2. Trauma MCQs

A 28-year-old downhill skier feels a sudden pop behind the lateral malleolus during a sharp turn. He presents with swelling and point tenderness over the distal fibula. Radiographs show a small longitudinal cortical avulsion fracture off the posterolateral margin of the distal fibula. What is the most likely diagnosis?

A 40-year-old man sustains a severe tibial pilon fracture with massive soft-tissue swelling and clear fracture blisters over the anterior ankle. Initial management consists of a spanning external fixator. What is the most reliable clinical indicator that the soft tissues are ready for definitive open reduction and internal fixation?

A 25-year-old snowboarder presents with acute lateral ankle pain after a hard landing. He has point tenderness just inferior to the tip of the lateral malleolus. Plain radiographs of the ankle are initially interpreted as normal, but a CT scan is obtained due to high clinical suspicion. What occult fracture is classically associated with this mechanism?

A 45-year-old man sustains a closed intra-articular calcaneal fracture. The surgeon relies on the Sanders classification to determine the fracture pattern and prognosis. This classification system is based on the number of articular fracture lines passing through the posterior facet as seen on which imaging view?

During an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, screws are directed medially into the sustentaculum tali. Penetration of the medial cortex places which of the following structures at greatest immediate risk?

A 21-year-old collegiate basketball player sustains an acute, non-displaced fracture of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction. What is the most appropriate treatment to optimize his return to play and minimize the risk of nonunion?

A 35-year-old man sustained a displaced talar neck fracture 8 weeks ago, which was treated with open reduction and internal fixation. A follow-up AP radiograph of the ankle shows a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

A 40-year-old construction worker falls from a roof, sustaining a high-energy pilon fracture.

On presentation, the limb is grossly swollen with fracture blisters developing. What is the most appropriate initial management?

A 38-year-old man sustains a displaced intra-articular calcaneus fracture.

The widely used Sanders classification system evaluates the severity of this fracture based on the number and location of primary fracture lines seen on which imaging plane and anatomical structure?

A 28-year-old male sustains a Hawkins type III talar neck fracture. Six weeks postoperatively, AP radiographs of the ankle reveal a linear radiolucent band in the subchondral bone of the talar dome. What does this radiographic finding indicate?

A 35-year-old roofer falls from a ladder and sustains a displaced, intra-articular calcaneus fracture. If surgical intervention via a lateral extensile approach is planned, what is the most significant risk factor for postoperative wound complications?

A 42-year-old man sustains a severe, high-energy tibial pilon fracture with massive soft tissue swelling and fracture blisters. What is the most appropriate initial management strategy?

A 19-year-old male track athlete complains of vague dorsal midfoot pain. Radiographs are normal, but an MRI demonstrates a stress fracture in the central third of the navicular body without displacement. What is the best initial management?

A 28-year-old male sustains a high-energy closed tibial pilon fracture with severe fracture blisters and massive soft tissue swelling. What is the most appropriate initial management?

A 30-year-old female presents with an irreducible ankle fracture-dislocation after a skiing accident. Radiographs reveal the proximal fibular fragment is entrapped behind the posterior tubercle of the distal tibia. What is the eponymous name for this specific injury pattern?

Which of the following radiographic parameters is the most accurate and reliable indicator of a syndesmotic injury on standard weight-bearing ankle radiographs?

A patient presents with a severe ankle injury where the proximal fibular fragment is entrapped behind the posterior tubercle of the tibia, rendering closed reduction impossible. Which mechanism is primarily responsible for this specific injury pattern (Bosworth fracture-dislocation)?

A 65-year-old poorly controlled diabetic patient sustains a closed, displaced bimalleolar equivalent ankle fracture. What is the most appropriate surgical strategy compared to a non-diabetic patient?

In the operative management of a trimalleolar ankle fracture, traditional guidelines indicate fixation of the posterior malleolus if the fragment involves what minimum percentage of the articular surface?

A patient presents with a painful, swollen midfoot after a fall from a horse. Plain anteroposterior radiographs reveal a small avulsion fracture in the space between the base of the first and second metatarsals. What is this radiographic finding called and what does it signify?