Menu

2. Trauma MCQs

Practice Set 604 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 12061

Topic: Upper Extremity Trauma

In a Type V acromioclavicular (AC) joint separation, which ligaments are disrupted and what is the typical pattern of displacement?

. AC ligaments disrupted, CC ligaments intact; 25% superior displacement
. AC and CC ligaments disrupted; 100-300% superior displacement with deltotrapezial fascial disruption
. AC and CC ligaments disrupted; posterior displacement of the clavicle into the trapezius
. AC and CC ligaments disrupted; inferior displacement of the clavicle under the coracoid

Correct Answer & Explanation

. AC and CC ligaments disrupted; 100-300% superior displacement with deltotrapezial fascial disruption

Explanation

A Type V AC joint injury involves disruption of both the AC and coracoclavicular (CC) ligaments, along with severe tearing of the deltotrapezial fascia. This leads to dramatic superior displacement of the clavicle, measuring 100% to 300% relative to the contralateral normal shoulder.

Question 12062

Topic: 2. Trauma

A 30-year-old man undergoes open reduction and internal fixation for a complex intra-articular distal humerus fracture. Which of the following is the most proven prophylactic measure against heterotopic ossification (HO) in this setting?

. Immediate continuous passive motion (CPM) therapy
. A single dose of 700 cGy localized radiation within 48 hours postoperatively
. Oral bisphosphonates for 6 weeks
. Short-course oral corticosteroids for 3 days

Correct Answer & Explanation

. A single dose of 700 cGy localized radiation within 48 hours postoperatively

Explanation

Prophylaxis against heterotopic ossification (HO) around the elbow is highly effective using either a single dose of localized radiation (700 cGy) given within 24-48 hours postoperatively, or a 3-to-6-week course of oral Indomethacin.

Question 12063

Topic: 2. Trauma

When utilizing an olecranon osteotomy for maximum exposure of a complex intra-articular distal humerus fracture (AO/OTA 13-C3), where should the osteotomy ideally be directed?

. Through the sublime tubercle
. Through the bare area of the greater sigmoid notch
. Proximal to the triceps insertion footprint
. Distal to the coronoid process

Correct Answer & Explanation

. Through the bare area of the greater sigmoid notch

Explanation

A chevron olecranon osteotomy should be carefully directed through the 'bare area' of the greater sigmoid notch. This transverse groove lacks articular cartilage, thereby minimizing iatrogenic damage to the joint surface during the approach.

Question 12064

Topic: 2. Trauma

Which of the following factors represents the greatest risk for nonunion following nonoperative management of a midshaft clavicle fracture?

. Age less than 30 years
. Fracture shortening greater than 2 cm
. Undisplaced fracture pattern
. Male sex
. Proximal third fracture location

Correct Answer & Explanation

. Fracture shortening greater than 2 cm

Explanation

Fracture shortening of >2 cm, 100% displacement, and Z-type comminution are major risk factors for nonunion and poor functional outcomes in midshaft clavicle fractures treated nonoperatively.

Question 12065

Topic: 2. Trauma
A coronal shear fracture of the distal humerus that involves the articular cartilage of the capitellum with very little or no attached subchondral bone is best classified as which of the following?
. Hahn-Steinthal fracture (Type I)
. Bryan-Morrey Type III fracture
. Kocher-Lorenz fracture (Type II)
. McKee modification (Type IV)
. Grantham fracture

Correct Answer & Explanation

. Kocher-Lorenz fracture (Type II)

Explanation

A Kocher-Lorenz (Type II) capitellum fracture is an articular cartilage shear fracture with minimal underlying subchondral bone. In contrast, a Hahn-Steinthal (Type I) fracture includes a large fragment of subchondral bone.

Question 12066

Topic: 2. Trauma

A 22-year-old professional soccer player sustains an acute fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. Which of the following is the recommended treatment to minimize the risk of nonunion and allow early return to play?

. Short leg walking boot for 6 weeks
. Non-weight-bearing cast for 8 weeks
. Intramedullary screw fixation
. Excision of the proximal fragment
. Plate and screw construct

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Fractures at the metaphyseal-diaphyseal junction (Jones fractures, Zone 2) occur in a vascular watershed area with a high risk of nonunion. In elite athletes, intramedullary screw fixation is recommended to reduce nonunion rates and accelerate return to sport.

Question 12067

Topic: 2. Trauma

A 22-year-old elite collegiate basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal. What is the recommended treatment to minimize the risk of nonunion and expedite return to play?

. Non-weight-bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement
. Plate and screw construct using a lateral approach

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) involve the metaphyseal-diaphyseal junction, a watershed vascular area prone to nonunion. In elite athletes, early intramedullary screw fixation is recommended to decrease nonunion rates and allow a faster return to competitive sports.

Question 12068

Topic: 2. Trauma
A 40-year-old male roofer falls from a height and sustains a closed, displaced intra-articular calcaneus fracture. CT scan shows a Sanders Type III fracture. Which of the following factors is most strongly associated with poor clinical outcomes following open reduction and internal fixation (ORIF)?
. Age less than 50 years
. Female gender
. Worker's compensation claim
. Smoking 1 pack of cigarettes per day
. Delay of surgery by 10 days to allow swelling to subside

Correct Answer & Explanation

. Worker's compensation claim

Explanation

While smoking increases wound complication rates, orthopedic literature consistently shows that Worker's compensation claims and ongoing litigation are the most significant predictors of poor functional outcomes following operative treatment of calcaneus fractures.

Question 12069

Topic: 2. Trauma

A 45-year-old male sustains a high-energy closed tibial pilon fracture with severe soft tissue swelling and fracture blisters. What is the most appropriate initial management strategy?

. Immediate open reduction and internal fixation with dual plates
. Spanning external fixation with delayed definitive fixation
. Intramedullary nailing of the tibia
. Circular fine-wire external fixator application definitively
. Long leg cast application

Correct Answer & Explanation

. Spanning external fixation with delayed definitive fixation

Explanation

High-energy pilon fractures are associated with significant soft tissue trauma. The standard of care is a staged approach utilizing a spanning external fixator initially, followed by definitive fixation once the soft tissue envelope has adequately healed.

Question 12070

Topic: 2. Trauma

A 20-year-old track athlete complains of vague, aching dorsal midfoot pain that worsens with running. Radiographs are normal, but a CT scan reveals an incomplete, non-displaced stress fracture of the tarsal navicular in the sagittal plane. What is the most appropriate initial treatment?

. Non-weight-bearing cast for 6-8 weeks
. Weight-bearing in a controlled ankle motion (CAM) boot for 4 weeks
. Percutaneous screw fixation
. Bone stimulator and immediate return to activity as tolerated
. Open reduction and internal fixation with bone grafting

Correct Answer & Explanation

. Non-weight-bearing cast for 6-8 weeks

Explanation

Non-displaced navicular stress fractures have a high risk of nonunion due to the watershed vascular supply of the central third of the bone. Strict non-weight-bearing in a cast for 6 to 8 weeks is the gold standard initial treatment to achieve union.

Question 12071

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal (Zone 2). To ensure the highest chance of union and fastest return to play, what is the best treatment option?

. Hard-soled shoe with weight-bearing as tolerated
. Short leg non-weight-bearing cast for 6 weeks
. Intramedullary screw fixation
. Closed reduction and percutaneous pinning
. Excision of the proximal fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 (Jones) fractures in elite athletes are best treated with intramedullary screw fixation to minimize the risk of nonunion and accelerate return to play. The fracture occurs in a vascular watershed area, making it prone to delayed union with conservative management.

Question 12072

Topic: 2. Trauma

A 30-year-old male is recovering from an operatively treated Hawkins Type II talar neck fracture. At 8 weeks post-operation, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome. What does this finding signify?

. Impending avascular necrosis of the talus
. Subchondral radiolucency of the talar dome indicating intact vascularity
. Infection of the talar dome
. Nonunion of the talar neck fracture
. Early post-traumatic osteoarthritis

Correct Answer & Explanation

. Subchondral radiolucency of the talar dome indicating intact vascularity

Explanation

This finding is known as the Hawkins sign. The subchondral radiolucency indicates that the bone is undergoing disuse osteopenia, which requires an intact blood supply, thereby prognosticating against the development of complete avascular necrosis.

Question 12073

Topic: 2. Trauma

A 20-year-old elite track athlete complains of insidious onset midfoot pain. A CT scan reveals a non-displaced, incomplete stress fracture involving the dorsal cortex of the tarsal navicular. What is the most appropriate initial management?

. Strict non-weight-bearing cast immobilization for 6 weeks
. Weight-bearing as tolerated in a pneumatic walker boot
. Immediate open reduction and internal fixation with a compression screw
. Bone marrow aspirate concentrate injection
. Extracorporeal shockwave therapy

Correct Answer & Explanation

. Strict non-weight-bearing cast immobilization for 6 weeks

Explanation

For non-displaced and incomplete navicular stress fractures, conservative management consisting of 6 weeks of strict non-weight-bearing in a cast is highly successful and remains the first-line treatment. Weight-bearing casts or boots have unacceptably high failure rates.

Question 12074

Topic: Lower Extremity Trauma

A 25-year-old male presents with lateral ankle pain and a snapping sensation behind the lateral malleolus when the ankle is actively dorsiflexed and everted. Radiographs demonstrate a small bony "fleck" lateral to the distal fibula. What is the anatomic basis of this pathology?

. Avulsion of the calcaneofibular ligament
. Avulsion of the superior peroneal retinaculum from the fibula
. Longitudinal split tear of the peroneus brevis
. Os trigonum impingement
. Rupture of the inferior peroneal retinaculum

Correct Answer & Explanation

. Avulsion of the superior peroneal retinaculum from the fibula

Explanation

The patient has peroneal tendon subluxation. The "fleck sign" on an AP ankle radiograph represents a bony avulsion of the superior peroneal retinaculum (SPR) from the lateral malleolus. Surgical treatment typically involves SPR repair and potential fibular groove deepening.

Question 12075

Topic: 2. Trauma

A 40-year-old male sustains a high-energy, severely displaced pilon fracture (OTA 43-C3) with massive soft tissue swelling and fracture blisters. A spanning external fixator is placed on the day of injury. What is the primary reason to delay definitive open reduction and internal fixation?

. To allow the fracture site to achieve partial fibrous union
. Allow resolution of soft tissue swelling until skin wrinkles appear
. To facilitate concurrent vascular bypass surgery
. To await the results of deep wound cultures
. To prevent the development of a deep vein thrombosis

Correct Answer & Explanation

. Allow resolution of soft tissue swelling until skin wrinkles appear

Explanation

Definitive ORIF of pilon fractures is staged primarily to allow the severe soft tissue envelope swelling to subside. Operating through compromised, swollen soft tissue dramatically increases the risk of wound dehiscence and deep infection. The reappearance of skin wrinkles indicates appropriate timing.

Question 12076

Topic: 2. Trauma

A 19-year-old collegiate runner presents with midfoot pain. MRI confirms a stress fracture of the navicular involving the central third with a 1 mm gap and no sclerosis. What is the recommended initial management?

. Weight-bearing in a CAM boot for 6 weeks
. Non-weight-bearing in a short leg cast for 6-8 weeks
. Immediate open reduction and internal fixation
. Extracorporeal shockwave therapy
. Corticosteroid injection and orthotics

Correct Answer & Explanation

. Non-weight-bearing in a short leg cast for 6-8 weeks

Explanation

Navicular stress fractures carry a high risk of nonunion due to the relatively avascular central third. Initial conservative management for nondisplaced fractures requires strict non-weight-bearing in a short leg cast for 6 to 8 weeks.

Question 12077

Topic: 2. Trauma

A 32-year-old male sustains a closed, highly comminuted, displaced tibial pilon fracture (OTA/AO 43-C3) with severe soft tissue swelling and fracture blisters. What is the most appropriate initial management?

. Immediate open reduction and internal fixation with dual plating
. Application of a spanning external fixator and delayed definitive fixation
. Closed reduction and short leg casting
. Intramedullary nailing of the tibia
. Primary tibiotalar arthrodesis

Correct Answer & Explanation

. Application of a spanning external fixator and delayed definitive fixation

Explanation

High-energy pilon fractures with severe soft tissue compromise should be managed with the "span, scan, and plan" approach. A spanning external fixator stabilizes the fracture and allows soft tissue recovery before delayed definitive open reduction and internal fixation.

Question 12078

Topic: 2. Trauma

In the Sanders classification for intra-articular calcaneal fractures, the primary coronal CT image used to determine the classification is located at which anatomic landmark?

. The widest portion of the posterior facet
. The sustentaculum tali
. The anterior process of the calcaneus
. The calcaneocuboid joint
. The sinus tarsi

Correct Answer & Explanation

. The widest portion of the posterior facet

Explanation

The Sanders classification is based on coronal CT images through the widest portion of the posterior facet of the calcaneus. It categorizes fractures based on the number and location of articular fragments, which guides surgical decision-making.

Question 12079

Topic: Lower Extremity Trauma

During evaluation of a patient with an acute ankle sprain, a positive external rotation stress test is elicited. On the AP radiograph, what is the normal expected tibiofibular overlap measured 1 cm proximal to the joint line?

. Less than 1 mm
. Greater than 10 mm
. Greater than 1 mm
. Less than 5 mm
. Greater than 6 mm

Correct Answer & Explanation

. Greater than 6 mm

Explanation

In a normal ankle, the tibiofibular overlap on an AP radiograph should be >6 mm (or >1 mm on the mortise view). Decreased overlap indicates a syndesmotic injury (distal tibiofibular diastasis) which may require surgical stabilization.

Question 12080

Topic: Lower Extremity Trauma

A 24-year-old soccer player sustains an inversion ankle injury. Weight-bearing radiographs reveal a 5 mm medial clear space, which increases to 8 mm on external rotation stress views. The fibula is intact. What is the most appropriate definitive management?

. Short leg cast for 6 weeks
. Cam boot with early functional rehabilitation
. Open reduction and internal fixation of the medial malleolus
. Syndesmotic screw or suture-button fixation
. Primary repair of the anterior talofibular ligament

Correct Answer & Explanation

. Syndesmotic screw or suture-button fixation

Explanation

This patient has a purely ligamentous syndesmotic injury with instability, demonstrated by widening of the medial clear space on stress views. Operative fixation with syndesmotic screws or suture-button devices is required to restore and maintain the mortise.

Test Yourself

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

On this Page