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2. Trauma MCQs

Practice Set 441 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 8801

Topic: 2. Trauma

A 50-year-old man sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling and fracture blisters. What is the optimal initial management strategy?

. Immediate open reduction and internal fixation of the tibia and fibula
. Closed reduction and long leg cast application
. Spanning external fixation with delayed definitive internal fixation
. Primary tibiotalar arthrodesis
. Percutaneous pinning of the articular surface

Correct Answer & Explanation

. Spanning external fixation with delayed definitive internal fixation

Explanation

The standard of care for high-energy pilon fractures with severe soft tissue compromise is damage control orthopedics using a spanning external fixator. Definitive internal fixation is delayed until soft tissue swelling resolves, typically 10 to 21 days later.

Question 8802

Topic: 2. Trauma
A 32-year-old man sustains a Gustilo-Anderson IIIB open tibial shaft fracture. After adequate debridement and skeletal stabilization, what is the optimal timeframe for soft tissue coverage to minimize infection rates?
. Within 24 hours
. Within 3 to 7 days
. Between 10 and 14 days
. After 3 weeks when granulation tissue is present
. Immediately at the time of initial debridement regardless of contamination

Correct Answer & Explanation

. Within 3 to 7 days

Explanation

Current literature supports early soft tissue coverage (flap reconstruction) for Gustilo IIIB open tibia fractures, ideally within 3 to 7 days, to significantly decrease the risk of deep infection and flap failure.

Question 8803

Topic: 2. Trauma

A 29-year-old motorcyclist sustains a severely comminuted distal femur fracture. Preoperative CT imaging reveals an independent coronal plane fracture of the medial condyle. Which of the following justifies the use of a supplemental medial surgical approach?

. Comminution of the lateral metaphyseal wall
. A medial Hoffa coronal plane fracture
. Associated patella fracture
. MCL tear
. Extension into the intercondylar notch

Correct Answer & Explanation

. A medial Hoffa coronal plane fracture

Explanation

A medial Hoffa fracture (coronal shear fracture of the medial condyle) often requires a separate medial arthrotomy or approach to obtain anatomic reduction and place lag screws directly, as it is exceedingly difficult to reduce and fix from a standard lateral approach.

Question 8804

Topic: 2. Trauma

Six weeks following open reduction and internal fixation of a displaced talar neck fracture, an AP radiograph of the ankle demonstrates a subchondral radiolucent line in the talar dome. What does this radiographic finding indicate?

. Avascular necrosis of the talar body
. Imminent collapse of the talar dome
. Intact vascular supply to the talar body
. Nonunion of the talar neck
. Post-traumatic osteoarthritis

Correct Answer & Explanation

. Intact vascular supply to the talar body

Explanation

A subchondral radiolucent line in the talar dome (Hawkins sign) visible at 6 to 8 weeks post-injury indicates subchondral osteopenia due to an intact vascular supply. It is a reliable predictor that avascular necrosis will not occur.

Question 8805

Topic: 2. Trauma

The Sanders classification for intra-articular calcaneus fractures is based on the number and location of fracture lines in which specific anatomic area as seen on coronal CT imaging?

. Anterior process
. Sustentaculum tali
. Posterior facet
. Calcaneocuboid joint
. Tuberosity

Correct Answer & Explanation

. Posterior facet

Explanation

The Sanders classification is based on coronal plane CT scans showing the number and location of fracture lines through the posterior articular facet of the calcaneus, which guides operative treatment and prognosis.

Question 8806

Topic: 2. Trauma

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

. Displacement greater than 2 cm
. Z-type fracture pattern
. Open fracture
. Patient preference for early return to sports
. Associated non-displaced scapula body fracture

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, associated neurovascular compromise, and severe skin tenting threatening skin integrity. Displacement alone is a relative indication.

Question 8807

Topic: 2. Trauma
A 30-year-old male sustains a high-energy motor vehicle collision resulting in a Hawkins type III fracture of the talar neck with an extruded talar body. What is the approximate risk of developing avascular necrosis (AVN) of the talar body?
. 0-10%
. 20-40%
. 40-50%
. 80-100%
. AVN does not occur in this fracture pattern

Correct Answer & Explanation

. 80-100%

Explanation

A Hawkins type III fracture involves the talar neck with subluxation or dislocation of both the subtalar and tibiotalar joints. The disruption of the major blood supplies results in an AVN rate historically reported between 80% and 100%.

Question 8808

Topic: 2. Trauma

A 28-year-old polytrauma patient with a closed tibia fracture is intubated in the intensive care unit. His diastolic blood pressure is 65 mmHg. Intracompartmental pressure monitoring is placed due to swelling. What is the minimum compartment pressure that would mandate a 4-compartment fasciotomy based on the delta P concept?

. 20 mmHg
. 25 mmHg
. 30 mmHg
. 36 mmHg
. 45 mmHg

Correct Answer & Explanation

. 36 mmHg

Explanation

The delta P is defined as the diastolic blood pressure minus the intracompartmental pressure. A delta P of less than 30 mmHg is the accepted threshold for diagnosing acute compartment syndrome and indicates the need for fasciotomy. With a diastolic BP of 65 mmHg, an absolute pressure of 36 mmHg results in a delta P of 29 mmHg.

Question 8809

Topic: 2. Trauma

A 32-year-old man sustains a closed tibial shaft fracture. Two hours later, he complains of severe pain out of proportion to the injury. Which of the following is the most reliable criterion for diagnosing acute compartment syndrome in a patient who is awake and alert?

. Loss of dorsalis pedis pulse
. Intracompartmental pressure > 30 mm Hg absolute
. Diastolic blood pressure minus intracompartmental pressure < 30 mm Hg
. Paresthesias in the first web space
. Pain with passive stretch of the toes

Correct Answer & Explanation

. Diastolic blood pressure minus intracompartmental pressure < 30 mm Hg

Explanation

The delta P (diastolic blood pressure minus compartment pressure) < 30 mm Hg is the most objective and reliable criterion for diagnosing compartment syndrome. Pain with passive stretch is an early clinical sign but remains highly subjective.

Question 8810

Topic: Pelvic & Acetabular Trauma
A 45-year-old woman is brought to the emergency department after a motor vehicle collision. Her blood pressure is 80/50 mm Hg. Pelvic radiographs show a widely displaced anteroposterior compression (APC) type III pelvic ring injury. After initial fluid resuscitation, a pelvic binder is applied. What is the optimal anatomic landmark for the proper placement of the pelvic binder?
. Iliac crests
. Anterior superior iliac spines
. Greater trochanters
. Symphysis pubis
. Ischial tuberosities

Correct Answer & Explanation

. Greater trochanters

Explanation

A pelvic binder should be placed at the level of the greater trochanters to effectively reduce pelvic volume and stabilize the fracture. Placement over the iliac crests is incorrect and can exacerbate the deformity or fail to reduce the volume.

Question 8811

Topic: 2. Trauma

A 28-year-old man sustains a subtrochanteric femur fracture. Preoperative radiographs demonstrate the classic flexion, abduction, and external rotation deformity of the proximal fragment. Which of the following muscles is primarily responsible for the external rotation deformity of the proximal fragment?

. Iliopsoas
. Gluteus medius
. Short external rotators
. Adductor longus
. Gluteus maximus

Correct Answer & Explanation

. Iliopsoas

Explanation

In a subtrochanteric fracture, the proximal fragment is flexed by the iliopsoas, abducted by the gluteus medius and minimus, and externally rotated by the short external rotators.

Question 8812

Topic: 2. Trauma

A 34-year-old man sustains a Hawkins type II talar neck fracture and undergoes open reduction and internal fixation. At his 8-week follow-up, an anteroposterior radiograph of the ankle reveals subchondral radiolucency in the talar dome. What does this radiographic finding indicate?

. Early onset osteoarthritis
. Nonunion of the talar neck
. Avascular necrosis of the talar body
. Intact vascular supply to the talar body
. Deep bone infection

Correct Answer & Explanation

. Intact vascular supply to the talar body

Explanation

The Hawkins sign is subchondral radiolucency in the talar dome observed 6 to 8 weeks after injury, indicating subchondral bone resorption secondary to an intact vascular supply, thereby ruling out avascular necrosis.

Question 8813

Topic: 2. Trauma

A 38-year-old woman is involved in a high-speed motor vehicle collision and sustains a distal femur fracture. CT scan reveals a coronal plane fracture of the lateral femoral condyle. What is the recommended surgical treatment for this specific fragment?

. Nonoperative management in a hinged knee brace
. Excision of the fractured fragment
. Fixation with anteroposteriorly or posteroanteriorly directed lag screws
. Fixation with mediolaterally directed lag screws
. Spanning external fixation

Correct Answer & Explanation

. Fixation with anteroposteriorly or posteroanteriorly directed lag screws

Explanation

A coronal plane fracture of the femoral condyle is known as a Hoffa fracture. It requires anatomic reduction and internal fixation, typically using anterior-to-posterior or posterior-to-anterior directed lag screws to compress the fracture.

Question 8814

Topic: 2. Trauma
A 55-year-old man sustains a tibial plateau fracture. Radiographs and CT demonstrate a bicondylar tibial plateau fracture with complete dissociation of the articular surface from the tibial diaphysis. According to the Schatzker classification, what is the correct grade?
. Type II
. Type IV
. Type V
. Type VI
. Type III

Correct Answer & Explanation

. Type VI

Explanation

A Schatzker Type VI fracture is defined by the complete dissociation of the tibial plateau from the underlying tibial diaphysis. Type V involves both condyles but retains continuity between the metaphysis and diaphysis.

Question 8815

Topic: 2. Trauma
A 30-year-old man sustains a Gustilo-Anderson Type IIIB open tibia fracture. Following serial debridement, a 6 cm soft tissue defect over the middle third of the tibia exposes bare bone. What is the most appropriate option for soft tissue coverage?
. Split-thickness skin graft
. Medial gastrocnemius rotational flap
. Soleus rotational flap
. Sural artery fasciocutaneous flap
. Free tissue transfer

Correct Answer & Explanation

. Soleus rotational flap

Explanation

For soft tissue defects over the middle third of the tibia exposing bare bone, a soleus rotational flap is the workhorse local flap. The medial gastrocnemius is used for the proximal third, and free flaps are typically required for the distal third.

Question 8816

Topic: Pelvic & Acetabular Trauma

In the pre-hospital and emergency department management of a hemodynamically unstable patient with a suspected pelvic ring injury, what is the proper anatomical placement of a circumferential pelvic binder?

. Over the iliac crests
. Over the greater trochanters
. Over the anterior superior iliac spines
. Over the mid-abdomen
. Over the symphysis pubis and lower lumbar spine

Correct Answer & Explanation

. Over the greater trochanters

Explanation

A pelvic binder should be centered directly over the greater trochanters. Placement over the iliac crests is a common error that can paradoxically widen the true pelvis and fail to adequately reduce pelvic volume.

Question 8817

Topic: 2. Trauma

A 32-year-old man sustains a closed tibial shaft fracture. Two hours later, he complains of severe leg pain out of proportion to the injury. His diastolic blood pressure is 70 mmHg, and his anterior compartment pressure measures 45 mmHg. What is the most appropriate next step in management?

. Observe and reassess in 2 hours
. Bivalve the cast and apply ice
. Immediate four-compartment fasciotomy
. Elevate the leg above the level of the heart
. Administer intravenous mannitol

Correct Answer & Explanation

. Immediate four-compartment fasciotomy

Explanation

The patient has a delta pressure (diastolic BP minus compartment pressure) of 25 mmHg. A delta pressure of less than 30 mmHg is an absolute indication for emergent four-compartment fasciotomy.

Question 8818

Topic: 2. Trauma
A 25-year-old man sustains a highly vertical (Pauwels Type III) femoral neck fracture. To maximize biomechanical stability and resist vertical shear forces, which fixation construct is most appropriate?
. Three parallel cannulated cancellous screws
. A sliding hip screw combined with a derotational screw
. A cephalomedullary nail
. A dynamic condylar screw
. A cemented hemiarthroplasty

Correct Answer & Explanation

. A sliding hip screw combined with a derotational screw

Explanation

For vertically oriented (Pauwels III) fractures in young adults, a sliding hip screw with a derotational screw provides superior biomechanical stability against shear forces compared to multiple cannulated screws.

Question 8819

Topic: 2. Trauma
A 40-year-old sustains a Gustilo-Anderson Type IIIB open tibia fracture. Following thorough debridement and skeletal stabilization, what is the optimal timing for soft tissue coverage to minimize the risk of deep infection?
. Within 24 hours
. Within 72 hours
. Between 5 and 7 days
. Between 10 and 14 days
. After 3 weeks of negative pressure wound therapy

Correct Answer & Explanation

. Within 72 hours

Explanation

Soft tissue coverage (flap) of Gustilo Type IIIB fractures within 72 hours is strongly associated with significantly lower infection rates and improved functional outcomes compared to delayed coverage.

Question 8820

Topic: 2. Trauma

A 22-year-old motorcycle crash victim sustains a scapulothoracic dissociation. Which of the following associated injuries is the strongest clinical predictor for the necessity of an early forequarter amputation?

. Subclavian artery tear
. Complete brachial plexus avulsion
. Massive soft tissue crush injury
. Axillary vein thrombosis
. Comminuted clavicle nonunion

Correct Answer & Explanation

. Complete brachial plexus avulsion

Explanation

Complete brachial plexus avulsion results in a flail, insensate upper extremity. This catastrophic neurologic injury is the strongest predictor for early forequarter amputation in patients with scapulothoracic dissociation.

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