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2. Trauma MCQs

Practice Set 404 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 8061

Topic: 2. Trauma

A 19-year-old college soccer player presents with an acute 5th metatarsal base fracture located at the metaphyseal-diaphyseal junction. To minimize the risk of nonunion and expedite return to play, what is the most appropriate management?

. Hard-soled shoe for 4 weeks
. Short leg walking cast for 6 weeks
. Non-weight-bearing cast for 6 weeks
. Intramedullary screw fixation
. Tension band wiring

Correct Answer & Explanation

. Hard-soled shoe for 4 weeks

Explanation

Zone 2 (Jones) fractures in elite or competitive athletes are best treated with early intramedullary screw fixation. Operative treatment significantly decreases the rate of delayed union or nonunion and allows for a much faster return to play compared to non-operative casting.

Question 8062

Topic: 2. Trauma

A 38-year-old roofer sustains a displaced intra-articular calcaneus fracture. An extensile lateral approach is planned. Which of the following is the most significant risk factor for wound complications following this procedure?

. Smoking
. Diabetes mellitus
. Delay in surgery of 10 days
. Use of a tourniquet
. Age over 35 years

Correct Answer & Explanation

. Smoking

Explanation

Smoking is the single greatest modifiable risk factor for wound edge necrosis and infection following an extensile lateral approach for calcaneus fractures. Surgery should generally be delayed 10-14 days until the "wrinkle sign" appears to decrease swelling and complication rates.

Question 8063

Topic: 2. Trauma

A 21-year-old male cross-country runner presents with vague midfoot pain. Plain radiographs are normal, but an MRI demonstrates a stress fracture in the central third of the navicular body without displacement. What is the recommended management?

. Open reduction and internal fixation with a compression screw
. Weight-bearing in a walking boot for 4 weeks
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Corticosteroid injection and immediate return to play
. Extracorporeal shockwave therapy only

Correct Answer & Explanation

. Open reduction and internal fixation with a compression screw

Explanation

Nondisplaced navicular stress fractures have a high risk of nonunion due to the avascular zone in the central third of the bone. The standard of care is strict non-weight-bearing cast immobilization for 6-8 weeks.

Question 8064

Topic: 2. Trauma

A 45-year-old man sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling. Spanning external fixation is applied. Which of the following is the most reliable clinical indicator that the soft tissues are ready for definitive open reduction and internal fixation?

. Return of palpable dorsalis pedis pulse
. Resolution of fracture blisters
. Appearance of skin wrinkles
. Decrease in leg circumference by 2 cm
. Negative pinch test

Correct Answer & Explanation

. Return of palpable dorsalis pedis pulse

Explanation

The appearance of skin wrinkles (the "wrinkle sign") is the most reliable clinical indicator that soft tissue swelling has subsided enough to safely proceed with definitive ORIF in pilon fractures.

Question 8065

Topic: 2. Trauma

A 21-year-old college soccer player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He wishes to return to play as soon as possible. What is the recommended treatment?

. Hard-soled shoe for 6 weeks
. Short leg cast for 8 weeks
. Intramedullary screw fixation
. Plate and screw fixation
. Excision of the proximal fragment

Correct Answer & Explanation

. Hard-soled shoe for 6 weeks

Explanation

For competitive athletes with an acute Jones fracture (Zone 2), intramedullary screw fixation is recommended to reduce the risk of nonunion and allow an earlier return to sport.

Question 8066

Topic: 2. Trauma

A 25-year-old track athlete complains of vague dorsal midfoot pain. Plain radiographs are normal. An MRI reveals a non-displaced navicular body stress fracture. What is the most appropriate initial management?

. Boot immobilization with weight-bearing as tolerated
. Non-weight bearing cast for 6 to 8 weeks
. Percutaneous screw fixation
. Open reduction and internal fixation
. Extracorporeal shockwave therapy

Correct Answer & Explanation

. Boot immobilization with weight-bearing as tolerated

Explanation

Non-displaced navicular stress fractures have a high risk of nonunion due to poor blood supply. The standard non-operative management is strict non-weight bearing in a cast for 6 to 8 weeks.

Question 8067

Topic: 2. Trauma

A 35-year-old male sustains a severely displaced intra-articular calcaneus fracture. On examination, he has tense swelling, severe pain out of proportion, and pain with passive toe extension. If a fasciotomy is performed, which compartment of the foot contains the quadratus plantae?

. Medial
. Lateral
. Central
. Interosseous
. Dorsal

Correct Answer & Explanation

. Medial

Explanation

The central compartment of the foot contains the quadratus plantae, flexor digitorum brevis, adductor hallucis, and the lumbricals. It is critical to decompress this compartment in foot compartment syndrome.

Question 8068

Topic: 2. Trauma

A 45-year-old construction worker falls from a height and sustains a severe pilon fracture, which is treated with a staged open reduction and internal fixation. Two years later, what is the most likely long-term complication this patient will experience?

. Nonunion of the tibial metaphysis
. Post-traumatic arthritis of the ankle joint
. Deep surgical site infection
. Avascular necrosis of the talus
. Malunion causing a severe varus deformity

Correct Answer & Explanation

. Nonunion of the tibial metaphysis

Explanation

The most common long-term complication following a pilon fracture is post-traumatic ankle arthritis, which can occur in up to 50% of patients due to the severe initial cartilage damage.

Question 8069

Topic: 2. Trauma

In the Sanders classification for intra-articular calcaneus fractures, what specific radiographic view is utilized to determine the classification grade, and what anatomical structure dictates it?

. Lateral view; Bohler's angle
. Harris axial view; Sustentaculum tali
. Coronal CT; Posterior facet
. Sagittal CT; Anterior process
. Axial CT; Calcaneocuboid joint

Correct Answer & Explanation

. Lateral view; Bohler's angle

Explanation

The Sanders classification relies on the number of intra-articular fracture lines extending through the posterior facet of the calcaneus, best visualized on the widest part of the facet on a coronal CT scan.

Question 8070

Topic: 2. Trauma

A 30-year-old male sustains a displaced talar neck fracture with subluxation of the subtalar joint (Hawkins type II). Following ORIF, the presence of the 'Hawkins sign' on AP radiographs at 6 to 8 weeks post-injury indicates what?

. Impending avascular necrosis of the talar body
. Intact vascularity of the talar body
. Nonunion of the talar neck
. Post-traumatic arthritis of the subtalar joint
. Impending hardware failure

Correct Answer & Explanation

. Impending avascular necrosis of the talar body

Explanation

The Hawkins sign appears as a subchondral radiolucent band in the talar dome. It represents disuse osteopenia (resorption of subchondral bone), which requires intact vascularity, thereby effectively ruling out complete avascular necrosis.

Question 8071

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains an acute, non-displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Jones fracture). To minimize time away from sports and decrease the risk of nonunion, which treatment is most appropriate?

. Short leg cast non-weight-bearing for 6 weeks
. Hard-soled shoe weight-bearing as tolerated
. Open reduction and plate fixation
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Short leg cast non-weight-bearing for 6 weeks

Explanation

In high-level athletes, early intramedullary screw fixation for acute Jones fractures is indicated to significantly decrease the risk of nonunion and accelerate the return to competitive sports.

Question 8072

Topic: 2. Trauma

A 28-year-old man undergoes open reduction and internal fixation for a Hawkins type II talar neck fracture. At his 8-week postoperative visit, a subchondral lucency is visible beneath the talar dome on the anteroposterior radiograph. What is the prognostic significance of this radiographic finding?

. It indicates early onset of post-traumatic subtalar arthritis.
. It demonstrates intact vascularity to the talar body.
. It represents a high likelihood of impending avascular necrosis.
. It is a sign of deep postoperative infection.
. It suggests failure of the internal fixation hardware.

Correct Answer & Explanation

. It indicates early onset of post-traumatic subtalar arthritis.

Explanation

The Hawkins sign is a subchondral lucency of the talar dome seen 6 to 8 weeks after injury. It represents subchondral osteopenia secondary to hyperemia, confirming intact vascularity to the talar body and virtually ruling out avascular necrosis.

Question 8073

Topic: 2. Trauma

An elite college football player sustains a Zone 2 (Jones) fracture of the proximal fifth metatarsal. To minimize the risk of nonunion and allow the fastest return to play, what is the most appropriate management?

. Non-weight-bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled boot
. Intramedullary screw fixation
. Open reduction and plate osteosynthesis
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

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

Explanation

Zone 2 fractures (Jones fractures) occur at the metaphyseal-diaphyseal junction, a watershed vascular area prone to nonunion. Intramedullary screw fixation is recommended for high-level athletes to promote reliable healing and expedite return to play.

Question 8074

Topic: 2. Trauma

A 45-year-old male falls from a ladder, sustaining a severely comminuted closed pilon fracture. The ankle exhibits severe swelling and early fracture blisters. A spanning external fixator is placed. What is the most appropriate clinical indicator for timing the definitive open reduction and internal fixation?

. Immediately, to prevent articular cartilage damage
. Within 3 to 5 days, once blisters are unroofed
. Appearance of skin wrinkles, typically at 10 to 21 days
. Exactly 6 weeks post-injury
. Definitive fixation should be avoided entirely in favor of circular external fixation

Correct Answer & Explanation

. Immediately, to prevent articular cartilage damage

Explanation

The standard of care for severe pilon fractures is initial temporary external fixation to allow the soft tissue envelope to recover. Definitive ORIF is delayed until the swelling subsides and skin wrinkles appear, usually between 10 and 21 days.

Question 8075

Topic: 2. Trauma

When evaluating a trimalleolar ankle fracture, which of the following is currently considered the strongest indication for direct posterior approach and internal fixation of the posterior malleolus?

. A posterior malleolar fragment involving exactly 15% of the articular surface
. A non-displaced posterior fragment in an elderly patient
. Any posterior fragment with articular step-off, subluxation, or intercalary fragments
. An isolated posterior malleolus fracture without syndesmotic injury
. The presence of a concurrent medial malleolus fracture

Correct Answer & Explanation

. A posterior malleolar fragment involving exactly 15% of the articular surface

Explanation

Modern indications for fixing the posterior malleolus have moved away from strict size cutoffs (e.g., 25%). Fixation is indicated for any fragment causing articular incongruity, talar subluxation, or involving intercalary (die-punch) fragments, as it crucially restores syndesmotic stability.

Question 8076

Topic: 2. Trauma

A 22-year-old track athlete presents with insidious onset of dorsal midfoot pain. Plain radiographs are negative, but a CT scan reveals an incomplete stress fracture in the dorsal central third of the navicular body. What is the most appropriate initial management?

. Continued full weight-bearing with custom orthotics
. Weight-bearing in a controlled ankle motion (CAM) boot for 4 weeks
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Immediate percutaneous screw fixation
. Excision of the fractured dorsal fragment

Correct Answer & Explanation

. Continued full weight-bearing with custom orthotics

Explanation

Non-displaced or incomplete navicular stress fractures have a high risk of nonunion due to the avascular central third of the bone. The gold standard initial treatment is strict non-weight-bearing in a cast for 6 to 8 weeks.

Question 8077

Topic: 2. Trauma

During open reduction and internal fixation of a calcaneus fracture via a lateral extensile approach, a screw directed medial to the sustentaculum tali is measured slightly too long. Which anatomical structure is at the greatest risk of being injured or tethered by this prominent screw?

. Tibialis anterior tendon
. Flexor hallucis longus tendon
. Deep peroneal nerve
. Medial plantar nerve
. Tibialis posterior tendon

Correct Answer & Explanation

. Tibialis anterior tendon

Explanation

The Flexor Hallucis Longus (FHL) tendon courses directly inferior to the sustentaculum tali. Screws that are directed medially and left too long past the sustentacular cortex can easily impale or tether the FHL, leading to fixed flexion of the hallux.

Question 8078

Topic: 2. Trauma

A 35-year-old male presents with a closed ankle fracture-dislocation after a fall. Closed reduction in the emergency department is unsuccessful. Radiographs show a posterior fracture-dislocation of the fibula behind the posterior tubercle of the distal tibia. Which of the following is the most likely diagnosis?

. Maisonneuve fracture
. Bosworth fracture
. Tillaux fracture
. Wagstaffe-Le Fort fracture
. Volkmann fracture

Correct Answer & Explanation

. Maisonneuve fracture

Explanation

A Bosworth fracture involves a dislocation of the proximal fibular fragment posterior to the posterior tubercle of the tibia. This anatomical block makes closed reduction virtually impossible and necessitates urgent open reduction.

Question 8079

Topic: 2. Trauma

A 45-year-old construction worker falls from a ladder, sustaining a closed, highly comminuted intra-articular distal tibia (pilon) fracture with severe soft tissue swelling and fracture blisters. What is the most appropriate initial management?

. Immediate open reduction and internal fixation with dual plating
. Spanning external fixation with fibular fixation if necessary
. Closed reduction and cast immobilization for 6 weeks
. Primary ankle arthrodesis
. Intramedullary nailing of the tibia

Correct Answer & Explanation

. Immediate open reduction and internal fixation with dual plating

Explanation

In high-energy pilon fractures with severe soft tissue compromise, staged management with an initial spanning external fixator allows soft tissue recovery before definitive ORIF. This approach minimizes catastrophic wound complications and infection.

Question 8080

Topic: 2. Trauma

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

. Onset of avascular necrosis
. Imminent hardware failure
. Intact vascularity to the talar body
. Nonunion of the talar neck
. Post-traumatic osteoarthritis

Correct Answer & Explanation

. Onset of avascular necrosis

Explanation

The Hawkins sign is a subchondral radiolucent band seen 6 to 8 weeks post-injury. It represents subchondral atrophy from disuse and confirms intact vascularity to the talar body, effectively excluding avascular necrosis.

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