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 10961
Topic: 2. Trauma
A 45-year-old male presents with a proximal-third ulnar shaft fracture and an associated radial head dislocation. The patient is diagnosed with a Bado Type I Monteggia fracture. Which of the following defines the direction of the radial head dislocation in a Bado Type I injury?
Correct Answer & Explanation
. Anterior
Explanation
Bado Type I Monteggia fractures are characterized by an anterior dislocation of the radial head along with a diaphyseal fracture of the ulna with anterior angulation.
Question 10962
Topic: 2. Trauma
A 55-year-old male undergoes open reduction and internal fixation of a distal humerus intercondylar fracture via an olecranon osteotomy approach. Which of the following is the most frequent complication associated specifically with the olecranon osteotomy?
Correct Answer & Explanation
. Ulnar nerve palsy
Explanation
Symptomatic prominent hardware at the osteotomy site is the most common complication of an olecranon osteotomy, frequently necessitating secondary removal.
Question 10963
Topic: 2. Trauma
Which of the following clinical scenarios is considered an absolute indication for operative fixation of a humeral shaft fracture?
Correct Answer & Explanation
. Open fracture with associated vascular injury requiring repair
Explanation
An open fracture with an associated vascular injury requiring repair is an absolute indication for internal or external fixation of a humeral shaft fracture to stabilize the repaired vessels.
Question 10964
Topic: 2. Trauma
A 7-year-old boy presents with a closed fracture of the proximal third of the ulna associated with an anterior dislocation of the radial head. According to the Bado classification, what type of Monteggia lesion is this?
Correct Answer & Explanation
. Type I
Explanation
A Bado Type I Monteggia fracture is characterized by a fracture of the proximal or middle third of the ulna with an anterior dislocation of the radial head. It is the most common type in children.
Question 10965
Topic: 2. Trauma
An adult patient sustains a Galeazzi fracture-dislocation. What is the standard of care for the definitive management of this injury?
Correct Answer & Explanation
. Closed reduction and long-arm casting in supination
Explanation
Galeazzi fractures (distal third radius fracture with DRUJ disruption) in adults are highly unstable and require ORIF of the radius, followed by intraoperative assessment and necessary stabilization of the distal radioulnar joint (DRUJ).
Question 10966
Topic: 2. Trauma
A 25-year-old male sustains a severe open tibia fracture with extensive soft tissue stripping (Gustilo-Anderson IIIB) after a motorcycle collision. What is the most critical factor in reducing the risk of deep infection in this patient?
Correct Answer & Explanation
. Time to initial systemic antibiotic administration
Explanation
The early administration of systemic antibiotics is the single most important factor in preventing infection in open fractures. Historically, the '6-hour rule' for operative debridement was considered paramount; however, recent large studies have debunked this, showing no significant difference in infection rates between debridement before or after 6 hours, provided antibiotics are given promptly.
Question 10967
Topic: Pelvic & Acetabular Trauma
A 40-year-old male is brought to the trauma bay after a severe motor vehicle crash. He is hemodynamically unstable with a blood pressure of 80/50 mmHg. Radiographs show an anteroposterior compression (APC-III) pelvic ring injury. A circumferential pelvic binder is indicated. What is the most appropriate anatomical landmark for the correct placement of the pelvic binder?
Correct Answer & Explanation
. Greater trochanters
Explanation
A pelvic binder should be centered over the greater trochanters. Placement at the level of the greater trochanters provides the most effective mechanical advantage to close the pelvic ring, decrease pelvic volume, and promote tamponade of venous bleeding. Placement higher (e.g., iliac crests) can paradoxically widen the symphysis in some fracture patterns.
Question 10968
Topic: 2. Trauma
A 28-year-old male sustains a vertically oriented (Pauwels type III) femoral neck fracture. What fixation construct provides the most biomechanically stable fixation to resist the high shear forces associated with this fracture pattern?
Correct Answer & Explanation
. Sliding hip screw with an anti-rotation screw
Explanation
Pauwels type III fractures are highly vertical and subjected to significant shear forces, leading to a high rate of displacement and nonunion when treated with multiple cancellous screws alone. A fixed-angle device, such as a sliding hip screw (SHS) combined with an anti-rotation (derotation) screw, provides superior biomechanical stability against shear stress in young patients requiring joint preservation.
Question 10969
Topic: 2. Trauma
A 32-year-old male presents with a closed midshaft tibia fracture treated with closed reduction and casting. Twelve hours later, he complains of severe pain out of proportion to the injury. Which of the following is the most sensitive early clinical sign of acute compartment syndrome?
Correct Answer & Explanation
. Pulselessness
Explanation
Pain with passive stretch of the muscles in the affected compartment is typically the earliest and most sensitive clinical sign of acute compartment syndrome. Pulselessness, pallor, and paralysis are late signs indicating irreversible ischemia. A high index of suspicion is required to diagnose compartment syndrome before nerve and muscle necrosis occurs.
Question 10970
Topic: 2. Trauma
A 45-year-old male sustains a coronal plane fracture of the lateral femoral condyle (Hoffa fracture) after a high-speed collision. Which of the following is true regarding the characteristics and management of this injury?
Correct Answer & Explanation
. It is best visualized on an anteroposterior (AP) radiograph of the knee.
Explanation
A Hoffa fracture is a coronal shear fracture of the femoral condyle, usually involving the posterior aspect of the lateral condyle. It is an unstable, intra-articular fracture that requires open reduction and internal fixation (typically with lag screws) to restore the articular surface and prevent post-traumatic arthritis. It is often missed on AP radiographs and is best seen on lateral radiographs or CT scans.
Question 10971
Topic: 2. Trauma
Which of the following scenarios is considered an absolute indication for the operative treatment of an acute midshaft clavicle fracture?
Correct Answer & Explanation
. 15 mm of fracture shortening
Explanation
Absolute indications for operative fixation of a clavicle fracture include open fractures, fractures with impending skin breakdown (tenting), and fractures associated with neurovascular injury (e.g., subclavian artery injury). Shortening > 2cm, 100% displacement, and severe comminution are considered relative indications where surgery may improve functional outcomes or decrease nonunion rates.
Question 10972
Topic: 2. Trauma
A 60-year-old female sustains a Schatzker type II tibial plateau fracture. During surgical fixation, elevation of the depressed lateral articular fragment is performed, leaving a large metaphyseal void.
What is the most appropriate intraoperative step to address this void?
Correct Answer & Explanation
. Immediate full weight-bearing postoperatively to stimulate callus
Explanation
When a depressed articular segment in a tibial plateau fracture is elevated to restore joint congruity, it creates a metaphyseal void. This void must be filled with bone graft (autograft, allograft) or a structural bone substitute (e.g., calcium phosphate cement) to mechanically support the elevated articular surface and prevent secondary subsidence before the bone heals.
Question 10973
Topic: 2. Trauma
A 35-year-old male sustains a high-energy acetabular fracture.
Imaging reveals involvement of both the anterior and posterior columns. Crucially, no portion of the articular surface remains attached to the intact axial skeleton (ilium). What is the correct Judet-Letournel classification for this fracture pattern?
Correct Answer & Explanation
. Transverse fracture
Explanation
A both-column acetabular fracture is uniquely defined by the entire articular surface being detached from the intact ilium (the intact axial skeleton). This is radiographically identified by the 'spur sign' on the obturator oblique view, which represents the intact portion of the ilium protruding above the displaced acetabular roof.
Question 10974
Topic: 2. Trauma
A 29-year-old snowboarder sustains a Hawkins type III fracture of the talar neck. On follow-up radiographs taken 6-8 weeks post-injury, a subchondral radiolucent band is noted in the talar dome (Hawkins sign). What does this radiographic finding indicate?
Correct Answer & Explanation
. Intact vascularity of the talar body
Explanation
The Hawkins sign is a subchondral radiolucent band visible in the talar dome on AP or mortise views around 6-8 weeks after a talar neck fracture. It represents disuse osteopenia, which can only occur if the bone has an intact blood supply allowing for osteoclastic resorption. Thus, a positive Hawkins sign reliably rules out avascular necrosis of the talar body.
Question 10975
Topic: 2. Trauma
A 40-year-old female falls from a height and sustains a 'terrible triad' injury of the elbow.
This complex injury pattern is associated with profound instability. Which of the following defines the three components of the terrible triad of the elbow?
The terrible triad of the elbow describes a traumatic elbow dislocation accompanied by fractures of the radial head and the coronoid process. It typically involves disruption of the lateral collateral ligament (LCL) complex as the elbow dislocates posterolaterally. Restoring stability involves fixing or replacing the radial head, fixing the coronoid, and repairing the LCL.
Question 10976
Topic: 2. Trauma
A 45-year-old roofer falls 15 feet, landing on his heels, and sustains bilateral intra-articular calcaneus fractures.
Which of the following radiographic angles is characteristically decreased, flattened, or inverted in this injury pattern due to posterior facet collapse?
Correct Answer & Explanation
. Angle of Gissane
Explanation
Bohler's angle is formed by drawing a line from the highest point of the anterior process to the highest point of the posterior facet, and another line from the posterior facet to the superior edge of the calcaneal tuberosity. The normal angle is 20 to 40 degrees. In intra-articular fractures, depression of the posterior facet causes Bohler's angle to decrease, flatten, or become negative (inverted).
Question 10977
Topic: 2. Trauma
A 50-year-old male presents with a high-energy closed pilon fracture. Clinical examination reveals severe soft tissue swelling and the presence of fracture blisters around the ankle.
What is the most appropriate initial management for this injury?
Correct Answer & Explanation
. Immediate open reduction and internal fixation through a formal anterior approach
Explanation
High-energy pilon fractures are fraught with soft tissue complications if treated with early open surgery. The standard of care is a staged protocol: initial application of a joint-spanning external fixator (to restore length and alignment) and elevation. Definitive internal fixation is delayed until the soft tissue envelope recovers, usually indicated by the return of skin wrinkles ('wrinkle sign'), typically 10-21 days post-injury.
Question 10978
Topic: 2. Trauma
A 25-year-old male is involved in a motor vehicle crash and sustains an isolated, closed midshaft femur fracture. He is resuscitated in the trauma bay and is hemodynamically stable.
What is the optimal timing for intramedullary nailing of his femur to minimize the risk of pulmonary complications (such as ARDS)?
Correct Answer & Explanation
. Within 24 hours
Explanation
In a hemodynamically stable patient with an isolated femur fracture, early definitive fixation (Early Total Care, typically within 24 hours) is indicated. It significantly decreases the incidence of pulmonary complications, acute respiratory distress syndrome (ARDS), and overall mortality by mobilizing the patient early and reducing systemic inflammatory response.
Question 10979
Topic: 2. Trauma
A 65-year-old female sustains a displaced 4-part proximal humerus fracture.
Recent anatomical studies (e.g., Hettrich et al.) have redefined the primary blood supply to the humeral head. Based on current evidence, which artery provides the predominant blood supply to the humeral head, placing it at risk for avascular necrosis?
Correct Answer & Explanation
. Anterior humeral circumflex artery
Explanation
Classical teaching stated that the anterior humeral circumflex artery (via the arcuate artery) was the main blood supply. However, recent MRI and anatomical studies by Hettrich et al. demonstrated that the posterior humeral circumflex artery provides the predominant blood supply (up to 64%) to the humeral head. Disruption of these vessels in 4-part fractures leads to a high risk of avascular necrosis.
Question 10980
Topic: 2. Trauma
A 28-year-old polytrauma patient presents with bilateral femoral shaft fractures and a severe pulmonary contusion. His admission lactate is 4.5 mmol/L, base deficit is 8 mEq/L, and he is hemodynamically transiently responsive to fluids. According to the principles of Damage Control Orthopedics (DCO), what is the most appropriate initial management of his femoral fractures?
Correct Answer & Explanation
. Bilateral reamed intramedullary nailing within 24 hours
Explanation
This patient is considered borderline/unstable based on elevated lactate, high base deficit, and severe chest injury. Damage Control Orthopedics (DCO) using temporary external fixation is indicated to minimize the "second hit" of systemic inflammation associated with intramedullary nailing.
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