Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1021: A clinician is assessing a patient for damage to the axillary nerve following a shoulder dislocation. Which clinical test should be performed to evaluate the integrity of this nerve?

A. Elbow flexion test
B. Shoulder abduction test (Correct Answer)
C. Wrist extension test
D. Finger adduction test

Explanation: ***Shoulder abduction test*** - The **axillary nerve** innervates the **deltoid muscle**, which is the primary muscle responsible for **shoulder abduction**. - Testing the patient's ability to abduct their shoulder against resistance directly assesses the motor function of the axillary nerve. *Elbow flexion test* - This test primarily evaluates the function of the **musculocutaneous nerve**, which innervates the **biceps brachii** and **brachialis muscles**. - It is not directly relevant to assessing the integrity of the axillary nerve. *Wrist extension test* - This test primarily assesses the function of the **radial nerve**, which innervates the extensors of the wrist and fingers. - Damage to the axillary nerve would not typically affect wrist extension. *Finger adduction test* - This test primarily evaluates the function of the **ulnar nerve**, which innervates the intrinsic muscles of the hand responsible for finger adduction. - This test is unrelated to the axillary nerve's distribution or function.

Question 1022: Which clinical test is used to assess the integrity of the radial nerve following a mid-shaft humerus fracture?

A. Wrist drop test (Correct Answer)
B. Tinel's sign
C. Phalen's maneuver
D. Froment's sign

Explanation: ***Wrist drop test*** - The **radial nerve** innervates the muscles responsible for **wrist extension** and **finger extension**. - Damage to the radial nerve (e.g., from a mid-shaft humeral fracture) can result in an inability to extend the wrist and fingers, known as **wrist drop**. *Tinel's sign* - This test assesses for **nerve irritation or compression** by percussing over the nerve, often used for **carpal tunnel syndrome** or **cubital tunnel syndrome**. - It checks for tingling or pain, not functional integrity of the radial nerve. *Phalen's maneuver* - This test is used to diagnose **carpal tunnel syndrome**, which involves compression of the **median nerve**. - It involves holding the wrists in maximal flexion to provoke symptoms, unrelated to radial nerve integrity. *Froment's sign* - This test assesses the integrity of the **ulnar nerve**, specifically the **adductor pollicis muscle**. - It involves asking the patient to hold a piece of paper between their thumb and index finger.

Question 1023: Which technique involves realigning bone fragments through external manipulation without surgical intervention?

A. Open reduction
B. External fixation
C. Internal fixation
D. Closed reduction (Correct Answer)

Explanation: ***Closed reduction*** - This technique involves **realigning fractured bone fragments** through **external manipulation** of the limb, without the need for an incision or direct visualization of the bone. - It is typically performed under **anesthesia** to relax muscles and minimize pain, allowing the surgeon to maneuver the bone ends into proper alignment. *Open reduction* - This method requires a **surgical incision** to directly visualize the fractured bone fragments and reduce them by hand or with surgical instruments. - It is generally reserved for fractures that cannot be adequately reduced by closed methods, or for those requiring **internal fixation**. *External fixation* - This technique uses **pins or wires inserted into the bone** through the skin, which are then connected to an external frame to stabilize the fracture. - While it involves external apparatus, its primary purpose is **stabilization**, not the initial realignment of bone fragments through manipulation. *Internal fixation* - This involves the surgical implantation of **plates, screws, rods, or wires** directly onto or within the bone fragments to stabilize them after reduction. - It is a method of **stabilizing** the fracture after reduction, which can be achieved through either open or closed techniques, rather than a reduction technique itself.

Question 1024: What is the most common complication of a posterior shoulder dislocation?

A. Bankart lesion
B. Rotator cuff tear
C. Fracture of the scapula
D. Reverse Hill-Sachs lesion (Correct Answer)

Explanation: ***Reverse Hill-Sachs lesion*** - A **reverse Hill-Sachs lesion** (also known as a **McLaughlin lesion**) is an impaction fracture on the anterior aspect of the humeral head, occurring when the humeral head strikes the posterior glenoid rim during a posterior dislocation. - It is the most common bony complication of a posterior shoulder dislocation due to the direct impact of the humeral head against the glenoid. *Bankart lesion* - A **Bankart lesion** is an injury to the anterior inferior glenoid labrum, often with an associated bony fragment, and is characteristic of **anterior shoulder dislocations**. - It results from the humeral head being forced anteriorly, tearing the labrum and capsule from the anterior glenoid, which is not the mechanism in posterior dislocations. *Rotator cuff tear* - While rotator cuff tears can occur with any shoulder dislocation, they are more commonly associated with **anterior dislocations**, especially in older patients. - They are also often seen with chronic instability or significant trauma, but a specific lesion like a reverse Hill-Sachs is more pathognomonic for a posterior dislocation. *Fracture of the scapula* - A **scapular fracture** is relatively uncommon with isolated shoulder dislocations and typically requires a significant, direct high-energy trauma. - Such fractures are less directly caused by the dislocation mechanism itself, compared to the impaction injury that creates a reverse Hill-Sachs lesion.

Question 1025: In a pelvic fracture, which nerve is most at risk of injury due to its location within the pelvis?

A. Sciatic nerve (Correct Answer)
B. Femoral nerve
C. Obturator nerve
D. Pudendal nerve

Explanation: ***Sciatic nerve*** - The **sciatic nerve** is formed by nerve roots from L4-S3 and exits the pelvis through the **greater sciatic foramen**, making it vulnerable to injury from pelvic fractures, especially those involving the **posterior pelvis** or **sacrum**. - Its large size and proximity to various pelvic structures increase the likelihood of compression or direct trauma during significant pelvic trauma. *Femoral nerve* - The **femoral nerve** originates from L2-L4 and courses through the **psoas major muscle** and then under the inguinal ligament, making it less directly exposed to typical sites of fracture in the deep pelvis. - While it can be injured in high-energy trauma, it is not typically the most vulnerable compared to the sciatic nerve in general pelvic fractures. *Obturator nerve* - The **obturator nerve** (L2-L4) passes through the **obturator canal** to supply the medial thigh muscles, which provides some protection from direct impact compared to nerves within the open pelvic cavity. - Injuries to the obturator nerve are usually associated with specific types of fractures involving the superior pubic rami or anterior pelvic region, rather than being the most commonly injured in all pelvic fractures. *Pudendal nerve* - The **pudendal nerve** (S2-S4) exits the pelvis through the greater sciatic foramen, hooks around the ischial spine, and re-enters through the lesser sciatic foramen to supply the perineum. - While it is located within the pelvis, its deep and somewhat protected course reduces its likelihood of direct trauma from typical pelvic fractures, compared to the more exposed sciatic nerve near major fracture lines.

Question 1026: Palpable femur head on per rectal exam is a feature of which of the following conditions?

A. Posterior hip dislocation (Correct Answer)
B. Anterior hip dislocation
C. Central hip dislocation
D. Inferior hip dislocation

Explanation: ***Posterior hip dislocation*** - In **posterior hip dislocation**, the femoral head is displaced posteriorly, often coming to rest on the **ischium**. - This posterior displacement can make the **femoral head palpable** through the rectum, particularly in thin individuals. *Anterior hip dislocation* - Involves the femoral head displacing **anteriorly**, usually into the **obturator foramen** or onto the **pubis**. - The femoral head would be palpable in the **groin region**, not rectally. *Central hip dislocation* - Occurs when the femoral head is driven **centrally** through the **acetabulum** into the pelvis. - While it involves intrapelvic displacement, the femoral head is typically covered by pelvic bone and not directly palpable per rectally. *Inferior hip dislocation* - This is a rare form of dislocation where the femoral head is forced **inferiorly** from the acetabulum. - The femoral head would typically be palpable in the **perineal region**, not through the rectum.

Question 1027: What is the management for the most dangerous type of odontoid fracture according to the Anderson and D'Alonzo classification?

A. Type I - immobilization in rigid collar
B. Type II - screw fixation (Correct Answer)
C. Type III - immobilization in rigid collar
D. Type III - halo vest immobilization

Explanation: **Type II - screw fixation** - **Type II odontoid fractures** are considered the most dangerous due to their location at the base of the dens, which has a **poor blood supply**, leading to a high rate of non-union. - **Screw fixation** (anterior odontoid screw fixation) is often preferred for Type II fractures to achieve stable internal fixation and promote healing. *Type I - immobilization in rigid collar* - **Type I odontoid fractures** are stable fractures of the tip of the dens, usually managed with a **rigid cervical collar** due to their excellent prognosis and low risk of instability. - This type does not represent the most dangerous category and typically heals well with conservative management. *Type III - halo vest immobilization* - **Type III odontoid fractures** involve the body of the axis and are generally more stable than Type II fractures due to a larger cancellous bone surface for healing. - While a **halo-vest immobilization** can be used, Type III fractures often have good healing potential and are not considered the most dangerous type. *Type III - immobilization in rigid collar* - Although some stable Type III fractures might be managed with rigid collar, it's not the primary or universal treatment, and this type is not the most dangerous. - More unstable Type III fractures might require **halo-vest immobilization** or surgical intervention, but the inherent instability and non-union risk of Type II make it the most critical.

Question 1028: Cubitus valgus develops as a complication of which type of fracture?

A. Smiths fracture
B. Malgaigne fracture
C. Saddle fracture
D. Supracondylar fracture of humerus (Correct Answer)

Explanation: ***Supracondylar fracture of humerus*** - **Cubitus valgus** is a common late complication of a **supracondylar fracture of the humerus**, especially if not properly reduced or fixed. - This deformity results from growth disturbance, malunion, or physeal damage at the **distal humerus**, leading to an increased carrying angle of the elbow. *Smith's fracture* - A **Smith's fracture** is a fracture of the **distal radius** with volar displacement of the distal fragment. - This fracture primarily affects the wrist and does not lead to cubitus valgus deformity, which is an elbow pathology. *Malgaigne fracture* - A **Malgaigne fracture** is an unstable pelvic fracture involving vertical shear forces affecting both anterior and posterior pelvic rings. - This fracture is located in the pelvis and has no anatomical or biomechanical connection to the elbow joint or the development of cubitus valgus. *Saddle fracture* - The term **saddle fracture** is not a standard or recognized orthopedic classification for a specific bone fracture. - This term does not correspond to a known fracture pattern that would lead to cubitus valgus.

Question 1029: A patient presents with wrist trauma and is diagnosed with a wrist sprain. Clinical examination reveals tenderness in the anatomical snuffbox, but imaging shows no evidence of fracture. In this clinical scenario, which ligament is most likely to be involved?

A. Scapholunate ligament (Correct Answer)
B. Radial collateral ligament
C. Lunotriquetral ligament
D. Ulnar collateral ligament

Explanation: ***Scapholunate ligament*** - Tenderness in the **anatomical snuffbox** despite negative imaging for scaphoid fracture strongly suggests a **scapholunate ligament injury**. - This ligament is crucial for maintaining **carpal stability**, and its injury can lead to **DISI (dorsal intercalated segmental instability)** if not managed appropriately. *Radial collateral ligament* - Injury to the radial collateral ligament typically presents with pain and tenderness on the **radial aspect of the wrist**, but not specifically localized to the **anatomical snuffbox**. - This ligament primarily resists **ulnar deviation** and contributes to wrist stability. *Lunotriquetral ligament* - A lunotriquetral ligament injury usually manifests as pain on the **ulnar side of the wrist**, often associated with a clunking sensation, distinct from **anatomical snuffbox tenderness**. - Its disruption can lead to **VISI (volar intercalated segmental instability)**. *Ulnar collateral ligament* - Injury to the ulnar collateral ligament causes pain and tenderness on the **ulnar aspect of the wrist**, particularly with **radial deviation**. - This ligament plays a key role in stabilizing the **distal radioulnar joint (DRUJ)** and resisting radial deviation.

Question 1030: The most common complication of intracapsular fracture neck of femur is

A. Mal union
B. Osteoarthritis
C. Non-Union (Correct Answer)
D. Shortening

Explanation: ***Non-Union*** - **Intracapsular fractures** of the femoral neck often disrupt the blood supply to the femoral head, increasing the risk of **avascular necrosis** and impaired healing. - Due to the limited blood supply and mechanical forces, the bone fragments may fail to unite, leading to **non-union**. *Mal union* - **Malunion** implies that the fracture has healed but in an anatomically incorrect or deformed position. - While it can occur, **non-union** is a more prevalent and severe complication in intracapsular femoral neck fractures due to the specific anatomical challenges. *Osteoarthritis* - **Osteoarthritis** can develop as a long-term complication if the fracture heals with altered joint mechanics or secondary to avascular necrosis. - However, it is a delayed consequence, whereas **non-union** is an early and direct failure of the healing process. *Shortening* - **Shortening** of the limb can occur due to fracture displacement or subsequent collapse, especially if the fracture is unstable or undergoes malunion. - It is a symptom or consequence that can be associated with failed healing or non-union, but **non-union** itself is the primary failure of bone repair.

Practice by Chapter

Principles of Fracture Management

Practice Questions

Upper Limb Fractures

Practice Questions

Lower Limb Fractures

Practice Questions

Spinal Trauma

Practice Questions

Pelvic and Acetabular Fractures

Practice Questions

Open Fractures

Practice Questions

Fractures in Children

Practice Questions

Fracture Complications

Practice Questions

Nonunion and Malunion

Practice Questions

Polytrauma Management

Practice Questions

Joint Dislocations

Practice Questions

Soft Tissue Injuries

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?