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2. Trauma MCQs

Practice Set 434 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 8661

Topic: 2. Trauma

A 78-year-old female falls and sustains a periprosthetic femur fracture around her cemented THA stem. Radiographs demonstrate a fracture around the tip of the stem, frank loosening of the femoral component, and severely deficient surrounding proximal bone stock. How is this classified under the Vancouver system?

. Type A
. Type B1
. Type B2
. Type B3
. Type C

Correct Answer & Explanation

. Type B3

Explanation

A Vancouver Type B3 fracture is characterized by a fracture around or just below the stem, a loose prosthesis, and inadequate bone stock. Treatment typically requires revision to a long-stem prosthesis with proximal femoral replacement or allograft.

Question 8662

Topic: Pelvic & Acetabular Trauma

A 28-year-old male athlete presents with anterior groin pain exacerbated by hip flexion and internal rotation. A lateral radiograph of the hip reveals an alpha angle of 75 degrees. Which of the following is the primary mechanism of cartilage injury in this condition?

. Pincer impingement causing global cartilage wear
. Shear stress at the chondrolabral junction
. Contrecoup lesion on the posterior acetabulum
. Labral hypertrophy leading to capsular laxity
. Dysplastic uncovering of the femoral head

Correct Answer & Explanation

. Shear stress at the chondrolabral junction

Explanation

Cam impingement, indicated by an alpha angle >50-55 degrees, involves a non-spherical femoral head compressing against the acetabulum. This creates shear stress that leads to delamination at the chondrolabral junction.

Question 8663

Topic: 2. Trauma
A 30-year-old man sustains a vertically oriented (Pauwels type III) displaced femoral neck fracture. He is planned for open reduction and internal fixation. Which construct provides the highest biomechanical stability for this specific fracture pattern?
. Three parallel cancellous screws
. Sliding hip screw with a derotation screw
. Two parallel cancellous screws
. Cephalomedullary nail
. Dynamic condylar screw

Correct Answer & Explanation

. Sliding hip screw with a derotation screw

Explanation

The sliding hip screw combined with a derotation screw provides superior biomechanical stability for vertical (Pauwels type III) femoral neck fractures. It resists the high shear forces better than parallel cancellous screws alone.

Question 8664

Topic: Pelvic & Acetabular Trauma

A 24-year-old woman presents with hip pain secondary to developmental dysplasia. Radiographs show a lateralized center of rotation, unroofed femoral head, and a sharply sloping sourcil. A periacetabular osteotomy (PAO) is planned. The cuts for a Ganz PAO involve which of the following pelvic bones?

. Ilium, ischium, and pubis
. Ilium and pubis only
. Ilium and ischium only
. Ischium and pubis only
. Ilium, ischium, pubis, and sacrum

Correct Answer & Explanation

. Ilium, ischium, and pubis

Explanation

The Ganz periacetabular osteotomy (PAO) involves cuts through the ilium, ischium, and pubis while preserving the posterior column. This allows for multiplanar correction while maintaining pelvic ring stability.

Question 8665

Topic: 2. Trauma

A 35-year-old man sustains an acetabular fracture in a motor vehicle collision. AP and Judet radiographs demonstrate disruption of both the iliopectineal and ilioischial lines, along with a prominent "spur sign" visible on the obturator oblique view. Based on the Letournel classification, what is the diagnosis?

. Transverse fracture
. T-type fracture
. Anterior column/posterior hemitransverse fracture
. Posterior column fracture
. Both-column fracture

Correct Answer & Explanation

. Both-column fracture

Explanation

The "spur sign" on an obturator oblique radiograph is pathognomonic for a both-column acetabular fracture. It represents the intact portion of the ilium that remains attached to the axial skeleton, displaced medial to the fractured articular columns.

Question 8666

Topic: Upper Extremity Trauma

A 28-year-old elite weightlifter complains of superior shoulder pain aggravated by dips and the bench press. Radiographs reveal widening of the acromioclavicular joint and subchondral cystic changes of the distal clavicle. If conservative management fails, what is the treatment of choice?

. Coracoacromial ligament release
. Arthroscopic distal clavicle excision
. Acromioclavicular joint reconstruction
. Proximal biceps tenodesis
. Subacromial decompression

Correct Answer & Explanation

. Arthroscopic distal clavicle excision

Explanation

Distal clavicle osteolysis commonly affects weightlifters. When nonoperative treatments fail, arthroscopic distal clavicle excision (Mumford procedure) provides excellent pain relief.

Question 8667

Topic: 2. Trauma

A 25-year-old cyclist falls onto his shoulder and sustains a midshaft clavicle fracture.

Which of the following is a widely accepted absolute indication for immediate open reduction and internal fixation?

. 1 cm of shortening
. 5 degrees of angulation
. Skin tenting with progressive ischemia
. Non-dominant arm involvement
. Associated nondisplaced rib fracture

Correct Answer & Explanation

. Skin tenting with progressive ischemia

Explanation

Absolute indications for ORIF of a clavicle fracture include open fractures, impending skin compromise (ischemia/tenting), and vascular injury. Shortening and angulation are relative indications.

Question 8668

Topic: 2. Trauma

Which of the following radiographic findings in a proximal humerus fracture is considered the strongest predictor of subsequent humeral head ischemia and avascular necrosis?

. Short metaphyseal head extension (calcar length) of less than 8 mm
. Disrupted lateral hinge
. Intact medial hinge
. Varus angulation greater than 20 degrees
. Fracture of the greater tuberosity with 1 cm of displacement

Correct Answer & Explanation

. Short metaphyseal head extension (calcar length) of less than 8 mm

Explanation

According to the Hertel criteria, a short metaphyseal head extension (<8 mm) and a disrupted medial hinge are highly predictive of ischemia, as they suggest disruption of the arcuate branch of the anterior humeral circumflex artery.

Question 8669

Topic: Upper Extremity Trauma

A 32-year-old bodybuilder feels a sudden, painful 'pop' in his anterior chest while performing a heavy bench press. Examination reveals an asymmetric anterior axillary fold and significant ecchymosis over the medial arm. Which of the following describes the most common anatomical site of this rupture?

. Intramuscular muscle belly of the pectoralis major
. Musculotendinous junction of the clavicular head
. Sternal head avulsion at the humeral insertion
. Clavicular head avulsion at the humeral insertion
. Origin of the sternal head at the sternum

Correct Answer & Explanation

. Sternal head avulsion at the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur as an avulsion of the sternocostal head from its insertion on the proximal humerus, typically occurring during eccentric loading such as the downward phase of a bench press.

Question 8670

Topic: Upper Extremity Trauma
A 35-year-old mountain biker falls directly onto the point of his shoulder. Radiographs show a 100% superior displacement of the clavicle relative to the acromion, with an increased coracoclavicular distance. What ligaments are ruptured?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Both acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament
. Sternoclavicular ligaments

Correct Answer & Explanation

. Both acromioclavicular and coracoclavicular ligaments

Explanation

A Type III acromioclavicular (AC) joint injury involves complete rupture of both the acromioclavicular and coracoclavicular (conoid and trapezoid) ligaments. This results in superior translation of the clavicle by 25% to 100%.

Question 8671

Topic: Upper Extremity Trauma

A 28-year-old professional rugby player sustains an acute type V acromioclavicular (AC) joint separation. He is scheduled for an anatomic coracoclavicular (CC) ligament reconstruction. To accurately recreate the native anatomy, the surgeon must place the grafts based on the anatomic insertions. Which of the following statements regarding the CC ligaments is true?

. The conoid is lateral and anterior to the trapezoid
. The conoid is medial and posterior to the trapezoid
. The trapezoid inserts on the medial base of the coracoid
. The conoid provides primary restraint to horizontal translation
. The trapezoid is the stronger of the two ligaments

Correct Answer & Explanation

. The conoid is medial and posterior to the trapezoid

Explanation

The conoid ligament is located medial and posterior to the trapezoid ligament and inserts on the conoid tubercle. The conoid is the primary restraint to superior translation, while the trapezoid primarily resists horizontal/axial compression.

Question 8672

Topic: 2. Trauma

A 45-year-old cyclist falls directly onto his right shoulder and sustains a midshaft clavicle fracture. Which of the following radiographic parameters is the strongest biomechanical and clinical indication for open reduction and internal fixation?

. Greater than 1 cm of displacement
. Greater than 2 cm of shortening
. Presence of a butterfly fragment
. Angulation of 15 degrees
. Associated undisplaced scapular body fracture

Correct Answer & Explanation

. Greater than 2 cm of shortening

Explanation

Shortening of greater than 2 cm in midshaft clavicle fractures is highly associated with symptomatic nonunion and persistent shoulder dysfunction, making it a strong indication for operative intervention.

Question 8673

Topic: Upper Extremity Trauma

Recent anatomic injection studies and quantitative MRI analyses have challenged traditional teaching regarding the vascular supply of the proximal humerus. According to current literature, which vessel provides the predominant blood supply to the articular segment of the humeral head?

. Ascending branch of the anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Thoracoacromial artery
. Suprascapular artery
. Subscapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent studies demonstrate that the posterior humeral circumflex artery provides the dominant blood supply to the humeral head, supplying up to 64% of the articular segment, refuting the traditional belief that the anterior humeral circumflex was primary.

Question 8674

Topic: 2. Trauma

A 68-year-old woman sustains a displaced proximal humerus fracture after a ground-level fall.

According to Hertel's criteria, which of the following specific radiographic findings is the most reliable predictor of ensuing avascular necrosis of the humeral head?

. Metaphyseal head extension less than 8 mm
. Metaphyseal head extension greater than 8 mm
. An intact medial hinge
. Disruption of the medial hinge less than 2 mm
. Angulation of the surgical neck greater than 45 degrees

Correct Answer & Explanation

. Metaphyseal head extension less than 8 mm

Explanation

Hertel established that a short calcar segment (metaphyseal head extension less than 8 mm) and a disrupted medial hinge (greater than 2 mm) are highly predictive of humeral head ischemia. These findings correlate strongly with disruption of the arcuate artery blood supply.

Question 8675

Topic: 2. Trauma

When evaluating a midshaft clavicle fracture for nonoperative management, which of the following radiographic findings is the most significant risk factor for subsequent nonunion?

. Inferior displacement of the medial fragment
. Superior displacement of the lateral fragment
. Initial shortening greater than 2 cm
. Comminution of the medial third
. Angulation of less than 15 degrees

Correct Answer & Explanation

. Initial shortening greater than 2 cm

Explanation

Significant fracture displacement, specifically initial shortening greater than 2 cm (or 100% displacement), is biomechanically strongly associated with an increased risk of nonunion and poor functional outcomes in nonoperatively treated clavicle fractures.

Question 8676

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder apex. Radiographs reveal 100% superior displacement of the distal clavicle relative to the acromion. The coracoclavicular distance is increased by 50% compared to the uninjured side. The deltotrapezial fascia remains intact. This represents what type of acromioclavicular (AC) joint injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type III

Explanation

A Type III AC joint separation involves complete rupture of both the AC and CC ligaments, resulting in 25-100% superior displacement of the clavicle. Type V involves >100% displacement with disruption of the overlying deltotrapezial fascia.

Question 8677

Topic: 2. Trauma

During the surgical approach for a displaced 3-part proximal humerus fracture, preservation of the blood supply to the humeral head is critical. Which artery provides the predominant blood supply to the humeral head?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Suprascapular artery
. Thoracoacromial artery
. Circflex scapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent anatomic injection studies have demonstrated that the posterior humeral circumflex artery provides the predominant blood supply to the humeral head. This challenges the historical belief that the anterior humeral circumflex artery was the main supplier.

Question 8678

Topic: 2. Trauma

Which of the following is considered an absolute indication for operative fixation of an acute midshaft clavicle fracture?

. Shortening greater than 2 cm
. Displacement greater than 100%
. Comminution with a Z-fragment
. Open fracture
. Patient preference to return to sports early

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, neurovascular compromise, and severe skin tenting that threatens skin integrity. Shortening and displacement are considered relative indications.

Question 8679

Topic: 2. Trauma

Which of the following radiographic findings is a widely accepted indication for operative fixation of an extra-articular scapular body/neck fracture?

. Medial/lateral displacement of greater than 20 mm
. Angulation of 10 degrees
. Shortening of 5 mm
. Glenopolar angle of 40 degrees
. Coracoid fracture with 2 mm displacement

Correct Answer & Explanation

. Medial/lateral displacement of greater than 20 mm

Explanation

Indications for operative treatment of extra-articular scapular fractures include medial/lateral displacement > 20 mm, angular deformity > 45 degrees, and an abnormally low glenopolar angle (typically < 22 degrees).

Question 8680

Topic: Upper Extremity Trauma

A 28-year-old male construction worker falls directly onto his right shoulder. Radiographs demonstrate an acromioclavicular (AC) joint injury with the distal clavicle displaced superiorly by 150% of the normal AC joint distance. What is the most appropriate management?

. Sling immobilization and early range of motion
. Corticosteroid injection and physical therapy
. Arthroscopic distal clavicle excision
. Surgical AC and coracoclavicular (CC) ligament reconstruction
. Open reduction and rigid plate fixation of the clavicle to the acromion

Correct Answer & Explanation

. Surgical AC and coracoclavicular (CC) ligament reconstruction

Explanation

A Type V AC joint separation is characterized by greater than 100% superior displacement of the distal clavicle with detachment of the deltotrapezial fascia. Operative reconstruction of the CC ligaments is indicated to restore normal shoulder mechanics.

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