphysis. It improves anterior and lateral coverage without altering the volume or shape of the acetabulum.

Question 7417

Topic: 2. Trauma

A 12-year-old boy presents with a triplane fracture of the distal tibia. Which of the following best describes the typical fracture planes on radiographs?

. Sagittal fracture through the metaphysis, coronal through the epiphysis, transverse through the physis
. Coronal fracture through the metaphysis, sagittal through the epiphysis, transverse through the physis
. Transverse fracture through the metaphysis, coronal through the epiphysis, sagittal through the physis
. Sagittal fracture through both metaphysis and epiphysis
. Coronal fracture through both metaphysis and epiphysis

Correct Answer & Explanation

. Sagittal fracture through the metaphysis, coronal through the epiphysis, transverse through the physis

Explanation

A classic triplane fracture consists of a coronal plane fracture through the posterior metaphysis, a sagittal plane fracture through the epiphysis, and a transverse plane fracture through the physis.

Question 7418

Topic: Upper Extremity Trauma

A newborn is examined in the nursery. The examiner places the infant's hips in 90 degrees of flexion and gently abducts them while applying an anteriorly directed force on the greater trochanter, resulting in a palpable "clunk." What is this provocative test called?

. Barlow maneuver
. Ortolani maneuver
. Galeazzi test
. Klisic test
. Trendelenburg test

Correct Answer & Explanation

. Barlow maneuver

Explanation

The Ortolani maneuver reduces a dislocated hip by elevating the greater trochanter and abducting the hip. The Barlow maneuver attempts to dislocate a reducible hip by applying posterior force during adduction.

Question 7419

Topic: Pelvic & Acetabular Trauma

A 2-year-old boy presents with developmental dysplasia of the hip. A Pemberton osteotomy is planned. What is the primary hinge point for this osteotomy?

. Pubic symphysis
. Triradiate cartilage
. Sacroiliac joint
. Ischial spine
. Anterior inferior iliac spine

Correct Answer & Explanation

. Pubic symphysis

Explanation

The Pemberton osteotomy is an incomplete pericapsular osteotomy that hinges on the flexible triradiate cartilage. It changes the shape and volume of the acetabulum, providing primarily anterior and lateral coverage.

Question 7420

Topic: 2. Trauma

A 10-year-old boy sustains a Salter-Harris II fracture of the distal femur. What is the most common significant complication associated with this specific injury?

. Nonunion
. Avascular necrosis of the femoral head
. Growth arrest leading to leg length discrepancy or angular deformity
. Compartment syndrome
. Fat embolism syndrome

Correct Answer & Explanation

. Nonunion

Explanation

Distal femoral physeal fractures have a high rate of complications, with growth arrest occurring in up to 50% of cases. This can lead to significant leg length discrepancies or angular deformities due to the high growth potential of this physis.

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