2. Trauma MCQs

A 40-year-old female sustains an ankle fracture. Radiographs show a transverse fracture of the lateral malleolus at the level of the joint line and a vertical fracture of the medial malleolus. Which Lauge-Hansen classification best describes this injury pattern?

A 28-year-old male sustains a severe crush injury to his midfoot. Radiographs show a divergent Lisfranc fracture-dislocation with significant comminution of the cuboid (nutcracker fracture). When performing ORIF, what is the primary goal of managing the lateral column (4th and 5th TMT joints)?

A 55-year-old poorly controlled diabetic patient presents with a red, hot, and swollen left foot. Radiographs are negative for fracture or overt destruction. Which of the following clinical findings best differentiates acute Charcot neuroarthropathy from a deep infection?

A 65-year-old patient with long-standing, poorly controlled diabetes mellitus and peripheral neuropathy sustains an unstable bimalleolar ankle fracture. Which of the following modifications to the standard surgical protocol is most appropriate?

Based on the classic biomechanical studies by Ramsey and Hamilton regarding ankle congruency following a fracture, 1 mm of lateral talar shift results in approximately what percentage decrease in tibiotalar contact area?

During the operative treatment of a complex ankle fracture, an avulsed bony fragment is identified attached to the anterior inferior tibiofibular ligament (AITFL). If this fragment originated from the tibia, it is anatomically referred to as the:

A 21-year-old collegiate basketball player sustains an acute fifth metatarsal fracture in the metaphyseal-diaphyseal junction (Zone 2). To minimize the risk of nonunion and expedite return to play, what is the best treatment?

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2) during practice. To optimize his return to play and minimize the risk of nonunion, what is the most appropriate management strategy?

A 22-year-old football player sustains a hyperplantarflexion injury to his midfoot. Weight-bearing radiographs demonstrate a 2 mm diastasis between the base of the first and second metatarsals, with a 'fleck sign' present. What is the most appropriate management?

A 40-year-old man presents with chronic lateral heel and ankle pain one year after being treated non-operatively for a joint-depressed calcaneus fracture. Examination reveals tenderness below the lateral malleolus and an inability to accommodate uneven terrain. Impingement of which of the following structures is most likely contributing to his pain?

A 21-year-old Division I basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. Given his athletic status, what is the most appropriate definitive management to ensure the fastest return to play and lowest nonunion risk?

A 22-year-old track athlete presents with an 8-week history of vague, ill-defined midfoot pain that worsens with sprinting. A CT scan confirms a non-displaced stress fracture of the tarsal navicular. The high risk of delayed union or nonunion of this fracture is primarily due to relative avascularity in which region of the navicular?

A 34-year-old man sustains a displaced talar neck fracture. At 8 weeks postoperatively, a plain AP radiograph of the ankle demonstrates subchondral lucency in the dome of the talus. What does this radiographic finding indicate?

A 21-year-old professional basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. Which of the following anatomical factors most directly contributes to the high risk of nonunion in this specific fracture pattern?

A 20-year-old track athlete presents with chronic midfoot pain. CT scan reveals a non-displaced stress fracture of the tarsal navicular. In which anatomic region of the navicular do these fractures predominantly occur and why?

A 40-year-old man falls from a roof and sustains a closed, highly comminuted pilon fracture with severe soft tissue swelling and fracture blisters. What is the most appropriate initial management?

A 28-year-old construction worker undergoes open reduction and internal fixation for a displaced intra-articular calcaneus fracture. Based on the Sanders classification, which utilizes coronal CT imaging, what specific anatomical structure is evaluated to determine the fracture grade?

Six weeks following open reduction and internal fixation of a Hawkins Type II talar neck fracture, an AP ankle radiograph demonstrates a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

A 45-year-old roofer falls from a ladder, sustaining a closed, displaced intra-articular calcaneus fracture.

Examination reveals severe swelling with intact skin and fracture blisters. What is the most reliable clinical indicator that the soft tissues are ready for surgical intervention via an extensile lateral approach?

A 68-year-old woman falls onto her outstretched arm and sustains a displaced 4-part proximal humerus fracture. She has a history of severe osteoporosis. Her tuberosities are widely displaced, and the anatomic neck is fractured. Which of the following factors is most predictive of humeral head avascular necrosis in this patient?