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2. Trauma MCQs

Practice Set 443 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 8841

Topic: 2. Trauma
A 25-year-old male arrives at the trauma bay hemodynamically unstable after a high-speed motorcycle collision. An AP pelvic radiograph demonstrates a symphysis pubis diastasis of 4 cm and widening of the sacroiliac joints consistent with an APC III injury. During initial resuscitation, a pelvic binder is applied. To maximize reduction of the pelvic volume, over which anatomical landmark should the binder be centered?
. Iliac crests
. Anterior superior iliac spines
. Greater trochanters
. Symphysis pubis
. Sacral promontory

Correct Answer & Explanation

. Greater trochanters

Explanation

To effectively reduce pelvic volume and tamponade venous bleeding in an open-book pelvic fracture, a pelvic binder must be centered directly over the greater trochanters. Placement over the iliac crests is incorrect and can paradoxically worsen the deformity.

Question 8842

Topic: 2. Trauma

A 40-year-old construction worker falls from a height of 15 feet and sustains bilateral joint-depression calcaneus fractures. Which of the following injuries is most commonly associated with this mechanism of trauma and must be actively ruled out?

. Cervical spine facet dislocation
. Thoracolumbar burst fracture
. Tibial plateau fracture
. Pelvic ring disruption
. Distal radius fracture

Correct Answer & Explanation

. Thoracolumbar burst fracture

Explanation

High-energy axial loading injuries that cause bilateral calcaneus fractures have a highly established association with spinal trauma, particularly thoracolumbar burst fractures. A thorough clinical and radiographic evaluation of the spine is mandatory.

Question 8843

Topic: 2. Trauma
A 28-year-old female sustains a high-energy basicervical femoral neck fracture (Pauwels III) following a motor vehicle collision. Which of the following fixation constructs is biomechanically optimal to resist the high shear forces inherent in this fracture pattern?
. Three parallel cancellous screws in an inverted triangle
. Two parallel cancellous screws
. Sliding hip screw with a supplemental derotational screw
. Cephalomedullary nail with a single lag screw
. Primary total hip arthroplasty

Correct Answer & Explanation

. Sliding hip screw with a supplemental derotational screw

Explanation

Pauwels III fractures are high-angle vertical fractures characterized by significant shear instability. A sliding hip screw coupled with a derotational screw provides superior biomechanical stability and higher load to failure compared to multiple cancellous screws.

Question 8844

Topic: 2. Trauma
A 50-year-old female sustains an open tibia fracture (Gustilo-Anderson IIIB) and undergoes initial surgical debridement and intramedullary nailing. A rotational muscle flap is planned. To minimize the risk of deep infection, what is the optimal timeframe for soft-tissue coverage?
. Within 24 hours
. Within 72 hours
. Between 7 and 10 days
. After complete granulation tissue formation (approx. 3 weeks)
. Once negative pressure wound therapy achieves wound contraction

Correct Answer & Explanation

. Within 72 hours

Explanation

Early soft-tissue coverage of Gustilo IIIB tibia fractures, optimally performed within 72 hours (and generally less than 5 to 7 days), significantly decreases the risk of deep infection and promotes fracture union. Delays beyond this window are associated with higher complication rates.

Question 8845

Topic: 2. Trauma

A 45-year-old male presents with a high-energy pilon fracture. The limb exhibits marked soft-tissue swelling and extensive fracture blisters circumferentially. Definitive open reduction and internal fixation is planned. What is the most appropriate initial management?

. Immediate open reduction and internal fixation with dual plates
. Application of a tight compression dressing and elevation
. Spanning external fixation and limb elevation
. Closed reduction and cast immobilization
. Primary arthrodesis of the tibiotalar joint

Correct Answer & Explanation

. Spanning external fixation and limb elevation

Explanation

The standard of care for severe pilon fractures with massive soft-tissue compromise is the 'span-scan-plan' approach. Initial management consists of a spanning external fixator and elevation to allow the soft-tissue envelope to recover before attempting definitive fixation.

Question 8846

Topic: 2. Trauma

A 32-year-old male is evaluated 8 weeks after open reduction and internal fixation of a displaced talar neck fracture. The AP radiograph of the ankle reveals a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?

. Impending avascular necrosis of the talar body
. Revascularization of the talar body
. Nonunion of the talar neck
. Post-traumatic arthritis of the tibiotalar joint
. Deep osteomyelitis

Correct Answer & Explanation

. Revascularization of the talar body

Explanation

The subchondral radiolucency is known as the Hawkins sign. It represents subchondral osteopenia secondary to hyperemia, which proves that the talar body has sufficient blood supply, making avascular necrosis highly unlikely.

Question 8847

Topic: 2. Trauma

A 38-year-old male sustains an isolated, displaced, midshaft clavicle fracture with 2.5 cm of shortening. What is the primary established benefit of operative fixation over non-operative management for this specific injury pattern?

. Decreased risk of nonunion
. Decreased risk of neurovascular injury
. Improved cosmetic appearance of the shoulder
. Lower rate of symptomatic hardware
. Prevention of adhesive capsulitis

Correct Answer & Explanation

. Decreased risk of nonunion

Explanation

Displaced and shortened (>2 cm) midshaft clavicle fractures have a significantly higher nonunion rate and worse functional outcomes when treated non-operatively. Operative fixation significantly decreases the risk of nonunion and symptomatic malunion.

Question 8848

Topic: Pelvic & Acetabular Trauma
A 33-year-old male sustains an anteroposterior compression (APC) pelvic ring injury. Which of the following anatomic disruptions defines an APC III injury and differentiates it from an APC II injury?
. Disruption of the anterior sacroiliac ligaments only
. Symphysis pubis diastasis greater than 2.5 cm
. Complete disruption of both the anterior and posterior sacroiliac ligaments
. Fracture of the superior and inferior pubic rami
. Avulsion of the sacrotuberous ligament

Correct Answer & Explanation

. Complete disruption of both the anterior and posterior sacroiliac ligaments

Explanation

According to the Young-Burgess classification, an APC II injury involves disruption of the anterior sacroiliac ligaments with an intact posterior hinge. An APC III injury involves complete disruption of both the anterior and posterior sacroiliac ligaments, leading to complete global instability.

Question 8849

Topic: 2. Trauma

A 40-year-old male sustains a low-velocity gunshot wound to the right thigh, resulting in a non-displaced midshaft femur fracture. Clinical examination reveals normal distal pulses and no neurologic deficits. What is the most appropriate initial management?

. Immediate formal operative debridement and intramedullary nailing
. Application of a spanning external fixator
. Local wound care, tetanus prophylaxis, and observation with bracing
. Surgical exploration of the femoral artery
. Primary amputation

Correct Answer & Explanation

. Local wound care, tetanus prophylaxis, and observation with bracing

Explanation

Low-velocity gunshot wounds resulting in non-displaced fractures without vascular compromise, severe contamination, or significant soft tissue loss can safely be managed non-operatively. Treatment consists of local wound care, tetanus prophylaxis, and appropriate immobilization.

Question 8850

Topic: 2. Trauma
A 25-year-old male sustains a high-energy motor vehicle collision, resulting in a displaced talar neck fracture with dislocation of both the subtalar and tibiotalar joints. According to the Hawkins classification, what is the approximate expected rate of avascular necrosis (AVN) of the talar body for this injury pattern?
. 0-10%
. 15-30%
. 40-50%
. 80-100%
. Always 100%

Correct Answer & Explanation

. 80-100%

Explanation

This describes a Hawkins Type III talar neck fracture. Because three distinct sources of blood supply are disrupted (artery of the tarsal canal, deltoid branches, and anterior tibial branches), the rate of AVN is exceptionally high, approaching 80-100%.

Question 8851

Topic: 2. Trauma

A 40-year-old presents to the emergency department with a closed middle-third humeral shaft fracture and an immediate, complete radial nerve palsy upon initial presentation. What is the most appropriate initial management?

. Immediate ORIF with radial nerve exploration
. Functional bracing and clinical observation
. External fixation
. Immediate EMG/NCV studies
. MRI of the humerus

Correct Answer & Explanation

. Functional bracing and clinical observation

Explanation

Immediate radial nerve palsy in a closed humeral shaft fracture is typically managed nonoperatively with a functional brace, as the majority are neuropraxias that recover spontaneously. Operative exploration is reserved for open fractures, failure to recover by 3-4 months, or palsies that develop after closed reduction.

Question 8852

Topic: 2. Trauma
A 45-year-old farmer is struck by a tractor, sustaining a Gustilo-Anderson Type IIIA open tibial shaft fracture heavily contaminated with soil and organic debris. Which initial intravenous antibiotic regimen is most appropriate?
. First-generation cephalosporin only
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin
. Vancomycin and Piperacillin-tazobactam
. Ciprofloxacin only

Correct Answer & Explanation

. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin

Explanation

For severe open fractures (Type III) with agricultural or soil contamination, standard protocols dictate coverage for Clostridium species. This requires adding high-dose penicillin to the baseline gram-positive (cephalosporin) and gram-negative (aminoglycoside) coverage.

Question 8853

Topic: 2. Trauma

A 50-year-old man sustains a high-energy bicondylar tibial plateau fracture. Axial and coronal CT imaging reveals a large, separate, and distally displaced posteromedial fragment. What is the optimal surgical approach to adequately address this specific fragment?

. Anterolateral approach with a locked plate
. Direct medial approach
. Posteromedial approach with an anti-glide plate
. Direct posterior approach
. Extensile anterolateral approach alone

Correct Answer & Explanation

. Posteromedial approach with an anti-glide plate

Explanation

Posteromedial fragments in tibial plateau fractures typically displace distally and posteriorly due to the pull of the semimembranosus. A dedicated posteromedial approach with anti-glide or buttress plating is required because anterolateral locked plates cannot adequately capture or compress this coronal shear fragment.

Question 8854

Topic: Pelvic & Acetabular Trauma
A 25-year-old male is brought to the trauma bay after a motorcycle crash with an anteroposterior compression type III (APC-III) pelvic ring injury. He remains hypotensive despite 2 liters of crystalloid and application of a pelvic binder. A FAST exam is negative. What is the next best step in management?
. Exploratory laparotomy
. Pelvic angiography with embolization or preperitoneal packing
. Immediate open reduction and internal fixation of the pelvis
. Retrograde urethrogram
. Placement of a Greenfield filter

Correct Answer & Explanation

. Pelvic angiography with embolization or preperitoneal packing

Explanation

In a hemodynamically unstable patient with a pelvic ring injury and a negative FAST (which rules out major intra-abdominal hemorrhage), the bleeding is primarily retroperitoneal. Pelvic angiography with embolization or preperitoneal pelvic packing is the preferred intervention.

Question 8855

Topic: 2. Trauma

A 40-year-old patient presents with a highly comminuted, displaced tibial pilon fracture resulting from a fall from height. The soft tissues are severely swollen with extensive fracture blisters spanning the ankle. What is the preferred initial management strategy?

. Immediate ORIF with dual locked plates
. Spanning external fixation and delayed ORIF
. Primary ankle arthrodesis
. Immediate intramedullary nailing
. Closed reduction and rigid cast application

Correct Answer & Explanation

. Spanning external fixation and delayed ORIF

Explanation

High-energy pilon fractures with severe soft tissue compromise must be managed in a staged fashion to minimize devastating wound complications. A spanning external fixator provides length and alignment while allowing the soft tissue envelope to recover prior to definitive delayed ORIF.

Question 8856

Topic: 2. Trauma

A 30-year-old male sustains a closed comminuted tibial shaft fracture. Which of the following clinical findings is the most sensitive early indicator of acute compartment syndrome?

. Absent dorsalis pedis and posterior tibial pulses
. Pallor of the foot
. Pain out of proportion and pain with passive stretch of the toes
. Loss of motor function (paresis)
. Capillary refill greater than 4 seconds

Correct Answer & Explanation

. Pain out of proportion and pain with passive stretch of the toes

Explanation

Pain out of proportion to the apparent injury and pain on passive stretch of the muscles in the involved compartments are the most sensitive and earliest clinical signs of acute compartment syndrome. Pulselessness, pallor, and paralysis are very late signs indicating irreversible ischemia.

Question 8857

Topic: 2. Trauma

A 45-year-old sustains a distal femur fracture. Coronal CT imaging demonstrates an isolated coronal shear fracture of the lateral femoral condyle (Hoffa fracture). Which surgical approach and fixation strategy is generally considered most appropriate?

. Lateral parapatellar arthrotomy with anterior-to-posterior countersunk lag screws
. Medial parapatellar approach with a bridging plate
. Direct posterior approach with an intramedullary nail
. Closed reduction and external fixation
. Medial subvastus approach with posterior-to-anterior lag screws

Correct Answer & Explanation

. Lateral parapatellar arthrotomy with anterior-to-posterior countersunk lag screws

Explanation

Hoffa fractures are coronal shear fractures, most commonly of the lateral condyle. They require an anatomic reduction via a lateral or anterolateral arthrotomy, followed by rigid fixation typically utilizing anterior-to-posterior (or posterior-to-anterior) countersunk lag screws to compress the articular fragment.

Question 8858

Topic: 2. Trauma

In evaluating a patient with a displaced intra-articular calcaneus fracture, which of the following demographic or socioeconomic factors is most strongly associated with a poor clinical outcome and lower return-to-work rates following operative intervention?

. Male gender
. Sustaining the injury in a motor vehicle collision
. Active involvement in a Workers' Compensation claim
. Age greater than 40 years
. Initial Bohler's angle of 10 degrees

Correct Answer & Explanation

. Active involvement in a Workers' Compensation claim

Explanation

Large prospective studies (such as Buckley et al.) have consistently demonstrated that patients receiving Workers' Compensation have significantly poorer functional outcomes and markedly lower return-to-work rates following operative fixation of calcaneus fractures compared to those who do not.

Question 8859

Topic: 2. Trauma

A 24-year-old male falls on an outstretched hand and sustains a displaced fracture of the proximal pole of the scaphoid. He is at high risk for avascular necrosis (AVN) primarily due to which unique anatomical feature of the scaphoid's blood supply?

. Blood supply enters proximally and flows distally
. Blood supply enters via the volar radiocarpal ligament exclusively
. The primary intraosseous blood supply enters distally and flows in a retrograde fashion
. The proximal pole relies entirely on synovial diffusion without intraosseous vessels
. The scaphoid lacks any identifiable arterial supply, relying on venous backflow

Correct Answer & Explanation

. The primary intraosseous blood supply enters distally and flows in a retrograde fashion

Explanation

The primary arterial supply to the scaphoid enters the dorsal ridge near the waist and flows in a retrograde fashion to the proximal pole. Fractures at the waist or proximal pole disrupt this retrograde supply, leading to high rates of nonunion and AVN.

Question 8860

Topic: 2. Trauma

A 35-year-old male involved in a high-speed MVC sustains an ipsilateral displaced midshaft clavicle fracture and a displaced scapular neck fracture ('floating shoulder'). What is the primary rationale for performing operative fixation of the clavicle in this specific scenario?

. Plating the clavicle typically restores stability to the superior suspensory shoulder complex, indirectly stabilizing the scapula
. Scapular neck fractures must always be plated first to tension the clavicle
. Fixation is only indicated if there is a documented brachial plexus injury
. The clavicle must be fixed to provide an anchor for a shoulder spica cast
. Dual fixation of both bones is strictly mandatory in all floating shoulder variants

Correct Answer & Explanation

. Plating the clavicle typically restores stability to the superior suspensory shoulder complex, indirectly stabilizing the scapula

Explanation

A 'floating shoulder' represents a double disruption of the superior suspensory shoulder complex. Plating the clavicle is often sufficient to restore stability to the entire complex, indirectly reducing and stabilizing the scapular neck without necessarily requiring scapular fixation.

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