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2. Trauma MCQs

Practice Set 585 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 11681

Topic: 2. Trauma

A 65-year-old female on chronic alendronate therapy presents with a subtrochanteric femur fracture after a ground-level fall. Contralateral femur radiographs show lateral cortical thickening and transverse lucency. What is the recommended management for the contralateral limb if she reports chronic thigh pain?

. Discontinue alendronate and begin physical therapy
. Prophylactic intramedullary nailing
. Prophylactic plate osteosynthesis
. Switch to denosumab
. Non-weight bearing for 12 weeks

Correct Answer & Explanation

. Prophylactic intramedullary nailing

Explanation

Bisphosphonate-associated atypical femur fractures typically present with lateral cortical thickening and transverse lucency. A symptomatic incomplete fracture with "dreaded black line" requires prophylactic intramedullary nailing to prevent complete displacement.

Question 11682

Topic: 2. Trauma
A 40-year-old farmer sustains an open tibial shaft fracture with a 12 cm wound, extensive muscle stripping, and exposed bare bone requiring a free tissue transfer for coverage. What is the Gustilo-Anderson classification of this fracture?
. Type II
. Type IIIA
. Type IIIB
. Type IIIC
. Type IV

Correct Answer & Explanation

. Type IIIB

Explanation

A Gustilo-Anderson Type IIIB fracture is characterized by extensive soft tissue stripping and inadequate tissue coverage requiring a local or free flap. Type IIIC would involve an arterial injury requiring repair.

Question 11683

Topic: 2. Trauma

When performing an anterolateral approach to the distal tibia for a pilon fracture, what nerve is most at risk and must be identified and protected during the surgical incision?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve crosses the surgical field in the anterolateral approach to the distal tibia. It must be carefully identified and protected during the superficial dissection.

Question 11684

Topic: 2. Trauma

A 7-year-old boy falls onto his outstretched hand and sustains a Bado Type I Monteggia fracture-dislocation. Which of the following best describes this injury pattern?

. Fracture of the proximal ulna with anterior dislocation of the radial head
. Fracture of the proximal ulna with posterior dislocation of the radial head
. Fracture of the distal radius with disruption of the DRUJ
. Fracture of the proximal radius with anterior dislocation of the ulna
. Fracture of the radial shaft with posterior dislocation of the radial head

Correct Answer & Explanation

. Fracture of the proximal ulna with anterior dislocation of the radial head

Explanation

A Bado Type I Monteggia injury consists of a fracture of the proximal or middle third of the ulna with an anterior dislocation of the radial head. This is the most common type in children.

Question 11685

Topic: 2. Trauma

A 25-year-old male sustains a low-velocity handgun gunshot wound to the thigh resulting in a comminuted femoral shaft fracture. The entry and exit wounds are clean and less than 1 cm. What is the most appropriate initial management of the wounds?

. Aggressive surgical debridement of the entire bullet tract in the OR
. Local wound care, tetanus prophylaxis, and antibiotics, followed by intramedullary nailing
. Application of a vacuum-assisted closure (VAC) device
. Primary closure of both wounds with sutures
. Amputation

Correct Answer & Explanation

. Local wound care, tetanus prophylaxis, and antibiotics, followed by intramedullary nailing

Explanation

Low-velocity gunshot wounds resulting in fractures without massive soft tissue destruction or vascular compromise do not require formal bullet tract debridement. They are best managed with local wound care, antibiotics, and standard internal fixation.

Question 11686

Topic: 2. Trauma

A 30-year-old male sustains a midshaft clavicle fracture in a cycling accident. Which of the following radiographic findings is most strongly associated with an increased risk of nonunion if treated nonoperatively?

. Superior displacement of the distal fragment
. Shortening of greater than 2 cm
. Presence of a small inferior butterfly fragment
. Fracture extension into the acromioclavicular joint
. Greenstick fracture pattern

Correct Answer & Explanation

. Shortening of greater than 2 cm

Explanation

In midshaft clavicle fractures, initial shortening of greater than 2 cm and 100% displacement are strong predictors of symptomatic nonunion and poor functional outcomes with nonoperative management. These findings are often indications for ORIF.

Question 11687

Topic: 2. Trauma
A 35-year-old male presents in hemorrhagic shock after a motorcycle crush injury. Radiographs demonstrate an APC III pelvic ring injury. After application of a pelvic binder and administration of 2 units of uncrossmatched blood, his blood pressure remains 75/40 mmHg. FAST exam is negative. What is the most appropriate next step in management?
. Exploratory laparotomy
. Retrograde urethrogram
. Preperitoneal pelvic packing or angiography
. Definitive anterior internal fixation
. Application of a supracondylar femoral traction pin

Correct Answer & Explanation

. Preperitoneal pelvic packing or angiography

Explanation

In a hemodynamically unstable patient with an APC III pelvic fracture and negative FAST, the source of bleeding is presumed to be the pelvis. Preperitoneal pelvic packing or pelvic angiography with embolization are the next most appropriate steps to control retroperitoneal hemorrhage.

Question 11688

Topic: 2. Trauma

A 28-year-old female sustains bilateral closed femoral shaft fractures and a severe bilateral pulmonary contusion in a high-speed collision. On arrival, she is tachycardic, hypotensive, and has a serum lactate of 6.2 mmol/L. What is the safest initial orthopaedic management strategy?

. Bilateral reamed intramedullary nailing
. Bilateral unreamed intramedullary nailing
. Unilateral intramedullary nailing and external fixation of the contralateral side
. Bilateral spanning external fixation
. Skeletal traction and delayed surgery at 3 weeks

Correct Answer & Explanation

. Bilateral spanning external fixation

Explanation

This patient exhibits signs of a "borderline" or "unstable" polytrauma patient (elevated lactate, shock, lung injury). Damage control orthopedics with bilateral external fixation is indicated to minimize the second hit of systemic inflammation associated with reaming and intramedullary nailing.

Question 11689

Topic: 2. Trauma
A 42-year-old male sustains a Gustilo-Anderson Type IIIB open tibia fracture. Following emergent meticulous debridement and external fixation, a large soft tissue defect with exposed bone remains. According to classical orthoplastic principles, to achieve the lowest rates of flap failure and infection, soft tissue free flap coverage should ideally be performed within what timeframe?
. 12 hours
. 72 hours
. 7 days
. 14 days
. 21 days

Correct Answer & Explanation

. 72 hours

Explanation

Godina's classic study demonstrated that early free flap coverage of Type IIIB open tibia fractures within 72 hours significantly decreases the rates of flap failure and deep infection compared to delayed soft tissue coverage.

Question 11690

Topic: 2. Trauma

A 25-year-old male undergoes intramedullary nailing of a closed tibial shaft fracture. Eight hours postoperatively, he complains of severe leg pain requiring escalating doses of narcotics and exacerbated by passive stretch. His diastolic blood pressure is 70 mmHg. The compartment pressure of the anterior compartment is measured at 45 mmHg. What is the most appropriate management?

. Elevate the leg above heart level
. Administer a continuous epidural infusion
. Bivalve the cast and observe
. Perform a single-incision fasciotomy
. Perform a two-incision four-compartment fasciotomy

Correct Answer & Explanation

. Perform a two-incision four-compartment fasciotomy

Explanation

The patient has acute compartment syndrome as evidenced by clinical signs and a Delta P (Diastolic BP minus Compartment Pressure) of 25 mmHg, which is less than the 30 mmHg diagnostic threshold. A two-incision, four-compartment fasciotomy is the definitive gold-standard treatment.

Question 11691

Topic: 2. Trauma
A 33-year-old male sustains a Hawkins Type III talar neck fracture following a fall from a height. Which of the following best describes the Hawkins sign seen on a follow-up AP radiograph at 6 to 8 weeks?
. Subchondral sclerosis indicating avascular necrosis
. Subchondral radiolucency indicating an intact vascular supply
. Displacement of the talonavicular joint
. Degenerative changes of the subtalar joint
. Nonunion at the fracture site

Correct Answer & Explanation

. Subchondral radiolucency indicating an intact vascular supply

Explanation

The Hawkins sign is a subchondral radiolucent band in the talar dome appearing 6 to 8 weeks post-injury, representing subchondral osteopenia secondary to active hyperemia. It is a highly reliable indicator that the talar body retains its blood supply, effectively ruling out complete avascular necrosis.

Question 11692

Topic: 2. Trauma
A 24-year-old male sustains a high-energy Pauwels Type III vertical femoral neck fracture. Which biomechanical factor best explains the high rate of nonunion and fixation failure in this specific fracture pattern?
. High compressive forces at the fracture site
. High shear forces leading to varus displacement
. Disruption of the ligamentum teres
. Excessive external rotation moments
. Inadequate cancellous bone stock

Correct Answer & Explanation

. High shear forces leading to varus displacement

Explanation

Pauwels Type III fractures (angle >50 degrees) are highly vertically oriented, converting physiologic axial loading into high shear forces across the fracture site. This excessive shear leads to varus collapse, high rates of nonunion, and implant failure.

Question 11693

Topic: Pelvic & Acetabular Trauma

A 40-year-old male is evaluated for an acetabular fracture. An iliac oblique Judet radiograph is obtained. Which primary structures are best profiled on this specific radiographic view?

. Anterior column and posterior wall
. Posterior column and anterior wall
. Iliac wing and obturator ring
. Superior pubic ramus and ischial spine
. Ischial tuberosity and symphysis pubis

Correct Answer & Explanation

. Posterior column and anterior wall

Explanation

The Judet views are standard for evaluating acetabular fractures. The iliac oblique view best profiles the posterior column and the anterior wall of the acetabulum, while the obturator oblique view profiles the anterior column and posterior wall.

Question 11694

Topic: 2. Trauma

A 55-year-old male sustains a high-energy Schatzker VI bicondylar tibial plateau fracture with severe soft tissue swelling and blistering. What is the most appropriate initial management strategy?

. Immediate dual-plating via two incisions
. Immediate intramedullary nailing
. Knee spanning external fixation and delayed ORIF
. Skeletal traction via a distal tibia pin
. Primary total knee arthroplasty

Correct Answer & Explanation

. Knee spanning external fixation and delayed ORIF

Explanation

In high-energy Schatzker VI tibial plateau fractures with compromised soft tissue, immediate definitive ORIF has unacceptably high rates of wound breakdown and deep infection. The standard of care is a spanning external fixator to maintain length and alignment until the soft tissues recover for delayed ORIF.

Question 11695

Topic: Upper Extremity Trauma

A 42-year-old construction worker sustains a severe direct blow to the superior aspect of his shoulder, resulting in an unstable, completely displaced Type V acromioclavicular (AC) joint separation. The surgeon plans an anatomic reconstruction of the coracoclavicular (CC) ligaments. What is the correct anatomical orientation of the native CC ligaments?

. The conoid is located lateral and anterior to the trapezoid
. The conoid is located medial and posterior to the trapezoid
. The trapezoid is located medial and anterior to the conoid
. The trapezoid is located medial and posterior to the conoid
. Both ligaments share a conjoint insertion at the medial border of the acromion

Correct Answer & Explanation

. The conoid is located medial and posterior to the trapezoid

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid ligaments. The conoid ligament is cone-shaped and inserts on the conoid tubercle of the clavicle, which is located more medial and posterior (approximately 45 mm from the distal clavicle). The trapezoid ligament is broad and inserts on the trapezoid line of the clavicle, located more lateral and anterior (approximately 25 mm from the distal clavicle).

Question 11696

Topic: Upper Extremity Trauma

What is the primary underlying biomechanical cause of posteromedial impingement (valgus extension overload syndrome) in the elbow of a throwing athlete?

. Attenuation of the lateral ulnar collateral ligament
. Contracture of the posterior band of the medial UCL
. Chronic attenuation of the anterior band of the medial UCL
. Hypertrophy of the anconeus muscle
. Radiocapitellar overload due to lateral compartment laxity

Correct Answer & Explanation

. Chronic attenuation of the anterior band of the medial UCL

Explanation

Valgus extension overload in throwers is primarily driven by chronic repetitive microtrauma leading to attenuation of the anterior band of the medial ulnar collateral ligament (UCL). This valgus laxity allows excessive abnormal shear forces on the posteromedial olecranon during the deceleration and follow-through phases, causing osteophyte formation and impingement.

Question 11697

Topic: Upper Extremity Trauma

Regarding the coracoclavicular (CC) ligaments in the setting of an acromioclavicular (AC) joint reconstruction, which of the following statements is true regarding their anatomic orientation and biomechanical function?

. The conoid is lateral and resists anterior-posterior translation
. The trapezoid is medial and resists superior translation
. The conoid is medial and acts as the primary restraint to superior translation
. The trapezoid is the primary restraint to superior translation
. Both ligaments insert on the anterior border of the clavicle

Correct Answer & Explanation

. The conoid is medial and acts as the primary restraint to superior translation

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid is located medial and posterior and is the primary restraint to superior translation of the clavicle. The trapezoid is lateral and anterior, and serves as the primary restraint against axial compression and anterior-posterior translation.

Question 11698

Topic: Upper Extremity Trauma
A 25-year-old sustains a Type III acromioclavicular (AC) joint separation. Biomechanically, which ligamentous complex serves as the primary restraint to superior translation of the distal clavicle?
. Acromioclavicular ligaments
. Coracoacromial ligament
. Coracoclavicular ligaments
. Coracohumeral ligament
. Superior glenohumeral ligament

Correct Answer & Explanation

. Coracoclavicular ligaments

Explanation

The coracoclavicular (CC) ligaments (conoid and trapezoid) are the primary static restraints to superior and inferior translation of the clavicle. The acromioclavicular ligaments primarily control horizontal (anteroposterior) stability.

Question 11699

Topic: 2. Trauma

During a lateral approach to the fibula for a distal third fracture, the surgeon must identify and protect the superficial peroneal nerve. Where does the superficial peroneal nerve typically pierce the deep crural fascia to become subcutaneous?

. At the fibular neck
. In the proximal third of the leg, anteriorly
. In the middle to distal third of the leg, crossing the anterior border of the fibula
. Just proximal to the extensor retinaculum
. Posterior to the lateral malleolus

Correct Answer & Explanation

. In the middle to distal third of the leg, crossing the anterior border of the fibula

Explanation

The superficial peroneal nerve courses in the lateral compartment of the leg and typically pierces the deep crural fascia to become subcutaneous in the middle to distal third of the leg (approximately 10-12 cm proximal to the tip of the lateral malleolus), crossing from the lateral to the anterior aspect of the fibula.

Question 11700

Topic: 2. Trauma

A trauma patient develops thigh compartment syndrome. Which muscle is located in the medial compartment of the thigh and is distinctly dually innervated by both the obturator nerve and the tibial division of the sciatic nerve?

. Adductor longus
. Adductor brevis
. Pectineus
. Adductor magnus
. Gracilis

Correct Answer & Explanation

. Adductor magnus

Explanation

The adductor magnus is a massive muscle with dual innervation. Its adductor (pubofemoral) portion is innervated by the posterior division of the obturator nerve, and its hamstring (ischiocondylar) portion is innervated by the tibial division of the sciatic nerve.

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