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2. Trauma MCQs

Practice Set 403 of 640

This practice set contains high-yield board review questions covering key concepts in 2. Trauma. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 8041

Topic: 2. Trauma

A 35-year-old man falls from a 20-foot height. Pelvic CT demonstrates a highly displaced transverse fracture through the S2 vertebral body connecting bilateral longitudinal sacral fractures. He has perianal numbness and absent sphincter tone. What is this fracture pattern classically termed, and what is the required surgical intervention?

. Vertical shear pelvic fracture requiring anterior plating
. Denis Zone I sacral fracture requiring iliosacral screws
. U-shaped sacral fracture requiring spinopelvic fixation
. Denis Zone II sacral fracture requiring nonoperative management
. Sacral ala fracture requiring posterior tension band wiring

Correct Answer & Explanation

. Vertical shear pelvic fracture requiring anterior plating

Explanation

A U-shaped sacral fracture represents a spinopelvic dissociation, meaning the axial spine is disconnected from the pelvic ring. Due to the high mechanical instability and neurologic injury, it requires robust lumbopelvic/spinopelvic fixation.

Question 8042

Topic: 2. Trauma

A 30-year-old female sustains a pelvic ring injury following a fall. CT imaging reveals a vertical fracture through the sacrum that extends through the central sacral canal. According to the Denis classification, what is the zone of this fracture and its associated hallmark neurologic complication?

. Zone I; L5 nerve root injury
. Zone II; S1 nerve root injury
. Zone III; Bowel and bladder dysfunction
. Zone I; Bowel and bladder dysfunction
. Zone II; L5 nerve root injury

Correct Answer & Explanation

. Zone I; L5 nerve root injury

Explanation

Denis Zone III sacral fractures involve the central sacral canal. Because they disrupt the sacral neural elements centrally, they have the highest incidence (up to 57%) of neurologic deficits, typically presenting as sphincter, bowel, and sexual dysfunction.

Question 8043

Topic: 2. Trauma

An 82-year-old woman sustains a Type II odontoid fracture after a ground-level fall. She is neurologically intact. If she is treated non-operatively with a hard cervical collar, which of the following is the most significant risk factor for nonunion?

. Age greater than 50 years
. Fracture displacement greater than 5 mm
. Angulation less than 10 degrees
. Use of a halo vest instead of a hard collar
. Presence of a posterior arch fracture of C1

Correct Answer & Explanation

. Age greater than 50 years

Explanation

In the management of Type II odontoid fractures, initial fracture displacement greater than 5 mm, angulation greater than 10 degrees, and advanced age are significant risk factors for nonunion.

Question 8044

Topic: 2. Trauma

A 40-year-old man presents with a C4-C5 fracture-dislocation following an accident. He complains of severe neck pain but has an intact neurologic examination. Which finding on a non-contrast cervical spine CT most strongly warrants obtaining a CT angiogram of the neck?

. Extension of a fracture line into the transverse foramen
. Presence of an isolated laminar fracture
. Prevertebral soft tissue swelling > 10 mm
. Avulsion fracture of the spinous process
. Mild loss of cervical lordosis

Correct Answer & Explanation

. Extension of a fracture line into the transverse foramen

Explanation

Fractures extending into the transverse foramen, facet dislocations, and significant subluxations are high-risk mechanisms for blunt vertebral artery injury. A CT angiogram is indicated to evaluate for vertebral artery dissection or occlusion.

Question 8045

Topic: 2. Trauma

Which of the following factors represents the highest risk for nonunion of a Type II odontoid fracture treated nonoperatively with a rigid orthosis or halo vest?

. Initial displacement greater than 5 mm
. Patient age less than 40 years
. Anterior displacement rather than posterior displacement
. Associated C1 ring fracture
. Impacted fracture pattern

Correct Answer & Explanation

. Initial displacement greater than 5 mm

Explanation

Risk factors for nonunion in Type II odontoid fractures include initial displacement > 5 mm, posterior displacement, angulation > 10 degrees, and age > 50 years. Displacement greater than 5 mm significantly decreases the bony apposition needed for successful healing.

Question 8046

Topic: 2. Trauma

A 30-year-old male is brought to the trauma bay after a high-speed motorcycle crash. Lateral cervical radiographs demonstrate a Basion-Dental Interval (BDI) of 14 mm. He is intubated and sedated. What is the most appropriate definitive management?

. Halo vest immobilization for 12 weeks
. Hard cervical collar for 8 weeks
. Occipitocervical fusion
. C1-C2 posterior instrumented fusion
. Anterior C1-C2 transarticular screws

Correct Answer & Explanation

. Halo vest immobilization for 12 weeks

Explanation

A Basion-Dental Interval (BDI) > 12 mm is diagnostic of occipitocervical dissociation, representing highly unstable craniocervical ligamentous disruption. Definitive treatment requires rigid occipitocervical fusion, as orthoses cannot maintain alignment and isolated C1-C2 fusion does not address the occipitocervical instability.

Question 8047

Topic: 2. Trauma

Which of the following parameters is the most critical risk factor for predicting nonunion with nonoperative management of a Type II odontoid fracture in an elderly patient?

. Patient age < 50 years
. Posterior displacement > 2 mm
. Initial fracture displacement > 5 mm
. Concurrent anterior arch fracture
. Transverse fracture orientation

Correct Answer & Explanation

. Patient age < 50 years

Explanation

In Type II odontoid fractures, initial displacement greater than 5 mm, angulation greater than 10 degrees, and age greater than 65 years are significant risk factors for nonunion with halo vest or collar immobilization.

Question 8048

Topic: 2. Trauma

An 82-year-old man presents with a Type II odontoid fracture after a mechanical fall. His neurologic examination is normal. If conservative management is chosen, which of the following orthoses is associated with the highest morbidity and mortality in this specific patient population?

. Miami J collar
. Philadelphia collar
. Halo vest
. SOMI brace
. Soft cervical collar

Correct Answer & Explanation

. Miami J collar

Explanation

Halo vest immobilization in elderly patients (>65 years) is associated with high morbidity and mortality due to respiratory complications and dysphagia. Rigid cervical collars are generally preferred as the initial nonoperative treatment in this cohort, despite a higher nonunion rate.

Question 8049

Topic: 2. Trauma

An 80-year-old male sustains a Type II dens fracture with 6 mm of posterior displacement and severe comminution at the fracture base. He is medically fit for surgery. What is the most appropriate management?

. Halo vest immobilization
. Rigid cervical collar
. Anterior odontoid screw fixation
. Posterior C1-C2 spinal fusion

Correct Answer & Explanation

. Halo vest immobilization

Explanation

Age >50 and displacement >5 mm are major risk factors for nonunion in Type II dens fractures. Comminution at the base contraindicates anterior screw fixation, making posterior C1-C2 fusion the most appropriate treatment for a medically fit elderly patient.

Question 8050

Topic: 2. Trauma

A 22-year-old male sustains a C4 fracture-dislocation in a motorcycle crash. Upon arrival, he is flaccid and areflexic below the neck. His blood pressure is 80/50 mmHg and heart rate is 50 beats per minute. His extremities are warm and flushed. What is the primary pathophysiology underlying his hemodynamic instability?

. Loss of descending sympathetic vascular tone
. Massive depletion of intravascular blood volume
. Loss of descending inhibitory parasympathetic signals
. Acute post-traumatic adrenal insufficiency

Correct Answer & Explanation

. Loss of descending sympathetic vascular tone

Explanation

The patient is experiencing neurogenic shock, characterized by hypotension, bradycardia, and warm extremities. It is caused by the disruption of descending sympathetic pathways in the cervical cord, leading to unopposed vagal tone and loss of peripheral vascular resistance.

Question 8051

Topic: 2. Trauma

A 28-year-old male sustained a Hawkins Type II talar neck fracture and underwent open reduction and internal fixation. At his 8-week postoperative visit, a subchondral lucency is visible in the talar dome on the AP mortise radiograph. What does this radiographic finding indicate?

. Imminent avascular necrosis of the talar body
. Nonunion of the talar neck
. Intact vascularity to the talar body
. Infection of the talar dome
. Post-traumatic osteoarthritis

Correct Answer & Explanation

. Imminent avascular necrosis of the talar body

Explanation

This finding is the Hawkins sign, which represents subchondral osteopenia secondary to hyperemia. It is a highly reliable indicator that vascularity to the talar body is intact, ruling out complete avascular necrosis.

Question 8052

Topic: 2. Trauma

A 21-year-old collegiate basketball player complains of lateral foot pain. Radiographs show a transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal.

What is the best treatment option to minimize time lost from play?

. Non-weight-bearing short leg cast for 6 weeks
. Weight-bearing as tolerated in a CAM boot
. Intramedullary screw fixation
. Open reduction and internal fixation with a mini-fragment plate
. Primary excision of the proximal fragment

Correct Answer & Explanation

. Non-weight-bearing short leg cast for 6 weeks

Explanation

Zone 2 fifth metatarsal fractures (Jones fractures) in elite or competitive athletes are best treated with intramedullary screw fixation to ensure a faster and more predictable return to play and to lower the risk of nonunion.

Question 8053

Topic: 2. Trauma

A 32-year-old construction worker sustained a displaced, intra-articular calcaneus fracture.

You are planning an open reduction and internal fixation via an extensile lateral approach. Which of the following factors poses the highest risk for postoperative wound edge necrosis and infection?

. History of deep vein thrombosis
. Male gender
. Current tobacco smoking
. Operating at 14 days post-injury
. Use of a non-locking plate

Correct Answer & Explanation

. History of deep vein thrombosis

Explanation

Current tobacco smoking significantly increases the risk of wound complications, including skin slough and deep infection, particularly with the extensile lateral approach for calcaneus fractures.

Question 8054

Topic: 2. Trauma

A 40-year-old male falls from a ladder and sustains a severely displaced intra-articular distal tibia (Pilon) fracture with severe soft tissue swelling and fracture blisters. What is the most widely accepted initial management strategy?

. Spanning external fixation and delayed open reduction internal fixation
. Immediate open reduction and internal fixation of the tibia and fibula
. Immediate intramedullary nailing of the tibia
. Primary ankle arthrodesis
. Closed reduction and long-leg casting for 6 weeks

Correct Answer & Explanation

. Spanning external fixation and delayed open reduction internal fixation

Explanation

Due to high complication rates associated with early surgery through compromised soft tissues, high-energy Pilon fractures are best managed with a staged protocol: initial spanning external fixation followed by delayed ORIF (typically at 10-21 days).

Question 8055

Topic: 2. Trauma

A 24-year-old male sustains a pronation-external rotation ankle injury with a frank syndesmotic diastasis. He undergoes stabilization with a flexible suture-button device instead of traditional syndesmotic screws. Which of the following is an expected advantage of the suture-button device?

. Superior mechanical stiffness compared to a tetracortical screw
. Lower rates of hardware removal
. Accelerated bone healing of the fibula fracture
. Prevention of post-traumatic osteoarthritis
. Elimination of the need for fibular plate fixation

Correct Answer & Explanation

. Superior mechanical stiffness compared to a tetracortical screw

Explanation

Dynamic (suture-button) fixation for syndesmotic injuries demonstrates similar functional outcomes to rigid screw fixation but is associated with significantly lower rates of symptomatic hardware requiring secondary removal.

Question 8056

Topic: 2. Trauma
A 30-year-old man presents with a Hawkins type III talar neck fracture following a motor vehicle collision. Which of the following is the most significant predictor of avascular necrosis (AVN) of the talar body in this patient?
. Timing of surgical fixation (before vs after 8 hours)
. Use of a dual-incision approach
. Degree of initial fracture displacement and dislocation
. Quality of the intraoperative reduction
. Postoperative weight-bearing status

Correct Answer & Explanation

. Degree of initial fracture displacement and dislocation

Explanation

The risk of AVN in talar neck fractures is most directly correlated with the degree of initial displacement and disruption of the blood supply. This severity is categorized by the Hawkins classification system; timing of fixation does not significantly alter the AVN rate.

Question 8057

Topic: 2. Trauma

A 19-year-old track athlete complains of vague dorsal midfoot pain that worsens with sprinting. Radiographs are negative. MRI reveals a stress fracture of the tarsal navicular in the central third, without a completed fracture line. What is the most appropriate initial management?

. Continued weight-bearing in a stiff-soled shoe
. Weight-bearing as tolerated in a controlled ankle motion (CAM) boot
. Non-weight-bearing in a short leg cast for 6-8 weeks
. Open reduction and internal fixation with bone grafting
. Percutaneous screw fixation

Correct Answer & Explanation

. Continued weight-bearing in a stiff-soled shoe

Explanation

The central third of the tarsal navicular is a watershed vascular area making it highly prone to nonunion. Incomplete stress fractures should be treated strictly non-weight-bearing in a cast for 6-8 weeks.

Question 8058

Topic: 2. Trauma

A 21-year-old professional basketball player sustains an acute, non-displaced fracture of the base of the fifth metatarsal at the metaphyseal-diaphyseal junction. He wishes to return to play as soon as possible. What is the recommended treatment?

. Short leg walking cast for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Resection of the proximal fragment and peroneus brevis advancement
. Non-weight-bearing cast for 8 weeks

Correct Answer & Explanation

. Short leg walking cast for 6 weeks

Explanation

A true Jones fracture occurs at the metaphyseal-diaphyseal junction where blood supply is tenuous. In elite athletes, intramedullary screw fixation is recommended to minimize nonunion risk and allow for an accelerated return to play.

Question 8059

Topic: 2. Trauma
A 25-year-old sustains a closed, high-energy hyperdorsiflexion injury to the foot. Radiographs show a talar neck fracture with subtalar subluxation, but the ankle joint remains perfectly intact. What is the Hawkins classification and approximate risk of avascular necrosis (AVN) for this fracture?
. Hawkins I (0-10%)
. Hawkins II (20-50%)
. Hawkins III (50-100%)
. Hawkins IV (100%)
. Hawkins I (20-50%)

Correct Answer & Explanation

. Hawkins II (20-50%)

Explanation

This is a Hawkins Type II fracture, defined by a talar neck fracture with subluxation or dislocation of the subtalar joint while the ankle joint remains intact. The risk of AVN for a Hawkins II fracture is approximately 20% to 50%.

Question 8060

Topic: 2. Trauma
A 25-year-old male sustains a high-energy motor vehicle collision resulting in a displaced talar neck fracture with subluxation of the subtalar joint. The tibiotalar joint remains concentrically reduced. According to the Hawkins classification, what is the estimated risk of avascular necrosis (AVN) of the talar body?
. <10%
. 20% to 50%
. 75% to 90%
. 100%
. AVN does not occur in this pattern

Correct Answer & Explanation

. 20% to 50%

Explanation

A Hawkins Type II fracture involves a talar neck fracture with subtalar subluxation or dislocation, carrying an AVN risk of 20-50%. Type I has a <10% risk, Type III has a >75% risk, and Type IV approaches 100%.

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