2. Trauma MCQs

A 24-year-old man presents with a closed femoral shaft fracture, multiple rib fractures, pulmonary contusions, and an initial Glasgow Coma Scale (GCS) of 6 following a high-speed motor vehicle collision. He is hypotensive in the emergency department and requires vasopressor support. What is the most appropriate management of his femur fracture?

A 28-year-old man sustains a closed spiral fracture of the distal third of the humerus (Holstein-Lewis fracture). Physical examination reveals an inability to actively extend the wrist or fingers. What is the most appropriate initial management?

A 32-year-old man sustains a posterior hip dislocation. Following emergent closed reduction, a CT scan reveals a concentric joint space, no intra-articular loose bodies, and a posterior wall fracture involving 15% of the acetabular articular surface. What is the most appropriate definitive management?

A 28-year-old man sustains a closed midshaft humeral fracture. He presents with a wrist drop and inability to extend his fingers. Radiographs show a transverse midshaft fracture. What is the most appropriate initial management of the nerve injury?

A 45-year-old polytrauma patient presents with a closed left femoral shaft fracture, multiple rib fractures, and bilateral pulmonary contusions. His serum lactate is 4.5 mmol/L and pH is 7.15. Which of the following is the most appropriate management of his femur fracture?

A 32-year-old man undergoes reamed intramedullary nailing for a closed tibial shaft fracture. Postoperatively, he complains of severe leg pain out of proportion to the injury, exacerbated by passive toe stretch. His blood pressure is 130/80 mmHg. What intracompartmental pressure finding definitively confirms acute compartment syndrome?

A 70-year-old woman on long-term alendronate therapy presents with vague thigh pain. Radiographs demonstrate an incomplete transverse fracture of the lateral cortex of the subtrochanteric femur with localized periosteal thickening.

What is the recommended prophylactic surgical treatment?

A 25-year-old cyclist falls directly onto his shoulder. Radiographs reveal a midshaft clavicle fracture with 2.5 cm of shortening and complete displacement. Which of the following is an expected outcome if this is treated nonoperatively rather than surgically?

A 34-year-old man sustains an isolated, closed, diaphyseal fracture of both the radius and ulna.

What is the preferred definitive management to maximize the restoration of forearm pronation and supination?

A 40-year-old man presents after a high-energy motor vehicle crash with a distal femur fracture. CT scan reveals a coronal plane fracture of the lateral femoral condyle. What is the optimal fixation strategy for this specific fracture fragment?

In a subtrochanteric femur fracture, the proximal fragment is typically deformed by specific muscle forces. Which of the following describes the typical position of the proximal fragment and the primary muscle responsible for its flexion?

A 28-year-old polytrauma patient sustains a highly comminuted, closed femoral shaft fracture in a motor vehicle collision. On arrival, he is tachycardic, has an SpO2 of 88% on room air, and exhibits petechiae across his axillae and chest. Which of the following is the most appropriate initial management for his femur fracture?

A 34-year-old man sustains a transverse midshaft humerus fracture during an arm wrestling match. In the emergency department, he demonstrates an inability to actively extend his wrist or digits. What is the most appropriate initial management?

The deforming muscular forces acting on a subtrochanteric femur fracture characteristically result in what position of the proximal fragment?

A 25-year-old man sustains a posterior hip dislocation following a dashboard injury. A closed reduction is performed within 4 hours. Post-reduction CT imaging shows a concentric joint reduction, no intra-articular fragments, and a non-displaced posterior wall fracture involving 10% of the articular surface. What is the most appropriate next step in management?

A 22-year-old male sustains a high-energy closed tibial diaphysis fracture. Four hours later, his leg is tense, and he complains of pain out of proportion to the injury. Passive stretch of his hallux elicits excruciating pain. His diastolic blood pressure is 65 mmHg, and his anterior compartment pressure measures 45 mmHg. What is the most appropriate management?

A 66-year-old woman presents with atraumatic thigh pain. She has been taking oral alendronate for 9 years. Radiographs reveal a transverse fracture of the femoral shaft with lateral cortical thickening and a medial cortical spike. What is the most appropriate management of this condition?

A 24-year-old man sustains a closed spiral fracture of the distal third of the humerus (Holstein-Lewis fracture). Initial examination in the emergency department documents normal wrist and finger extension. Following closed reduction and application of a coaptation splint, the patient immediately develops an inability to extend his wrist and digits. What is the most appropriate next step in management?

A 25-year-old man sustains a subtrochanteric femur fracture. To achieve an anatomic reduction, the surgeon must overcome the deforming forces acting on the proximal fragment. The proximal fragment is typically pulled into which of the following positions, and by which corresponding muscles?

A 32-year-old man undergoes reamed intramedullary nailing for a closed tibial shaft fracture. Twelve hours postoperatively, he complains of severe leg pain requiring rapidly escalating doses of narcotics. Which of the following is the most objective and definitive threshold indicating the need for emergent fasciotomy?