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2. Trauma MCQs

Practice Set 405 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 8081

Topic: 2. Trauma

Which of the following patient profiles is associated with the worst outcomes following open reduction and internal fixation of a displaced intra-articular calcaneus fracture?

. A 25-year-old female who is a recreational runner
. A 50-year-old male who performs heavy manual labor and smokes 2 packs of cigarettes per day
. A 40-year-old male receiving workers' compensation who does not smoke
. A 30-year-old male with an undisplaced fracture pattern
. A 60-year-old female with osteoporosis

Correct Answer & Explanation

. A 25-year-old female who is a recreational runner

Explanation

Smokers, heavy laborers, and patients receiving workers' compensation have significantly poorer clinical outcomes following ORIF of intra-articular calcaneus fractures. Smoking significantly increases the risk of severe wound breakdown.

Question 8082

Topic: Lower Extremity Trauma

A 24-year-old soccer player presents with lateral ankle pain and a popping sensation behind the fibula when circumducting the foot. Radiographs reveal a cortical avulsion off the lateral ridge of the distal fibula. This "fleck sign" indicates an injury to which of the following structures?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Superior peroneal retinaculum
. Inferior extensor retinaculum
. Cervical ligament

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

The "fleck sign" on a mortise or AP radiograph represents an osseous avulsion of the superior peroneal retinaculum from the posterolateral fibula. It is pathognomonic for peroneal tendon dislocation or subluxation.

Question 8083

Topic: 2. Trauma

A 20-year-old track athlete complains of vague dorsal midfoot pain that worsens with sprinting. MRI demonstrates a stress fracture of the tarsal navicular. Which region of the navicular is most susceptible to this injury due to its relative hypovascularity?

. Plantar pole
. Medial tuberosity
. Central third
. Dorsal lip
. Plantar-lateral quadrant

Correct Answer & Explanation

. Plantar pole

Explanation

The central third of the tarsal navicular is a relative watershed area for blood supply. This localized hypovascularity makes it the most common site for navicular stress fractures and nonunions.

Question 8084

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal base. What is the most appropriate management to minimize the risk of nonunion and allow for an expedited return to play?

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

Correct Answer & Explanation

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

Explanation

Zone 2 fractures (Jones fractures) in elite athletes have a high risk of delayed union or nonunion due to watershed vascularity. Early intramedullary screw fixation accelerates the return to play and significantly lowers nonunion rates.

Question 8085

Topic: 2. Trauma

A 20-year-old cross-country runner complains of vague midfoot pain. Radiographs are normal, but an MRI demonstrates a nondisplaced, incomplete stress fracture involving the central third of the navicular. What is the most appropriate initial management?

. Weight-bearing as tolerated in a controlled ankle motion (CAM) boot
. Strict non-weight-bearing in a cast for 6 to 8 weeks
. Primary open reduction and internal fixation with lag screws
. Extracorporeal shockwave therapy and immediate return to running
. Ultrasound-guided corticosteroid injection

Correct Answer & Explanation

. Weight-bearing as tolerated in a controlled ankle motion (CAM) boot

Explanation

Nondisplaced or incomplete navicular stress fractures should initially be treated with strict non-weight-bearing cast immobilization for 6 to 8 weeks. The central third is a vascular watershed area, making it highly susceptible to nonunion if weight-bearing is allowed too early.

Question 8086

Topic: 2. Trauma

A 30-year-old man sustains a displaced talar neck fracture with subluxation of the subtalar joint but an intact ankle joint (Hawkins Type II) after a motor vehicle collision. What is the approximate risk of developing avascular necrosis (AVN) of the talar body?

. 0-10%
. 20-50%
. 70-90%
. 100%
. AVN does not occur in Hawkins Type II fractures

Correct Answer & Explanation

. 0-10%

Explanation

Hawkins Type II talar neck fractures (involving subtalar subluxation or dislocation) carry a 20% to 50% risk of avascular necrosis. The presence of a Hawkins sign (subchondral radiolucency) at 6-8 weeks indicates intact vascularity.

Question 8087

Topic: 2. Trauma

A 40-year-old man sustains a high-energy distal tibia pilon fracture. Clinical examination reveals massive soft tissue swelling and multiple fracture blisters over the anterior ankle. What is the safest and most appropriate initial management?

. Immediate open reduction and internal fixation with dual plating
. Immediate intramedullary nailing of the tibia
. Spanning external fixation and delayed definitive fixation
. Primary ankle arthrodesis
. Closed reduction and short leg cast

Correct Answer & Explanation

. Immediate open reduction and internal fixation with dual plating

Explanation

High-energy pilon fractures with severe soft tissue compromise are best treated with a staged approach. Early spanning external fixation allows the soft tissues to heal before definitive ORIF is performed, significantly reducing infection rates.

Question 8088

Topic: 2. Trauma

A 26-year-old man undergoes evaluation for a pronation-external rotation ankle sprain. Radiographs are negative for fractures. Intraoperatively, the "Cotton test" is strongly positive. Which of the following ligaments is definitively disrupted in this scenario?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Anterior inferior tibiofibular ligament
. Deltoid ligament
. Spring ligament

Correct Answer & Explanation

. Anterior talofibular ligament

Explanation

A positive Cotton test (lateral translation of the fibula using a bone hook) indicates syndesmotic instability. The anterior inferior tibiofibular ligament (AITFL) is the primary constraint and the first syndesmotic ligament to rupture in this injury pattern.

Question 8089

Topic: 2. Trauma

A 22-year-old elite collegiate football player sustains a proximal fifth metatarsal fracture at the metaphyseal-diaphyseal junction (Zone 2) during practice. To optimize his chance of union and early return to play, what is the recommended treatment?

. Weight-bearing as tolerated in a stiff-soled shoe
. Non-weight-bearing short leg cast for 6 to 8 weeks
. Intramedullary screw fixation
. Tension band wiring
. Excision of the proximal fragment with peroneus brevis advancement

Correct Answer & Explanation

. Weight-bearing as tolerated in a stiff-soled shoe

Explanation

Zone 2 proximal fifth metatarsal fractures (Jones fractures) occur in a vascular watershed area and have a high rate of nonunion. In elite athletes, early intramedullary screw fixation is recommended to reduce nonunion risk and significantly accelerate return to play.

Question 8090

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains an acute transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. What is the most appropriate management to minimize nonunion risk and expedite return to play?

. Short leg cast non-weight-bearing for 6 weeks
. Intramedullary screw fixation
. Open reduction and plate fixation
. Hard-soled shoe with immediate weight-bearing

Correct Answer & Explanation

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

Explanation

Acute metaphyseal-diaphyseal junction (Jones) fractures in elite athletes are best treated with early intramedullary screw fixation. This approach significantly reduces the risk of nonunion and shortens return-to-play time.

Question 8091

Topic: 2. Trauma

A 21-year-old Division I basketball player sustains an acute fifth metatarsal base fracture located at the metaphyseal-diaphyseal junction without comminution. To minimize the risk of nonunion and allow the fastest return to play, what is the treatment of choice?

. Non-weight-bearing short leg cast for 6 weeks
. Weight-bearing in a hard-soled shoe
. Open reduction and internal fixation with a tension band construct
. Percutaneous intramedullary screw fixation
. Primary partial metatarsectomy

Correct Answer & Explanation

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

Explanation

An acute Zone 2 fracture of the fifth metatarsal base (Jones fracture) in a high-level athlete is best treated with early percutaneous intramedullary screw fixation. This method significantly lowers the nonunion rate associated with the tenuous vascular watershed zone and accelerates return to athletic activity.

Question 8092

Topic: 2. Trauma

A 28-year-old man sustains a Hawkins Type II talar neck fracture and undergoes urgent open reduction and internal fixation. At his 8-week follow-up, an anteroposterior radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

. Impending avascular necrosis requiring bone grafting
. Intact vascularity and bone resorption
. Immediate need for subtalar arthrodesis
. Septic arthritis of the tibiotalar joint
. Nonunion of the talar neck

Correct Answer & Explanation

. Impending avascular necrosis requiring bone grafting

Explanation

A subchondral radiolucency in the talar dome 6 to 8 weeks post-injury is known as the Hawkins sign. It indicates intact vascularity and active bone resorption, meaning avascular necrosis is highly unlikely.

Question 8093

Topic: 2. Trauma

A 22-year-old elite collegiate football player sustains a fracture of the base of the fifth metatarsal at the metaphyseal-diaphyseal junction (Zone 2). To minimize the risk of nonunion and expedite his return to play, what is the most appropriate management?

. Stiff-soled shoe with weight-bearing as tolerated
. Short leg cast, non-weight-bearing for 6 weeks
. Intramedullary screw fixation
. Excision of the proximal fragment with peroneus brevis advancement
. Tension band wiring

Correct Answer & Explanation

. Stiff-soled shoe with weight-bearing as tolerated

Explanation

Zone 2 fractures (Jones fractures) have high rates of delayed union or nonunion due to a watershed blood supply. Elite athletes benefit from early intramedullary screw fixation to expedite return to play and minimize nonunion risk.

Question 8094

Topic: 2. Trauma

A 40-year-old man sustains a high-energy pilon fracture with severe soft tissue swelling and multiple fracture blisters over the medial and lateral ankle. What is the standard staged surgical protocol for this injury?

. Immediate open reduction and internal fixation (ORIF) with dual plating
. Immediate spanning external fixation (with or without fibular ORIF), followed by delayed tibial ORIF
. Immediate intramedullary nailing of the tibia
. Primary tibiotalar arthrodesis
. External fixation only until complete bony union

Correct Answer & Explanation

. Immediate open reduction and internal fixation (ORIF) with dual plating

Explanation

High-energy pilon fractures with severe soft tissue compromise are best managed with a staged approach. Immediate spanning external fixation allows the soft tissues to recover, reducing complication rates before delayed definitive tibial ORIF.

Question 8095

Topic: 2. Trauma
A 30-year-old man sustains a Hawkins type III talar neck fracture in a motor vehicle collision. He undergoes open reduction and internal fixation 24 hours after the injury. At his 8-week postoperative visit, a subchondral radiolucent band is observed in the talar dome on the anteroposterior radiograph of the ankle. What is the clinical significance of this radiographic finding?
. It indicates complete avascular necrosis of the talar body.
. It is a sign of impending nonunion.
. It indicates the presence of an occult osteochondral lesion.
. It represents subchondral atrophy and confirms that the talar body is revascularizing.
. It suggests deep postoperative infection.

Correct Answer & Explanation

. It represents subchondral atrophy and confirms that the talar body is revascularizing.

Explanation

The radiographic finding described is Hawkins' sign, which is a subchondral radiolucent band seen in the talar dome, typically visible on the mortise or AP ankle view at 6 to 8 weeks post-injury. It represents subchondral osteopenia secondary to disuse and active hyperemia. The presence of Hawkins' sign is a reliable indicator that the talar body has sufficient blood supply and is not undergoing avascular necrosis.

Question 8096

Topic: 2. Trauma

A 22-year-old collegiate soccer player sustains an acute fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2) during a match. He desires to return to competitive play as quickly and safely as possible. What is the most recommended treatment for this athlete, and what is the primary reason this specific anatomical region is prone to nonunion?

. Conservative management in a hard-soled shoe; due to an excessively rich but disorganized periosteal blood supply
. Non-weight-bearing cast for 8 weeks; to protect the adjacent intra-articular surface of the cuboid
. Intramedullary screw fixation; it is a vascular watershed zone with high risk of delayed union or nonunion
. Tension band wiring; to counteract the continuous deforming force of the peroneus brevis tendon
. Excision of the proximal fragment; to prevent avascular necrosis of the tuberosity

Correct Answer & Explanation

. Conservative management in a hard-soled shoe; due to an excessively rich but disorganized periosteal blood supply

Explanation

A fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal is an acute Jones fracture (Zone 2). This area is a vascular watershed zone between the metaphyseal arteries (which supply the tuberosity) and the intramedullary nutrient artery (which supplies the diaphysis). Because of this tenuous blood supply, these fractures have a high rate of delayed union and nonunion. In elite or competitive athletes, early intramedullary screw fixation is highly recommended as it significantly decreases the time to union and allows for a faster, safer return to play compared to non-operative management.

Question 8097

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains an acute foot injury. Radiographs show a transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2) without displacement. He is eager to return to play as quickly and safely as possible. What is the recommended treatment to minimize the risk of nonunion and expedite his return to sports?

. Non-weight bearing short leg cast for 6-8 weeks
. Intramedullary screw fixation
. Tension band wiring of the proximal fifth metatarsal
. Excision of the proximal bone fragment
. Use of a carbon fiber orthosis with immediate full weight-bearing

Correct Answer & Explanation

. Non-weight bearing short leg cast for 6-8 weeks

Explanation

A fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal is a true Jones fracture (Zone 2). Because this area is a vascular watershed zone, it has a high rate of delayed union or nonunion with conservative management. In high-level or elite athletes desiring an expedited return to play, intramedullary screw fixation is the gold standard. It significantly decreases the time to union and return to sports compared to non-operative treatment.

Question 8098

Topic: 2. Trauma

A 24-year-old competitive runner presents with severe, bilateral anterolateral leg pain that begins 15 minutes into her runs. The pain is accompanied by numbness in the first dorsal web space of both feet and a transient inability to actively dorsiflex her ankles. Symptoms completely resolve after 30 minutes of rest. Intracompartmental pressure testing reveals an elevated anterior compartment pressure of 45 mmHg immediately post-exercise. Compression of which nerve is directly responsible for her sensory and motor symptoms?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The patient's presentation is classic for chronic exertional compartment syndrome (CECS) of the anterior compartment. The anterior compartment contains the deep peroneal nerve, which provides motor innervation to the ankle dorsiflexors (tibialis anterior, EHL, EDL) and sensory innervation to the first dorsal web space. Increased pressure in the anterior compartment compresses the deep peroneal nerve, leading to transient foot drop and first web space numbness. The superficial peroneal nerve courses through the lateral compartment.

Question 8099

Topic: 2. Trauma

A 32-year-old man undergoes open reduction and internal fixation for a Hawkins type III talar neck fracture following a high-energy motor vehicle collision. At his 8-week postoperative visit, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the dome of the talus. What does this radiographic finding indicate?

. Advanced avascular necrosis of the talar body
. Impending talar dome collapse requiring weight-bearing restriction
. Nonunion of the talar neck fracture
. Post-traumatic osteomyelitis of the talar dome
. Intact vascularity to the talar body

Correct Answer & Explanation

. Advanced avascular necrosis of the talar body

Explanation

The subchondral radiolucent band described is known as Hawkins sign. It represents subchondral osteopenia secondary to disuse and hyperemia. The presence of this sign indicates that there is intact vascularity to the talar body, effectively ruling out avascular necrosis (AVN). Its absence, however, does not definitively confirm AVN, though it raises the clinical suspicion.

Question 8100

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2) during a game. Radiographs show a non-displaced fracture without evidence of intramedullary sclerosis. He wishes to return to athletic competition as soon as safely possible. What is the most appropriate management?

. Non-weight-bearing cast immobilization for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Crossed K-wire fixation
. Extracorporeal shockwave therapy

Correct Answer & Explanation

. Non-weight-bearing cast immobilization for 6 weeks

Explanation

Zone 2 fractures of the fifth metatarsal (Jones fractures) involve a vascular watershed area and have a high rate of delayed union or nonunion. In elite or high-level athletes who desire an expedited return to play, intramedullary screw fixation is the standard of care. It has been shown to significantly reduce the time to union and return to sports compared to conservative management.

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