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2. Trauma MCQs

Practice Set 448 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 8941

Topic: 2. Trauma

A 40-year-old male sustains a high-energy distal femur fracture. CT imaging reveals a coronal plane fracture of the lateral femoral condyle. This specific fracture pattern is best described as and typically requires:

. Barton's fracture; conservative cast immobilization
. Hoffa fracture; operative fixation with anterior-to-posterior lag screws
. Hoffa fracture; operative fixation with posterior-to-anterior lag screws
. Chauffeur's fracture; percutaneous pinning
. Holstein-Lewis fracture; open reduction and internal fixation

Correct Answer & Explanation

. Hoffa fracture; operative fixation with anterior-to-posterior lag screws

Explanation

A coronal fracture of the femoral condyle is known as a Hoffa fracture. It is typically managed with operative fixation utilizing anterior-to-posterior lag screws to counteract shear forces and anatomically reduce the articular surface.

Question 8942

Topic: Pelvic & Acetabular Trauma

On an anteroposterior (AP) radiograph of the pelvis, disruption of the iliopectineal line indicates a fracture involving which structural component of the acetabulum?

. Posterior column
. Anterior column
. Posterior wall
. Anterior wall
. Ischial spine

Correct Answer & Explanation

. Anterior column

Explanation

The iliopectineal line is the primary radiographic landmark for the anterior column of the acetabulum. Disruption of this line on an AP pelvis radiograph is indicative of an anterior column fracture.

Question 8943

Topic: 2. Trauma

A 38-year-old roofer falls from a height, sustaining a closed, displaced intra-articular calcaneus fracture. Which of the following radiographic findings is most characteristic of this injury on a lateral view?

. Increased Bohler's angle
. Decreased Bohler's angle
. Increased angle of Gissane
. Increased Meary's angle
. Decreased talocalcaneal angle

Correct Answer & Explanation

. Decreased Bohler's angle

Explanation

Intra-articular calcaneus fractures typically result in impaction and depression of the posterior facet. This classically presents on a lateral radiograph as a decreased (flattened) Bohler's angle.

Question 8944

Topic: Lower Extremity Trauma

A 22-year-old football player sustains a hyperplantarflexion injury to his midfoot. Radiographs show a small bony avulsion in the first intermetatarsal space, known as the Fleck sign. What does this finding pathognomonically represent?

. Avulsion of the anterior talofibular ligament
. Avulsion of the Lisfranc ligament from the base of the second metatarsal
. Fracture of the os peroneum
. Avulsion of the spring ligament
. Fracture of the cuboid

Correct Answer & Explanation

. Avulsion of the Lisfranc ligament from the base of the second metatarsal

Explanation

The Fleck sign is a small bony avulsion located in the first intermetatarsal space. It is pathognomonic for a Lisfranc injury, representing the avulsion of the Lisfranc ligament that connects the medial cuneiform to the second metatarsal base.

Question 8945

Topic: 2. Trauma

A 45-year-old male sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling and fracture blisters. What is the most widely accepted initial management strategy?

. Immediate open reduction and internal fixation of the tibia and fibula
. Application of a spanning external fixator and delayed definitive fixation
. Closed reduction and casting until union
. Immediate primary arthrodesis of the ankle joint
. Immediate intramedullary nailing

Correct Answer & Explanation

. Application of a spanning external fixator and delayed definitive fixation

Explanation

High-energy pilon fractures with severe soft tissue compromise are best managed with a staged approach. Initial spanning external fixation allows soft tissues to heal and swelling to subside, followed by delayed definitive ORIF to minimize severe wound complications.

Question 8946

Topic: 2. Trauma

A 72-year-old female with osteoporosis presents with a 4-part proximal humerus fracture and significant tuberosity displacement. Which of the following surgical options is most likely to provide the most reliable functional outcome and pain relief?

. Non-operative management in a sling
. Open reduction and internal fixation with a locking plate
. Intramedullary nailing
. Hemiarthroplasty
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

In elderly patients with poor bone stock and complex 4-part proximal humerus fractures, reverse total shoulder arthroplasty provides superior and more reliable restoration of function compared to ORIF or hemiarthroplasty. This is primarily because its functional success relies less on anatomic tuberosity healing.

Question 8947

Topic: 2. Trauma

Which of the following scenarios represents an absolute indication for operative fixation of an acute midshaft clavicle fracture?

. 1 cm of shortening
. Skin tenting without ischemia
. Open fracture
. Comminution
. Displacement of 1.5 cm

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, vascular injury requiring repair, and progressive neurologic deficits. Skin tenting without ischemia and shortening of less than 2 cm are considered relative indications.

Question 8948

Topic: 2. Trauma

A 55-year-old female falls on an outstretched hand, sustaining a fracture-dislocation of the radiocarpal joint with a displaced volar rim fragment of the distal radius. This injury is best classified as a:

. Colles' fracture
. Smith's fracture
. Volar Barton's fracture
. Chauffeur's fracture
. Die-punch fracture

Correct Answer & Explanation

. Volar Barton's fracture

Explanation

A volar Barton's fracture is a shear-type intra-articular fracture of the distal radius involving the volar articular margin. It is classically accompanied by volar subluxation or dislocation of the carpus along with the fracture fragment.

Question 8949

Topic: 2. Trauma

In the management of intertrochanteric femur fractures, the presence of an incompetent or fractured lateral femoral wall is a strong indication for using:

. Non-operative management
. Sliding hip screw
. Cephalomedullary nailing
. Cancellous lag screws
. Hemiarthroplasty

Correct Answer & Explanation

. Cephalomedullary nailing

Explanation

An incompetent lateral wall in an intertrochanteric fracture often leads to excessive collapse and construct failure if treated with a sliding hip screw. Cephalomedullary nailing is indicated because it bypasses the lateral wall, providing stable intramedullary fixation.

Question 8950

Topic: 2. Trauma

Which of the following clinical parameters is the strongest indication to proceed with Damage Control Orthopedics (DCO) rather than Early Total Care (ETC) in a polytrauma patient with a femur fracture?

. Age over 40 years
. Arterial lactate of 1.5 mmol/L
. Base deficit of 8 mEq/L
. Glasgow Coma Scale of 14
. Isolated closed head injury

Correct Answer & Explanation

. Base deficit of 8 mEq/L

Explanation

A base deficit greater than 8 mEq/L, along with elevated lactate and hypothermia, are critical markers of physiologic exhaustion and shock. These parameters identify a borderline or in-extremis patient who requires Damage Control Orthopedics rather than immediate definitive fixation.

Question 8951

Topic: 2. Trauma

A 35-year-old man presents hemodynamically unstable following a motorcycle crash. An AP pelvis radiograph demonstrates a symphyseal diastasis of 4 cm and widening of both SI joints. What is the most appropriate initial orthopaedic management?

. Application of a pelvic binder centered over the iliac crests
. Application of a pelvic binder centered over the greater trochanters
. Immediate anterior plate fixation of the symphysis pubis
. Immediate external fixation
. Bilateral internal iliac artery embolization

Correct Answer & Explanation

. Application of a pelvic binder centered over the greater trochanters

Explanation

For an unstable APC pelvic ring injury with hemodynamic instability, the initial management is closing the pelvic volume. A pelvic binder must be centered over the greater trochanters, not the iliac crests, to effectively reduce the ring and decrease pelvic volume.

Question 8952

Topic: 2. Trauma



A 28-year-old sustains a high-energy distal femur fracture. CT imaging reveals a coronal plane fracture of the lateral femoral condyle. If missed, this fragment most frequently displaces in which direction?

. Anterior and superior
. Posterior and superior
. Medial and inferior
. Lateral and inferior
. It rarely displaces due to strong capsular attachments

Correct Answer & Explanation

. Posterior and superior

Explanation

A Hoffa fracture is a coronal shear fracture of the femoral condyle, most commonly lateral. Unopposed pull from the gastrocnemius and popliteus muscles causes posterior and superior displacement if not adequately stabilized.

Question 8953

Topic: 2. Trauma
In a 25-year-old patient with a vertically oriented (Pauwels type III) femoral neck fracture, what biomechanical force is most responsible for fixation failure?
. Compressive forces
. Tensile forces
. Shear forces
. Torsional forces
. Distraction forces

Correct Answer & Explanation

. Shear forces

Explanation

Pauwels type III fractures have a vertical fracture line (angle >50 degrees), which converts weight-bearing forces into high shear forces across the fracture site. This increases the risk of varus collapse and nonunion.

Question 8954

Topic: 2. Trauma

A 32-year-old male with a closed tibial shaft fracture develops severe, escalating leg pain. Blood pressure is 100/65 mmHg. Intracompartmental pressure of the anterior compartment is 40 mmHg. What is the most appropriate next step?

. Immediate four-compartment fasciotomy
. Repeat pressure measurement in 4 hours
. Elevation of the leg above the level of the heart
. Application of a short leg cast
. Administration of a regional nerve block for pain control

Correct Answer & Explanation

. Immediate four-compartment fasciotomy

Explanation

Compartment syndrome is diagnosed when the delta pressure (diastolic blood pressure minus intracompartmental pressure) is 30 mmHg or less. Here, the delta pressure is 25 mmHg (65 - 40), mandating immediate four-compartment fasciotomy.

Question 8955

Topic: 2. Trauma

A 28-year-old woman sustained a Hawkins type II talar neck fracture and underwent ORIF. At 8 weeks postoperatively, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome. What does this finding indicate?

. Avascular necrosis of the talar body
. Revascularization of the talar body
. Infection of the tibiotalar joint
. Early post-traumatic arthritis
. Nonunion of the talar neck

Correct Answer & Explanation

. Revascularization of the talar body

Explanation

The Hawkins sign is a subchondral radiolucent band visible on AP radiographs 6-8 weeks after a talus fracture. It represents subchondral osteopenia from hypervascularity, indicating that the talar body has preserved blood supply and is not undergoing avascular necrosis.

Question 8956

Topic: 2. Trauma

Which of the following radiographic findings is the strongest predictor of avascular necrosis following a proximal humerus fracture?

. Greater tuberosity displacement > 5 mm
. Varus angulation of 20 degrees
. Disrupted medial hinge with < 2 mm of calcar attached to the articular segment
. Surgical neck translation of 50%
. Lesser tuberosity fracture

Correct Answer & Explanation

. Disrupted medial hinge with < 2 mm of calcar attached to the articular segment

Explanation

A disrupted medial hinge and a short metaphyseal head extension (calcar segment) are the most reliable predictors of ischemia to the articular segment. A calcar segment < 2 mm indicates a very high risk of avascular necrosis.

Question 8957

Topic: Pelvic & Acetabular Trauma
A 35-year-old male is brought to the trauma bay after a high-speed motorcycle collision. He has an anteroposterior compression (APC) type III pelvic ring injury. Despite the application of a pelvic binder and aggressive fluid resuscitation, his blood pressure remains 75/40 mm Hg. Focused Assessment with Sonography for Trauma (FAST) is negative for intra-abdominal fluid. What is the most appropriate next step in management?
. Immediate laparotomy for mesenteric repair
. Application of an external fixator and observation
. Preperitoneal pelvic packing or pelvic angiography
. Transfer to the CT scanner for a contrast-enhanced scan
. Administration of tranexamic acid and admission to the ICU

Correct Answer & Explanation

. Preperitoneal pelvic packing or pelvic angiography

Explanation

In a hemodynamically unstable patient with a pelvic ring injury and a negative FAST, the source of bleeding is presumed to be retroperitoneal/pelvic. Preperitoneal pelvic packing or immediate pelvic angiography with embolization are the gold standards for hemorrhage control.

Question 8958

Topic: 2. Trauma
A 28-year-old man sustains a high-energy Pauwels type III (vertical) femoral neck fracture. Which internal fixation construct provides the most biomechanically stable fixation for this specific fracture pattern?
. Three parallel cancellous screws in an inverted triangle
. Two crossed cannulated screws
. A sliding hip screw (SHS) with a derotation screw
. A dynamic condylar screw
. A long cephalomedullary nail

Correct Answer & Explanation

. A sliding hip screw (SHS) with a derotation screw

Explanation

Pauwels type III fractures experience high vertical shear forces. Biomechanical studies consistently show that a sliding hip screw supplemented with a derotation screw provides superior fixation and resists shear forces better than multiple parallel screws.

Question 8959

Topic: 2. Trauma

A 22-year-old football player sustains a closed tibial shaft fracture. Two hours post-injury, he complains of severe leg pain out of proportion to the injury. Which of the following intracompartmental pressure measurements is the most reliable threshold for indicating a four-compartment fasciotomy?

. Absolute compartment pressure > 20 mm Hg
. Absolute compartment pressure > 30 mm Hg
. Delta pressure (Diastolic BP - Compartment Pressure) < 30 mm Hg
. Delta pressure (Mean Arterial BP - Compartment Pressure) < 40 mm Hg
. Delta pressure (Systolic BP - Compartment Pressure) < 50 mm Hg

Correct Answer & Explanation

. Delta pressure (Diastolic BP - Compartment Pressure) < 30 mm Hg

Explanation

The Delta pressure (diastolic blood pressure minus intracompartmental pressure) is the most accurate predictor for compartment syndrome. A Delta pressure of less than 30 mm Hg is a universally accepted threshold for performing an emergency fasciotomy.

Question 8960

Topic: 2. Trauma

A 72-year-old woman with a well-fixed total knee arthroplasty (TKA) sustains a closed distal femur fracture just proximal to the femoral component (Lewis-Rorabeck type II). The bone quality is poor. Which of the following is an acceptable and highly effective surgical treatment?

. Non-weight bearing in a hinged knee brace for 12 weeks
. Distal femoral replacement
. Retrograde intramedullary nailing or lateral locking plate fixation
. Application of a circular external fixator
. Revision of the femoral component to a primary stemmed implant

Correct Answer & Explanation

. Retrograde intramedullary nailing or lateral locking plate fixation

Explanation

Lewis-Rorabeck type II periprosthetic fractures involve a displaced fracture with a well-fixed TKA component. Lateral locked plating or retrograde intramedullary nailing are the standard operative treatments, offering excellent stability while preserving the implant.

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