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Elbow & Forearm MCQs

Practice Set 28 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 541

Topic: Elbow & Forearm
A 40-year-old female falls on an outstretched hand and sustains a coronal shear fracture of the distal humerus that involves the capitellum and extends medially to include the majority of the trochlea. According to the Bryan and Morrey classification with McKee's modification, what type of fracture is this?
. Type I (Hahn-Steinthal)
. Type II (Kocher-Lorenz)
. Type III (Broghter)
. Type IV (McKee modification)
. Type V (Bicolumnar shear)

Correct Answer & Explanation

. Type IV (McKee modification)

Explanation

The McKee modification added the Type IV fracture to the Bryan and Morrey classification. A Type IV lesion represents a coronal shear fracture that involves the capitellum and extends medially to include the majority of the trochlea, often necessitating separate medial and lateral internal fixation.

Question 542

Topic: Elbow & Forearm

A 45-year-old man falls on an outstretched hand and sustains a terrible triad injury of the elbow. What is the recommended surgical sequence for repairing these injuries?

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

Correct Answer & Explanation

. Coronoid fixation, radial head fixation, LCL repair

Explanation

The standard surgical sequence for a terrible triad injury is to address deep to superficial structures. Fixation progresses from the coronoid, then the radial head, and finally the lateral collateral ligament (LCL) complex to restore stability from the inside out.

Question 543

Topic: Elbow & Forearm

A 45-year-old man sustains a terrible triad injury of the elbow consisting of an elbow dislocation, radial head fracture, and coronoid fracture. What is the generally recommended surgical sequence of reconstruction?

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

Correct Answer & Explanation

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

Explanation

The classic inside-out sequence of surgical reconstruction for a terrible triad injury begins deep with the coronoid. This is followed by radial head fixation or arthroplasty, and finally repair of the lateral collateral ligament (LCL) complex to restore stability.

Question 544

Topic: Elbow & Forearm

A 45-year-old man sustains a terrible triad injury to his elbow. During surgical reconstruction, what is the recommended sequence of repair to restore elbow stability?

. LUCL, radial head, coronoid
. Coronoid, radial head, LUCL
. Radial head, LUCL, coronoid
. Coronoid, LUCL, radial head
. LUCL, coronoid, radial head

Correct Answer & Explanation

. Coronoid, radial head, LUCL

Explanation

Standard surgical protocol for a terrible triad injury involves repairing structures from deep to superficial: the coronoid first, followed by the radial head, and finally the lateral ulnar collateral ligament (LUCL).

Question 545

Topic: Elbow & Forearm

A 42-year-old man falls on an outstretched hand and sustains a "terrible triad" injury to his elbow. During surgical reconstruction, what is the recommended sequence of repair to restore elbow stability?

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

Correct Answer & Explanation

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

Explanation

The standard surgical protocol for terrible triad injuries is a deep-to-superficial approach. The anterior column (coronoid) is fixed first, followed by the lateral column (radial head fixation or arthroplasty), and finally the LCL complex is repaired to the lateral epicondyle.

Question 546

Topic: Elbow & Forearm

A 35-year-old woman sustains a displaced type I (Hahn-Steinthal) capitellum fracture. What is the most appropriate management?

. Closed reduction and cast immobilization for 4 weeks
. Open reduction and internal fixation with headless compression screws
. Excision of the fracture fragment
. Fragment excision and radial head arthroplasty
. Hinged elbow external fixation

Correct Answer & Explanation

. Open reduction and internal fixation with headless compression screws

Explanation

A Type I (Hahn-Steinthal) capitellum fracture involves a large osseous piece of the capitellum and part of the trochlea. Open reduction and internal fixation, typically using headless compression screws placed from anterior to posterior, is required to restore articular congruity and allow early motion.

Question 547

Topic: Elbow & Forearm

A 40-year-old man sustains a highly comminuted radial head fracture, an interosseous membrane disruption, and a DRUJ dislocation. What is the most appropriate management strategy?

. Radial head excision and DRUJ pinning
. Radial head arthroplasty and DRUJ stabilization
. Radial head ORIF and Darrach procedure
. Closed reduction of the elbow and wrist casting
. Radial head excision and interosseous membrane reconstruction

Correct Answer & Explanation

. Radial head arthroplasty and DRUJ stabilization

Explanation

This triad of injuries defines an Essex-Lopresti fracture-dislocation. Excision of the radial head without replacement in this setting is strictly contraindicated as it leads to proximal radial migration; treatment requires radial head arthroplasty and stabilization of the DRUJ.

Question 548

Topic: Elbow & Forearm

A 45-year-old male falls on an outstretched hand and sustains a 'terrible triad' injury of the elbow. During surgical intervention, what is the most appropriate standard sequence of repair?

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

Correct Answer & Explanation

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

Explanation

The standard surgical algorithm for a terrible triad injury works from deep to superficial and medial to lateral: fixation of the coronoid first, followed by radial head repair or replacement, and finally LCL repair. The MCL is typically only addressed if the elbow remains unstable after the lateral-sided repair.

Question 549

Topic: Elbow & Forearm

During a single-incision anterior approach for a distal biceps tendon repair, injury to which nerve is the most frequently reported complication?

. Posterior interosseous nerve
. Anterior interosseous nerve
. Lateral antebrachial cutaneous nerve
. Superficial radial nerve
. Median nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve is the most commonly injured nerve during the single-incision anterior approach for distal biceps repair. The posterior interosseous nerve (PIN) is more at risk during a two-incision approach.

Question 550

Topic: Elbow & Forearm

A 40-year-old male sustains an Essex-Lopresti injury characterized by a comminuted radial head fracture, interosseous membrane tear, and DRUJ disruption. If the radial head is unreconstructible, what is the most appropriate management?

. Radial head excision alone
. Radial head excision and DRUJ pinning
. Radial head arthroplasty and DRUJ stabilization
. Radial head excision and creation of a one-bone forearm
. Closed management with early range of motion

Correct Answer & Explanation

. Radial head arthroplasty and DRUJ stabilization

Explanation

In an Essex-Lopresti injury, the longitudinal stabilizers of the forearm are compromised. Excision of the radial head is strictly contraindicated as it will lead to proximal radius migration. The appropriate treatment is radial head arthroplasty combined with DRUJ stabilization.

Question 551

Topic: Elbow & Forearm

A 35-year-old male presents with a 'terrible triad' injury of the elbow after a fall from a ladder. When performing surgical stabilization, what is the generally accepted optimal sequence of repair for the injured structures?

. Lateral collateral ligament (LCL), Coronoid, Radial Head
. Coronoid, Radial Head, Lateral collateral ligament (LCL)
. Radial Head, Lateral collateral ligament (LCL), Coronoid
. Coronoid, Medial collateral ligament (MCL), Radial Head
. Lateral collateral ligament (LCL), Radial Head, Coronoid

Correct Answer & Explanation

. Coronoid, Radial Head, Lateral collateral ligament (LCL)

Explanation

Standard surgical management of terrible triad injuries proceeds from deep to superficial (or anterior to posterior). The accepted sequence is fixation of the coronoid first, followed by the radial head (repair or replace), and finally the LCL complex.

Question 552

Topic: Elbow & Forearm
A 45-year-old female presents with an Essex-Lopresti injury characterized by a comminuted Mason Type III radial head fracture and distal radioulnar joint (DRUJ) dislocation. Regarding the management of the radial head, which of the following is most appropriate?
. Excision of the radial head alone
. Excision of the radial head and casting in supination
. Radial head arthroplasty
. Closed reduction of the radial head
. Resection of the distal ulna (Darrach procedure)

Correct Answer & Explanation

. Radial head arthroplasty

Explanation

In an Essex-Lopresti injury, the interosseous membrane is disrupted. Excision of the radial head is strictly contraindicated as it will lead to proximal migration of the radius. If the radial head is unreconstructable, a radial head arthroplasty is required.

Question 553

Topic: Elbow & Forearm

A 40-year-old male falls from a height and sustains a highly comminuted, unsalvageable radial head fracture, accompanied by distal radioulnar joint (DRUJ) instability. What is the most appropriate management of the radial head?

. Radial head excision alone
. Radial head excision and pinning of the DRUJ
. Radial head arthroplasty
. Silastic radial head replacement
. Open reduction and internal fixation regardless of comminution

Correct Answer & Explanation

. Radial head arthroplasty

Explanation

This patient has an Essex-Lopresti injury (radial head fracture, interosseous membrane disruption, DRUJ instability). Radial head arthroplasty is required to restore longitudinal stability; excision alone leads to proximal radial migration and chronic wrist pain.

Question 554

Topic: Elbow & Forearm

A 35-year-old female presents with an isolated coronal shear fracture of the capitellum with no posterior comminution. If open reduction and internal fixation with headless compression screws is planned, what is the biomechanically optimal screw trajectory?

. Lateral to medial
. Medial to lateral
. Anterior to posterior
. Posterior to anterior
. Superior to inferior

Correct Answer & Explanation

. Posterior to anterior

Explanation

For isolated capitellar coronal shear fractures, screws placed from posterior to anterior provide superior biomechanical stability compared to anterior-to-posterior screws and avoid articular cartilage penetration.

Question 555

Topic: Elbow & Forearm

A 45-year-old falls on an outstretched hand and sustains a terrible triad injury of the elbow. Which of the following is the recommended surgical sequence of fixation?

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

Correct Answer & Explanation

. Coronoid fixation, radial head fixation, LCL repair

Explanation

The standard protocol for treating a terrible triad injury of the elbow progresses from deep to superficial structures. This involves coronoid fixation or repair, followed by radial head replacement or fixation, and finally lateral collateral ligament (LCL) repair.

Question 556

Topic: Elbow & Forearm

A 35-year-old woman sustains a comminuted radial head fracture with more than 3 articular fragments that cannot be anatomically reconstructed. There is an associated disruption of the medial collateral ligament. What is the most appropriate surgical treatment?

. Radial head excision
. Radial head open reduction and internal fixation
. Radial head arthroplasty
. Annular ligament reconstruction
. Closed reduction and early mobilization

Correct Answer & Explanation

. Radial head arthroplasty

Explanation

In the setting of an irreparable radial head fracture with associated elbow instability (such as an MCL tear or interosseous membrane injury), radial head arthroplasty is indicated to restore radiocapitellar stability. Simple excision is contraindicated due to the risk of valgus instability or proximal radial migration.

Question 557

Topic: Elbow & Forearm
A 30-year-old male sustains a severely comminuted, unfixable Mason Type III radial head fracture. You plan to perform a radial head excision. This procedure is strictly contraindicated without a radial head replacement in the presence of which concurrent injury?
. Nondisplaced coronoid tip fracture
. Tear of the interosseous membrane (Essex-Lopresti injury)
. Isolated capitellum fracture
. Distal radioulnar joint (DRUJ) arthritis
. Medial epicondyle avulsion

Correct Answer & Explanation

. Tear of the interosseous membrane (Essex-Lopresti injury)

Explanation

Radial head excision without arthroplasty in the setting of a torn interosseous membrane (Essex-Lopresti injury) will lead to proximal migration of the radius, DRUJ dissociation, and severe wrist pain. The radial head must be replaced to maintain longitudinal stability of the forearm.

Question 558

Topic: Elbow & Forearm

In the O'Driscoll classification of coronoid fractures, an anteromedial facet fracture is most commonly associated with which specific mechanism and injury pattern?

. Valgus stress with acute MCL rupture
. Varus posteromedial rotatory instability (VPMRI)
. Posterolateral rotatory instability (PLRI)
. Isolated anterior elbow dislocation
. Trans-olecranon fracture-dislocation

Correct Answer & Explanation

. Varus posteromedial rotatory instability (VPMRI)

Explanation

Anteromedial facet fractures of the coronoid result from a varus force combined with posteromedial rotation. This causes avulsion of the LCL and compression of the anteromedial coronoid facet against the medial trochlea, leading to VPMRI.

Question 559

Topic: Elbow & Forearm

A 45-year-old female presents with a coronal shear fracture of the capitellum extending into the trochlea (Hahn-Steinthal or Bryan and Morrey Type I).

What is the optimal surgical approach and internal fixation strategy?

. Medial approach with standard compression plates
. Lateral approach with headless compression screws placed posterior-to-anterior
. Lateral approach with headless compression screws placed anterior-to-posterior
. Posterior trans-olecranon approach with K-wires
. Anterior approach with T-plate fixation

Correct Answer & Explanation

. Lateral approach with headless compression screws placed anterior-to-posterior

Explanation

Capitellum fractures are best managed via an extensile lateral approach. Fixation using headless compression screws placed anterior-to-posterior, buried beneath the articular cartilage, provides optimal biomechanical stability.

Question 560

Topic: Elbow & Forearm

A 35-year-old male sustains a terrible triad injury to the elbow after a fall from a ladder. During the standard surgical reconstruction, what is the generally recommended sequence of repair?

. Lateral collateral ligament, radial head, coronoid
. Radial head, coronoid, lateral collateral ligament
. Coronoid, lateral collateral ligament, radial head
. Coronoid, radial head, lateral collateral ligament
. Radial head, lateral collateral ligament, coronoid

Correct Answer & Explanation

. Coronoid, radial head, lateral collateral ligament

Explanation

The standard surgical sequence for a terrible triad injury is to work deep to superficial: fixation of the coronoid first, followed by radial head repair or replacement, and finally repair of the lateral collateral ligament complex.

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