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2. Trauma MCQs

Practice Set 487 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 9721

Topic: 2. Trauma

Which type of both bones forearm fracture has the highest risk of acute compartment syndrome?

. Simple, transverse diaphyseal fracture.
. Greenstick fracture in a child.
. Highly comminuted fracture with significant soft tissue injury.
. Distal metaphyseal fracture.
. Open fracture Gustilo-Anderson Type I.

Correct Answer & Explanation

. Highly comminuted fracture with significant soft tissue injury.

Explanation

Highly comminuted fractures with significant soft tissue injury (Option C), especially high-energy trauma, have the highest risk of acute compartment syndrome due to extensive tissue damage, hemorrhage, and swelling within the unyielding fascial compartments. While other fracture types can lead to compartment syndrome, high-energy, comminuted injuries are particularly prone. Open fractures (Option E) may actually have a lower risk if the wound provides a decompression effect, though they can still occur.

Question 9722

Topic: 2. Trauma

Following ORIF of a both bones forearm fracture, the patient develops a painful, stiff forearm with skin changes (shiny, thin), allodynia, and swelling out of proportion to the expected recovery. Plain radiographs show diffuse osteopenia. What is the most likely diagnosis?

. Delayed union
. Deep infection
. Complex Regional Pain Syndrome (CRPS) Type I
. Hardware failure
. Malunion

Correct Answer & Explanation

. Complex Regional Pain Syndrome (CRPS) Type I

Explanation

The described symptoms (pain, stiffness, shiny skin, allodynia, swelling, and diffuse osteopenia on X-ray) are classic features of Complex Regional Pain Syndrome (CRPS) Type I (formerly Reflex Sympathetic Dystrophy). This condition is a neuropathic pain disorder that can develop after trauma or surgery. Delayed union (Option A), infection (Option B), hardware failure (Option D), and malunion (Option E) would present with different clinical and radiographic findings, though CRPS can coexist with some of these.

Question 9723

Topic: 2. Trauma

What is the primary rationale for routinely assessing elbow and wrist joints in a patient with a suspected both bones forearm fracture?

. To look for signs of early osteomyelitis.
. To assess for carpal bone instability.
. To exclude associated injuries such as Monteggia or Galeazzi patterns.
. To evaluate the integrity of the growth plates.
. To confirm the patient's age.

Correct Answer & Explanation

. To exclude associated injuries such as Monteggia or Galeazzi patterns.

Explanation

The primary rationale for routinely assessing the elbow and wrist joints is to identify associated injuries such as Monteggia (ulnar fracture with radial head dislocation) or Galeazzi (radial fracture with distal radioulnar joint dislocation) fracture-dislocations (Option C). These are often missed if not specifically looked for and can significantly impact management and prognosis. While ligamentous injuries (Option B) can be associated, the major 'named' associated injuries are the Monteggia and Galeazzi patterns. Carpal tunnel syndrome (Option A) is a complication, not a reason for initial joint assessment. Severity (Option D) and remodeling potential (Option E) are assessed differently.

Question 9724

Topic: 2. Trauma

A fracture in which the bone fragments are separated by muscle or periosteum, making closed reduction impossible, is termed what?

. Impaction fracture.
. Stress fracture.
. Pathological fracture.
. Irreducible fracture.
. Comminuted fracture.

Correct Answer & Explanation

. Irreducible fracture.

Explanation

An irreducible fracture (Option D) is one where the fracture fragments cannot be anatomically reduced by closed means due to interposed soft tissues (muscle, periosteum) or severe comminution/displacement. This is a common indication for operative intervention in forearm fractures. Impaction (A) involves bone fragments driven together. Stress (B) is repetitive microtrauma. Pathological (C) is through diseased bone. Comminuted (E) means multiple fragments, which can be irreducible but isn't the definition of irreducibility due to soft tissue.

Question 9725

Topic: 2. Trauma

Which of the following physical examination findings is most indicative of early acute compartment syndrome in the forearm?

. Absence of a radial pulse.
. Pallor and coolness of the hand.
. Pain out of proportion to injury, especially with passive stretch.
. Numbness in the little finger.
. Visible ecchymosis and swelling.

Correct Answer & Explanation

. Pain out of proportion to injury, especially with passive stretch.

Explanation

Pain out of proportion to injury and pain with passive stretch of the digits (Option C) are the cardinal early signs of acute compartment syndrome. While late signs can include pulselessness (Option A) and pallor (Option B), these indicate severe, irreversible ischemia. Numbness (Option D) can be a sign of nerve compression, but 'pain with passive stretch' is considered more sensitive and specific for early diagnosis. Visible ecchymosis and swelling (Option E) are common with any fracture and not specific to compartment syndrome.

Question 9726

Topic: 2. Trauma

The primary cause of non-union in adult diaphyseal forearm fractures treated with plating is most commonly attributed to:

. Inadequate antibiotics.
. Early physiotherapy and mobilization.
. Excessive periosteal stripping during surgery.
. Inadequate stability/fixation.
. Smoking.

Correct Answer & Explanation

. Inadequate stability/fixation.

Explanation

Inadequate stability/fixation (Option D) is the most common mechanical cause of non-union in adult diaphyseal forearm fractures treated with plating. If the fixation is not rigid enough, excessive motion at the fracture site prevents primary bone healing and can lead to non-union. While excessive periosteal stripping (Option C) can compromise blood supply and contribute, and smoking (Option E) is a significant patient-related risk factor, the primary surgical cause is insufficient mechanical stability. Inadequate antibiotics (Option A) would lead to infection, and early physiotherapy (Option B) is desired with stable fixation.

Question 9727

Topic: 2. Trauma

A 5-year-old child presents with a radial shaft fracture distal to the pronator teres insertion, and an associated ulnar shaft fracture. How would the proximal radial fragment typically be displaced rotationally?

. Neutral position.
. Mild pronation.
. Supination.
. Marked pronation.
. Marked supination.

Correct Answer & Explanation

. Supination.

Explanation

If the radial shaft fracture is distal to the insertion of the pronator teres, the pronator teres is still attached to the proximal fragment. However, the powerful supinators (biceps brachii and supinator) still act on the proximal fragment, pulling it into supination (Option C). The distal fragment, which is now isolated from the pronator teres, will tend to follow the hand, or be pronated by the pronator quadratus. This is a common misconception; the pronator teres inserts mid-shaft, so if the fracture is distal to this, the proximal fragment is still supinated by the biceps and supinator.

Question 9728

Topic: 2. Trauma

Which of the following is an absolute contraindication to non-operative management of a closed diaphyseal both bones forearm fracture in an adult?

. Age over 60 years.
. Obesity.
. Inability to achieve acceptable reduction.
. Associated nerve palsy (e.g., median nerve neuropraxia).
. History of previous forearm fracture.

Correct Answer & Explanation

. Inability to achieve acceptable reduction.

Explanation

The inability to achieve acceptable reduction (Option C) or to maintain it is an absolute contraindication to non-operative management for adult diaphyseal forearm fractures. Adult remodeling potential is minimal, and malunion significantly impairs function. Age (A), obesity (B), or a history of previous fracture (E) are not absolute contraindications, though they might influence the decision-making process. Associated nerve palsy (D) may itself require intervention but does not, by definition, makeclosed reductioncontraindicated if acceptable alignment can be achieved and maintained.

Question 9729

Topic: 2. Trauma

Which of the following describes the most common mechanism of injury for both bones forearm fractures in adults?

. Low-energy fall from standing height.
. Twisting injury to the forearm.
. Direct blow or high-energy trauma.
. Repetitive stress or overuse.
. Avulsion injury from muscle contraction.

Correct Answer & Explanation

. Direct blow or high-energy trauma.

Explanation

In adults, both bones forearm fractures are typically the result of direct blows or high-energy trauma (Option C), such as motor vehicle accidents, falls from height, or sports injuries. These mechanisms generate sufficient force to break both the radius and ulna, often with significant displacement or comminution. Low-energy falls (Option A) are more common for distal radius fractures. Twisting injuries (Option B) can cause spiral fractures but less commonly involve both bones simultaneously unless very high energy.

Question 9730

Topic: 2. Trauma

What is the typical management of a refracture of a previously plated and healed adult both bones forearm fracture after hardware removal?

. Non-operative management with casting due to compromised bone.
. Repeat plating of the refracture, often with bone grafting.
. Intramedullary nailing of the refracture.
. External fixation.
. Observation and symptomatic treatment.

Correct Answer & Explanation

. Repeat plating of the refracture, often with bone grafting.

Explanation

Refracture after hardware removal, particularly in the adult forearm, is a known complication. The standard management is repeat open reduction and internal fixation with plating (Option B), often combined with bone grafting, especially if there's any concern about bone viability or delayed union. The refracture site can be weakened due to stress shielding and screw holes. Non-operative management (Option A) is rarely successful for adult diaphyseal refractures. IM nailing (Option C) or external fixation (Option D) are generally less preferred for this specific scenario unless there are complicating factors like infection or significant bone loss.

Question 9731

Topic: 2. Trauma

What is the purpose of contouring a dynamic compression plate (DCP) to the bone's anatomy before application in forearm fracture fixation?

. To increase the flexibility of the plate for easier insertion.
. To prevent stress shielding of the bone.
. To achieve precise anatomical reduction and direct compression across the fracture.
. To reduce the risk of infection by minimizing the gap between plate and bone.
. To allow for early weight-bearing.

Correct Answer & Explanation

. To achieve precise anatomical reduction and direct compression across the fracture.

Explanation

Contouring a dynamic compression plate (DCP) to match the bone's natural anatomy is crucial to achieve precise anatomical reduction and apply direct compression across the fracture site (Option C). This also prevents creation of gaps that can lead to malreduction or excessive stress on screws. Incorrect contouring can result in malreduction, gapping on one cortex, or uneven load distribution. It doesn't primarily increase flexibility (A), prevent stress shielding (B), reduce infection risk (D), or allow for early weight-bearing (E) beyond what rigid fixation already provides.

Question 9732

Topic: 2. Trauma

Which classification system is most commonly used for describing diaphyseal both bones forearm fractures in adults, particularly for surgical planning?

. Gustilo-Anderson classification.
. Salter-Harris classification.
. AO/OTA classification.
. Frykman classification.
. Mason classification.

Correct Answer & Explanation

. AO/OTA classification.

Explanation

The AO/OTA classification system (Option C) is the most comprehensive and widely used system for describing diaphyseal fractures, including those of the forearm (radius and ulna), in adults. It provides a standardized method for classifying fracture morphology, location, and severity, which is essential for surgical planning and communication among orthopedic surgeons. Gustilo-Anderson (A) is for open fractures. Salter-Harris (B) is for physeal fractures. Frykman (D) is for distal radius fractures. Mason (E) is for radial head fractures.

Question 9733

Topic: 2. Trauma

A 12-year-old child presents with a non-displaced mid-diaphyseal both bones forearm fracture. Radiographs show a fracture line but no cortical breach. What type of fracture is this most likely to be?

. Complete transverse fracture.
. Greenstick fracture.
. Torus fracture.
. Plastic deformation.
. Spiral fracture.

Correct Answer & Explanation

. Plastic deformation.

Explanation

Plastic deformation (Option D), also known as bowing fracture, occurs when the bone is bent beyond its elastic limit but does not overtly fracture or break its cortex (though microfractures occur). In children, particularly the ulna, this can occur. If there's a visible fracture line but no cortical breach, it indicates a high degree of deformity without macroscopic break. A Greenstick fracture (Option B) involves a break in one cortex and buckling of the other. A Torus fracture (Option C) is a buckle fracture, typically at the metaphysis. Complete (A) and spiral (E) fractures involve full cortical disruption.

Question 9734

Topic: 2. Trauma

What is the significance of obtaining an X-ray of the elbow and wrist joint after initial radiographs of a both bones forearm fracture showing isolated diaphyseal fractures?

. To look for signs of early osteomyelitis.
. To assess for carpal bone instability.
. To exclude associated injuries such as Monteggia or Galeazzi patterns.
. To evaluate the integrity of the growth plates.
. To confirm the patient's age.

Correct Answer & Explanation

. To exclude associated injuries such as Monteggia or Galeazzi patterns.

Explanation

The significance of obtaining X-rays of the joints above and below a forearm fracture is to exclude associated injuries, specifically Monteggia (ulnar fracture with radial head dislocation at the elbow) and Galeazzi (radial fracture with distal radioulnar joint dislocation at the wrist) patterns (Option C). These 'terrible triad' injuries of the forearm are often missed if not specifically looked for and carry significant implications for treatment and prognosis. This is a critical principle in fracture management.

Question 9735

Topic: 2. Trauma

Which of the following factors has the strongest association with the development of synostosis after both bones forearm fracture fixation?

. Type of internal fixation (plate vs. nail).
. Smoking history.
. High-energy trauma and extensive soft tissue injury.
. Age of the patient (pediatric vs. adult).
. Presence of an open fracture.

Correct Answer & Explanation

. High-energy trauma and extensive soft tissue injury.

Explanation

High-energy trauma with extensive soft tissue injury and prolonged operative time (Option C) are strongly associated with the development of synostosis (heterotopic ossification between the radius and ulna). The severity of the initial injury and the resultant soft tissue damage, combined with aggressive surgical dissection, seem to be key triggers. While other factors might play a role, severe soft tissue trauma stands out as a primary risk factor. The type of fixation (Option A) has some influence, but injury severity is more paramount. Open fractures (Option E) may also involve high energy but are not the sole determinant.

Question 9736

Topic: 2. Trauma

A 25-year-old female presents with a closed mid-diaphyseal both bones forearm fracture. She is pregnant. What is the most appropriate management strategy?

. Non-operative management with serial X-rays, avoiding surgery at all costs.
. Immediate operative fixation with plating, using minimal fluoroscopy.
. Delayed operative fixation after delivery, if non-operative fails.
. External fixation to minimize radiation exposure.
. Closed reduction and long-arm casting, with consideration for operative fixation if non-operative fails or is unacceptable.

Correct Answer & Explanation

. Closed reduction and long-arm casting, with consideration for operative fixation if non-operative fails or is unacceptable.

Explanation

For a pregnant patient, while avoiding radiation and surgery is ideal, an adult diaphyseal both bones forearm fracture often requires operative fixation for optimal functional outcome. Closed reduction and long-arm casting (Option E) should be attempted first. If an acceptable reduction cannot be achieved or maintained, then operative fixation with plating (Option B) is indicated, but with strict shielding and minimal fluoroscopy. Delaying fixation until after delivery (Option C) risks malunion in an adult. Non-operative 'at all costs' (Option A) or external fixation (Option D) are not ideal for definitive fixation in this scenario.

Question 9737

Topic: 2. Trauma

What is the main advantage of dynamic compression plates (DCP) over neutralization plates in the direct treatment of simple diaphyseal forearm fractures?

. DCPs are less stiff and allow for more physiological micromotion.
. DCPs provide direct axial compression at the fracture site.
. DCPs are easier to contour to complex bone shapes.
. DCPs are primarily designed for bridge plating comminuted fractures.
. DCPs allow for earlier hardware removal.

Correct Answer & Explanation

. DCPs provide direct axial compression at the fracture site.

Explanation

Dynamic compression plates (DCPs) derive their name from their ability to create direct axial compression across a fracture site as the screws are tightened into their eccentric holes (Option B). This compression promotes primary bone healing. Neutralization plates primarily protect lag screws or provide stability against bending/torsion without actively compressing the fracture. DCPs are not less stiff (A) – rigid fixation is sought. Ease of contouring (C) is not a specific advantage. They are not primarily for bridge plating (D) (locking plates are often preferred). Earlier hardware removal (E) is not a direct advantage of DCP mechanics.

Question 9738

Topic: 2. Trauma

A patient with a both bones forearm fracture requiring ORIF has a history of poorly controlled diabetes and peripheral vascular disease. Which specific intraoperative consideration is paramount?

. Using smaller plates and screws to minimize bone trauma.
. Aggressive periosteal stripping to improve fracture visualization.
. Maintaining meticulous hemostasis and minimizing soft tissue dissection.
. Performing a fasciotomy prophylactically.
. Administering a higher dose of prophylactic antibiotics.

Correct Answer & Explanation

. Maintaining meticulous hemostasis and minimizing soft tissue dissection.

Explanation

In patients with poorly controlled diabetes and peripheral vascular disease, maintaining meticulous hemostasis and minimizing soft tissue dissection (Option C) are paramount. These patients have compromised microvascularity, making them highly susceptible to impaired wound healing, infection, and flap necrosis. Excessive soft tissue damage or hematoma formation can further exacerbate these risks. Prophylactic fasciotomy (D) is not indicated unless compartment syndrome is confirmed or highly suspected. While higher dose antibiotics (E) may be considered, meticulous surgical technique is more critical. Minimizing bone trauma (A) is good but less crucial than soft tissue. Aggressive periosteal stripping (B) is detrimental.

Question 9739

Topic: 2. Trauma

What is the typical timeframe for hardware removal (plates and screws) after a well-healed adult both bones forearm fracture?

. 3-6 months.
. 6-9 months.
. 12-18 months.
. 24-36 months.
. Hardware is rarely removed unless symptomatic.

Correct Answer & Explanation

. 12-18 months.

Explanation

Hardware removal (plates and screws) in adults after a well-healed both bones forearm fracture is typically performed at 12-18 months (Option C) post-operatively. This timeframe allows for complete bone healing and cortical remodeling, reducing the risk of refracture through screw holes. Earlier removal increases refracture risk. While hardware removal is not always mandatory, it is often performed in younger, active individuals to prevent complications like stress shielding, refracture, and irritation. Option E is often true for other anatomical sites, but in the forearm, removal is more common due to the unique mechanics and high functional demand.

Question 9740

Topic: 2. Trauma

Which post-operative complication is uniquely addressed by placing the forearm in neutral rotation or slight supination post-operatively after plating of both bones forearm fractures, particularly for proximal radial fractures?

. Non-union.
. Synostosis.
. Hardware failure.
. Acute compartment syndrome.
. Refracture.

Correct Answer & Explanation

. Synostosis.

Explanation

Placing the forearm in neutral rotation or slight supination post-operatively, especially after plating proximal radial fractures, is specifically aimed at reducing the risk of synostosis (Option B). This position aims to minimize tension on the interosseous membrane and reduce potential inflammatory response that can lead to heterotopic ossification between the radius and ulna, which is a major complication impairing forearm rotation. The other complications are not directly addressed by this specific rotational positioning.

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