2. Trauma MCQs

Which physical examination finding is considered the most pathognomonic cutaneous manifestation of dermatomyositis, often preceding the onset of significant muscle weakness?

A 55-year-old male is undergoing open reduction and internal fixation of a displaced lateral malleolus fracture via an anterolateral approach. The surgeon makes a longitudinal incision over the distal fibula. Which of the following neurological structures is at greatest risk during the superficial dissection and must be meticulously identified and retracted?

A 22-year-old soccer player sustains a severe inversion injury to the ankle, complicated by a compartment syndrome of the leg requiring fasciotomy. Postoperatively, the patient exhibits a foot drop and sensory loss over the dorsal aspect of the first web space. Which of the following nerves was most likely compromised?

A surgeon is performing an anterolateral approach to the distal fibula for fixation of a lateral malleolus fracture. The incision extends from 6 cm proximal to the tip of the lateral malleolus towards the calcaneocuboid joint. Which of the following neural structures is at greatest risk during the superficial dissection and must be carefully identified and protected?

A 30-year-old male sustains a severe crush injury to the lower leg, resulting in anterior compartment syndrome. Following emergent fasciotomy, he is noted to have a sensory deficit. Based on the anatomical distribution of the nerve traversing the anterior compartment, where would the patient most likely experience decreased sensation?

A 35-year-old female is undergoing open reduction and internal fixation of a displaced lateral malleolus fracture. The surgeon utilizes a standard anterolateral approach to the distal fibula. During the superficial dissection, which of the following neurological structures is at greatest risk and must be meticulously identified and protected as it crosses the surgical field anteriorly?

A hospital administrator is reviewing resource allocation for the orthopedic trauma service and notes a high volume of ankle fractures. Based on established epidemiological data, the administrator should anticipate the highest incidence of these injuries to occur in which of the following demographic distributions?

A 19-year-old basketball player sustains a fracture of the proximal fifth metatarsal. Radiographs show a transverse fracture line located 2 cm distal to the tuberosity, extending into the fourth-fifth intermetatarsal articulation. This specific fracture pattern is at high risk for nonunion due to a vascular watershed area located between which two blood supplies?

A 32-year-old skier sustains an acute twisting injury to his ankle. Radiographs reveal a small cortical avulsion fracture at the posterolateral margin of the distal fibula. This pathognomonic "fleck sign" is most highly associated with which of the following injuries?

A 28-year-old male sustains a severe crush injury to his right foot and develops worsening, intractable pain out of proportion to the injury. The surgeon diagnoses compartment syndrome of the foot and prepares for emergent fasciotomies. To ensure complete decompression, how many distinct anatomical fascial compartments must be recognized and released?

A 3-year-old boy sustains an isolated, closed, diaphyseal spiral fracture of the right femur after a fall from a playground structure. Radiographs show 1.5 cm of shortening. What is the most appropriate definitive treatment?

A 7-year-old boy weighing 25 kg sustains a closed, isolated transverse midshaft femur fracture. What is the most appropriate surgical treatment modality associated with the best clinical outcomes for this patient?

A 9-year-old boy presents with mild, vague shoulder pain. A radiograph of the proximal humerus reveals a centrally located, completely radiolucent metaphyseal lesion with a "fallen leaf" sign. The cortices are thinned but intact. What is the most appropriate initial management?

A 35-year-old man presents with progressive intrinsic hand weakness, clawing of the small and ring fingers, and numbness on the ulnar aspect of his hand. He reports a history of a childhood elbow fracture treated non-operatively. Physical examination reveals a profound cubitus valgus deformity. Which of the following pediatric fractures did he most likely sustain?

An 8-year-old boy presents with acute arm pain after throwing a baseball. Radiographs demonstrate a centrally located, completely lytic lesion in the proximal humeral metaphysis with a subtle "fallen leaf" sign and a pathologic fracture. What is the most appropriate initial management?

A 30-year-old mechanic sustains a closed fracture of the proximal phalanx of the index finger after a minor trauma. Radiographs reveal a central, lytic lesion with thin cortices and a non-displaced pathologic fracture.

What is the recommended treatment plan?

A 30-year-old patient presents with acute finger pain after minor trauma. Imaging shows a pathologic fracture through a central, lytic lesion with faint calcification.

What is the most appropriate initial management?

A 22-year-old man presents with acute pain and swelling in his index finger after a minor fall. Radiographs demonstrate a pathologic fracture through a central, lytic, expansile lesion with stippled calcification in the proximal phalanx.

What is the recommended management?

A 16-year-old boy presents with a painless lump on his proximal humerus. Imaging demonstrates a surface lesion causing saucerization of the underlying cortex with a sclerotic margin and cartilaginous matrix.

What is the most appropriate management for a growing, symptomatic lesion of this type?

A 35-year-old man sustains a closed, minimally displaced fracture through a lytic lesion in the proximal phalanx of his ring finger. Radiographs show a well-circumscribed, expansile lucency with stippled calcifications.

What is the most appropriate initial management?