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2. Trauma MCQs

Practice Set 450 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 8981

Topic: 2. Trauma

An 82-year-old woman with severe COPD presents with neck pain after a fall. CT demonstrates a displaced Type II odontoid fracture. Neurologic exam is normal. The decision is made to manage her nonoperatively with a rigid cervical collar rather than a halo vest. What is the primary reason to avoid halo vest immobilization in this specific patient?

. Unacceptably high rate of fracture nonunion
. Risk of respiratory failure and increased mortality
. Inability to achieve adequate fracture reduction
. High incidence of deep pin site infections
. Risk of severe dysphagia and malnutrition

Correct Answer & Explanation

. Risk of respiratory failure and increased mortality

Explanation

Halo vest immobilization in the elderly, particularly those with severe pulmonary comorbidities like COPD, is associated with a high incidence of morbidity and mortality due to restricted chest excursion, pneumonia, and respiratory failure. A rigid cervical collar is generally favored for nonoperative management in this demographic.

Question 8982

Topic: 2. Trauma

A 30-year-old female sustains a U-shaped sacral fracture following a fall from height. She presents with perineal numbness and urinary retention. What mechanism is typically responsible for this injury pattern?

. Axial loading causing spino-pelvic dissociation
. Lateral compression of the pelvic ring
. Anteroposterior compression
. Shear force through the sacroiliac joint
. Avulsion of the sacrotuberous ligaments

Correct Answer & Explanation

. Axial loading causing spino-pelvic dissociation

Explanation

U-shaped sacral fractures typically result from severe axial loading that leads to spino-pelvic dissociation. This highly unstable injury commonly presents with neurologic deficits, including cauda equina syndrome, due to bilateral sacral foraminal involvement.

Question 8983

Topic: 2. Trauma

A 45-year-old man undergoes an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture. What is the most common complication of this specific surgical approach?

. Sural nerve injury
. Wound healing problems and infection
. Tibial nerve entrapment
. Peroneal tendon subluxation
. Nonunion

Correct Answer & Explanation

. Wound healing problems and infection

Explanation

The extensile lateral approach to the calcaneus has a high rate of wound healing complications and dehiscence due to the tenuous vascular supply of the lateral skin flap.

Question 8984

Topic: 2. Trauma

A 20-year-old track athlete has vague midfoot pain for 3 months. Plain radiographs are normal. MRI confirms a non-displaced navicular stress fracture in the middle third of the bone. What is the initial recommended treatment?

. Non-weight-bearing short leg cast for 6 to 8 weeks
. Walking boot with immediate weight-bearing
. Open reduction and internal fixation with screws
. Extracorporeal shockwave therapy
. Excision of the navicular and talocuneiform arthrodesis

Correct Answer & Explanation

. Non-weight-bearing short leg cast for 6 to 8 weeks

Explanation

Uncomplicated, non-displaced navicular stress fractures are initially treated with strict non-weight-bearing immobilization in a cast for 6 to 8 weeks due to the high risk of nonunion from the avascular central third.

Question 8985

Topic: 2. Trauma

A 35-year-old male undergoes open reduction and internal fixation of a displaced intra-articular calcaneus fracture via an extensile lateral approach. Which of the following is the most significant modifiable risk factor for wound complications postoperatively?

. Obesity
. Smoking
. Hypertension
. Heavy alcohol use
. Delayed surgery by 2 weeks

Correct Answer & Explanation

. Smoking

Explanation

Smoking is the most significant modifiable risk factor for wound healing complications following the extensile lateral approach for calcaneus fractures. Delayed surgery until soft tissue swelling subsides actually decreases wound complication rates.

Question 8986

Topic: 2. Trauma
A 28-year-old male sustains a Hawkins type III fracture of the talar neck. Open reduction and internal fixation is performed. Which of the following radiographic signs at 6 to 8 weeks postoperatively indicates intact vascularity to the talar body?
. Sclerosis of the talar body
. Subchondral radiolucency in the talar dome
. Cystic changes in the talar head
. Complete obliteration of the subtalar joint
. Hypertrophic callus formation at the fracture site

Correct Answer & Explanation

. Subchondral radiolucency in the talar dome

Explanation

Hawkins sign is characterized by subchondral radiolucency of the talar dome on the mortise radiograph at 6-8 weeks. It indicates intact vascularity and active bone resorption, making the development of avascular necrosis unlikely.

Question 8987

Topic: 2. Trauma

A 20-year-old collegiate basketball player sustains an acute, minimally displaced fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Jones fracture). He wishes to return to play as soon as safely possible. What is the recommended treatment?

. Short leg walking boot for 6 weeks
. Non-weight-bearing short leg cast for 6 weeks
. Intramedullary screw fixation
. Plate and screw fixation
. Excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Intramedullary screw fixation is recommended for acute Jones fractures in high-level athletes. It significantly decreases the risk of nonunion and allows for a faster return to play compared to nonoperative management.

Question 8988

Topic: 2. Trauma
A 32-year-old man sustains a Hawkins type III talar neck fracture. Radiographs at 8 weeks post-ORIF show a subchondral lucency in the talar dome. What does this radiographic finding indicate?
. High likelihood of avascular necrosis
. Imminent collapse of the talar body
. Revascularization of the talar body
. Nonunion of the talar neck
. Deep prosthetic infection

Correct Answer & Explanation

. Revascularization of the talar body

Explanation

The Hawkins sign is a subchondral radiolucent band in the talar dome typically seen 6-8 weeks post-injury. It indicates intact vascularity and active bone resorption, demonstrating that the talar body is viable and not undergoing avascular necrosis.

Question 8989

Topic: 2. Trauma

A 55-year-old woman undergoes a calcaneal lengthening osteotomy (Evans procedure), FDL transfer, and medial displacement calcaneal osteotomy for Stage IIb adult-acquired flatfoot deformity. Postoperatively, she develops new-onset, deep aching pain over the lateral aspect of the midfoot. What is the most likely cause of this complication?

. Sural nerve entrapment
. Calcaneocuboid joint subluxation or arthritis
. Nonunion of the medial displacement osteotomy
. FDL transfer rupture
. Spring ligament failure

Correct Answer & Explanation

. Calcaneocuboid joint subluxation or arthritis

Explanation

The Evans lateral column lengthening procedure increases joint reactive forces across the calcaneocuboid (CC) joint. This commonly leads to CC joint subluxation or postoperative arthritis, which is a leading cause of lateral midfoot pain after this surgery.

Question 8990

Topic: 2. Trauma

A 22-year-old collegiate track athlete presents with insidious onset dorsal midfoot pain. A CT scan reveals an incomplete, non-displaced stress fracture of the tarsal navicular involving the dorsal cortex. What is the most appropriate initial management?

. Immediate open reduction and internal fixation with a compression screw
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Bone stimulator and continued training as tolerated
. Excision of the dorsal navicular fragment

Correct Answer & Explanation

. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks

Explanation

Non-displaced, incomplete navicular stress fractures are initially treated with strict non-weight-bearing in a cast for 6-8 weeks due to the high risk of nonunion from the avascular central third of the bone. Surgical fixation is reserved for displaced fractures, complete fractures, or symptomatic nonunions.

Question 8991

Topic: 2. Trauma

A 21-year-old college basketball player sustains an acute fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction (Zone 2) during a game. He wishes to return to play as quickly as possible. What is the recommended treatment?

. Non-weight-bearing cast for 6 weeks
. Intramedullary screw fixation
. Excision of the proximal fragment
. Plate and screw fixation
. Taping and immediate return to play

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) have a higher risk of delayed union or nonunion due to a vascular watershed area. In elite or high-demand athletes seeking early return to play, intramedullary screw fixation is recommended to reduce nonunion risk and accelerate functional recovery.

Question 8992

Topic: 2. Trauma

A 31-year-old man underwent open reduction and internal fixation of a displaced talar neck fracture 6 weeks ago. A follow-up AP mortise radiograph is obtained. Which of the following radiographic findings would be the most reliable indicator of intact talar vascularity?

. Diffuse sclerosis of the talar dome
. Subchondral radiolucency in the talar dome
. Narrowing of the tibiotalar joint space
. Periosteal reaction along the talar neck
. Cystic changes in the body of the talus

Correct Answer & Explanation

. Subchondral radiolucency in the talar dome

Explanation

Hawkins sign is a subchondral radiolucent band seen in the talar dome 6 to 8 weeks post-injury. It indicates active bone resorption secondary to hyperemia, confirming an intact vascular supply and a low risk of avascular necrosis.

Question 8993

Topic: 2. Trauma

A 21-year-old Division 1 basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal (Jones fracture). To minimize the risk of nonunion and expedite return to play, what is the recommended treatment?

. Non-weight-bearing cast for 6 weeks
. Weight-bearing as tolerated in a hard-soled shoe
. Open reduction and plate fixation
. Percutaneous intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Percutaneous intramedullary screw fixation

Explanation

Intramedullary screw fixation is recommended for acute Jones fractures in high-level athletes. It provides a faster return to sport and significantly lowers the rate of nonunion compared to conservative management.

Question 8994

Topic: 2. Trauma

When evaluating a displaced intra-articular calcaneus fracture, the Sanders classification is commonly used for preoperative planning and prognosis. This classification is primarily based on the number and location of fracture lines through which of the following structures?

. The anterior facet on sagittal CT images
. The middle facet on axial CT images
. The posterior facet on coronal CT images
. The calcaneocuboid joint on 3D reconstructed CT images
. The sustentaculum tali on transverse CT images

Correct Answer & Explanation

. The posterior facet on coronal CT images

Explanation

The Sanders classification is based on coronal CT sections that show the widest portion of the posterior facet of the calcaneus. It categorizes fractures based on the number of articular fracture fragments.

Question 8995

Topic: 2. Trauma

A 20-year-old track athlete presents with an insidious onset of vague dorsal midfoot pain. T1-weighted MRI demonstrates a linear band of low signal intensity in the central third of the tarsal navicular. The fracture is incomplete and non-displaced. What is the most appropriate initial treatment?

. Carbon-fiber shoe insert and continued training
. Weight-bearing in a controlled ankle motion (CAM) boot for 4 weeks
. Non-weight-bearing cast immobilization for 6 to 8 weeks
. Percutaneous retrograde screw fixation
. Extracorporeal shock wave therapy

Correct Answer & Explanation

. Non-weight-bearing cast immobilization for 6 to 8 weeks

Explanation

Navicular stress fractures occur in a relative "watershed" avascular zone. The initial treatment for acute, non-displaced fractures is strict non-weight-bearing cast immobilization for 6 to 8 weeks to prevent progression to complete fracture or nonunion.

Question 8996

Topic: 2. Trauma

A patient with a high-energy distal tibia "pilon" fracture presents to the emergency department. The soft tissue envelope is significantly swollen with blistering. What is the most widely accepted surgical strategy for managing this injury?

. Immediate definitive open reduction and internal fixation of the tibia and fibula
. Immediate intramedullary nailing of the tibia
. Spanning external fixation with delayed definitive internal fixation
. Closed reduction and long-leg cast immobilization
. Primary below-knee amputation

Correct Answer & Explanation

. Spanning external fixation with delayed definitive internal fixation

Explanation

High-energy pilon fractures are fraught with severe soft-tissue complications. The standard of care is a staged approach: immediate joint-spanning external fixation (with or without fibular fixation), followed by definitive ORIF once the soft tissue envelope recovers (appearance of skin wrinkles).

Question 8997

Topic: Lower Extremity Trauma

During closed reduction and internal fixation of a syndesmotic injury, an external rotation stress test is performed under fluoroscopy. Widening of the medial clear space greater than 4 mm is observed. This finding specifically indicates incompetence of which of the following structures?

. Anterior inferior tibiofibular ligament
. Calcaneofibular ligament
. Spring ligament
. Deep deltoid ligament
. Interosseous membrane

Correct Answer & Explanation

. Deep deltoid ligament

Explanation

The medial clear space on a mortise view evaluates the integrity of the deltoid ligament. Widening >4 mm during external rotation or gravity stress testing indicates rupture or incompetence of the deep deltoid ligament.

Question 8998

Topic: 2. Trauma

A 28-year-old male sustains an unstable ankle fracture requiring syndesmotic fixation. Which of the following factors is most strongly associated with a favorable long-term functional outcome following this procedure?

. Use of a tightrope construct over standard screws
. Placement of screws across four cortices instead of three
. Anatomic reduction of the distal tibiofibular joint
. Routine removal of the syndesmotic screws at 3 months
. Maintaining maximum dorsiflexion of the ankle during fixation

Correct Answer & Explanation

. Anatomic reduction of the distal tibiofibular joint

Explanation

The most significant predictor of good clinical outcome after syndesmotic injury is accurate, anatomic reduction of the distal tibiofibular joint. Ankle position during fixation and routine screw removal do not significantly alter long-term functional scores.

Question 8999

Topic: 2. Trauma

When performing an extensile lateral approach for open reduction and internal fixation of a displaced intra-articular calcaneus fracture, preserving the vascular supply to the lateral soft-tissue flap is critical. Which artery provides the primary blood supply to the apex of this flap?

. Anterior tibial artery
. Dorsalis pedis artery
. Lateral calcaneal artery
. Medial calcaneal artery
. Peroneal artery perforating branch

Correct Answer & Explanation

. Lateral calcaneal artery

Explanation

The lateral calcaneal artery, a branch of the peroneal artery, provides the primary blood supply to the lateral extensile flap. The incision should be full thickness to the bone to protect this vascular supply and prevent wound edge necrosis.

Question 9000

Topic: 2. Trauma

A 21-year-old collegiate soccer player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Jones fracture). Why is this specific anatomic location prone to delayed union and nonunion?

. High concentration of nutrient arteries causing hyperemic resorption
. It is a vascular watershed area with limited retrograde blood flow
. Constant distraction forces from the peroneus brevis tendon
. Constant distraction forces from the plantar fascia
. Excessive micromotion at the cuboid articulation

Correct Answer & Explanation

. It is a vascular watershed area with limited retrograde blood flow

Explanation

Zone 2 of the fifth metatarsal (Jones fracture) lies at the metaphyseal-diaphyseal junction, which represents a vascular watershed area. This tenuous blood supply significantly increases the risk of delayed union and nonunion.

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