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2. Trauma MCQs

Practice Set 432 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 8621

Topic: 2. Trauma

A 4-year-old otherwise healthy boy sustains an isolated midshaft transverse femur fracture after a fall from a trampoline. He weighs 16 kg (35 lbs). Shortening is measured at 1.5 cm on initial radiographs. What is the most appropriate definitive management for this patient?

. Pavlik harness application
. Early immediate hip spica casting
. Flexible intramedullary nailing
. Rigid trochanteric entry intramedullary nailing
. Open reduction and internal fixation with a compression plate

Correct Answer & Explanation

. Early immediate hip spica casting

Explanation

For children aged 6 months to 5 years with isolated diaphyseal femur fractures and less than 2 cm of shortening, early immediate hip spica casting is the gold standard of treatment. Flexible intramedullary nails are typically indicated for children aged 5 to 11 years or those weighing over 20 kg. Rigid IM nailing is contraindicated in this age group due to the risk of trochanteric arrest or avascular necrosis. Pavlik harnesses are reserved for infants <6 months old.

Question 8622

Topic: 2. Trauma

An 8-year-old boy weighing 30 kg sustains a midshaft, transverse femur fracture. He is treated with titanium elastic nails (TENs). To optimize biomechanical stability, how should the diameter of the nails be selected?

. Each nail should be 20% of the narrowest diaphyseal medullary canal diameter.
. Each nail should be 40% of the narrowest diaphyseal medullary canal diameter.
. Each nail should be 60% of the narrowest diaphyseal medullary canal diameter.
. A single nail filling 80% of the canal should be used.
. Nail diameter is based solely on patient age rather than canal size.

Correct Answer & Explanation

. Each nail should be 40% of the narrowest diaphyseal medullary canal diameter.

Explanation

For maximum stability using titanium elastic nails in pediatric femur fractures, two nails of identical diameter should be used. Each nail should represent approximately 40% (totaling 80%) of the narrowest diameter of the medullary canal.

Question 8623

Topic: 2. Trauma

A 6-year-old boy weighing 22 kg sustains an isolated, closed, length-stable midshaft femur fracture after falling off a trampoline. What is the most appropriate definitive treatment?

. Hip spica casting
. Flexible intramedullary nailing
. Rigid reamed locked intramedullary nailing
. External fixation
. Open reduction and internal fixation with a compression plate

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

Flexible intramedullary nailing is the standard of care for length-stable midshaft femur fractures in children aged 5-11 years weighing less than 50 kg (100 lbs). Spica casting is typically reserved for children under 5 years of age.

Question 8624

Topic: 2. Trauma
A 14-year-old male presents after feeling a 'pop' in his anterior knee while jumping. Radiographs show a displaced Ogden type III tibial tubercle avulsion fracture. Which of the following complications requires the most vigilant monitoring in the acute postoperative period following internal fixation?
. Recurrent anterior knee instability
. Compartment syndrome
. Genu recurvatum
. Patella baja
. Deep vein thrombosis

Correct Answer & Explanation

. Compartment syndrome

Explanation

Tibial tubercle avulsion fractures are highly associated with anterior compartment syndrome due to disruption of the anterior tibial recurrent artery. Vigilant postoperative monitoring is essential.

Question 8625

Topic: 2. Trauma

A 3-year-old boy weighing 15 kg (33 lbs) sustains an isolated, closed, midshaft femur fracture after a fall from a playground structure. What is the treatment of choice?

. Flexible intramedullary nailing
. Rigid locked intramedullary nailing
. Early Spica casting
. Open reduction and plate fixation
. External fixation

Correct Answer & Explanation

. Early Spica casting

Explanation

Early Spica casting is the standard of care for isolated, closed femur fractures in children aged 6 months to 5 years. Flexible nailing is generally reserved for children >5 years old or those weighing >20 kg.

Question 8626

Topic: 2. Trauma

An 11-year-old boy weighing 55 kg (121 lbs) sustains a midshaft transverse femur fracture. Which of the following stabilization methods is most appropriate and carries the lowest risk of complications for this specific patient?

. Spica casting
. Flexible intramedullary nailing
. Rigid trochanteric-entry intramedullary nailing
. Rigid lateral entry intramedullary nailing
. External fixation

Correct Answer & Explanation

. Rigid lateral entry intramedullary nailing

Explanation

In children older than 11 or weighing more than 49 kg (100 lbs), flexible nails have an unacceptably high failure rate. Rigid locked nailing using a lateral entry (to avoid the piriformis fossa and risk of AVN) is the preferred treatment.

Question 8627

Topic: 2. Trauma

A 4-year-old boy sustains a completely displaced, midshaft spiral fracture of the right femur from a fall off a slide. He weighs 16 kg. What is the most appropriate definitive management?

. Titanium elastic nailing
. Submuscular bridge plating
. Trochanteric entry rigid intramedullary nail
. Early spica casting
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 6 months to 5 years with a femur fracture and appropriate weight (usually < 20 kg), early spica casting is the standard of care with excellent outcomes. Flexible nailing is typically reserved for older children aged 5 to 11 years.

Question 8628

Topic: Lower Extremity Trauma

A 9-year-old girl presents with a painful, loud "clunk" in her left knee during extension. MRI demonstrates a thickened lateral meniscus covering the entire tibial plateau without tears, but lacking posterior meniscotibial attachments. What is the diagnosis and best treatment?

. Incomplete discoid meniscus; partial meniscectomy
. Complete discoid meniscus; observation
. Wrisberg variant discoid meniscus; partial meniscectomy and peripheral stabilization
. Torn discoid meniscus; total meniscectomy
. Normal variant; reassurance

Correct Answer & Explanation

. Wrisberg variant discoid meniscus; partial meniscectomy and peripheral stabilization

Explanation

The Wrisberg variant of a discoid meniscus lacks normal posterior meniscotibial attachments (coronary ligaments), leading to hypermobility and the classic snapping knee syndrome. Treatment requires saucerization (partial meniscectomy) along with surgical stabilization of the posterior horn to the capsule.

Question 8629

Topic: 2. Trauma

Which of the following fracture patterns in a 4-month-old infant is most highly specific for non-accidental trauma?

. Linear skull fracture
. Clavicle fracture
. Posterior rib fracture
. Distal radius buckle fracture
. Midshaft femur fracture

Correct Answer & Explanation

. Posterior rib fracture

Explanation

Posterior rib fractures, metaphyseal corner fractures, and scapular fractures are highly specific for child abuse (non-accidental trauma) in infants.

Question 8630

Topic: 2. Trauma

A 3-year-old child sustains an isolated closed spiral fracture of the femoral shaft after a fall. The child weighs 16 kg (35 lbs). What is the most appropriate definitive treatment?

. Pavlik harness
. Early spica casting
. Flexible intramedullary nailing
. Rigid locked intramedullary nailing
. Plate osteosynthesis

Correct Answer & Explanation

. Early spica casting

Explanation

For children between 6 months and 5 years of age weighing less than 20 kg (44 lbs), early spica casting is the treatment of choice for closed, isolated femoral shaft fractures.

Question 8631

Topic: 2. Trauma

A 3-year-old boy sustains an isolated, closed, spiral midshaft fracture of the right femur after a fall from a playground slide. He has no other injuries, and child abuse is not suspected. What is the most appropriate definitive management?

. Immediate application of a hip spica cast
. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. Open reduction and internal fixation with a compression plate
. External fixation

Correct Answer & Explanation

. Immediate application of a hip spica cast

Explanation

For isolated femoral shaft fractures in children aged 6 months to 5 years with less than 2 cm of shortening, immediate hip spica casting is the gold standard. Flexible nailing is generally reserved for children aged 5 to 11 years or those with severe shortening/polytrauma.

Question 8632

Topic: 2. Trauma

A 3-year-old boy sustains an isolated, closed, midshaft femur fracture with 2 cm of shortening. The child has no other injuries, and child abuse is not suspected. What is the gold standard of treatment for this patient?

. Early spica casting
. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. External fixation
. Open reduction and internal fixation with a plate

Correct Answer & Explanation

. Early spica casting

Explanation

For children between the ages of 6 months and 5 years with an isolated diaphyseal femur fracture and less than 2-3 cm of shortening, early spica casting is the gold standard treatment. Flexible nailing is typically reserved for children aged 5 to 11 years.

Question 8633

Topic: Lower Extremity Trauma

A 9-year-old boy weighing 38 kg sustains an isolated, closed midshaft femur fracture. What is the current gold standard treatment modality for this patient?

. Early spica casting
. Flexible intramedullary nailing
. Rigid reamed intramedullary nailing via the piriformis fossa
. Rigid reamed intramedullary nailing via the lateral trochanter
. Open reduction and plate osteosynthesis

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

Flexible intramedullary nailing is the treatment of choice for length-stable femoral shaft fractures in school-aged children (5-11 years) weighing less than 50 kg. Rigid nailing via the piriformis is contraindicated in this age group due to the risk of avascular necrosis of the femoral head.

Question 8634

Topic: 2. Trauma

A 12-year-old girl sustains a Salter-Harris type II fracture of the distal femur. She undergoes an anatomic closed reduction and percutaneous pinning. The parents are counseled regarding the prognosis. Which of the following complications is most notoriously common with this specific injury?

. Avascular necrosis of the femoral condyle
. Nonunion of the metaphyseal fragment
. Physeal growth arrest leading to limb length discrepancy
. Acute compartment syndrome of the thigh
. Massive heterotopic ossification

Correct Answer & Explanation

. Physeal growth arrest leading to limb length discrepancy

Explanation

Distal femur physeal fractures, regardless of displacement, have a very high rate of growth arrest (approaching 50%). This is due to the undulating, peg-and-groove anatomy of the distal femoral physis, which sustains severe crushing forces during injury.

Question 8635

Topic: 2. Trauma
A 10-year-old boy sustains a completely displaced (Meyers and McKeever Type III) tibial eminence fracture during a bicycle accident. Closed reduction is attempted but is unsuccessful. Which of the following structures is most commonly entrapped, preventing an anatomic closed reduction?
. Anterior horn of the medial meniscus
. Transverse intermeniscal ligament
. Posterior cruciate ligament
. Patellar tendon
. Medial collateral ligament

Correct Answer & Explanation

. Anterior horn of the medial meniscus

Explanation

The anterior horn of the medial meniscus is the structure most frequently entrapped beneath a displaced tibial eminence fracture. This interposition blocks reduction and is a primary indication for arthroscopic or open surgical intervention.

Question 8636

Topic: 2. Trauma

An 8-year-old boy who weighs 35 kg (77 lbs) sustains an isolated, closed, length-stable midshaft femur fracture. What is the most appropriate definitive treatment?

. Immediate hip spica cast
. Flexible intramedullary nailing
. Rigid antegrade trochanteric entry intramedullary nail
. External fixation
. Submuscular bridge plating

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

For a child aged 5 to 11 years weighing less than 50 kg (110 lbs) with a length-stable femur fracture, flexible intramedullary nailing is the gold standard treatment. It provides excellent outcomes with a rapid return to function and low risk of AVN.

Question 8637

Topic: 2. Trauma

A 3-year-old boy presents with a completely displaced, spiral fracture of the femoral shaft following a reported fall from a 2-foot bed. He has no other injuries, and his neurovascular status is intact. What is the most appropriate definitive management?

. Pavlik harness application
. Titanium elastic nailing
. Open reduction and dynamic compression plating
. External fixation
. Immediate hip spica casting

Correct Answer & Explanation

. Immediate hip spica casting

Explanation

For children aged 6 months to 5 years with an isolated diaphyseal femur fracture and <2 cm of shortening, immediate hip spica casting is the gold standard of treatment. However, the reported low-energy mechanism warrants a high index of suspicion for child abuse.

Question 8638

Topic: 2. Trauma

A 4-year-old girl sustains a lateral condyle fracture of the humerus. Radiographs show 3 mm of displacement. Which of the following complications is most likely if this fracture is treated non-operatively with a cast?

. Cubitus varus
. Nonunion and progressive cubitus valgus
. Ulnar nerve palsy immediately post-injury
. Brachial artery laceration
. Heterotopic ossification

Correct Answer & Explanation

. Nonunion and progressive cubitus valgus

Explanation

Lateral condyle fractures with >2 mm of displacement are prone to nonunion if treated non-operatively due to poor vascularity and the presence of synovial fluid bathing the fracture. This typically leads to progressive cubitus valgus and tardy ulnar nerve palsy.

Question 8639

Topic: 2. Trauma

A 3-year-old boy is brought to the emergency department after sustaining an isolated midshaft femur fracture from a low-energy fall. Examination reveals no other injuries. What is the gold standard treatment for this patient?

. Rigid intramedullary nailing
. Elastic stable intramedullary nailing (ESIN)
. Submuscular plating
. Early spica casting
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 6 months to 5 years with isolated femur fractures and less than 2 cm of shortening, early spica casting is the gold standard treatment. Flexible nailing is generally reserved for older children (aged 5 to 11 years).

Question 8640

Topic: 2. Trauma

A 4-year-old boy who weighs 18 kg (40 lbs) sustains an isolated, closed, length-stable midshaft femur fracture after falling from a playground slide. What is the most appropriate definitive treatment?

. Pavlik harness
. Early spica casting
. Flexible intramedullary nailing
. Rigid antegrade locked intramedullary nail
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 6 months to 5 years presenting with a length-stable femur fracture (<2 cm of shortening), early spica casting is the standard of care. Flexible intramedullary nails are generally reserved for older children (ages 5 to 11 years).

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