2. Trauma MCQs

Following a severe fracture-dislocation at T4, a patient presents with flaccid paralysis, hypotension (BP 80/40 mmHg), bradycardia (HR 45 bpm), and warm, flushed extremities. Which of the following mechanisms best explains this specific constellation of systemic findings?

A 72-year-old female sustains a Type II odontoid fracture after a ground-level fall. Which of the following radiographic or clinical parameters is the strongest predictor of nonunion if this fracture is treated nonoperatively?

Which of the following is considered the most significant risk factor for nonunion in a patient treated nonoperatively for a Type II odontoid fracture?

In a Supination-External Rotation (SER) stage IV ankle fracture, which of the following structures is injured last (Stage IV) according to the Lauge-Hansen classification?

A 30-year-old male presents with a severely displaced ankle fracture-dislocation. Closed reduction under conscious sedation in the ED is mechanically blocked. A true lateral radiograph shows the proximal segment of the fibula locked posterior to the tibia. Behind which specific anatomic structure is the fibula typically entrapped in this rare injury pattern?

A 42-year-old man sustains an ankle injury. Radiographs reveal an ankle fracture-dislocation that is irreducible in the emergency department. A CT scan demonstrates the proximal fibular shaft fragment is locked behind the posterior tubercle of the tibia. Which of the following is the most likely diagnosis?

A 35-year-old man presents with an ankle fracture-dislocation. Radiographs show a posterior dislocation of the proximal fibular fragment behind the lateral ridge of the distal tibia, which is irreducible by closed means. What is this specific injury pattern named?

A 40-year-old patient presents with a trimalleolar ankle fracture. The posterior malleolus fracture involves 35% of the articular surface and is displaced. What is the primary biomechanical rationale for surgical fixation of the posterior malleolus in this case?

A 40-year-old male sustains a severe ankle fracture-dislocation. Closed reduction in the emergency department is unsuccessful despite adequate sedation. A CT scan reveals that the proximal fragment of the fibula is locked behind the posterior tubercle of the distal tibia. What is the eponymous name for this specific injury pattern?

When treating a Weber B (supination-external rotation) distal fibula fracture, what is the primary biomechanical advantage of utilizing a posterior antiglide plate compared to a lateral neutralization plate?

Ankle radiographs of a 28-year-old male reveal a vertical shear fracture of the medial malleolus and a transverse fracture of the lateral malleolus at the level of the joint line. According to the Lauge-Hansen classification, what is the most likely mechanism of injury?

During the radiographic evaluation of a suspected syndesmotic injury, external rotation stress views are obtained. Which of the following radiographic measurements on an AP or mortise view is the most reliable indicator of deep deltoid ligament incompetence and syndesmotic instability?

A 45-year-old female sustains a trimalleolar ankle fracture. The posterior malleolar fragment involves 35% of the articular surface and remains displaced 3 mm after fibular fixation. Which of the following is the primary biomechanical advantage of directly fixing this posterior malleolar fragment?

A 72-year-old obese female with advanced diabetic neuropathy and a history of a contralateral Charcot midfoot presents with a closed, unstable, displaced bimalleolar ankle fracture. In addition to standard open reduction and internal fixation, what supplemental surgical strategy is increasingly favored to minimize the high risk of catastrophic failure?

A 24-year-old athlete sustains a twisting injury to the ankle. Anteroposterior (AP) and mortise radiographs are obtained to evaluate for a syndesmotic injury. Which of the following radiographic parameters is considered abnormal and highly suggestive of a syndesmotic disruption on a standard mortise view?

A 21-year-old Division I collegiate basketball player sustains an acute fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2). He desires to return to competition as rapidly and safely as possible. What is the most appropriate management?

A 30-year-old woman is brought to the emergency department after a high-speed motor vehicle collision. Radiographs demonstrate a Hawkins Type III fracture of the talar neck. What is the approximate reported rate of avascular necrosis (AVN) of the talar body associated with this specific injury pattern?

A 45-year-old roofer falls 15 feet, sustaining a displaced intra-articular calcaneus fracture. An extensile lateral approach is planned for open reduction and internal fixation. To prevent flap necrosis, the surgeon must preserve the primary blood supply to the corner of this flap. Which artery provides this critical vascularity?

A 21-year-old elite collegiate basketball player sustains an acute, displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Jones fracture). What is the most appropriate management to ensure the fastest return to sport and lowest risk of nonunion?

A 19-year-old male track athlete complains of vague dorsal midfoot pain that worsens with running. Radiographs are negative. An MRI confirms a stress fracture involving the central third of the tarsal navicular. The fracture is non-displaced. What is the standard recommended treatment?