Menu

2. Trauma MCQs

Practice Set 591 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 11801

Topic: 2. Trauma

A 15-month-old toddler presents with a refusal to bear weight on his left leg after twisting it while playing. Radiographs of the tibia and fibula show a non-displaced spiral fracture of the distal tibia. The child denies direct trauma, and there are no other signs of injury or abuse. What is this fracture commonly referred to as?

. Greenstick fracture.
. Toddler's fracture.
. Bumper fracture.
. Triplane fracture.
. Segond fracture.

Correct Answer & Explanation

. Toddler's fracture.

Explanation

A 'toddler's fracture' is a common, non-displaced, spiral or oblique fracture of the distal tibia typically seen in children between 9 months and 3 years of age. It often results from a low-energy torsional force, such as twisting the leg, and the child may present with refusal to bear weight or limp. Radiographs can be subtle but usually show a faint spiral line. It's important to differentiate from child abuse, but in the absence of other signs, it's a common accidental injury. Greenstick fractures are incomplete fractures common in children but often involve bending forces. Bumper fractures are tibial plateau fractures. Triplane fractures are complex Salter-Harris Type IV distal tibia fractures. Segond fracture is an avulsion fracture of the lateral tibial plateau, associated with ACL tears.

Question 11802

Topic: 2. Trauma
A 40-year-old male sustains a high-energy pelvic fracture (APC II) with significant pubic symphysis diastasis. He is hemodynamically stable. Which of the following is the most effective immediate measure to reduce pelvic volume and potentially control hemorrhage while awaiting definitive fixation?
. Application of an external fixator to the anterior pelvic ring.
. Placement of a pelvic binder or sheet.
. Insertion of a Foley catheter.
. Fluid resuscitation with crystalloids.
. Transfusion of packed red blood cells.

Correct Answer & Explanation

. Placement of a pelvic binder or sheet.

Explanation

For an unstable pelvic fracture, particularly an 'open book' (APC II or III), the primary immediate goal is to reduce the pelvic volume. This mechanically compresses the bleeding venous plexus and small arterial branches, providing immediate hemorrhage control. A simple pelvic binder or a tightly wrapped sheet around the greater trochanters is a rapid and effective method to achieve this. While external fixation is a definitive mechanical stabilization, a binder is typically applied first, especially in the pre-hospital or immediate ED setting. Fluid resuscitation and blood products are crucial for managing hypovolemia, but they do not address the source of bleeding. Foley insertion is for bladder assessment and not volume reduction.

Question 11803

Topic: 2. Trauma

A 35-year-old male presents with a painful swelling in his lower leg after a direct blow. He has paresthesia in the web space between his first and second toes and weakness in ankle dorsiflexion. The leg is tense, and pain is exacerbated by passive stretch of the toes. The compartment pressure in the anterior compartment is 45 mmHg, and his diastolic blood pressure is 70 mmHg. What is the delta pressure and what does it indicate?

. Delta pressure = 115 mmHg; indicates no compartment syndrome.
. Delta pressure = 25 mmHg; indicates acute compartment syndrome requiring fasciotomy.
. Delta pressure = -25 mmHg; indicates acute compartment syndrome requiring fasciotomy.
. Delta pressure = 45 mmHg; indicates borderline compartment syndrome.
. Delta pressure = 70 mmHg; indicates vascular compromise.

Correct Answer & Explanation

. Delta pressure = 25 mmHg; indicates acute compartment syndrome requiring fasciotomy.

Explanation

The delta pressure is calculated as Diastolic Blood Pressure - Intracompartmental Pressure. In this case, 70 mmHg (DBP) - 45 mmHg (ICP) = 25 mmHg. A delta pressure of less than 30 mmHg (some sources use 20 mmHg) is a strong indication for fasciotomy, even if the absolute compartment pressure is below 30 mmHg, especially when clinical signs are also present. A negative delta pressure means the compartment pressure is higher than the diastolic blood pressure, a clear and urgent indication for fasciotomy. The patient's symptoms (paresthesia, weakness, tense leg, pain on passive stretch) are classic clinical signs of acute compartment syndrome. Therefore, this indicates acute compartment syndrome requiring emergent fasciotomy. The absolute pressure of 45 mmHg alone is also an indication given the clinical signs.

Question 11804

Topic: 2. Trauma

A 65-year-old male presents with severe pain in his left thigh after a ground-level fall. Radiographs show a displaced, comminuted intertrochanteric hip fracture. He has a history of severe Parkinson's disease, making him a high fall risk and non-compliant with weight-bearing restrictions. What is the most appropriate surgical management to allow for early weight-bearing and mobilization?

. Dynamic hip screw (DHS).
. Short cephalomedullary nail.
. Arthroplasty (hemi or total).
. Skeletal traction.
. Open reduction and internal fixation (ORIF) with plate and screws.

Correct Answer & Explanation

. Short cephalomedullary nail.

Explanation

For unstable (comminuted) intertrochanteric hip fractures, especially in elderly patients with comorbidities or those at high risk for non-compliance with weight-bearing, a short cephalomedullary nail (intramedullary hip screw) is generally preferred over a dynamic hip screw (DHS). IM nails provide greater biomechanical stability, particularly against medial collapse and rotation, allowing for earlier and more confident weight-bearing. While DHS is a good option for stable intertrochanteric fractures, it is less stable for comminuted patterns. Arthroplasty might be considered for very specific, highly comminuted patterns in active patients, but the IM nail is typically the go-to. Skeletal traction is outdated for definitive management. ORIF with plates is rarely used for intertrochanteric fractures.

Question 11805

Topic: 2. Trauma

A 30-year-old male sustains a high-energy trauma to his ankle, resulting in a lateral malleolus fracture, a small posterior malleolus fracture, and complete disruption of the syndesmosis. What is the most important component of surgical fixation for stability in this injury?

. Lag screw fixation of the lateral malleolus.
. Tension band wiring of the posterior malleolus.
. Suture button or screw fixation across the syndesmosis.
. Excision of the posterior malleolus fragment.
. Fixation of the deltoid ligament.

Correct Answer & Explanation

. Suture button or screw fixation across the syndesmosis.

Explanation

This injury pattern (lateral malleolus fracture + posterior malleolus fracture + syndesmotic disruption) describes a severe rotational ankle fracture with syndesmotic instability. While fixation of the malleoli is important, the most crucial component for restoring ankle stability and preventing long-term complications is addressing the syndesmotic disruption. This is typically achieved with syndesmotic screw fixation or a suture-button construct. Without stable syndesmotic fixation, the mortise remains widened, leading to chronic pain and arthritis. Lag screw fixation of the lateral malleolus is standard but not sufficient for syndesmotic disruption. The posterior malleolus fixation depends on its size. Deltoid ligament repair is rarely performed directly, as medial stability is usually restored with fibular and syndesmotic reduction and fixation.

Question 11806

Topic: 2. Trauma

A 28-year-old male sustains a spiral fracture of the middle third of the femur. He is hemodynamically stable. Which of the following is an absolute indication for emergent intramedullary nailing (IMN) rather than delayed or staged fixation?

. Open fracture (Gustilo-Anderson Type I).
. Polytrauma patient with chest injury (flail chest).
. Associated nerve injury.
. Extensive soft tissue swelling and blistering.
. Isolated femoral shaft fracture.

Correct Answer & Explanation

. Polytrauma patient with chest injury (flail chest).

Explanation

For an isolated femoral shaft fracture in a stable patient, IMN is the treatment of choice, but the timing (urgent vs. delayed) can vary. However, in the setting of polytrauma, particularly with associated chest injuries (e.g., flail chest, pulmonary contusion), early total care (ETC) with emergent intramedullary nailing of long bone fractures is an absolute indication. This 'fix and stabilize' approach helps prevent complications like fat embolism, improves pulmonary mechanics (reducing atelectasis and pneumonia), and facilitates patient mobilization and nursing care. While open fractures are also treated urgently, this scenario specifically points to the benefits of early fixation in polytrauma. Extensive swelling is a relative contraindication to immediate definitive fixation, often requiring staged management (damage control orthopedics).

Question 11807

Topic: 2. Trauma
A 40-year-old male falls from a ladder and sustains an open, comminuted distal tibia fracture with significant soft tissue loss and bone exposure (Gustilo-Anderson Type IIIB). Which of the following principles guides the initial surgical management of the soft tissue defect?
. Immediate primary closure of the wound over the fracture.
. Copious irrigation and debridement, followed by planned delayed primary closure or flap coverage.
. Application of a vacuum-assisted closure (VAC) device without debridement.
. Immediate bone grafting of the defect.
. Placement of a bulky compression dressing only.

Correct Answer & Explanation

. Copious irrigation and debridement, followed by planned delayed primary closure or flap coverage.

Explanation

For a Gustilo-Anderson Type IIIB open fracture, the initial surgical priority after ATLS and temporary stabilization is copious irrigation and thorough debridement of all devitalized tissue (skin, muscle, bone). This is critical to minimize the risk of infection. Following debridement, the wound is typically left open and managed with serial debridements and wound care. Primary closure is contraindicated due to the high risk of infection in contaminated, high-energy wounds. A vacuum-assisted closure (VAC) device can be used after debridement, but not in place of it. Bone grafting is performed later, once the soft tissue envelope is stable and infection-free. Bulky compression dressing alone is insufficient.

Question 11808

Topic: 2. Trauma

A 28-year-old male sustains a high-energy patella fracture, disrupting the extensor mechanism. He undergoes tension band wiring and cerclage fixation. Postoperatively, what is the most critical early rehabilitation goal to prevent long-term complications?

. Immediate full weight-bearing on the affected leg.
. Achieving full knee flexion (140 degrees).
. Early protected range of motion exercises for the knee.
. Strengthening the quadriceps against heavy resistance.
. Complete immobilization of the knee for 8-12 weeks.

Correct Answer & Explanation

. Early protected range of motion exercises for the knee.

Explanation

After surgical fixation of a patella fracture that restores the extensor mechanism, the most critical early rehabilitation goal is protected range of motion (ROM) exercises for the knee. This helps prevent arthrofibrosis (severe stiffness) of the knee, which is a common and debilitating complication of patella fractures and prolonged immobilization. Full weight-bearing is usually delayed, and quadriceps strengthening is initiated cautiously. Achieving full flexion is a long-term goal. Complete immobilization, while necessary acutely for some injuries, is generally avoided for patella fractures after stable fixation to prevent stiffness. The key is protected motion to balance healing with mobility.

Question 11809

Topic: 2. Trauma
A 30-year-old male sustains an open Gustilo Type IIIA distal tibial shaft fracture with a small zone of exposed bone. After urgent irrigation and debridement, the wound remains open. What is the next most appropriate step in soft tissue management?
. Immediate primary closure over the exposed bone.
. Leave the wound open and apply a standard dressing for delayed secondary intention healing.
. Application of a vacuum-assisted closure (VAC) device with planned delayed soft tissue coverage.
. Immediate skin grafting of the exposed bone.
. High-dose intravenous antibiotics for 6 weeks.

Correct Answer & Explanation

. Application of a vacuum-assisted closure (VAC) device with planned delayed soft tissue coverage.

Explanation

For an open Gustilo Type IIIA fracture with a soft tissue defect after debridement, immediate primary closure is contraindicated due to the risk of infection and potential for wound breakdown. Leaving the wound open with standard dressings allows for granulation tissue formation, but a vacuum-assisted closure (VAC) device is highly beneficial. VAC therapy promotes granulation tissue formation, reduces edema, removes exudate, and prepares the wound bed for delayed definitive soft tissue coverage (e.g., skin graft or flap, depending on the extent of the defect) in a controlled manner. Skin grafting directly over exposed bone is unlikely to take. High-dose antibiotics are part of treatment but don't address the soft tissue defect directly.

Question 11810

Topic: 2. Trauma

A 30-year-old male presents with a closed, displaced transverse fracture of the proximal third of the tibia shaft. The fracture is unstable. He has no neurovascular deficits. What is the optimal definitive surgical management for this fracture?

. External fixation.
. Intramedullary nailing (IMN).
. Open reduction internal fixation (ORIF) with plate and screws.
. Cast immobilization.
. Skeletal traction.

Correct Answer & Explanation

. Intramedullary nailing (IMN).

Explanation

For displaced and unstable tibial shaft fractures, particularly in the proximal or middle third, intramedullary nailing (IMN) is generally considered the gold standard. IMN offers excellent biomechanical stability, allows for early weight-bearing, has high union rates, and provides good soft tissue preservation. While ORIF with plates and screws is an option, it requires more extensive soft tissue dissection and can be associated with higher rates of infection and wound complications, especially in the proximal tibia where soft tissue coverage is poorer. External fixation is usually reserved for open fractures, highly contaminated wounds, or as a temporary measure. Cast immobilization is typically only for non-displaced or very stable fractures. Skeletal traction is not a definitive treatment.

Question 11811

Topic: 2. Trauma

A 75-year-old female presents with a non-displaced fracture of the lateral condyle of the tibia (Schatzker Type I) after a low-energy fall. She has significant medical comorbidities, including heart failure and chronic kidney disease. What is the most appropriate management approach?

. Open reduction internal fixation (ORIF) with plate and screws.
. External fixation.
. Non-operative management with protected weight-bearing and early range of motion.
. Total knee arthroplasty (TKA).
. Skeletal traction.

Correct Answer & Explanation

. Non-operative management with protected weight-bearing and early range of motion.

Explanation

A Schatzker Type I tibial plateau fracture is a split fracture of the lateral tibial plateau that is typically non-displaced and involves minimal articular depression. In elderly patients with significant medical comorbidities, non-operative management with protected weight-bearing (initially non-weight-bearing, then toe-touch or partial weight-bearing as tolerated) and early range of motion is often the preferred approach. This avoids the risks of surgery in a medically fragile patient, while still allowing for fracture healing. ORIF is typically reserved for displaced or unstable fractures. External fixation is more for open or highly comminuted fractures. TKA is for end-stage arthritis. Skeletal traction is outdated.

Question 11812

Topic: 2. Trauma
A 22-year-old male sustains a motorcycle accident resulting in a comminuted open distal femur fracture (Gustilo Type IIIA). He has diminished pulses in the foot. After emergent irrigation and debridement, and closed reduction, pulses remain diminished. What is the most appropriate next step?
. Immediate external fixation and observation.
. Repeat closed reduction attempts.
. Perform an Ankle-Brachial Index (ABI) and if abnormal, a CT angiogram.
. Proceed directly to open surgical exploration of the popliteal artery.
. Apply skeletal traction.

Correct Answer & Explanation

. Perform an Ankle-Brachial Index (ABI) and if abnormal, a CT angiogram.

Explanation

In the setting of an open distal femur fracture with diminished pulses after initial reduction, there is a high suspicion for vascular injury (popliteal artery). While the wound needs debridement and fracture needs stabilization, the vascular status is critical. An ABI should be immediately performed. If the ABI is abnormal (<0.9), a CT angiogram is the next diagnostic step to localize and characterize the vascular injury. Surgical exploration is reserved for hard signs of vascular injury (absent pulses, expanding hematoma, pulsatile bleeding) or after imaging confirms a repairable injury. Repeating reduction attempts can worsen vascular injury. External fixation is often used for damage control but doesn't address the vascular issue. Skeletal traction is not definitive.

Question 11813

Topic: 2. Trauma

A 35-year-old male sustains a midshaft tibia and fibula fracture in a motor vehicle accident. He presents to the ED with severe pain and a tense anterior compartment of his lower leg. What is the most appropriate initial management step to assess for potential compartment syndrome?

. Obtain an immediate CT scan of the lower leg.
. Administer aggressive pain medication and observe.
. Perform intracompartmental pressure measurements.
. Apply a tight compression bandage to the leg.
. Order a Doppler ultrasound to check distal pulses.

Correct Answer & Explanation

. Perform intracompartmental pressure measurements.

Explanation

Given the clinical suspicion for acute compartment syndrome (severe pain, tense compartment, and a mechanism that suggests high energy), the most appropriate initial management step to confirm the diagnosis is to perform intracompartmental pressure measurements. While clinical signs (the '6 Ps': pain, paresthesia, pallor, paralysis, pulselessness, poikilothermia) are crucial, direct pressure measurement is the objective and most reliable diagnostic tool. Aggressive pain medication might mask symptoms. A tight compression bandage is contraindicated as it can worsen the pressure. Doppler ultrasound checks pulses, which are typically intact until late stages. CT scans are not used for diagnosing compartment syndrome directly.

Question 11814

Topic: Pelvic & Acetabular Trauma

Which of the following describes the most appropriate method for reducing a posterior hip dislocation?

. Stimson maneuver (patient prone, hip flexed 90 degrees, downward force on knee).
. Allis maneuver (patient supine, hip flexed 90 degrees, axial traction, internal/external rotation).
. Bigelow maneuver (patient supine, hip flexed 90 degrees, abduction, external rotation).
. Captain Morgan technique (patient supine, hip flexed 90 degrees, foot on gurney, hip extension).
. Immediate open reduction without attempting closed reduction.

Correct Answer & Explanation

. Stimson maneuver (patient prone, hip flexed 90 degrees, downward force on knee).

Explanation

Several techniques exist for closed reduction of a posterior hip dislocation, but the Stimson maneuver is widely taught and effective. In this maneuver, the patient is prone with the affected hip and knee flexed to 90 degrees, and downward axial pressure is applied to the knee while an assistant stabilizes the pelvis. The Allis maneuver (axial traction with internal/external rotation while the patient is supine) is also common. The Bigelow maneuver involves circumduction. The Captain Morgan technique involves placing the operator's knee under the patient's knee for leverage. All these maneuvers aim to apply traction and then gently rotate the femoral head into the acetabulum. Immediate open reduction is reserved for failed closed reduction or irreducible dislocations.

Question 11815

Topic: 2. Trauma

A 13-year-old female presents with a pathological fracture through an Aneurysmal Bone Cyst in the distal femur. What is the initial management strategy?

. Immediately proceed with definitive surgical curettage and bone grafting.
. Administer systemic corticosteroids and observe.
. Immobilize the fracture, then treat the underlying ABC after fracture healing.
. Perform urgent en bloc resection of the fractured segment.
. Initiate preoperative embolization immediately.

Correct Answer & Explanation

. Immobilize the fracture, then treat the underlying ABC after fracture healing.

Explanation

When a pathological fracture occurs through an Aneurysmal Bone Cyst, the initial management priority is to stabilize and immobilize the fracture, similar to any other fracture. Once the acute fracture is managed (often with cast immobilization or internal fixation, depending on the fracture pattern and location), the underlying ABC can be definitively treated. Attempting definitive tumor surgery on an acutely fractured bone can be challenging due to bleeding and distorted anatomy. Urgent en bloc resection is usually too aggressive. Corticosteroids are not indicated for an ABC with fracture. Preoperative embolization might be done later, but immobilization is first.

Question 11816

Topic: 2. Trauma

A patient undergoes curettage and bone grafting for a symptomatic enchondroma in the proximal humerus. Which of the following is the most common complication of this procedure?

. Infection
. Nerve injury
. Fracture of the bone graft
. Local recurrence
. Dislodgement of bone graft

Correct Answer & Explanation

. Local recurrence

Explanation

Local recurrence is the most common complication following intralesional curettage of enchondromas. This is typically due to incomplete removal of the cartilaginous lesion. While infection, nerve injury, and graft-related issues can occur, they are less frequent than local recurrence.

Question 11817

Topic: 2. Trauma

A 45-year-old female sustains a pathological fracture through a previously undiagnosed enchondroma in her proximal humerus. She undergoes ORIF and the lesion is curetted and grafted. What is the most important aspect of her long-term follow-up?

. Monitoring for healing of the fracture
. Regular MRI for rotator cuff integrity
. Surveillance for local recurrence and malignant transformation
. Annual DEXA scans
. Psychological counseling for coping with cancer diagnosis

Correct Answer & Explanation

. Surveillance for local recurrence and malignant transformation

Explanation

While acute fracture healing is important, the most critical aspect of long-term follow-up for a treated enchondroma (especially one that fractured, which can be an early sign of activity) is surveillance for local recurrence and the rare but potential risk of malignant transformation. This typically involves serial radiographs of the treated area. The patient did not necessarily receive a cancer diagnosis, so that counseling is not indicated.

Question 11818

Topic: 2. Trauma

In which of the following scenarios would surgical intervention (e.g., curettage and bone grafting) be most strongly considered for an otherwise asymptomatic enchondroma?

. A 2 cm lesion in the distal phalanx of the finger
. A 3 cm lesion in the iliac wing
. A 4 cm lesion with significant cortical thinning (>50%) in the distal femur
. A 1 cm lesion in the calcaneus
. A 2.5 cm lesion in the proximal ulna

Correct Answer & Explanation

. A 4 cm lesion with significant cortical thinning (>50%) in the distal femur

Explanation

Significant cortical thinning, especially when it exceeds 50% of the cortical thickness in a weight-bearing long bone like the distal femur, creates a substantial risk of pathological fracture. Even if asymptomatic, prophylactic curettage and bone grafting would be strongly considered in this scenario to prevent a potentially devastating fracture and to restore structural integrity. The other options describe lesions in less mechanically critical locations or without significant fracture risk.

Question 11819

Topic: 2. Trauma
A 28-year-old male sustains a high-energy pelvic ring injury after a motor vehicle collision. On initial assessment, he is hypotensive (BP 80/50 mmHg) and tachycardic (HR 125 bpm). Pelvic radiographs show an anterior-posterior compression (APC) Type III injury according to the Young-Burgess classification. What is the most appropriate initial management step after primary survey and resuscitation?
. Immediate external fixation of the pelvis
. CT angiogram to localize bleeding
. Diagnostic peritoneal lavage
. Application of a pelvic binder or sheet
. Emergent surgical exploration for retroperitoneal hemorrhage

Correct Answer & Explanation

. Application of a pelvic binder or sheet

Explanation

For hemodynamically unstable patients with an APC Type III pelvic injury, immediate stabilization of the pelvic ring is paramount to reduce pelvic volume and tamponade venous hemorrhage. A pelvic binder or sheet is the quickest and most effective initial method to achieve this. While external fixation may be required, it's typically done after initial binder application and resuscitation. CT angiogram is important for localizing arterial bleeds but should follow mechanical stabilization in an unstable patient. DPL is less specific for retroperitoneal hemorrhage and has largely been replaced by FAST or CT. Emergent surgical exploration for retroperitoneal hemorrhage is rarely indicated initially, as most pelvic bleeding is venous and responds to mechanical stabilization.

Question 11820

Topic: 2. Trauma
A 35-year-old male presents with a Gustilo-Anderson Type IIIA open tibia shaft fracture. After initial debridement and external fixation, what is the most critical next step in management?
. Immediate conversion to intramedullary nailing (IMN)
. Soft tissue coverage within 72 hours
. Repeat debridement and antibiotics for 6 weeks
. Delayed primary closure after 7 days
. Early weight-bearing to promote healing

Correct Answer & Explanation

. Soft tissue coverage within 72 hours

Explanation

For Gustilo-Anderson Type IIIA open tibia fractures, achieving adequate soft tissue coverage within 72 hours (the 'golden window') is crucial to minimize infection risk and promote healing. This often involves local or free flap coverage. While repeat debridement is common, it is typically combined with planning for coverage. Immediate IMN is contraindicated in fresh open fractures due to high infection risk, especially Type IIIA. Delayed primary closure is often insufficient for Type IIIA defects. Early weight-bearing is not appropriate for an acutely unstable open fracture requiring soft tissue coverage.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page