Pelvic and Acetabular Trauma MCQs

Orthopedics · 40 free questions with answers & explanations.

1. A motorcyclist in a high-speed accident presents with hypotension (BP 80/50 mmHg) and a pelvic X-ray showing widening of the symphysis pubis >2.5 cm with opening of the right sacroiliac joint. This is classified as Tile type B (open-book injury). The MOST IMMEDIATE life-saving intervention while resuscitation is ongoing is:
2. In the Young-Burgess classification of pelvic ring injuries, an Anteroposterior Compression (APC) Type III injury is characterized by:
3. A 45-year-old man sustains an acetabular fracture in a motor vehicle accident. CT scan shows a posterior wall fracture with 40% involvement of the posterior wall and an associated posterior dislocation of the hip that has been reduced. What is the indication for surgical fixation in this case?
4. Which structure is MOST at risk during the Kocher-Langenbeck (KL) surgical approach for posterior acetabular fracture fixation?
5. A 32-year-old pedestrian struck by a vehicle sustains a pelvic ring injury. Radiograph shows widening of the symphysis pubis to 4 cm with disruption of the anterior sacroiliac ligaments but intact posterior sacroiliac complex. According to the Young-Burgess classification, this is:
6. A 45-year-old man sustains a posterior hip dislocation with an associated acetabular posterior wall fracture in a dashboard injury. The Letournel classification of acetabular fractures divides them into 5 elementary and 5 associated fracture patterns. A fracture involving the anterior wall, posterior column, and the quadrilateral plate is classified as:
7. A patient with APC-III pelvic ring injury arrives in hemorrhagic shock with BP 70/40 mmHg after massive external pelvic binder application. Despite 4 units pRBC, she remains unstable. What is the next MOST appropriate intervention?
8. A 32-year-old is brought to the emergency department after a motorcycle crash. Radiograph shows a widening of the pubic symphysis (> 2.5 cm) and disruption of the sacroiliac joint unilaterally with posterior displacement. He is hypotensive despite resuscitation. According to the Young–Burgess classification, this is an Anterior–Posterior Compression Type III (APC III) injury. The most immediately life-saving intervention is:
9. On a radiograph, an acetabular fracture shows the classic 'gull-wing' deformity of the ilioischial line with disruption of both the anterior and posterior columns. The fracture type is:
10. An unstable pelvic ring disruption (Tile C1 vertical shear injury) is being managed operatively. Which fixation method best controls the posterior ring?
11. Morel–Lavallée lesion associated with pelvic/acetabular fractures is best described as:
12. A 30-year-old motorcyclist is brought in hemodynamically unstable after a high-velocity crush injury. Pelvic X-ray shows a wide pubic symphysis diastasis with disruption of both sacroiliac joints. According to the Young-Burgess classification, this is a:
13. A 45-year-old woman sustains a posterior hip dislocation with a posterior wall acetabular fracture after a road traffic accident. On examination, the hip is flexed, adducted and internally rotated, and there is foot drop on the same side. The nerve most commonly injured in this pattern of acetabular fracture-dislocation is:
14. According to the Letournel classification of acetabular fractures, a transverse fracture plus posterior wall fracture is classified as:
15. For a displaced posterior wall acetabular fracture requiring open reduction and internal fixation (ORIF), the recommended surgical approach that provides direct visualization of the posterior acetabular wall is:
16. A 35-year-old male is brought in after a high-speed motor vehicle collision. He is hypotensive (BP 80/60 mmHg) with obvious pelvic instability on examination. A pelvic X-ray shows an 'open book' injury (AP compression type II, Young-Burgess classification). The most urgent hemostatic intervention for ongoing pelvic hemorrhage after pelvic binder application has temporarily stabilized the ring is:
17. In the Judet and Letournel classification of acetabular fractures, a fracture involving both the anterior column and the posterior hemitransverse element (with the characteristic spur sign on CT) is classified as:
18. The safest definitive surgical approach for an isolated posterior wall acetabular fracture with marginal impaction and associated posterior hip dislocation (reduced urgently) is:
19. A patient after a head-on vehicle collision has a pelvic X-ray showing symphyseal diastasis >2.5 cm with disruption of the sacroiliac joint. Classified as APC (Anterior-Posterior Compression) Type II by Tile/Young-Burgess, the immediate priority in hemodynamically unstable patients is:
20. In the Judet-Letournel classification of acetabular fractures, a posterior column fracture with a posterior wall component (associated fracture) is distinguished from a pure posterior wall fracture by:
21. A patient with both-column acetabular fracture shows the 'spur sign' on CT reconstruction. This sign indicates:
22. The 'open book' pelvic injury involves symphysis pubis diastasis with external rotation of hemipelvis. Which ligamentous structure is the PRIMARY stabilizer of the posterior pelvic ring that must be intact for a stable ring injury?
23. A 30-year-old motorcyclist is brought to the emergency department after a head-on collision. He is hemodynamically unstable (BP 70/40 mmHg, HR 130). Pelvic X-ray shows widening of the pubic symphysis >2.5 cm and widening of the right sacroiliac joint. Tile/Young-Burgess classification is APC (anteroposterior compression) Type II. The immediate priority is:
24. The Tile classification of pelvic fractures is based on stability. A Type C fracture is defined as:
25. In acetabular fracture classification (Judet-Letournel), a posterior wall fracture combined with posterior column fracture results in which classification?
26. A 55-year-old woman sustains a posterior hip dislocation with posterior wall acetabular fracture. After closed reduction, CT pelvis reveals a posterior wall fragment involving 40% of the posterior wall with an intra-articular osteochondral fragment. The appropriate management is:
27. A 30-year-old man is brought in after a high-speed motor vehicle accident. Pelvic X-ray shows bilateral pubic rami fractures anteriorly and a sacroiliac joint disruption posteriorly on one side, with an overall lateral compression pattern. According to the Tile/AO classification, this is:
28. A patient with an unstable pelvic ring fracture arrives in haemorrhagic shock. After ATLS primary survey, which immediate measure most effectively reduces pelvic haematoma volume?
29. In Judet and Letournel acetabular fracture classification, a posterior column fracture differs from a posterior wall fracture in that it:
30. According to Young and Burgess classification, which type of pelvic ring injury is associated with the highest risk of major vascular injury and hemorrhage?
31. The Judet and Letournel classification divides acetabular fractures into elementary and associated patterns. The most common acetabular fracture pattern overall is:
32. An 'open book' pelvis (APC-II/III) is initially managed in the Emergency Department by application of a pelvic binder. The binder should be positioned at the level of:
33. Morel-Lavallée lesion associated with pelvic trauma is best described as:
34. A 30-year-old motorcyclist sustains a high-energy pelvic fracture with pubic symphysis diastasis of 4 cm and sacroiliac joint widening on AP pelvis X-ray. He is hemodynamically unstable despite 2L crystalloid resuscitation. The FIRST step in the orthopaedic management of this pelvic ring injury is:
35. In the Tile classification of pelvic ring injuries, a Type C fracture is defined as:
36. A 45-year-old man sustains a posterior dislocation of the hip with an acetabular fracture. On CT scan, a posterior wall fragment involving 40% of the articular surface is identified. The management is:
37. A 28-year-old female pedestrian is struck by a vehicle, sustaining a lateral compression Type II pelvic fracture (LC-II). This characteristically includes:
38. A 30-year-old victim of a high-speed motor vehicle accident has an open-book pelvic injury with pubic symphysis diastasis of 5 cm on AP X-ray, hemodynamic instability, and blood pressure of 80/50 mmHg. The immediate life-saving intervention is:
39. The Judet and Letournel classification of acetabular fractures identifies 10 fracture types. A fracture that involves the anterior column, posterior column, and the quadrilateral plate with disruption of both columns from the iliac wing is termed:
40. Morel-Lavallée lesion associated with pelvic/hip trauma is best described as: