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2. Trauma MCQs

Practice Set 41 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 801

Topic: 2. Trauma

A 22-year-old female sustains a severe crush injury to her forearm. Within hours, she develops acute volar compartment syndrome. Due to their deep, central anatomical location, which two muscles are typically the earliest and most severely affected by ischemia in this scenario?

. Flexor carpi radialis and pronator teres
. Flexor digitorum superficialis and flexor carpi ulnaris
. Flexor digitorum profundus and flexor pollicis longus
. Extensor digitorum communis and extensor pollicis longus
. Brachioradialis and supinator

Correct Answer & Explanation

. Flexor digitorum profundus and flexor pollicis longus

Explanation

The flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) are located in the deep volar compartment of the forearm. They rest directly against the interosseous membrane, making them the most vulnerable to early ischemic necrosis in forearm compartment syndrome.

Question 802

Topic: 2. Trauma

A 28-year-old male sustains a low-velocity civilian gunshot wound to the mid-thigh, resulting in a comminuted diaphyseal femur fracture. The patient is hemodynamically stable, has palpable distal pulses, and normal neurologic function. Which of the following is the most appropriate initial management?

. Emergent open debridement of the bullet track and external fixation
. Local wound care, tetanus prophylaxis, and locked intramedullary nailing
. Extensive wound debridement, bullet retrieval, and open reduction internal fixation with plating
. Routine formal angiography prior to any surgical intervention
. Application of a skeletal traction pin and delayed spica cast application

Correct Answer & Explanation

. Local wound care, tetanus prophylaxis, and locked intramedullary nailing

Explanation

Low-velocity gunshot wounds resulting in femur fractures without vascular injury do not typically require formal surgical debridement of the bullet tract or bullet removal. Standard treatment involves superficial wound care, tetanus/antibiotics, and standard intramedullary nailing.

Question 803

Topic: 2. Trauma

Which of the following clinical scenarios serves as the most widely accepted absolute indication for Damage Control Orthopaedics (DCO) using temporary external fixation rather than Early Total Care (ETC) for a closed bilateral femoral shaft fracture?

. Isolated closed head injury with a Glasgow Coma Scale of 14
. Base deficit of -2 mmol/L and normal serum lactate levels
. Initial body temperature of 36.5°C and pH of 7.35
. Sustained intracranial pressure greater than 25 mmHg despite medical management
. Concurrent ipsilateral displaced intra-articular distal radius fracture

Correct Answer & Explanation

. Sustained intracranial pressure greater than 25 mmHg despite medical management

Explanation

Damage Control Orthopaedics (DCO) is indicated in hemodynamically unstable "in extremis" patients or those with severe closed head injuries and unyielding elevated intracranial pressure (>20-25 mmHg). Early Total Care with IM nailing in these patients risks catastrophic secondary brain injury.

Question 804

Topic: Pelvic & Acetabular Trauma

A 42-year-old female is brought in by EMS after being struck by a motor vehicle. Her blood pressure is 80/40 mmHg, and examination reveals a mechanically unstable "open book" pelvic ring injury. To achieve the most effective reduction of pelvic volume and assist in hemorrhage control, a commercial pelvic binder should be centered directly over which anatomic landmark?

. Anterior superior iliac spines
. Iliac crests
. Greater trochanters
. Pubic symphysis
. Ischial tuberosities

Correct Answer & Explanation

. Greater trochanters

Explanation

To optimally compress the pelvic ring and reduce pelvic volume, a pelvic binder or sheet must be centered directly over the greater trochanters. Placing it higher over the iliac crests is less effective and can paradoxically open the pelvis further in certain fracture patterns.

Question 805

Topic: 2. Trauma

A 22-year-old polytrauma patient develops acute hypoxia, confusion, and a petechial rash on his axillae 48 hours after sustaining bilateral femur fractures. Which of the following interventions has been proven to most effectively reduce the incidence of this specific syndrome?

. Prophylactic administration of systemic high-dose corticosteroids
. Early operative stabilization of the long bone fractures within 24 hours
. Placement of a prophylactic inferior vena cava (IVC) filter
. Aggressive diuresis and strict intravenous fluid restriction
. Prophylactic administration of unfractionated heparin

Correct Answer & Explanation

. Early operative stabilization of the long bone fractures within 24 hours

Explanation

The patient is exhibiting the classic triad of Fat Embolism Syndrome (hypoxemia, neurologic compromise, petechial rash). Early operative stabilization of long bone fractures (within 24 hours) is the most effective proven method to decrease the incidence of FES.

Question 806

Topic: 2. Trauma
A 35-year-old male sustains a Gustilo-Anderson Type IIIA open tibia fracture following an industrial accident. According to current evidence-based orthopaedic trauma guidelines, which of the following factors has the greatest impact on decreasing the patient's risk of subsequent deep infection?
. Time from injury to the administration of systemic antibiotics
. Time from injury to the initial surgical debridement
. Choice of internal intramedullary fixation versus external fixation
. Use of high-pressure pulsatile lavage during irrigation
. Addition of local antibiotic-impregnated PMMA beads

Correct Answer & Explanation

. Time from injury to the administration of systemic antibiotics

Explanation

The early administration of systemic antibiotics (ideally within 1 hour of injury) is the single most important factor in reducing infection rates in open fractures. Delaying antibiotics significantly increases the risk of osteomyelitis.

Question 807

Topic: 2. Trauma

Acute compartment syndrome of the foot is a severe limb-threatening complication often associated with high-energy midfoot crush injuries. When planning a surgical release, the surgeon must be aware of the anatomy. How many distinct fascial compartments are anatomically recognized in the foot?

. 3
. 4
. 5
. 7
. 9

Correct Answer & Explanation

. 9

Explanation

There are 9 recognized fascial compartments in the foot: 4 interosseous, 3 central (superficial, deep, and calcaneal), 1 medial, and 1 lateral. Complete release requires multiple incisions, most commonly via a dual dorsal approach.

Question 808

Topic: 2. Trauma

A 24-year-old male sustains a closed tibial shaft fracture. Which of the following best describes the pathophysiological cascade leading to acute compartment syndrome in this patient?

. Arterial spasm leading to decreased capillary hydrostatic pressure
. Local tissue pressure exceeding venous capillary pressure, causing venous outflow obstruction and capillary collapse
. Primary lymphatic obstruction leading to interstitial edema and secondary arterial occlusion
. Direct mechanical compression of the major axial arteries within the fascial envelope
. Systemic hypotension causing decreased arteriovenous pressure gradient across the capillary bed

Correct Answer & Explanation

. Local tissue pressure exceeding venous capillary pressure, causing venous outflow obstruction and capillary collapse

Explanation

Acute compartment syndrome begins when local tissue pressure exceeds venous capillary pressure, obstructing venous outflow. This leads to capillary collapse, progressive local ischemia, and further edema in a self-perpetuating cycle.

Question 809

Topic: 2. Trauma

You are evaluating a 28-year-old male with a diaphyseal tibia fracture for suspected compartment syndrome. His blood pressure is 115/65 mmHg. Utilizing the Delta P concept, at what absolute intracompartmental pressure would emergent fasciotomies be definitively indicated?

. 20 mmHg
. 25 mmHg
. 30 mmHg
. 40 mmHg
. 65 mmHg

Correct Answer & Explanation

. 25 mmHg

Explanation

The Delta P is calculated as the diastolic blood pressure minus the intracompartmental pressure. A Delta P of less than 30 mmHg (in this case, 65 - 40 = 25 mmHg) is an absolute indication for emergent fasciotomy.

Question 810

Topic: 2. Trauma

During a two-incision, four-compartment fasciotomy of the lower leg, the lateral incision is made over the intermuscular septum between the anterior and lateral compartments. Which of the following structures is most at risk of iatrogenic injury during the superficial dissection of this approach?

. Deep peroneal nerve
. Sural nerve
. Superficial peroneal nerve
. Saphenous nerve
. Anterior tibial artery

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve exits the deep fascia in the distal third of the leg, near the intermuscular septum between the anterior and lateral compartments. It is highly susceptible to iatrogenic injury during the lateral fasciotomy incision.

Question 811

Topic: 2. Trauma

A 35-year-old male undergoes a single-incision perifibular fasciotomy for a tibial plateau fracture associated with compartment syndrome. Postoperatively, he has an isolated inability to flex his great toe. Which compartment was most likely inadequately decompressed?

. Anterior compartment
. Lateral compartment
. Superficial posterior compartment
. Deep posterior compartment
. Peroneal compartment

Correct Answer & Explanation

. Deep posterior compartment

Explanation

The deep posterior compartment contains the flexor hallucis longus, flexor digitorum longus, and tibialis posterior. It is the most commonly missed compartment during lower extremity fasciotomies, leading to fixed flexor contractures if left untreated.

Question 812

Topic: 2. Trauma

A 40-year-old patient presents to the emergency department 72 hours after being found down following a drug overdose. The right lower extremity is swollen, woody, and entirely pulseless with fixed mottling and no motor or sensory function. Which of the following is the most appropriate management?

. Emergent four-compartment fasciotomy
. Thrombolytic therapy followed by fasciotomy
. Observation, splinting, and supportive care for rhabdomyolysis
. Hyperbaric oxygen therapy
. Immediate above-knee amputation

Correct Answer & Explanation

. Observation, splinting, and supportive care for rhabdomyolysis

Explanation

Fasciotomy in the setting of established, late compartment syndrome (>48 hours) with dead muscle is generally contraindicated due to a high risk of lethal sepsis. Observation and supportive care for rhabdomyolysis, or definitive amputation if systemic toxicity occurs, is the recommended course.

Question 813

Topic: 2. Trauma

A 6-year-old boy presents with a displaced supracondylar humerus fracture. After closed reduction and percutaneous pinning, the child remains restless, requires escalating doses of opioids, and becomes agitated. What is the most reliable early clinical indicator of acute compartment syndrome in this pediatric patient?

. Loss of the radial pulse
. Increasing anxiety and agitation out of proportion to the injury
. Capillary refill time greater than 3 seconds
. Pallor of the distal digits
. Decreased oxygen saturation on pulse oximetry

Correct Answer & Explanation

. Increasing anxiety and agitation out of proportion to the injury

Explanation

In young children, classic signs of compartment syndrome such as paresthesias or pain with passive stretch are notoriously difficult to assess. Increasing anxiety, agitation, and escalating analgesic requirements (the '3 As') are the most sensitive early clinical indicators.

Question 814

Topic: 2. Trauma

A patient presents with acute compartment syndrome of the hand following a severe crush injury. To adequately decompress all compartments of the hand, how many distinct fascial compartments must be released?

. 4
. 7
. 10
. 12
. 14

Correct Answer & Explanation

. 10

Explanation

The human hand contains 10 fascial compartments: 4 dorsal interosseous, 3 volar interosseous, the thenar, the hypothenar, and the adductor pollicis. All 10 must be evaluated and released during a hand fasciotomy.

Question 815

Topic: 2. Trauma
A 22-year-old male sustains a highly comminuted Gustilo IIIB open tibial shaft fracture. Despite the large open soft tissue wound, he develops tense, swollen compartments. Which of the following best explains why acute compartment syndrome can still occur in the presence of an open fracture?
. The traumatic fascial tear is often localized and insufficient to fully decompress the entire length of the compartment
. Open fractures selectively spare the deep posterior compartment, concentrating the pressure
. Hemorrhage from the open wound causes a paradoxical increase in venous return
. Open fractures stimulate massive systemic hypercoagulability, leading to microvascular thrombosis
. The exposed periosteum aggressively produces a highly viscous inflammatory exudate

Correct Answer & Explanation

. The traumatic fascial tear is often localized and insufficient to fully decompress the entire length of the compartment

Explanation

Acute compartment syndrome can occur in up to 9% of open tibial fractures. The fascial laceration created by the initial trauma is usually localized and completely insufficient to adequately decompress the entire rigid fascial envelope.

Question 816

Topic: 2. Trauma

Epidemiological studies indicate that acute compartment syndrome is most frequently associated with which of the following specific demographic and fracture profiles?

. Elderly females with distal radius fractures
. Middle-aged males with calcaneus fractures
. Young males with diaphyseal tibial fractures
. Young females with supracondylar humerus fractures
. Elderly males with intertrochanteric femur fractures

Correct Answer & Explanation

. Young males with diaphyseal tibial fractures

Explanation

The highest overall incidence of acute compartment syndrome occurs in young males (average age 30) sustaining fractures of the tibial diaphysis. This is largely due to higher energy mechanisms and a larger mass of muscle contained within unyielding fascial compartments.

Question 817

Topic: 2. Trauma

You are performing a prophylactic fasciotomy of the thigh following a massive crush injury. Prior to sedation, the patient exhibited extreme pain with passive knee flexion. Which compartment of the thigh is most frequently affected in this scenario?

. Medial compartment
. Lateral compartment
. Anterior compartment
. Posterior compartment
. Adductor compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

Thigh compartment syndrome is a rare but highly morbid condition that most commonly affects the anterior compartment. It classically presents with tense swelling and severe pain upon passive flexion of the knee, which stretches the ischemic quadriceps musculature.

Question 818

Topic: 2. Trauma
A 45-year-old male presents to the emergency department after a high-energy fall onto an outstretched hand (FOOSH). Radiographs reveal a fracture of the ulnar diaphysis with anterior angulation and an associated anterior dislocation of the radial head. A thorough neurovascular exam is unremarkable. Based on the provided case information, what is the most likely Bado classification for this injury?
. Type II
. Type III
. Type I
. Type IV
. Monteggia-equivalent

Correct Answer & Explanation

. Type I

Explanation

The patient's presentation of an anterior dislocation of the radial head with an associated fracture of the ulnar diaphysis, typically angulated anteriorly, matches the description of a Bado Type I Monteggia fracture-dislocation. Type I is the most common, accounting for approximately 60% of adult cases, and typically results from a FOOSH with hyperpronation, leading to anterior radial head dislocation and anterior ulnar angulation.

Question 819

Topic: 2. Trauma

A 62-year-old male presents with a complex Monteggia fracture-dislocation involving significant comminution of the ulnar shaft and suspected involvement of the radial head articular surface. The initial plain radiographs are difficult to interpret fully due to the comminution. Which advanced imaging modality is most highly recommended in this scenario to provide detailed information for surgical planning?

. Magnetic Resonance Imaging (MRI)
. Ultrasound
. Computed Tomography (CT) scan with 3D reconstructions
. Bone scintigraphy
. Repeat plain radiographs with different views

Correct Answer & Explanation

. Computed Tomography (CT) scan with 3D reconstructions

Explanation

Correct Answer: CThe case states, 'Computed Tomography (CT) Scan: Highly recommended for complex Monteggia injuries. It provides invaluable detailed information on: Fracture morphology of the ulna (comminution, bone loss). Presence and extent of radial head or neck fractures (often occult on plain films). Coronoid process fractures (critical for elbow stability). Articular impaction or osteochondral lesions. Identifying intra-articular loose bodies or incarcerated soft tissues preventing reduction. 3D Reconstructions: Aid in surgical planning, especially for complex articular involvement.'Option A (Magnetic Resonance Imaging - MRI):MRI is rarely indicated in acute settings unless suspicion for significant ligamentous injury (e.g., severe MCL/LCL tears) persists despite stable fixation of the ulna and radial head, or to evaluate annular ligament integrity more directly. It is not the primary modality for detailed bony fracture morphology.Option B (Ultrasound):Ultrasound has limited utility in assessing complex bony fractures and articular surfaces in the acute setting of a Monteggia injury.Option D (Bone scintigraphy):Bone scintigraphy (bone scan) is used to assess metabolic activity in bone, typically for stress fractures, infections, or tumors, not for acute fracture morphology or surgical planning.Option E (Repeat plain radiographs with different views):While additional plain views can be helpful, they are often insufficient to fully delineate complex comminuted fractures or subtle articular involvement, which is precisely why CT is recommended.

Question 820

Topic: 2. Trauma

A 22-year-old male presents with a Bado Type IV Monteggia fracture-dislocation after a high-energy trauma. During the initial assessment, he is found to have a complete wrist drop and inability to extend his fingers at the MCP joints, with no sensory deficits. The surgical team plans for emergent ORIF. Based on the case, what is the most appropriate initial management strategy for this pre-existing neurological deficit?

. Immediate surgical exploration and neurolysis of the affected nerve prior to fracture fixation.
. Observation, splinting, and electrophysiological studies, as most pre-operative palsies are neurapraxic and resolve spontaneously.
. Administer high-dose corticosteroids to reduce nerve swelling and improve function.
. Delay surgical fixation of the fractures until nerve function shows signs of recovery.
. Perform a tendon transfer immediately to restore wrist and finger extension.

Correct Answer & Explanation

. Observation, splinting, and electrophysiological studies, as most pre-operative palsies are neurapraxic and resolve spontaneously.

Explanation

Correct Answer: BThe case states under 'Complications and Management' regarding nerve injury: 'Pre-operative PIN palsy is typically observed as most are neurapraxic and resolve spontaneously over weeks to months. Post-operative PIN palsy requires immediate evaluation. If a complete palsy exists and there is suspicion of direct transection or impingement (e.g., by hardware), surgical exploration is warranted. Otherwise, observation, splinting, and electrophysiological studies guide management.'Option A (Immediate surgical exploration and neurolysis):This is generally not the initial approach for a pre-operative PIN palsy unless there is strong evidence of direct transection or entrapment by a bone fragment that cannot be resolved by fracture reduction. Most pre-operative palsies are traction-related neurapraxias.Option C (Administer high-dose corticosteroids):There is no evidence to support the use of corticosteroids for traumatic nerve palsies in this context.Option D (Delay surgical fixation):Delaying definitive fixation of a Monteggia fracture-dislocation is associated with poorer outcomes and increased difficulty of reduction. The fracture should be fixed promptly, and the nerve managed concurrently.Option E (Perform a tendon transfer immediately):Tendon transfers are reconstructive procedures forpermanentnerve deficits and are performed much later, typically after 6-12 months of observation if no recovery occurs.

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