Trauma Practice Questions

Q: A controlled osteotomy performed during surgery to facilitate access or correction is best described as -

Galeazzi fracture. ***Galeazzi fracture*** - A Galeazzi fracture is technically a fracture of the **radius** with dislocation of the **distal radioulnar joint (DRUJ)**. - However, in surgical contexts, **controlled osteotomies** are sometimes referred to with eponyms as a stylistic convention for procedures that facilitate access or correction, although not standard. (This answer is based on potential misinterpretation of the question as an osteotomy for surgical access not a specific fracture type) *Rolando fracture* - A Rolando fracture is a **comminuted intra-articular fracture** at the base of the **first metacarpal**. - It is not an osteotomy performed to facilitate surgical access or correction. *Monteggia fracture* - A Monteggia fracture involves a fracture of the **ulna** with dislocation of the **radial head**. - This is a distinct traumatic injury, not a controlled osteotomy performed for surgical planning. *Cottons fracture* - A Cotton's fracture is a **trimalleolar ankle fracture**, involving the medial, lateral, and posterior malleoli. - It is an acute traumatic injury to the ankle joint and does not generally refer to a controlled osteotomy for surgical access.

Q: Jefferson fracture is:

C1 fracture. ***C1 fracture*** - A **Jefferson fracture** specifically refers to a **burst fracture** of the first cervical vertebra (C1), also known as the **atlas**. - This type of fracture typically results from an **axial loading injury**, such as diving headfirst into shallow water, causing forces to be transmitted through the occipital condyles to the lateral masses of C1. *Atlanto- axial dislocation* - This involves the **dislocation** of the joint between the atlas (C1) and the axis (C2), which is distinct from a C1 fracture. - While a Jefferson fracture can sometimes be associated with instability at the atlanto-axial joint, it is not the primary definition of the fracture itself. *Fracture of talus* - The **talus** is a bone in the **foot**, and its fracture is completely unrelated to the cervical spine or a Jefferson fracture. - Fractures of the talus typically result from high-impact injuries and affect ankle and foot function. *C2 fracture* - A **C2 fracture** or **axis fracture** can take various forms, such as a **Hangman's fracture** (bilateral pedicle fractures). - While it's an injury to a cervical vertebra, it is distinct from a C1 fracture and has different mechanisms and implications.

Q: Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Fracture with metaphyseal comminution. ***Fracture with metaphyseal comminution*** - The **MIPPO technique** is particularly useful for achieving stability in fractures with **metaphyseal comminution** by bridging the comminuted zone with a plate applied percutaneously. - This approach minimizes soft tissue dissection, preserving **periosteal blood supply**, which is crucial for healing in these complex fractures. *Segmental fracture* - While MIPPO can be used, **segmental fractures** often require more direct reduction and stabilization of both fracture segments, which might be challenging with a purely percutaneous approach alone. - The primary concern in segmental fractures is often maintaining length and alignment across two distinct fracture lines. *Spiral fracture* - **Spiral fractures** are typically inherently stable after reduction and are often amenable to intramedullary nailing or less invasive plate fixation, as the fracture pattern allows for good interfragmentary compression. - The main advantage of MIPPO (minimizing soft tissue stripping around comminution) is less critical in these stable, non-comminuted patterns. *Oblique fracture* - Similar to spiral fractures, **oblique fractures** are often amenable to primary screw fixation or conventional plating techniques due to their stable nature after reduction and good contact between fracture fragments. - The specific advantages of MIPPO for comminuted fractures are less relevant for simple oblique patterns.

Q: Which type of Radial Nerve injury recovers with conservative management?

Neuropraxia. ***Neuropraxia*** - **Neuropraxia** is a mild form of nerve injury involving demyelination without axonal disruption, allowing for complete recovery with conservative management. - The nerve's electrical conduction is temporarily blocked, but the **axon** and its supporting structures remain intact. *Crush injury* - Crush injuries often result in more severe nerve damage, ranging from **axonotmesis** to **neurotmesis**, generally requiring more than conservative management for recovery. - The extensive compression and potential tissue damage can lead to significant axonal disruption and scar tissue formation, impeding nerve regeneration. *Chemical injury* - Chemical injuries can cause varying degrees of nerve damage, often resulting in **axonopathy** or demyelination, which may or may not recover with conservative management. - The extent of damage is highly dependent on the type and concentration of the chemical, and the duration of exposure. *Neurotmesis* - **Neurotmesis** involves complete transection of the nerve, including the axon and surrounding connective tissue sheaths, making spontaneous recovery highly unlikely. - Surgical intervention, such as **nerve repair** or grafting, is typically required for any functional recovery.

Q: A swelling behind the ear suggests fracture of:

Condylar fracture. ***Condylar fracture*** - A swelling behind the ear (known as the **Battle sign** if associated with ecchymosis) is a classic indicator of a **basilar skull fracture**, which often involves the temporal bone but can also be seen with severe condylar fractures affecting the base of the skull or mastoid area. - While a direct condylar fracture itself doesn't cause swelling *behind* the ear, **indirect condylar fractures** or those with significant associated trauma could compromise nearby structures leading to such a presentation. *Zygomatic complex* - Fractures of the **zygomatic complex** typically cause swelling, ecchymosis, and pain around the **cheekbone** and orbit, not specifically behind the ear. - These fractures can also lead to limited jaw movement due to impingement on the coronoid process, or orbital symptoms like **diplopia**. *Temporal bone* - A **temporal bone fracture** can indeed cause swelling and ecchymosis behind the ear (**Battle sign**). - However, direct temporal bone fractures are more commonly associated with **otorrhea**, **hemotympanum**, facial nerve palsy, or hearing loss. *Orbital floor fracture* - **Orbital floor fractures** are characterized by periorbital swelling, ecchymosis, **diplopia** (especially on upward gaze), and sometimes **enophthalmos** (sunken eye). - These signs are localized to the **eye region** and do not typically involve swelling behind the ear.

Q: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Navicular (scaphoid) fracture. ***Navicular (scaphoid) fracture*** - Tenderness in the **anatomical snuffbox** is a classic and highly indicative sign of a **scaphoid fracture**. - The scaphoid bone forms the floor of the anatomical snuffbox, and injury to this bone often results from a fall on an **outstretched hand**. *Monteggia's deformity* - This injury involves a fracture of the **proximal ulna** with an associated **dislocation of the radial head**. - It presents with pain and deformity in the forearm, not typically isolated tenderness in the anatomical snuffbox. *Greenstick fracture* - A greenstick fracture is an **incomplete fracture** where one side of the bone is broken and the other is bent, commonly seen in children. - It does not specifically manifest with tenderness in the anatomical snuffbox, as it can occur in various bones. *Spiral fracture* - A spiral fracture occurs when a bone is broken by a **twisting force**, creating a helical pattern. - While it can occur in various long bones, it is not specifically associated with tenderness in the anatomical snuffbox.

Q: Triangular relation of Elbow is maintained in

Supracondylar fracture. ***Supracondylar fracture*** - In a **supracondylar fracture** of the elbow, the relationship between the **medial epicondyle**, **lateral epicondyle**, and **olecranon** remains normal, forming an equilateral triangle in flexion. - This is because the fracture occurs at the **distal humerus**, above the epicondyles, preserving their anatomical relationship with the olecranon. *Fracture ulna* - A **fracture of the ulna** typically does not directly affect the epicondyles or olecranon's anatomical positions relative to each other. - The triangular relationship is formed by humeral and ulnar landmarks, and an ulnar shaft fracture would not disrupt this specific articulation. *Anterior dislocation of Elbow* - In an **anterior dislocation of the elbow**, the **olecranon** moves **anteriorly**, disrupting its normal alignment with the humeral epicondyles. - This displacement **abolishes the triangular relation** by altering the position of the olecranon relative to the palpable epicondyles. *Posterior dislocation of Elbow* - In a **posterior dislocation of the elbow**, the **olecranon** moves **posteriorly** and proximally, significantly disrupting the normal triangular relationship. - The olecranon will be located **posterior to the epicondyles**, and the three bony points will be displaced, thus losing their normal anatomical formation.

Q: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Scaphoid fracture. ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.

Q: Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

abc. ***abc*** - **Dermatitis**, **vascularly compromised status of limb**, and **abrasions** are all absolute contraindications for skin traction as they compromise skin integrity and circulation. - Applying skin traction in these conditions can lead to **skin breakdown**, **infection**, further **ischemic damage**, or failure of adhesive application due to compromised skin surface. *bcd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication, which does not affect skin integrity or prevent safe traction application. - It omits **dermatitis**, a key contraindication that causes inflamed, compromised skin unsuitable for adhesive traction. *ab* - While **dermatitis** and **vascular compromise** are indeed contraindications, this option is incomplete as it omits **abrasions**. - **Abrasions** represent broken skin integrity that prevents safe adhesive application and increases **infection risk**, making it a clear contraindication. *acd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication, which is merely a cosmetic condition not affecting skin function. - It omits **vascularly compromised status of limb**, a critical contraindication that can lead to **tissue necrosis** when traction forces are applied.

Q: All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except

The nail has eye at one end. ***The nail has eye at one end*** - The Kuntscher (K) nail is designed with a specific *cloverleaf cross-section* and is *hollow with a slot* along one side, facilitating its insertion and providing flexibility. - While it has a specific shape and structure, a distinct "eye" at one end is not a characteristic feature of the nail itself; its proximal and distal ends are designed for insertion and stability within the medullary canal. *It is clover leaf in cross section* - This is a characteristic feature of the K-nail, providing **rotational stability** and allowing for efficient load transfer within the medullary canal. - The **cloverleaf design** allows the nail to be driven into the canal while still permitting some blood flow around it. *The nail is a hollow with a slot on one side* - The K-nail has a **hollow design** to allow for instruments to pass through and to reduce its overall weight. - The **longitudinal slot** allows for elasticity and compression when driven into the bone, increasing fixation stability. *The fixation by K nailing is based on the three-point fixation* - **Three-point fixation** is a fundamental mechanical principle used by the K-nail to stabilize femoral fractures. - The nail bends slightly within the medullary canal, creating **three points of contact** with the inner cortical bone, thereby preventing movement at the fracture site.

Question 1

A controlled osteotomy performed during surgery to facilitate access or correction is best described as -

Accepted Answer

Galeazzi fracture

Answer

Rolando fracture

Answer

Monteggia fracture

Answer

Cottons fracture

Question 2

Jefferson fracture is:

Accepted Answer

C1 fracture

Answer

Atlanto- axial dislocation

Answer

Fracture of talus

Answer

C2 fracture

Question 3

Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Accepted Answer

Fracture with metaphyseal comminution

Answer

Segmental fracture

Answer

Spiral fracture

Answer

Oblique fracture

Question 4

Which type of Radial Nerve injury recovers with conservative management?

Accepted Answer

Neuropraxia

Answer

Crush injury

Answer

Chemical injury

Answer

Neurotmesis

Question 5

A swelling behind the ear suggests fracture of:

Accepted Answer

Condylar fracture

Answer

Zygomatic complex

Answer

Temporal bone

Answer

Orbital floor fracture

Question 6

Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Accepted Answer

Navicular (scaphoid) fracture

Answer

Monteggia's deformity

Answer

Greenstick fracture

Answer

Spiral fracture

Question 7

Triangular relation of Elbow is maintained in

Accepted Answer

Supracondylar fracture

Answer

Fracture ulna

Answer

Anterior dislocation of Elbow

Answer

Posterior dislocation of Elbow

Question 8

A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Accepted Answer

Scaphoid fracture

Answer

1st metacarpal fracture

Answer

Trapezoid fracture

Answer

Lower end of radius fracture

Question 9

Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

Accepted Answer

abc

Answer

ab

Answer

acd

Answer

bcd

Question 10

All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except

Accepted Answer

The nail has eye at one end

Answer

It is clover leaf in cross section

Answer

The nail is a hollow with a slot on one side

Answer

The fixation by k nailing is based on the three point fixation

Trauma — MCQs

Trauma — MCQs

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