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Elbow & Forearm MCQs

Practice Set 31 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 601

Topic: Elbow & Forearm

A 45-year-old woman falls on an outstretched hand and sustains a comminuted radial head fracture, wrist pain, and instability of the distal radioulnar joint (DRUJ). Radial head excision is contraindicated in this setting primarily due to the risk of:

. Posterior interosseous nerve (PIN) palsy
. Proximal migration of the radius and ulnocarpal impaction
. Radioulnar synostosis
. Valgus instability of the elbow without ulnar nerve compromise
. Avascular necrosis of the capitellum

Correct Answer & Explanation

. Proximal migration of the radius and ulnocarpal impaction

Explanation

This presentation is consistent with an Essex-Lopresti fracture-dislocation, which includes a longitudinal tear of the interosseous membrane. Excising the radial head removes the primary restraint to proximal radial migration, leading to severe ulnocarpal impaction and wrist pain.

Question 602

Topic: Elbow & Forearm

A 45-year-old laborer undergoes surgical repair of a distal biceps tendon rupture using a two-incision technique. Compared to a single anterior incision technique, the two-incision approach is associated with a higher risk of which specific complication?

. Posterior interosseous nerve (PIN) palsy
. Lateral antebrachial cutaneous nerve palsy
. Radioulnar synostosis
. Tendon re-rupture
. Radial artery transection

Correct Answer & Explanation

. Radioulnar synostosis

Explanation

The two-incision technique for distal biceps repair was developed to minimize the risk to the radial nerve (PIN) and lateral antebrachial cutaneous nerve seen in single-incision approaches. However, it carries a higher risk of heterotopic ossification and potentially debilitating radioulnar synostosis.

Question 603

Topic: Elbow & Forearm

During surgical reconstruction of a 'terrible triad' injury of the elbow, which of the following is the generally recommended sequence of repair to best restore stability?

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

Correct Answer & Explanation

. Coronoid, radial head, lateral collateral ligament

Explanation

The standard surgical protocol for a terrible triad injury proceeds from deep to superficial: fixation of the coronoid, followed by radial head repair or replacement, and finally lateral collateral ligament (LCL) repair.

Question 604

Topic: Elbow & Forearm

A 40-year-old bodybuilder feels a 'pop' in his antecubital fossa during a heavy deadlift, accompanied by bruising and a positive hook test. If a single-incision anterior approach is used for repair, which nerve is at the highest risk of iatrogenic injury?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve is the most frequently injured structure during a single-incision anterior approach for distal biceps tendon repair due to its superficial course.

Question 605

Topic: Elbow & Forearm

A 45-year-old man feels a 'pop' in his antecubital fossa while lifting a heavy box and experiences weakness in forearm supination. He undergoes a distal biceps tendon repair using a traditional two-incision technique. Compared to a single anterior incision approach, this technique carries a historically higher risk of which of the following complications?

. Posterior interosseous nerve palsy
. Lateral antebrachial cutaneous nerve neuropraxia
. Radioulnar synostosis
. Tendon re-rupture
. Median nerve transection

Correct Answer & Explanation

. Radioulnar synostosis

Explanation

The two-incision technique for distal biceps repair carries a higher risk of heterotopic ossification and radioulnar synostosis. Conversely, the single-incision approach has a higher rate of lateral antebrachial cutaneous nerve (LABCN) neuropraxia.

Question 606

Topic: Elbow & Forearm

A 35-year-old male falls from a ladder and sustains a 'terrible triad' injury of the elbow. Operative fixation is planned. What is the most widely accepted sequence of surgical reconstruction to restore elbow stability?

. Coronoid fixation, radial head repair or replacement, followed by lateral collateral ligament (LCL) repair
. Radial head replacement, LCL repair, followed by coronoid fixation
. LCL repair, radial head replacement, followed by coronoid fixation
. Medial collateral ligament (MCL) repair, radial head replacement, followed by coronoid fixation
. Coronoid fixation, LCL repair, followed by radial head replacement

Correct Answer & Explanation

. Coronoid fixation, radial head repair or replacement, followed by lateral collateral ligament (LCL) repair

Explanation

The standard protocol for terrible triad reconstruction proceeds from deep to superficial. This involves coronoid fixation first, followed by radial head repair or arthroplasty, and finally lateral ulnar collateral ligament (LUCL) repair.

Question 607

Topic: Elbow & Forearm

A 40-year-old bodybuilder sustains an acute distal biceps tendon rupture. He elects to undergo surgical repair. A two-incision (modified Boyd-Anderson) approach is chosen over a single anterior incision. The two-incision approach carries a higher historical risk of which of the following complications?

. Lateral antebrachial cutaneous nerve (LABCN) injury
. Posterior interosseous nerve (PIN) injury
. Radioulnar synostosis
. Tendon re-rupture
. Radial artery transection

Correct Answer & Explanation

. Radioulnar synostosis

Explanation

The two-incision approach for distal biceps repair exposes the interosseous membrane and carries a higher risk of radioulnar synostosis compared to a single-incision approach. Conversely, the single-incision approach has a higher rate of LABCN neurapraxia.

Question 608

Topic: Elbow & Forearm

A 40-year-old woman complains of a "snapping" sensation and apprehension in her elbow when pushing herself up from a chair. She has a history of an elbow dislocation treated nonoperatively 2 years ago. On examination, a pivot-shift test reproduces her symptoms. Which structure is most likely deficient?

. Medial ulnar collateral ligament
. Lateral ulnar collateral ligament (LUCL)
. Annular ligament
. Common extensor origin
. Anterior capsule

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

Posterolateral rotatory instability (PLRI) occurs due to insufficiency of the lateral ulnar collateral ligament (LUCL). Patients typically describe clicking, snapping, or apprehension when the elbow is subjected to axial load, supination, and valgus stress.

Question 609

Topic: Elbow & Forearm

When performing a surgical repair of a distal biceps tendon rupture, the choice between a single-incision anterior approach and a two-incision approach affects the complication profile. The single-incision approach carries a significantly higher risk of which of the following complications compared to the two-incision technique?

. Radioulnar synostosis
. Radial nerve palsy
. Lateral antebrachial cutaneous nerve (LABCN) neurapraxia
. Re-rupture of the tendon
. Ulnar nerve neurapraxia

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN) neurapraxia

Explanation

The single-incision anterior approach places the lateral antebrachial cutaneous nerve (LABCN) at a higher risk of neurapraxia due to traction. The two-incision approach historically carries a higher risk of heterotopic ossification and radioulnar synostosis.

Question 610

Topic: Elbow & Forearm

A 55-year-old man sustains a "terrible triad" injury of the elbow after a fall. Surgical management is planned. What is the standard recommended sequence of surgical repair for this specific injury pattern?

. Lateral ulnar collateral ligament -> Radial head -> Coronoid
. Radial head -> Coronoid -> Lateral ulnar collateral ligament
. Coronoid -> Radial head -> Lateral ulnar collateral ligament
. Lateral ulnar collateral ligament -> Coronoid -> Radial head
. Coronoid -> Lateral ulnar collateral ligament -> Radial head

Correct Answer & Explanation

. Coronoid -> Radial head -> Lateral ulnar collateral ligament

Explanation

The standard surgical approach for a terrible triad injury involves a deep-to-superficial repair sequence. This typically begins with coronoid fixation, followed by radial head repair or replacement, and concludes with lateral ulnar collateral ligament (LUCL) repair.

Question 611

Topic: Elbow & Forearm

A 42-year-old bodybuilder feels a pop in his anterior elbow while lifting heavy weights. He exhibits weakness in supination and flexion, and the "hook test" is positive. What is the most common complication of a single-incision anterior approach repair for this injury?

. Posterior interosseous nerve (PIN) palsy
. Lateral antebrachial cutaneous nerve (LABCN) neuropraxia
. Heterotopic ossification
. Radial artery injury
. Re-rupture

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN) neuropraxia

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most frequently injured nerve during a single-incision anterior approach for distal biceps repair. Posterior interosseous nerve (PIN) injury is more commonly associated with a two-incision approach or deep lateral dissection.

Question 612

Topic: Elbow & Forearm

A 40-year-old man sustains a "terrible triad" injury to his elbow following a fall. According to standard biomechanical principles of reconstruction for this specific injury pattern, what is the most widely accepted surgical sequence?

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

Correct Answer & Explanation

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

Explanation

The standard surgical sequence for treating a terrible triad injury (elbow dislocation, radial head fracture, coronoid fracture) progresses from deep to superficial. Fixation of the coronoid or anterior capsule is performed first, followed by radial head fixation or arthroplasty, and finally lateral collateral ligament (LCL) repair.

Question 613

Topic: Elbow & Forearm

A 35-year-old woman falls from a ladder and sustains a 'terrible triad' injury of the elbow. Which of the following describes the standard sequence of surgical reconstruction to restore elbow stability?

. Repair the LCL, fix the coronoid, fix the radial head.
. Fix the coronoid, fix or replace the radial head, repair the LCL complex.
. Fix the radial head, repair the MCL, repair the LCL.
. Repair the MCL, fix the coronoid, fix or replace the radial head.
. Fix or replace the radial head, fix the coronoid, repair the MCL complex.

Correct Answer & Explanation

. Fix the coronoid, fix or replace the radial head, repair the LCL complex.

Explanation

The standard surgical protocol for a terrible triad injury involves fixing the coronoid first to restore the anterior buttress, followed by fixing or replacing the radial head, and finally repairing the lateral collateral ligament (LCL) complex.

Question 614

Topic: Elbow & Forearm

A 30-year-old man presents with a highly comminuted, un-reconstructable radial head fracture and severe ipsilateral wrist pain following a fall. Examination reveals distal radioulnar joint (DRUJ) instability. If the radial head is excised and not replaced, which of the following complications is most likely to occur?

. Proximal migration of the radius with ulnar-sided wrist pain
. Distal migration of the radius with radial-sided wrist pain
. Heterotopic ossification of the elbow
. Posterolateral rotatory instability of the elbow
. Nonunion of the coronoid process

Correct Answer & Explanation

. Proximal migration of the radius with ulnar-sided wrist pain

Explanation

This is an Essex-Lopresti injury, involving a radial head fracture, interosseous membrane disruption, and DRUJ instability. Excising the radial head without replacing it with a prosthesis will lead to proximal migration of the radius and severe ulnar impaction syndrome.

Question 615

Topic: Elbow & Forearm

A 22-year-old gymnast falls on an outstretched arm and sustains a Type I (Hahn-Steinthal) capitellum fracture. Which of the following best describes this fracture pattern?

. An articular cartilage sleeve avulsion with minimal subchondral bone attached.
. A large coronal shear fracture of the capitellum involving a significant portion of the bony hemisphere.
. A comminuted fracture involving both the capitellum and the trochlea.
. A fracture extending into the lateral epicondyle.
. An osteochondral defect of the radial head.

Correct Answer & Explanation

. A large coronal shear fracture of the capitellum involving a significant portion of the bony hemisphere.

Explanation

A Type I (Hahn-Steinthal) capitellum fracture is a large coronal shear fracture containing a significant amount of subchondral bone. A Type II (Kocher-Lorenz) fracture involves articular cartilage with minimal attached subchondral bone.

Question 616

Topic: Elbow & Forearm

A 35-year-old man falls on an outstretched hand and sustains the injury shown in

. The injury includes a posterior elbow dislocation, radial head fracture, and coronoid fracture. During operative management, what is the most appropriate sequence of repair?

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

Correct Answer & Explanation

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

Explanation

The standard inside-out approach for a terrible triad injury involves repairing the coronoid first, followed by the radial head (fixation or replacement), and finally the lateral collateral ligament (LCL) complex.

Question 617

Topic: Elbow & Forearm

After closed reduction of a simple posterior elbow dislocation, the elbow is stable in pronation but subluxates when extended in supination. This finding indicates insufficiency of which of the following structures?

. Anterior bundle of the MCL
. Lateral ulnar collateral ligament (LUCL)
. Posterior bundle of the MCL
. Annular ligament
. Brachialis tendon

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

The LUCL is the primary stabilizer against posterolateral rotatory instability (PLRI). Pronation tightens the medial soft tissues and flexor-pronator mass, stabilizing the elbow when the lateral side is incompetent.

Question 618

Topic: Elbow & Forearm
A 40-year-old woman falls onto her outstretched hand and presents with lateral elbow pain. A lateral elbow radiograph demonstrates a 'double arc' sign. What specific type of injury does this radiographic finding represent?
. Type I capitellum fracture (Hahn-Steinthal)
. Type II capitellum fracture (Kocher-Lorenz)
. Type III capitellum fracture (Broberg-Morrey)
. Type IV capitellum fracture (McKee modification)
. Radial head fracture with an associated loose body

Correct Answer & Explanation

. Type IV capitellum fracture (McKee modification)

Explanation

The 'double arc' sign on a lateral elbow radiograph represents the displaced subchondral bone of the capitellum and the lateral ridge of the trochlea. This is pathognomonic for a Type IV capitellum fracture (McKee modification), which indicates extension into the trochlea.

Question 619

Topic: Elbow & Forearm

A 45-year-old weightlifter feels a sudden 'pop' in his anterior elbow during a heavy deadlift. Examination reveals a positive hook test. He undergoes a single-incision anterior approach for distal biceps tendon repair. What is the most common complication associated with this specific surgical approach?

. Lateral antebrachial cutaneous nerve neuropraxia
. Posterior interosseous nerve palsy
. Massive heterotopic ossification
. Tendon re-rupture
. Median nerve transection

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve neuropraxia

Explanation

The single-incision anterior approach for distal biceps tendon repair retracts structures laterally, carrying a high risk of injury to the lateral antebrachial cutaneous nerve. This typically results in transient neuropraxia and numbness over the lateral forearm.

Question 620

Topic: Elbow & Forearm

A 35-year-old woman undergoes ORIF for a Mason Type II radial head fracture with a mechanical block. To avoid hardware impingement on the proximal radioulnar joint during forearm rotation, plates must be placed within the radial head 'safe zone.' Which clinical landmarks define this safe zone?

. Between the supinator crest and the bicipital tuberosity
. A 90-degree arc defined by projecting the radial styloid and Lister's tubercle proximally with the forearm in neutral
. Directly medial to the bicipital tuberosity
. Posterior to the radial tuberosity
. Directly anterior to the radial neck

Correct Answer & Explanation

. A 90-degree arc defined by projecting the radial styloid and Lister's tubercle proximally with the forearm in neutral

Explanation

The non-articulating 'safe zone' of the radial head is a 90- to 110-degree lateral arc. Intraoperatively, it can be reliably identified by keeping the forearm in neutral rotation and using the proximal projections of the radial styloid and Lister's tubercle as boundaries.

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