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Question 11: What is the most likely complication resulting from a lateral condyle fracture in a 4-year-old child treated in a cast?

Elbow stiffness
Nonunion
Osteonecrosis
Varus malunion from overgrowth
Fishtail deformity

Question 12: What is the most commonly associated complication with an open clavicular fracture?

Scapulothoracic dissociation
Closed head injury
Calcaneus fracture
Pelvic ring injury
Open tibial fracture

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Discussion:

Open clavicular fractures resulting from high-energy trauma may cause closed head injury, pulmonary injuries, or cervical/thoracic spine fractures. Scapulothoracic dissociation rarely occurs with this type of injury.

Question 13: In a 22-year-old woman with a burst fracture at T7, what is the most likely diagnosis for lack of motor or sensory recovery in the lower extremities 48 hours after injury despite the presence of bulbocavernosus reflex?

Spinal shock
Anterior cord syndrome
Cauda equina syndrome
Complete cord syndrome
Brown-Sequard syndrome

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Discussion:

Spinal shock generally ends after 48 hours and is characterized by the return of reflexes, including the bulbocavernosus reflex. Lack of motor or sensory recovery in the lower extremities with the return of reflexes is indicative of complete cord syndrome.

Question 14: What is the definitive management for a 26-year-old man with a comminuted distal radius metaphysis fracture from a high-energy injury?

Closed reduction and casting
External fixation and percutaneous pinning of the distal radius
Open reduction and internal fixation of the distal radius
Open reduction and internal fixation of the distal radius and open repair of the ulnar styloid
Non-bridging external fixation of the distal radius

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Discussion:

Present plate fixation devices employing locking screw technology have better resistance against radial shortening and dorsal angulation, which are common with immobilization or external fixation. Fixation of the ulnar styloid is only warranted if there is instability or significant displacement of the styloid.

Question 15: Which study is best for diagnosing femoral neck fractures in patients with femoral shaft fractures?

MRI
Fine-cut CT scan
Bone scan
AP radiograph of the femur
AP radiograph of the pelvis

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Discussion:

Fine-cut CT scanning is the most effective screening tool for diagnosing femoral neck fractures in patients with femoral shaft fractures according to research.

Question 16: What anatomic points define the axis of forearm rotation?

Radial head, radial styloid
Radial head, ulnar styloid
Radial head, ulnar head
Coronoid, sigmoid notch
Coronoid, radial styloid

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Discussion:

Forearm rotation occurs around a longitudinal forearm axis that runs from the center of the radial head to the foveal region of the ulnar head.

Question 17: What is the most common complication of an acetabular or pelvic ring injury?

Infection
Sciatic nerve palsy
Heterotopic ossification
Deep venous thrombosis
Degenerative arthritis

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Discussion:

Deep venous thrombosis is a high risk following acetabular or pelvic ring injuries without prophylaxis. The incidence of infection is relatively low but may increase with a history of diabetes mellitus or a significant Morel-Lavalle lesion. Sciatic nerve palsy may occur due to injury but is much less common than DVT. Degenerative changes of the hip after this injury are common despite anatomic reduction.

Question 18: What factor predicts reoperation following open reduction and internal fixation of intertrochanteric fractures with a sliding-compression hip-screw device?

Standard obliquity fracture pattern
Tip-apex distance of 15 mm
Fracture through the lateral femoral cortex
Sliding-compression hip-screw device with a two-hole side plate
Fracture of the lesser trochanter

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Discussion:

The integrity of the lateral femoral cortex is a significant predictor of reoperation in intertrochanteric hip fractures. The tip-apex distance of greater than 25 mm is associated with high risk of femoral head cut-out according to Baumgartner and associates.

Question 19: What is the expected outcome after fixation of a displaced intra-articular fracture of the distal humerus through a posterior approach?

Development of arthritic changes at 1 year
Restoration of full elbow range of motion
Loss of approximately 25% of elbow flexion strength
Posterolateral rotatory instability
Olecranon nonunion

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Discussion:

Regaining full elbow range of motion is rare after repair of a displaced intra-articular fracture of the distal humerus via a posterior approach.

Question 20: In a 15-year-old boy with an elbow injury, what is the most appropriate treatment after an incongruous post-reduction radiograph reveals a medial epicondyle fracture?

Conversion to cast immobilization for 6 weeks
Application of an articulated external fixator
Begin early motion as soon as pain resolves
Open reduction
MRI to assess ligament integrity

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Discussion:

Simple elbow dislocations in adolescents are treated with immobilization and physical therapy, but medial epicondyle fractures require open reduction if they are still displaced after reduction.