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2. Trauma MCQs

Practice Set 60 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 1181

Topic: 2. Trauma

A 6-year-old child sustains a complete, dorsally angulated distal radius fracture. Radiographs show 25 degrees of dorsal angulation and 5 mm of shortening. The child is right-hand dominant. Based on the principles of pediatric fracture management, what is the most appropriate initial management strategy?

. Immediate open reduction and internal fixation with a plate.
. Closed reduction and percutaneous K-wire fixation.
. Closed reduction and long arm cast application.
. Observation with a short arm splint due to excellent remodeling potential.
. Elastic stable intramedullary nailing (ESIN).

Correct Answer & Explanation

. Closed reduction and long arm cast application.

Explanation

Correct Answer: CThe case text highlights the significant remodeling potential in younger children for distal radius fractures. It states: 'Acceptable angulation varies significantly with age. For distal radius, 20-25 degrees of dorsal angulation is often acceptable in children under 10, decreasing to 10-15 degrees in adolescents. Rotational deformity is poorly tolerated at any age. Shortening up to 1 cm can remodel.' This 6-year-old falls within the age group where 25 degrees of dorsal angulation and 5 mm of shortening are generally acceptable after closed reduction and casting.Option A (Immediate open reduction and internal fixation with a plate):ORIF is rarely indicated for isolated distal radius fractures in children, typically reserved for open fractures, highly comminuted articular fractures, or irreducibility with soft tissue interposition. This fracture does not meet those criteria.Option B (Closed reduction and percutaneous K-wire fixation):K-wire fixation is indicated for unstable fractures after reduction, large metaphyseal-diaphyseal angle, or significant displacement in older children that cannot be maintained in a cast. While this fracture is complete and displaced, the angulation and shortening are within acceptable limits for a 6-year-old after closed reduction and casting, making K-wires potentially overtreatment initially.Option C (Closed reduction and long arm cast application):Given the acceptable angulation and shortening for a 6-year-old, closed reduction followed by immobilization in a cast (often a short arm cast for distal radius, but a long arm cast might be chosen for initial stability or surgeon preference) is the most appropriate initial management. The text mentions 'The majority of pediatric fractures are managed non-operatively.'Option D (Observation with a short arm splint due to excellent remodeling potential):While remodeling potential is excellent, a complete, dorsally angulated fracture requires reduction to achieve acceptable alignment and prevent malunion, even if minor. Observation without reduction is not appropriate for a displaced complete fracture.Option E (Elastic stable intramedullary nailing (ESIN)):ESINs are typically used for unstable forearm shaft fractures, significantly displaced distal radius fractures, comminuted patterns, and in older children/adolescents, especially when K-wires might not provide sufficient stability or for diaphyseal fractures. For a simple complete distal radius fracture within acceptable parameters for a 6-year-old, it's generally not the first-line treatment.

Question 1182

Topic: 2. Trauma

A 10-year-old male presents with a severely displaced forearm shaft fracture involving both the radius and ulna. He complains of severe pain, disproportionate to the injury, and pain with passive extension of his fingers. On examination, his forearm is tense and swollen, and he has paresthesia in the median nerve distribution. Radial and ulnar pulses are palpable, and capillary refill is brisk. What is the most appropriate immediate management?

. Elevation of the limb and close observation.
. Administration of intravenous opioids and muscle relaxants.
. Urgent closed reduction and casting.
. Immediate four-compartment fasciotomy of the forearm.
. CT scan of the forearm to assess soft tissue injury.

Correct Answer & Explanation

. Immediate four-compartment fasciotomy of the forearm.

Explanation

Correct Answer: DThe patient's symptoms (pain out of proportion, pain with passive stretch of fingers, paresthesia, tense compartments) are classic signs of impending or manifest compartment syndrome, as detailed in the case text under 'Complications & Management'. The text states: 'Compartment Syndrome: Pain out of proportion to injury, pain with passive stretch, paresthesia, tense compartments, weakness. (Pulselessness, pallor are late signs). Salvage Strategy: Emergency! Immediate four-compartment fasciotomy of the forearm.'Option A (Elevation of the limb and close observation):While elevation is part of general fracture management, it is insufficient and dangerous for compartment syndrome, which requires immediate surgical intervention. Close observation will lead to irreversible muscle and nerve damage.Option B (Administration of intravenous opioids and muscle relaxants):Pain medication might mask the critical symptom of pain out of proportion and delay diagnosis, which is detrimental in compartment syndrome. Muscle relaxants are not indicated.Option C (Urgent closed reduction and casting):While the fracture needs reduction, attempting closed reduction and casting in the presence of compartment syndrome symptoms can worsen the condition by increasing pressure within the already compromised compartments. The compartment syndrome must be addressed first.Option D (Immediate four-compartment fasciotomy of the forearm):This is the definitive and emergency treatment for compartment syndrome to relieve pressure and prevent irreversible tissue damage.Option E (CT scan of the forearm to assess soft tissue injury):Imaging like CT is not indicated for the acute diagnosis and management of compartment syndrome. Clinical diagnosis and immediate surgical intervention are paramount.

Question 1183

Topic: 2. Trauma

A 4-year-old child presents with an isolated, non-displaced greenstick fracture of the distal radius. The interosseous membrane is intact. Which of the following statements regarding this injury and its management is most accurate?

. The strong interosseous membrane dictates that this isolated fracture implies high-energy trauma.
. Rotational deformities remodel well in this age group.
. The thick periosteum often hinges dorsally, aiding in reduction but requiring careful assessment of stability.
. This fracture pattern typically requires percutaneous K-wire fixation due to inherent instability.
. Aggressive passive stretching should be initiated early in rehabilitation to prevent stiffness.

Correct Answer & Explanation

. The thick periosteum often hinges dorsally, aiding in reduction but requiring careful assessment of stability.

Explanation

Correct Answer: CThe question asks for the most accurate statement regarding a greenstick distal radius fracture in a 4-year-old, drawing on various sections of the text.Option A (The strong interosseous membrane dictates that this isolated fracture implies high-energy trauma):The text states: 'The strong interosseous membrane dictates that isolated shaft fractures are rare, implying high-energy trauma if present.' This statement refers toshaftfractures, not distal radius fractures. Distal radius fractures are very common and often isolated, not necessarily implying high-energy trauma.Option B (Rotational deformities remodel well in this age group):The text explicitly states: 'Rotational deformities remodel poorly, regardless of age.' This makes the statement inaccurate.Option C (The thick periosteum often hinges dorsally, aiding in reduction but requiring careful assessment of stability):The text states under 'Distal Radius & Ulna': 'The thick periosteum often hinges dorsally, allowing for closed reduction but requiring careful assessment of stability.' This is an accurate statement and a key characteristic of pediatric distal radius fractures.Option D (This fracture pattern typically requires percutaneous K-wire fixation due to inherent instability):Greenstick fractures are described as 'inherently stable fracture patterns that typically heal well with immobilization' in the 'Non-Operative Indications' section. K-wire fixation is generally not required for non-displaced greenstick fractures.Option E (Aggressive passive stretching should be initiated early in rehabilitation to prevent stiffness):The 'Post-Operative Rehabilitation Protocols' section, particularly for SCHF, warns: 'Avoid forceful passive stretching or manipulation of the elbow joint, as this can increase the risk of heterotopic ossification and myositis ossificans.' This principle generally applies to pediatric fractures, favoring gentle active range of motion.

Question 1184

Topic: 2. Trauma

A 14-year-old male sustains a displaced, comminuted distal radius fracture. He is skeletally mature. After closed reduction, the fracture remains unstable and significantly displaced. Which of the following fixation methods would be most appropriate for this patient, considering his age and fracture pattern?

. Long arm cast immobilization without fixation.
. Percutaneous K-wire fixation.
. Elastic stable intramedullary nailing (ESIN).
. Open reduction and internal fixation with a small pediatric plate.
. Observation with a short arm splint.

Correct Answer & Explanation

. Open reduction and internal fixation with a small pediatric plate.

Explanation

Correct Answer: DThe patient is a 14-year-old male with a displaced, comminuted, and unstable distal radius fracture. While K-wires and ESINs are options for pediatric fractures, the combination of age (older adolescent, closer to skeletal maturity), comminution, and instability makes ORIF with a plate a strong consideration, especially if anatomical reduction and stable fixation are difficult to achieve otherwise.Option A (Long arm cast immobilization without fixation):Given the fracture is unstable and significantly displaced after reduction, casting alone is unlikely to maintain an acceptable reduction, especially in an older adolescent with less remodeling potential.Option B (Percutaneous K-wire fixation):K-wires are a common and effective method for unstable distal radius fractures. However, for acomminutedfracture in anolder adolescent, K-wires might not provide sufficient stability, and maintaining reduction could be challenging.Option C (Elastic stable intramedullary nailing (ESIN)):ESINs are primarily used for unstable forearm shaft fractures and some significantly displaced distal radius fractures, particularly in younger children or adolescents. While an option, for a comminuted fracture, a plate might offer more rigid and anatomical fixation.Option D (Open reduction and internal fixation with a small pediatric plate):The text states under 'Distal Radius Fracture - Open Reduction Internal Fixation (ORIF)': 'Indications: Very rare for isolated distal radius fractures; primarily for open fractures, highly comminuted articular fractures, or irreducibility with soft tissue interposition. Fixation: Small pediatric plates and screws or K-wires.' While rare forisolateddistal radius fractures, acomminutedandunstablefracture in anolder adolescent(closer to adult bone) is a stronger indication for ORIF with a plate to achieve and maintain anatomical reduction, especially if closed methods fail. This provides the most rigid fixation for a comminuted pattern.Option E (Observation with a short arm splint):This is inappropriate for a displaced, unstable fracture that requires reduction and stabilization.

Question 1185

Topic: 2. Trauma

A 3-year-old child presents with a suspected non-displaced lateral condyle fracture of the humerus. Plain radiographs are equivocal due to the largely cartilaginous nature of the distal humerus at this age. What is the most appropriate next imaging modality to confirm the diagnosis and guide management?

. Magnetic Resonance Imaging (MRI).
. Computed Tomography (CT) scan.
. Stress views of the elbow.
. Repeat plain radiographs in 1 week.
. Arteriography.

Correct Answer & Explanation

. Computed Tomography (CT) scan.

Explanation

Correct Answer: BThe case text discusses imaging modalities: 'Computed Tomography (CT): Reserved for complex intra-articular fractures (e.g., lateral condyle, capitellum), multi-fragmentary fractures, or when precise anatomical detail is needed for surgical planning. Not routinely used due to radiation exposure.' In a 3-year-old, the lateral condyle is largely cartilaginous, making plain radiographs difficult to interpret for non-displaced fractures. CT provides superior bony detail to confirm the fracture and assess displacement, which is crucial for lateral condyle fractures due to their high risk of nonunion and growth disturbance if not anatomically reduced.Option A (Magnetic Resonance Imaging (MRI)):MRI is primarily for soft tissue injuries, ligamentous damage, or avascular necrosis. While it can show cartilage, CT is generally preferred for acute bony detail, especially for fracture assessment.Option B (Computed Tomography (CT) scan):This is the most appropriate choice. CT provides excellent bony detail, which is essential for diagnosing subtle or non-displaced intra-articular fractures like lateral condyle fractures in young children where much of the bone is still cartilage and not visible on plain X-rays.Option C (Stress views of the elbow):Stress views are rarely indicated in acute trauma and are primarily for assessing ligamentous stability, not for diagnosing a bony fracture.Option D (Repeat plain radiographs in 1 week):While sometimes used for subtle fractures (e.g., scaphoid), waiting a week for a potentially displaced intra-articular fracture like a lateral condyle fracture can delay definitive treatment and worsen prognosis.Option E (Arteriography):Arteriography is indicated for suspected vascular injury (e.g., pulseless pale hand where reduction fails), not for diagnosing a bony fracture.

Question 1186

Topic: 2. Trauma

A 10-year-old patient presents with a malunion of a forearm shaft fracture, exhibiting 20 degrees of angulation in the sagittal plane and 15 degrees of rotational deformity. The fracture occurred 6 months ago and has healed. Based on the remodeling potential described in the case, what is the most important consideration for surgical correction?

. The sagittal plane angulation will remodel completely over time, requiring no intervention.
. The rotational deformity will remodel poorly and is the primary indication for corrective osteotomy.
. Both angulation and rotation will remodel significantly due to the patient's age.
. Surgical correction is contraindicated as the fracture has already healed.
. The distance from the physis is the sole determinant of remodeling potential.

Correct Answer & Explanation

. The rotational deformity will remodel poorly and is the primary indication for corrective osteotomy.

Explanation

Correct Answer: BThe case text provides clear guidance on remodeling potential: 'Remodeling potential is significant, especially in younger children, but rotational deformities remodel poorly. Rotational deformities remodel poorly, regardless of age. Angulatory deformities remodel best when in the plane of motion of the joint and closer to the physis.'Option A (The sagittal plane angulation will remodel completely over time, requiring no intervention):While sagittal plane angulation remodels well, 20 degrees in a 10-year-old (an older child) might not remodelcompletely, especially if it's a shaft fracture (further from the physis). The statement 'completely' is too absolute.Option B (The rotational deformity will remodel poorly and is the primary indication for corrective osteotomy):This is accurate. The text explicitly states that rotational deformities remodel poorly regardless of age. Therefore, a 15-degree rotational deformity is a significant concern and a strong indication for surgical correction (osteotomy) if it causes functional impairment or severe cosmetic deformity.Option C (Both angulation and rotation will remodel significantly due to the patient's age):This is incorrect. While angulation might remodel to some extent, rotational deformities remodel poorly.Option D (Surgical correction is contraindicated as the fracture has already healed):This is incorrect. Corrective osteotomy is a standard procedure for symptomatic malunions after fracture healing, especially for deformities that do not remodel.Option E (The distance from the physis is the sole determinant of remodeling potential):This is incorrect. While distance from the physis is a factor, age and the plane of deformity (sagittal vs. coronal) are also critical, and rotational deformities remodel poorly irrespective of these factors.

Question 1187

Topic: 2. Trauma

A 3-month-old boy is brought to the ER by his grandmother, who noticed his thigh was swollen, and he cried with leg movement during diaper changes. He is not voluntarily moving the affected leg. An X-ray is obtained as shown below:

What is your immediate primary concern, even before meeting the patient and family?

. Compartment syndrome
. Birth trauma
. Nonaccidental trauma (NAT)
. Osteogenesis imperfecta
. Sepsis with osteomyelitis

Correct Answer & Explanation

. Nonaccidental trauma (NAT)

Explanation

Correct Answer: CThe correct answer is Nonaccidental Trauma (NAT). The case describes a femur fracture in a nonambulatory child less than 1 year of age. It is a critical teaching point that approximately 80% of femur fractures in nonambulatory children are due to nonaccidental trauma (child abuse). This high index of suspicion mandates that NAT be the immediate primary concern.Option A (Compartment syndrome)is incorrect. While compartment syndrome is a serious complication of fractures, it is quite rare in the thigh after a femur fracture, especially in infants, and is not the most likely initial concern in this specific clinical scenario, although it should be assessed during the physical examination.Option B (Birth trauma)is incorrect. The child is 3 months old. If the fracture had occurred at birth, it would likely be healed with a robust callus formation by this point, which is not suggested by the acute presentation.Option D (Osteogenesis imperfecta)is incorrect. Osteogenesis imperfecta (OI) is a genetic disorder causing brittle bones and is certainly a differential diagnosis to consider in a child with unexplained fractures. However, nonaccidental trauma is statistically more common and must be ruled out first. If there is concern for OI based on history and examination, a work-up can be included as part of the overall evaluation of potential nonaccidental trauma.Option E (Sepsis with osteomyelitis)is incorrect. While osteomyelitis can present with pain and swelling, the X-ray clearly shows a fracture, making infection a less likely primary diagnosis for the acute presentation of a swollen, painful, non-moving leg with a visible fracture.

Question 1188

Topic: 2. Trauma

Following your initial evaluation of the 3-month-old boy with a femur fracture, a skeletal survey is performed due to high suspicion for nonaccidental trauma. The survey reveals a both-bone forearm fracture with callus formation, distal tibia corner fractures, and posteromedial rib fractures in various stages of healing.

Among the findings from the skeletal survey, which fracture types are considered most specific for nonaccidental trauma?

. The femur fracture, given the child's nonambulatory status
. Multiple fractures in different stages of healing
. The both-bone forearm fracture with callus formation
. The rib fractures (particularly posteromedial) and corner fractures
. Vertebral body fractures and transphyseal separations

Correct Answer & Explanation

. The rib fractures (particularly posteromedial) and corner fractures

Explanation

Correct Answer: DThe correct answer is the rib fractures (particularly posteromedial) and corner fractures. The teaching case explicitly states that fractures with the highest specificity for nonaccidental trauma (NAT) are corner fractures, rib fractures (especially posteromedial rib fractures), scapular fractures, sternal fractures, and spinous process fractures.Option A (The femur fracture, given the child's nonambulatory status)is incorrect. While a femur fracture in a nonambulatory child is highly concerning for NAT (as discussed in Q1), long-bone shaft fractures (like a femur shaft fracture) generally have low specificity for abuse when considered in isolation. The context of the child's age and non-ambulatory status elevates suspicion, but the fracture type itself is not among the 'most specific'.Option B (Multiple fractures in different stages of healing)is incorrect. Multiple fractures and fractures in different stages of healing are indeed highly concerning for NAT and fall under 'moderate specificity' for abuse. However, they are not considered 'most specific' when compared to corner or posteromedial rib fractures.Option C (The both-bone forearm fracture with callus formation)is incorrect. Similar to the femur fracture, long-bone shaft fractures (like a forearm fracture) have low specificity for abuse on their own. The presence of callus indicates an older injury, which is concerning in the context of NAT, but the fracture type itself is not 'most specific'.Option E (Vertebral body fractures and transphyseal separations)is incorrect. Vertebral body fractures and transphyseal separations are listed as having 'moderate specificity' for abuse, not the highest specificity.

Question 1189

Topic: 2. Trauma

A 15-year-old male is brought to the emergency department after an ATV accident where the vehicle rolled over multiple times. He reports inability to move or feel his legs. On arrival, his GCS is 15, he has a left wrist deformity, blood pressure 105/68, heart rate 102, respiratory rate 26, and SpO2 98% on room air. He is in a hard cervical collar and appears in no acute distress.

According to Advanced Trauma Life Support (ATLS) principles, what is your immediate next action?

. Immediate CT scan of cervical, thoracic, and lumbar spine
. Exchange of hard cervical collar for a Miami-J collar
. Neurosurgical consultation
. Evaluation of lungs with a stethoscope
. Obtain radiographs of the left wrist to evaluate for fracture

Correct Answer & Explanation

. Evaluation of lungs with a stethoscope

Explanation

Correct Answer: DThe correct answer is evaluation of lungs with a stethoscope. This question tests the fundamental principles of Advanced Trauma Life Support (ATLS). Regardless of other injuries, the primary survey (ABCDEs) must always be completed first. The 'B' in ABCDE stands for Breathing and Ventilation. Auscultating the lungs with a stethoscope is a critical component of assessing breathing and ventilation to ensure adequate air entry and rule out life-threatening conditions such as pneumothorax or hemothorax, which could be present after a high-energy trauma like an ATV rollover.Option A (Immediate CT scan of cervical, thoracic, and lumbar spine)is incorrect. While imaging of the spine is crucial given the patient's neurological deficit, it comes after the primary survey and stabilization of life-threatening conditions. Imaging is part of the secondary survey.Option B (Exchange of hard cervical collar for a Miami-J collar)is incorrect. The type of cervical collar is a secondary concern. The priority is to maintain spinal immobilization and assess vital functions, not to change the specific type of collar at this immediate stage.Option C (Neurosurgical consultation)is incorrect. While a neurosurgical consultation will be necessary, it is not the immediate next action. The orthopedic surgeon (or trauma team leader) must first complete the primary survey and stabilize the patient before initiating specialty consultations.Option E (Obtain radiographs of the left wrist to evaluate for fracture)is incorrect. Evaluation and management of musculoskeletal injuries like a wrist deformity are part of the secondary survey, after the primary survey has been completed and life-threatening conditions addressed.

Question 1190

Topic: 2. Trauma

A 3-year-old child weighing 14 kg sustains an isolated, closed, diaphyseal spiral fracture of the femur after a twisting fall. What is the gold standard initial treatment?

. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. Immediate early spica casting
. Open reduction and plate fixation
. External fixation

Correct Answer & Explanation

. Immediate early spica casting

Explanation

For children under 5 years of age and weighing less than 20 kg (45 lbs), immediate early spica casting is the gold standard treatment for closed, isolated femoral shaft fractures. It yields excellent outcomes with minimal risk.

Question 1191

Topic: 2. Trauma

A 5-year-old boy falls and sustains a lateral condyle humerus fracture. Radiographs reveal 3 mm of displacement of the fracture fragment. What is the most appropriate management?

. Long arm cast in supination
. Closed reduction and percutaneous pinning
. Open reduction and internal fixation
. Skeletal traction
. Collar and cuff

Correct Answer & Explanation

. Open reduction and internal fixation

Explanation

Lateral condyle humerus fractures with >2 mm of displacement carry a high risk of nonunion and subsequent cubitus valgus or tardy ulnar nerve palsy. Open reduction and internal fixation is indicated to ensure joint congruity and rigid fixation.

Question 1192

Topic: 2. Trauma

An 84-year-old osteoporotic lady sustains a proximal humerus fracture after a low-energy fall. Her X-ray shows a fracture involving the surgical neck, greater tuberosity, and lesser tuberosity, with articular displacement. According to the Neer classification, how would you classify this fracture?

. 2-part fracture
. 3-part fracture
. 4-part fracture
. Articular displacement fracture
. Valgus-impacted fracture

Correct Answer & Explanation

. 4-part fracture

Explanation

Correct Answer: CThe Neer classification divides the proximal humerus into four anatomical parts: the humeral head (articular segment), greater tuberosity, lesser tuberosity, and humeral shaft. A fracture involving all three tuberosities and the surgical neck (which separates the head from the shaft) constitutes four distinct displaced segments, thus classifying it as a 4-part fracture. Each displaced segment (>1cm displacement or >45 degrees angulation) counts as a 'part.' A 2-part involves one displaced segment, a 3-part involves two displaced segments (e.g., head + greater tuberosity + shaft). Articular displacement is a characteristic of 4-part fractures but not a primary classification part itself. Valgus-impacted is a specific stable variant, usually 2- or 3-part.

Question 1193

Topic: 2. Trauma

The candidate correctly describes several indications for a posterior approach to the knee. Which of the following conditions would generally not be considered a primary indication for a posterior approach as outlined in the case?

. Open reduction and internal fixation of a posterior tibial plateau shear fracture.
. Excision of a large popliteal cyst.
. Repair of a posterior vascular injury.
. Arthroscopic meniscal repair of a medial meniscus posterior horn tear.
. Fixation of a bone avulsion associated with a PCL injury.

Correct Answer & Explanation

. Arthroscopic meniscal repair of a medial meniscus posterior horn tear.

Explanation

Correct Answer: DThe case lists the indications for a posterior approach to the knee, which include: removal of popliteal cysts and neoplasms, posterior synovectomy, open reduction and internal fixation of posterior tibial plateau shear fractures, fixation of bone avulsions associated with a PCL injury, and repair of posterior vascular injuries. Arthroscopic meniscal repair, even for a posterior horn tear, is typically performed arthroscopically through standard portals, not via an open posterior approach as described for these more extensive procedures.

Question 1194

Topic: Upper Extremity Trauma
A 35-year-old manual laborer sustains a Type III acromioclavicular (AC) joint separation. The coracoclavicular (CC) ligaments are completely ruptured. Which of the following describes the correct anatomic orientation of the native CC ligaments?
. The conoid is lateral and anterior, the trapezoid is medial and posterior
. The conoid is medial and posterior, the trapezoid is lateral and anterior
. The conoid and trapezoid both originate from the acromion
. The coracoacromial ligament is the primary vertical stabilizer
. The conoid is lateral and posterior, the trapezoid is medial and anterior

Correct Answer & Explanation

. The conoid is medial and posterior, the trapezoid is lateral and anterior

Explanation

The coracoclavicular ligaments consist of the conoid and trapezoid. The conoid is situated medial and posterior, while the trapezoid is located lateral and anterior.

Question 1195

Topic: 2. Trauma

A 22-year-old cyclist falls and sustains a displaced midshaft clavicle fracture. Which of the following represents an absolute indication for operative fixation of this fracture?

. 100% displacement of the fracture fragments
. 2 cm of clavicular shortening
. Associated subclavian artery injury
. Z-type comminution
. High-demand overhead athlete

Correct Answer & Explanation

. Associated subclavian artery injury

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, skin tenting with impending compromise, and associated neurovascular injuries like subclavian artery involvement. Displacement and shortening are relative indications.

Question 1196

Topic: 2. Trauma

A 45-year-old roofer falls from a ladder and sustains an intra-articular calcaneus fracture. You are reviewing his CT scan to determine the Sanders classification. Which specific imaging plane is used to define the Sanders classification?

. Sagittal CT through the anterior facet
. Axial CT through the sustentaculum tali
. Coronal CT through the posterior facet
. Harris axial radiograph
. Broden's view radiograph

Correct Answer & Explanation

. Coronal CT through the posterior facet

Explanation

The Sanders classification for intra-articular calcaneus fractures is based on the number and location of articular fracture lines through the posterior facet. This is evaluated using the coronal CT imaging plane.

Question 1197

Topic: 2. Trauma

A 45-year-old male sustains a Schatzker Type II tibial plateau fracture after a fall from a height. This fracture pattern involves a split-depression of the lateral plateau. What is the most frequently associated soft tissue injury that should be evaluated during surgical fixation?

. Medial meniscus tear
. Lateral meniscus tear
. Posterior cruciate ligament (PCL) rupture
. Popliteal artery intimal tear
. Common peroneal nerve transection

Correct Answer & Explanation

. Lateral meniscus tear

Explanation

Schatzker II fractures heavily impact the lateral articular surface and joint capsule. The lateral meniscus is injured in over 50% of these cases and often requires repair or peripheral reattachment during internal fixation.

Question 1198

Topic: 2. Trauma

A 22-year-old basketball player sustains a fracture at the base of the fifth metatarsal. Radiographs show a transverse fracture at the metaphyseal-diaphyseal junction (Zone 2), extending into the fourth-fifth intermetatarsal facet. What is the primary reason this specific fracture is at a high risk for nonunion?

. Excessive pull of the peroneus brevis tendon
. Disruption of the Lisfranc ligament
. It is located in a vascular watershed area
. High incidence of associated compartment syndrome
. Frequent missed diagnosis leading to weight-bearing

Correct Answer & Explanation

. It is located in a vascular watershed area

Explanation

A Jones fracture occurs in Zone 2 of the fifth metatarsal base, at the metaphyseal-diaphyseal junction. It has a notoriously high nonunion rate because it is located in a vascular watershed area between the metaphyseal and diaphyseal blood supplies.

Question 1199

Topic: 2. Trauma

A 28-year-old male sustains a severe traction injury to his right shoulder in a motorcycle accident. Examination reveals a completely flail arm, laterally displaced scapula, and massive swelling. Radiographs show a displaced clavicle fracture and acromioclavicular separation. This constellation of findings (scapulothoracic dissociation) carries the highest risk for which of the following concomitant injuries?

. Subclavian artery tear and brachial plexus avulsion
. Pneumothorax and rib fractures
. Cervical spine fracture
. Axillary nerve neurapraxia
. Massive rotator cuff tear

Correct Answer & Explanation

. Subclavian artery tear and brachial plexus avulsion

Explanation

Scapulothoracic dissociation is a highly morbid, high-energy injury characterized by lateral displacement of the scapula. It is frequently associated with devastating injuries to the subclavian artery and complete avulsions of the brachial plexus, which can lead to early mortality or permanent severe disability.

Question 1200

Topic: 2. Trauma



A 25-year-old male twists his knee while playing soccer. His radiograph shows an elliptic bone fragment avulsed from the lateral tibial plateau, distal to the joint line. This 'Segond fracture' is considered pathognomonic for an anterior cruciate ligament (ACL) tear. Which structural avulsion is responsible for this radiographic finding?

. Anterolateral ligament (ALL) / lateral capsular ligament
. Fibular collateral ligament (FCL)
. Biceps femoris tendon
. Iliotibial band
. Popliteus tendon

Correct Answer & Explanation

. Anterolateral ligament (ALL) / lateral capsular ligament

Explanation

The Segond fracture is an avulsion of the anterolateral ligament (ALL) or the meniscotibial portion of the mid-third lateral capsular ligament. It occurs with excessive internal rotation and varus stress, making it highly specific for an underlying ACL rupture.

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