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2. Trauma MCQs

Practice Set 81 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 1601

Topic: 2. Trauma

A 30-year-old male sustains a basicervical femoral neck fracture. Which of the following internal fixation constructs provides the greatest biomechanical stability for this specific fracture pattern?

. Three parallel cancellous lag screws
. Sliding hip screw (SHS) with an anti-rotation screw
. Dynamic condylar screw
. Proximal femoral locking plate
. Multiple fully threaded cortical screws

Correct Answer & Explanation

. Sliding hip screw (SHS) with an anti-rotation screw

Explanation

Basicervical femoral neck fractures behave biomechanically like intertrochanteric fractures and are rotationally unstable. A sliding hip screw (SHS) provides superior biomechanical stability compared to multiple cancellous screws for this pattern.

Question 1602

Topic: 2. Trauma

During closed reduction and intramedullary nailing of a subtrochanteric femur fracture, the proximal fragment is noted to be flexed, abducted, and externally rotated. Which muscle is primarily responsible for the flexion deformity of the proximal segment?

. Gluteus medius
. Gluteus minimus
. Iliopsoas
. Piriformis
. Adductor longus

Correct Answer & Explanation

. Iliopsoas

Explanation

The iliopsoas inserts onto the lesser trochanter and acts as the primary flexor of the proximal fragment. The gluteus medius and minimus cause abduction, while the short external rotators cause external rotation.

Question 1603

Topic: 2. Trauma

A 35-year-old female sustains a high-energy distal femur fracture. A CT scan reveals an isolated coronal plane fracture of the lateral femoral condyle. What is the appropriate eponymous classification and the optimal screw trajectory for this fragment?

. Bankart fracture; anterior-to-posterior lag screws
. Hoffa fracture; anterior-to-posterior lag screws
. Hoffa fracture; lateral-to-medial lag screws
. Barton fracture; superior-to-inferior lag screws
. Malgaigne fracture; medial-to-lateral lag screws

Correct Answer & Explanation

. Hoffa fracture; anterior-to-posterior lag screws

Explanation

A coronal shear fracture of the distal femoral condyle is known as a Hoffa fracture (OTA 33B3). It is optimally fixed using anterior-to-posterior (or posterior-to-anterior) interfragmentary lag screws to compress the fracture plane.

Question 1604

Topic: 2. Trauma

A 45-year-old male sustains a high-energy pelvic injury. Radiographs demonstrate an acetabular fracture with a "spur sign" visible on the obturator oblique view. Which of the following fracture patterns is most likely present?

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

Correct Answer & Explanation

. Both column

Explanation

The "spur sign" is pathognomonic for a both-column acetabular fracture and is best visualized on the obturator oblique view. It represents the intact portion of the ilium that remains attached to the axial skeleton while the articular segments are displaced.

Question 1605

Topic: 2. Trauma
A 38-year-old female presents with a displaced femoral neck fracture. Due to the high-energy nature of the injury, a vertical fracture pattern (Pauwels type III) is noted. Which of the following biomechanical forces contributes most to the high rate of failure and nonunion in this specific fracture pattern?
. Compressive forces
. Tensile forces
. Shear forces
. Torsional forces
. Distraction forces

Correct Answer & Explanation

. Shear forces

Explanation

Pauwels type III femoral neck fractures are characterized by a vertically oriented fracture line (>50 degrees). This vertical orientation subjects the fracture site to high shear forces during axial loading, increasing the risk of varus collapse and nonunion.

Question 1606

Topic: 2. Trauma

A 25-year-old male is involved in a motorcycle collision and sustains a highly comminuted femoral shaft fracture. A dedicated CT scan of the pelvis is ordered as part of the trauma protocol. What is the approximate incidence of an ipsilateral femoral neck fracture in this setting?

. 1-3%
. 5-9%
. 15-20%
. 25-30%
. 40-50%

Correct Answer & Explanation

. 5-9%

Explanation

Ipsilateral femoral neck fractures occur in approximately 5-9% of femoral shaft fractures. Up to 30% of these neck fractures are initially missed, highlighting the necessity of a dedicated CT scan or fine-cut protocol for the proximal femur.

Question 1607

Topic: 2. Trauma

A 40-year-old male sustains a distal femur fracture. CT imaging reveals a coronal plane fracture of the lateral femoral condyle (Hoffa fracture). Which of the following approaches and fixation strategies is most appropriate?

. Medial parapatellar approach with lateral-to-medial lag screws
. Direct lateral approach with anterior-to-posterior lag screws
. Posterior approach with posterior buttress plating only
. Anterolateral approach with anterior-to-posterior lag screws
. Direct lateral approach with posterior-to-anterior lag screws

Correct Answer & Explanation

. Anterolateral approach with anterior-to-posterior lag screws

Explanation

A Hoffa fracture is a coronal shear fracture of the femoral condyle, most commonly the lateral condyle. It is best accessed via an anterolateral approach and fixed with anterior-to-posterior (or P-A) interfragmentary lag screws, often supplemented with a plate.

Question 1608

Topic: 2. Trauma

A 30-year-old male presents with a pelvic ring injury following a motor vehicle collision. Radiographs demonstrate an acetabular fracture. Which specific radiographic finding differentiates a T-type acetabular fracture from a simple transverse fracture?

. Involvement of the iliac wing
. Disruption of the iliopectineal line
. Disruption of the ilioischial line
. A fracture line extending through the obturator ring
. A detached posterior wall fragment

Correct Answer & Explanation

. A fracture line extending through the obturator ring

Explanation

A T-type fracture is distinguished from a transverse fracture by the presence of a vertical split that divides the ischiopubic segment. Radiographically, this is seen as a fracture line extending through the obturator foramen.

Question 1609

Topic: 2. Trauma

A 50-year-old female sustains a subtrochanteric femur fracture. To minimize the risk of iatrogenic varus malreduction during cephalomedullary nailing with a piriformis entry point, what is the most critical technical consideration?

. Starting lateral to the greater trochanter tip
. Starting strictly medial to the greater trochanter in the piriformis fossa
. Starting anterior to the midline of the femoral neck
. Reaming the diaphysis to 3 mm larger than the selected nail
. Locking the nail distally before proximal fixation

Correct Answer & Explanation

. Starting lateral to the greater trochanter tip

Explanation

A piriformis fossa entry point is colinear with the femoral shaft axis. Starting lateral to this point forces the nail to eccentrically ream the medial cortex, inadvertently pushing the proximal segment into varus.

Question 1610

Topic: 2. Trauma

A 35-year-old polytrauma patient sustains an ipsilateral midshaft femur fracture and a basicervical femoral neck fracture. What is the most widely recommended timing and sequence for the definitive surgical fixation of these injuries?

. Intramedullary nailing of the shaft first, followed by screw fixation of the neck
. Anatomical reduction and fixation of the neck first, followed by fixation of the shaft
. Non-operative management in traction for 7 days to allow physiologic optimization
. Simultaneous bilateral total hip arthroplasties
. External fixation of both fractures until definitive callus forms

Correct Answer & Explanation

. Anatomical reduction and fixation of the neck first, followed by fixation of the shaft

Explanation

The femoral neck fracture takes priority and should be anatomically reduced and fixed first to minimize the risk of avascular necrosis and nonunion. The shaft is subsequently addressed with a retrograde nail or plate.

Question 1611

Topic: 2. Trauma

A 40-year-old male presents with an isolated distal femoral coronal plane fracture involving the lateral condyle (Hoffa fracture). Which of the following surgical approaches and fixation strategies is most appropriate?

. Medial parapatellar approach with a medial bridging plate
. Lateral parapatellar approach with anterior-to-posterior lag screws
. Direct lateral approach with posterior-to-anterior lag screws
. Subvastus approach with retrograde intramedullary nailing
. Anterolateral approach with external fixation

Correct Answer & Explanation

. Lateral parapatellar approach with anterior-to-posterior lag screws

Explanation

Hoffa fractures require direct articular exposure and anatomic reduction, typically via a lateral or medial parapatellar approach. Fixation is achieved with lag screws placed orthogonal to the fracture plane (anterior-to-posterior or posterior-to-anterior).

Question 1612

Topic: 2. Trauma

According to the Letournel classification of acetabular fractures, which of the following is strictly categorized as an elementary fracture pattern?

. T-type
. Transverse
. Transverse with posterior wall
. Anterior column with posterior hemitransverse
. Both columns

Correct Answer & Explanation

. Transverse

Explanation

The Letournel classification identifies five elementary patterns: anterior wall, anterior column, posterior wall, posterior column, and transverse. The other options represent associated (complex) fracture patterns.

Question 1613

Topic: 2. Trauma

A 65-year-old male undergoes fixation of an unstable intertrochanteric femur fracture with a short cephalomedullary nail. Which intraoperative radiographic parameter is most highly predictive of subsequent lag screw cut-out?

. Tip-apex distance greater than 25 mm
. Tip-apex distance less than 15 mm
. Neck-shaft angle restored to 135 degrees
. Lag screw placement in the inferior-posterior quadrant
. Use of a long rather than a short nail

Correct Answer & Explanation

. Tip-apex distance greater than 25 mm

Explanation

Baumgaertner et al. demonstrated that a combined tip-apex distance (TAD) greater than 25 mm on AP and lateral radiographs is the most powerful predictor of lag screw cut-out in intertrochanteric fractures.

Question 1614

Topic: Pelvic & Acetabular Trauma

When evaluating Judet views for a suspected acetabular fracture, the obturator oblique view provides the optimal assessment for which specific combination of anatomical structures?

. Anterior wall and posterior column
. Anterior column and posterior wall
. Iliac wing and sacral ala
. Ischial spine and superior pubic ramus
. Quadrilateral plate and symphysis pubis

Correct Answer & Explanation

. Anterior column and posterior wall

Explanation

The obturator oblique view is obtained by rotating the patient 45 degrees away from the affected side. It profiles the anterior column and posterior wall of the acetabulum, as well as the pelvic inlet.

Question 1615

Topic: 2. Trauma

A 70-year-old female on long-term alendronate reports a 3-month history of insidious right thigh pain. Radiographs reveal transverse lateral cortical thickening with a small cortical 'beak' in the subtrochanteric region. What is the most appropriate definitive management?

. Discontinue alendronate, initiate teriparatide, and allow full weight-bearing
. Prophylactic cephalomedullary nailing of the right femur
. Prophylactic lateral locking plate osteosynthesis
. Core decompression of the subtrochanteric region
. Observation with serial radiographs every 6 months

Correct Answer & Explanation

. Prophylactic cephalomedullary nailing of the right femur

Explanation

Symptomatic patients with radiographic evidence of an impending atypical femur fracture (cortical thickening/beaking) require prophylactic intramedullary nailing to prevent fracture completion and promote healing.

Question 1616

Topic: 2. Trauma
A 28-year-old male sustains a transverse plus posterior wall acetabular fracture and a massive, fluctuant swelling over the ipsilateral greater trochanter (Morel-Lavallée lesion). Regarding the management of the soft-tissue lesion, what is the best practice?
. Simple aspiration and application of a compressive dressing
. Observation only, as it rarely influences deep surgical sites
. Corticosteroid injection to minimize the inflammatory response
. Surgical debridement and closure prior to or concurrent with definitive acetabular fixation
. Percutaneous drainage delayed until 6 weeks postoperatively

Correct Answer & Explanation

. Surgical debridement and closure prior to or concurrent with definitive acetabular fixation

Explanation

Morel-Lavallée lesions are closed degloving injuries prone to bacterial colonization. They require aggressive surgical debridement to reduce the high risk of secondary deep infection following definitive orthopedic fixation.

Question 1617

Topic: 2. Trauma
A 28-year-old male sustains a highly vertical, displaced femoral neck fracture (Pauwels type III) following a motor vehicle collision. Which of the following internal fixation constructs provides the greatest biomechanical stability to counteract the significant shear forces associated with this specific fracture pattern?
. Three parallel fully-threaded cancellous screws
. Three parallel partially-threaded cancellous screws
. Dynamic hip screw (DHS) combined with a derotational screw
. Proximal femoral nail with a single helical blade
. Two parallel fully-threaded cancellous screws

Correct Answer & Explanation

. Dynamic hip screw (DHS) combined with a derotational screw

Explanation

Pauwels type III fractures are highly vertical and subject to massive shear forces that predispose to varus collapse. A fixed-angle device, such as a Dynamic Hip Screw (DHS) supplemented with an anti-rotation screw, provides superior biomechanical stability compared to multiple cancellous screws for this pattern.

Question 1618

Topic: 2. Trauma

A 35-year-old male polytrauma patient presents with bilateral closed femoral shaft fractures, multiple rib fractures, and a severe closed head injury (GCS 6). He is hemodynamically labile despite initial resuscitation. According to Damage Control Orthopedics (DCO) principles, what is the most appropriate initial management of his femoral fractures?

. Immediate reamed intramedullary nailing bilaterally
. Immediate unreamed intramedullary nailing bilaterally
. Bilateral external fixation with conversion to intramedullary nailing once physiologically optimized
. Open reduction and internal fixation with compression plates bilaterally
. Skeletal traction until definitive nailing at 3 weeks

Correct Answer & Explanation

. Bilateral external fixation with conversion to intramedullary nailing once physiologically optimized

Explanation

In a severe polytrauma patient with hemodynamic instability or severe traumatic brain injury, Damage Control Orthopedics (DCO) dictates rapid provisional stabilization using external fixation. This approach minimizes surgical time, blood loss, and the systemic "second hit" inflammatory response that can exacerbate lung and brain injury.

Question 1619

Topic: 2. Trauma
A 29-year-old female sustains a posterior hip dislocation in a high-speed collision. CT imaging after closed reduction demonstrates a large fracture of the femoral head that involves the primary weight-bearing articular surface cephalad to the fovea centralis. There are no associated femoral neck or acetabular fractures. What is the correct Pipkin classification for this injury?
. 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 caudad to the fovea (non-weight-bearing), whereas a Type II fracture involves the articular surface cephalad to the fovea centralis, affecting the primary weight-bearing area.

Question 1620

Topic: 2. Trauma

An AP pelvis radiograph of a 40-year-old male following a crush injury reveals an isolated disruption of the ilioischial line, while the iliopectineal line, anterior wall, and posterior wall remain intact. Which of the following acetabular fracture patterns is present?

. Anterior column fracture
. Posterior column fracture
. Transverse fracture
. T-type fracture
. Anterior column/posterior hemitransverse fracture

Correct Answer & Explanation

. Posterior column fracture

Explanation

On an anteroposterior (AP) radiograph of the pelvis, the ilioischial line radiographically represents the posterior column, and the iliopectineal line represents the anterior column. An isolated disruption of the ilioischial line characterizes a posterior column fracture.

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