Menu

Elbow & Forearm MCQs

Practice Set 27 of 57

This practice set contains high-yield board review questions covering key concepts in Elbow & Forearm. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 521

Topic: Elbow & Forearm

A 29-year-old male sustains a midshaft humerus fracture and presents with a complete radial nerve palsy. He is managed conservatively in a functional brace. At 12 weeks, there is no clinical or electromyographic (EMG) evidence of nerve recovery. Tendon transfers are planned. Which of the following is the most commonly used donor tendon to restore active wrist extension?

. Flexor carpi ulnaris (FCU)
. Pronator teres (PT)
. Flexor digitorum superficialis (FDS) of the middle finger
. Palmaris longus (PL)
. Flexor carpi radialis (FCR)

Correct Answer & Explanation

. Pronator teres (PT)

Explanation

In standard radial nerve palsy tendon transfers, the pronator teres (PT) is the most commonly used donor muscle to restore wrist extension by transferring it to the extensor carpi radialis brevis (ECRB). The ECRB is chosen as the recipient because its central insertion provides balanced wrist extension without severe radial deviation.

Question 522

Topic: Elbow & Forearm

A 35-year-old male sustains a "terrible triad" injury of the elbow. Which of the following is the generally recommended surgical sequence for repairing these injuries?

. LCL repair, radial head fixation/replacement, coronoid fixation
. Coronoid fixation, radial head fixation/replacement, LCL repair
. Radial head fixation/replacement, coronoid fixation, LCL repair
. LCL repair, coronoid fixation, radial head fixation/replacement
. Coronoid fixation, LCL repair, radial head fixation/replacement

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair

Explanation

The standard inside-out sequence for repairing a terrible triad injury of the elbow is first fixing the coronoid, followed by addressing the radial head (fixation or replacement), and finally repairing the lateral collateral ligament (LCL) complex. MCL repair or hinged external fixation may be added if instability persists.

Question 523

Topic: Elbow & Forearm

In a patient with an irreversible high radial nerve palsy, a standard tendon transfer is planned to restore wrist extension. The Pronator Teres (PT) is most commonly transferred to the Extensor Carpi Radialis Brevis (ECRB) rather than the Extensor Carpi Radialis Longus (ECRL). What is the primary biomechanical rationale for selecting the ECRB?

. ECRB has a significantly longer excursion than ECRL.
. ECRB provides central wrist extension without excessive radial deviation.
. ECRB acts synergistically with digital flexion, unlike ECRL.
. ECRL requires an interposition vein graft to reach the PT insertion.
. ECRB is a physically thicker tendon, providing a biomechanically stronger repair.

Correct Answer & Explanation

. ECRB provides central wrist extension without excessive radial deviation.

Explanation

The ECRB inserts at the base of the third metacarpal, which is centrally located. Therefore, it provides pure wrist extension. The ECRL inserts at the base of the second metacarpal, and utilizing it for wrist extension transfer would result in undesirable radial deviation of the wrist upon extension.

Question 524

Topic: Elbow & Forearm

A 35-year-old man presents with a permanent low radial nerve palsy after a humerus fracture. A standard Jones tendon transfer procedure is planned. To restore thumb extension, which of the following muscle-tendon transfers is classically utilized in this procedure?

. Pronator teres to extensor carpi radialis brevis
. Flexor carpi radialis to extensor digitorum communis
. Flexor digitorum superficialis to extensor pollicis longus
. Palmaris longus to extensor pollicis longus
. Flexor carpi ulnaris to extensor digitorum communis

Correct Answer & Explanation

. Pronator teres to extensor carpi radialis brevis

Explanation

In the classic Jones transfer for radial nerve palsy, three primary transfers are performed: 1) Pronator teres to ECRB (to restore wrist extension), 2) FCU (or FCR in modified versions) to EDC (to restore finger extension), and 3) Palmaris longus (PL) to EPL (to restore thumb extension).

Question 525

Topic: Elbow & Forearm

A 35-year-old patient with a high radial nerve palsy secondary to a humerus fracture fails to show nerve recovery at 6 months. In a standard tendon transfer procedure to restore wrist extension, which of the following muscles is most commonly utilized as the motor unit?

. Pronator teres (PT)
. Flexor carpi radialis (FCR)
. Flexor carpi ulnaris (FCU)
. Flexor digitorum superficialis (FDS)
. Palmaris longus (PL)

Correct Answer & Explanation

. Pronator teres (PT)

Explanation

In standard radial nerve tendon transfers (e.g., Boyes, Jones, or modified Green transfers), the Pronator Teres (PT) is the most common muscle transferred to the Extensor Carpi Radialis Brevis (ECRB) to restore wrist extension. It is synergistic and provides excellent excursion and power.

Question 526

Topic: Elbow & Forearm

A 35-year-old man sustains a 'terrible triad' injury of the elbow following a fall. When performing surgical stabilization, what is the generally accepted and most biomechanically sound sequence of repair?

. MCL repair, coronoid fixation, radial head fixation
. Coronoid fixation, radial head fixation/replacement, LCL repair
. LCL repair, MCL repair, radial head excision
. Radial head fixation, LCL repair, coronoid excision
. Coronoid fixation, MCL repair, LCL repair

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair

Explanation

The standard surgical algorithm for a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) works from deep to superficial and typically from medial to lateral: 1) Coronoid repair or fixation, 2) Radial head repair or replacement, 3) Lateral collateral ligament (LCL) repair. If the elbow remains unstable, MCL repair or an external fixator may be considered.

Question 527

Topic: Elbow & Forearm

A 45-year-old male sustains a 'terrible triad' injury of the elbow following a fall. He is scheduled for operative fixation. What is the standard, biomechanically supported sequence for surgical reconstruction in this injury?

. Radial head fixation/replacement, followed by LCL repair, then coronoid fixation
. Coronoid fixation, followed by radial head fixation/replacement, then LCL complex repair
. LCL complex repair, followed by radial head fixation, then coronoid fixation
. MCL repair, followed by coronoid fixation, then radial head replacement
. Coronoid fixation, followed by MCL repair, then radial head fixation

Correct Answer & Explanation

. Coronoid fixation, followed by radial head fixation/replacement, then LCL complex repair

Explanation

The terrible triad of the elbow consists of a coronoid fracture, radial head fracture, and LCL tear. The standard surgical sequence works from deep to superficial: first repairing the coronoid (to restore the anterior buttress), then fixing or replacing the radial head (lateral buttress), and finally repairing the lateral collateral ligament (LCL) complex. MCL repair or hinged external fixation is reserved for residual instability.

Question 528

Topic: Elbow & Forearm

An 8-year-old girl injures her elbow playing soccer. After attempted reduction in the emergency department, radiographs of the elbow are shown in Figures 35a through 35c. What is the next most appropriate step in treatment?

. Cast immobilization for 2 weeks followed by early motion
. Minimal treatment for this congenital radial head dislocation
. Open reduction and internal fixation
. Annular ligament reconstruction
. Attempt a repeat closed reduction

Correct Answer & Explanation

. Open reduction and internal fixation

Explanation

Ninety percent of injuries to the proximal radius in children are radial neck fractures, and 50% of these fractures are through the metaphyseal bone. The remaining 50% are Salter-Harris type I or II fractures. These radiographs show a fracture of the radial head and subluxation of the radius anteriorly. Most congenital radial head dislocations are posterior lateral. Nonsurgical treatment modalities are unlikely to be successful due to the wide displacement of the fracture fragments, as well as dislocation of the radial head. Leung AG, Peterson HA: Fractures of the proximal radial head and neck in children with emphasis on those that involve the articular cartilage. J Pediatr Orthop 2000;20:7-14. Hashemi-Nejad A, Goddard NJ: Radial head fractures. Br J Hosp Med 1994;51:223-226.

Question 529

Topic: Elbow & Forearm

A 20-year-old man sustained an injury to his arm during a tug-of-war contest. An MRI scan is shown in Figure 18. What is the most likely diagnosis?

General Orthopedics Board Review 2026: High-Yield MCQs (Set 12) - Figure 18

. Lipoma
. Proximal biceps rupture
. Distal biceps rupture
. Biceps and brachialis rupture
. Biceps brachii transection

Correct Answer & Explanation

. Biceps brachii transection

Explanation

The MRI scan reveals a transection of the biceps muscle. The underlying brachialis is intact. This injury can occur as a result of a cord wrapped around the upper arm. Care should be taken to ensure that there is no concurrent vascular injury. A posterior subcutaneous lipoma appears as a well-encapsulated mass on T2-weighted images. Heckman JD, Levine MI: Traumatic closed transection of the biceps brachii in the military parachutist. J Bone Joint Surg Am 1978;60:369-372.

Question 530

Topic: Elbow & Forearm

A 35-year-old male falls from a ladder and sustains a 'terrible triad' injury of the elbow. Operative management is planned. According to standard principles of surgical reconstruction for this specific injury, what is the recommended sequence of repair?

. Lateral ulnar collateral ligament (LUCL), radial head, coronoid
. Coronoid (and/or anterior capsule), radial head, lateral ulnar collateral ligament (LUCL)
. Radial head, coronoid, LUCL
. LUCL, coronoid, radial head
. Radial head, LUCL, coronoid

Correct Answer & Explanation

. Coronoid (and/or anterior capsule), radial head, lateral ulnar collateral ligament (LUCL)

Explanation

The standard surgical approach to a terrible triad injury proceeds from deep to superficial. The recommended sequence is stabilization of the coronoid (or anterior capsule), followed by radial head repair or replacement, and finally repair of the LUCL complex.

Question 531

Topic: Elbow & Forearm

A 42-year-old male sustains a terrible triad injury of the elbow. Which of the following represents the most widely accepted surgical sequence for restoring stability?

. Radial head fixation, coronoid fixation, LCL repair
. Coronoid fixation, radial head fixation/replacement, LCL repair
. LCL repair, radial head fixation, coronoid fixation
. Coronoid fixation, MCL repair, radial head replacement
. Radial head replacement, LCL repair, coronoid fixation

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair

Explanation

The standard sequence for a terrible triad injury is coronoid fixation, followed by radial head repair or replacement, and finally lateral collateral ligament (LCL) repair. This inside-out approach restores the anterior buttress before reconstructing the lateral column.

Question 532

Topic: Elbow & Forearm

When surgically managing a 'Terrible Triad' injury of the elbow, what is the recommended standard sequence of repair to restore stability?

. Lateral collateral ligament repair, radial head fixation, coronoid fixation
. Coronoid fixation, radial head fixation or replacement, lateral collateral ligament repair
. Medial collateral ligament repair, coronoid fixation, radial head replacement
. Radial head fixation, lateral collateral ligament repair, medial collateral ligament repair
. Coronoid fixation, medial collateral ligament repair, radial head replacement

Correct Answer & Explanation

. Coronoid fixation, radial head fixation or replacement, lateral collateral ligament repair

Explanation

The standard algorithm for a Terrible Triad injury works deep to superficial and inside out: fix the coronoid first, then fix or replace the radial head, and finally repair the lateral ulnar collateral ligament (LUCL). The medial collateral ligament is only repaired if the elbow remains unstable after these steps.

Question 533

Topic: Elbow & Forearm
A coronal shear fracture of the distal humerus involving the capitellum and the majority of the trochlea is classified as which of the following?
. Hahn-Steinthal (Type I)
. Kocher-Lorenz (Type II)
. Broberg-Morrey (Type III)
. McKee modification (Type IV)
. Jupiter Type V

Correct Answer & Explanation

. McKee modification (Type IV)

Explanation

In the Bryan and Morrey classification of capitellum fractures, a Type IV (added by McKee) represents a coronal shear fracture that extends medially to include the capitellum and the majority of the trochlea. This pattern often requires an expansile surgical approach for adequate fixation.

Question 534

Topic: Elbow & Forearm

A 35-year-old man sustains an acute Essex-Lopresti injury with a highly comminuted, unsalvageable radial head. What is the most appropriate definitive management?

. Radial head excision and casting in supination
. Radial head replacement and pinning of the distal radioulnar joint
. Silicone radial head arthroplasty and early active motion
. Forearm both-bone plating with distal radioulnar joint excision
. Primary radial head excision and Darrach procedure

Correct Answer & Explanation

. Radial head replacement and pinning of the distal radioulnar joint

Explanation

An Essex-Lopresti injury involves a radial head fracture, interosseous membrane tear, and DRUJ disruption. Radial head excision alone leads to proximal radial migration; therefore, a rigid metallic radial head arthroplasty and DRUJ stabilization are required to prevent longitudinal radioulnar dissociation.

Question 535

Topic: Elbow & Forearm

A 45-year-old female sustains a fall on an outstretched hand resulting in an elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture. During surgical management of this 'terrible triad' injury, what is the most widely accepted sequence of repair?

. Lateral collateral ligament (LCL), radial head, coronoid
. Coronoid, radial head, lateral collateral ligament (LCL)
. Radial head, lateral collateral ligament (LCL), coronoid
. Coronoid, medial collateral ligament (MCL), radial head
. Radial head, coronoid, medial collateral ligament (MCL)

Correct Answer & Explanation

. Coronoid, radial head, lateral collateral ligament (LCL)

Explanation

The standard surgical algorithm for terrible triad injuries proceeds from deep to superficial. This involves coronoid fixation or anterior capsular repair, followed by radial head repair or replacement, and finally LCL complex repair.

Question 536

Topic: Elbow & Forearm

A 60-year-old female requires open reduction and internal fixation for a Type IV coronal shear fracture of the capitellum that extends into the trochlea (Dubberley Type 3B). Extensive posterior dissection is performed. What is the most significant risk associated with this surgical approach?

. Avascular necrosis of the capitellum
. Transection of the ulnar nerve
. Posterolateral rotatory instability
. Radial nerve palsy
. Nonunion of an olecranon osteotomy

Correct Answer & Explanation

. Avascular necrosis of the capitellum

Explanation

Extensive posterior dissection and stripping of the lateral column to address coronal shear fractures disrupt the tenuous intraosseous blood supply, significantly increasing the risk of avascular necrosis of the capitellum.

Question 537

Topic: Elbow & Forearm

A 33-year-old female sustains a highly comminuted radial head fracture. During examination, she complains of severe wrist pain, and radiographs show proximal migration of the radius. Which of the following treatments is absolutely contraindicated?

. Radial head excision alone
. Radial head arthroplasty with DRUJ pinning
. Open reduction and internal fixation of the radial head
. Reconstruction of the interosseous membrane
. Ulnar shortening osteotomy

Correct Answer & Explanation

. Radial head arthroplasty with DRUJ pinning

Explanation

This patient has an Essex-Lopresti lesion, consisting of a radial head fracture, interosseous membrane tear, and DRUJ disruption. Radial head excision alone is contraindicated as it leads to unchecked proximal migration of the radius and severe ulnocarpal impaction.

Question 538

Topic: Elbow & Forearm

Following surgical repair of a terrible triad elbow injury (radial head replacement, coronoid fixation, and LCL repair), a patient is noted to have a persistent block to forearm pronation. Which of the following is the most likely cause?

. Over-tightening of the medial collateral ligament
. An oversized radial head arthroplasty prosthesis
. Heterotopic ossification of the brachialis muscle
. Unrecognized capitellum fracture
. Malunion of the coronoid process

Correct Answer & Explanation

. An oversized radial head arthroplasty prosthesis

Explanation

An oversized (overstuffed) radial head prosthesis after a terrible triad injury causes excessive radiocapitellar pressure. This leads to a mechanical block in forearm rotation, most commonly pronation, as well as limited flexion.

Question 539

Topic: Elbow & Forearm

A 7-year-old boy sustains a Bado Type I Monteggia fracture-dislocation. Closed reduction of the ulna is achieved, but the radial head remains anteriorly dislocated. What is the most appropriate next step?

. Perform an open reduction of the radiocapitellar joint and repair the annular ligament
. Accept the alignment and cast in 90 degrees of flexion
. Improve the reduction of the ulnar shaft fracture
. Perform a radial head excision
. Perform an osteotomy of the proximal radius

Correct Answer & Explanation

. Improve the reduction of the ulnar shaft fracture

Explanation

In pediatric Monteggia fractures, the radial head dislocation is almost always secondary to the ulnar deformity. If the radial head remains dislocated, it usually means ulnar length or bow is not adequately restored, so improving the ulnar reduction is the critical next step.

Question 540

Topic: Elbow & Forearm

A 38-year-old female sustains a fracture of the capitellum that extends medially to include the lateral aspect of the trochlea, with a separate posterior comminuted fragment. According to the Dubberley classification, what type of fracture is this?

. Type 1A
. Type 2A
. Type 3A
. Type 3B
. Type 4B

Correct Answer & Explanation

. Type 3B

Explanation

The Dubberley classification distinguishes capitellar fractures based on trochlear extension. Type 3 involves both the capitellum and the trochlea. The "B" modifier indicates posterior condylar comminution.

Test Yourself

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

On this Page