Menu

2. Trauma MCQs

Practice Set 435 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 8681

Topic: Upper Extremity Trauma
A 25-year-old manual laborer falls directly onto his shoulder. Radiographs show a Rockwood type III acromioclavicular (AC) joint separation. What is the current consensus regarding the initial management of this injury?
. Immediate open reduction and hook plate fixation
. Arthroscopic coracoclavicular ligament reconstruction
. Nonoperative management with a sling and early rehabilitation
. Primary distal clavicle excision
. Figure-of-eight bracing for 6 weeks

Correct Answer & Explanation

. Nonoperative management with a sling and early rehabilitation

Explanation

Most Rockwood type III AC joint separations are managed nonoperatively initially, yielding good functional outcomes comparable to surgery but with fewer complications. Surgery may be considered later for chronic pain or specific high-demand needs.

Question 8682

Topic: Upper Extremity Trauma
A 24-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a complete dislocation of the acromioclavicular (AC) joint with the clavicle displaced superiorly by 200% compared to the contralateral side. The deltotrapezial fascia is completely stripped from the distal clavicle. Which Rockwood classification best describes this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

A Type V AC joint injury features superior displacement of the distal clavicle by 100% to 300% relative to the acromion, accompanied by severe stripping of the deltotrapezial fascia. This degree of displacement and fascial compromise generally warrants operative intervention.

Question 8683

Topic: 2. Trauma

In planning for an anatomic total shoulder arthroplasty, preoperative CT shows a B2 glenoid with 25 degrees of retroversion. Which of the following is the most appropriate management of the glenoid?

. Standard polyethylene pegged glenoid with no reaming
. Asymmetric anterior reaming to neutralize version
. Asymmetric posterior reaming to neutral version
. Glenoid bone grafting or augmented glenoid component
. Hemiarthroplasty

Correct Answer & Explanation

. Glenoid bone grafting or augmented glenoid component

Explanation

A B2 glenoid with excessive retroversion (>15-20 degrees) is best managed with an augmented glenoid component or bone grafting. Eccentric posterior reaming for 25 degrees of retroversion would remove excessive subchondral bone, severely risking component subsidence.

Question 8684

Topic: 2. Trauma

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

. 1.5 cm of shortening
. Skin tenting without compromise
. Open fracture
. Comminution
. Displacement of 100%

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, neurovascular compromise, and severe skin compromise (such as impending skin breakdown). Shortening and complete displacement are relative indications.

Question 8685

Topic: 2. Trauma

A 68-year-old female sustains a 4-part proximal humerus fracture. According to Hertel's criteria, which of the following radiographic findings is the strongest predictor of subsequent humeral head ischemia?

. Greater tuberosity displacement > 1 cm
. Metaphyseal head extension (calcar length) < 8 mm
. Head-shaft angulation > 45 degrees
. Shaft displacement > 2 cm
. Lesser tuberosity comminution

Correct Answer & Explanation

. Metaphyseal head extension (calcar length) < 8 mm

Explanation

Hertel identified specific predictors for humeral head ischemia in proximal humerus fractures. A metaphyseal head extension (calcar length) of less than 8 mm, along with disruption of the medial hinge, strongly predicts ischemia and potential avascular necrosis.

Question 8686

Topic: 2. Trauma

A 70-year-old female undergoes locking plate fixation of a 3-part proximal humerus fracture. At 6 months, she presents with progressive shoulder pain, and radiographs show superior screw cutout into the joint. What is the most likely initial technical error during surgery?

. Failure to restore medial calcar support
. Placement of screws too inferiorly
. Use of a structurally short plate
. Over-reduction of the fracture in valgus
. Too early initiation of active range of motion

Correct Answer & Explanation

. Failure to restore medial calcar support

Explanation

Loss of medial hinge/calcar support is a major risk factor for varus collapse and subsequent superior screw cutout in locked plating of proximal humerus fractures. Proper restoration of the inferomedial cortex is crucial to prevent this complication.

Question 8687

Topic: 2. Trauma

A 65-year-old woman undergoes open reduction and internal fixation of a 3-part proximal humerus fracture with a locked plate. Which of the following technical factors is most critical for minimizing the risk of varus collapse and subsequent screw cut-out?

. Placement of superiorly directed calcar screws
. Using a plate with a shorter working length
. Tying the rotator cuff to the plate
. Routine bone grafting of the metaphysis
. Fixation in 10 degrees of varus

Correct Answer & Explanation

. Placement of superiorly directed calcar screws

Explanation

Placement of calcar screws into the inferomedial quadrant of the humeral head provides essential medial support. This significantly reduces the risk of varus collapse and secondary screw cut-out.

Question 8688

Topic: Upper Extremity Trauma

Recent quantitative anatomical studies investigating the arterial supply to the proximal humerus have redefined classic teachings. Based on these contemporary studies, which artery provides the majority of the blood supply to the humeral head?

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

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent studies (e.g., Hettrich et al.) demonstrated that the posterior humeral circumflex artery supplies approximately 64% of the blood to the humeral head. This contradicts older literature which emphasized the anterolateral ascending branch of the anterior humeral circumflex artery.

Question 8689

Topic: Upper Extremity Trauma

A 45-year-old man falls directly onto his shoulder. Clinical examination and weight-bearing radiographs reveal a Type V acromioclavicular (AC) joint separation with 150% superior displacement of the clavicle relative to the acromion. What is the most appropriate management?

. Sling immobilization for 6 weeks followed by physical therapy
. Closed reduction and figure-of-eight bracing
. Coracoclavicular (CC) ligament reconstruction
. Distal clavicle excision alone
. Acromioplasty and subacromial decompression

Correct Answer & Explanation

. Coracoclavicular (CC) ligament reconstruction

Explanation

Type V AC separations represent severe displacement (>100-300%) due to disruption of both the AC and CC ligaments, along with stripping of the deltotrapezial fascia. Surgical reconstruction of the CC ligaments is the standard of care.

Question 8690

Topic: 2. Trauma

A 68-year-old woman sustains a displaced proximal humerus fracture after a fall. According to the Hertel criteria, which of the following radiographic findings is the most significant predictor of humeral head ischemia and subsequent avascular necrosis?

. Short calcar length (<8 mm)
. Intact medial hinge
. Greater tuberosity displacement <5 mm
. Metaphyseal extension >10 mm
. Fracture isolated to the surgical neck

Correct Answer & Explanation

. Short calcar length (<8 mm)

Explanation

Hertel's criteria for high risk of humeral head ischemia include a short metaphyseal head extension (calcar length <8 mm), disrupted medial hinge, and an anatomic neck fracture pattern.

Question 8691

Topic: Upper Extremity Trauma
A 28-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint injury with 50% superior displacement of the clavicle relative to the acromion. How is this injury classified according to Rockwood?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

A Rockwood Type III injury involves complete disruption of both the AC and coracoclavicular (CC) ligaments, resulting in 25% to 100% superior displacement of the distal clavicle compared to the contralateral side.

Question 8692

Topic: 2. Trauma

An 18-year-old football player presents to the trauma bay after landing forcefully on his lateral shoulder. He complains of severe chest pain, dyspnea, and dysphagia. On exam, the medial clavicle is not palpable anteriorly. What is the most appropriate next step in management?

. Immediate blind closed reduction in the emergency department
. CT scan of the chest followed by emergent reduction in the OR with cardiothoracic surgery backup
. Observation and sling immobilization
. Immediate clavicle open reduction and internal fixation
. Acromioclavicular joint reconstruction

Correct Answer & Explanation

. CT scan of the chest followed by emergent reduction in the OR with cardiothoracic surgery backup

Explanation

Posterior sternoclavicular dislocations are orthopedic emergencies due to potential compression of the trachea, esophagus, and great vessels. They require a CT scan to confirm the diagnosis and must be reduced in the OR with cardiothoracic surgery available.

Question 8693

Topic: 2. Trauma

Recent quantitative anatomical studies indicate that the primary blood supply to the humeral head, which is highly relevant in determining the risk of avascular necrosis following a 4-part proximal humerus fracture, is derived from which of the following vessels?

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

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

While older literature emphasized the arcuate branch of the anterior humeral circumflex artery, recent studies demonstrate that the posterior humeral circumflex artery provides the vast majority (roughly 64%) of the blood supply to the humeral head.

Question 8694

Topic: Upper Extremity Trauma
A 26-year-old cyclist sustains an injury to his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint separation where the distal clavicle is displaced superiorly by 150% relative to the acromion. The coracoclavicular distance is more than doubled compared to the contralateral side. What is the Rockwood classification of this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

Rockwood Type V AC joint injuries are characterized by 100% to 300% superior displacement of the distal clavicle with severe disruption of the coracoclavicular ligaments and the deltotrapezial fascia.

Question 8695

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Clinical exam shows severe prominence of the distal clavicle. Radiographs reveal a Type V acromioclavicular (AC) joint injury with >100% superior displacement. Surgical reconstruction of the coracoclavicular (CC) ligaments is planned. What are the names and typical medial-to-lateral orientation of the native CC ligaments?
. Conoid is medial, trapezoid is lateral
. Trapezoid is medial, conoid is lateral
. Coracoacromial is medial, conoid is lateral
. Conoid is medial, coracoacromial is lateral
. Superior AC is medial, trapezoid is lateral

Correct Answer & Explanation

. Conoid is medial, trapezoid is lateral

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid (medial) and trapezoid (lateral) ligaments. The conoid primarily prevents superior translation, while the trapezoid resists axial compression of the AC joint.

Question 8696

Topic: 2. Trauma

A 30-year-old man sustains a midshaft clavicle fracture with 100% displacement and 2.5 cm of shortening. He undergoes open reduction and internal fixation with a superior plate. Which of the following is the most common complication associated with this specific surgical approach?

. Nonunion
. Brachial plexus injury
. Subclavian artery pseudoaneurysm
. Anterior chest wall numbness
. Pneumothorax

Correct Answer & Explanation

. Anterior chest wall numbness

Explanation

The supraclavicular nerves cross directly over the superior aspect of the clavicle. The superior surgical approach frequently results in injury to these nerve branches, leading to postoperative numbness over the anterior chest wall as the most common complication.

Question 8697

Topic: Pelvic & Acetabular Trauma

A 19-year-old rugby player sustains a lateral compression injury to his left shoulder. He presents with severe chest pain, shortness of breath, and dysphagia. Examination shows a depression at the left sternoclavicular (SC) joint. Which of the following imaging modalities is the gold standard for diagnosing and assessing the direction of this dislocation?

. Anteroposterior chest radiograph
. Serendipity view radiograph
. Magnetic Resonance Imaging (MRI)
. Computed Tomography (CT) scan
. Ultrasound

Correct Answer & Explanation

. Computed Tomography (CT) scan

Explanation

Posterior sternoclavicular joint dislocations are orthopedic emergencies due to the proximity of the great vessels and trachea. A CT scan of the chest is the gold standard for confirming the dislocation and evaluating the compression of critical mediastinal structures.

Question 8698

Topic: 2. Trauma

A 65-year-old woman sustains a displaced 3-part proximal humerus fracture. According to Hertel's criteria, which of the following radiographic findings is the strongest predictor for the development of humeral head avascular necrosis?

. Greater tuberosity displacement > 5 mm
. Metaphyseal head extension (calcar length) < 8 mm
. Anatomic neck fracture angulation > 30 degrees
. Intact medial hinge
. Lesser tuberosity displacement

Correct Answer & Explanation

. Metaphyseal head extension (calcar length) < 8 mm

Explanation

Hertel's criteria for predicting ischemia of the humeral head following proximal humerus fractures include a metaphyseal head extension (calcar length) of <8 mm, disrupted medial hinge, and an anatomic neck fracture pattern. A short calcar length strongly predicts AVN.

Question 8699

Topic: Upper Extremity Trauma
A 27-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a displaced acromioclavicular joint injury with 150% superior displacement of the clavicle relative to the acromion. What is the classification of this injury and the standard recommended treatment?
. Type III; Nonoperative management initially
. Type III; Immediate operative reconstruction
. Type IV; Nonoperative management initially
. Type V; Immediate operative reconstruction
. Type V; Nonoperative management initially

Correct Answer & Explanation

. Type V; Immediate operative reconstruction

Explanation

A Type V AC joint injury involves 100% to 300% superior displacement of the clavicle with severe disruption of the deltotrapezial fascia. Treatment for Type V injuries is generally operative reconstruction of the coracoclavicular ligaments.

Question 8700

Topic: 2. Trauma

A 70-year-old man undergoes open reduction and internal fixation of a 3-part proximal humerus fracture with a locking plate. Postoperatively, he has profound weakness in shoulder abduction but intact external rotation and normal distal pulses. Radiographs show anatomic reduction.

What is the most likely cause of his deficit?

. Intraoperative injury to the axillary nerve
. Intraoperative injury to the suprascapular nerve
. Postoperative hematoma compressing the brachial plexus
. Failure of the greater tuberosity fixation
. Missed associated subscapularis tear

Correct Answer & Explanation

. Intraoperative injury to the axillary nerve

Explanation

The axillary nerve courses circumferentially around the surgical neck of the humerus and is at high risk during lateral approaches and plate placement for proximal humerus fractures. Injury leads to deltoid weakness (abduction).

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page