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2. Trauma MCQs

Practice Set 73 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 1441

Topic: 2. Trauma

A 50-year-old patient presents with an intracapsular hip fracture. During pre-operative assessment, a CT scan is ordered. What is the primary utility of a CT scan in the acute setting for this type of injury, as described in the case?

. To detect early avascular necrosis (AVN) of the femoral head.
. To assess for occult nonunion or early chondral damage post-operatively.
. To provide detailed fracture morphology, assess comminution, and aid in surgical planning for reduction maneuvers.
. To evaluate the integrity of the retinacular vessels and quantify blood flow to the femoral head.
. To confirm the diagnosis of an intracapsular fracture, which is not reliably done with X-rays.

Correct Answer & Explanation

. To provide detailed fracture morphology, assess comminution, and aid in surgical planning for reduction maneuvers.

Explanation

Correct Answer: CThe 'Pre-Operative Planning & Patient Positioning' section states that a 'Computed Tomography (CT) Scan is essential for detailed fracture morphology, especially for comminution, impaction patterns, and articular involvement. It aids in surgical planning for reduction maneuvers and screw placement. It can also rule out occult fractures.'Option A is incorrect:MRI is the gold standard for early detection of AVN, not CT in the acute setting.Option B is incorrect:MRI is valuable post-operatively for assessing occult nonunion or early chondral damage, not CT in the acute setting.Option D is incorrect:While advanced imaging techniques can assess vascularity, a standard CT scan is not primarily used to evaluate the integrity of retinacular vessels or quantify blood flow. Angiography or MRI with contrast might provide some vascular information, but this is not the primary role of a routine pre-operative CT for fracture morphology.Option E is incorrect:AP Pelvis and Cross-Table Lateral Hip X-rays are the standard initial imaging to confirm diagnosis and classify the fracture. CT provides more detail, but X-rays are usually sufficient for initial diagnosis.

Question 1442

Topic: 2. Trauma

A 30-year-old male sustains a femoral neck fracture. The surgeon is considering the optimal placement of cannulated screws for fixation. Which of the following principles of screw placement is most crucial for maximizing stability and preventing complications?

. Screws should be fully threaded to achieve maximum compression across the fracture site.
. Screws should be placed perpendicular to the fracture line to resist shear forces.
. Screws should be placed parallel to each other and parallel to the axis of the femoral neck, ending in the subchondral bone.
. Screws should be placed only in the inferior aspect of the femoral neck to avoid damaging the superior retinacular vessels.
. The guide wires should be placed as close to the articular surface as possible to maximize purchase.

Correct Answer & Explanation

. Screws should be placed parallel to each other and parallel to the axis of the femoral neck, ending in the subchondral bone.

Explanation

Correct Answer: CThe 'Fixation Technique' section, specifically under 'Cannulated Screws (CS),' details the crucial principles: 'The screws should be placed parallel to each other and parallel to the axis of the femoral neck, ending in the subchondral bone of the femoral head. This maximizes purchase and stability.' The image also visually reinforces the parallel placement and engagement with the subchondral bone.Option A is incorrect:The case states: 'The screws should be partially threaded, allowing for interfragmentary compression, or fully threaded if no compression is desired (e.g., if there is already good impaction).' Fully threaded screws do not allow for interfragmentary compression, which is often desired. Excessive compression can also lead to collapse.Option B is incorrect:Screws are typically placed parallel to the femoral neck axis, not perpendicular to the fracture line, to provide optimal stability and compression along the neck axis.Option D is incorrect:While the inferior screw along the calcar is important, the inverted triangle configuration requires superior screws as well to provide rotational stability. Avoiding the superior retinacular vessels is achieved by careful surgical technique and approach (e.g., anterior open reduction), not by avoiding screw placement in the superior neck altogether.Option E is incorrect:The case states: 'The guide wire should be centrally placed in the femoral neck on both views and approximately 5-10mm from the articular surface in the femoral head.' Placing them too close risks breaching the articular cartilage, leading to iatrogenic damage and potential early arthritis.

Question 1443

Topic: 2. Trauma

A 72-year-old female with a history of osteoporosis and 8 years of alendronate use presents to the emergency department after a low-energy fall. She complains of severe left thigh pain. Radiographs reveal a transverse fracture of the left subtrochanteric femur with a characteristic medial spike and minimal comminution. She reports prodromal thigh pain for the past 3 months. Which of the following classifications or associated conditions best describes this fracture?

. Russell-Taylor Type IA
. AO/OTA 32-A1
. Atypical Femoral Fracture (AFF)
. High-energy trauma subtrochanteric fracture
. Pathologic fracture due to metastatic disease

Correct Answer & Explanation

. Atypical Femoral Fracture (AFF)

Explanation

Correct Answer: CThe case explicitly describes Atypical Femoral Fractures (AFFs) as typically presenting as transverse or short oblique fractures with a characteristic medial spike, often preceded by prodromal thigh pain, and associated with prolonged bisphosphonate use, particularly in the elderly. The patient's history of 8 years of alendronate use, low-energy fall, prodromal thigh pain, and the radiographic description (transverse fracture with a medial spike) are all classic features of an AFF. Russell-Taylor and AO/OTA classifications describe general subtrochanteric patterns but do not specifically identify the etiology or unique features of AFFs. While AFFs are a type of subtrochanteric fracture, 'Atypical Femoral Fracture' is the most specific and accurate description given the detailed clinical vignette. It is not a high-energy trauma fracture, nor is there information to suggest a pathologic fracture from metastatic disease.

Question 1444

Topic: 2. Trauma

A 35-year-old male sustains a high-energy subtrochanteric femur fracture. During surgical planning, the orthopedic surgeon anticipates significant displacement of the proximal fragment. Which combination of muscles is primarily responsible for the classic flexion, abduction, and external rotation deformity of the proximal fragment?

. Adductor magnus, vastus lateralis, rectus femoris
. Gluteus medius, gluteus minimus, iliopsoas, short external rotators
. Hamstrings, gastrocnemius, soleus
. Pectineus, adductor longus, adductor brevis
. Quadriceps femoris, sartorius, tensor fascia lata

Correct Answer & Explanation

. Gluteus medius, gluteus minimus, iliopsoas, short external rotators

Explanation

Correct Answer: BThe case details the muscular attachments and deforming forces on the proximal fragment of a subtrochanteric fracture. It states: 'The iliopsoas, inserting on the lesser trochanter, causes flexion and external rotation of the proximal fragment. The gluteus medius and minimus, inserting on the greater trochanter, cause abduction. The short external rotators (piriformis, obturators, gemelli, quadratus femoris) further contribute to external rotation.' Therefore, the combination of gluteus medius, gluteus minimus, iliopsoas, and short external rotators is responsible for the classic flexion, abduction, and external rotation deformity.

Question 1445

Topic: Lower Extremity Trauma

A 68-year-old female with severe osteoporosis presents with a comminuted subtrochanteric femur fracture. The surgical team is debating between intramedullary nailing (IMN) and plate fixation. Based on the biomechanical principles discussed in the case, which statement accurately describes the advantage of IMN in this scenario?

. IMNs are load-bearing devices, providing superior stability by bridging the fracture site on the lateral cortex.
. Plates are load-sharing devices, reducing stress shielding and promoting bone healing more effectively than IMNs.
. IMNs are placed closer to the mechanical axis, allowing the bone-implant construct to share axial and bending loads, reducing fatigue failure.
. Extramedullary plates are inherently less susceptible to fatigue failure in comminuted or osteoporotic bone due to their broad surface area.
. IMNs require more extensive periosteal stripping, which enhances localized blood supply and bone healing.

Correct Answer & Explanation

. IMNs are placed closer to the mechanical axis, allowing the bone-implant construct to share axial and bending loads, reducing fatigue failure.

Explanation

Correct Answer: CThe case clearly differentiates between load-sharing and load-bearing devices under the 'Biomechanics' section. It states: 'Intramedullary Nails (IMN): As load-sharing devices, IMNs are placed within the medullary canal, closer to the mechanical axis of the femur. This central placement allows the bone-implant construct to share axial and bending loads, reducing stress shielding and promoting bone healing. IMNs are particularly effective in resisting bending forces, which are predominant in the subtrochanteric region. Their inherent stability against torsion, especially with two proximal and two distal locking screws, is a significant advantage.' Conversely, plates are described as load-bearing devices, 'more susceptible to fatigue failure, particularly in comminuted or osteoporotic bone.' Options A, B, D, and E contradict the information provided in the case.

Question 1446

Topic: 2. Trauma

A 92-year-old male with end-stage heart failure, severe dementia, and a life expectancy estimated at less than 3 months, sustains a minimally displaced subtrochanteric femur fracture after a fall. He is bed-bound, non-ambulatory, and experiences only mild pain managed with oral analgesics. His medical team deems him unfit for anesthesia and surgery due to prohibitive risks. Based on the case, which of the following is the most appropriate management strategy?

. Urgent intramedullary nailing to prevent further displacement and facilitate mobilization.
. Plate fixation with bone grafting due to the patient's age and poor bone quality.
. Non-operative management with palliative care, given his medical status and functional demands.
. External fixation followed by delayed definitive internal fixation once his medical status improves.
. Prophylactic nailing of the contralateral femur due to increased risk of future fracture.

Correct Answer & Explanation

. Non-operative management with palliative care, given his medical status and functional demands.

Explanation

Correct Answer: CThe case outlines specific, highly limited circumstances for non-operative management. It states: 'Non-operative management for subtrochanteric fractures is exceedingly rare and generally reserved for specific, highly limited circumstances: Non-Ambulatory Patients with Minimal Pain: Patients who are bed-bound or severely debilitated with very limited functional demands, and who experience minimal pain from their fracture, may be considered for palliative non-operative care if surgical risks outweigh potential benefits. Extremely Poor Medical Status: Patients with severe, uncontrolled medical comorbidities where the risk of anesthesia and surgery is deemed prohibitive, and whose life expectancy is very limited, may be managed non-operatively (e.g., hospice care).' This patient's profile (92 years old, end-stage heart failure, severe dementia, bed-bound, minimal pain, prohibitive surgical risks, limited life expectancy) perfectly aligns with these non-operative indications.

Question 1447

Topic: 2. Trauma

A 55-year-old male with a subtrochanteric femur fracture is undergoing pre-operative planning for intramedullary nailing. The surgeon is reviewing the radiographs, including the image below, to assess the fracture pattern, comminution, and femoral bowing.

Which of the following is a critical step during pre-operative radiographic assessment and templating, as highlighted in the case, to ensure optimal nail selection and prevent complications?

. Obtaining only AP and lateral views of the hip joint to assess proximal fragment rotation.
. Relying solely on intraoperative measurements for nail length and diameter.
. Assessing the contralateral, uninjured femur with AP and lateral views for templating nail length, diameter, and femoral bow.
. Avoiding CT scans, as they provide redundant information for subtrochanteric fractures.
. Planning for a nail diameter that is 3-4 mm smaller than the narrowest point of the femoral canal to prevent iatrogenic fracture.

Correct Answer & Explanation

. Assessing the contralateral, uninjured femur with AP and lateral views for templating nail length, diameter, and femoral bow.

Explanation

Correct Answer: CThe 'Pre-Operative Planning' section emphasizes the importance of comprehensive radiographic assessment. It specifically states under 'Radiographic Assessment': 'Contralateral Femur: AP and lateral views of the contralateral, uninjured femur can be invaluable for templating nail length, diameter, and assessing normal femoral bow.' This step is crucial for selecting the correct implant size and curvature to match the patient's anatomy and prevent complications like iatrogenic fracture or malalignment. Options A, B, D, and E contradict the detailed planning steps outlined in the case. Standard views of the entire femur are needed, not just the hip. Intraoperative measurements are confirmatory, not primary. CT scans are useful for complex comminution. Reaming is typically 1-2mmlargerthan the nail, not smaller.

Question 1448

Topic: 2. Trauma

During intramedullary nailing of a subtrochanteric femur fracture, the surgeon encounters difficulty reducing the classic deformity: the proximal fragment is flexed, abducted, and externally rotated, while the distal fragment is adducted and shortened. Which intraoperative maneuver or adjunct is most effective in overcoming the adduction of the distal fragment and facilitating reduction?

. Increasing longitudinal traction alone.
. Applying direct manual pressure to internally rotate the proximal fragment.
. Using percutaneously placed large pointed reduction clamps or bone hooks to manipulate the distal fragment.
. Decreasing the reamer size by 2 mm to allow for easier nail passage.
. Performing a mini-open reduction and applying a plate to the medial cortex.

Correct Answer & Explanation

. Using percutaneously placed large pointed reduction clamps or bone hooks to manipulate the distal fragment.

Explanation

Correct Answer: CThe 'Fracture Reduction' section explicitly addresses challenges in reduction and lists various aids. It states: 'Reduction Aids: Manual Manipulation: Direct pressure on the proximal or distal fragment. Percutaneous Clamps/Bone Hooks: Large pointed reduction clamps or bone hooks can be inserted percutaneously to grasp and manipulate fragments, particularly to overcome the adduction of the distal fragment or the flexion/external rotation of the proximal fragment.' While traction helps with length and some alignment, it alone may not overcome strong adduction. Manual pressure for internal rotation addresses the proximal fragment's external rotation, not the distal fragment's adduction. Decreasing reamer size is incorrect technique. Applying a plate to the medial cortex is not a primary reduction maneuver for IMN and is a different fixation strategy.

Question 1449

Topic: 2. Trauma

A surgeon is preparing to insert an intramedullary nail for a subtrochanteric femur fracture. The case emphasizes the importance of selecting the correct entry point. For a subtrochanteric fracture, which entry point is often preferred for providing a more central alignment with the femoral shaft, and what is a key consideration for its placement?

. Trochanteric tip entry; it is located directly at the tip of the greater trochanter and requires a straight nail.
. Piriformis fossa entry; it is located slightly medial to the tip of the greater trochanter and slightly posterior, aiming for central alignment.
. Anterior superior iliac spine entry; it provides a direct path to the femoral canal.
. Lateral femoral condyle entry; it allows for retrograde nailing, which is preferred for subtrochanteric fractures.
. Lesser trochanter entry; it directly addresses the iliopsoas pull.

Correct Answer & Explanation

. Piriformis fossa entry; it is located slightly medial to the tip of the greater trochanter and slightly posterior, aiming for central alignment.

Explanation

Correct Answer: BThe 'Entry Point & Guidewire Insertion' section under 'Intramedullary Nailing Antegrade Technique' discusses entry point selection. It states: 'Piriformis Fossa Entry: Often preferred for subtrochanteric fractures as it provides a more central alignment with the femoral shaft. The entry point is located slightly medial to the tip of the greater trochanter and slightly posterior.' It also emphasizes that 'Fluoroscopic Guidance: A guidewire is advanced under fluoroscopy (AP and lateral views) to confirm the optimal entry point. It should be placed centrally in both planes of the proximal femoral canal.' This aligns perfectly with option B. Other options describe incorrect or less preferred entry points for antegrade subtrochanteric nailing.

Question 1450

Topic: 2. Trauma

A 58-year-old male undergoes intramedullary nailing for a comminuted subtrochanteric femur fracture. Six months post-operatively, radiographs show no signs of union, and he experiences persistent pain and inability to bear full weight. There are no signs of infection. The surgeon diagnoses an aseptic nonunion. Based on the case, what is generally considered the most common and effective salvage procedure for this complication?

. Removal of the existing nail and insertion of a smaller diameter nail.
. Application of a lateral locking plate without removing the existing nail.
. Exchange nailing (removing the current nail and inserting a larger diameter nail), potentially with bone grafting.
. Prolonged non-weight-bearing and observation for another 6 months.
. Total hip arthroplasty.

Correct Answer & Explanation

. Exchange nailing (removing the current nail and inserting a larger diameter nail), potentially with bone grafting.

Explanation

Correct Answer: CThe 'Late Postoperative' complications section, specifically under 'Nonunion/Delayed Union,' addresses the management of this issue. It states: 'Revision surgery is often required. Exchange nailing (removing the current nail and inserting a larger diameter nail) is the most common and effective salvage procedure for aseptic nonunion. This can be augmented with bone grafting (autograft or allograft), particularly if there is a significant bone defect.' Inserting a smaller diameter nail (Option A) would reduce stability. Applying a plate without removing the nail (Option B) is not the primary or most effective salvage. Prolonged non-weight-bearing (Option D) is unlikely to resolve an established nonunion. Total hip arthroplasty (Option E) is not typically indicated for subtrochanteric nonunion unless there is severe femoral head pathology, which is not described here.

Question 1451

Topic: 2. Trauma

A 42-year-old active male undergoes intramedullary nailing for a stable subtrochanteric femur fracture with good bone quality and anatomical reduction. Post-operatively, the surgeon discusses the rehabilitation plan. Based on the general principles outlined in the case, what is the most likely initial weight-bearing status prescribed for this patient?

. Non-weight-bearing (NWB) for 12 weeks to allow for complete bone healing.
. Toe-touch weight-bearing (TTWB) for 6 weeks, followed by gradual progression.
. Weight-bearing as tolerated (WBAT) with an assistive device.
. Partial weight-bearing (PWB) at 25% body weight for 8 weeks.
. Full weight-bearing immediately without an assistive device.

Correct Answer & Explanation

. Weight-bearing as tolerated (WBAT) with an assistive device.

Explanation

Correct Answer: CThe 'Post-Operative Rehabilitation Protocols' section, under 'General Principles,' discusses weight-bearing status. It states: 'Weight-Bearing As Tolerated (WBAT): Generally allowed for stable intramedullary nail constructs with good bone quality and adequate reduction. This allows patients to use pain as a guide and often accelerates functional recovery.' Given the patient's profile (active male, stable IMN construct, good bone quality, anatomical reduction), WBAT with an assistive device is the most appropriate initial weight-bearing status. NWB is rarely indicated, and TTWB/PWB are typically reserved for more comminuted or unstable fractures. Full weight-bearing immediately without an assistive device is too aggressive.

Question 1452

Topic: 2. Trauma

A 70-year-old patient presents with a subtrochanteric femur fracture that extends into the piriformis fossa, making standard intramedullary nail insertion challenging. The surgeon is considering alternative fixation methods. Based on the 'Summary of Key Literature / Guidelines' section, which statement best reflects the current consensus regarding the primary treatment for most subtrochanteric fractures and the role of alternative fixation?

. Extramedullary plate fixation (e.g., LCP) is the gold standard due to its superior load-bearing capabilities and lower rates of nonunion.
. Intramedullary nailing (IMN) is the gold standard, but plate fixation may be considered for specific scenarios like extensive piriformis fossa comminution or existing hardware.
. External fixation is preferred for all subtrochanteric fractures to minimize soft tissue stripping and preserve blood supply.
. Non-operative management is increasingly favored due to the high complication rates associated with surgical intervention.
. The choice between IMN and plate fixation is largely surgeon preference, with no significant difference in outcomes.

Correct Answer & Explanation

. Intramedullary nailing (IMN) is the gold standard, but plate fixation may be considered for specific scenarios like extensive piriformis fossa comminution or existing hardware.

Explanation

Correct Answer: BThe 'Summary of Key Literature / Guidelines' section explicitly addresses this. Under 'Intramedullary Nailing vs Plate Fixation,' it states: 'Numerous Level I and II studies, systematic reviews, and meta-analyses consistently demonstrate the superiority of intramedullary nailing (IMN) over extramedullary plate fixation for the treatment of most subtrochanteric femoral fractures.' It then clarifies the role of plates: 'While modern locking compression plates (LCPs) offer improved angular stability, their use for primary fixation of subtrochanteric fractures remains generally limited to specific scenarios (e.g., extensive piriformis fossa comminution, specific atypical fracture patterns, or cases where IMN insertion is impossible due to existing hardware).' This directly supports option B. Options A, C, D, and E contradict the established consensus and evidence presented in the case.

Question 1453

Topic: 2. Trauma

A 45-year-old male is brought to the trauma bay after a motor vehicle collision. Radiographs and CT of the pelvis reveal a complex acetabular fracture. A 'spur sign' is identified on the obturator oblique radiograph. This radiographic finding is pathognomonic for which of the following fracture patterns?

. Anterior column with posterior hemitransverse
. T-type acetabular fracture
. Transverse acetabular fracture
. Both column acetabular fracture
. Posterior column with posterior wall

Correct Answer & Explanation

. Both column acetabular fracture

Explanation

The spur sign is seen on the obturator oblique radiograph and represents the intact portion of the ilium superior to the acetabulum. It is pathognomonic for a both column acetabular fracture, distinguishing it from other patterns that leave a portion of the articular surface attached to the axial skeleton.

Question 1454

Topic: 2. Trauma
A 24-year-old male sustains a high-energy Pauwels type III vertical femoral neck fracture. Which of the following fixation constructs provides the greatest biomechanical stability and lowest rate of mechanical failure for this specific fracture pattern?
. Three parallel cannulated screws in an inverted triangle
. Three parallel cannulated screws in a standard triangle
. A sliding hip screw with an anti-rotation screw
. A cephalomedullary nail
. Multiple divergent Knowles pins

Correct Answer & Explanation

. A sliding hip screw with an anti-rotation screw

Explanation

Pauwels type III fractures are vertically oriented and experience high shear forces. Fixed-angle constructs, such as a sliding hip screw with an anti-rotation screw, provide superior biomechanical stability and resist shear forces significantly better than parallel cannulated screws.

Question 1455

Topic: 2. Trauma

A 55-year-old male sustains a subtrochanteric femur fracture. Following injury, the proximal fragment typically assumes a characteristic deformed position. Which of the following muscle combinations is primarily responsible for the flexion and abduction of the proximal segment?

. Iliopsoas and adductor longus
. Gluteus maximus and piriformis
. Iliopsoas and gluteus medius/minimus
. Rectus femoris and tensor fasciae latae
. Sartorius and gluteus maximus

Correct Answer & Explanation

. Iliopsoas and gluteus medius/minimus

Explanation

In subtrochanteric femur fractures, the proximal fragment is flexed by the iliopsoas, abducted by the gluteus medius and minimus, and externally rotated by the short external rotators. The distal fragment is typically pulled proximally and into varus by the adductors.

Question 1456

Topic: 2. Trauma
A 25-year-old male sustains a high-energy vertical shear femoral neck fracture (Pauwels Type III) following a motor vehicle collision. Which of the following fixation constructs offers the highest biomechanical stability against shear forces for this specific fracture pattern?
. Three parallel partially threaded cannulated screws
. Sliding hip screw with a supplemental derotational screw
. Dynamic condylar screw
. Multiple fully threaded Steinmann pins
. Hemiarthroplasty

Correct Answer & Explanation

. Sliding hip screw with a supplemental derotational screw

Explanation

Pauwels Type III fractures are characterized by a vertically oriented fracture line, making them highly susceptible to shear forces and varus collapse. Biomechanical studies indicate that a fixed-angle construct, such as a sliding hip screw combined with a derotational screw, provides superior stability compared to parallel cannulated screws.

Question 1457

Topic: 2. Trauma

A 35-year-old male sustains a subtrochanteric femur fracture. On the AP radiograph, the proximal fragment is visibly flexed, abducted, and externally rotated. Which of the following muscle insertions is primarily responsible for the external rotation deformity of the proximal fragment?

. Iliopsoas
. Gluteus medius
. Short external rotators
. Gluteus maximus
. Adductor longus

Correct Answer & Explanation

. Iliopsoas

Explanation

In a subtrochanteric fracture, the proximal fragment undergoes characteristic deformation due to unopposed muscle pulls: flexion by the iliopsoas, abduction by the gluteus medius and minimus, and external rotation by the short external rotators (e.g., piriformis, gemelli, obturator internus).

Question 1458

Topic: Pelvic & Acetabular Trauma

In the evaluation of a patient with a complex acetabular fracture, an obturator oblique radiograph is obtained. Which two primary structures of the acetabulum are best visualized in profile on this specific radiographic view?

. Anterior column and posterior wall
. Posterior column and anterior wall
. Iliac wing and posterior column
. Ischial spine and anterior wall
. Quadrilateral plate and anterior column

Correct Answer & Explanation

. Anterior column and posterior wall

Explanation

Judet-Letournel radiographic evaluation of the acetabulum includes orthogonal views. The obturator oblique view best profiles the anterior column and the posterior lip/wall of the acetabulum.

Question 1459

Topic: 2. Trauma

A 30-year-old male undergoes antegrade intramedullary nailing for an isolated, high-energy femoral shaft fracture. The surgeon utilizes a piriformis fossa entry portal. Damage to which of the following structures is the most significant concern if the starting point is inadvertently placed too anteriorly and medially?

. Femoral nerve
. Medial femoral circumflex artery (MFCA)
. Superior gluteal nerve
. Inferior gluteal artery
. Lateral femoral circumflex artery

Correct Answer & Explanation

. Medial femoral circumflex artery (MFCA)

Explanation

An anterior and medial starting point relative to the piriformis fossa risks iatrogenic injury to the deep branch of the medial femoral circumflex artery (MFCA). This complication can compromise the primary blood supply to the femoral head, potentially leading to avascular necrosis.

Question 1460

Topic: 2. Trauma
A 50-year-old male sustains a posterior hip dislocation with an associated femoral head fracture. CT imaging reveals a fracture fragment that involves the weight-bearing surface of the femoral head, extending superior to the fovea capitis. According to the Pipkin classification, what type of fracture is this?
. Pipkin Type I
. Pipkin Type II
. Pipkin Type III
. Pipkin Type IV
. Pipkin Type V

Correct Answer & Explanation

. Pipkin Type II

Explanation

The Pipkin classification describes femoral head fractures associated with posterior hip dislocations. A Type I fracture is inferior to the fovea (non-weight bearing), whereas a Type II fracture extends superior to the fovea, involving the primary weight-bearing articular surface.

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