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2. Trauma MCQs

Practice Set 451 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 9001

Topic: 2. Trauma

Six weeks following open reduction and internal fixation of a Hawkins type II talar neck fracture, a radiograph is obtained. A subchondral radiolucent band is seen in the talar dome (Hawkins sign). What does this radiographic finding indicate?

. Impending avascular necrosis of the talar body
. Complete avascular necrosis of the talar body
. Intact vascularity to the talar body
. Subchondral fracture propagation
. Infection of the tibiotalar joint

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

A positive Hawkins sign is a subchondral radiolucent band representing subchondral osteopenia. It indicates intact vascularity to the talar body because hyperemic bone resorption requires active blood flow.

Question 9002

Topic: 2. Trauma

A 20-year-old collegiate sprinter presents with 2 months of insidious onset midfoot pain, worse during practice. Tenderness is noted at the dorsal aspect of the navicular. CT scan reveals an incomplete, nondisplaced stress fracture involving the dorsal cortex of the navicular. What is the recommended initial management?

. Weight-bearing in a CAM boot for 6 weeks
. Non-weight-bearing in a short leg cast for 6 to 8 weeks
. Open reduction and internal fixation with a compression screw
. Extracorporeal shockwave therapy
. Ultrasound bone stimulation while wearing supportive shoes

Correct Answer & Explanation

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

Explanation

Incomplete, nondisplaced navicular stress fractures have a high risk of nonunion if subjected to mechanical stress. They are best treated initially with strict non-weight-bearing in a cast for 6-8 weeks.

Question 9003

Topic: 2. Trauma

A 28-year-old professional basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal. He wishes to return to play as soon as possible. A radiograph of a similar fracture is shown in the figure.

What is the optimal surgical treatment?

. Intramedullary screw fixation
. Tension band wiring
. Plantar plating
. Closed reduction and percutaneous pinning
. Nonoperative management in a hard-soled shoe

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Intramedullary screw fixation is the gold standard for high-level athletes with acute Zone 2 (Jones) fractures. It minimizes the risk of nonunion and expedites the return to professional play.

Question 9004

Topic: 2. Trauma

A 40-year-old male construction worker falls from a ladder, sustaining a highly comminuted, displaced intra-articular calcaneus fracture (Sanders type IV). He is a heavy smoker (2 packs per day). What is the most appropriate surgical management to minimize wound complications while providing definitive treatment?

. Open reduction and internal fixation via an extensile lateral approach
. Primary subtalar arthrodesis via a percutaneous or limited approach
. Percutaneous pinning alone
. Ilizarov external fixation
. Conservative management in a cast

Correct Answer & Explanation

. Primary subtalar arthrodesis via a percutaneous or limited approach

Explanation

Sanders type IV fractures are highly comminuted and have poor outcomes with ORIF. In a high-risk patient (heavy smoker), primary subtalar arthrodesis via a minimal incision minimizes disastrous soft-tissue necrosis while addressing the severe articular damage.

Question 9005

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. It extends into the fourth-fifth intermetatarsal articulation. What is the most appropriate treatment to minimize time to return to play?

. Non-weight-bearing cast for 6-8 weeks
. Weight-bearing in a stiff-soled boot for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Primary excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

A Zone 2 (Jones) fracture in an elite athlete has a high risk of nonunion or delayed union due to the watershed blood supply. Intramedullary screw fixation is recommended to accelerate healing and minimize the time to return to play.

Question 9006

Topic: 2. Trauma

A 21-year-old collegiate basketball player complains of lateral foot pain for 3 weeks and presents with an acute exacerbation after a pivot mechanism. Radiographs reveal a fracture through the proximal metaphyseal-diaphyseal junction of the fifth metatarsal. Which of the following treatments is the most appropriate management to optimize his return to play?

. Non-weight-bearing in a short-leg cast for 6 weeks
. Weight-bearing as tolerated in a hard-soled shoe
. Excision of the proximal fragment with peroneus brevis advancement
. Intramedullary screw fixation
. External fixation spanning the calcaneocuboid joint

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

A fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Jones fracture) occurs in a vascular watershed area. High-level athletes require surgical intervention with intramedullary screw fixation to minimize the risk of nonunion and expedite return to sport.

Question 9007

Topic: Lower Extremity Trauma

A 28-year-old skier presents with acute lateral ankle pain after catching an edge. Physical examination reveals tenderness posterior to the lateral malleolus and a snapping sensation with resisted active dorsiflexion and eversion. Radiographs show a small bony avulsion flake lateral to the distal fibula. What is the most likely mechanism of this specific injury?

. Inversion and plantarflexion with an axially loaded limb
. Direct crush injury to the lateral ankle
. Hyper-plantarflexion with internal rotation of the tibia
. Sudden forceful dorsiflexion with eversion of the foot
. Gradual repetitive microtrauma from tight footwear

Correct Answer & Explanation

. Sudden forceful dorsiflexion with eversion of the foot

Explanation

The clinical presentation and "fleck sign" on radiographs describe a superior peroneal retinaculum (SPR) avulsion and subsequent peroneal tendon subluxation. This injury classically occurs via sudden, forceful dorsiflexion combined with reflex contraction of the peroneal muscles during forced eversion.

Question 9008

Topic: 2. Trauma

A 35-year-old man sustains a closed, high-energy tibial pilon fracture. Initial management consists of a spanning external fixator. Before proceeding with definitive open reduction and internal fixation (ORIF), the surgeon must ensure the soft tissue envelope is adequately recovered. Which clinical sign is the most reliable indicator that it is safe to proceed with definitive surgery?

. Resolution of all ecchymosis
. Return of palpable pedal pulses
. Erythrocyte sedimentation rate (ESR) returning to normal
. Presence of clear serous drainage from the pin sites
. Appearance of skin wrinkles upon gentle compression

Correct Answer & Explanation

. Appearance of skin wrinkles upon gentle compression

Explanation

The most reliable clinical sign that swelling has resolved sufficiently to safely perform definitive internal fixation of a pilon fracture is the return of skin wrinkles (the "wrinkle sign"). This typically occurs 10 to 14 days after the initial injury.

Question 9009

Topic: 2. Trauma
A 30-year-old male sustains a high-energy motor vehicle accident resulting in a Hawkins Type III talar neck fracture. What is the approximate reported risk of developing avascular necrosis (AVN) of the talar body in this injury pattern?
. 0-10%
. 15-30%
. 35-50%
. 75-100%
. AVN does not occur in Type III fractures

Correct Answer & Explanation

. 75-100%

Explanation

Hawkins Type III fractures involve displacement of the talar neck with subluxation or dislocation of both the subtalar and tibiotalar joints. This severely disrupts the blood supply, resulting in a 75-100% risk of AVN.

Question 9010

Topic: 2. Trauma

A 42-year-old roofer falls from a height and sustains a severely displaced intra-articular calcaneus fracture. It is treated with an extensile lateral approach and plate fixation. Three months postoperatively, he complains of clawing of his lesser toes and numbness on the plantar aspect of his foot. Which of the following is the most likely cause?

. Sural nerve entrapment in the surgical incision
. Flexor hallucis longus tethering at the sustentaculum tali
. Undiagnosed compartment syndrome of the foot
. Malunion of the calcaneus with varus heel alignment
. Complex regional pain syndrome

Correct Answer & Explanation

. Undiagnosed compartment syndrome of the foot

Explanation

Undiagnosed compartment syndrome of the deep calcaneal or intrinsic foot compartments following high-energy fracture leads to ischemic contracture of the intrinsic muscles. This typically manifests as clawing of the toes and persistent plantar numbness.

Question 9011

Topic: 2. Trauma
A 31-year-old male sustains a Hawkins Type III talar neck fracture and undergoes urgent open reduction and internal fixation. At 8 weeks postoperatively, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome. What does this radiographic finding indicate?
. Avascular necrosis of the entire talar body
. Impending nonunion of the talar neck
. Subchondral collapse requiring salvage arthrodesis
. Revascularization and preserved blood supply to the talar body
. Osteomyelitis of the talar dome

Correct Answer & Explanation

. Revascularization and preserved blood supply to the talar body

Explanation

A subchondral radiolucent band on the talar dome at 6 to 8 weeks is known as the Hawkins sign. It represents subchondral osteopenia due to active hyperemia, indicating intact vascularity and ruling out complete avascular necrosis of the talar body.

Question 9012

Topic: 2. Trauma

A 22-year-old professional soccer player sustains an acute Zone 2 fifth metatarsal base fracture. He wishes to return to play as soon as possible. What is the most appropriate surgical treatment?

. Closed reduction and percutaneous pinning
. Open reduction and internal fixation with a tension band construct
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement
. Plantar plating

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) in elite athletes are best treated with intramedullary screw fixation to minimize nonunion risk and expedite return to play. The screw threads must cross the fracture site completely for adequate compression.

Question 9013

Topic: 2. Trauma

A 35-year-old construction worker falls from a scaffold, sustaining a severe high-energy comminuted tibial plafond (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 with dual plating
. Spanning external fixation and delayed definitive fixation in 10-14 days
. Intramedullary nailing
. Primary arthrodesis
. Closed reduction and long leg cast

Correct Answer & Explanation

. Spanning external fixation and delayed definitive fixation in 10-14 days

Explanation

High-energy pilon fractures are associated with massive soft tissue injury. The standard of care is a staged protocol: initial spanning external fixation until the soft tissue envelope recovers (typically 10-14 days), followed by definitive ORIF.

Question 9014

Topic: 2. Trauma

A 24-year-old professional football player sustains an acute Jones fracture (Zone 2) of the fifth metatarsal. Which of the following is the most appropriate management?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight bearing as tolerated in a hard-soled shoe
. Intramedullary screw fixation
. Excision of the proximal fragment
. Plate and screw fixation

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

In high-level athletes, intramedullary screw fixation of acute Zone 2 fifth metatarsal fractures (Jones fractures) is recommended to decrease nonunion risk and expedite return to play compared to conservative management.

Question 9015

Topic: 2. Trauma
A 30-year-old male sustains a Hawkins type III talar neck fracture following a motor vehicle accident. What is the expected rate of avascular necrosis (AVN) of the talar body?
. Less than 10%
. 15-25%
. 40-50%
. 75-100%
. 0%

Correct Answer & Explanation

. 75-100%

Explanation

A Hawkins type III fracture is a talar neck fracture with subtalar and tibiotalar dislocation, disrupting all three major blood supplies to the talar body. The risk of AVN is exceptionally high, approaching 75-100%.

Question 9016

Topic: 2. Trauma

An elite collegiate basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal. To minimize the risk of nonunion and expedite his return to play, which of the following treatments is most appropriate?

. Hard-soled shoe with full weight-bearing as tolerated
. Non-weight-bearing in a short leg cast for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Excision of the proximal pole fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) occur at the metaphyseal-diaphyseal junction, a watershed vascular area prone to nonunion. In high-level athletes, early intramedullary screw fixation is recommended to reduce nonunion rates and accelerate return to sport.

Question 9017

Topic: 2. Trauma

A 19-year-old track athlete presents with insidious onset of vague midfoot pain that worsens with sprinting. Imaging reveals a stress fracture of the tarsal navicular. This fracture most commonly occurs in which anatomic region of the bone?

. Medial third
. Central third
. Lateral third
. Plantar tuberosity
. Dorsal articular margin

Correct Answer & Explanation

. Central third

Explanation

Tarsal navicular stress fractures predominantly occur in the central third of the bone in the sagittal plane. This area represents a relatively avascular watershed zone, making it highly susceptible to fatigue failure and nonunion.

Question 9018

Topic: 2. Trauma

A 38-year-old construction worker falls from scaffolding, sustaining a high-energy comminuted tibial pilon fracture with severe fracture blisters and massive soft tissue edema. What is the most appropriate initial management?

. Primary ankle arthrodesis
. Immediate ORIF of the distal tibia
. Spanning external fixation and delayed ORIF
. Intramedullary nailing of the tibia
. Non-weight bearing in a long leg cast

Correct Answer & Explanation

. Spanning external fixation and delayed ORIF

Explanation

High-energy pilon fractures are fraught with severe soft-tissue complications if operated on acutely. The standard of care is a staged protocol: initial spanning external fixation to allow soft tissues to recover, followed by definitive ORIF 1 to 3 weeks later.

Question 9019

Topic: 2. Trauma

A 22-year-old elite collegiate basketball player presents with acute midfoot pain after a cutting maneuver. Radiographs demonstrate a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, extending into the fourth-fifth intermetatarsal articulation. What is the most appropriate management for this patient to minimize the risk of nonunion and expedite return to play?

. Stiff-soled shoe with progressive weight-bearing as tolerated
. Short leg non-weight-bearing cast for 6 to 8 weeks
. Intramedullary screw fixation
. Closed reduction and percutaneous K-wire fixation
. Open reduction and internal fixation with a mini-fragment plate

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Zone 2 (Jones) fracture. In elite athletes, early intramedullary screw fixation is recommended to significantly decrease the time to union and lower the high rate of nonunion associated with conservative management.

Question 9020

Topic: Lower Extremity Trauma

When evaluating an ankle mortise radiograph for a suspected syndesmotic injury, which of the following radiographic parameters is the most reliable indicator of syndesmotic diastasis?

. Tibiofibular clear space > 5 mm measured 1 cm above the joint line
. Tibiofibular overlap < 10 mm on the AP view
. Medial clear space > 4 mm with the foot in neutral
. Talar tilt > 5 degrees on stress view
. Lateral clear space > 3 mm

Correct Answer & Explanation

. Tibiofibular clear space > 5 mm measured 1 cm above the joint line

Explanation

A tibiofibular clear space greater than 5 mm (measured 1 cm proximal to the tibial plafond) is the most reliable radiographic parameter for detecting syndesmotic widening on both AP and mortise views.

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