Trauma Practice Questions

Q: Sectoral sign is positive in which of the following conditions?

Avascular necrosis of femur head. **Explanation:** The **Sectoral Sign** is a classic radiological feature of **Avascular Necrosis (AVN) of the femoral head**. It refers to the phenomenon where the necrotic segment of the femoral head appears relatively more radiopaque (denser) compared to the surrounding osteopenic bone. This occurs because the dead bone maintains its original density while the surrounding viable bone undergoes disuse atrophy and resorption, creating a "sector" of increased density, usually in the anterolateral weight-bearing portion. **Analysis of Options:** * **A. Avascular Necrosis (AVN):** Correct. The sectoral sign, along with the **"Crescent Sign"** (subchondral fracture), is a hallmark of Ficat and Arlet Stage II/III AVN. * **B. Osteoarthritis of Hip:** Characterized by joint space narrowing, subchondral sclerosis, and osteophytes. While sclerosis is present, it is usually diffuse along the joint line rather than a specific "sectoral" density. * **C. Protrusio Acetabuli:** This refers to the medial displacement of the femoral head beyond the ilioischial (Kohler’s) line. It is seen in rheumatoid arthritis and Paget’s disease, not characterized by sectoral density. * **D. Slipped Capital Femoral Epiphysis (SCFE):** This involves the displacement of the epiphysis postero-inferiorly. Key signs include **Trethowan’s sign** (Klein’s line not intersecting the epiphysis) and the **Steel sign** (metaphyseal blanching). **High-Yield Clinical Pearls for NEET-PG:** * **Most sensitive imaging for AVN:** MRI (shows the "Double Line Sign" on T2 images). * **Earliest X-ray sign of AVN:** Sclerosis/Sectoral sign (Stage II). * **Crescent Sign:** Indicates an impending articular collapse (Stage III). * **Commonest site for AVN:** Femoral head (due to retrograde blood supply via the medial circumflex femoral artery).

Q: Which of the following are the characteristic features of a fracture of the neck of the femur?

Shortening and lateral rotation. **Explanation:** The classic clinical presentation of a **fracture of the neck of the femur** (intracapsular fracture) is a limb that is **shortened and externally (laterally) rotated**. 1. **Shortening:** This occurs due to the proximal migration of the distal femoral fragment caused by the upward pull of the powerful hip muscles (rectus femoris, hamstrings, and adductors) which are no longer resisted by the intact femoral neck. 2. **Lateral Rotation:** The distal fragment rotates externally because the short external rotators of the hip are unopposed. Furthermore, the weight of the foot naturally tends to roll the limb outward once the structural integrity of the femoral neck is lost. **Analysis of Incorrect Options:** * **Options A, B, and D:** While flexion may occasionally be seen due to pain response, it is not a defining diagnostic feature of the fracture. **Abduction** is incorrect because the limb typically lies in a neutral or slightly adducted position. The combination of shortening and lateral rotation is the "pathognomonic" clinical sign tested in exams. **NEET-PG High-Yield Pearls:** * **Degree of Rotation:** In **Intracapsular** (Neck) fractures, lateral rotation is typically **45°** because the capsule limits further movement. In **Extracapsular** (Intertrochanteric) fractures, the rotation is more severe, often reaching **90°** (the foot touches the bed). * **Vascularity:** The main blood supply to the femoral head is the **Medial Circumflex Femoral Artery**. Fractures here carry a high risk of **Avascular Necrosis (AVN)** and non-union. * **Classification:** Garden’s Classification is used for femoral neck fractures, while Boyd and Griffin or Jensen’s is used for intertrochanteric fractures.

Q: A 36-year-old man sustained a soccer injury. What procedure needs to be performed urgently?

Manipulation to improve alignment. ***Manipulation to improve alignment*** - **Anterior shoulder dislocation** requires urgent **closed reduction** to restore glenohumeral joint alignment and prevent complications. - Delayed reduction increases risk of **muscle spasm**, **axillary nerve injury**, and **anterior circumflex humeral artery** compromise. *A CT scan* - While useful for detecting **associated fractures**, CT is not the urgent priority in obvious dislocation cases. - **Clinical examination** and **plain radiographs** are sufficient for diagnosis; reduction should not be delayed for advanced imaging. *Application of a cast to maintain alignment* - Casting without **prior reduction** would immobilize the shoulder in a **dislocated position**, causing permanent damage. - **Sling immobilization** is appropriate only **after successful reduction** to allow soft tissue healing. *Internal fixation* - **Surgical fixation** is reserved for **recurrent dislocations**, **associated fractures**, or **failed closed reduction**. - Initial management of **acute anterior dislocation** is always **closed reduction** unless contraindicated by fractures.

Q: A 32-year-old male with a history of recurrent posterior dislocation of the shoulder joint. Which aspect of the humeral head is likely to show the lesion?

Anteromedial. ### Explanation The correct answer is **A. Anteromedial**. #### 1. The Underlying Concept: Reverse Hill-Sachs Lesion In a **posterior dislocation** of the shoulder, the humeral head is forced posteriorly against the posterior rim of the glenoid labrum. As the humeral head impacts the sharp glenoid rim, an impaction fracture occurs on the **anteromedial** aspect of the humeral head. This specific injury is known as a **Reverse Hill-Sachs lesion**. #### 2. Analysis of Options * **Anteromedial (Correct):** This is the site of impaction during posterior dislocation. The anterior part of the humeral head hits the posterior part of the glenoid. * **Posterolateral (Incorrect):** This is the site of a classic **Hill-Sachs lesion**, which occurs during **anterior shoulder dislocation** (the most common type). Here, the posterolateral humeral head impacts the anterior glenoid rim. * **Anterolateral & Posteromedial (Incorrect):** These anatomical locations do not correspond to the standard impaction points during common shoulder dislocations. #### 3. High-Yield Clinical Pearls for NEET-PG * **Posterior Dislocation:** Often associated with **seizures** or **electric shocks** (due to the strength of internal rotators). * **Clinical Sign:** The patient presents with the arm fixed in **adduction and internal rotation**. External rotation is impossible. * **Radiology:** Look for the **"Light Bulb Sign"** on AP view (the humeral head appears rounded due to internal rotation) and the **"Rim Sign"** (increased space between the glenoid and humeral head). * **Reverse Bankart Lesion:** This refers to the detachment of the **posterior-inferior** labrum, often seen alongside a Reverse Hill-Sachs lesion in recurrent posterior instability.

Q: A 32-year-old man sustains fractures of the right femur and tibia and the left humerus following a vehicular accident. The fractures are stabilized surgically. He remains in stable condition for 2 days, but then suddenly becomes severely dyspneic. Which of the following complications from his injuries is the most likely cause of his sudden respiratory difficulty?

Fat embolism. **Explanation:** The clinical presentation is classic for **Fat Embolism Syndrome (FES)**. This condition typically occurs following fractures of **long bones** (femur, tibia, humerus) or pelvic fractures. **1. Why Fat Embolism is correct:** Fat embolism occurs when fat globules from the bone marrow enter the systemic circulation following a fracture. There is typically a **latent period of 24–72 hours** after the injury (matching this patient's 2-day stable period). The "Classic Triad" of FES includes: * **Respiratory distress:** Sudden dyspnea, hypoxia, and tachypnea (the most common early sign). * **Neurological symptoms:** Confusion, agitation, or seizures. * **Petechial rash:** Typically found on the conjunctiva, neck, and axilla (pathognomonic but seen in only 20-50% of cases). **2. Why the other options are incorrect:** * **Cardiac Tamponade:** This presents acutely with Beck’s Triad (hypotension, JVP distension, muffled heart sounds), usually immediately following penetrating chest trauma, not 2 days later after limb stabilization. * **Pulmonary Edema:** While it causes dyspnea, it is usually associated with fluid overload or cardiac failure. In a young trauma patient without a history of heart disease, it is less likely than FES. * **Pulmonary Infarction:** This is a late complication of Pulmonary Embolism (PE). While PE is a differential, it usually occurs later (5–10 days post-surgery) due to DVT, whereas FES occurs within the first 72 hours. **Clinical Pearls for NEET-PG:** * **Gurd’s Criteria** is used for the diagnosis of FES. * **Snowstorm appearance** on Chest X-ray is a characteristic (though late) finding. * **Management:** Primarily supportive (Oxygenation/Ventilation). Early stabilization of fractures is the best preventive measure. * **Most common site of petechiae:** Conjunctiva and axilla.

Q: Which of the following is NOT a common site for fracture non-union?

Distal end of the radius. **Explanation:** The correct answer is **Distal end of the radius**. Non-union is defined as a permanent failure of bone healing. The distal end of the radius is characterized by **cancellous (spongy) bone** and a rich vascular supply. Cancellous bone has a large surface area and high osteogenic potential, which facilitates rapid and reliable healing. Consequently, fractures like Colles' fracture almost always unite, though they may result in *malunion* (healing in a bad position) rather than non-union. **Why the other options are common sites for non-union:** * **Waist of the scaphoid:** This site is notorious for non-union due to its **retrograde blood supply**. The vessels enter the distal pole; a fracture at the waist cuts off the blood supply to the proximal pole, leading to avascular necrosis (AVN) and non-union. * **Neck of the femur:** This is an **intracapsular** fracture. The synovial fluid contains collagenases that inhibit callus formation, and the blood supply (mainly via the medial circumflex femoral artery) is frequently disrupted, leading to high rates of non-union and AVN. * **Distal third of tibia:** This area has a **tenuous blood supply** and minimal soft tissue/muscle cover. The nutrient artery enters the bone in the upper third, leaving the distal third prone to ischemia and subsequent non-union. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of non-union in the body:** Scaphoid (specifically the waist). * **Most common long bone for non-union:** Tibia (distal third). * **Atrophic Non-union:** Characterized by "pencil-like" bone ends on X-ray due to poor vascularity. * **Hypertrophic Non-union:** Characterized by "elephant foot" appearance, indicating adequate blood supply but inadequate immobilization.

Q: A fracture of the proximal third of the ulna is associated with dislocation of the radial head. Which of the following injury types is this most likely to be?

Monteggia's deformity. **Explanation:** The correct answer is **Monteggia’s deformity**. This injury is defined as a **fracture of the proximal third of the ulna** associated with **dislocation of the proximal radio-ulnar joint (radial head dislocation)**. The underlying medical concept involves the anatomical relationship between the radius and ulna; they act as a "closed ring" system. When one bone suffers a displaced fracture, the force is often transmitted to the other, leading to either a second fracture or a dislocation of the adjacent joint. In Monteggia's injury, the ulnar shaft breaks, and the force displaces the radial head, most commonly in an anterior direction. **Analysis of Incorrect Options:** * **A. Navicular (scaphoid) fracture:** This is a fracture of a carpal bone in the wrist, usually caused by a fall on an outstretched hand (FOOSH). It does not involve the ulna or radial head. * **C. Greenstick fracture:** This is an incomplete fracture typically seen in children where the bone bends and cracks but does not break completely. It describes a fracture morphology, not a specific injury pattern involving dislocation. * **D. Spiral fracture:** This describes a fracture line caused by a twisting (rotational) force. Like the greenstick fracture, it is a descriptive term for the break itself rather than a named fracture-dislocation complex. **Clinical Pearls for NEET-PG:** * **Mnemonic (MU-GR):** **M**onteggia = **U**lna fracture (proximal); **G**aleazzi = **R**adius fracture (distal). * **Galeazzi Fracture:** Fracture of the distal third of the radius with dislocation of the distal radio-ulnar joint (DRUJ). * **Bado Classification:** Used to classify Monteggia fractures based on the direction of radial head dislocation (Type I/Anterior is the most common). * **Nerve Injury:** The **Posterior Interosseous Nerve (PIN)**, a branch of the radial nerve, is the most commonly injured nerve in Monteggia fractures.

Q: Ruedi and Allgower classification is used for which of the following fractures?

Distal tibial fracture. The **Ruedi-Allgower classification** is the standard system used to categorize **Pilon fractures**, which are intra-articular fractures of the **distal tibia** caused by high-energy axial loading (vertical compression). ### Why the Correct Answer is Right: The classification focuses on the degree of comminution and displacement of the distal tibial articular surface. It is divided into three types: * **Type I:** Non-displaced articular fracture. * **Type II:** Displaced articular fracture but without significant comminution. * **Type III:** Highly comminuted and displaced articular fracture (the most severe). ### Why Other Options are Wrong: * **Radius fracture:** Distal radius fractures are commonly classified using the **Frykman** or **Fernandez** classifications. * **Fibular fracture:** While often associated with Pilon fractures, isolated fibular fractures are typically classified using the **Danis-Weber** system (based on the level of the fracture relative to the syndesmosis). * **Proximal tibial fracture:** These are known as Tibial Plateau fractures and are classified using the **Schatzker** classification. ### High-Yield Clinical Pearls for NEET-PG: * **Mechanism of Injury:** Pilon fractures usually result from a fall from height or motor vehicle accidents where the talus is driven into the tibial plafond like a "pestle" into a "mortar." * **Associated Injuries:** Always look for "Don Juan Syndrome" (calcaneal fractures and lumbar spine compression fractures) in axial loading injuries. * **Management Tip:** Soft tissue management is critical; these are often managed with initial external fixation followed by delayed internal fixation (ORIF) once the "wrinkle sign" appears.

Q: Avascular necrosis is not uncommon. Select the type of fracture or dislocation with which it is most likely to be associated.

Navicular (scaphoid) fracture. **Explanation:** The correct answer is **A. Navicular (scaphoid) fracture**. **Why Scaphoid Fracture?** Avascular Necrosis (AVN) occurs when the blood supply to a bone is disrupted, leading to bone death. The scaphoid bone (historically called the navicular bone of the hand) has a unique **retrograde blood supply**. The nutrient arteries enter the bone through the distal pole and flow proximally. Therefore, a fracture across the waist or proximal pole of the scaphoid often severs this blood supply, leaving the proximal fragment ischemic and prone to AVN (Preiser’s disease). **Analysis of Incorrect Options:** * **B. Monteggia’s deformity:** This involves a fracture of the proximal third of the ulna with dislocation of the radial head. While it can lead to nerve injuries (PIN) or malunion, it is not typically associated with AVN. * **C. Greenstick fracture:** This is an incomplete fracture seen in children where the bone bends and breaks only on one side. Because the periosteum remains largely intact and pediatric bone is highly vascular, AVN is not a risk. * **D. Spiral fracture:** This is a descriptive term for a fracture pattern caused by a twisting force. It does not inherently imply a risk of AVN unless it occurs in a specific "at-risk" anatomical site. **High-Yield Clinical Pearls for NEET-PG:** * **Common sites for AVN post-trauma:** Head of femur (most common), Scaphoid (proximal pole), Talus (neck), and Humeral head. * **Scaphoid Fracture:** Tenderness in the **Anatomical Snuffbox** is the classic clinical sign. * **Radiology:** AVN appears as **increased radiodensity** (sclerosis) on X-ray because the dead bone does not undergo the resorption seen in surrounding vascularized bone. * **Management:** Undisplaced scaphoid fractures are treated with a Scaphoid cast; displaced fractures require ORIF with a Herbert screw.

Q: A patient involved in a road traffic accident is found lying in the right lateral position with bruises on the face, elbow, and lateral side of the knee. Which nerve injury has the maximum chance of occurring in this position of the victim?

Common peroneal nerve. **Explanation:** The correct answer is **Common Peroneal Nerve (CPN)**. The common peroneal nerve is the most frequently injured nerve in the lower limb due to its superficial and vulnerable anatomical course. It winds around the **neck of the fibula**, where it is covered only by skin and fascia, making it highly susceptible to compression against the underlying bone. In this scenario, the patient is lying in a **right lateral position**. This position causes the lateral aspect of the right knee (specifically the fibular neck) to be compressed against the hard ground. The presence of bruises on the lateral side of the knee further confirms a direct impact or prolonged pressure in this specific anatomical region, leading to a "compression neuropathy" of the CPN. **Analysis of Incorrect Options:** * **Trigeminal Nerve (A):** While facial bruises are present, the trigeminal nerve is deep-seated and protected by the skull and facial bones; it is rarely injured by simple lateral positioning. * **Ulnar Nerve (B):** Although there are bruises on the elbow, the ulnar nerve is most vulnerable at the medial epicondyle (cubital tunnel). In a lateral position, the lateral elbow is usually the point of contact, not the medial side. * **Tibial Nerve (D):** This nerve is deeply embedded in the popliteal fossa and posterior compartment of the leg, protected by thick muscle and fat, making it much less likely to be injured by external compression compared to the CPN. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** CPN injury leads to **Foot Drop** (loss of dorsiflexion) and loss of sensation over the first dorsal web space (deep peroneal) and lateral leg/dorsum of the foot (superficial peroneal). * **Common Causes:** Tight plaster casts, cross-legged sitting, or lateral decubitus positioning during surgery/unconsciousness. * **Mnemonic:** **PED** (Peroneal Everts and Dorsiflexes; if injured, you get **D**rop foot).

Question 1

Sectoral sign is positive in which of the following conditions?

Accepted Answer

Avascular necrosis of femur head

Answer

Osteoarthritis of hip

Answer

Protrusio acetabuli

Answer

Slipped capital femoral epiphyses

Question 2

Which of the following are the characteristic features of a fracture of the neck of the femur?

Accepted Answer

Shortening and lateral rotation

Answer

Flexion at the hip and lateral rotation

Answer

Flexion at the hip and abduction

Answer

Shortening and flexion

Question 3

A 36-year-old man sustained a soccer injury. What procedure needs to be performed urgently?

Accepted Answer

Manipulation to improve alignment

Answer

A CT scan

Answer

Application of a cast to maintain alignment

Answer

Internal fixation

Question 4

A 32-year-old male with a history of recurrent posterior dislocation of the shoulder joint. Which aspect of the humeral head is likely to show the lesion?

Accepted Answer

Anteromedial

Answer

Anterolateral

Answer

Posteromedial

Answer

Posterolateral

Question 5

A 32-year-old man sustains fractures of the right femur and tibia and the left humerus following a vehicular accident. The fractures are stabilized surgically. He remains in stable condition for 2 days, but then suddenly becomes severely dyspneic. Which of the following complications from his injuries is the most likely cause of his sudden respiratory difficulty?

Accepted Answer

Fat embolism

Answer

Cardiac tamponade

Answer

Pulmonary edema

Answer

Pulmonary infarction

Question 6

Which of the following is NOT a common site for fracture non-union?

Accepted Answer

Distal end of the radius

Answer

Waist of the scaphoid

Answer

Neck of the femur

Answer

Distal third of tibia and fibula

Question 7

A fracture of the proximal third of the ulna is associated with dislocation of the radial head. Which of the following injury types is this most likely to be?

Accepted Answer

Monteggia's deformity

Answer

Navicular (scaphoid) fracture

Answer

Greenstick fracture

Answer

Spiral fracture

Question 8

Ruedi and Allgower classification is used for which of the following fractures?

Accepted Answer

Distal tibial fracture

Answer

Radius fracture

Answer

Fibular fracture

Answer

Proximal tibial fracture

Question 9

Avascular necrosis is not uncommon. Select the type of fracture or dislocation with which it is most likely to be associated.

Accepted Answer

Navicular (scaphoid) fracture

Answer

Monteggia's deformity

Answer

Greenstick fracture

Answer

Spiral fracture

Question 10

A patient involved in a road traffic accident is found lying in the right lateral position with bruises on the face, elbow, and lateral side of the knee. Which nerve injury has the maximum chance of occurring in this position of the victim?

Accepted Answer

Common peroneal nerve

Answer

Trigeminal nerve

Answer

Ulnar nerve

Answer

Tibial nerve

Trauma — MCQs

Trauma — MCQs

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