Menu

Elbow & Forearm MCQs

Practice Set 32 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 621

Topic: Elbow & Forearm
A 40-year-old woman falls on an outstretched hand and sustains a comminuted, unfixable Mason type III radial head fracture combined with distal radioulnar joint instability (Essex-Lopresti lesion). What is the most appropriate management of the radial head?
. Radial head excision alone
. Open reduction and internal fixation with a mini-fragment plate
. Radial head arthroplasty
. Closed reduction and casting in supination
. Radial head excision with immediate silastic spacer replacement

Correct Answer & Explanation

. Radial head arthroplasty

Explanation

In an Essex-Lopresti injury, the interosseous membrane is disrupted, leading to longitudinal radioulnar instability. Radial head excision is absolutely contraindicated; radial head arthroplasty is required to restore longitudinal stability.

Question 622

Topic: Elbow & Forearm

A 35-year-old man falls from a height and sustains a 'terrible triad' injury to his elbow. When proceeding with operative management, what is the most accepted sequence of surgical repair to restore elbow stability?

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

Correct Answer & Explanation

. Coronoid, radial head, lateral collateral ligament

Explanation

The classic sequence for repairing a terrible triad injury proceeds from deep to superficial. The coronoid is addressed first, followed by the radial head, and finally the lateral collateral ligament complex.

Question 623

Topic: Elbow & Forearm

A 40-year-old woman presents with elbow pain after a fall on an outstretched hand. The lateral radiograph reveals a 'double arc' sign. Which of the following is the most likely diagnosis?

. Type II radial head fracture
. Type IV capitellum fracture
. Coronoid process fracture
. Olecranon fracture
. Supracondylar humerus fracture

Correct Answer & Explanation

. Type IV capitellum fracture

Explanation

The 'double arc' sign on a lateral elbow radiograph represents the subchondral bone of the capitellum and the lateral trochlear ridge. It is pathognomonic for a Type IV (McKee modification) capitellum fracture that extends medially into the trochlea.

Question 624

Topic: Elbow & Forearm

A 30-year-old manual laborer sustains a comminuted radial head fracture, wrist pain, and distal radioulnar joint (DRUJ) instability. If the radial head is excised and not replaced, what is the most likely long-term complication?

. Cubitus varus deformity
. Proximal migration of the radius and ulnocarpal impaction
. Median nerve palsy
. Heterotopic ossification of the wrist
. Posterior interosseous nerve palsy

Correct Answer & Explanation

. Proximal migration of the radius and ulnocarpal impaction

Explanation

This presentation describes an Essex-Lopresti injury, which involves a radial head fracture, interosseous membrane tear, and DRUJ disruption. Excision of the radial head without replacement leads to proximal radial migration and severe ulnocarpal impaction.

Question 625

Topic: Elbow & Forearm

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

. MCL repair, radial head fixation, coronoid fixation, LCL repair
. Coronoid fixation, radial head fixation/replacement, LCL repair, MCL repair (if needed)
. Radial head replacement, LCL repair, coronoid fixation, MCL repair
. LCL repair, coronoid fixation, radial head replacement
. MCL repair, coronoid fixation, radial head replacement

Correct Answer & Explanation

. Coronoid fixation, radial head fixation/replacement, LCL repair, MCL repair (if needed)

Explanation

The standard surgical algorithm for a terrible triad injury begins with restoring deep to superficial and anterior to posterior structures. This typically involves coronoid fixation first, followed by radial head fixation or replacement, and finally LCL complex repair.

Question 626

Topic: Elbow & Forearm

A 6-year-old boy sustains a Bado Type I Monteggia fracture-dislocation. Closed reduction of the ulna fracture is achieved and stabilized with an intramedullary wire, but the radial head remains anteriorly dislocated. What is the most appropriate next step in management?

. Open reduction of the radial head and annular ligament reconstruction
. Resection of the radial head
. Critically assess and correct the ulnar reduction
. Application of a hinged external fixator
. Radial head pinning to the capitellum

Correct Answer & Explanation

. Critically assess and correct the ulnar reduction

Explanation

In pediatric Monteggia fractures, the radial head dislocation almost always reduces once the ulnar fracture is anatomically reduced and aligned. If the radial head remains dislocated, the surgeon must first critically evaluate the ulnar reduction (ruling out plastic deformation) before attempting open reduction of the radiocapitellar joint.

Question 627

Topic: Elbow & Forearm

A 45-year-old construction worker falls from a ladder and sustains an elbow dislocation. Radiographs reveal a posterior elbow dislocation associated with a radial head fracture and a coronoid fracture. During surgical reconstruction of this 'terrible triad' injury, what is the standard sequence of repair?

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

Correct Answer & Explanation

. Coronoid, radial head, LCL

Explanation

The standard surgical sequence for a terrible triad injury proceeds from deep/medial to superficial/lateral. The coronoid is fixed first to restore anterior stability, followed by radial head repair or replacement, and finally the LCL complex is repaired.

Question 628

Topic: Elbow & Forearm

A 35-year-old male falls on an outstretched hand and sustains a 'terrible triad' injury to the elbow. Operative management is planned. Following a standard deep-to-superficial surgical approach, what is the accepted sequence of structural repair to restore elbow stability?

. Lateral ulnar collateral ligament (LUCL), radial head, coronoid
. Radial head, coronoid, LUCL
. Coronoid, radial head, LUCL
. LUCL, coronoid, radial head
. Coronoid, LUCL, radial head

Correct Answer & Explanation

. Coronoid, radial head, LUCL

Explanation

The standard sequence of repair for a terrible triad injury addresses structures from deep to superficial: first the coronoid, followed by the radial head, and finally the lateral ulnar collateral ligament (LUCL).

Question 629

Topic: Elbow & Forearm

A 24-year-old male sustains a posterior elbow dislocation. After closed reduction, the elbow is stable in 90 degrees of flexion but immediately subluxates when extended with the forearm in supination. This specific pattern of instability indicates insufficiency of which of the following structures?

. Anterior bundle of the UCL
. Lateral ulnar collateral ligament (LUCL)
. Annular ligament
. Quadrate ligament
. Biceps brachii tendon

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

Posterolateral rotatory instability (PLRI) occurs due to insufficiency of the lateral ulnar collateral ligament (LUCL). It typically manifests as subluxation or dislocation when the elbow is extended, supinated, and subjected to an axial load or valgus force.

Question 630

Topic: Elbow & Forearm

A 42-year-old woman falls on an outstretched hand and sustains a "terrible triad" injury of the elbow. Which of the following structures is the primary restraint to posterolateral rotatory instability (PLRI) and must be meticulously repaired or reconstructed during surgery?

. Medial ulnar collateral ligament
. Lateral ulnar collateral ligament (LUCL)
. Radial collateral ligament
. Annular ligament
. Anterior capsule

Correct Answer & Explanation

. Lateral ulnar collateral ligament (LUCL)

Explanation

The lateral ulnar collateral ligament (LUCL) is the primary restraint to posterolateral rotatory instability. In a terrible triad injury, the LUCL is typically avulsed from the lateral epicondyle and must be repaired to restore elbow stability.

Question 631

Topic: Elbow & Forearm

A 44-year-old weightlifter sustained an acute complete distal biceps tendon rupture and underwent surgical repair using a two-incision technique. Postoperatively, he has profound restriction of forearm pronation and supination but full elbow flexion and extension. What is the most likely complication responsible for his restricted motion?

. Posterior interosseous nerve (PIN) palsy
. Heterotopic ossification (radioulnar synostosis)
. Rerupture of the distal biceps tendon
. Anterior interosseous nerve (AIN) palsy
. Myositis ossificans of the brachialis

Correct Answer & Explanation

. Heterotopic ossification (radioulnar synostosis)

Explanation

The two-incision technique for distal biceps tendon repair has historically carried a higher risk of radioulnar synostosis (heterotopic ossification bridging the radius and ulna) compared to the single-incision technique. This complication directly causes profound loss of forearm rotation.

Question 632

Topic: Elbow & Forearm

A 42-year-old male presents with a "terrible triad" injury of the elbow following a fall onto an outstretched hand. When performing the surgical reconstruction, what is the most widely accepted sequence of repair?

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

Correct Answer & Explanation

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

Explanation

The terrible triad of the elbow involves an elbow dislocation with concomitant radial head and coronoid process fractures. The standard surgical sequence proceeds from deep to superficial: fixing the coronoid first, followed by the radial head, and finally repairing the lateral collateral ligament (LCL).

Question 633

Topic: Elbow & Forearm

A 35-year-old bodybuilder feels a sudden pop in his anterior elbow during a heavy bicep curl. The hook test is positive. The surgeon utilizes a single-incision anterior approach to repair the distal biceps tendon. Which of the following nerves is at highest risk of iatrogenic injury with this specific approach?

. Median nerve
. Radial nerve
. Ulnar nerve
. Lateral antebrachial cutaneous nerve
. Posterior interosseous nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) courses superficially in the lateral aspect of the antecubital fossa near the cephalic vein. It is the most commonly injured nerve during a single-incision anterior approach for distal biceps tendon repair, resulting in lateral forearm paresthesias.

Question 634

Topic: Elbow & Forearm

A 42-year-old man falls from a height and sustains a complex elbow dislocation.

Imaging reveals a posterolateral elbow dislocation, a comminuted radial head fracture, and a type II coronoid fracture. During operative management, what is the most appropriate sequence of reconstruction?

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

Correct Answer & Explanation

. Coronoid fixation, radial head arthroplasty, LCL repair

Explanation

The standard surgical sequence for a terrible triad injury is from deep to superficial: coronoid fixation, followed by radial head replacement or fixation, and finally lateral collateral ligament (LCL) repair. This restores the anterior and lateral bony and ligamentous buttresses to prevent recurrent posterior subluxation.

Question 635

Topic: Elbow & Forearm

A 45-year-old man undergoes a single-incision anterior approach for repair of an acute distal biceps tendon rupture. Postoperatively, he notes numbness along the lateral aspect of his forearm. Which nerve was most likely injured during the exposure?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABC) is the most commonly injured structure during a single-incision anterior approach for distal biceps repair. The posterior interosseous nerve (PIN) is more at risk during a two-incision approach or when deep retractors are placed laterally.

Question 636

Topic: Elbow & Forearm

A 40-year-old weightlifter felt a sudden pop in his antecubital fossa and presents with weakness in supination. The Hook test is positive. If he undergoes a single-incision anterior approach for distal biceps tendon repair, which nerve is most at risk of injury?

. Posterior interosseous nerve
. Median nerve
. Lateral antebrachial cutaneous nerve
. Ulnar nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

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

Question 637

Topic: Elbow & Forearm

A 35-year-old woman falls on an outstretched hand, sustaining an elbow dislocation with associated fractures of the radial head and the coronoid process. During surgical reconstruction, what is the most widely accepted sequence of repair?

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

Correct Answer & Explanation

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

Explanation

The standard surgical sequence for treating a terrible triad injury of the elbow is fixation of the coronoid first (to restore the anterior buttress), followed by radial head replacement or fixation, and finally repair of the lateral ulnar collateral ligament (LUCL).

Question 638

Topic: Elbow & Forearm

A 45-year-old male weightlifter undergoes surgical repair of an acute distal biceps tendon rupture using a single anterior incision approach. Postoperatively, he complains of numbness and tingling over the anterolateral aspect of his forearm. Which nerve is most likely injured?

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

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve

Explanation

The lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve during a single anterior incision approach for distal biceps repair. Injury typically occurs due to retraction forces or direct damage, as the nerve lies in close proximity to the cephalic vein and the surgical field.

Question 639

Topic: Elbow & Forearm

A 35-year-old woman falls on an outstretched hand, sustaining an elbow dislocation, a comminuted radial head fracture, and a Type II coronoid fracture. What is the generally accepted sequence of surgical reconstruction for this "terrible triad" injury?

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

Correct Answer & Explanation

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

Explanation

The standard surgical algorithm for fixing a terrible triad injury proceeds from deep to superficial: coronoid fixation first, followed by radial head repair or arthroplasty, and finally lateral collateral ligament (LCL) reconstruction.

Question 640

Topic: Elbow & Forearm

A 38-year-old man falls on an outstretched hand, sustaining an elbow dislocation, a radial head fracture, and a coronoid fracture. Which of the following is the standard recommended surgical sequence for restoring stability in this terrible triad injury?

. Fix or replace radial head, fix coronoid, repair lateral collateral ligament (LCL)
. Fix coronoid, fix or replace radial head, repair lateral collateral ligament (LCL)
. Repair lateral collateral ligament (LCL), fix coronoid, fix or replace radial head
. Repair medial collateral ligament (MCL), repair LCL, fix radial head
. Fix coronoid, repair MCL, fix radial head

Correct Answer & Explanation

. Fix coronoid, fix or replace radial head, repair lateral collateral ligament (LCL)

Explanation

The standard surgical algorithm for terrible triad elbow injuries begins with fixing the coronoid to restore deep anterior stability. This is followed by addressing the radial head, and finally repairing the lateral collateral ligament (LCL).

Test Yourself

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

On this Page