Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1031: 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 1032: 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 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: 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 1035: The Kocher maneuver is primarily indicated for which of the following conditions?

A. Shoulder reduction (Correct Answer)
B. Elbow reduction
C. Ankle dislocation
D. Knee dislocation

Explanation: ***Shoulder reduction*** - The **Kocher maneuver** is a classic technique used to reduce an anterior shoulder dislocation. - It involves a specific sequence of **external rotation, adduction, and internal rotation** of the arm. *Elbow reduction* - Elbow dislocations are typically reduced using **traction-countertraction** techniques, not the Kocher maneuver. - These methods focus on overcoming muscle spasm and restoring the alignment of the **ulna and radius** with the humerus. *Ankle dislocation* - Ankle dislocations usually require **traction and direct manipulation** to realign the talus within the ankle mortise. - These reductions often address associated fractures or ligamentous injuries of the **tibiotalar joint**. *Knee dislocation* - Knee dislocations are serious injuries involving complete disruption of the **tibiofemoral joint**, and their reduction primarily involves **gentle longitudinal traction** and direct manipulation. - Prompt reduction is crucial due to the high risk of **neurovascular compromise**.

Question 1036: What condition is associated with the absence of femoral artery pulsation in the affected limb?

A. Fracture of the neck of femur
B. Legg-Calvé-Perthes disease
C. Posterior dislocation of the hip (Correct Answer)
D. None of the options

Explanation: ***Posterior dislocation of the hip*** - A **posterior hip dislocation** can compress or injure the **femoral artery** due to the displacement of the femoral head posteriorly, leading to a diminished or absent pulse. - This is a **medical emergency** as vascular compromise can lead to **ischemia and necrosis** of the affected limb. *Fracture of the neck of femur* - While a **femoral neck fracture** can cause significant pain and may sometimes be associated with a compromised blood supply to the femoral head, it typically does not directly compress or injure the **femoral artery** itself. - The main vascular concern with femoral neck fractures is often the **avascular necrosis** of the femoral head due to disruption of its nutrient arteries. *Legg-Calvé-Perthes disease* - This condition involves **avascular necrosis of the femoral head** in children, primarily affecting the blood supply to the epiphysis, not the main femoral artery. - Though it affects hip vascularity, it does not typically manifest with an **absent femoral pulse**. *None of the options* - This option is incorrect because a **posterior dislocation of the hip** is a recognized cause of compromised femoral artery pulsation.

Question 1037: Chauffeur fracture is -

A. Intra-articular fracture of the radial styloid process (Correct Answer)
B. Intra-articular fracture of the base of the 1st metacarpal
C. Extra-articular fracture of the base of the 1st metacarpal
D. Extra-articular fracture of the styloid process

Explanation: ***Intra-articular fracture of the radial styloid process*** - A **chauffeur fracture**, also known as a **Hutchinson fracture**, is an **intra-articular fracture** of the distal radius involving the radial styloid process. - This fracture often results from a **direct impact** or **compressive force** on the wrist, historically seen in individuals cranking early automobiles. *Intra-articular fracture of the base of the 1st metacarpal* - This description refers to a **Bennett's fracture**, which is a **two-part intra-articular fracture** of the base of the first metacarpal. - It is typically caused by **axial force** directed along the metacarpal, often from a punch, rather than a wrist-level injury. *Extra-articular fracture of the base of the 1st metacarpal* - An **extra-articular fracture** of the base of the 1st metacarpal is known as a **Rolando fracture** if comminuted, or a simpler extra-articular fracture. - These fractures do not involve the joint surface, distinguishing them from intra-articular fractures. *Extra-articular fracture of the styloid process* - While it involves the styloid process, an **extra-articular fracture of the styloid process** would imply a fracture not extending into the joint space. - A Chauffeur's fracture specifically involves the **articular surface** of the radial styloid, making this option incorrect.

Question 1038: Dunlop traction is a type of traction used in the management of?

A. Fracture of the humerus (Correct Answer)
B. Fracture of the radius
C. Fracture of the femur
D. Fracture of the tibia

Explanation: ***Fracture of the humerus*** - **Dunlop traction** is specifically designed for the management of **supracondylar fractures** of the humerus in children. - It involves traction applied to the arm, often in conjunction with skin or skeletal traction to maintain reduction and alignment. *Fracture of the radius* - Fractures of the radius, particularly distal radius fractures, are typically managed with **closed reduction and casting** or **surgical fixation**, not Dunlop traction. - Traction methods for forearm fractures are less common and usually involve specialized techniques for specific fracture patterns. *Fracture of the femur* - Femur fractures, especially in children, are commonly managed with **Bryant's traction** or **femoral skeletal traction** in younger children, or surgical intervention. - Dunlop traction is not suitable due to the significant muscle mass and bone size of the femur requiring stronger, more robust traction. *Fracture of the tibia* - Tibia fractures are generally managed with **casting**, **external fixation**, or **intramedullary nailing**. - While traction can be used initially for severely displaced or open tibial fractures, it typically involves **skeletal traction** rather than Dunlop traction.

Question 1039: 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 1040: Functional cast bracing not used in fracture of ?

A. Humerus fracture
B. Tibia fracture
C. Ulna fracture
D. Thoracolumbar spine fracture (Correct Answer)

Explanation: ***Thoracolumbar spine fracture*** - **Functional cast bracing** is unsuitable for **thoracolumbar spine fractures** because it cannot adequately immobilize this segment of the spine due to the complex anatomy and motion involved. - These fractures often require rigid external immobilization or **surgical stabilization** to prevent neurological compromise and ensure proper healing. *Humerus fracture* - **Functional bracing** for **humerus fractures** allows for limited, controlled motion at the shoulder and elbow joints while supporting the fracture site. - This approach helps to prevent joint stiffness and promote **early rehabilitation**, which is beneficial for humeral healing. *Tibia fracture* - **Functional cast bracing** is often used for **tibia shaft fractures** to allow weight-bearing and controlled ankle and knee motion. - This helps to stimulate bone healing (Wolff's Law) and maintain muscle strength while providing adequate **fracture stability**. *Ulna fracture* - Depending on the specific type and location, **functional bracing** for **ulna fractures** can permit some wrist and elbow movement while stabilizing the fracture. - This method helps to preserve **range of motion** and facilitate earlier return to normal activities.

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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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