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2. Trauma MCQs

Practice Set 489 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 9761

Topic: 2. Trauma

What is an 'Essex-Lopresti lesion', and why is it sometimes considered a 'Galeazzi equivalent' in terms of forearm instability?

. A fracture of the distal ulna with radial head dislocation
. A comminuted distal radius fracture with carpal subluxation
. A radial head fracture with disruption of the interosseous membrane and DRUJ instability
. A nonunion of the scaphoid with concomitant TFCC tear
. A dislocation of the lunate without a fracture

Correct Answer & Explanation

. A radial head fracture with disruption of the interosseous membrane and DRUJ instability

Explanation

The Essex-Lopresti lesion is a fracture of the radial head with associated disruption of the interosseous membrane (IOM) and distal radioulnar joint (DRUJ) instability. It is considered a 'Galeazzi equivalent' because, like a Galeazzi, it results in longitudinal instability of the forearm. In both injuries, the intact ulna acts as a stable column, but the radius (or radial head) is compromised, leading to a loss of the normal length relationship between the radius and ulna, culminating in DRUJ disruption.

Question 9762

Topic: 2. Trauma

What is the approximate incidence of associated neurovascular injury in Galeazzi fractures?

. Less than 1%
. 1-5%
. 5-10%
. 10-15%
. Greater than 15%

Correct Answer & Explanation

. 1-5%

Explanation

Neurovascular injuries are relatively uncommon in Galeazzi fractures, typically occurring in less than 5% of cases. The most frequently injured nerve is the anterior interosseous nerve (AIN), although the median nerve can also be affected. Vascular injuries are rare but can occur with severe displacement or open fractures. Thorough preoperative neurological and vascular assessment is always warranted.

Question 9763

Topic: 2. Trauma

Which factor is most strongly associated with failure of closed reduction and casting for a Galeazzi fracture in an adult?

. Patient age over 40
. Fracture comminution
. Coexisting medical conditions like diabetes
. Fracture of the proximal third of the radius
. Inadequate immobilization technique

Correct Answer & Explanation

. Fracture comminution

Explanation

In adults, Galeazzi fractures are notoriously unstable due to muscle forces (brachioradialis, pronator quadratus) and disruption of the DRUJ. Any significant displacement or comminution of the radial shaft fracture makes closed reduction virtually impossible to maintain. Fracture comminution leads to inherent instability and difficulty in achieving stable reduction, making ORIF almost always necessary in adults.

Question 9764

Topic: 2. Trauma

A Galeazzi fracture is sometimes referred to as a 'reverse Monteggia' by some authors due to what shared characteristic?

. Both always involve an open fracture.
. Both are primarily seen in pediatric patients.
. Both involve a single bone fracture with dislocation of an adjacent joint in the forearm.
. Both have a high incidence of radial nerve palsy.
. Both are typically managed non-operatively.

Correct Answer & Explanation

. Both involve a single bone fracture with dislocation of an adjacent joint in the forearm.

Explanation

Galeazzi and Monteggia fractures share the characteristic of involving a single bone fracture (radius in Galeazzi, ulna in Monteggia) with dislocation of an adjacent joint (DRUJ in Galeazzi, radial head/elbow in Monteggia). This makes them combined bony and ligamentous injuries of the forearm, leading to inherent instability. This is why some authors refer to them as 'evil twins' or 'reverse' versions of each other in terms of the bone fractured and joint dislocated.

Question 9765

Topic: 2. Trauma

Which muscle's insertion can sometimes prevent closed reduction of the distal radius fracture fragment in a Galeazzi injury?

. Biceps brachii
. Brachialis
. Pronator teres
. Brachioradialis
. Supinator

Correct Answer & Explanation

. Brachioradialis

Explanation

The Brachioradialis muscle inserts onto the lateral aspect of the radial styloid and can exert a deforming force, causing proximal migration and shortening of the distal radial fragment, making closed reduction difficult or unstable. The pronator quadratus can also act as a deforming force and can get interposed. Pronator teres is more proximal.

Question 9766

Topic: 2. Trauma

In a Galeazzi fracture, what type of plate fixation is typically utilized for the radial shaft?

. Tension band wiring
. Intramedullary nailing
. Lag screws alone
. Compression plating or locking plate fixation
. External fixation as a definitive treatment

Correct Answer & Explanation

. Compression plating or locking plate fixation

Explanation

For diaphyseal forearm fractures like Galeazzi, rigid internal fixation with either dynamic compression plates (DCPs) or, more commonly now, locking compression plates (LCPs) is the standard of care. This provides absolute stability, allows for anatomical reduction, and facilitates early motion, which is crucial for preventing stiffness and achieving good functional outcomes. Lag screws alone are insufficient for diaphyseal fractures. Intramedullary nailing is less common for radius fractures and doesn't address rotation as effectively as plates.

Question 9767

Topic: 2. Trauma

When considering the long-term prognosis of a Galeazzi fracture, which factor is most critical for a good functional outcome?

. Patient's age at the time of injury
. The length of postoperative cast immobilization
. The degree of soft tissue injury associated with the fracture
. Achieving anatomical reduction and stable fixation of the radial shaft and a stable DRUJ
. The use of prophylactic antibiotics

Correct Answer & Explanation

. Achieving anatomical reduction and stable fixation of the radial shaft and a stable DRUJ

Explanation

The most critical factor for a good long-term functional outcome after a Galeazzi fracture is achieving anatomical reduction and stable internal fixation of the radial shaft, along with a stable and well-reduced distal radioulnar joint. Failure to restore radial length, rotation, or to stabilize the DRUJ will lead to malunion, pain, limited forearm rotation, and poor function, regardless of other factors.

Question 9768

Topic: 2. Trauma

Which of the following conditions is an absolute contraindication to closed reduction and casting for a Galeazzi fracture in an adult?

. Patient refusal for surgery
. Obesity
. Significant radial shortening (e.g., > 5mm) and DRUJ instability after attempted reduction
. Smoking history
. Associated nerve contusion

Correct Answer & Explanation

. Significant radial shortening (e.g., > 5mm) and DRUJ instability after attempted reduction

Explanation

In an adult, if significant radial shortening (> 5mm) and DRUJ instability persist after attempted closed reduction, it is an absolute contraindication to non-operative treatment. Such instability and shortening in adults have a very high rate of malunion and poor functional outcomes, necessitating open reduction and internal fixation to restore anatomy and stability.

Question 9769

Topic: 2. Trauma

A fracture of the radial shaft with an intact DRUJ is known as what?

. Monteggia fracture
. Isolated radial shaft fracture
. Colles fracture
. Smith fracture
. Both Monteggia and Colles

Correct Answer & Explanation

. Isolated radial shaft fracture

Explanation

An isolated radial shaft fracture, without associated DRUJ disruption, is simply termed an isolated radial shaft fracture. It distinguishes itself from a Galeazzi fracture precisely by the absence of DRUJ involvement. Monteggia involves an ulnar fracture with radial head dislocation. Colles and Smith are distal radius fractures.

Question 9770

Topic: 2. Trauma

Which of the following is considered a hallmark of a properly reduced and stable Galeazzi fracture fixation?

. Prominent plate on the volar aspect of the radius
. Residual radial shortening of 2mm
. Full and painless passive pronation and supination post-operatively
. Anatomical restoration of radial length, rotation, and alignment, with a stable DRUJ
. Immediate return to heavy lifting without pain

Correct Answer & Explanation

. Anatomical restoration of radial length, rotation, and alignment, with a stable DRUJ

Explanation

The hallmark of successful Galeazzi fracture fixation is anatomical restoration of radial length, rotation, and alignment, which then facilitates stability of the distal radioulnar joint. Achieving these goals is paramount for restoring normal forearm kinematics and ensuring a good functional outcome, characterized by painless and full forearm rotation.

Question 9771

Topic: 2. Trauma

What is the typical age group for Galeazzi fractures?

. Children under 5 years old
. Adolescents (10-16 years old)
. Young to middle-aged adults
. Elderly individuals over 70
. Infants (0-1 year old)

Correct Answer & Explanation

. Young to middle-aged adults

Explanation

Galeazzi fractures predominantly occur in young to middle-aged adults, often as a result of high-energy trauma or falls. While they can occur in children, the typical adult management strategy differs significantly due to differences in bone healing and remodeling potential.

Question 9772

Topic: 2. Trauma

A patient presents with an open Galeazzi fracture. What is the immediate priority in management after initial stabilization and assessment?

. Begin extensive physiotherapy to prevent stiffness.
. Administer oral antibiotics and discharge with outpatient follow-up.
. Debridement and irrigation in the operating theatre, followed by fixation.
. Apply a simple splint and wait for swelling to subside.
. Perform a CT scan of the entire forearm immediately.

Correct Answer & Explanation

. Debridement and irrigation in the operating theatre, followed by fixation.

Explanation

For any open fracture, the immediate priority after initial stabilization and thorough assessment (including tetanus prophylaxis, intravenous antibiotics) is urgent surgical debridement and irrigation in the operating theatre. This reduces the risk of infection, followed by definitive fracture fixation. Delaying this increases the risk of serious complications like osteomyelitis.

Question 9773

Topic: 2. Trauma

What is the definition of a Monteggia fracture-dislocation?

. A fracture of the distal radius with DRUJ dislocation.
. A fracture of the ulna with dislocation of the radial head.
. A comminuted fracture of both forearm bones.
. An intra-articular distal radius fracture.
. A fracture of the radial head with an intact ulna.

Correct Answer & Explanation

. A fracture of the ulna with dislocation of the radial head.

Explanation

A Monteggia fracture-dislocation is defined as a fracture of the ulna with an associated dislocation of the radial head. This is distinct from a Galeazzi fracture, which involves a radial shaft fracture and DRUJ dislocation.

Question 9774

Topic: 2. Trauma

Which type of fracture pattern in the radial shaft is most amenable to compression plating in a Galeazzi fracture?

. Highly comminuted spiral fracture
. Long oblique or transverse fracture
. Segmental fracture
. Highly unstable fracture with significant bone loss
. Proximal metaphyseal fracture

Correct Answer & Explanation

. Long oblique or transverse fracture

Explanation

Compression plating is most effective for long oblique or transverse fractures. These patterns allow for good interfragmentary compression across the fracture site, which provides absolute stability and promotes primary bone healing. Highly comminuted fractures or those with bone loss are better suited for bridging with a locking plate, acting as an internal fixator.

Question 9775

Topic: 2. Trauma

What is the most common cause of persistent pain and dysfunction after a well-fixed Galeazzi fracture?

. Residual median nerve irritation
. Chronic elbow stiffness
. Persistent distal radioulnar joint (DRUJ) instability or arthritis
. Nonunion of the radial shaft
. Avascular necrosis of the radial head

Correct Answer & Explanation

. Persistent distal radioulnar joint (DRUJ) instability or arthritis

Explanation

Even after a well-fixed radial shaft fracture, persistent pain and dysfunction are most commonly attributed to ongoing issues at the distal radioulnar joint (DRUJ), such as instability, malunion, or post-traumatic arthritis. This is why thorough assessment and stabilization of the DRUJ are critical components of Galeazzi fracture management. While nonunion can occur, DRUJ pathology is a more frequent cause of long-term problems.

Question 9776

Topic: 2. Trauma

In cases of a pediatric Galeazzi fracture treated with closed reduction, what is a key feature of the cast application to help maintain DRUJ reduction?

. Forearm in full pronation
. Wrist in full flexion
. Elbow at 120 degrees of flexion
. Forearm in full supination or neutral position
. Fingers immobilized in extension

Correct Answer & Explanation

. Forearm in full supination or neutral position

Explanation

In pediatric Galeazzi fractures, if closed reduction is successful, the forearm is typically immobilized in full supination or a neutral position within a long arm cast. This position helps to tighten the DRUJ ligaments (particularly the volar radioulnar ligament in supination for dorsal dislocations) and the interosseous membrane, thereby stabilizing the distal radioulnar joint and preventing redislocation.

Question 9777

Topic: 2. Trauma

What is the consequence of leaving a Galeazzi fracture untreated in an adult regarding functional outcome?

. Excellent remodeling with minimal functional loss
. Mild cosmetic deformity with full range of motion
. Severe malunion of the radius, gross DRUJ instability, and painful loss of forearm rotation
. Only minor limitation in wrist extension
. Increased grip strength due to altered biomechanics

Correct Answer & Explanation

. Severe malunion of the radius, gross DRUJ instability, and painful loss of forearm rotation

Explanation

An untreated Galeazzi fracture in an adult will almost invariably lead to severe malunion of the radial shaft (shortening, angulation), gross and painful instability of the distal radioulnar joint, and profound loss of forearm pronation and supination. This results in significant functional impairment and chronic pain, highlighting the necessity of operative intervention in adults.

Question 9778

Topic: 2. Trauma

Which of the following statements accurately describes the epidemiology and clinical manifestation of Spondyloepiphyseal Dysplasia Tarda (SEDT)?

. It affects both males and females equally and presents at birth.
. It is an autosomal dominant condition characterized by long limbs and a short trunk.
. It affects males only, manifests in childhood, and is associated with progressive arthropathy.
. It is caused by a mutation in type I collagen and presents with frequent fractures.
. Heterozygous carrier females exhibit severe radiographic abnormalities but no clinical symptoms.

Correct Answer & Explanation

. It affects males only, manifests in childhood, and is associated with progressive arthropathy.

Explanation

Correct Answer: It affects males only, manifests in childhood, and is associated with progressive arthropathy.SEDT is an X-linked recessive disorder, meaning it affects males only, while heterozygous carrier females are clinically and radiographically normal. It manifests in childhood with disproportionate short stature, a short neck and trunk, and a broad chest, and is commonly associated with progressive arthropathy.

Question 9779

Topic: 2. Trauma

A patient presents with recurrent deep-seated abscesses and impaired wound healing following orthopedic trauma. Lab work reveals a deficiency in neutrophil chemotaxis and phagocytosis. Which adhesion molecule family, crucial for neutrophil extravasation from blood vessels into inflamed tissues, is most likely implicated in such a scenario?

. Immunoglobulin superfamily
. Cadherins
. Integrins
. Selectins
. Mucins

Correct Answer & Explanation

. Integrins

Explanation

Integrins are a family of heterodimeric cell surface adhesion molecules that play a crucial role in leukocyte adhesion to endothelial cells and subsequent extravasation into tissues. They bind to ligands such as ICAM-1 (an immunoglobulin superfamily member) on endothelial cells. A deficiency in integrin function would impair neutrophil chemotaxis and their ability to reach sites of infection, leading to recurrent infections and impaired wound healing. Selectins mediate initial rolling, while integrins mediate firm adhesion and transmigration.

Question 9780

Topic: 2. Trauma

In the context of severe musculoskeletal trauma and subsequent systemic inflammatory response syndrome (SIRS), which cytokine is a major mediator of systemic inflammation, fever, and acute phase protein production by the liver, potentially contributing to multi-organ dysfunction?

. Interleukin-4 (IL-4)
. Interleukin-10 (IL-10)
. Interleukin-6 (IL-6)
. Interferon-gamma (IFN-gamma)
. Transforming Growth Factor-beta (TGF-beta)

Correct Answer & Explanation

. Interleukin-6 (IL-6)

Explanation

Interleukin-6 (IL-6) is a pleiotropic cytokine that plays a central role in acute inflammation and the systemic inflammatory response syndrome (SIRS) often seen after severe trauma. It is a major inducer of the acute phase response, stimulating the liver to produce acute phase proteins (like CRP and fibrinogen). IL-6 also contributes to fever, induces differentiation of B cells into plasma cells, and influences T-cell differentiation. High levels of IL-6 are associated with poor outcomes in trauma and sepsis. IL-4 is associated with Th2 responses, IL-10 is anti-inflammatory, IFN-gamma is Th1-related, and TGF-beta is involved in tissue repair and immune suppression.

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