Trauma — MCQs

A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

Q1090

Which part of the mandible is most commonly fractured?

Trauma Indian Medical PG Practice Questions and MCQs

Question 1081: Which of the following statements is true regarding supracondylar fractures of the humerus?

A. Extension type most common (Correct Answer)
B. Flexion type is less common than extension type
C. Both types are equally common
D. More common in adults

Explanation: **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.

Question 1082: Heterotopic ossification is primarily associated with which of the following?

A. Bone
B. Joint
C. Soft tissues (Correct Answer)
D. None of the options

Explanation: ***Soft tissues*** - **Heterotopic ossification** is the pathological formation of mature, lamellar bone in **non-osseous (soft tissues)** where bone does not normally exist. - This process often occurs in muscles, tendons, ligaments, or fascia, particularly after trauma or neurological injury. *Bone* - Heterotopic ossification is the formation of bone *outside* of normal skeletal structures, not within existing bone. - While it involves bone formation, its defining characteristic is its location in **extraskeletal sites**, not within the bone itself. *Joint* - Although heterotopic ossification can occur around joints, leading to **joint stiffness** and limited range of motion, it is the formation of bone within the **soft tissues surrounding the joint**, not within the joint capsule or articular cartilage itself. - The primary location is the adjacent soft tissue, which then secondarily impacts joint mobility. *None of the options* - This option is incorrect because "Soft tissues" accurately describes the primary location where heterotopic ossification occurs. - The condition is specifically defined by bone formation in these non-skeletal sites.

Question 1083: 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 1084: What is the primary reason for early stabilization of a femur shaft fracture?

A. To prevent significant blood loss.
B. To reduce pain and discomfort.
C. To facilitate quicker healing.
D. To prevent fat embolism syndrome and systemic complications (Correct Answer)

Explanation: ***To prevent fat embolism syndrome and systemic complications*** - Early stabilization of femur shaft fractures significantly **reduces the incidence of fat embolism syndrome (FES)**. Fat emboli released from the bone marrow can travel to the lungs and brain, causing severe respiratory distress and neurological deficits. - By stabilizing the fracture, the **release of fat globules is minimized**, thereby preventing FES and associated systemic complications such as acute respiratory distress syndrome (ARDS) and adult respiratory distress syndrome (ADRS). *To prevent significant blood loss.* - While femur fractures can cause significant blood loss, the primary reason for early stabilization is not solely to prevent it but to reduce complications. **Blood loss is a direct consequence**, but FES poses a greater immediate threat to life. - Furthermore, **blood loss can often be managed initially by other means**, such as fluid resuscitation and direct pressure, while FES requires prompt reduction of fracture movement. *To reduce pain and discomfort.* - Reducing pain and discomfort is an important benefit of stabilization, but it is **not the primary life-saving reason** for early intervention. Analgesics and proper splinting can also address pain. - The focus on early stabilization goes beyond symptomatic relief to actively prevent **potentially fatal systemic complications**. *To facilitate quicker healing.* - While stability is crucial for proper healing, **early stabilization primarily addresses acute, life-threatening complications** rather than long-term healing rates. Optimal healing depends on many factors, including blood supply and infection control, not solely on initial stabilization. - **Quicker healing is a secondary benefit**; the immediate priority is to prevent acute morbidity and mortality associated with the fracture.

Question 1085: 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.

Question 1086: Green stick fracture is

A. Fracture in adults
B. Complete fracture
C. Fracture spine
D. Incomplete fracture (Correct Answer)

Explanation: ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

Question 1087: Which of the following best describes a Monteggia fracture?

A. Fracture of distal radius with dislocation of the distal ulna
B. Fracture of distal third of ulna with dislocation of the radial head.
C. Fracture of the proximal third of the ulna with dislocation of the radial head. (Correct Answer)
D. Fracture of proximal one third of radius with dislocation of the distal ulna.

Explanation: ***Fracture of the proximal third of the ulna with dislocation of the radial head.*** - A Monteggia fracture is characterized by a fracture in the **proximal third of the ulna** accompanied by a **dislocation of the radial head**. - This injury typically results from a fall on an outstretched hand with hyperpronation, leading to disruption of the radiocapitellar joint. *Fracture of distal radius with dislocation of the distal ulna* - This describes a **Galeazzi fracture-dislocation**, where there is a fracture of the distal or mid-shaft of the radius with dislocation of the distal radioulnar joint. - Unlike a Monteggia fracture, the primary fracture involves the **radius**, not the ulna, and the dislocation is at the **distal ulna**, not the radial head. *Fracture of distal third of ulna with dislocation of the radial head.* - While it mentions dislocation of the radial head, the fracture site is incorrectly identified as the **distal third of the ulna**. - A Monteggia fracture specifically involves the **proximal third** of the ulna, which is crucial for its classification and clinical presentation. *Fracture of proximal one third of radius with dislocation of the distal ulna.* - This description involves a fracture of the **radius** and a dislocation of the **distal ulna**, which does not align with a Monteggia fracture. - A Monteggia fracture is defined by an **ulnar fracture** and a **radial head dislocation**.

Question 1088: In which of the following conditions is the Kocher-Langenbeck approach for emergency acetabular fixation contraindicated?

A. Morel - Lavallee lesion (Correct Answer)
B. Progressive sciatic nerve injury
C. Open fracture
D. Recurrent dislocation despite closed reduction and traction

Explanation: ***Morel - Lavallee lesion*** - A Morel-Lavallee lesion is a **closed degloving injury** where the skin and subcutaneous tissue are avulsed from the underlying fascia, creating a potential space that fills with hematoma, fat, and lymphatic fluid. - The **Kocher-Langenbeck approach** involves significant soft tissue dissection, which increases the risk of **wound complications**, infection, and flap necrosis in an already compromised and devascularized soft tissue envelope found in a Morel-Lavallee lesion. *Open fracture* - An **open fracture** involves a break in the skin, exposing the fracture site, which significantly increases the risk of infection. - While it presents a challenge, an open fracture is generally a **stronger indication for urgent surgical stabilization** to prevent further contamination and promote healing, rather than a contraindication to a specific surgical approach if it's the most appropriate for the fracture pattern. *Progressive sciatic nerve injury* - **Progressive neurologic deficits**, including sciatic nerve injury, often necessitate urgent surgical intervention to decompress the nerve and prevent irreversible damage. - This symptom emphasizes the **urgency of surgical stabilization** and internal fixation for the acetabular fracture, making it an indication for rather than a contraindication to the Kocher-Langenbeck approach if it provides optimal access. *Recurrent dislocation despite closed reduction and traction* - **Instability** of the hip joint despite conservative measures indicates a need for surgical intervention to achieve stable reduction and fixation of the acetabular fracture. - This situation generally **supports the need for open reduction and internal fixation**, often via approaches like Kocher-Langenbeck, to restore joint congruity and stability, making it an indication, not a contraindication.

Question 1089: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

A. Anterior dislocation of hip
B. Central fracture dislocation
C. Posterior dislocation
D. Pipkin's type 4 fracture (Correct Answer)

Explanation: ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.

Question 1090: Which part of the mandible is most commonly fractured?

A. Angle of mandible (Correct Answer)
B. Body of mandible
C. Coronoid process of mandible
D. Condylar process of mandible

Explanation: ***Angle of mandible*** - The **angle of the mandible** is a common site for fractures due to its anatomical position and the forces it experiences during trauma. - This area is relatively weaker than other parts and is often impacted during direct blows to the jaw. *Body of mandible* - While fractures of the **mandibular body** can occur (often in the canine region), they are less frequent than those at the angle. - The body of the mandible is generally a robust structure, making fractures here typically result from higher-impact trauma. *Condylar process of mandible* - Fractures of the **condylar process** are very common, especially in children, and are often associated with indirect trauma. - However, the angle region still holds the highest frequency of fractures due to direct impact and leverage forces. *Coronoid process of mandible* - Fractures of the **coronoid process** are relatively rare and usually occur as part of a more extensive mandibular fracture or due to direct trauma to the temporal region. - Its protected position beneath the zygomatic arch makes it less susceptible to isolated injury.

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?