Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1031: 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 1032: What is the treatment for patient with hypertrophic nonunion with deformity at fracture site?

A. No treatment required
B. Bone grafting only
C. Fixation with possible bone grafting
D. Fixation with bone grafting (Correct Answer)

Explanation: ***Fixation with bone grafting*** - In a **hypertrophic nonunion**, there is biological activity and callus formation, indicating that the problem is primarily mechanical instability, which requires **fixation**. - Since a **deformity** is present, **bone grafting** may also be necessary to correct the alignment and fill any bone defects, thus providing additional structural support and osteogenic potential. *No treatment required* - A **hypertrophic nonunion** with **deformity** indicates a persistent problem that will not resolve spontaneously and requires intervention due to instability and malalignment. - Doing nothing would lead to continued pain, functional impairment, and potential long-term complications from the uncorrected deformity. *Fixation with possible bone grafting* - While fixation is crucial for hypertrophic nonunions, the presence of a **deformity** strongly suggests that bone grafting will likely be necessary, rather than just "possible," to address the morphological defect and promote union. - This option understates the probable need for grafting when a deformity is a key feature of the nonunion. *Bone grafting only* - **Bone grafting** alone does not address the fundamental issue of **mechanical instability** in a hypertrophic nonunion, which is characterized by adequate biological response but insufficient stability for healing. - Without stable **fixation**, the grafted bone would likely fail to incorporate, and the nonunion would persist or worsen.

Question 1033: What type of fracture is associated with seat belt injuries?

A. Tear drop fracture
B. Wedge fracture
C. Chance fracture (Correct Answer)
D. Whiplash injury

Explanation: ***Chance fracture*** - A **Chance fracture** is a **horizontal fracture** of a vertebral body, commonly occurring at the thoracolumbar junction (T12-L2) due to hyperflexion and distraction forces, characteristic of seat belt injuries. - The classic mechanism involves **flexion over a lap belt**, causing the anterior column to compress and the posterior and middle columns to experience tensile failure. *Tear drop fracture* - A **teardrop fracture** is typically caused by severe flexion and axial compression, resulting in a triangular fragment from the **anterior inferior corner of a vertebral body**. - While serious, they are often associated with **diving accidents** or severe hyperextension, rather than the specific mechanism of a seat belt injury. *Wedge fracture* - A **wedge fracture** is a type of compression fracture where the vertebral body collapses anteriorly, forming a wedge shape. - These are common in **osteoporosis** or high-energy axial compression, but the seat belt mechanism involves a more complex combination of flexion and distraction, leading to a Chance fracture. *Whiplash injury* - **Whiplash** refers to a soft tissue injury (ligaments, muscles, discs) in the neck caused by a rapid hyperextension-hyperflexion motion, commonly seen in **rear-end car collisions**. - It is primarily a **soft tissue injury** and not a bone fracture, although severe whiplash can sometimes be associated with minor fractures, this is not its primary definition or common association.

Question 1034: Most common complication of fracture of tibia

A. Infection
B. Compartment syndrome
C. Delayed union (Correct Answer)
D. Vascular injury

Explanation: ***Delayed union*** - The **tibia** has a relatively **poor blood supply** compared to other long bones, especially in its distal third, making it prone to delayed healing. - Delayed union is defined as a fracture that takes **longer than expected** to heal, but still has the potential to unite. *Infection* - While possible, especially with **open fractures**, infection is not the most common complication of all tibia fractures. - Infections can lead to **osteomyelitis**, but this specific complication is less frequent than delayed union. *Compartment syndrome* - This is a **serious complication** resulting from increased pressure within a closed fascial compartment, often of the lower leg. - While it is a significant risk with tibia fractures and requires immediate attention, it is **not the most common** complication overall. *Vascular injury* - Significant **vascular injury** is a rare but severe complication, particularly with high-energy trauma or displaced fractures. - Such injuries can lead to limb ischemia and require urgent surgical intervention, but occur **less frequently** than delayed union.

Question 1035: 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.

Question 1036: 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 1037: Management of displaced non comminuted intercondylar humerus fracture is?

A. Open reduction and internal fixation (Correct Answer)
B. Above elbow plaster cast application
C. Olecranon pin traction method
D. External fixation method

Explanation: ***Open reduction and internal fixation*** - **Displaced intra-articular fractures** of the humeral condyles, even if non-comminuted, require **anatomic reduction** and **stable fixation** to restore joint congruity and function. - ORIF allows direct visualization for accurate reduction and provides excellent stability, crucial for early range of motion and preventing long-term complications like **post-traumatic arthritis**. *Above elbow plaster cast application* - This method is typically reserved for **stable, non-displaced fractures** or as a temporary measure. - It would not achieve or maintain adequate reduction for a **displaced intra-articular fracture**, potentially leading to malunion, stiffness, and pain. *Olecranon pin traction method* - Traction methods are generally less precise for achieving **anatomic reduction** of complex articular fractures compared to ORIF. - While it can be used for some complex elbow fractures, its role in **displaced non-comminuted intercondylar fractures** is limited due to the need for precise articular alignment. *External fixation method* - External fixation is often used for **open fractures**, **severely comminuted fractures**, or when internal fixation is not feasible due to soft tissue compromise. - While it provides stability, it does not allow for the same level of **anatomic reduction** of the articular surface as ORIF for a displaced intercondylar fracture and can limit early motion.

Question 1038: Which of the following statements about Galeazzi fracture dislocation is incorrect?

A. Results from fall on outstretched hand
B. Fracture of distal third of radius and dislocation of DRUJ
C. Radius is angulated laterally and posteriorly
D. Ulna dislocates dorsally at DRUJ (Correct Answer)

Explanation: ***Ulna dislocates dorsally at DRUJ*** - This statement is incorrect because in a **Galeazzi fracture-dislocation**, the **ulna typically dislocates volarly (anteriorly)** relative to the radius at the **distal radio-ulnar joint (DRUJ)**. - The DRUJ dislocation is usually in a volar direction due to the force of injury. *Fracture of distal third of radius and dislocation of DRUJ* - This is a hallmark of a **Galeazzi fracture-dislocation**, explicitly defining the two main components of the injury. - The **distal third of the radius** is the most common site of fracture, coupled with the disruption of the DRUJ. *Radius is angulated laterally and posteriorly* - This describes the typical displacement pattern of the **radial fracture fragment** in a Galeazzi injury. - The angulation often results from the forces acting on the forearm during the injury, with the pronator quadratus pulling the distal fragment volarly and an abduction force causing lateral angulation. *Results from fall on outstretched hand* - This is the most common mechanism of injury for a **Galeazzi fracture-dislocation**, similar to many other forearm and wrist fractures. - The axial load and pronation forces generated during a fall on an **outstretched hand** contribute to the characteristic fracture and dislocation.

Question 1039: 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 1040: Most common complication of mid shaft humerus fracture is ?

A. Radial nerve palsy (Correct Answer)
B. Median nerve palsy
C. Nonunion
D. Malunion

Explanation: ***Radial nerve palsy*** - The **radial nerve** runs in close proximity to the **spiral groove** of the humerus, making it highly vulnerable to injury in mid-shaft fractures. - This results in the characteristic **wrist drop** and loss of sensation over the dorsal aspect of the hand. *Median nerve palsy* - The **median nerve** is not typically affected by mid-shaft humeral fractures as it is located more medially and anteriorly. - Injury to the median nerve is more common with supracondylar fractures of the humerus or carpal tunnel syndrome. *Nonunion* - While **nonunion** (failure of bone healing) occasionally occurs after mid-shaft humerus fractures, **radial nerve palsy** is a more immediate and frequent complication observed at the time of injury. - Risks for nonunion include severe trauma, soft tissue interposition, and inadequate immobilization. *Malunion* - **Malunion** (healing in an unacceptable alignment) can occur, especially with conservative management, but like nonunion, it is a complication of the healing process rather than an acute injury presentation. - Functional outcomes are generally good even with some degree of angulation in humeral shaft fractures.

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Principles of Fracture Management

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Upper Limb Fractures

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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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