Abstract
Trauma II Structured SBA Questions
Trauma II Structured SBA Questions
1. A 35-year-old scaffolder carrying a heavy weight steps into a shallow pit and twists his ankle, sustaining a tri-malleolar fracture of his ankle. He has a Weber B fibular, medial malleolus and posterior malleolus fracture. The posterior malleolus involves approximately 40% of the articular surface.
What is the best management option for him to allow early weight bearing?
CT scan of the ankle followed by open reduction and internal fixation of the posterior malleolus with a buttress plate and fibula plating (posterolateral approach) and medial malleolus fixation with cannulated screws (medial approach) +/– syndesmosis stabilisation
CT scan of the ankle followed by open reduction and internal fixation of the fibula (lateral approach) followed by fixation of the medial malleolus (medial approach)
Open reduction and internal fixation of the fibula (lateral approach) followed by fixation of the medial malleolus (medial approach) +/– syndesmosis stabilisation
Open reduction and internal fixation of the fibula (lateral approach) followed by fixation of the medial malleolus (medial approach) followed by anterior to posterior screws of the posterior malleolus +/– syndesmosis stabilisation
Spanning external fixation of the ankle joint with 5mm pins to his tibia, calcaneum and 4mm to the 1st metatarsal.
2. A 42-year-old motor cyclist comes off her bike. She has sustained a flexion distraction injury to her cervical spine, leading to a bilateral facet dislocation at level C5–6. On further assessment, she is found to have decreased sensation over her left thumb and decreased power with left wrist extension. Her other injuries include a small hemopneumothorax with anterior 5th to 10th rib fractures, successfully treated with a chest drain. Her GCS is currently 15.
After ATLS® assessment and adequate resuscitation, an MRI of the cervical spine demonstrates a large disc herniation at level C5–6. What is the single best option for management?
General anaesthesia with patient prone, followed by a posterior approach to the cervical spine to reduce and stabilise the spine. MRI scan of her cervical spine following reduction
General anaesthesia with patient supine, followed by an anterior approach to the C spine for removal of the herniated disc and then reduction of the dislocation +/– fixation
General anaesthesia with patient supine, followed by cervical in line traction with increasing weights and serial radiography until reduction is achieved. MRI scan of her cervical spine following reduction
With patient supine perform awake in line traction with increasing weights and serial radiography in theatre and neurological examination to achieve reduction. CT scan of her cervical spine following reduction
With patient supine perform awake in line traction with serial radiography in theatre. Once reduced, place patient in a hard collar and follow up in 4 weeks with extension/flexion radiography of the cervical spine
3. A 45-year-old female fell while wall climbing and landed on her right forearm, sustaining a closed displaced fracture at the junction of proximal one-third to midshaft radius and midshaft ulna fracture.
What is the best approach for open reduction and fixation of the radius and ulna fracture with plates and screws?
Approach the midshaft of the radius via the brachioradialis / flexor carpi radialis first with the forearm pronated during deep dissection and then work proximally between brachioradialis / pronator teres with the forearm supinated. Then fix the ulna through a separate approach
Approach the midshaft of the radius via the brachioradialis / flexor carpi radialis first with the forearm pronated and then work proximally between brachioradialis / pronator teres with the forearm supinated. Approach the ulna through the incision for the radius and fix the ulna with plates and screws.
Approach the midshaft of the radius via the brachioradialis / flexor carpi radialis first with the forearm supinated during deep dissection and then work proximally between brachioradialis / pronator teres with the forearm pronated. Then fix the ulna through a separate approach
Approach the proximal radius first through the brachioradialis / pronator teres interval with forearm supinated and then the midshaft of the radius via the brachioradialis / flexor carpi radialis with the forearm pronated during deep dissection. Then fix the ulna through a separate approach
Approach the ulna first and fix the fracture with plates and screws. Then approach the midshaft of the radius via the brachioradialis / flexor carpi radialis first with the forearm pronated and then work proximally between brachioradialis / pronator teres with the forearm supinated
4. A 9-year-old girl has fallen from monkey bars and landed on her hand. Radiographs demonstrate a lateral condyle distal humerus fracture with 5mm displacement and rotation with extension into the trochlear groove.
Which management approach will give her the best outcome?
A closed reduction of the fracture with the arm in an above-elbow cast with the forearm in neutral rotation
Exposure via a lateral approach viewing the reduction of the joint anteriorly and insert two divergent Kirshner wires for stabilisation. Removal of the wires in 4–6 weeks’ time in clinic and follow-up over 2 years
Exposure via a lateral approach viewing the reduction of the joint posteriorly and insert two divergent Kirshner wires for stabilisation. Removal of the wires in 4–6 weeks’ time in clinic and follow-up over 2 years
Exposure via a lateral approach viewing the reduction of the joint anteriorly and insert two convergent Kirshner wires for stabilisation. Removal of the wires in 4–6 weeks’ time in clinic and follow-up over 2 years
Exposure via posterior approach to the distal humerus and reducing the fracture with direct visualisation of the joint surface. Once reduced, place two divergent Kirschner wires for fixation. Removal of the wires in 4–6 weeks’ time in clinic and follow-up over 2 years
5. Which of these patients can most likely proceed directly for intramedullary nailing?
A 35-year-old male with a pathological fracture through a lytic area in the subtrochanteric region of the femur
A 69-year-old male with lung cancer treated 10 years ago with a lobectomy who presents with a pathological fracture through a lytic area in the subtrochanteric region of the femur
A 70-year-old male with known renal cell carcinoma who presents with a pathological fracture through a lytic area in the subtrochanteric region of the femur
A 71-year-old female admitted with a pathological fracture through a lytic area in the subtrochanteric region of the femur, who has been complaining of an irregular hard mass in her right breast
A 78-year-old female with known breast cancer with metastasis in her liver and vertebrae undergoing radiotherapy with a pathological fracture through a lytic area in the subtrochanteric region of the femur
6. Which of the following will most likely benefit from posterior stabilisation of the spine? (posterior ligament complex – PLC)
A 12-year-old male has fallen out of the third-floor balcony and found to have isolated compression fracture to his L1 with 60% loss of anterior height of the vertebral body. He has no sensation or movement from L1 below and an MRI shows no injury to his spinal cord or compromise or the PLC
A 25-year-old male is involved in an accident as a front seat passenger. He is found to have a fracture extending from the anterior aspect of the L2 vertebral body passing all the way posteriorly with widening of the interspinous area. He has reduced sensation over his knee, medial malleolus and posterior calf and reduced power with knee extension, ankle dorsiflexion and great toe extension
A 38-year-old male falls from a low bridge and sustains a burst fracture of the L2 vertebrae. He has normal neurology, no posterior midline tenderness and mild canal encroachment on CT. On MRI his PLC is intact
A 45-year-old male falls from the first floor with a compression fracture of the spine involving <50% of the anterior vertebral body with normal neurology. On MRI his PLC is intact
A 78-year-old female with vertebral compression fractures of the L1 and L2 vertebrae after a fall from standing height. She is found to have some midline tenderness over L1 and L2 and normal neurology
7. A tendon rupture is most commonly encountered with undisplaced fractures of the distal radius.
Which of the following reconstruction techniques is advised?
8. A 30-year-old male is unable flex his DIPJ of the middle finger following pulling on an opponent’s shirt. Radiography of the finger does not show any fractures. On attempting to make a grip, his middle finger interphalangeal joints extend. An ultrasound demonstrates the torn end of the tendon over the proximal interphalangeal joint (PIPJ).
What structure limits the movement of the tendon end to this region?
9. A 33-year-old motorcyclist is admitted following a fracture dislocation of the talus. There is dislocation of the tibiotalar and subtalar joints with comminution of the talus medially. Once it is reduced, the surgeon requires fixation of the talar body medially.
Which approach is best utilised for fixation and to ensure the blood supply of the talus is least compromised?
A posteromedial approach protecting the neurovascular structures and dividing the deltoid ligament which is repaired later
A posteromedial approach protecting the neurovascular structures and splitting the deltoid ligament in line with its fibres
An anterior approach to the ankle joint with intermuscular plane between the extensor hallucis and digitorum longus
An anteromedial approach to the medial malleolus protecting the long saphenous vein and nerve with exposure of the talus
10. A 71-year-old fit and well male sustains a fracture of his femur between a hip and knee replacement. The fracture is in the supracondylar area, 3cm above the superior aspect of the knee replacement. The fixation of either hip or knee replacement is not involved. You are planning the fixation and need to decide which modality of treatment will give you best fixation for early weight bearing and decrease future complications.
Which treatment strategy will you choose?
Combined retrograde nail from the knee to the tip of the hip replacement with a locking plate to the tip of the hip replacement
Combined retrograde nail from the knee to the tip of the hip replacement with a locking plate to the proximal femur with screws around the femoral stem of the hip replacement
Locking plate fixation from the distal femur to the proximal femur with screws around the femoral stem of the hip replacement
11. A 25-year-old has sustained an isolated knee dislocation. On examination his foot is pale, and pulses are not palpable. Reduction of the knee is performed and maintained in a back slab, and the pulses have returned with an ankle brachial pressure index (ABPI) of 0.7.
What is the best sequence of management for this patient?
Angiogram of the limb in theatre, repair/reconstruction of vessels, maintain reduction with a back slab, delayed knee ligament reconstruction following MRI of the knee
Angiogram of the limb in theatre, shunting to bypass, external fixator to hold reduction, reconstruction/repair of vessels +/- fasciotomies, delayed knee ligament reconstruction following MRI of the knee
External fixation to maintain reduction, angiogram of the limb in theatre, repair/reconstruction of vessels, delayed knee ligament reconstruction following MRI of the knee
External fixation to maintain reduction, delayed knee ligament reconstruction following MRI of the knee
MRI to plan reconstruction, immediate reconstruction of ligaments and sequential neurovascular status monitoring
12. A 40-year-old patient presents to you in fracture clinic with a displaced two-part midshaft clavicle fracture. He has 2cm of shortening and is enquiring about treatment options.
Which of these outcomes has no statistically significant benefit with open reduction and internal fixation with plate and screws as opposed to non-operative treatment?
Complications such as neurological complication, complex regional pain syndrome, rotator cuff diseases, and complications due to operation (bent plate, plate breakage, implant failure, infection)
13. Which of the following manoeuvres is least likely to help with reducing subtrochanteric femoral fractures?
14. When performing dual incision fasciotomies of the leg with compartment syndrome, which of the following structures are not encountered with your incisions?
15. A 14-year-old male with a proximal ulna fracture and anterior radial head dislocation underwent fixation with plates and screws of the proximal ulna and manipulation of the radial head. Postoperative radiographs show excellent reduction of the fracture and radio humeral articulation. He was placed in a cast with 80 degrees of elbow flexion and supination. After one week, a repeat radiograph in clinic shows a recurrent dislocation of the radial head anteriorly with maintained reduction of the ulna. He has been listed on your trauma list.
What would be the best management?
Isolated closed reduction of radial head and placed into cast after procedure with 110 degrees elbow flexion and pronation
Related posts:
Chapter 6 – Knee II Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 19 – Structure and Function of Connective Tissue Structured SBA
Chapter 5 – Knee Structured I SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 15 – Hand II Structured SBA
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