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2. Trauma MCQs

Practice Set 67 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 1321

Topic: 2. Trauma
A 40-year-old male presents to the emergency department with a distal humerus fracture. Upon examination, there is a 3 cm laceration over the medial aspect of the elbow, communicating with the fracture site. Which of the following is an absolute indication for surgical intervention in this distal humerus fracture?
. An open fracture
. Neurovascular deficit (motor only)
. Intra-articular displacement > 2 mm
. Age greater than 65 years
. Associated olecranon fracture

Correct Answer & Explanation

. An open fracture

Explanation

An open fracture is an absolute indication for emergent surgical débridement and fixation due to the high risk of infection and subsequent devastating complications. Neurovascular deficits, especially an acute deficit following injury, often warrant emergent exploration but can sometimes be observed if a neuropraxia is suspected without overt vascular compromise. Intra-articular displacement > 2 mm is a strong indication for ORIF but is generally considered a relative indication (compared to an open fracture). Age > 65 years is a patient factor, not a fracture characteristic dictating surgery. An associated olecranon fracture is a complex injury but not an absolute indication in itself compared to an open fracture.

Question 1322

Topic: 2. Trauma

A 55-year-old male undergoes ORIF of a distal humerus fracture. Six hours post-operatively, he develops severe pain in the forearm, swelling, and bullae around the elbow. He reports pain out of proportion to the injury and analgesia. What is the most appropriate initial management step to prevent catastrophic complications?

. Elevate the limb and administer oral analgesics
. Immediate release of constrictive dressings and fasciotomy if compartment syndrome is suspected
. Start intravenous antibiotics immediately
. Perform a diagnostic ultrasound to rule out DVT
. Apply a hot pack to reduce swelling

Correct Answer & Explanation

. Immediate release of constrictive dressings and fasciotomy if compartment syndrome is suspected

Explanation

Correct Answer: BSevere pain, swelling, and bullae post-operatively, especially pain out of proportion to the injury, are highly concerning for evolving compartment syndrome, particularly in the forearm. Immediate release of all constrictive dressings (splints, casts, bandages) is paramount. If suspicion remains high or objective signs (e.g., pain with passive stretch of digits, paresthesia, tense compartments) are present, emergent fasciotomy is indicated to prevent irreversible ischemic damage to muscles and nerves. While elevation is good, and antibiotics might be considered later if infection is suspected, the immediate life-altering threat is compartment syndrome. Ultrasound for DVT is not relevant to acute swelling and pain in this context, and hot packs would worsen swelling.

Question 1323

Topic: 2. Trauma

A 24-year-old male presents with a scaphoid proximal pole fracture nonunion. The proximal pole is at high risk for avascular necrosis due to its retrograde blood supply. Which of the following vessels is the primary source of this retrograde perfusion?

. Volar carpal branch of the radial artery
. Dorsal carpal branch of the radial artery
. Superficial palmar arch
. Anterior interosseous artery
. Deep palmar arch

Correct Answer & Explanation

. Dorsal carpal branch of the radial artery

Explanation

The scaphoid receives its primary blood supply from the dorsal carpal branch of the radial artery, which enters the dorsal ridge distally and supplies the proximal pole in a retrograde fashion. This vulnerable vascular anatomy highly predisposes proximal pole fractures to nonunion and avascular necrosis.

Question 1324

Topic: 2. Trauma

A 65-year-old male presents with a highly comminuted, displaced olecranon fracture that extends distally toward the coronoid process. Which of the following fixation constructs is most biomechanically appropriate and carries the lowest rate of hardware failure for this specific fracture pattern?

. Tension band wiring (TBW)
. Intramedullary screw fixation alone
. Bridge plating with a pre-contoured locking plate
. Hook plate fixation
. Excision of the proximal fragment and triceps advancement

Correct Answer & Explanation

. Bridge plating with a pre-contoured locking plate

Explanation

Bridge plating with a pre-contoured locking plate provides superior stability for comminuted olecranon fractures, preventing the shortening and collapse that often occur with compression techniques. Tension band wiring is contraindicated in comminuted fractures because it relies on anterior cortical contact to convert tensile forces into compressive forces.

Question 1325

Topic: 2. Trauma

During open reduction and internal fixation of a Galeazzi fracture-dislocation, after anatomic rigid plating of the radius, the distal radioulnar joint (DRUJ) remains irreducible. Which of the following anatomic structures is most commonly blocking reduction?

. Extensor carpi ulnaris (ECU) tendon
. Flexor carpi ulnaris (FCU) tendon
. Extensor digiti minimi (EDM) tendon
. Median nerve
. Pronator quadratus muscle belly

Correct Answer & Explanation

. Extensor carpi ulnaris (ECU) tendon

Explanation

An irreducible DRUJ following anatomic fixation of the radius in a Galeazzi fracture is most often caused by soft tissue interposition. The extensor carpi ulnaris (ECU) tendon is the most common offending structure, frequently becoming entrapped in the ulnar notch.

Question 1326

Topic: 2. Trauma

A 30-year-old male sustains a dorsal fracture-dislocation of the PIP joint. Radiographs show a volar lip fracture involving 45% of the articular surface of the middle phalanx. The joint is unstable on extension block splinting at 30 degrees. What is the most appropriate definitive management?

. Buddy taping and immediate active range of motion
. Extension block pinning
. Volar plate arthroplasty or hemihamate osteochondral autograft
. Closed reduction and percutaneous pinning of the PIP joint in extension
. Primary arthrodesis of the PIP joint

Correct Answer & Explanation

. Volar plate arthroplasty or hemihamate osteochondral autograft

Explanation

For unstable dorsal PIP fracture-dislocations involving greater than 40% of the volar articular surface, joint reconstruction via volar plate arthroplasty, hemihamate autograft, or dynamic external fixation is indicated to restore stability and congruity.

Question 1327

Topic: 2. Trauma

A 35-year-old avid golfer presents with chronic ulnar-sided wrist pain and weakness in grip strength. Examination reveals localized tenderness over the hypothenar eminence. If left untreated, a nonunion of the suspected fracture most commonly puts which of the following tendons at risk of spontaneous rupture?

. Flexor carpi ulnaris
. Extensor carpi ulnaris
. Flexor digitorum profundus to the small finger
. Flexor pollicis longus
. Abductor digiti minimi

Correct Answer & Explanation

. Flexor digitorum profundus to the small finger

Explanation

A nonunion of a hook of the hamate fracture can lead to chronic friction and subsequent spontaneous rupture of the adjacent flexor tendons, most commonly the flexor digitorum profundus (FDP) to the small finger.

Question 1328

Topic: 2. Trauma

A 60-year-old male undergoes tension band wiring for a displaced transverse olecranon fracture. Six months postoperatively, the fracture has healed, but he complains of pain at the posterior elbow. What is the most common complication associated with this specific surgical technique?

. Ulnar nerve palsy
. Heterotopic ossification
. Symptomatic hardware requiring removal
. Nonunion of the fracture
. Triceps tendon rupture

Correct Answer & Explanation

. Symptomatic hardware requiring removal

Explanation

The most common complication of tension band wiring for olecranon fractures is symptomatic prominent hardware, reported in up to 40-80% of patients. This frequently necessitates a secondary procedure for hardware removal.

Question 1329

Topic: 2. Trauma

A 6-year-old boy presents with a Bado Type I Monteggia fracture-dislocation. Closed reduction of the apex-anterior ulnar diaphyseal fracture is achieved and pinned, but the radial head remains persistently dislocated anteriorly. What is the most common anatomical block to closed reduction of the radial head in this scenario?

. Interposition of the annular ligament
. Entrapment of the radial nerve
. Interposition of the brachialis tendon
. Tethering by the interosseous membrane
. Entrapment of the biceps tendon

Correct Answer & Explanation

. Interposition of the annular ligament

Explanation

In Monteggia fracture-dislocations, if the radial head remains irreducible after restoring ulnar length and alignment, the most common block to reduction is soft tissue interposition, specifically the annular ligament or joint capsule.

Question 1330

Topic: 2. Trauma

A 30-year-old male presents with severe forearm pain and pain with passive finger extension following a crush injury. Compartment pressures measure 45 mmHg, and an emergent volar fasciotomy is planned. Which muscle bellies in the forearm are most susceptible to ischemic necrosis and must be carefully decompressed due to their location in the deep volar compartment?

. Flexor carpi radialis and flexor carpi ulnaris
. Flexor digitorum superficialis and palmaris longus
. Flexor digitorum profundus and flexor pollicis longus
. Pronator teres and brachioradialis
. Extensor digitorum communis and extensor indicis

Correct Answer & Explanation

. Flexor digitorum profundus and flexor pollicis longus

Explanation

The deep volar compartment contains the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL). Because they rest directly against the interosseous membrane and bone, they are subjected to the highest pressures during compartment syndrome, making them the most susceptible to profound ischemia and subsequent Volkmann's ischemic contracture.

Question 1331

Topic: 2. Trauma
A 32-year-old male sustains a Gustilo-Anderson Type II open both bones forearm fracture after a motor vehicle accident. Initial assessment reveals a 3 cm laceration over the mid-ulna, minimal contamination, and intact neurovascular status. After initial wound irrigation and debridement in the emergency department, what is the most appropriate next step in definitive management?
. Application of a long arm cast after wound closure.
. Immediate open reduction and internal fixation (ORIF) with dual plates and screws.
. Application of an external fixator with delayed definitive fixation.
. Flexible intramedullary nailing of both bones.
. Serial debridement and delayed primary closure, followed by casting.

Correct Answer & Explanation

. Immediate open reduction and internal fixation (ORIF) with dual plates and screws.

Explanation

For Gustilo-Anderson Type II open both bones forearm fractures, immediate definitive internal fixation with plates is generally recommended after thorough initial debridement. Type II open fractures typically have moderate soft tissue damage but sufficient coverage for internal fixation. The goal is to achieve stable osteosynthesis, which allows for early soft tissue coverage and rehabilitation, minimizing the risk of infection and non-union. Plating provides rigid fixation crucial for adult forearm fractures.

Question 1332

Topic: 2. Trauma

A 40-year-old male undergoes open reduction and internal fixation (ORIF) of a mid-diaphyseal radial fracture using a 3.5mm dynamic compression plate (DCP) via the Henry approach. To achieve optimal stability and promote primary bone healing, which biomechanical principle is primarily utilized by the DCP in this scenario?

. Neutralization of shear forces across an oblique fracture.
. Bridge plating for comminuted segments.
. Direct axial compression across the fracture site.
. Buttress support to prevent collapse of metaphyseal bone.
. Lag screw fixation for interfragmentary compression.

Correct Answer & Explanation

. Direct axial compression across the fracture site.

Explanation

Correct Answer: CDynamic compression plates (DCPs) are specifically designed to create direct axial compression across a fracture site (Option C) as the screws are tightened into their eccentric holes. This compression reduces the fracture gap, increases interfragmentary friction, and promotes primary bone healing, which is the goal for simple diaphyseal fractures in adults. This is a fundamental principle of stable internal fixation for these types of fractures.Incorrect Options:A. Neutralization of shear forces across an oblique fracture:While a plate can neutralize forces, this is typically the role of a neutralization plate, which protects lag screws providing interfragmentary compression in oblique fractures. The primary mechanism of a DCP for a simple fracture is axial compression.B. Bridge plating for comminuted segments:Bridge plating is a technique used for comminuted fractures where direct compression is not possible. The plate spans the comminuted zone without screws in the central fragments, allowing for indirect reduction and callus formation (secondary healing). This is not the primary function of a DCP in a simple fracture.D. Buttress support to prevent collapse of metaphyseal bone:Buttress plating is used for metaphyseal fractures to prevent collapse under axial load, often seen in articular fractures. This is not the primary role of a DCP in a diaphyseal fracture.E. Lag screw fixation for interfragmentary compression:Lag screws provide interfragmentary compression, which is crucial for oblique fractures. While lag screws can be used in conjunction with a plate, the plate itself, when used as a compression plate, provides axial compression across the fracture ends, which is distinct from lag screw function.

Question 1333

Topic: 2. Trauma

A 6-year-old child presents with a completely displaced, unstable mid-diaphyseal both bones forearm fracture after a fall from a swing. Initial attempts at closed reduction under conscious sedation in the emergency department were unsuccessful. What is the most appropriate next step in management?

. Repeat closed reduction under general anesthesia and apply a long arm cast.
. Open reduction and internal fixation (ORIF) with 3.5mm dynamic compression plates.
. Flexible intramedullary nailing (FIN) of both radius and ulna.
. Application of an external fixator for temporary stabilization.
. Observation with serial radiographs for remodeling potential.

Correct Answer & Explanation

. Flexible intramedullary nailing (FIN) of both radius and ulna.

Explanation

Correct Answer: CFor unstable and completely displaced diaphyseal forearm fractures in children where closed reduction fails, flexible intramedullary nailing (FIN) is the treatment of choice (Option C). FIN provides stable fixation, allows for early motion, and preserves the growth plates. In a 6-year-old, the remodeling potential is still significant, but complete displacement and instability after failed closed reduction necessitate surgical stabilization to ensure anatomical alignment and prevent malunion. FIN is minimally invasive and allows for excellent functional outcomes.Incorrect Options:A. Repeat closed reduction under general anesthesia and apply a long arm cast:While a repeat closed reduction under general anesthesia might be attempted, if the fracture is truly unstable and completely displaced, maintaining reduction with casting alone is often difficult and prone to failure, especially after an initial failed attempt. This is not themost appropriate next stepfor definitive management if stability is a concern.B. Open reduction and internal fixation (ORIF) with 3.5mm dynamic compression plates:Plating is generally reserved for older adolescents or specific complex cases in children (e.g., highly comminuted, open fractures, or failed FIN) due to potential issues with growth plate injury, larger dissection, and the need for hardware removal. FIN is preferred in this age group.D. Application of an external fixator for temporary stabilization:External fixation is typically reserved for open fractures with significant contamination, highly comminuted fractures with severe soft tissue injury, or situations where internal fixation is contraindicated. It is not the primary definitive treatment for a closed, unstable diaphyseal fracture in a child.E. Observation with serial radiographs for remodeling potential:Observation is inappropriate for a completely displaced and unstable fracture after failed reduction in a child, as remodeling potential is limited for rotational or significant angular deformities, and instability will lead to malunion.

Question 1334

Topic: 2. Trauma

A 28-year-old male undergoes ORIF of a closed mid-diaphyseal both bones forearm fracture. Six hours post-operatively, he complains of severe, unrelenting pain in his forearm, disproportionate to the expected post-operative discomfort. He reports numbness in his thumb and index finger. On examination, his fingers are swollen, and passive extension of his fingers elicits excruciating pain. Distal pulses are present and strong. What is the most appropriate immediate diagnostic and management step?

. Administer additional opioid analgesics and reassess in 2 hours.
. Obtain an immediate CT scan of the forearm to rule out hematoma.
. Remove the surgical dressing and bivalve the cast/splint.
. Measure forearm compartment pressures urgently.
. Elevate the limb above heart level and apply ice packs.

Correct Answer & Explanation

. Measure forearm compartment pressures urgently.

Explanation

Correct Answer: DThe patient's symptoms (severe pain disproportionate to injury, pain with passive stretch of fingers, paresthesias in the median nerve distribution affecting the thumb and index finger, and swelling) are classic signs of acute compartment syndrome. Despite palpable pulses, which are often preserved until late stages, the clinical picture is highly suspicious. The most appropriate immediate diagnostic and management step is to urgently measure forearm compartment pressures (Option D). This is the definitive diagnostic test, and if pressures are elevated above a critical threshold (typically within 30 mmHg of diastolic blood pressure or absolute pressure >30-40 mmHg), emergent fasciotomy is indicated.Incorrect Options:A. Administer additional opioid analgesics and reassess in 2 hours:This is dangerous and can mask the worsening symptoms of compartment syndrome, leading to delayed diagnosis and irreversible tissue damage.B. Obtain an immediate CT scan of the forearm to rule out hematoma:A CT scan is not the primary diagnostic tool for compartment syndrome. While a hematoma can contribute to compartment pressure, the definitive diagnosis relies on direct pressure measurements.C. Remove the surgical dressing and bivalve the cast/splint:While removing a tight dressing or bivalving a cast/splint is a crucial initial step if external compression is suspected, it is not themost appropriate immediate diagnostic and management stepforsuspected compartment syndromein a post-operative setting where internal swelling is the primary concern. Pressure measurement is still required to confirm the diagnosis and guide fasciotomy.E. Elevate the limb above heart level and apply ice packs:Elevation can reduce blood flow to the limb, potentially worsening ischemia in a limb with compromised perfusion due as in compartment syndrome. Ice packs are also generally contraindicated as they can cause vasoconstriction and further reduce blood flow. The limb should be kept at heart level.

Question 1335

Topic: 2. Trauma

A 55-year-old male develops a painful loss of forearm pronation and supination 6 months after open reduction and internal fixation of a both bones forearm fracture. Radiographs show abnormal bone formation bridging the radius and ulna in the mid-diaphyseal region. Which of the following is the most likely diagnosis and a significant risk factor for its development?

. Delayed union; patient age.
. Deep infection; inadequate antibiotic prophylaxis.
. Complex Regional Pain Syndrome (CRPS) Type I; prolonged immobilization.
. Heterotopic ossification leading to synostosis; high-energy trauma and extensive soft tissue injury.
. Hardware failure; inadequate plate length.

Correct Answer & Explanation

. Heterotopic ossification leading to synostosis; high-energy trauma and extensive soft tissue injury.

Explanation

Correct Answer: DThe described symptoms (painful loss of pronation/supination) and radiographic findings (abnormal bone formation bridging the radius and ulna) are classic for heterotopic ossification leading to synostosis (Option D). Synostosis is the abnormal fusion of the radius and ulna, severely impairing the unique rotational function of the forearm. High-energy trauma with extensive soft tissue injury and prolonged operative time are significant risk factors for its development, as they lead to a robust inflammatory response that can trigger heterotopic bone formation.Incorrect Options:A. Delayed union; patient age:Delayed union would present as persistent pain at the fracture site with radiographic evidence of incomplete healing, not abnormal bone bridging the two bones. While age can influence healing, it's not the primary risk for synostosis.B. Deep infection; inadequate antibiotic prophylaxis:Deep infection would typically present with pain, fever, erythema, swelling, and possibly purulent discharge. While infection can lead to bone changes, it doesn't typically cause bone bridging between the radius and ulna in this manner.C. Complex Regional Pain Syndrome (CRPS) Type I; prolonged immobilization:CRPS presents with pain, swelling, skin changes (shiny, thin), allodynia, and diffuse osteopenia. While it can cause stiffness, it does not involve abnormal bone bridging between the radius and ulna. Prolonged immobilization is a risk factor for CRPS, but not the primary cause of synostosis.E. Hardware failure; inadequate plate length:Hardware failure would involve breakage or loosening of the plate/screws, leading to instability and pain, not bone fusion between the two bones. Inadequate plate length is a risk factor for non-union or refracture, not synostosis.

Question 1336

Topic: 2. Trauma

A 30-year-old male presents with a 15-degree rotational malunion of the radius after non-operative management of a mid-diaphyseal forearm fracture. Clinically, he has a significant loss of pronation and supination. What is the most accurate method to quantify this rotational deformity for surgical planning?

. Clinical estimation of forearm rotation compared to the contralateral side.
. Standard AP and lateral radiographs of the forearm.
. CT scan with 3D reconstruction and specific rotational measurements.
. MRI scan of the forearm to assess soft tissue impingement.
. Ultrasound assessment of muscle contracture.

Correct Answer & Explanation

. CT scan with 3D reconstruction and specific rotational measurements.

Explanation

Correct Answer: CA CT scan with 3D reconstruction and specific rotational measurements (Option C) is the most accurate and reliable method to quantify rotational malunion of the forearm. Plain radiographs are notoriously unreliable for assessing rotational deformities. CT provides detailed axial images that can be used to measure the relative rotation between the proximal and distal fragments, which is crucial for precise surgical correction.Incorrect Options:A. Clinical estimation of forearm rotation compared to the contralateral side:Clinical assessment is essential for initial evaluation and determining functional impairment, but it is subjective and lacks the precision required for accurate quantification and surgical planning of rotational malunion.B. Standard AP and lateral radiographs of the forearm:Plain radiographs are excellent for assessing angulation, shortening, and translation, but they are highly inaccurate for quantifying rotational deformities due to projectional artifacts.D. MRI scan of the forearm to assess soft tissue impingement:MRI is superior for evaluating soft tissue structures, ligaments, and cartilage, but it is not the primary modality for precise bone rotational measurements.E. Ultrasound assessment of muscle contracture:Ultrasound can assess muscle and tendon integrity or contracture, but it cannot accurately quantify bone rotational malunion.

Question 1337

Topic: 2. Trauma

A 45-year-old male presents with a painful, hypertrophic non-union of the mid-shaft ulna 9 months after open reduction and internal fixation with a plate and screws. He has persistent pain with activity and localized tenderness. Radiographs show a persistent fracture line with abundant, but non-bridging, callus. There are no signs of infection. What is the most appropriate management strategy?

. Continue with conservative management and physiotherapy, as hypertrophic non-unions often heal spontaneously.
. Bone graft stimulation via percutaneous injection (e.g., PRP or bone marrow aspirate).
. Revision open reduction, rigid internal fixation with a new plate and screws, and bone grafting.
. Application of an external fixator with bone transport.
. Conversion to intramedullary nail with reaming.

Correct Answer & Explanation

. Revision open reduction, rigid internal fixation with a new plate and screws, and bone grafting.

Explanation

Correct Answer: CFor a hypertrophic non-union of the ulna shaft with persistent pain and abundant but non-bridging callus, the primary issue is typically inadequate stability at the fracture site. The most appropriate management strategy is revision open reduction, rigid internal fixation with a new plate and screws, and bone grafting (Option C). The bone graft provides osteoinductive and osteoconductive properties to stimulate healing, while the rigid fixation addresses the mechanical instability. A hypertrophic non-union indicates biological activity but insufficient mechanical environment for healing.Incorrect Options:A. Continue with conservative management and physiotherapy, as hypertrophic non-unions often heal spontaneously:While some hypertrophic non-unions might eventually heal, 9 months post-ORIF with persistent symptoms indicates a failed attempt at healing. Continued conservative management is unlikely to succeed without addressing the underlying mechanical issue.B. Bone graft stimulation via percutaneous injection:Percutaneous injections (e.g., PRP, bone marrow aspirate) are typically used for delayed unions or atrophic non-unions where biological stimulation is the primary need. For a hypertrophic non-union, the biological response is already present, but mechanical stability is lacking.D. Application of an external fixator with bone transport:External fixation with bone transport is a complex technique reserved for infected non-unions with significant bone loss or limb length discrepancy. It is not indicated for a sterile hypertrophic non-union.E. Conversion to intramedullary nail with reaming:While intramedullary nailing can be used for some long bone non-unions, it is generally less favored for adult forearm non-unions due to concerns about rotational stability and the difficulty of achieving adequate compression. Plating offers superior rotational control and compression for forearm non-unions.

Question 1338

Topic: 2. Trauma

A 10-year-old child presents with a mid-diaphyseal both bones forearm fracture. The fracture pattern is a complete transverse fracture of the ulna and a greenstick fracture of the radius with 15 degrees of volar angulation. Which of the following statements regarding remodeling potential for this injury is most accurate?

. Rotational deformities remodel significantly in children of this age.
. Angulation in the coronal plane (radial or ulnar) remodels better than in the sagittal plane.
. Volar angulation has superior remodeling potential compared to dorsal angulation.
. Remodeling potential is excellent for all types of deformities in a 10-year-old.
. Remodeling potential is minimal for diaphyseal fractures in children over 8 years old.

Correct Answer & Explanation

. Volar angulation has superior remodeling potential compared to dorsal angulation.

Explanation

Correct Answer: CIn children, remodeling potential for forearm fractures is influenced by age, proximity to the physis, and the plane of deformity. Volar angulation (Option C) in the sagittal plane generally has superior remodeling potential compared to dorsal angulation, and significantly better than angulation in the coronal plane (radial or ulnar angulation) or rotational deformities. This is due to the inherent growth and remodeling capabilities of bone, which are more effective in correcting sagittal plane deformities, especially when the apex of the deformity is directed away from the joint.Incorrect Options:A. Rotational deformities remodel significantly in children of this age:Rotational deformities remodel poorly at any age, and even small degrees of rotational malalignment can lead to significant functional impairment of pronation and supination.B. Angulation in the coronal plane (radial or ulnar) remodels better than in the sagittal plane:This is incorrect. Angulation in the sagittal plane (volar or dorsal) generally remodels better than angulation in the coronal plane.D. Remodeling potential is excellent for all types of deformities in a 10-year-old:Remodeling potential decreases with age, and while still present in a 10-year-old, it is not excellent for all types of deformities, particularly rotational and significant coronal plane angulation.E. Remodeling potential is minimal for diaphyseal fractures in children over 8 years old:While remodeling potential decreases with age, it is not minimal for diaphyseal fractures in a 10-year-old, especially for sagittal plane angulation. However, it is less than in younger children.

Question 1339

Topic: 2. Trauma
A 65-year-old female sustains a distal radius fracture with significant comminution, articular involvement spanning both the scaphoid and lunate fossae, and severe metaphyseal comminution, extending into the diaphysis. According to the Fernandez classification, how would this fracture typically be categorized?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type V

Explanation

The Fernandez classification categorizes distal radius fractures based on the mechanism of injury and fracture morphology. Type I is bending (meta-epiphyseal), Type II is shearing (Barton, Hutchinson), Type III is compression (die-punch), Type IV is avulsion (ligament), and Type V is combined or high-energy fractures with extensive comminution and bone loss. Significant comminution, articular involvement of both fossae, and extension into the diaphysis points strongly towards a high-energy injury, characteristic of a Type V Fernandez fracture.

Question 1340

Topic: 2. Trauma

A 40-year-old male presents with persistent wrist pain and decreased range of motion 1 year after non-operative management of a distal radius fracture. Radiographs show a dorsal tilt of 25 degrees, radial shortening of 5mm, and a 3mm intra-articular step-off. According to common malunion criteria, which of these findings is *least* acceptable for good functional outcomes in a younger, active patient?

. Dorsal tilt of 25 degrees
. Radial shortening of 5mm
. 3mm intra-articular step-off
. Loss of radial inclination
. Ulnar positive variance

Correct Answer & Explanation

. 3mm intra-articular step-off

Explanation

Correct Answer: CWhile all listed findings represent aspects of malunion, an intra-articular step-off of 3mm is widely considered the most critical predictor of poor long-term outcomes, particularly post-traumatic arthritis, especially in an active younger patient. Even 1-2mm of intra-articular incongruity is often deemed unacceptable. Dorsal tilt >10-15 degrees and radial shortening >2-3mm are also significant, and ulnar positive variance is directly related to radial shortening. However, articular step-off directly compromises joint congruity and leads to accelerated degenerative changes, making it the least acceptable from a functional prognosis standpoint.

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