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Elbow & Forearm MCQs

Practice Set 39 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 761

Topic: Elbow & Forearm
A 9-year-old child sustains a displaced radial neck fracture with 45 degrees of angulation. Closed reduction attempts in the emergency department fail to improve the alignment. What is the next best step in management?
. Cast immobilization in current position
. Percutaneous pin leverage (Métaizeau technique)
. Open reduction and internal fixation with a plate
. Excision of the radial head
. Observation with early range of motion

Correct Answer & Explanation

. Percutaneous pin leverage (Métaizeau technique)

Explanation

Radial neck fractures with unacceptable angulation (>30-45 degrees) that fail closed reduction are best treated with percutaneous techniques, such as the Métaizeau retrograde intramedullary pinning method.

Question 762

Topic: Elbow & Forearm

A 9-year-old boy falls on an outstretched hand and sustains a radial neck fracture with 25 degrees of angulation. He has 60 degrees of pronation and supination. What is the most appropriate management?

. Open reduction and internal fixation
. Closed reduction and percutaneous pinning
. Long arm casting in situ
. Sling for comfort and early range of motion
. Excision of the radial head

Correct Answer & Explanation

. Sling for comfort and early range of motion

Explanation

In children younger than 10 years, radial neck fractures with less than 30 degrees of angulation and acceptable rotation (>50 degrees of pronation/supination) can be managed non-operatively. A sling and early range of motion are sufficient as remodeling potential is excellent.

Question 763

Topic: Elbow & Forearm

A 42-year-old mechanic sustains an acute distal biceps tendon rupture and undergoes repair using a two-incision technique. Compared to a single anterior incision approach, the two-incision technique carries a historically higher risk of which of the following postoperative complications?

. Lateral antebrachial cutaneous nerve palsy
. Posterior interosseous nerve injury
. Heterotopic ossification and radioulnar synostosis
. Re-rupture of the tendon
. Brachial artery injury

Correct Answer & Explanation

. Heterotopic ossification and radioulnar synostosis

Explanation

The two-incision technique for distal biceps repair avoids the anterior structures, reducing the risk of lateral antebrachial cutaneous nerve (LABCN) and radial nerve injuries. However, it carries a higher risk of heterotopic ossification and radioulnar synostosis.

Question 764

Topic: Elbow & Forearm

Posterolateral rotatory instability (PLRI) of the elbow commonly occurs due to insufficiency of the lateral ulnar collateral ligament (LUCL). What is the specific distal insertion site of the LUCL?

. Radial tuberosity
. Annular ligament
. Coronoid process
. Supinator crest of the ulna
. Olecranon tip

Correct Answer & Explanation

. Supinator crest of the ulna

Explanation

The lateral ulnar collateral ligament (LUCL) originates at the lateral epicondyle and inserts distally on the supinator crest of the proximal ulna. It acts as a stabilizing sling for the radial head, preventing posterolateral rotatory subluxation.

Question 765

Topic: Elbow & Forearm

Which of the following is the primary anatomic footprint for the distal attachment of the lateral ulnar collateral ligament (LUCL)?

. Radial tuberosity
. Sublime tubercle
. Supinator crest of the ulna
. Coronoid process
. Annular ligament

Correct Answer & Explanation

. Supinator crest of the ulna

Explanation

The LUCL originates on the lateral epicondyle and inserts on the supinator crest of the proximal ulna. It acts as the primary restraint to posterolateral rotatory instability (PLRI) of the elbow.

Question 766

Topic: Elbow & Forearm

An anatomic repair of a distal biceps tendon rupture requires reattachment to its native footprint. Which of the following best describes the normal anatomical insertion of the distal biceps tendon?

. Anterior aspect of the radial tuberosity
. Posterior-ulnar aspect of the radial tuberosity
. Coronoid process of the ulna
. Brachialis tuberosity
. Interosseous crest of the radius

Correct Answer & Explanation

. Posterior-ulnar aspect of the radial tuberosity

Explanation

The distal biceps tendon inserts onto the posterior-ulnar aspect of the radial tuberosity. This specific anatomical location maximizes its mechanical advantage as a supinator of the forearm.

Question 767

Topic: Elbow & Forearm

A patient develops posterolateral rotatory instability (PLRI) of the elbow following a dislocation. The primary deficient structure originates on the lateral epicondyle and inserts on which of the following structures?

. Radial tuberosity
. Coronoid process of the ulna
. Supinator crest of the ulna
. Radial head
. Tip of the olecranon

Correct Answer & Explanation

. Supinator crest of the ulna

Explanation

PLRI is caused by deficiency of the lateral ulnar collateral ligament (LUCL). The LUCL originates from the lateral epicondyle and inserts on the supinator crest of the ulna, acting as the primary restraint to posterolateral subluxation of the radial head.

Question 768

Topic: Elbow & Forearm

A 32-year-old man presents with chronic elbow instability. Examination reveals apprehension during supination, valgus stress, and axial loading of the elbow. Which structure is most likely deficient, and what is its normal anatomic insertion site?

. Ulnar collateral ligament; sublime tubercle
. Lateral ulnar collateral ligament; supinator crest of the ulna
. Annular ligament; radial notch of the ulna
. Radial collateral ligament; annular ligament
. Lateral ulnar collateral ligament; sublime tubercle

Correct Answer & Explanation

. Lateral ulnar collateral ligament; supinator crest of the ulna

Explanation

The patient's clinical presentation is classic for posterolateral rotatory instability (PLRI), which is caused by deficiency of the lateral ulnar collateral ligament (LUCL). The LUCL originates on the lateral epicondyle and inserts on the supinator crest of the ulna.

Question 769

Topic: Elbow & Forearm

A 35-year-old heavy laborer sustains an acute distal biceps tendon rupture. During a single-incision anterior repair using cortical button fixation, the surgeon must be particularly careful to protect which of the following nerves as it pierces the supinator muscle?

. Anterior interosseous nerve
. Posterior interosseous nerve
. Radial nerve
. Musculocutaneous nerve
. Median nerve

Correct Answer & Explanation

. Posterior interosseous nerve

Explanation

The posterior interosseous nerve (PIN) courses through the arcade of Frohse into the supinator muscle. It is at significant risk during the drilling and placement of a cortical button in single-incision distal biceps repairs.

Question 770

Topic: Elbow & Forearm

A 19-year-old male sustains a complete distal biceps tendon rupture during a wrestling match. He undergoes an anatomic surgical repair. Which of the following complications is most frequently associated with a single-incision anterior approach using a cortical button?

. Posterior interosseous nerve (PIN) palsy
. Lateral antebrachial cutaneous nerve (LABCN) neurapraxia
. Radioulnar synostosis
. Median nerve transection
. Superficial radial nerve neurapraxia

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN) neurapraxia

Explanation

The single-incision anterior approach for distal biceps repair is most commonly associated with lateral antebrachial cutaneous nerve (LABCN) neurapraxia due to traction and its superficial proximity to the surgical window.

Question 771

Topic: Elbow & Forearm

A 14-year-old female gymnast presents with lateral elbow pain and catching. Radiographs show an unstable osteochondritis dissecans (OCD) lesion of the capitellum. Which of the following is the most likely etiology of this condition?

. Excessive medial tension forces
. Repetitive valgus compression forces
. Avascular necrosis of the radial head
. Ulnar nerve subluxation
. Panner's disease

Correct Answer & Explanation

. Repetitive valgus compression forces

Explanation

Capitellar OCD lesions in young athletes (especially gymnasts and throwers) are primarily caused by repetitive valgus stress, leading to excessive lateral compartment compression. Unlike Panner's disease, which affects the entire capitellum in younger children, OCD causes localized focal defects.

Question 772

Topic: Elbow & Forearm
An 8-year-old boy falls on an outstretched hand and sustains a radial neck fracture. Radiographs reveal 25 degrees of angulation. What is the most appropriate management?
. Observation with a long arm cast
. Closed reduction under conscious sedation
. Percutaneous intramedullary pinning (Métaizeau technique)
. Open reduction and internal fixation
. Radial head excision

Correct Answer & Explanation

. Observation with a long arm cast

Explanation

In children younger than 10 years, up to 30 degrees of radial neck angulation is acceptable due to their excellent remodeling potential. Therefore, observation and cast immobilization are the most appropriate initial management steps.

Question 773

Topic: Elbow & Forearm

A 7-year-old boy is evaluated for a progressive deformity of his right elbow. He sustained a supracondylar humerus fracture 4 years ago that was treated with closed reduction and percutaneous pinning. Physical examination reveals a cubitus varus deformity of 15 degrees. If left untreated, what long-term complication is most uniquely associated with this specific deformity?

. Anterior interosseous nerve palsy
. Post-traumatic osteoarthritis of the ulnohumeral joint
. Tardive posterolateral rotatory instability
. Ulnar nerve subluxation and neuritis
. Chronic medial epicondylitis

Correct Answer & Explanation

. Tardive posterolateral rotatory instability

Explanation

Cubitus varus alters the mechanical axis, shifting the triceps line of pull medially. Over time, this repetitive stress causes chronic stretching of the lateral collateral ligament complex, leading to tardive posterolateral rotatory instability (PLRI) of the elbow.

Question 774

Topic: Elbow & Forearm

A 29-year-old male sustains a terrible triad injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture). Operative management is planned. According to standard treatment algorithms, what is the typical sequence of surgical repair?

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

Correct Answer & Explanation

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

Explanation

The standard surgical algorithm for a terrible triad injury proceeds from deep to superficial. Fixation begins with the coronoid, followed by addressing the radial head (repair or replacement), and finally repairing the lateral collateral ligament complex.

Question 775

Topic: Elbow & Forearm

A 45-year-old man feels a 'pop' in his anterior elbow while lifting a heavy object. The Hook test is positive. If surgical repair of the distal biceps is performed utilizing a single-incision anterior approach, which nerve is at greatest risk of iatrogenic injury?

. Median nerve
. Ulnar nerve
. Lateral antebrachial cutaneous nerve (LABCN)
. Radial nerve
. Posterior interosseous nerve (PIN)

Correct Answer & Explanation

. Lateral antebrachial cutaneous nerve (LABCN)

Explanation

During a single-incision anterior approach for distal biceps repair, the lateral antebrachial cutaneous nerve (LABCN) is the most commonly injured nerve due to its superficial location in the surgical field. The PIN is more classically at risk during a two-incision approach.

Question 776

Topic: Elbow & Forearm

A 55-year-old female sustains a complex elbow injury consisting of a radial head fracture, a coronoid process fracture, and elbow dislocation. What is the standard algorithmic sequence of surgical reconstruction for this terrible triad injury?

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

Correct Answer & Explanation

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

Explanation

The standard surgical algorithm for a terrible triad injury builds stability from deep/anterior to superficial/lateral. The accepted sequence is fixation or replacement of the coronoid, followed by the radial head, and finally repair of the lateral ulnar collateral ligament (LUCL).

Question 777

Topic: Elbow & Forearm

A 45-year-old woman falls on an outstretched hand and sustains a "terrible triad" injury of the elbow. What is the recommended surgical sequence for reconstructing this injury?

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

Correct Answer & Explanation

. Coronoid, radial head, LCL

Explanation

The standard surgical algorithm for terrible triad injuries follows a deep-to-superficial approach. The surgeon should first fix the coronoid, then repair or replace the radial head, and finally reconstruct the lateral ulnar collateral ligament (LUCL/LCL complex).

Question 778

Topic: Elbow & Forearm

A 40-year-old man falls from a height, sustaining a "terrible triad" injury of the elbow. What is the generally recommended sequence of surgical reconstruction to restore stability?

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

Correct Answer & Explanation

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

Explanation

The standard surgical protocol for a terrible triad injury proceeds from deep to superficial and medial to lateral. The sequence is typically coronoid fixation, followed by radial head fixation or arthroplasty, and finally lateral collateral ligament (LCL) repair.

Question 779

Topic: Elbow & Forearm

A 42-year-old bodybuilder hears a "pop" in his antecubital fossa while performing heavy deadlifts. He has a reverse Popeye sign and weakness in forearm supination. The distal biceps tendon inserts onto which of the following structures?

. Coronoid process of the ulna
. Radial tuberosity
. Olecranon
. Ulnar tuberosity
. Lateral epicondyle

Correct Answer & Explanation

. Radial tuberosity

Explanation

The distal biceps tendon inserts primarily on the posterior aspect of the radial tuberosity. This anatomical position allows the biceps to act as a powerful supinator of the forearm.

Question 780

Topic: Elbow & Forearm

During a distal biceps tendon repair, the surgeon must reattach the tendon to its anatomical footprint on the radial tuberosity. In which portion of the radial tuberosity does the distal biceps predominantly insert?

. Anterior and proximal
. Ulnar and posterior
. Radial and distal
. Volar and distal
. Dorsal and proximal

Correct Answer & Explanation

. Ulnar and posterior

Explanation

The distal biceps tendon inserts on the ulnar and posterior aspect of the radial tuberosity. This eccentric, posterior insertion maximizes its mechanical advantage as a powerful supinator of the forearm.

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