Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1071: 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 1072: 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 1073: Pilon fracture is

A. Bimalleolar fracture
B. Trimalleolar fracture
C. Distal tibia Intraarticular fracture (Correct Answer)
D. Proximal tibia fracture

Explanation: ***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.

Question 1074: In an extension type of supracondylar fracture, what is the usual direction of displacement?

A. Posterolateral (Correct Answer)
B. Anteromedial
C. Anterolateral
D. Posteromedial

Explanation: ***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.

Question 1075: Whiplash injury is a tear of which ligament?

A. Ligamenta flava
B. Supraspinal ligament
C. Post. longitudinal ligament (Correct Answer)
D. Anterior longitudinal ligament

Explanation: ***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.

Question 1076: Saturday night palsy is which type of nerve injury?

A. Neuropraxia (Correct Answer)
B. Axonotemesis
C. Complete section
D. Neurotmesis

Explanation: ***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.

Question 1077: 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.

Question 1078: Which of the following describes grade 2 fracture neck femur?

A. Incomplete fracture, medial trabeculae intact
B. Complete fracture with undisplaced neck (Correct Answer)
C. Complete fracture with ischemic head
D. Moderate displacement of neck, vascularity damaged

Explanation: ***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 1079: Tardy ulnar nerve palsy is specifically associated with which type of fracture?

A. Lateral condyle fracture of the humerus (Correct Answer)
B. Medial condyle fracture of the humerus
C. Fracture of the humeral shaft
D. Fracture of the radial shaft

Explanation: ***Lateral condyle fracture of the humerus*** - This fracture, especially in children, can lead to **cubitus valgus deformity** as a long-term complication if it heals incorrectly. - The resulting **valgus angulation** at the elbow abnormally stretches the ulnar nerve behind the medial epicondyle, causing **tardy ulnar nerve palsy** years after the initial injury. *Medial condyle fracture of the humerus* - While close to the ulnar nerve, medial condyle fractures are more likely to cause **immediate nerve damage** due to direct impingement, rather than delayed or "tardy" palsy from chronic stretching. - Complications typically involve varus deformity, which does not commonly stretch the ulnar nerve in the same manner as valgus. *Fracture of the humeral shaft* - This type of fracture is more commonly associated with **radial nerve injury** (e.g., wrist drop), especially in fractures of the mid-shaft. - It does not typically lead to long-term deformities at the elbow that would cause **delayed ulnar nerve compression**. *Fracture of the radial shaft* - Radial shaft fractures (e.g., Monteggia, Galeazzi) primarily affect the **radial nerve** or the **posterior interosseous nerve**. - They do not directly involve the elbow joint in a manner that would cause **tardy ulnar nerve palsy**.

Question 1080: What is the most common complication of lateral condyle humerus fracture?

A. Malunion
B. Nonunion (Correct Answer)
C. Vascular injury and compromise (VIC)
D. Median nerve injury

Explanation: ***Nonunion*** - The lateral condyle is an **epiphyseal apophysis**, meaning it's a secondary ossification center that doesn't contribute to longitudinal bone growth, and it is covered by **cartilage**, limiting the contact area between fracture fragments. - Due to the cartilage covering, the periosteal blood supply is compromised leading to difficulty in healing, making **nonunion the most common complication**. *Malunion* - While **malunion** can occur, it is less common than nonunion in lateral condyle fractures due to the specific anatomy and blood supply of the lateral condyle. - **Growth disturbances** or **cubitus valgus** can result from malunion, but nonunion remains the primary concern. *Vascular injury and compromise (VIC)* - **Vascular injuries** are rare due to the relatively intact soft tissue envelope around the fracture site. - The main vessels are not typically in close proximity to the fracture line of the lateral condyle. *Median nerve injury* - The **median nerve** courses anterior to the elbow joint, more medially. - It is rarely affected by lateral condyle fractures, which are on the lateral aspect of the distal humerus.

Practice by Chapter

Principles of Fracture Management

Practice Questions

Upper Limb Fractures

Practice Questions

Lower Limb Fractures

Practice Questions

Spinal Trauma

Practice Questions

Pelvic and Acetabular Fractures

Practice Questions

Open Fractures

Practice Questions

Fractures in Children

Practice Questions

Fracture Complications

Practice Questions

Nonunion and Malunion

Practice Questions

Polytrauma Management

Practice Questions

Joint Dislocations

Practice Questions

Soft Tissue Injuries

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?