Trauma Practice Questions

Q: Whiplash injury is a tear of which ligament?

Post. longitudinal ligament. ***Post. longitudinal ligament*** - Whiplash injury, often caused by **hyperextension-hyperflexion** of the cervical spine, commonly results in a tear of the **posterior longitudinal ligament**. - This ligament is crucial for stabilizing the spine and preventing **hyperflexion**, making it vulnerable during sudden, forceful movements. *Ligamenta flava* - The **ligamenta flava** are located on the posterior aspect of the vertebral canal and are primarily composed of elastic tissue, providing flexibility. - While they can be injured in severe trauma, they are less commonly implicated in typical whiplash compared to the **posterior longitudinal ligament**. *Anterior longitudinal ligament* - The **anterior longitudinal ligament** is primarily involved in preventing **hyperextension** of the spine. - While it can be injured in whiplash, the hyperextension phase typically stresses this ligament, but the hyperflexion rebound phase is more damaging to posterior structures. *Supraspinal ligament* - The **supraspinal ligament** connects the tips of the spinous processes and primarily limits **flexion** of the spine. - While it can be strained during whiplash, it is not the primary ligament commonly torn in typical whiplash injuries, which often involve deeper spinal ligaments.

Q: Saturday night palsy is which type of nerve injury?

Neuropraxia. ***Neuropraxia*** - This is the mildest form of nerve injury, involving a **temporary conduction block** without axonal disruption, often due to **compression** or mild stretching. - **Saturday night palsy**, caused by prolonged compression of the radial nerve, is a classic example, characterized by rapid and complete recovery, typically within days to weeks. *Axonotemesis* - This involves **axon damage** and Wallerian degeneration distal to the injury, but the **endoneurium and connective tissue sheaths remain intact**. - Recovery is slower and often incomplete, as it requires axonal regeneration through the preserved connective tissue tubes, taking months. *Neurotmesis* - This is the most severe type of nerve injury, involving **complete transection of the nerve fiber**, including the axon, myelin, and all connective tissue sheaths. - Recovery is often poor and requires surgical intervention to attempt re-approximation of the nerve ends. *Complete section* - This term is largely synonymous with **neurotmesis**, indicating a full anatomical disruption of the nerve. - It involves the severance of all nerve components, leading to complete loss of function distal to the injury and the poorest prognosis for spontaneous recovery.

Q: Pilon fracture is

Distal tibia Intraarticular fracture. ***Distal tibia Intraarticular fracture*** - A **pilon fracture** specifically refers to an **intra-articular fracture of the distal tibia**, involving the weight-bearing surface of the **ankle joint**. - These fractures typically result from high-energy axial loading mechanisms, driving the talus into the plafond and causing extensive articular damage. *Bimalleolar fracture* - A **bimalleolar fracture** involves fractures of both the **medial malleolus** (distal tibia) and the **lateral malleolus** (distal fibula). - While it involves the ankle, it does not necessarily involve the **tibial plafond** articular surface in the same destructive manner as a pilon fracture. *Trimalleolar fracture* - A **trimalleolar fracture** includes fractures of the medial, lateral, and **posterior malleolus** (a portion of the distal tibia). - Like bimalleolar fractures, it primarily describes the involvement of the malleoli rather than the intra-articular surface load-bearing portion of the distal tibia. *Proximal tibia fracture* - This term refers to a fracture occurring in the **upper part of the tibia**, near the knee joint. - It does not involve the **distal end of the tibia** or the ankle joint, which is characteristic of a pilon fracture.

Q: In an extension type of supracondylar fracture, what is the usual direction of displacement?

Posterolateral. ***Posterolateral*** - In an **extension type supracondylar fracture**, the distal fragment (forearm and hand) is typically displaced **posteriorly and laterally**. - This common displacement pattern is often caused by a **fall on an outstretched hand** with the elbow in extension, forcing the olecranon against the humerus. *Anteromedial* - This is an **uncommon displacement** in supracondylar fractures and is not characteristic of the extension type. - While displacement can have a medial or lateral component, the primary displacement in extension type is posterior. *Anterolateral* - Displacement in an anterior direction is typically seen in **flexion-type supracondylar fractures**, which are much rarer. - Even in flexion-type fractures, the lateral component of displacement is less common than medial. *Posteromedial* - While posterior displacement is characteristic of extension supracondylar fractures, a **posteromedial displacement** is encountered, but **posterolateral** is the *most common* pattern. - The varus force often involved in these injuries tends to promote lateral displacement of the distal fragment.

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

Radial nerve injury. ***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**.

Q: Garden spade deformity is seen in ?

Smith's fracture. ***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.

Q: Which of the following statements is true regarding supracondylar fractures of the humerus?

Extension type most common. **Extension type most common** - **Extension-type supracondylar fractures** account for the vast majority (about 95%) of all supracondylar humerus fractures. - This type typically results from a fall on an **outstretched hand** with the elbow in extension, forcing the distal fragment posteriorly. *More common in adults* - **Supracondylar fractures of the humerus** are predominantly observed in children, especially between 5 and 10 years of age. - They are the **most common elbow fracture in children**, making this statement incorrect. *Flexion type is less common than extension type* - While flexion-type fractures do occur, they are significantly less common, representing only about 5% of all supracondylar fractures. - This type typically results from a direct blow to the posterior aspect of the elbow, with the distal fragment displaced anteriorly. *Both types are equally common* - As established, extension-type fractures are far more prevalent than flexion-type fractures, making them not equally common. - The significant disparity in incidence confirms that this statement is incorrect.

Q: Proximal humerus fracture which has maximum chances of avascular necrosis

Four part. ***Four part fracture*** - A **four-part proximal humerus fracture** typically involves displacement of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. - This extensive displacement significantly disrupts the **blood supply** to the humeral head, specifically the **arcuate artery** and its branches, leading to a high risk of **avascular necrosis**. *One part fracture* - A **one-part fracture** indicates that the fracture fragments are minimally displaced (<1 cm or <45° angulation). - The **blood supply** to the humeral head remains largely intact, resulting in a very low risk of avascular necrosis. *Two part fracture* - A **two-part fracture** involves displacement of one major fragment (e.g., surgical neck or tuberosity) from the humeral head. - While there is some disruption, the overall risk of **avascular necrosis** is lower compared to more complex fractures. *Three part fracture* - A **three-part fracture** involves separate displacement of the humeral head and two tuberosities. - This fracture pattern causes more significant disruption to the **vascularity** of the humeral head than two-part fractures but generally less than four-part fractures.

Q: Which of the following describes grade 2 fracture neck femur?

Complete fracture with undisplaced neck. ***Complete fracture with undisplaced neck*** - A **Garden Type II fracture** of the femoral neck is characterized by a **complete fracture line** through the femoral neck. - Despite the complete fracture, the **femoral head remains undisplaced** and in its anatomical position, indicating an intact or minimally disrupted posteromedial soft-tissue hinge. *Incomplete fracture, medial trabeculae intact* - This description corresponds to a **Garden Type I fracture**, which is an **incomplete fracture** of the femoral neck, usually impacted in valgus. - In such cases, the medial trabeculae are often intact, or show buckling on the lateral side, indicating a stable fracture. *Complete fracture with ischemic head* - The presence of an **ischemic head** is a complication that can occur with any displaced femoral neck fracture (Garden Type III or IV), but it's not a primary defining characteristic of a specific Garden grade. - **Avascular necrosis (AVN)** of the femoral head is a risk, especially with displacement, due to disruption of the blood supply. *Moderate displacement of neck, vascularity damaged* - This description is more consistent with a **Garden Type III fracture**, where there is a **complete fracture with moderate displacement** of the femoral head, usually with some varus angulation. - Such displacement significantly increases the risk of **vascular injury** to the femoral head, predisposing to avascular necrosis.

Question 1

Whiplash injury is a tear of which ligament?

Accepted Answer

Post. longitudinal ligament

Answer

Ligamenta flava

Answer

Supraspinal ligament

Answer

Anterior longitudinal ligament

Question 2

Saturday night palsy is which type of nerve injury?

Accepted Answer

Neuropraxia

Answer

Axonotemesis

Answer

Complete section

Answer

Neurotmesis

Question 3

Pilon fracture is

Accepted Answer

Distal tibia Intraarticular fracture

Answer

Bimalleolar fracture

Answer

Trimalleolar fracture

Answer

Proximal tibia fracture

Question 4

In an extension type of supracondylar fracture, what is the usual direction of displacement?

Accepted Answer

Posterolateral

Answer

Anteromedial

Answer

Anterolateral

Answer

Posteromedial

Question 5

Which of the following is NOT a complication of elbow dislocation?

Accepted Answer

Radial nerve injury

Answer

Vascular injury

Answer

Median nerve injury

Answer

Myositis ossificans

Question 6

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

Accepted Answer

The proximal fragment exhibits flexion, abduction, and external rotation.

Answer

The proximal fragment is flexed.

Answer

The proximal fragment is abducted.

Answer

The proximal fragment is externally rotated.

Question 7

Garden spade deformity is seen in ?

Accepted Answer

Smith's fracture

Answer

Colle’s fracture

Answer

Bennett’s fracture

Answer

Barton’s fracture

Question 8

Which of the following statements is true regarding supracondylar fractures of the humerus?

Accepted Answer

Extension type most common

Answer

Flexion type is less common than extension type

Answer

Both types are equally common

Answer

More common in adults

Question 9

Proximal humerus fracture which has maximum chances of avascular necrosis

Accepted Answer

Four part

Answer

One part

Answer

Two part

Answer

Three part

Question 10

Which of the following describes grade 2 fracture neck femur?

Accepted Answer

Complete fracture with undisplaced neck

Answer

Incomplete fracture, medial trabeculae intact

Answer

Complete fracture with ischemic head

Answer

Moderate displacement of neck, vascularity damaged

Trauma — MCQs

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