Trauma — MCQs
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A controlled osteotomy performed during surgery to facilitate access or correction is best described as -
Jefferson fracture is:
Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:
Radial Nerve injury of this type recovers with conservative management
A swelling behind the ear suggests fracture of:
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)
Triangular relation of Elbow is maintained in
A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity
All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except
Trauma Indian Medical PG Practice Questions and MCQs
Question 991: A controlled osteotomy performed during surgery to facilitate access or correction is best described as -
- A. Galeazzi fracture (Correct Answer)
- B. Rolando fracture
- C. Monteggia fracture
- D. Cottons fracture
Explanation: ***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.
Question 992: Jefferson fracture is:
- A. Atlanto- axial dislocation
- B. Fracture of talus
- C. C2 fracture
- D. C1 fracture (Correct Answer)
Explanation: ***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.
Question 993: Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:
- A. Fracture with metaphyseal comminution (Correct Answer)
- B. Segmental fracture
- C. Spiral fracture
- D. Oblique fracture
Explanation: ***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.
Question 994: Radial Nerve injury of this type recovers with conservative management
- A. Crush injury
- B. Chemical injury
- C. Neurotmesis
- D. Neuropraxia (Correct Answer)
Explanation: ***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.
Question 995: A swelling behind the ear suggests fracture of:
- A. Zygomatic complex
- B. Temporal bone
- C. Condylar fracture (Correct Answer)
- D. Orbital floor fracture
Explanation: ***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.
Question 996: 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)
- A. Navicular (scaphoid) fracture (Correct Answer)
- B. Monteggia's deformity
- C. Greenstick fracture
- D. Spiral fracture
Explanation: ***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.
Question 997: Triangular relation of Elbow is maintained in
- A. Fracture ulna
- B. Anterior dislocation of Elbow
- C. Posterior dislocation of Elbow
- D. Supracondylar fracture (Correct Answer)
Explanation: ***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.
Question 998: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
- A. 1st metacarpal fracture
- B. Scaphoid fracture (Correct Answer)
- C. Trapezoid fracture
- D. Lower end of radius fracture
Explanation: ***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.
Question 999: Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity
- A. ab
- B. abc (Correct Answer)
- C. acd
- D. bcd
Explanation: ***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.
Question 1000: All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except
- A. It is clover leaf in cross section
- B. The nail is a hollow with a slot on one side
- C. The nail has eye at one end (Correct Answer)
- D. The fixation by k nailing is based on the three point fixation
Explanation: ***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.
Practice by Chapter
Principles of Fracture Management
Practice Questions
Upper Limb Fractures
Practice Questions
Lower Limb Fractures
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Spinal Trauma
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Pelvic and Acetabular Fractures
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Open Fractures
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Fractures in Children
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Fracture Complications
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Nonunion and Malunion
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Polytrauma Management
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Joint Dislocations
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Soft Tissue Injuries
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