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2. Trauma MCQs

Practice Set 452 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 9021

Topic: Lower Extremity Trauma

Which of the following radiographic parameters on a standard mortise ankle radiograph is the most reliable direct indicator of a syndesmotic injury?

. Medial clear space greater than 4 mm
. Tibiofibular overlap less than 1 mm
. Tibiofibular clear space greater than 6 mm
. Talocrural angle less than 75 degrees
. Talar tilt greater than 5 degrees

Correct Answer & Explanation

. Tibiofibular clear space greater than 6 mm

Explanation

A tibiofibular clear space greater than 6 mm, measured 1 cm proximal to the joint line on AP and mortise views, is a reliable direct radiographic indicator of syndesmotic widening. Normal tibiofibular clear space is < 6 mm.

Question 9022

Topic: 2. Trauma

A 19-year-old elite collegiate basketball player complains of lateral foot pain after a cutting maneuver. A radiograph is shown.

What is the recommended treatment to minimize nonunion and expedite return to play?

. Hard-soled shoe and weight-bearing as tolerated
. Short leg walking cast for 6 weeks
. Non-weight bearing cast for 8 weeks
. Intramedullary screw fixation
. Plate and screw construct with bone grafting

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

The clinical scenario and typical imaging describe a true Jones fracture (Zone 2 of the 5th metatarsal base). In high-demand athletes, early intramedullary screw fixation is recommended to reduce nonunion risk and allow faster return to sport.

Question 9023

Topic: 2. Trauma



A 65-year-old woman sustained a 3-part proximal humerus fracture. Open reduction and internal fixation with a locking plate was performed. At 3-month follow-up, radiographs demonstrate varus collapse of the humeral head and intra-articular screw penetration. What is the most critical technical factor at the time of index surgery to prevent this complication?

. Use of a deltopectoral instead of a deltoid-splitting approach
. Placement of an inferomedial calcar screw
. Tying the rotator cuff to the plate
. Using unicortical rather than bicortical screws in the diaphysis
. Placing the plate lateral to the bicipital groove

Correct Answer & Explanation

. Placement of an inferomedial calcar screw

Explanation

Loss of medial column support leads to varus collapse after proximal humerus fracture fixation. Placement of an inferomedial calcar screw into the inferomedial quadrant of the humeral head provides structural support and significantly reduces this risk.

Question 9024

Topic: Upper Extremity Trauma
A 28-year-old cyclist fell onto his shoulder point. Radiographs reveal a Type III acromioclavicular (AC) joint injury (100% superior translation of the clavicle). What is the consensus regarding initial management?
. Immediate hook plate fixation
. Nonoperative management with a sling and early range of motion
. Coracoclavicular ligament reconstruction using a semitendinosus autograft
. Arthroscopic tight-rope fixation
. Distal clavicle excision

Correct Answer & Explanation

. Nonoperative management with a sling and early range of motion

Explanation

The initial management for uncomplicated Type III AC joint injuries is nonoperative, focusing on brief sling immobilization and early range of motion. Surgery is generally reserved for patients who remain symptomatic after conservative care.

Question 9025

Topic: 2. Trauma

A 65-year-old woman sustains a 3-part proximal humerus fracture involving the surgical neck and greater tuberosity.

If an open reduction and internal fixation (ORIF) is performed, what is the most important radiographic predictor of postoperative avascular necrosis of the humeral head?

. Length of the metaphyseal extension
. Integrity of the medial calcar hinge
. Number of locking screws in the humeral head
. Concomitant lesser tuberosity fracture
. Age of the patient

Correct Answer & Explanation

. Integrity of the medial calcar hinge

Explanation

Disruption of the medial calcar hinge significantly increases the risk of avascular necrosis. It indicates severe soft-tissue and periosteal stripping, jeopardizing the blood supply from the circumflex humeral vessels.

Question 9026

Topic: Upper Extremity Trauma
A 30-year-old cyclist falls directly onto his shoulder. Radiographs show 150% superior displacement of the distal clavicle relative to the acromion. Which ligaments are disrupted?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament only
. Sternoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

Displacement greater than 100% indicates a high-grade acromioclavicular joint injury (Type III or V). This requires complete disruption of both the acromioclavicular (AC) and coracoclavicular (CC) ligament complexes.

Question 9027

Topic: Upper Extremity Trauma

A 30-year-old cyclist falls directly onto his right shoulder. Radiographs demonstrate 150% superior displacement of the distal clavicle relative to the acromion, and the coracoclavicular distance is more than doubled compared to the contralateral side. What is the most appropriate management for this Rockwood Type V acromioclavicular (AC) joint injury?

. Sling immobilization for 2 weeks followed by physical therapy
. Distal clavicle excision alone
. Coracoclavicular (CC) ligament reconstruction or operative fixation
. Acromionectomy
. Corticosteroid injection into the AC joint

Correct Answer & Explanation

. Coracoclavicular (CC) ligament reconstruction or operative fixation

Explanation

Rockwood Type V injuries involve severe superior displacement (>100%) due to disruption of both the AC and CC ligaments, along with stripping of the deltotrapezial fascia. Operative intervention (CC ligament reconstruction/fixation) is generally indicated for Type V injuries to restore mechanics and alleviate pain.

Question 9028

Topic: 2. Trauma

A 65-year-old female sustains a displaced 3-part proximal humerus fracture after a ground-level fall. On examination, she has decreased pinprick sensation over the lateral aspect of her shoulder. Based on this neurologic deficit, what additional clinical finding is she most likely to exhibit once pain allows for strength testing?

. Weakness in elbow extension
. Weakness in internal rotation
. Weakness in external rotation and abduction
. Inability to flex the thumb interphalangeal joint
. Winging of the scapula

Correct Answer & Explanation

. Weakness in external rotation and abduction

Explanation

Decreased sensation over the lateral shoulder indicates an axillary nerve injury, which is the most common nerve injured in proximal humerus fractures. The axillary nerve innervates the deltoid (abduction) and the teres minor (external rotation).

Question 9029

Topic: 2. Trauma

In the evaluation of a displaced proximal humerus fracture, which of the following criteria described by Hertel is the strongest radiographic predictor of humeral head ischemia?

. Calcar length greater than 8 mm
. Disruption of the medial periosteal hinge
. Fracture extension into the bicipital groove
. Diaphyseal comminution
. Varus angulation of 20 degrees

Correct Answer & Explanation

. Calcar length greater than 8 mm

Explanation

Hertel's criteria for a high risk of avascular necrosis (ischemia) after proximal humerus fractures include a calcar length of less than 8 mm, disruption of the medial periosteal hinge, and an anatomic neck fracture pattern.

Question 9030

Topic: 2. Trauma

A 19-year-old man presents to the trauma bay after a high-speed motor vehicle collision. He complains of shortness of breath and difficulty swallowing. His left clavicle is clinically absent medially. A CT scan confirms a posterior sternoclavicular dislocation. What is the most critical logistical step before attempting closed reduction?

. Administering intravenous broad-spectrum antibiotics
. Applying a figure-of-eight harness
. Ensuring a cardiothoracic surgeon is immediately available in the OR
. Performing a diagnostic angiogram
. Placing a chest tube on the contralateral side

Correct Answer & Explanation

. Ensuring a cardiothoracic surgeon is immediately available in the OR

Explanation

Posterior sternoclavicular dislocations can compress or tear the great vessels, trachea, or esophagus. Closed reduction should be performed in the operating room with a cardiothoracic surgeon available in case of catastrophic vascular injury during reduction.

Question 9031

Topic: 2. Trauma

A 68-year-old woman sustains a displaced 4-part proximal humerus fracture. According to Hertel's criteria, which of the following radiographic findings is the strongest predictor of ensuing humeral head ischemia?

. Metaphyseal head extension (calcar length) less than 8 mm
. Intact medial hinge
. Greater tuberosity displacement of 5 mm
. Valgus impaction of the head

Correct Answer & Explanation

. Metaphyseal head extension (calcar length) less than 8 mm

Explanation

Hertel's criteria for predicting ischemia of the humeral head include a calcar length of less than 8 mm, disruption of the medial hinge, and an anatomic neck fracture pattern. These factors indicate severe disruption of the vascular supply to the articular segment.

Question 9032

Topic: Upper Extremity Trauma

In a severe acromioclavicular (AC) joint separation, the coracoclavicular (CC) ligaments are disrupted. Which of the following accurately describes the relative anatomy and function of the intact CC ligaments?

. The conoid is lateral to the trapezoid and resists horizontal translation
. The trapezoid is medial to the conoid and resists horizontal translation
. The conoid is medial to the trapezoid and resists superior translation
. The trapezoid is medial to the conoid and resists superior translation
. The conoid is lateral to the trapezoid and resists superior translation

Correct Answer & Explanation

. The conoid is medial to the trapezoid and resists superior translation

Explanation

The conoid ligament is situated medial to the trapezoid ligament and provides the primary restraint against superior translation of the clavicle. The trapezoid provides primary restraint to axial compression.

Question 9033

Topic: Upper Extremity Trauma

A 25-year-old male weightlifter complains of superior shoulder pain localized to the AC joint during bench press. Radiographs reveal subchondral cysts and osteopenia of the distal clavicle. If 6 months of conservative management fails, what is the most appropriate surgical intervention?

. Weaver-Dunn procedure
. Coracoclavicular ligament reconstruction
. Distal clavicle excision
. Acromioclavicular joint fusion
. Subacromial decompression

Correct Answer & Explanation

. Distal clavicle excision

Explanation

Distal clavicle osteolysis commonly affects weightlifters. If nonoperative treatment (rest, NSAIDs, injections) fails, arthroscopic or open distal clavicle excision provides reliable symptomatic relief.

Question 9034

Topic: Upper Extremity Trauma



During an anatomic coracoclavicular (CC) ligament reconstruction for a chronic Type V acromioclavicular joint separation, the surgeon drills tunnels in the clavicle to recreate the conoid and trapezoid ligaments. To accurately replicate native anatomy, the conoid tunnel should be placed approximately:

. 25 mm medial to the distal clavicle and anterior
. 25 mm medial to the distal clavicle and posterior
. 45 mm medial to the distal clavicle and posterior
. 45 mm medial to the distal clavicle and anterior
. 15 mm medial to the distal clavicle and central

Correct Answer & Explanation

. 45 mm medial to the distal clavicle and posterior

Explanation

The conoid ligament inserts approximately 45 mm medial to the distal end of the clavicle on its posterior aspect. The trapezoid ligament inserts more laterally (approximately 25 mm medial) and anteriorly.

Question 9035

Topic: Upper Extremity Trauma

A 14-year-old elite Little League pitcher presents with progressive, insidious-onset throwing arm shoulder pain. Radiographs demonstrate widening and irregularity of the proximal humeral physis compared to the contralateral side. What is the standard of care for this condition?

. Surgical pinning of the epiphysis
. Arthroscopic SLAP repair
. Corticosteroid injection into the subacromial space
. Absolute cessation of throwing for 3 months followed by a progressive return
. Immediate physical therapy emphasizing aggressive internal rotation stretching

Correct Answer & Explanation

. Absolute cessation of throwing for 3 months followed by a progressive return

Explanation

Little League shoulder is an epiphysiolysis of the proximal humerus caused by repetitive torsional stress. It is managed nonoperatively with complete cessation of throwing (typically 3 months) until symptoms resolve and radiographs normalize.

Question 9036

Topic: 2. Trauma

A 75-year-old woman sustains a displaced 4-part proximal humerus fracture.

If open reduction and internal fixation is attempted, which of the following initial radiographic findings is the most reliable predictor of subsequent humeral head avascular necrosis?

. Displacement of the greater tuberosity by more than 5 mm
. Varus angulation of the humeral head of 10 degrees
. Length of the posteromedial metaphyseal head extension (calcar) less than 8 mm
. Intact medial periosteal hinge
. Associated surgical neck fracture comminution

Correct Answer & Explanation

. Length of the posteromedial metaphyseal head extension (calcar) less than 8 mm

Explanation

According to Hertel's criteria, a posteromedial metaphyseal head extension (calcar length) of less than 8 mm and disruption of the medial periosteal hinge are the strongest predictors of ischemia. These indicators suggest severe compromise to the ascending branches of the anterior humeral circumflex artery and capsular vessels.

Question 9037

Topic: 2. Trauma

A 70-year-old woman sustains a 3-part proximal humerus fracture treated with open reduction and internal fixation using a locking plate. Postoperatively, she develops severe shoulder pain and crepitus with range of motion. What is the most common complication associated with this specific fixation method?

. Nonunion
. Axillary nerve palsy
. Primary screw cut-out into the joint
. Hardware failure (plate breakage)
. Avascular necrosis of the humeral head

Correct Answer & Explanation

. Primary screw cut-out into the joint

Explanation

Primary or secondary screw cut-out into the articular space is the most frequent complication following locked plating of proximal humerus fractures, particularly in osteoporotic bone.

Question 9038

Topic: 2. Trauma

A 65-year-old right-hand-dominant woman sustains the proximal humerus fracture shown in Figure 17 after a fall from a standing height.

According to Hertel's radiographic criteria, which of the following fracture characteristics is the most reliable predictor of humeral head ischemia and subsequent avascular necrosis?

. Metaphyseal head extension (calcar length) less than 8 mm
. An intact medial calcar hinge
. Fracture line exiting strictly through the surgical neck
. Greater tuberosity displacement exceeding 5 mm
. Varus angulation of the articular segment

Correct Answer & Explanation

. Metaphyseal head extension (calcar length) less than 8 mm

Explanation

Hertel identified a metaphyseal head extension (calcar length attached to the articular segment) of less than 8 mm, disruption of the medial hinge, and a basicervical (anatomic neck) fracture pattern as the most reliable predictors of humeral head ischemia. A short calcar segment indicates severe disruption of the vascular supply from the ascending branch of the anterior humeral circumflex artery and intraosseous vessels.

Question 9039

Topic: Upper Extremity Trauma
A 28-year-old cyclist falls directly onto his shoulder. Radiographs reveal 100% superior displacement of the clavicle relative to the acromion, with the clavicle displaced posteriorly into the trapezius fascia on the axillary lateral view. What is the Rockwood classification and optimal management for this injury?
. Type III; nonoperative management
. Type IV; surgical reconstruction
. Type V; nonoperative management
. Type VI; surgical reconstruction
. Type II; nonoperative management

Correct Answer & Explanation

. Type IV; surgical reconstruction

Explanation

A Rockwood Type IV AC joint separation involves posterior displacement of the distal clavicle into or through the trapezius fascia. Because it is highly symptomatic and functionally limiting, it generally requires surgical reduction and stabilization.

Question 9040

Topic: 2. Trauma

Which of the following arteries is considered the predominant blood supply to the humeral head, making its preservation critical during proximal humerus fracture fixation?

. Anterior humeral circumflex artery
. Posterior humeral circumflex artery
. Thoracoacromial artery
. Subscapular artery
. Suprascapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Recent anatomical perfusion studies have demonstrated that the posterior humeral circumflex artery provides the predominant blood supply to the humeral head (approximately 64%). This contrasts with older literature which favored the anterior humeral circumflex.

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