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2. Trauma MCQs

Practice Set 376 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 7501

Topic: 2. Trauma

A patient with a Schatzker VI bicondylar tibial plateau fracture is treated with dual orthogonal plating through a single extensile anterior midline incision. What is the most significant risk associated with this surgical strategy?

. Nonunion of the diaphyseal extension
. Deep vein thrombosis
. Severe soft tissue compromise and wound necrosis
. Iatrogenic popliteal artery injury
. Early hardware failure

Correct Answer & Explanation

. Nonunion of the diaphyseal extension

Explanation

Accessing both the medial and lateral plateau through a single anterior midline incision requires massive subcutaneous tissue stripping. This severely disrupts the blood supply to the skin flaps, resulting in an unacceptably high rate of wound necrosis and deep infection.

Question 7502

Topic: 2. Trauma

In managing a bleeding polytrauma patient, the trauma team must rapidly intervene to prevent the "lethal triad" of trauma. Which three clinical entities comprise this triad?

. Hypothermia, acidosis, and coagulopathy
. Hypoxia, hypercapnia, and hypotension
. Anemia, thrombocytopenia, and hypofibrinogenemia
. Hypothermia, hyperkalemia, and acidosis
. Coagulopathy, hypoglycemia, and hypoxia

Correct Answer & Explanation

. Hypothermia, acidosis, and coagulopathy

Explanation

The lethal triad of trauma consists of hypothermia, acidosis, and coagulopathy. These three derangements create a vicious cycle that exacerbates bleeding and represents a severe failure of physiologic compensation.

Question 7503

Topic: Lower Extremity Trauma

Which specific type of tibial plateau fracture is most strongly associated with an injury to the medial collateral ligament (MCL) or a lateral meniscal tear?

. Schatzker I
. Schatzker II
. Schatzker IV
. Schatzker V
. Schatzker VI

Correct Answer & Explanation

. Schatzker I

Explanation

Schatzker II (lateral split-depression) fractures are typically caused by a valgus load with axial compression. This mechanism frequently results in a concurrent lateral meniscal tear or stretching/rupture of the medial collateral ligament (MCL).

Question 7504

Topic: 2. Trauma

When placing an emergency spanning external fixator across the knee for a severely comminuted tibial plateau fracture in a polytrauma patient, where should the femoral half-pins be optimally placed to minimize complications?

. Posterolaterally through the IT band
. Anteriorly through the rectus femoris tendon
. Anterolaterally through the vastus lateralis
. Medially through the vastus medialis
. Posteriorly avoiding the extensor mechanism

Correct Answer & Explanation

. Posterolaterally through the IT band

Explanation

Femoral pins for a knee-spanning external fixator should be placed anterolaterally or directly laterally into the femur. This avoids impaling the rectus femoris tendon, which can cause severe knee stiffness, and avoids the medial neurovascular structures.

Question 7505

Topic: Lower Extremity Trauma

A 45-year-old male sustains a high-energy Schatzker VI tibial plateau fracture. CT imaging demonstrates a displaced posteromedial shear fragment. You elect to utilize a posteromedial approach for buttress plating. Which of the following represents the correct internervous or intermuscular plane for this approach?

. Between the pes anserinus and the medial head of the gastrocnemius
. Between the medial head of the gastrocnemius and the soleus
. Between the semimembranosus and semitendinosus
. Between the tibialis posterior and the flexor digitorum longus
. Between the popliteus and the soleus

Correct Answer & Explanation

. Between the pes anserinus and the medial head of the gastrocnemius

Explanation

The posteromedial approach to the tibial plateau utilizes the interval between the medial head of the gastrocnemius (tibial nerve) and the pes anserinus (femoral and tibial nerves). Retracting the medial gastrocnemius laterally protects the neurovascular bundle.

Question 7506

Topic: 2. Trauma

A 35-year-old male sustains a high-energy Schatzker VI tibial plateau fracture. During the initial emergency department evaluation, which clinical finding is the most reliable early indicator of acute compartment syndrome?

. Loss of palpable dorsalis pedis pulse
. Inability to actively dorsiflex the toes
. Pain out of proportion to the injury with passive stretch
. Capillary refill greater than 4 seconds
. Decreased sensation in the first web space

Correct Answer & Explanation

. Loss of palpable dorsalis pedis pulse

Explanation

Pain out of proportion to the injury, especially elicited by passive stretch of the involved muscles, is the earliest and most sensitive clinical sign of acute compartment syndrome. Pulselessness and paralysis are late findings indicating irreversible nerve and muscle ischemia.

Question 7507

Topic: 2. Trauma

In a polytraumatized patient with bilateral femur fractures, which of the following metabolic markers is the most accurate indicator of adequate tissue resuscitation to safely proceed with Early Total Care (ETC)?

. Serum bicarbonate > 20 mEq/L
. Gastric pH > 7.0
. Serum lactate < 2.5 mmol/L
. Central venous pressure > 8 mm Hg
. Urine output > 0.5 mL/kg/hr

Correct Answer & Explanation

. Serum bicarbonate > 20 mEq/L

Explanation

Serum lactate (< 2.5 mmol/L) and base deficit are the most reliable indicators of global tissue perfusion. Normalization of these markers indicates adequate resuscitation in polytrauma patients, guiding the safe transition from Damage Control Orthopedics to Early Total Care.

Question 7508

Topic: 2. Trauma

A 42-year-old female presents with a closed, severe tibial pilon fracture (AO/OTA 43-C3) with massive soft tissue swelling and fracture blisters. A spanning external fixator is placed. When is the optimal time to proceed with definitive open reduction and internal fixation (ORIF)?

. Within 24 hours of the injury
. At 3-5 days when fracture blisters are newly formed
. Once the 'wrinkle sign' appears and blisters epithelialize
. Immediately after the ESR normalizes
. After 6 weeks of external fixation

Correct Answer & Explanation

. Within 24 hours of the injury

Explanation

Definitive ORIF of pilon fractures should be delayed until the soft tissue envelope has adequately recovered to minimize wound complications. This is clinically indicated by the presence of the "wrinkle sign" and the re-epithelialization of fracture blisters, typically taking 10-21 days.

Question 7509

Topic: Lower Extremity Trauma

A 28-year-old male sustains a Schatzker IV medial tibial plateau fracture. A CT scan reveals a displaced posteromedial coronal shear fragment. Which surgical approach is most appropriate for direct visualization and buttress plating of this specific fragment?

. Anterolateral approach
. Direct anterior approach with tibial tubercle osteotomy
. Posteromedial approach
. Posterolateral approach
. Standard medial approach

Correct Answer & Explanation

. Anterolateral approach

Explanation

A posteromedial approach allows direct visualization and application of an anti-glide or buttress plate on the posterior aspect of the medial tibial condyle. This mechanically counteracts the typical apex distal and posterior displacement of a posteromedial shear fragment.

Question 7510

Topic: 2. Trauma

Which of the following inflammatory cytokines is considered the best early predictor for the severity of systemic inflammatory response syndrome (SIRS) and the subsequent development of acute respiratory distress syndrome (ARDS) in polytrauma patients?

. Interleukin-1 (IL-1)
. Interleukin-6 (IL-6)
. Interleukin-10 (IL-10)
. Tumor Necrosis Factor-alpha (TNF-alpha)
. Transforming Growth Factor-beta (TGF-beta)

Correct Answer & Explanation

. Interleukin-1 (IL-1)

Explanation

Interleukin-6 (IL-6) is a key pro-inflammatory cytokine. Its serum levels peak early after major trauma and strongly correlate with the severity of the injury, the magnitude of the SIRS response, and the risk of multiorgan failure.

Question 7511

Topic: 2. Trauma

When utilizing an anterolateral surgical approach for the definitive fixation of a tibial pilon fracture, which neurovascular structure is at the highest risk of iatrogenic injury during the superficial dissection?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve
. Posterior tibial artery

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve crosses the surgical field from medial to lateral in the anterolateral approach to the distal tibia and ankle. It must be carefully identified and protected during the superficial dissection to avoid neuroma formation or sensory deficits.

Question 7512

Topic: 2. Trauma

A patient with a Schatzker II (split-depression) lateral tibial plateau fracture undergoes an MRI prior to surgery. Which of the following soft tissue injuries is most frequently associated with this specific fracture pattern?

. Medial collateral ligament (MCL) tear
. Anterior cruciate ligament (ACL) tear
. Lateral meniscus tear
. Medial meniscus tear
. Posterior cruciate ligament (PCL) tear

Correct Answer & Explanation

. Medial collateral ligament (MCL) tear

Explanation

Lateral meniscal tears are highly associated with Schatzker II lateral tibial plateau fractures. The meniscus is frequently injured, trapped, or driven into the metaphyseal defect as the lateral femoral condyle impacts and depresses the articular surface.

Question 7513

Topic: 2. Trauma

According to the principles of Damage Control Orthopedics (DCO), which of the following scenarios is an absolute indication for temporary external fixation of a femoral shaft fracture instead of primary intramedullary nailing?

. Isolated closed femur fracture in a 20-year-old
. Patient with an isolated head injury and a GCS of 14
. Patient in extremis with uncorrectable coagulopathy and hypothermia
. Open grade I femur fracture
. Bilateral femur fractures in a hemodynamically stable patient

Correct Answer & Explanation

. Isolated closed femur fracture in a 20-year-old

Explanation

DCO is mandated for patients in extremis or those exhibiting the 'lethal triad' of coagulopathy, hypothermia, and acidosis. Primary intramedullary nailing in this setting risks a severe "second hit" phenomenon, worsening the systemic inflammatory response.

Question 7514

Topic: 2. Trauma

In the staged treatment of a highly comminuted, intra-articular tibial pilon fracture (OTA 43-C3) with an associated distal fibula fracture, what is the primary rationale for plating the fibula first?

. It guarantees anatomic articular reduction of the tibial plafond
. It restores lateral column length and assists with indirect reduction of the tibia
. It minimizes the risk of deep vein thrombosis
. It allows for immediate full weight-bearing postoperatively
. It avoids the need for a medial tibial plate entirely

Correct Answer & Explanation

. It guarantees anatomic articular reduction of the tibial plafond

Explanation

Plating the fibula restores the length, rotation, and alignment of the lateral column of the leg. Through the intact anterior and posterior syndesmotic ligaments, this assists in the indirect reduction of the anterolateral (Chaput) and posterolateral (Volkmann) tibial fragments.

Question 7515

Topic: Lower Extremity Trauma

When using a laterally applied pre-contoured locking plate for a bicondylar tibial plateau fracture (Schatzker VI), what is the primary biomechanical advantage of the locking screws in the proximal segment?

. They rely on friction between the plate and bone for stability
. They pull the metaphyseal bone to the plate to aid reduction
. They act as fixed-angle devices to prevent varus collapse
. They provide dynamic compression across the articular surface
. They allow for earlier hardware removal

Correct Answer & Explanation

. They rely on friction between the plate and bone for stability

Explanation

Locking screws thread directly into the plate, creating a fixed-angle construct. In metaphyseal bone, this construct strongly resists cantilever bending and prevents varus collapse of the medial plateau when relying on a single lateral plate.

Question 7516

Topic: 2. Trauma

A 50-year-old male sustains a pilon fracture characterized by significant articular comminution and metaphyseal impaction, without massive diaphyseal extension. According to the Ruedi-Allgower classification, what grade is this injury?

. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

The Ruedi-Allgower classification categorizes pilon fractures into three types based on articular displacement and comminution. Type III fractures involve significant articular comminution and metaphyseal impaction, representing the most severe grade in this system.

Question 7517

Topic: 2. Trauma

Following open reduction and internal fixation of a severe tibial pilon fracture, what is the most common angular deformity that alters ankle biomechanics and accelerates post-traumatic arthrosis?

. Valgus malunion
. Varus malunion
. Procurvatum malunion
. Recurvatum malunion
. Rotational malunion

Correct Answer & Explanation

. Valgus malunion

Explanation

Valgus malunion is the most common deformity observed following pilon fractures. It typically occurs due to inadequate surgical restoration of the comminuted medial column or subsequent late medial collapse.

Question 7518

Topic: 2. Trauma

In a hemodynamically unstable polytrauma patient with an anteroposterior compression (APC) pelvic ring injury, what is the primary mechanism by which a pelvic binder improves hemodynamics?

. Decreasing arterial bleeding from the superior gluteal artery
. Reducing pelvic volume to tamponade presacral venous bleeding
. Immobilizing the lower extremities to prevent reflex muscle spasms
. Increasing intra-abdominal pressure to compress the distal aorta
. Directly compressing the external iliac vein

Correct Answer & Explanation

. Decreasing arterial bleeding from the superior gluteal artery

Explanation

The primary source of hemorrhage in pelvic ring injuries is the presacral venous plexus and exposed cancellous bone. A pelvic binder mechanically reduces the pelvic volume, facilitating the tamponade of this low-pressure venous bleeding.

Question 7519

Topic: 2. Trauma

A 33-year-old male sustains a severe bicondylar tibial plateau fracture. Following provisional gross reduction and splinting, his dorsalis pedis pulse is weakly palpable, and his Ankle-Brachial Index (ABI) is calculated at 0.8. What is the most appropriate next step?

. Discharge home with close outpatient follow-up
. Routine ORIF on the next available elective list
. CT angiography of the lower extremity
. Immediate four-compartment fasciotomy
. Application of a circular frame external fixator

Correct Answer & Explanation

. Discharge home with close outpatient follow-up

Explanation

An Ankle-Brachial Index (ABI) of less than 0.9 in the setting of high-energy lower extremity trauma indicates a high suspicion for vascular injury. The appropriate next step is a CT angiogram to accurately define the arterial anatomy and injury.

Question 7520

Topic: 2. Trauma

A 24-year-old male with bilateral femur fractures is admitted to the ICU. On post-injury day 2, he develops confusion, tachypnea, and a petechial rash over his axillae. What is the most effective intervention for preventing the development of this syndrome?

. High-dose prophylactic corticosteroids
. Prophylactic placement of an inferior vena cava (IVC) filter
. Early definitive surgical fixation of the long bone fractures
. Continuous administration of systemic heparin
. Aggressive diuresis with intravenous furosemide

Correct Answer & Explanation

. High-dose prophylactic corticosteroids

Explanation

The clinical triad of hypoxemia, neurological abnormalities, and petechial rash describes Fat Embolism Syndrome (FES). Early immobilization and definitive surgical fixation of long bone fractures (within 24 hours) is the most proven method to reduce the incidence of FES.

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