Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1101: Which of the following is NOT a primary goal of open reduction and internal fixation (ORIF)?

A. Consolidation (final healing phase) (Correct Answer)
B. Stability (maintaining bone position)
C. Better function (restoring mobility)
D. Better alignment (correct positioning)

Explanation: ***Consolidation (final healing phase)*** - While ORIF aims to facilitate healing, **consolidation** is the *result* of successful treatment, not a direct primary goal achieved *during* the surgical procedure itself. - The surgical goals focus on creating the optimal environment for consolidation to occur naturally after the operation. *Stability (maintaining bone position)* - Achieving and maintaining **stability** of the fractured bone fragments is a fundamental goal of ORIF. - This prevents micromotion at the fracture site, which is crucial for reducing pain and promoting proper healing. *Better function (restoring mobility)* - Restoring **normal or near-normal function and mobility** to the injured limb or body part is a key objective of ORIF. - By stabilizing the fracture and allowing early mobilization, the procedure helps minimize joint stiffness and muscle atrophy. *Better alignment (correct positioning)* - **Accurate anatomical reduction and alignment** of the fractured bone fragments are paramount in ORIF. - Proper alignment is essential for restoring biomechanical integrity and ensuring optimal long-term functional outcomes.

Question 1102: Subtrochanteric fractures of the femur can be treated by all of the following methods, except:

A. Ender's nail
B. Skeletal traction on Thomas' splint
C. Condylar blade plate
D. Smith Petersen Nail (Correct Answer)

Explanation: ***Smith Petersen Nail*** - The **Smith Petersen nail** is an **intramedullary device** used primarily for **femoral neck fractures** or certain types of **intertrochanteric fractures**, but it is generally **not indicated** for subtrochanteric fractures due to suboptimal stability in this region. - Its design does not provide adequate fixation or rotational control for the unique forces acting on the **subtrochanteric area**, which is under significant bending and shear stress. *Skeletal traction on Thomas' splint* - **Skeletal traction** can be used as a **temporary measure** for subtrochanteric fractures to maintain length and alignment, especially in cases where definitive surgical fixation is delayed. - The **Thomas' splint** helps to support the limb and keep it in traction, reducing pain and preventing further displacement. *Condylar blade plate* - A **condylar blade plate** or **proximal femoral locking plate** is a suitable implant for **complex subtrochanteric fractures**, particularly those with comminution or extending into the trochanteric region. - It provides **angular stability** and strong fixation, which is crucial for successful healing in this high-stress area. *Ender's nail* - **Ender's nails** are flexible **intramedullary nails** that can be used for certain types of subtrochanteric fractures, particularly in situations where a less invasive approach is desired or in elderly patients. - While they offer some stability, their use for subtrochanteric fractures has largely been superseded by more rigid interlocking nails due to **higher rates of malunion** and **rotational instability**.

Question 1103: Which of the following is a contraindication for open reduction & internal fixation (ORIF)?

A. Active infection
B. Soft bones
C. Soft tissue contractures around the fracture site
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Active infection** at the surgical site is a significant contraindication for ORIF due to the high risk of **osteomyelitis** and implant failure. - **Soft bones**, such as those found in patients with **osteoporosis**, may not adequately hold the internal fixation devices (screws, plates), leading to implant loosening or cutout. - **Soft tissue contractures** around the fracture site can make surgical access difficult, compromise soft tissue coverage, and increase the risk of wound complications and poor functional outcomes. *Active infection* - While a direct contraindication, it's not the *only* one for ORIF. - Performing ORIF in the presence of infection significantly increases the risk of **surgical site infection** and implant failure, potentially leading to chronic osteomyelitis. *Soft bones* - This is a significant challenge for ORIF, as the bone quality may not be sufficient to hold the hardware securely. - It increases the risk of **implant failure** and non-union, but again, it's not the sole contraindication listed. *Soft tissue contractures around the fracture site* - Severe contractures can **impede surgical exposure**, make anatomical reduction difficult, and compromise the vascularity of the tissues. - This can lead to increased rates of **wound complications** and poor healing, but it is one of several contraindications.

Question 1104: Avascular necrosis (AVN) is commonly associated with which type of femoral neck fracture?

A. Transcervical
B. Basal
C. Subcapital (Correct Answer)
D. Intertrochanteric

Explanation: ***Subcapital*** - Subcapital fractures occur at the anatomical **neck of the femur**, just below the femoral head, and often disrupt the **blood supply** to the femoral head due to injury to the lateral epiphyseal arteries. - The high rate of **vascular disruption** in these fractures significantly increases the risk of avascular necrosis (AVN) a condition where bone tissue dies due to lack of blood supply. *Transcervical* - Transcervical fractures are located through the **middle part of the femoral neck**, between subcapital and basal fractures, and also carry a risk of AVN. - However, the risk of AVN is generally considered **lower than subcapital fractures** but higher than basal fractures, due to less consistent disruption of the retinacular vessels. *Basal* - Basal fractures occur at the **base of the femoral neck**, near the intertrochanteric line, and typically have a **better prognosis** regarding AVN. - The principal blood supply to the femoral head is usually **less compromised** in basal fractures compared to subcapital or transcervical fractures, as the fracture line is more distal to the weight-bearing femoral head. *Intertrochanteric* - Intertrochanteric fractures occur **outside the hip joint capsule**, in the region between the greater and lesser trochanters, and are considered **extracapsular**. - Due to their location being well away from the **femoral head's vascular supply**, these fractures have a very low risk of avascular necrosis and primarily raise concerns about stability and healing.

Question 1105: Which of the following is not considered an emergency treatment for acetabular fractures?

A. Open acetabular fracture
B. Recurrent dislocations despite fixation with traction
C. Progressive sciatic nerve involvement
D. Morel-Lavallee lesion (Correct Answer)

Explanation: **Morel-Lavallee lesion** - While a Morel-Lavallee lesion is a serious injury that can occur with acetabular fractures, it is not typically considered an **absolute emergency** requiring immediate surgical intervention in the same way other complications are. - Management often involves drainage and compression, and surgical débridement is usually performed electively if it significantly enlarges or becomes symptomatic. *Recurrent dislocations despite fixation with traction* - This indicates **instability** of the hip joint, which can lead to further damage to the articular cartilage, labrum, and surrounding soft tissues, necessitating **urgent surgical stabilization**. - Persistent dislocation can result in avascular necrosis of the femoral head or damage to the **neurovascular structures**. *Open acetabular fracture* - An open fracture presents a direct communication between the fracture site and the external environment, carrying a **high risk of infection** (osteomyelitis). - This requires **immediate surgical débridement** and antibiotics to prevent severe complications. *Progressive sciatic nerve involvement* - Progressive neurological deficit, such as increasing weakness or sensory loss in the distribution of the sciatic nerve, indicates **ongoing nerve compression or injury**. - This is a neurosurgical emergency that requires **urgent decompression** to prevent permanent neurological damage.

Question 1106: What is the acceptable angle of reduction for a tibial fracture?

A. 1
B. 5 (Correct Answer)
C. 20
D. 15

Explanation: ***5*** - A **5-degree angulation** for a tibial shaft fracture is generally considered an acceptable radiographic reduction in most planes. - This degree of **angulation** typically allows for satisfactory healing and good functional outcomes without significant long-term complications. *1* - While **1 degree of angulation** would represent an excellent reduction, it is not the standard "acceptable" maximum. - Achieving such a minimal **angulation** can be challenging and is often unnecessary for a good functional outcome. *20* - **Twenty degrees of angulation** in a tibial shaft fracture is generally considered an unacceptable degree of displacement. - Such significant **angulation** can lead to malunion, functional impairment, and aesthetic deformities. *15* - **Fifteen degrees of angulation** is typically considered excessive for an acceptable reduction of a tibial shaft fracture. - This much angulation can interfere with proper gait, cause abnormal joint loading, and increase the risk of delayed union or nonunion.

Question 1107: In which type of fracture is closed pinning not typically performed?

A. Neck humerus fracture
B. Shaft humerus fracture (Correct Answer)
C. Distal radius fracture
D. Supracondylar fracture humerus

Explanation: ***Shaft humerus fracture*** - Closed pinning (intramedullary nailing) for **humeral shaft fractures** is technically challenging due to the curved anatomy and the risk of neurovascular injury, especially with *retrograde nailing*. - **Open reduction and internal fixation (ORIF)** with plates and screws is generally preferred for **humeral shaft fractures** to achieve stable fixation and union. *Neck humerus fracture* - **Minimally invasive pinning** is a common technique for stabilizing **displaced humeral neck fractures**, particularly in older patients, to achieve good functional outcomes. - The anatomical location allows for safe percutaneous pin insertion under fluoroscopic guidance, minimizing soft tissue disruption. *Distal radius fracture* - **Percutaneous pinning** is a well-established and effective treatment for many types of **distal radius fractures**, especially those that are unstable or reduced but difficult to hold in place with casting alone. - It provides internal support while allowing for early motion of unaffected joints. *Supracondylar fracture humerus* - **Closed reduction and percutaneous pinning** (CRPP) is the gold standard for displaced **supracondylar humerus fractures** in children. - This technique achieves stable fixation with minimal surgical exposure and has excellent outcomes when performed correctly.

Question 1108: The most common site for spinal trauma across all mechanisms of injury in the general population is

A. Cervical spine (Correct Answer)
B. Thoracic spine
C. Lumbar spine
D. Sacral spine

Explanation: ***Cervical spine*** - The **cervical spine** is the **most flexible** part of the vertebral column with a wide range of motion, making it highly susceptible to injury from various mechanisms, including falls, motor vehicle accidents, and diving accidents. - Its anatomical position at the base of the skull directly supporting the head makes it vulnerable to **acceleration-deceleration forces** and impacts. *Thoracic spine* - The **thoracic spine** is relatively **stable and rigid** due to its attachment to the rib cage, which provides significant protection against trauma. - Injuries to the thoracic spine are less frequent compared to the cervical spine, often requiring **high-energy forces**. *Lumbar spine* - The **lumbar spine** is also a common site for trauma, particularly in flexion-distraction injuries, but it is generally **less frequently injured** than the cervical spine across all mechanisms. - While flexible, its larger vertebral bodies and strong musculature provide more stability than the cervical region. *Sacral spine* - The **sacral spine**, being fused and part of the pelvic ring, is **well-protected** and less prone to isolated traumatic injury compared to the mobile segments of the spine. - Injuries to the sacrum often occur in conjunction with pelvic fractures due to **high-impact trauma**.

Question 1109: True about proximal fragment in subtrochanteric fracture is?

A. Flexion
B. Abduction
C. External rotation
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - In a subtrochanteric fracture, the **proximal fragment** is under the influence of several strong muscle groups, leading to a characteristic displacement. - The **iliopsoas muscle** causes **flexion**, the **gluteus medius and minimus** cause **abduction**, and the **short external rotators** cause **external rotation**. *Flexion* - The powerful **iliopsoas muscle** inserts on the lesser trochanter and acts to flex the hip. - This muscle pulls the proximal fragment anteriorly and superiorly, resulting in a **flexion deformity**. *Abduction* - The **gluteus medius and minimus muscles** attach to the greater trochanter and exert a strong abducting force. - This action pulls the proximal fragment away from the midline, causing **abduction**. *External rotation* - The **short external rotators** (e.g., piriformis, obturators, gemelli) insert around the greater trochanter. - These muscles collectively cause the proximal fragment to rotate outwards, resulting in **external rotation**.

Question 1110: Which of the following injuries can be classified as Gustilo-Anderson Grade III injuries?

A. Open fracture with clean wounds less than 1 cm long
B. Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions
C. Compartment syndrome with an open fracture
D. Open segmental fractures, open fractures with extensive soft tissue damage, or traumatic amputation. (Correct Answer)

Explanation: ***Open segmental fractures, open fractures with extensive soft tissue damage, or traumatic amputation.*** - Gustilo-Anderson **Grade III** injuries are characterized by **extensive soft tissue damage**, often with significant contamination and compromised vascularity. - This grade includes **segmental fractures**, traumatic amputations, or open fractures with **soil contamination** or a high-energy mechanism. *Open fracture with clean wounds less than 1 cm long* - This description corresponds to a **Gustilo-Anderson Grade I** injury, which involves a clean wound with minimal soft tissue damage. - The wound is typically less than 1 cm, and there is no significant muscle contusion or crushing. *Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions* - This would be classified as a **Gustilo-Anderson Grade II** injury, characterized by a skin laceration greater than 1 cm but without significant soft tissue loss or extensive periosteal stripping. - The soft tissue damage is moderate, and the fracture pattern is usually simple. *Compartment syndrome with an open fracture* - While **compartment syndrome** is a serious complication often associated with high-energy open fractures, its presence alone does not define the Gustilo-Anderson classification grade. - The grading focuses on the extent of soft tissue injury, fracture pattern, and contamination at the time of injury, not secondary complications.

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Principles of Fracture Management

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Upper Limb Fractures

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Lower 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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