2. Trauma MCQs

A 30-year-old polytrauma patient develops petechiae, confusion, and hypoxemia 48 hours after sustaining bilateral femur fractures. What is the most likely underlying pathophysiologic mechanism for this syndrome?

A 38-year-old man undergoes open reduction and internal fixation of a Schatzker IV (medial) tibial plateau fracture.

Which surgical approach is most appropriate for direct visualization and buttress plating of the posteromedial fragment?

A 22-year-old male presents with a highly comminuted, severely shortened distal radius fracture and an associated ipsilateral diaphyseal ulna fracture after a high-speed motorcycle crash. He requires multiple surgeries for other life-threatening injuries. What is the most appropriate temporary or definitive construct for the wrist?

A 35-year-old male requires open reduction and internal fixation of a displaced posteromedial tibial plateau fracture. A posteromedial approach is utilized. Which of the following structures is at greatest risk of iatrogenic injury during the superficial dissection?

A 25-year-old multiply injured patient is brought to the trauma bay after a motorcycle collision. He has bilateral femur fractures and a severe closed head injury. Which of the following physiological markers is the most reliable indicator of adequate global tissue perfusion and resuscitation prior to proceeding with Early Total Care (ETC)?

A 32-year-old male sustains a Schatzker VI bicondylar tibial plateau fracture. Twelve hours post-admission, he develops severe, unrelenting leg pain exacerbated by passive stretch of the great toe. Intra-compartmental pressure monitoring reveals a pressure of 45 mm Hg in the anterior compartment, with a diastolic blood pressure of 60 mm Hg. What is the most appropriate next step in management?

In the initial management of a hemodynamically unstable polytrauma patient with an open-book pelvic ring injury (APC III), a pelvic binder is applied. To achieve optimal mechanical closure of the pelvic volume, the binder should be centered over which of the following anatomic landmarks?

A 45-year-old male presents with a severely displaced bicondylar tibial plateau fracture and massive soft tissue swelling with fracture blisters over the anterolateral and medial aspects of the proximal leg. What is the most appropriate initial management of this fracture?

A 22-year-old male sustains closed bilateral femur fractures in an ATV accident. On post-admission day 2, he develops acute hypoxia, a petechial rash over his axillae, and confusion. Which of the following interventions is the most effective definitive method to prevent the development of this syndrome?

A 42-year-old female sustains a split-depression lateral tibial plateau fracture (Schatzker type II). During surgical fixation, a submeniscal arthrotomy is performed. Which of the following intra-articular injuries is most frequently encountered with this specific fracture pattern?

A polytrauma patient with multiple long-bone fractures, pulmonary contusions, and a severe head injury is initially managed with damage control orthopedics (DCO). According to the classic "two-hit" model of systemic inflammation, definitive fracture fixation should ideally be performed during which window to minimize the risk of ARDS and multiple organ failure?

A 25-year-old male is brought to the emergency department after a high-speed motor vehicle collision. He has a severe traumatic brain injury, multiple rib fractures, and a comminuted midshaft femur fracture. Which of the following systemic markers best indicates that the patient has been adequately resuscitated and is a suitable candidate for early total care?

A 55-year-old woman undergoes volar locked plating for a comminuted intra-articular distal radius fracture. At 6-month follow-up, she is unable to actively flex the interphalangeal joint of her thumb. What is the most likely cause of this complication?

A 40-year-old man sustains a bicondylar tibial plateau fracture (Schatzker VI) with a displaced posteromedial coronal split fragment. Standard anterolateral plating alone is planned. What is the most likely consequence of failing to specifically address the posteromedial fragment?

A hypotensive 30-year-old polytrauma patient presents with an anteroposterior compression (APC) type III pelvic ring injury. To effectively reduce the pelvic volume and control hemorrhage, a pelvic binder should be centered over which of the following anatomic landmarks?

A 35-year-old man undergoes staged management of a high-energy Schatzker VI tibial plateau fracture. He is initially placed in a knee-spanning external fixator. Within 12 hours, he develops severe, unrelenting leg pain exacerbated by passive stretch of the hallux. What is the next most appropriate step in management?

According to the principles of Damage Control Orthopedics (DCO), which of the following clinical scenarios represents a borderline patient where temporary external fixation of a femoral shaft fracture is favored over early intramedullary nailing?

A 45-year-old man sustains a Schatzker II (split-depression) fracture of the lateral tibial plateau. During operative fixation, a peripheral tear of the lateral meniscus is identified. What is the most appropriate management of the meniscus?

A 78-year-old polytrauma patient with bilateral lower extremity fractures sustains a highly comminuted, intra-articular fracture of the distal radius extending into the metadiaphysis. The patient requires the use of the upper extremities for weight-bearing transfers. What is the most appropriate fixation strategy for the wrist?

A 45-year-old male sustains a high-energy Schatzker VI bicondylar tibial plateau fracture. Thirty-six hours after undergoing open reduction and internal fixation with dual plating, he develops severe, unrelenting leg pain that is exacerbated by passive plantar flexion of the toes. Examination reveals decreased sensation in the first dorsal web space. Which of the following compartments is most likely affected, and which nerve is at greatest risk?