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2. Trauma MCQs

Practice Set 44 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 861

Topic: 2. Trauma

The patient's injury mechanism involved an external rotation force on a planted foot. This mechanism, combined with the asymmetrical physeal closure, predisposes adolescents to specific fracture patterns. Considering the provided image, which depicts a complex multi-planar fracture, what is the most accurate description of the typical fracture lines in a triplane fracture?

. A single fracture line propagating through the epiphysis in the coronal plane.
. A fracture line through the physis in the axial plane, exiting the metaphysis in the sagittal plane, and the epiphysis in the coronal plane.
. A fracture line through the epiphysis in the sagittal plane, along the open physis in the axial plane, and through the posterior metaphysis in the coronal plane.
. A fracture line exclusively through the metaphysis in the transverse plane, sparing the physis and epiphysis.
. An avulsion fracture of the medial malleolus with an associated syndesmotic disruption.

Correct Answer & Explanation

. A fracture line through the epiphysis in the sagittal plane, along the open physis in the axial plane, and through the posterior metaphysis in the coronal plane.

Explanation

Correct Answer: CThe case specifically describes the biomechanics of a triplane fracture: 'The fracture line propagates through the epiphysis in the sagittal plane, travels along the open physis in the axial plane, and exits through the posterior metaphysis in the coronal plane.' This multi-planar nature is what gives the triplane fracture its name and makes it complex to diagnose and treat.Option A describes a simpler fracture pattern, not a triplane. Option B incorrectly describes the planes of exit for the metaphyseal and epiphyseal components. Option D describes a metaphyseal fracture, which is distinct from a triplane fracture involving the physis and epiphysis. Option E describes a different injury altogether, although medial malleolus fractures can occur with external rotation, it's not the defining characteristic of a triplane fracture.

Question 862

Topic: 2. Trauma

Following initial radiographs for the 14-year-old male with a suspected complex distal tibial physeal fracture, the plain films are inconclusive regarding the exact extent of articular displacement. The patient's clinical presentation and mechanism of injury are highly suggestive of a triplane fracture.

Based on the case, what is the most appropriate next imaging modality for definitive preoperative planning?

. Repeat plain radiographs with stress views to better visualize displacement.
. Magnetic Resonance Imaging (MRI) to assess soft tissue injury and physeal integrity.
. A high-resolution Computed Tomography (CT) scan with sagittal, coronal, and 3D reconstructions.
. Bone scintigraphy to identify occult stress fractures.
. Arthrography to evaluate articular cartilage damage.

Correct Answer & Explanation

. A high-resolution Computed Tomography (CT) scan with sagittal, coronal, and 3D reconstructions.

Explanation

Correct Answer: CThe case explicitly states: 'A high-resolution Computed Tomography scan with sagittal, coronal, and three-dimensional reconstructions is mandatory for all suspected triplane and Tillaux fractures. The CT scan allows the orthopedic surgeon to precisely map the fracture lines, quantify the articular step-off, identify the presence of intercalary articular fragments, and plan the exact trajectory for internal fixation.' Plain films frequently underestimate the degree of articular displacement and the number of fracture fragments in these complex, multi-planar injuries.Option A is incorrect because stress views are not the primary method for assessing articular displacement in complex physeal fractures and are often limited by pain. Option B, MRI, is excellent for soft tissue and cartilage assessment but is not the primary modality for detailed bony architecture and fracture mapping in the acute setting for surgical planning of these specific fractures. Option D, bone scintigraphy, is used for stress fractures but not for acute, complex intra-articular fracture planning. Option E, arthrography, is an invasive procedure not indicated for routine preoperative planning of these fractures.

Question 863

Topic: 2. Trauma

A 14-year-old male presents with a triplane fracture of the distal tibia. Preoperative CT scan reveals 3 mm of articular step-off and a displaced metaphyseal fragment. The primary goal of management is anatomic restoration of the articular surface. Based on the provided guidelines, what is the most appropriate management strategy?

. Non-operative management with a long leg cast for 6 weeks, followed by a short leg cast.
. Attempt closed reduction; if successful, proceed with cast immobilization; if unsuccessful, consider ORIF.
. Immediate open reduction and internal fixation (ORIF) to achieve anatomic reduction.
. External fixation to stabilize the fracture and allow for soft tissue swelling to subside before definitive fixation.
. Percutaneous pinning without open reduction, as the patient is nearing skeletal maturity.

Correct Answer & Explanation

. Immediate open reduction and internal fixation (ORIF) to achieve anatomic reduction.

Explanation

Correct Answer: CThe case clearly states the operative decision-making criteria: 'Operative intervention is strictly indicated when there is unacceptable displacement of the articular surface. The universally accepted threshold for surgical intervention in intra-articular fractures of the weight-bearing distal tibia is greater than two millimeters of displacement or step-off.' With 3 mm of articular step-off, this patient unequivocally meets the criteria for immediate open reduction and internal fixation (ORIF) to prevent post-traumatic osteoarthritis.Option A is incorrect because non-operative management is reserved for undisplaced fractures or those with less than 2 mm of displacement. Option B is partially correct in that closed reduction may be attempted, but with 3mm of displacement, the likelihood of successful anatomic closed reduction is low, and the guidelines indicate that if displacement is >2mm, ORIF is indicated. The table also states 'Failed Closed Reduction -> Operative ORIF'. Given the initial displacement, proceeding directly to ORIF is the most appropriate and definitive management. Option D, external fixation, is typically reserved for open fractures, highly comminuted fractures, or those with significant soft tissue compromise, which are not described here. Option E, percutaneous pinning without open reduction, is less likely to achieve anatomic reduction of a complex triplane fracture with 3mm of articular step-off and is generally not recommended for displaced intra-articular fractures.

Question 864

Topic: 2. Trauma

During open reduction and internal fixation of the patient's triplane fracture via an anterolateral approach, the surgeon encounters difficulty achieving anatomic reduction of the anterolateral epiphyseal fragment despite adequate exposure. What is the most common impediment to closed and open reduction in these types of fractures?

. Significant comminution of the articular surface.
. Interposition of the anterior inferior tibiofibular ligament.
. Excessive fracture hematoma obscuring visualization.
. Interposition of periosteum at the fracture site.
. Premature physeal closure blocking fragment manipulation.

Correct Answer & Explanation

. Interposition of periosteum at the fracture site.

Explanation

Correct Answer: DThe case explicitly states: 'The fracture edges are often covered with interposed periosteum, which is the most common impediment to closed reduction. This periosteum must be carefully elevated and retracted to expose the raw cancellous bone of the fracture site.' This soft tissue interposition is a frequent reason for failed closed reduction and requires meticulous surgical technique during open reduction.Option A, significant comminution, can make reduction challenging but is not described as the 'most common impediment' in the text. Option B, interposition of the anterior inferior tibiofibular ligament, can occur, particularly in Tillaux fractures, but the text highlights periosteum as the most common impediment. Option C, excessive fracture hematoma, must be irrigated and debrided for visualization, but it is not the primary mechanical block to reduction. Option E, premature physeal closure, is a complication that occurs after healing, not an impediment to acute reduction.

Question 865

Topic: 2. Trauma

The patient successfully undergoes ORIF for his triplane fracture. During the rehabilitation phase, the orthopedic surgeon emphasizes the importance of addressing the underlying etiology of the injury. Beyond the phased weight-bearing and functional recovery, what is the most critical long-term recommendation for this patient, given his history?

. Enroll in a high-intensity strength and conditioning program immediately upon cast removal.
. Return to competitive soccer as soon as pain subsides, typically within 6-8 weeks.
. Incorporate at least three months of off-season rest or participation in a different sport annually.
. Focus solely on sport-specific training to regain peak performance quickly.
. Undergo prophylactic hardware removal at 3 months post-op to prevent future issues.

Correct Answer & Explanation

. Incorporate at least three months of off-season rest or participation in a different sport annually.

Explanation

Correct Answer: CThe case emphasizes: 'A critical component of the rehabilitation phase for this specific patient population is addressing the underlying etiology of the injury: single-sport specialization. ...the patient must be counseled to incorporate at least three months of off-season rest or participation in a different sport annually to allow for adequate skeletal remodeling and to mitigate the risk of future stress-related catastrophic failures.'Option A is incorrect; immediate high-intensity strength training upon cast removal could overload the healing bone and is not part of a phased recovery. Option B is incorrect; return to competitive soccer is typically permitted between three and five months postoperatively, contingent upon full recovery, not just pain subsidence, and without addressing the underlying specialization issue, recurrence is likely. Option D is incorrect; focusing solely on sport-specific training perpetuates the problem of single-sport specialization and increases the risk of overuse injuries. Option E is incorrect; hardware removal is typically elective and performed after complete radiographic consolidation, usually 6-12 months postoperatively, not at 3 months, and it does not address the underlying etiology of the injury.

Question 866

Topic: 2. Trauma

A 10-year-old boy crushes his long finger in a door. Examination shows a laceration through the nail bed and the proximal nail plate sits superficial to the eponychial fold. Radiographs show a displaced Salter-Harris I fracture of the distal phalanx. What is the most appropriate definitive management?

. Closed reduction and splinting for 3 weeks
. Nail bed repair, fracture reduction, and oral antibiotics
. Amputation of the distal phalanx
. Kirschner wire fixation without soft tissue repair
. Application of a short arm cast

Correct Answer & Explanation

. Nail bed repair, fracture reduction, and oral antibiotics

Explanation

This is a Seymour fracture, characterized by a displaced distal phalanx physeal fracture with an associated nail bed laceration (open fracture). Treatment requires nail removal, irrigation, nail bed repair, reduction of the fracture, and antibiotic therapy to prevent osteomyelitis.

Question 867

Topic: 2. Trauma

A 40-year-old sustains an ankle fracture-dislocation. Closed reduction in the emergency department is unsuccessful. CT scan reveals the proximal fibular fragment is entrapped behind the posterior tubercle of the distal tibia. What is this specific injury pattern called?

. Maisonneuve fracture
. Tillaux fracture
. Bosworth fracture-dislocation
. Wagstaffe-Le Fort avulsion
. Dupuytren fracture

Correct Answer & Explanation

. Bosworth fracture-dislocation

Explanation

A Bosworth fracture-dislocation involves the entrapment of the proximal fibula behind the posterior tibial tubercle. It is irreducible by closed means and requires emergent open reduction to prevent severe soft tissue complications.

Question 868

Topic: 2. Trauma

A 45-year-old male is evaluated in the emergency department following a fall from a height. He sustained a severely comminuted pilon fracture with massive soft tissue swelling and hemorrhagic fracture blisters. The decision is made to place a spanning external fixator. What is the primary rationale for this staged approach ('span, scan, and plan')?

. To prevent nonunion of the metaphyseal fragments
. To allow the articular cartilage to revascularize
. To minimize the risk of devastating soft tissue complications and infection
. To definitively reduce the articular surface through ligamentotaxis
. To avoid the need for computed tomography (CT) imaging

Correct Answer & Explanation

. To minimize the risk of devastating soft tissue complications and infection

Explanation

Early open reduction and internal fixation of pilon fractures with severe soft tissue injury carries a very high risk of wound breakdown and deep infection. Staged management allows the soft tissue envelope to recover before definitive fixation.

Question 869

Topic: 2. Trauma

In a patient presenting with an irreducible fracture-dislocation of the ankle, radiographs show the fibula displaced behind the posterior tubercle of the tibia. Attempts at closed reduction in the emergency department are unsuccessful. What is this specific injury pattern called?

. Tillaux fracture
. Wagstaffe-Le Fort fracture
. Bosworth fracture-dislocation
. Maisonneuve fracture
. Pott's fracture

Correct Answer & Explanation

. Bosworth fracture-dislocation

Explanation

A Bosworth fracture-dislocation involves the proximal fibular shaft fragment becoming entrapped behind the posterior tubercle of the tibia. This mechanical block usually makes closed reduction impossible, necessitating open reduction.

Question 870

Topic: 2. Trauma

A 35-year-old male falls 15 feet from a ladder, sustaining a closed, severely comminuted tibial pilon fracture. On presentation, his ankle exhibits massive soft tissue swelling and multiple fracture blisters. What is the most appropriate initial management for this patient to minimize catastrophic soft tissue complications?

. Immediate Open Reduction Internal Fixation (ORIF) of both the tibia and fibula
. Spanning external fixation with delayed definitive ORIF of the tibia
. Immediate intramedullary nailing of the tibia
. Closed reduction and placement in a short leg cast for 6 weeks
. Primary tibiotalar arthrodesis

Correct Answer & Explanation

. Spanning external fixation with delayed definitive ORIF of the tibia

Explanation

High-energy pilon fractures with severe soft tissue compromise require a staged approach to prevent skin necrosis and deep infection. Immediate spanning external fixation allows the soft tissues to recover, followed by delayed definitive ORIF once the 'wrinkle sign' is present (typically 10-21 days later).

Question 871

Topic: 2. Trauma

A 28-year-old male sustains a fall onto an outstretched hand (FOOSH) injury. Initial radiographs are negative, but clinical suspicion for a scaphoid fracture remains high due to persistent anatomical snuffbox tenderness. After 10 days of immobilization, repeat radiographs show a non-displaced fracture in the most common anatomical location.

Which of the following fracture patterns is most likely present, and what is its approximate incidence among all scaphoid fractures?

. Distal pole fracture; 5-10%
. Tubercle fracture; <5%
. Waist fracture; 70-80%
. Proximal pole fracture; 15-20%
. Vertical oblique fracture; Not specified, but rare

Correct Answer & Explanation

. Waist fracture; 70-80%

Explanation

Correct Answer: CThe case describes a non-displaced fracture in the most common anatomical location. According to the provided text,waist fracturesare the most common, accounting for approximately 70-80% of all scaphoid fractures. Distal pole fractures are 5-10%, proximal pole fractures are 15-20%, and tubercle fractures are rare. Vertical oblique fractures are a pattern of waist fracture, but not a distinct anatomical location with a separate incidence percentage in the provided text.Incorrect Options:A) Distal pole fracture; 5-10%:While a possible location, it is not the most common.B) Tubercle fracture; <5%:These are rare and generally stable, but not the most common type.D) Proximal pole fracture; 15-20%:These are less common than waist fractures and carry the highest risk of AVN, but are not the most frequently encountered.E) Vertical oblique fracture; Not specified, but rare:This describes a fracture pattern, often mechanically unstable, but not the most common anatomical location in terms of overall incidence.

Question 872

Topic: 2. Trauma

A 22-year-old professional baseball player sustains a scaphoid fracture. Initial radiographs show a non-displaced waist fracture. However, a follow-up CT scan reveals a scaphoid sagittal angle of 65 degrees and a 1.5 mm displacement at the fracture site.

Based on the provided case information and general guidelines, which of the following is the most compelling indication for operative management in this patient?

. Patient's profession as a high-demand athlete.
. Non-displaced waist fracture.
. Scaphoid sagittal angle > 60 degrees and >1 mm displacement.
. Risk of prolonged immobilization with non-operative treatment.
. The fracture being a waist fracture.

Correct Answer & Explanation

. Scaphoid sagittal angle > 60 degrees and >1 mm displacement.

Explanation

Correct Answer: CThe text lists specific indications for operative management. Ascaphoid sagittal angle > 60 degrees (indicating humpback deformity)anddisplacement > 1 mmare both explicit criteria for surgical intervention, as they signify an unstable fracture pattern with a high risk of malunion and altered carpal kinematics. The patient's CT scan confirms both of these critical findings.Incorrect Options:A) Patient's profession as a high-demand athlete:While a valid consideration for operative management (high-demand patients desiring early return to activity), it is a patient factor, not a direct fracture characteristic indicating instability or displacement. The fracture characteristics in option C are more compelling indications for surgery in this specific case.B) Non-displaced waist fracture:The initial radiographs showed a non-displaced fracture, but the CT scan revealed displacement and angulation, making this option incorrect based on the full clinical picture. Non-displaced waist fractures can often be treated non-operatively.D) Risk of prolonged immobilization with non-operative treatment:This is a general advantage of surgical fixation (allowing earlier mobilization), but it is not the primary or most compelling indication for surgery based on the specific fracture characteristics of displacement and angulation.E) The fracture being a waist fracture:Waist fractures are the most common type, and while many are treated operatively, the location alone is not a definitive indication for surgery without other factors like displacement, angulation, or instability.

Question 873

Topic: 2. Trauma

A 68-year-old sedentary female presents with wrist pain after a minor fall. Radiographs show a non-displaced fracture of the scaphoid tubercle. She has significant medical comorbidities, including uncontrolled diabetes and severe cardiac disease.

Considering her fracture pattern and comorbidities, which of the following is the most appropriate initial management strategy?

. Open reduction and internal fixation with a headless compression screw.
. Percutaneous screw fixation.
. Immobilization in a short arm thumb spica cast.
. Vascularized bone grafting due to age-related vascular compromise.
. Proximal row carpectomy to prevent future arthritis.

Correct Answer & Explanation

. Immobilization in a short arm thumb spica cast.

Explanation

Correct Answer: CThe text states thatdistal tubercle fracturesare generally stable and heal reliably with short-term immobilization, making them an indication for non-operative management. Furthermore, the patient has significant medical comorbidities (uncontrolled diabetes, severe cardiac disease) which are listed as contraindications for operative management due to increased surgical risk. Therefore, conservative management with immobilization is the most appropriate initial strategy.Incorrect Options:A) Open reduction and internal fixation with a headless compression screw:This is an operative intervention. Given the stable nature of a tubercle fracture and the patient's severe comorbidities, surgery is contraindicated.B) Percutaneous screw fixation:This is also an operative intervention, and while minimally invasive, it still carries surgical risks that are heightened by the patient's comorbidities. It is not indicated for a stable tubercle fracture.D) Vascularized bone grafting due to age-related vascular compromise:Vascularized bone grafting is a complex procedure reserved for nonunions with AVN or challenging cases, not for an acute, non-displaced tubercle fracture. Age alone does not necessitate this.E) Proximal row carpectomy to prevent future arthritis:Proximal row carpectomy is a salvage procedure for advanced arthritis (e.g., SNAC wrist) and is not indicated for an acute, non-displaced fracture.

Question 874

Topic: 2. Trauma

A 30-year-old construction worker presents with persistent anatomical snuffbox tenderness after a FOOSH injury, despite initial radiographs being negative. A scaphoid fracture is highly suspected.

Which advanced imaging modality is considered the gold standard for assessing fracture displacement, comminution, and fragment orientation, and is crucial for surgical planning?

. Magnetic Resonance Imaging (MRI)
. Bone Scan
. Computed Tomography (CT) Scan
. Ultrasound
. Repeat plain radiographs in 10 days

Correct Answer & Explanation

. Computed Tomography (CT) Scan

Explanation

Correct Answer: CThe text explicitly states: "Computed Tomography (CT) Scan:The gold standard for assessing fracture displacement, comminution, and fragment orientation, especially in waist and proximal pole fractures. Axial, coronal, and sagittal reconstructions are critical for 3D understanding. It aids in surgical approach selection and screw trajectory planning." This makes CT the ideal choice for detailed fracture assessment and surgical planning.Incorrect Options:A) Magnetic Resonance Imaging (MRI):MRI is highly useful for diagnosing occult scaphoid fractures not visible on radiographs or CT, and for detecting bone contusion or ligamentous injuries. However, for detailed assessment of fracture geometry, displacement, and comminution for surgical planning, CT is superior.B) Bone Scan:Rarely used for acute fractures, it can confirm occult fractures by showing increased uptake but provides limited anatomical detail for surgical planning.D) Ultrasound:While useful for soft tissue assessment, ultrasound has limited utility for diagnosing scaphoid fractures and assessing their detailed characteristics.E) Repeat plain radiographs in 10 days:This is a common initial strategy for occult fractures, but it is not an advanced imaging modality and does not provide the detailed 3D information needed for surgical planning, especially if displacement or comminution is suspected.

Question 875

Topic: 2. Trauma

A patient undergoes open reduction and internal fixation of a scaphoid waist fracture with a headless compression screw. The fixation is deemed stable.

According to typical post-operative rehabilitation protocols for stable scaphoid fixation, when would the patient most likely transition from full-time cast immobilization to controlled active wrist range of motion?

. Immediately post-operatively.
. At 2-3 weeks, after initial wound healing.
. At 6-8 weeks, after initial radiographic signs of healing.
. At 12 weeks, regardless of radiographic healing.
. At 4-6 months, after complete radiographic union.

Correct Answer & Explanation

. At 6-8 weeks, after initial radiographic signs of healing.

Explanation

Correct Answer: CThe text describes Phase 2 of rehabilitation (Controlled Active Range of Motion) as typically beginning at "Weeks 6/8-12." It explicitly states: "Repeat radiographs (and potentially CT scan) at 6-8 weeks to confirm signs of fracture healing. If healing is sufficient, progress to active ROM." This indicates that the transition from full-time immobilization to active ROM is contingent on radiographic evidence of initial healing, usually around 6-8 weeks for stable fixation.Incorrect Options:A) Immediately post-operatively:While some surgeons may allow immediate gentle ROM with exceptionally rigid fixation and high patient compliance, the typical protocol for stable fixation still involves an initial period of immobilization (4-6 weeks) to protect healing.B) At 2-3 weeks, after initial wound healing:This is generally too early for active wrist ROM, as significant bone healing has not yet occurred, and the fracture site remains vulnerable.D) At 12 weeks, regardless of radiographic healing:While 12 weeks is within the broader range for rehabilitation progression, the text emphasizes that progression is based on "initial radiographic signs of healing," which typically occur earlier than 12 weeks for stable fixation. Waiting until 12 weeks regardless of healing might delay rehabilitation unnecessarily.E) At 4-6 months, after complete radiographic union:This timeframe is typically for return to full activity or contact sports, not for initiating controlled active wrist ROM. Complete union often takes longer, but active ROM starts earlier.

Question 876

Topic: 2. Trauma

A 35-year-old male is diagnosed with a scaphoid nonunion and avascular necrosis of the proximal pole. A free vascularized bone graft from the medial femoral condyle (MFC) is planned. The MFC graft is based on which of the following vessels?

. Medial superior genicular artery
. Descending genicular artery
. Popliteal artery
. Sural artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Descending genicular artery

Explanation

The medial femoral condyle (MFC) free vascularized bone graft is reliably based on the articular branch of the descending genicular artery. It provides structurally robust, vascularized bone for challenging scaphoid nonunions.

Question 877

Topic: 2. Trauma

A patient with a chronic scaphoid waist nonunion presents with a 'humpback' deformity. Which of the following biomechanical patterns occurs in the carpus as a direct result of this deformity?

. Volar intercalated segment instability (VISI)
. Dorsal intercalated segment instability (DISI)
. Ulnar translation of the carpus
. Proximal migration of the capitate
. Radiocarpal joint widening

Correct Answer & Explanation

. Dorsal intercalated segment instability (DISI)

Explanation

A humpback deformity occurs when the distal scaphoid pole flexes. Without the normal stabilizing link of an intact scaphoid, the lunate extends with the triquetrum, resulting in a Dorsal Intercalated Segment Instability (DISI) posture.

Question 878

Topic: 2. Trauma

Recent randomized controlled trials comparing standard short arm casting to thumb spica casting for non-displaced scaphoid waist fractures have demonstrated which of the following?

. Thumb spica casting significantly reduces time to union
. Standard short arm casting results in a higher nonunion rate
. No significant difference in union rates or functional outcomes
. Thumb spica casting significantly decreases the risk of AVN
. Standard short arm casting leads to higher rates of carpal instability

Correct Answer & Explanation

. No significant difference in union rates or functional outcomes

Explanation

Multiple studies have shown that there is no statistically significant difference in union rates or functional outcomes when treating non-displaced scaphoid waist fractures with a short arm cast versus a thumb spica cast.

Question 879

Topic: 2. Trauma

A 45-year-old undergoes treatment for a humpback scaphoid nonunion. The surgeon utilizes a volar approach for a structural interposition bone graft (e.g., modified Russe technique). What is the main anatomical advantage of this approach?

. Avoids the dorsal blood supply while facilitating correction of the flexion deformity
. Allows direct visualization of the scapholunate interosseous ligament
. Prevents injury to the superficial radial nerve
. Permits easier harvest of the distal radius bone graft
. Bypasses the need for hardware fixation

Correct Answer & Explanation

. Avoids the dorsal blood supply while facilitating correction of the flexion deformity

Explanation

The volar approach is ideal for humpback waist nonunions because it avoids the critical dorsal blood supply. It also easily accommodates a volar wedge graft to restore scaphoid length and correct the DISI deformity.

Question 880

Topic: 2. Trauma

Which of the following best describes the dominant vascular supply to the scaphoid and its clinical implication for fracture management?

. Volar carpal branch supplies the proximal pole directly, promoting rapid healing.
. Dorsal carpal branch of the radial artery enters distally and provides retrograde flow to the proximal pole.
. Anterior interosseous artery supplies the scaphoid waist via an antegrade network.
. The superficial palmar arch supplies the distal pole exclusively, predisposing to waist nonunions.
. The ulnar artery provides the dominant supply to the proximal pole through the lunotriquetral ligament.

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery enters distally and provides retrograde flow to the proximal pole.

Explanation

The major blood supply to the scaphoid is from the dorsal carpal branch of the radial artery, which enters the dorsal ridge distally and provides retrograde flow. This makes proximal pole fractures highly susceptible to delayed union or avascular necrosis.

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