Trauma Practice Questions

Q: Functional cast bracing not used in fracture of ?

Thoracolumbar spine fracture. ***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.

Q: Most common complication of mid shaft humerus fracture is ?

Radial nerve palsy. ***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.

Q: Which of the following factors does NOT indicate an unstable pelvis?

Avulsion fractures of the L5 transverse process. ***Avulsion fractures of the L5 transverse process*** - While significant, avulsion fractures of the **L5 transverse process** are generally considered indicative of a **high-energy trauma** and potential for associated injuries, but they do not directly represent **pelvic instability** in the same way as disruptions to the pelvic ring itself. - These fractures point to powerful shearing forces but don't disrupt the **structural integrity** of the pelvic ring that dictates its stability. *Posterior sacroiliac complex displacement by > 1 cm* - This degree of displacement signifies a substantial injury to the **strong posterior ligamentous structures** of the sacroiliac joint. - Such displacement indicates a highly unstable pelvic ring, often associated with significant hemorrhage and requiring surgical stabilization. *Avulsion fracture of sacral or ischial end of the sacrospinous ligament* - An avulsion fracture at either the sacral or ischial attachment of the **sacrospinous ligament** suggests a severe disruption of the posterior pelvic ring. - The **sacrospinous ligament** is a key stabilizer of the pelvis, and injury to it indicates pelvic instability due to the loss of its anchoring function between the sacrum and ischium. *Isolated disruption of pubic symphysis with pubic diastasis of 2 cm.* - A **pubic diastasis of 2 cm** signifies a significant opening of the pubic symphysis, which is a critical anterior component of the pelvic ring. - This indicates **anterior pelvic instability**, even in the absence of posterior injuries, as the normal interlocking mechanism of the symphysis is compromised.

Q: Garden's classification used for which fracture?

Neck of femur. ***Neck of femur*** - **Garden's classification** is a widely used system to categorize **femoral neck fractures** based on displacement. - This classification helps guide treatment decisions, as different grades of displacement have varying prognoses for **avascular necrosis** and **non-union**. *Fracture of the surgical neck of the humerus* - Fractures of the surgical neck of the humerus are typically classified using the **Neer classification system**. - The Neer classification is based on the number of displaced parts, such as the **humeral head**, **greater tuberosity**, **lesser tuberosity**, and **humeral shaft**. *Fracture of the shaft of the humerus* - Fractures of the humeral shaft are generally classified by their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., spiral, transverse, oblique, comminuted), and the presence of **open vs. closed injuries**. - There is no specific, widely recognized classification system comparable to Garden's used exclusively for these fractures. *Fracture of the shaft of the femur* - Fractures of the femoral shaft are commonly classified based on their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., transverse, oblique, spiral, comminuted), and the presence of **segmental or open fractures**. - The **Winquist and Hansen classification** is sometimes used for comminuted femoral shaft fractures, but Garden's classification is not applicable here.

Q: Thomas splint is used for immobilizing fractures of ?

Femur. ***Femur*** - The **Thomas splint** is primarily designed for the temporary immobilization and traction of **femoral shaft fractures**. - Its design allows for effective stabilization and helps reduce muscle spasms and pain associated with these types of fractures. *Tibia* - While it can be used in some lower limb injuries, the Thomas splint is not the primary or most effective device for isolated **tibial fractures**. - Other splints, such as a **long leg posterior splint** or an air splint, are typically preferred for tibial immobilization. *Radius* - The **radius** is a bone in the forearm, and its fractures are typically managed with a variety of **short arm casts** or splints. - The Thomas splint is specifically designed for the much longer and larger **femur** and would be completely unsuitable for a forearm injury. *Ulna* - Similar to the radius, the **ulna** is a forearm bone, and its fractures require immobilization techniques appropriate for the upper limb. - The **Thomas splint's bulk** and mechanism are inappropriate for the immobilization of forearm bones.

Q: Which part of scaphoid fracture is most susceptible to avascular necrosis?

Proximal 1/3rd. ***Proximal 1/3rd*** - The **scaphoid bone** has a **retrograde blood supply**, meaning blood vessels enter distally and flow towards the proximal pole. - A fracture in the **proximal 1/3rd** can disrupt the blood supply to the **proximal fragment**, making it highly susceptible to **avascular necrosis**. *Distal 1/3rd* - Fractures in the **distal 1/3rd** of the scaphoid generally have a robust blood supply due to the entry of vessels from the distal pole. - While still requiring proper management, the risk of **avascular necrosis** is significantly lower compared to proximal fractures. *Middle 1/3rd* - Fractures in the **middle 1/3rd** (waist) of the scaphoid are common and can still compromise blood flow to the proximal segment, but the risk of **avascular necrosis** is intermediate. - The more proximal the fracture within the middle third, the higher the risk of **avascular necrosis**. *Scaphoid Tubercle* - The **scaphoid tubercle** is a distal projection of the scaphoid bone. - Fractures of the **scaphoid tubercle** are extra-articular and typically have an excellent blood supply; thus, they are at very low risk for **avascular necrosis**.

Q: As an intern in the emergency department, you encounter four patients with different types of fractures. Which patient should you prioritize for orthopedic consultation based on the severity of their condition?

Patient's finger shows signs of severe vascular compromise.. ***Patient's finger shows signs of severe vascular compromise*** - **Vascular compromise** is an orthopedic emergency as it can lead to **tissue ischemia**, necrosis, and permanent loss of function if not addressed immediately. - Urgent consultation is needed to restore **blood flow** and prevent irreversible damage to the limb. *Patient can't extend his arm* - This symptom suggests a potential **nerve injury** (e.g., radial nerve) or **tendon rupture**, which requires prompt evaluation but is generally less immediately life-threatening than vascular compromise. - While important, **nerve injuries** typically do not require the same emergent intervention as severe vascular compromise unless there's a rapidly deteriorating neurological deficit. *Intra articular fracture of Elbow Joint* - **Intra-articular fractures** involve the joint space and can lead to long-term complications like **arthrosis** and stiffness if not managed properly, often requiring surgical fixation. - Although significant, it is not as urgent as vascular compromise, which can lead to rapid **tissue death**. *Simple closed fracture of the radius with good distal circulation* - A **simple closed fracture** with **good distal circulation** is a stable injury that is typically managed non-surgically or with elective surgical intervention. - This type of fracture does not present an immediate threat to limb viability.

Q: Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Distal radius. ***Distal radius*** - The **distal radius** is the bone most frequently fractured when a person falls on an **outstretched hand**. This is commonly known as a **Colles fracture** if the fragment is displaced dorsally. - The force of impact is transmitted directly to the distal end of the radius, making it susceptible to fracture, especially in cases of **osteoporosis**. *Scaphoid* - The **scaphoid** bone is also commonly fractured with a fall on an outstretched hand, but it is less frequent than the distal radius. - A scaphoid fracture is concerning due to its **precarious blood supply**, which can lead to **avascular necrosis** and non-union. *Lunate* - The **lunate** bone is centrally located in the wrist and is less commonly fractured but can be dislocated or injured in high-impact trauma. - Injuries to the lunate are often associated with **perilunate dislocations**, which are severe wrist injuries. *Capitate* - The **capitate** is the largest carpal bone, located in the center of the wrist, and is rarely fractured in isolation from a fall on an outstretched hand. - Fractures of the capitate are often associated with more extensive carpal injuries due to its robust nature and central, protected position.

Question 1

Functional cast bracing not used in fracture of ?

Accepted Answer

Thoracolumbar spine fracture

Answer

Humerus fracture

Answer

Tibia fracture

Answer

Ulna fracture

Question 2

Most common complication of mid shaft humerus fracture is ?

Accepted Answer

Radial nerve palsy

Answer

Median nerve palsy

Answer

Nonunion

Answer

Malunion

Question 3

Which of the following factors does NOT indicate an unstable pelvis?

Accepted Answer

Avulsion fractures of the L5 transverse process

Answer

Posterior sacroiliac complex displacement by > 1 cm

Answer

Avulsion fracture of sacral or ischial end of the sacrospinous ligament

Answer

Isolated disruption of pubic symphysis with pubic diastasis of 2 cm.

Question 4

Garden's classification used for which fracture?

Accepted Answer

Neck of femur

Answer

Fracture of the surgical neck of the humerus

Answer

Fracture of the shaft of the humerus

Answer

Fracture of the shaft of the femur

Question 5

Thomas splint is used for immobilizing fractures of ?

Accepted Answer

Femur

Answer

Tibia

Answer

Radius

Answer

Ulna

Question 6

Which part of scaphoid fracture is most susceptible to avascular necrosis?

Accepted Answer

Proximal 1/3rd

Answer

Distal 1/3rd

Answer

Middle 1/3rd

Answer

Scaphoid Tubercle

Question 7

An RTA patient presented to the emergency department with severe pain in the ankle. An X-ray was performed, given below. What is the best next step in management?

Accepted Answer

Neurovascular Assessment and Closed reduction with slab application

Answer

Neurovascular Assessment and Closed reduction with cast application

Answer

Neurovascular Assessment and Immediate surgery

Answer

Neurovascular Assessment and Immediate open reduction

Question 8

As an intern in the emergency department, you encounter four patients with different types of fractures. Which patient should you prioritize for orthopedic consultation based on the severity of their condition?

Accepted Answer

Patient's finger shows signs of severe vascular compromise.

Answer

Patient can't extend his arm

Answer

Intra articular fracture of Elbow Joint

Answer

Simple closed fracture of the radius with good distal circulation

Question 9

Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Accepted Answer

Distal radius

Answer

Scaphoid

Answer

Lunate

Answer

Capitate

Question 10

What is meant by perilunate dislocations?

Accepted Answer

Lower radius, scaphoid, and lunate in alignment; capitate alone is out of plane.

Answer

Lower radius, scaphoid, and capitate in alignment; lunate alone out of plane.

Answer

Both lunate and capitate are out of plane.

Answer

Lower radius, scaphoid, lunate, and capitate all in the same plane.

Trauma — MCQs

Trauma — MCQs

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