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2. Trauma MCQs

Practice Set 447 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 8921

Topic: 2. Trauma

A 40-year-old female presents with an isolated closed transverse fracture of the midshaft humerus. Which of the following is generally considered an absolute indication for operative fixation?

. Fracture angulation of 15 degrees in the sagittal plane
. Shortening of 2 centimeters
. An ipsilateral brachial plexus injury
. An ipsilateral both-bone forearm fracture (floating elbow)
. Radial nerve palsy present before any manipulation

Correct Answer & Explanation

. An ipsilateral both-bone forearm fracture (floating elbow)

Explanation

An ipsilateral forearm fracture ('floating elbow') is an absolute indication for surgical fixation of a humeral shaft fracture. This allows for early mobilization and stable restoration of the extremity, whereas an initial radial nerve palsy is not an absolute indication.

Question 8922

Topic: Pelvic & Acetabular Trauma
A 45-year-old male is brought to the trauma bay in hemorrhagic shock following a motorcycle collision. An anteroposterior pelvic radiograph demonstrates an anteroposterior compression (APC) type III pelvic ring injury. A pelvic binder is to be applied. What is the correct anatomical landmark for the optimal placement of the pelvic binder?
. Anterior superior iliac spines
. Iliac crests
. Greater trochanters
. Symphysis pubis
. Umbilicus

Correct Answer & Explanation

. Greater trochanters

Explanation

Pelvic binders must be centered over the greater trochanters to effectively reduce pelvic volume and control hemorrhage. Placement over the iliac crests is a common error and can paradoxically widen the true pelvis in APC injuries.

Question 8923

Topic: 2. Trauma
A 28-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels type III). Which of the following fixation constructs provides the most biomechanically stable fixation for this specific fracture pattern?
. Three parallel partially threaded cannulated screws
. A sliding hip screw with a derotational screw
. A cephalomedullary nail
. A dynamic condylar screw
. Multiple fully threaded cortical screws

Correct Answer & Explanation

. A sliding hip screw with a derotational screw

Explanation

Vertical femoral neck fractures (Pauwels type III) experience high shear forces. A sliding hip screw combined with a derotational screw provides superior biomechanical stability against shear stress compared to multiple parallel cannulated screws.

Question 8924

Topic: 2. Trauma
A 32-year-old construction worker sustains a Grade IIIB open tibial shaft fracture. According to recent literature, which of the following factors has the most significant impact on reducing the risk of deep infection?
. Time to surgical debridement within 6 hours
. Time to surgical debridement within 12 hours
. Time to administration of systemic intravenous antibiotics
. Use of high-pressure pulsatile lavage
. Primary wound closure at the index procedure

Correct Answer & Explanation

. Time to administration of systemic intravenous antibiotics

Explanation

The single most critical factor in preventing infection in open fractures is the early administration of systemic intravenous antibiotics, ideally within 1 hour of injury. The strict 6-hour rule for surgical debridement has not been shown to independently alter infection rates if antibiotics are given promptly.

Question 8925

Topic: 2. Trauma

A 24-year-old male presents with a comminuted tibial plateau fracture. He is obtunded due to a concurrent traumatic brain injury. Intracompartmental pressure monitoring of the leg is performed. Which of the following parameters is most diagnostic of acute compartment syndrome requiring fasciotomy?

. Absolute compartment pressure of 25 mm Hg
. Absolute compartment pressure of 35 mm Hg
. Diastolic blood pressure minus compartment pressure is less than 30 mm Hg
. Mean arterial pressure minus compartment pressure is less than 40 mm Hg
. Systolic blood pressure minus compartment pressure is less than 30 mm Hg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure is less than 30 mm Hg

Explanation

The most reliable diagnostic parameter for acute compartment syndrome is a delta pressure (diastolic blood pressure minus intracompartmental pressure) of less than 30 mm Hg. Relying solely on absolute pressure can lead to misdiagnosis depending on the patient's systemic blood pressure.

Question 8926

Topic: 2. Trauma

Review the radiograph provided.

In a patient with an isolated, closed extra-articular fracture of the scapula body, which of the following is generally considered an accepted absolute indication for operative fixation?

. Medial/lateral displacement of 5 mm
. Angular deformity of 15 degrees
. Glenopolar angle of 35 degrees
. Medial displacement of the glenoid block greater than 20 mm
. Presence of a concomitant non-displaced clavicle fracture

Correct Answer & Explanation

. Medial displacement of the glenoid block greater than 20 mm

Explanation

Operative indications for extra-articular scapular neck/body fractures include severe medial displacement (generally >20-25 mm) or profound angular deformity (>45 degrees). Lesser degrees of displacement are typically managed non-operatively with excellent functional outcomes.

Question 8927

Topic: 2. Trauma

A 40-year-old male presents with a closed middle-third humeral shaft fracture. On initial examination, he has normal wrist and finger extension. Following a closed reduction and application of a coaptation splint, the patient is noted to have a complete wrist drop and inability to extend his MCP joints. What is the most appropriate management?

. Immediate surgical exploration of the radial nerve
. Observation with serial clinical examinations for 3 months
. Electromyography (EMG) testing immediately
. Application of a functional fracture brace
. Administration of high-dose corticosteroids

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve

Explanation

A secondary (iatrogenic) radial nerve palsy that develops immediately following a closed reduction attempt of a humerus fracture is an absolute indication for surgical exploration. This is to extract the nerve if it has become entrapped within the fracture site.

Question 8928

Topic: Pelvic & Acetabular Trauma

In the Young-Burgess classification of pelvic ring injuries, which of the following ligamentous structures remains completely intact in an anteroposterior compression type II (APC II) injury?

. Anterior sacroiliac ligaments
. Sacrotuberous ligaments
. Sacrospinous ligaments
. Posterior sacroiliac ligaments
. Symphyseal ligaments

Correct Answer & Explanation

. Posterior sacroiliac ligaments

Explanation

An APC II pelvic ring injury is characterized by rupture of the symphyseal, anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The strong posterior sacroiliac ligaments remain intact, providing continued vertical stability to the hemipelvis.

Question 8929

Topic: 2. Trauma

An extensile lateral approach is planned for the open reduction and internal fixation of a displaced intra-articular calcaneus fracture. The vascular supply to the lateral soft-tissue flap is primarily dependent on which of the following arteries?

. Medial plantar artery
. Dorsalis pedis artery
. Lateral calcaneal artery
. Sural artery
. Lateral plantar artery

Correct Answer & Explanation

. Lateral calcaneal artery

Explanation

The lateral calcaneal artery, a terminal branch of the peroneal artery, provides the primary blood supply to the apex of the standard extensile lateral approach flap. Preserving this supply and utilizing a full-thickness "no-touch" subperiosteal flap minimizes the high risk of wound necrosis.

Question 8930

Topic: 2. Trauma

A 25-year-old male sustains an isolated, low-velocity gunshot wound to the thigh resulting in a comminuted midshaft femur fracture. The entrance and exit wounds are clean and approximately 1 cm in diameter. There are no vascular deficits. What is the most appropriate initial treatment?

. Extensive wound excision, fracture debridement, and external fixation
. Immediate locked intramedullary nailing with local wound care
. Immediate locked intramedullary nailing with extensive formal tract debridement
. Traction pin placement and delayed nailing at 2 weeks
. Plating of the femur to avoid medullary canal contamination

Correct Answer & Explanation

. Immediate locked intramedullary nailing with local wound care

Explanation

Low-velocity gunshot wounds resulting in femur fractures without gross contamination or neurovascular injury are treated similarly to closed fractures. Local wound care, appropriate antibiotics, and standard immediate intramedullary nailing yield excellent outcomes without formal tract excision.

Question 8931

Topic: 2. Trauma
A 35-year-old male presents in hemorrhagic shock after a motorcycle crash. A pelvic radiograph demonstrates an anteroposterior compression type III (APC-III) pelvic ring injury. A pelvic binder is promptly applied, and he receives massive transfusion therapy but remains persistently hypotensive. A Focused Assessment with Sonography for Trauma (FAST) exam is negative. What is the most appropriate next step in management?
. Retrograde urethrogram
. Exploratory laparotomy
. Preperitoneal pelvic packing and/or angioembolization
. Application of a supra-acetabular external fixator
. Computed tomography (CT) of the abdomen and pelvis

Correct Answer & Explanation

. Preperitoneal pelvic packing and/or angioembolization

Explanation

Hemodynamic instability in a patient with a mechanically unstable pelvic fracture and a negative FAST exam indicates retroperitoneal bleeding. Preperitoneal pelvic packing or angioembolization is indicated to achieve rapid hemostasis. External fixation provides mechanical stability but is insufficient alone for severe arterial or venous hemorrhage.

Question 8932

Topic: 2. Trauma
A 25-year-old man sustains a Pauwels type III (highly vertical) femoral neck fracture. Which of the following internal fixation constructs offers the highest biomechanical stability for this specific fracture pattern in a young adult?
. Three parallel fully threaded cancellous screws
. A sliding hip screw construct with a supplemental derotation screw
. A dynamic condylar screw plate
. A short cephalomedullary nail
. A partially threaded cannulated screw system

Correct Answer & Explanation

. A sliding hip screw construct with a supplemental derotation screw

Explanation

Pauwels type III fractures experience high shear forces due to their vertical orientation. A sliding hip screw with a supplemental derotation screw is biomechanically superior to parallel screws for resisting vertical shear in young patients.

Question 8933

Topic: 2. Trauma

A 28-year-old female sustains a closed distal-third spiral humeral shaft fracture (Holstein-Lewis type). Upon initial presentation in the emergency department, her radial nerve motor and sensory functions are intact. Following a closed reduction and application of a coaptation splint, she is immediately unable to extend her wrist or fingers. What is the most appropriate management?

. Observation and an EMG at 6 weeks
. Immediate surgical exploration and fracture fixation
. Change to a functional fracture brace
. Administration of high-dose intravenous corticosteroids
. Urgent magnetic resonance imaging of the arm

Correct Answer & Explanation

. Immediate surgical exploration and fracture fixation

Explanation

A secondary radial nerve palsy that develops immediately following a closed reduction maneuver of a humeral shaft fracture strongly suggests iatrogenic nerve entrapment in the fracture site. This is a widely accepted relative indication for early surgical exploration.

Question 8934

Topic: 2. Trauma
A 42-year-old agricultural worker sustains a highly contaminated open diaphyseal tibia fracture with significant periosteal stripping and muscle loss (Gustilo-Anderson IIIB) after a farming tractor accident. Which of the following intravenous antibiotic regimens is most appropriate upon presentation?
. Cefazolin alone
. Cefazolin and gentamicin
. Cefazolin, gentamicin, and high-dose penicillin
. Vancomycin and piperacillin-tazobactam
. Ceftriaxone and clindamycin

Correct Answer & Explanation

. Cefazolin, gentamicin, and high-dose penicillin

Explanation

Farm injuries carry a high risk of anaerobic contamination, including Clostridium species. Current guidelines recommend adding penicillin to a first-generation cephalosporin and an aminoglycoside for highly contaminated agricultural open fractures.

Question 8935

Topic: 2. Trauma

A 45-year-old man presents with a high-energy closed tibial pilon fracture. Clinical examination reveals significant soft tissue swelling with hemorrhagic fracture blisters over the anterolateral ankle. What is the most appropriate initial management?

. Immediate open reduction and internal fixation through an anterolateral approach
. Application of a spanning external fixator and delayed definitive fixation once soft tissues permit
. Application of a well-molded short leg cast
. Immediate definitive fixation utilizing a circular fine-wire frame
. Incision and drainage of the hemorrhagic blisters followed by early internal fixation

Correct Answer & Explanation

. Application of a spanning external fixator and delayed definitive fixation once soft tissues permit

Explanation

High-energy pilon fractures are fraught with soft tissue complications. A staged protocol featuring initial spanning external fixation allows the soft tissue envelope to recover prior to definitive internal fixation.

Question 8936

Topic: 2. Trauma

A 25-year-old male with a tibial shaft fracture complains of escalating, out-of-proportion leg pain 12 hours post-injury. His systemic blood pressure is 110/70 mmHg. Intracompartmental pressure monitoring is performed. Using the delta P concept, at or above what absolute intracompartmental pressure reading is an emergency fasciotomy strictly indicated?

. 20 mmHg
. 30 mmHg
. 40 mmHg
. 50 mmHg
. 60 mmHg

Correct Answer & Explanation

. 30 mmHg

Explanation

The Delta P is calculated as Diastolic BP minus Compartment Pressure. A Delta P of 30 mmHg or less is an indication for fasciotomy. With a diastolic BP of 70 mmHg, a compartment pressure of 40 mmHg yields a Delta P of 30.

Question 8937

Topic: Pelvic & Acetabular Trauma
In a patient with an anterior-posterior compression (APC) type III pelvic ring injury, what is the most common source of major retroperitoneal hemorrhage?
. Anterior division of the internal iliac artery
. Posterior division of the internal iliac artery
. Venous plexus and cancellous bone
. Superior gluteal artery
. External iliac artery

Correct Answer & Explanation

. Venous plexus and cancellous bone

Explanation

Despite the life-threatening nature of arterial bleeding, the most common source of hemorrhage in pelvic ring injuries is venous, originating from the presacral and prevesical plexuses, as well as bleeding from fractured cancellous bone.

Question 8938

Topic: 2. Trauma
A 28-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels type III). Which of the following fixation constructs provides the most biomechanically stable fixation for this specific fracture pattern?
. Three parallel cancellous lag screws
. Sliding hip screw with a derotational screw
. Two fully threaded cortical screws
. Cephalomedullary nail
. Hemiarthroplasty

Correct Answer & Explanation

. Sliding hip screw with a derotational screw

Explanation

Pauwels type III fractures experience high shear forces due to their vertical orientation. A sliding hip screw combined with a derotational screw provides superior biomechanical stability compared to multiple cancellous screws in these specific fractures.

Question 8939

Topic: 2. Trauma
A 32-year-old woman sustains an open tibial shaft fracture with a 6 cm laceration, moderate soft tissue damage, and adequate periosteal coverage. What is the most appropriate initial antibiotic regimen according to current guidelines?
. First-generation cephalosporin only
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin, aminoglycoside, and penicillin
. Fluoroquinolone only
. Third-generation cephalosporin only

Correct Answer & Explanation

. First-generation cephalosporin and an aminoglycoside

Explanation

This injury represents a Gustilo-Anderson Type IIIA open fracture. Current guidelines recommend administering a first-generation cephalosporin combined with an aminoglycoside (or a broad-spectrum equivalent) to adequately cover both gram-positive and gram-negative organisms.

Question 8940

Topic: 2. Trauma

A 24-year-old male presents with severe leg pain following a tibial shaft fracture. His diastolic blood pressure is 75 mmHg. Intracompartmental pressure testing reveals an anterior compartment pressure of 50 mmHg. What is the delta p and the appropriate management?

. 25 mmHg, immediate four-compartment fasciotomy
. 25 mmHg, observe and repeat measurements in 2 hours
. 50 mmHg, immediate four-compartment fasciotomy
. 50 mmHg, observe and repeat measurements in 2 hours
. 125 mmHg, immediate single-incision fasciotomy

Correct Answer & Explanation

. 25 mmHg, immediate four-compartment fasciotomy

Explanation

Delta p is calculated as diastolic blood pressure minus intracompartmental pressure (75 - 50 = 25 mmHg). A delta p of less than 30 mmHg is an absolute indication for an immediate four-compartment fasciotomy to prevent irreversible muscle necrosis.

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