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2. Trauma MCQs

Practice Set 439 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 8761

Topic: 2. Trauma

A 3-year-old girl is diagnosed with a completely displaced diaphyseal femur fracture after a minor fall. She weighs 14 kg (31 lbs). What is the most appropriate initial treatment?

. Pavlik harness
. Spica cast
. Flexible intramedullary nailing
. Rigid locked intramedullary nailing
. Submuscular plating

Correct Answer & Explanation

. Spica cast

Explanation

For children aged 6 months to 5 years weighing less than 50 lbs, immediate spica casting is the standard of care for diaphyseal femur fractures.

Question 8762

Topic: 2. Trauma

A 7-year-old boy has an isolated, closed midshaft fracture of the radius and ulna with 20 degrees of apex volar angulation. What is the maximum acceptable angulation for a diaphyseal both-bone forearm fracture in a child of this age?

. 5 degrees
. 15 degrees
. 30 degrees
. 45 degrees
. 60 degrees

Correct Answer & Explanation

. 15 degrees

Explanation

For children under 9 years old, up to 15 degrees of angulation and 45 degrees of malrotation are acceptable due to their immense remodeling potential.

Question 8763

Topic: 2. Trauma

A 6-year-old girl falls from monkey bars and sustains a significantly displaced extension-type supracondylar humerus fracture. On presentation, her hand is well-perfused and pink, but the radial pulse is absent. After closed reduction and percutaneous pinning, the hand remains pink, but the radial pulse is still nonpalpable. What is the most appropriate next step?

. Immediate vascular exploration
. Angiography
. Observation and admission for 24-48 hours
. Remove the pins and open the fracture
. Fasciotomy of the forearm

Correct Answer & Explanation

. Observation and admission for 24-48 hours

Explanation

In a pulseless but well-perfused (pink) hand after closed reduction and pinning of a supracondylar humerus fracture, careful clinical observation is recommended. Collateral circulation is typically adequate, and immediate vascular exploration is not indicated.

Question 8764

Topic: 2. Trauma

A 4-year-old boy sustains an isolated midshaft femur fracture after a low-energy fall. He weighs 18 kg (40 lbs). What is the most appropriate definitive management?

. Pavlik harness
. Early spica casting
. Flexible intramedullary nailing
. Rigid trochanteric entry intramedullary nailing
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 6 months to 5 years weighing less than 20 kg (44 lbs), early spica casting is the gold standard for isolated femoral shaft fractures. Flexible intramedullary nailing is typically reserved for older children.

Question 8765

Topic: 2. Trauma
A 15-year-old male athlete presents with sudden anterior knee pain and inability to extend the knee after jumping. Radiographs show a displaced Ogden type III tibial tubercle avulsion fracture extending into the joint. What is the most devastating acute complication associated with this injury that must be closely monitored?
. Anterior cruciate ligament tear
. Popliteal artery injury
. Acute compartment syndrome
. Patellar tendon rupture
. Avascular necrosis of the tibial epiphysis

Correct Answer & Explanation

. Acute compartment syndrome

Explanation

Displaced tibial tubercle fractures, particularly Ogden types II and III, carry a significant risk of acute anterior compartment syndrome. This is due to disruption of the anterior tibial recurrent artery and subsequent bleeding into the anterior compartment.

Question 8766

Topic: 2. Trauma

A 4-year-old boy weighing 18 kg sustains an isolated, closed midshaft femur fracture. He has no other injuries and is neurologically intact. What is the most appropriate definitive management?

. Flexible intramedullary nailing
. Early spica casting
. Rigid locked intramedullary nail
. Open reduction and internal fixation with a compression plate
. Skeletal traction for 3 weeks followed by a spica cast

Correct Answer & Explanation

. Early spica casting

Explanation

Early spica casting is the gold standard for isolated femur fractures in children aged 6 months to 5 years weighing less than 20 kg. Flexible nailing is generally reserved for children older than 5 years or weighing more than 20 kg.

Question 8767

Topic: 2. Trauma

A 9-year-old boy sustains mild trauma and presents with shoulder pain. Radiographs reveal a minimally displaced pathologic fracture through a centrally located, completely radiolucent lesion in the proximal humerus metaphysis demonstrating a "fallen leaf" sign. What is the most appropriate initial management?

. Immediate curettage and autologous bone grafting
. Immobilization in a sling followed by observation
. Urgent intralesional injection of methylprednisolone
. Wide excision and structural allografting
. Flexible intramedullary nailing

Correct Answer & Explanation

. Immobilization in a sling followed by observation

Explanation

The "fallen leaf" or "fallen fragment" sign is pathognomonic for a unicameral (simple) bone cyst. Initial management of a stable pathologic fracture through a UBC is conservative (immobilization) to allow the fracture to heal; healing of the fracture often stimulates partial or complete resolution of the cyst.

Question 8768

Topic: 2. Trauma

An 8-year-old boy weighing 35 kg (77 lb) sustains an isolated, closed transverse midshaft femur fracture. What is the most appropriate definitive management?

. Immediate spica casting
. Pavlik harness application
. Flexible intramedullary nailing
. Rigid reamed intramedullary nailing
. External fixation

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

Flexible intramedullary nailing is the treatment of choice for length-stable midshaft femur fractures in children aged 5 to 11 years weighing under 50 kg (110 lb). It offers excellent outcomes, rapid mobilization, and minimizes the risk of avascular necrosis of the femoral head seen with rigid rigid trochanteric entry nails in this age group.

Question 8769

Topic: 2. Trauma
A 14-year-old boy presents to the emergency department after sustaining a knee injury while jumping for a rebound during a basketball game. He has severe anterior knee pain and cannot actively extend the knee against gravity. A radiograph is shown in Figure 5. Assuming the imaging confirms an Ogden Type III tibial tubercle avulsion fracture with intra-articular extension, what is the most devastating acute complication associated with this specific injury pattern?
. Popliteal artery laceration
. Anterior compartment syndrome
. Common peroneal nerve neurapraxia
. Recurrent patellar instability
. Premature physeal closure leading to genu recurvatum

Correct Answer & Explanation

. Anterior compartment syndrome

Explanation

Tibial tubercle avulsion fractures can cause tearing of the anterior tibial recurrent artery, which bleeds directly into the tight anterior compartment of the lower leg. Surgeons must maintain a high index of suspicion for acute anterior compartment syndrome in these patients.

Question 8770

Topic: 2. Trauma
A 14-year-old boy sustains a Type III tibial tubercle avulsion fracture while playing basketball. He undergoes open reduction and internal fixation. Twelve hours postoperatively, he complains of unremitting leg pain disproportionate to the injury and pain with passive toe extension. What is the most critical next step?
. Prescribe additional opioid analgesics
. Obtain a stat duplex ultrasound
. Loosen the postoperative dressing and cast
. Perform four-compartment fasciotomies of the leg
. Obtain a CT scan to assess intra-articular extension

Correct Answer & Explanation

. Perform four-compartment fasciotomies of the leg

Explanation

Tibial tubercle avulsion fractures have a well-documented association with anterior compartment syndrome due to disruption of the anterior tibial recurrent artery. Severe, unremitting pain and pain on passive stretch are hallmark signs requiring emergent fasciotomy.

Question 8771

Topic: 2. Trauma

A 6-year-old girl sustains a severely displaced extension-type supracondylar humerus fracture. On presentation, her hand is pink but the radial pulse is absent. After closed reduction and percutaneous pinning, the fracture is anatomically aligned, the hand remains pink and warm, but the radial pulse remains impalpable by Doppler. What is the most appropriate next step in management?

. Immediate exploration of the brachial artery
. Remove the pins and perform an open reduction
. Observe and admit for serial neurovascular checks
. Perform an immediate forearm fasciotomy
. Obtain a CT angiogram

Correct Answer & Explanation

. Observe and admit for serial neurovascular checks

Explanation

A "pulseless, pink" hand after anatomic reduction of a supracondylar fracture is typically managed with observation. Collateral circulation is sufficient, and the pulse often returns within a few days; exploration is only indicated if the hand becomes poorly perfused.

Question 8772

Topic: 2. Trauma

A 13-year-old boy sustains a twisting injury to his ankle. CT scan demonstrates a fracture pattern that is sagittal in the epiphysis, axial in the physis, and coronal in the metaphysis. Which direction of external force typically causes this specific fracture pattern?

. Pronation-abduction
. Supination-inversion
. External rotation
. Plantarflexion-axial load
. Direct anterior trauma

Correct Answer & Explanation

. External rotation

Explanation

A triplane fracture typically occurs in adolescents due to an external rotation force. The asymmetric closure of the distal tibial physis (central, then anteromedial, then posteromedial, then lateral) dictates this classic multiplanar propagation.

Question 8773

Topic: 2. Trauma
A 14-year-old girl sustains an isolated fracture of the anterolateral distal tibial epiphysis. Radiographs show 3 mm of displacement. What is the primary deforming force causing this specific fracture pattern?
. Pull of the anterior talofibular ligament
. Pull of the anterior inferior tibiofibular ligament
. Impaction from the talar dome
. Pull of the deltoid ligament
. Avulsion from the calcaneofibular ligament

Correct Answer & Explanation

. Pull of the anterior inferior tibiofibular ligament

Explanation

A juvenile Tillaux fracture is a Salter-Harris III fracture of the anterolateral distal tibia. It is an avulsion fracture caused by the pull of the anterior inferior tibiofibular ligament (AITFL) during an external rotation injury.

Question 8774

Topic: 2. Trauma
A 10-year-old boy falls while skiing and sustains a displaced Meyers and McKeever Type III tibial eminence fracture. Which of the following structures is most commonly entrapped in the fracture site, preventing closed reduction?
. Anterior cruciate ligament
. Medial collateral ligament
. Anterior horn of the lateral meniscus
. Anterior horn of the medial meniscus
. Transverse intermeniscal ligament

Correct Answer & Explanation

. Anterior horn of the lateral meniscus

Explanation

The anterior horn of the lateral meniscus is the most common structure to become entrapped in a displaced tibial eminence fracture. This interposition often necessitates arthroscopic or open reduction.

Question 8775

Topic: 2. Trauma

A 4-year-old boy, weighing 18 kg (40 lbs), sustains an isolated closed midshaft femur fracture after falling from a slide. What is the gold standard treatment for this patient?

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

Correct Answer & Explanation

. Early spica casting

Explanation

For preschool children aged 6 months to 5 years (and weighing less than 20 kg), early spica casting is the standard of care for isolated closed midshaft femur fractures, yielding excellent clinical outcomes.

Question 8776

Topic: 2. Trauma
A 10-year-old girl falls while skiing and sustains a Type III (completely displaced) tibial eminence fracture. Closed reduction under anesthesia is attempted but is unsuccessful in achieving an acceptable reduction. What is the most likely anatomic structure blocking the reduction?
. Posterior cruciate ligament
. Anterior horn of the medial meniscus
. Medial collateral ligament
. Transverse intermeniscal ligament
. Fat pad

Correct Answer & Explanation

. Anterior horn of the medial meniscus

Explanation

The anterior horn of the medial meniscus is the most common structure that becomes entrapped under a completely displaced tibial eminence fracture, blocking closed reduction. Arthroscopic or open reduction is required to extricate the meniscus and fix the fracture.

Question 8777

Topic: 2. Trauma

A 5-year-old boy weighing 22 kg sustains a closed, length-stable diaphyseal transverse fracture of the femur. What is the standard of care for definitive management?

. Pavlik harness
. Hip spica casting
. Flexible intramedullary nailing (titanium elastic nails)
. Rigid locked intramedullary nailing
. Open reduction and internal fixation with a compression plate

Correct Answer & Explanation

. Flexible intramedullary nailing (titanium elastic nails)

Explanation

For children aged 5 to 11 years weighing less than 50 kg with length-stable femoral shaft fractures, flexible intramedullary nailing is the treatment of choice. It provides rapid mobilization and minimizes malunion compared to spica casting.

Question 8778

Topic: 2. Trauma
A 6-year-old girl with Osteogenesis Imperfecta Type III presents with a severely bowed femur and a new midshaft fracture. She has a history of multiple fractures. What is the most appropriate surgical management for this fracture?
. Closed reduction and spica cast application
. Open reduction and rigid intramedullary nailing
. Fixation with an extramedullary locking plate
. Multiple osteotomies and telescoping intramedullary rodding
. External fixation and gradual correction

Correct Answer & Explanation

. Multiple osteotomies and telescoping intramedullary rodding

Explanation

In severely bowing and frequently fracturing long bones of patients with severe OI, the standard surgical treatment is multiple corrective osteotomies to straighten the bone. This is followed by stabilization with a telescoping intramedullary rod that elongates with growth.

Question 8779

Topic: 2. Trauma

A 2-year-old boy with neurofibromatosis type 1 develops a non-healing fracture of the tibia through an area of anterolateral bowing. Which surgical approach provides the highest union rate for this condition?

. Closed reduction and spica casting
. External fixation with gradual angular correction alone
. Plate osteosynthesis without bone grafting
. Intramedullary fixation combined with hamartoma excision and bone grafting
. Primary below-knee amputation

Correct Answer & Explanation

. Intramedullary fixation combined with hamartoma excision and bone grafting

Explanation

Congenital pseudarthrosis of the tibia (CPT) is notoriously difficult to heal. The most successful surgical strategy involves radical resection of the hamartoma, robust bone grafting, and mechanical stabilization using intramedullary fixation, often spanning the ankle.

Question 8780

Topic: 2. Trauma

A healthy 3-year-old boy sustains a closed, length-stable, isolated midshaft femur fracture after a fall from a playground slide. What is the recommended definitive treatment?

. Pavlik harness application
. Flexible intramedullary nailing
. Early spica casting
. Rigid antegrade intramedullary nailing
. Submuscular bridge plating

Correct Answer & Explanation

. Early spica casting

Explanation

For children between 6 months and 5 years of age with closed, stable diaphyseal femur fractures, early spica casting is the gold standard treatment with excellent remodeling potential and low complication rates.

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