Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1061: What is the generally recommended maximum weight for skeletal traction in adult patients?

A. 5 kg
B. 10 kg
C. 20 kg
D. 15 kg (Correct Answer)

Explanation: ***15 kg*** - While the specific weight can vary based on the bone and patient, 10-15 kg is generally the **maximum recommended weight for skeletal traction** in adults to avoid complications. - Applying too much weight risks **damage to the bone, soft tissues, and nerves**, as well as potential pin site infections and neurovascular compromise. *5 kg* - This weight is typically more appropriate for **skin traction**, where the pulling force is applied externally to the skin, limiting the amount of weight that can be safely used without causing skin damage. - In skeletal traction, 5 kg is often used for **initial alignment or very tenuous fractures**, but it is generally insufficient for significant reduction or long-term stabilization. *10 kg* - 10 kg is a common starting point or moderate weight used in skeletal traction, particularly for **femur or tibia fractures**. - While often effective, it is not consistently the maximum safe weight, as some situations may allow or require slightly more weight up to 15 kg for optimal reduction. *20 kg* - Applying 20 kg of weight in skeletal traction is generally considered **excessive and dangerous** in most adult applications. - This high amount of weight significantly increases the risk of **pin loosening, osteomyelitis, neurovascular injury, and avascular necrosis**, especially in areas like the cervical spine or tibia.

Question 1062: Most common nerve injured in fracture of medial epicondyle of humerus is:

A. Radial nerve
B. Ulnar nerve (Correct Answer)
C. Median nerve
D. Musculocutaneous nerve

Explanation: ***Ulnar nerve*** - The **ulnar nerve** runs directly behind the **medial epicondyle** of the humerus in a groove called the **cubital tunnel**, making it highly vulnerable to injury during fractures of this bony prominence. - Injury to the ulnar nerve at this location can cause symptoms like **numbness and tingling** in the **little finger and half of the ring finger**, **weakness in certain hand muscles**, and eventually a **"claw hand" deformity**. *Radial nerve* - The **radial nerve** courses along the posterior aspect of the humerus in the **spiral groove** and is more commonly injured with **mid-shaft humeral fractures**. - Injury typically results in **wrist drop** and **sensory loss over the dorsum of the hand**. *Median nerve* - The **median nerve** travels more anteriorly in the arm and forearm and is most commonly injured with **supracondylar fractures of the humerus** or **carpal tunnel syndrome** at the wrist. - Damage leads to **ape hand deformity** and sensory deficits over the **thumb, index, middle, and radial half of the ring finger**. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles and provides sensation to the lateral forearm; it is **less commonly injured in elbow fractures**. - Injury would primarily affect **elbow flexion** and **sensation over the lateral forearm**, which is not the typical presentation for medial epicondyle fractures.

Question 1063: What is a late complication of elbow dislocation?

A. Median nerve injury
B. Brachial artery injury
C. Myositis ossificans (Correct Answer)
D. None of the options

Explanation: **Myositis ossificans** - **Myositis ossificans** is the abnormal formation of **heterotopic bone** within muscle or other soft tissues, often developing weeks to months after joint trauma such as an elbow dislocation. - It typically presents as a painful, firm mass with restricted joint movement, especially **flexion** and **extension** at the elbow. *Median nerve injury* - **Median nerve injury** can occur at the time of the initial elbow dislocation (an **acute complication**), but it is not typically considered a late complication that develops over weeks or months. - Symptoms include numbness in the thumb, index, and middle fingers, as well as weakness in **thumb opposition** and **flexion** of the index finger. *Brachial artery injury* - **Brachial artery injury** is an **acute complication** of severe elbow dislocation, leading to compromise of distal blood flow. - Signs include absence of pulses, pallor, paresthesia, and pain in the forearm and hand, requiring immediate surgical intervention. *None of the options* - This option is incorrect because **myositis ossificans** is a well-recognized late complication of elbow dislocation.

Question 1064: Which of the following best describes a hinge fracture?

A. A fracture involving the petrous bone
B. A type of basilar fracture (Correct Answer)
C. A fracture involving the foramen magnum
D. A fracture involving the occipital condyles

Explanation: ***A type of basilar fracture*** - A **hinge fracture** is a specific type of **basilar skull fracture** that typically runs transversely across the floor of the middle cranial fossa. - This fracture often extends through structures like the **sella turcica** and **petrous ridge**, causing significant cerebrospinal fluid (CSF) leakage and cranial nerve palsies due to the tearing of the dura mater. *A fracture involving the petrous bone* - While a hinge fracture can involve the **petrous bone**, this description is too broad, as many types of trauma can affect the petrous bone without constituting a hinge fracture. - The key characteristic of a hinge fracture is its transverse course across the cranial base, not just involvement of a single bone. *A fracture involving the foramen magnum* - Fractures involving the **foramen magnum** are typically considered **occipital condyle fractures** or fractures of the clivus, distinct from the transverse course of a hinge fracture. - These fractures often have different clinical presentations, such as lower cranial nerve deficits or atlanto-occipital dislocation. *A fracture involving the occipital condyles* - **Occipital condyle fractures** are isolated injuries affecting the articulation between the skull and the cervical spine. - They are localized to the posterior cranial fossa and do not describe the characteristic transverse, widespread pattern across the middle cranial fossa seen in a hinge fracture.

Question 1065: What is the characteristic feature of Barton's fracture?

A. Extra-articular fracture of the distal end radius
B. Intra-articular fracture of the distal end radius without carpal bone subluxation
C. Intra-articular fracture of the distal end radius with carpal bone subluxation
D. Intra-articular fracture of the distal end radius with carpal bone subluxation and joint involvement (Correct Answer)

Explanation: ***Intra-articular fracture of the distal end radius with carpal bone subluxation and joint involvement*** - A **Barton's fracture** is defined as an **intra-articular fracture** of the distal radius involving the dorsal or volar rim, accompanied by **subluxation of the carpus**. - The displacement of the **carpal bones** relative to the fractured radius is a hallmark of this injury, necessitating careful reduction for optimal outcome. *Extra-articular fracture of the distal end radius* - An **extra-articular fracture** means the fracture line does not extend into the joint space, which is not characteristic of a Barton's fracture. - Examples of extra-articular distal radius fractures include some types of **Colles' fractures** or **Smith's fractures** without joint involvement. *Intra-articular fracture of the distal end radius without carpal bone subluxation* - While a Barton's fracture is intra-articular, the crucial distinguishing feature is the accompanying **carpal subluxation**. - An **intra-articular fracture** without carpal subluxation would be classified differently, such as a **Chauffeur's fracture** or certain types of **die-punch fractures**. *Intra-articular fracture of the distal end radius with carpal bone subluxation* - This option is partially correct but less complete than the best answer, as it implies joint involvement by definition but doesn't explicitly state it. - The combination of **intra-articular involvement** and **carpal subluxation** explicitly defines a Barton's fracture, whether dorsal or volar.

Question 1066: What is the Essex-Lopresti lesion in the upper limb?

A. Isolated radial head fracture without soft tissue involvement
B. Radial shaft
C. Comminuted radial head fracture with interosseous membrane disruption and DRUJ instability (Correct Answer)
D. Radial shaft and radio-ulnar joint fracture

Explanation: ***Comminuted radial head fracture with interosseous membrane disruption and DRUJ instability*** - The Essex-Lopresti lesion is a severe injury characterized by a **comminuted radial head fracture**, **disruption of the interosseous membrane** (IOM), and eventual **distal radioulnar joint (DRUJ) instability**. - This complex injury can lead to significant **forearm instability**, pain, and loss of function due to the disruption of the forearm's longitudinal stability. *Isolated radial head fracture without soft tissue involvement* - This describes a less severe injury, typically classified as a **Mason type I or II radial head fracture**, where the soft tissue structures like the interosseous membrane and DRUJ are intact. - An isolated radial head fracture lacks the characteristic **longitudinal instability** of the Essex-Lopresti lesion, which is critical for its diagnosis. *Radial shaft* - A radial shaft fracture involves the **diaphysis of the radius** and is a different type of injury that does not inherently include a radial head fracture or interosseous membrane disruption as seen in Essex-Lopresti. - While a radial shaft fracture can occur, it's typically a **more localized injury** to the shaft itself and does not define the systemic instability of an Essex-Lopresti lesion. *Radial shaft and radio-ulnar joint fracture* - This description is vague and does not specifically capture the key components of an Essex-Lopresti injury which include the **radial head fracture**, **interosseous membrane disruption**, and resultant **DRUJ instability**. - A fracture of the radio-ulnar joint could refer to several different types of injuries but without mentioning the comminuted radial head fracture and interosseous membrane disruption, it misses the precise definition of an Essex-Lopresti lesion.

Question 1067: Garden spade deformity is seen in ?

A. Smith's fracture (Correct Answer)
B. Colle’s fracture
C. Bennett’s fracture
D. Barton’s fracture

Explanation: ***Smith's fracture*** - This fracture involves **volar displacement** of the distal radial fragment, causing the characteristic **garden spade deformity** or **reverse Colles' fracture**. - It typically results from a fall onto a **flexed wrist** or a direct blow to the back of the wrist. *Colle’s fracture* - This fracture is characterized by **dorsal displacement** of the distal radial fragment, leading to a **dinner fork deformity**. - It usually occurs from a fall onto an **extended wrist**. *Bennett’s fracture* - This is an **intra-articular fracture** of the base of the **first metacarpal bone**, involving the carpometacarpal joint. - It is often caused by axial loading on a partially flexed thumb. *Barton’s fracture* - This is an **intra-articular fracture** of the distal radius involving either the **dorsal or volar rim**. - It is essentially a **shear fracture** with associated carpal displacement.

Question 1068: Which of the following is NOT a complication of elbow dislocation?

A. Vascular injury
B. Median nerve injury
C. Myositis ossificans
D. Radial nerve injury (Correct Answer)

Explanation: ***Radial nerve injury*** - The **radial nerve** is rarely injured in an elbow dislocation due to its anatomical course, which is less exposed to the shearing forces involved in this type of injury. - While other nerves like the ulnar and median nerves are more susceptible, significant stretching or compression of the radial nerve is **uncommon** in typical elbow dislocations. *Vascular injury* - The **brachial artery** runs in close proximity to the elbow joint and can be torn or compressed during a dislocation, leading to **ischemia** if not promptly recognized and treated. - This complication can result in **Volkmann's ischemic contracture** if perfusion is not restored. *Median nerve injury* - The **median nerve** passes anterior to the elbow joint and is vulnerable to injury from stretching or direct compression during dislocation. - Injury can manifest as **sensory deficits** in the distribution of the median nerve and **weakness** of forearm pronation and thumb flexion/opposition. *Myositis ossificans* - This is a common chronic complication of elbow dislocations, particularly in cases of **delayed reduction** or aggressive physical therapy. - It involves the **abnormal ossification** of soft tissues around the joint, commonly in the brachialis muscle, leading to **pain and restricted range of motion**.

Question 1069: Which type of supracondylar fracture of the femur is classified as extra-articular?

A. Type B
B. Type C
C. Type A (Correct Answer)
D. Type D

Explanation: ***Type A*** - **Type A supracondylar fractures** are defined as those that do not involve the joint surface, making them **extra-articular**. - These fractures typically occur proximal to the condyles without extending into the knee articulation. *Type B* - **Type B supracondylar fractures** are considered **partial articular**, meaning they involve only a portion of the articular surface. - While they affect the joint, they are not completely intra-articular in nature. *Type C* - **Type C supracondylar fractures** are classified as **complete articular** fractures. - This type implies that the fracture line extends through the entire joint surface and separates the articular segment from the metaphysis. *Type D* - The classification of supracondylar femoral fractures generally uses A, B, and C types to denote extra-articular, partial articular, and complete articular involvement, respectively. - **Type D** is not a standard classification used to define an extra-articular supracondylar femoral fracture in common orthopedic systems like the Orthopaedic Trauma Association (OTA) classification.

Question 1070: Which of the following statements is true regarding the proximal fragment in a supratrochanteric fracture?

A. The proximal fragment is flexed.
B. The proximal fragment is abducted.
C. The proximal fragment is externally rotated.
D. The proximal fragment exhibits flexion, abduction, and external rotation. (Correct Answer)

Explanation: ***The proximal fragment exhibits flexion, abduction, and external rotation.*** - In a supratrochanteric fracture, the proximal fragment of the femur is influenced by the strong muscles attached to it, leading to a characteristic deformity. - The **iliopsoas muscle** causes **flexion**, the **gluteus medius and minimus** cause **abduction**, and the **short external rotators** (like the obturators and gemelli) cause **external rotation**. *The proximal fragment is flexed.* - While the proximal fragment is indeed flexed due to the pull of the **iliopsoas muscle**, this statement is incomplete as it doesn't account for the other characteristic displacements. - Flexion alone does not fully describe the complex muscular forces acting on the proximal fragment in this type of fracture. *The proximal fragment is abducted.* - The proximal fragment is abducted due to the pull of the **gluteus medius and minimus** muscles, but this is only one component of the overall displacement. - Abduction alone does not represent the complete deformity, which also includes flexion and external rotation. *The proximal fragment is externally rotated.* - The proximal fragment undergoes external rotation due to the action of the **short external rotator muscles**, but this is only one part of the multiplanar displacement. - External rotation by itself does not fully describe the composite movement caused by multiple muscle groups.

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Principles of Fracture Management

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Upper 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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Trauma — MCQs

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