Trauma Practice Questions

Q: Tibial Fracture with > 1 cm wound, slight comminution and moderate crushing is

Grade II. I apologize, but I must follow the instructions to keep the correct option at the top. Based on the provided correct option in the input (Grade II), I will proceed with that as the correct answer. ***Grade II*** - A tibial fracture with a **wound > 1 cm** and **moderate crushing** without extensive periosteal stripping or significant contamination is classified as Grade II in the **Gustilo-Anderson classification** of open fractures. - This grade indicates **moderate soft tissue damage** and comminution, which is consistent with the description provided. *Grade III B* - **Grade III B** involves extensive soft tissue damage, **periosteal stripping**, and often massive contamination, requiring reconstructive procedures. - The description of a **moderate crushing injury** without mention of extensive stripping or massive contamination does not fit Grade IIIB. *Grade III A* - **Grade III A** open fractures involve adequate soft tissue coverage of the bone despite extensive laceration or flaps, or high-energy trauma with **severe comminution**. - While there is slight comminution, the defining characteristic of Grade IIIA — **adequate soft tissue coverage** — is not explicitly mentioned to differentiate it from Grade II. *Grade I* - **Grade I** open fractures have a **wound less than 1 cm** and minimal soft tissue damage, with the appearance of a puncture hole. - The given wound size of **> 1 cm** immediately rules out a Grade I classification.

Q: Most common fractured facial bone

Nasal bone. ***Nasal bone*** - The **nasal bone** is the **most commonly fractured facial bone** due to its prominent and anterior position on the face. - Its relatively thin and delicate structure makes it highly susceptible to direct trauma, especially during sports injuries, falls, or assaults. *Nasoethmoid bone* - Fractures of the **nasoethmoid complex** are serious but less frequent than isolated nasal bone fractures, often resulting from high-impact trauma. - These fractures typically involve the **nasal bones**, **ethmoid sinuses**, and sometimes the medial orbital walls, leading to complex midfacial injuries. *Zygomatic bone* - The **zygomatic bone (cheekbone)** is the second most commonly fractured facial bone, but not the first. - Zygomatic fractures often occur from direct blows to the cheek but require more force than nasal bone fractures due to its sturdier structure. *Mandible* - The **mandible (jawbone)** is a robust bone, and while mandibular fractures are common facial injuries, they are secondary to nasal bone fractures in terms of frequency. - Mandibular fractures often result from significant force, such as motor vehicle accidents or direct blows to the jaw.

Q: Russell and Taylor classification is used for:

Subtrochanteric femoral fracture. ***Subtrochanteric femoral fracture*** - The **Russell and Taylor classification** system is specifically designed to classify **subtrochanteric femoral fractures**. - It categorizes these fractures based on the involvement of the **lesser trochanter** and the extension into the **piriformis fossa**, guiding treatment decisions. *Shaft of tibia fracture* - **Shaft of tibia fractures** are typically classified using other systems, such as the **AO/OTA classification**, which focuses on bone segment, morphology, and comminution. - The Russell and Taylor system is not applicable to lower leg fractures. *Humerus shaft fracture* - **Humerus shaft fractures** are commonly classified by systems that describe the **location (proximal, middle, distal third)**, **morphology (transverse, oblique, spiral)**, and **displacement**. - The Russell and Taylor classification does not apply to upper limb fractures. *Fracture of neck of femur* - **Fractures of the neck of the femur** are usually classified by the **Garden classification** (based on displacement) or the **Pauwels classification** (based on angle of fracture line). - These classifications determine the risk of **avascular necrosis** and guide treatment, which is distinct from the Russell and Taylor system.

Q: A 27-year-old right hand dominant man sustains a right distal radius fracture after a fall. He is treated with closed reduction. Which radiographic parameter has the greatest bearing on functional outcome

Palmar tilt. ***Palmar tilt*** - Restoration of **normal palmar tilt** is crucial for maintaining proper wrist biomechanics and preventing secondary osteoarthritis. - **Dorsal angulation** >20 degrees is associated with poor functional outcomes. *Radial height* - While important for overall wrist mechanics, studies show that functional outcomes are less affected by minor changes in **radial height** compared to palmar tilt. - **Loss of radial height** can lead to carpal instability and premature arthritis. *Ulnar variance* - **Positive ulnar variance** can lead to ulnocarpal impingement, while negative can cause Kienbock's disease. - However, for distal radius fractures, its impact on overall functional outcome is generally considered secondary to palmar tilt. *Radial inclination* - **Loss of radial inclination** can affect the articulation between the radius and carpal bones. - Good restoration of **radial inclination** is desirable, but it is not as strong a predictor of ultimate functional outcome as palmar tilt.

Q: Position for transport of a patient with lumbar spine fracture:

Neutral. ***Neutral*** - Maintaining a **neutral spine position** during transport is crucial to prevent further displacement of fractured vertebral fragments. - This position minimizes stress on the spinal cord and existing injuries, reducing the risk of neurological damage. *Hyperextension* - **Hyperextension** of the spine can worsen a lumbar fracture by creating a "gap" at the injury site, potentially leading to increased instability or compression of the spinal cord. - This position is generally contraindicated for spinal fractures due to the risk of further injury. *Hyper flexion* - **Hyperflexion** of the spine can compress the anterior aspect of a fractured vertebra, potentially leading to further collapse or retropulsion of fragments into the spinal canal. - This movement should be strictly avoided as it can destabilize the fracture and increase the risk of neurological compromise. *Alternating* - **Alternating positions** during transport is inappropriate and dangerous for a patient with a lumbar spine fracture. - Frequent movement or changes in position can cause unstable fracture fragments to shift, risking further spinal cord injury or exacerbating existing damage.

Q: Which of the following fractures is associated with high mortality and morbidity?

Pelvic fractures. ***Pelvic fractures*** - Pelvic fractures, especially **unstable** ones, are associated with significant **hemorrhage** due to the rich vascular supply of the pelvis. This can lead to **hypovolemic shock** and high mortality. - They often result from **high-energy trauma** and can cause damage to internal organs, nerves, and blood vessels, leading to high morbidity including long-term pain and disability. *Femur Shaft fractures* - While femur shaft fractures can cause significant **blood loss** (up to 1500 ml), they are generally less critical than pelvic fractures in terms of immediate mortality risks, provided adequate resuscitation. - These fractures typically result from **high-energy trauma** but are usually managed surgically with low long-term morbidity when treated appropriately. *Shaft tibia fractures* - Tibia shaft fractures, while painful and requiring long recovery, are generally not associated with high mortality due to low risk of major hemorrhage or damage to critical organs. - The main complications are **non-union**, **malunion**, and **compartment syndrome**, which contribute to morbidity but not typically mortality. *Subtrochanteric fractures* - Subtrochanteric fractures are located in the **proximal femur** and are often seen in elderly individuals or those with osteoporosis. They can cause considerable pain and disability. - While they can lead to complications such as **non-union** or implant failure, their mortality and immediate life-threatening risks are typically lower compared to severe pelvic fractures.

Q: What is luxatio erecta ?

Inferior shoulder dislocation. ***Inferior shoulder dislocation*** - Luxatio erecta is a rare type of shoulder dislocation where the humeral head is displaced **inferiorly** and the arm is fixed in an **elevated position**, often described as looking as if the patient is "waving hello." - This dislocation typically results from **hyperabduction** of the arm, forcing the humeral head out of the glenoid fossa. *Anterior shoulder dislocation* - This is the most common type of shoulder dislocation, where the humeral head is displaced **anteriorly** and **inferiorly** beneath the coracoid process. - The arm is typically held in **abduction** and **external rotation**, not a sustained elevation. *Posterior hip dislocation* - This involves the displacement of the **femoral head** out of the acetabulum in a **posterior direction**, often due to high-energy trauma dashboard injuries. - The leg typically presents in **internal rotation**, adduction, and flexion. *Anterior hip dislocation* - This less common hip dislocation involves the femoral head displacing **anteriorly** relative to the acetabulum. - The affected leg is usually held in **external rotation**, abduction, and slight flexion.

Q: Most common complication of intertrochanteric fracture femur is:

Malunion. ***Malunion*** - **Malunion** is the most common complication of intertrochanteric fractures, particularly with unstable fracture patterns or inadequate reduction and fixation. - This typically results in leg length discrepancy, gait disturbance, and persistent pain due to abnormal alignment. *Nerve injury* - **Nerve injury** is a rare complication of intertrochanteric fractures, as the major nerves (e.g., sciatic, femoral) are not in close proximity to the fracture site. - While possible with severe trauma or surgical errors, it is not considered the most common complication. *Osteoarthritis* - **Osteoarthritis** can develop years after an intertrochanteric fracture due to altered biomechanics, but it is a long-term sequela, not an immediate or most common post-fracture complication. - Early complications like malunion or infection are more prevalent. *Non-union* - **Non-union** is relatively uncommon in intertrochanteric fractures because this area of the femur has an excellent blood supply, which promotes healing. - This complication is more frequently seen in femoral neck fractures due to their tenuous blood supply.

Q: Which fracture results in the 'cubitus varus' deformity?

Supracondylar fracture of humerus. ***Supracondylar fracture of humerus*** - This fracture, especially in children, can lead to **malunion** and subsequent **cubitus varus deformity**, also known as **gunstock deformity**. - The varus angulation occurs due to the medial displacement and rotation of the distal fragment, causing the forearm to deviate medially when the elbow is extended. *Olecranon fracture* - While it affects the elbow joint, an olecranon fracture typically results in loss of **extensor mechanism function** and potentially **elbow instability**, but not primarily cubitus varus. - The deformity associated with an olecranon fracture is usually a prominence of the olecranon or a loss of elbow extension. *Lateral condylar fracture* - A lateral condylar fracture can lead to **cubitus valgus** due to premature epiphyseal closure of the humeral capitellum and continued growth of the medial condyle. - It does not characteristically cause a cubitus varus deformity. *Radial head fracture* - Radial head fractures primarily affect forearm rotation and elbow stability, often leading to **pain with pronation and supination**. - They are not a direct cause of cubitus varus or valgus deformity of the elbow.

Q: Patient with shoulder dislocation has axillary nerve injury. Which movement will be most affected?

Shoulder Abduction. ***Shoulder Abduction*** - The **axillary nerve** innervates the **deltoid muscle**, which is the primary muscle responsible for **shoulder abduction** beyond the initial 15 degrees. - Injury to this nerve would significantly impair the patient's ability to lift their arm away from their body. *Forward Flexion* - **Forward flexion** of the shoulder is primarily carried out by the **anterior deltoid**, **pectoralis major**, and **coracobrachialis muscles**. - While the anterior deltoid is affected, other muscles can still contribute to this movement, making it less severely impaired than abduction. *Internal Rotation* - **Internal rotation** is largely controlled by the **subscapularis**, **latissimus dorsi**, **teres major**, and **pectoralis major**. - These muscles are not innervated by the axillary nerve, so internal rotation would be largely preserved. *External Rotation* - **External rotation** is primarily performed by the **infraspinatus** and **teres minor muscles**. - These muscles are supplied by the **suprascapular nerve** and **axillary nerve** (for teres minor), respectively, but the deltoid's role is minimal, so overall external rotation would be less affected compared to abduction.

Question 1

Tibial Fracture with > 1 cm wound, slight comminution and moderate crushing is

Accepted Answer

Grade II

Answer

Grade III B

Answer

Grade III A

Answer

Grade I

Question 2

Most common fractured facial bone

Accepted Answer

Nasal bone

Answer

Nasoethmoid bone

Answer

Zygomatic bone

Answer

Mandible

Question 3

Russell and Taylor classification is used for:

Accepted Answer

Subtrochanteric femoral fracture

Answer

Shaft of tibia fracture

Answer

Humerus shaft fracture

Answer

Fracture of neck of femur

Question 4

A 27-year-old right hand dominant man sustains a right distal radius fracture after a fall. He is treated with closed reduction. Which radiographic parameter has the greatest bearing on functional outcome

Accepted Answer

Palmar tilt

Answer

Radial height

Answer

Ulnar variance

Answer

Radial inclination

Question 5

Position for transport of a patient with lumbar spine fracture:

Accepted Answer

Neutral

Answer

Hyperextension

Answer

Hyper flexion

Answer

Alternating

Question 6

Which of the following fractures is associated with high mortality and morbidity?

Accepted Answer

Pelvic fractures

Answer

Femur Shaft fractures

Answer

Shaft tibia fractures

Answer

Subtrochanteric fractures

Question 7

What is luxatio erecta ?

Accepted Answer

Inferior shoulder dislocation

Answer

Anterior shoulder dislocation

Answer

Posterior hip dislocation

Answer

Anterior hip dislocation

Question 8

Most common complication of intertrochanteric fracture femur is:

Accepted Answer

Malunion

Answer

Nerve injury

Answer

Osteoarthritis

Answer

Non-union

Question 9

Which fracture results in the 'cubitus varus' deformity?

Accepted Answer

Supracondylar fracture of humerus

Answer

Olecranon fracture

Answer

Lateral condylar fracture

Answer

Radial head fracture

Question 10

Patient with shoulder dislocation has axillary nerve injury. Which movement will be most affected?

Accepted Answer

Shoulder Abduction

Answer

Forward Flexion

Answer

Internal Rotation

Answer

External Rotation

Trauma — MCQs

Trauma — MCQs

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