Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1121: In the case of an inferior shoulder dislocation, which nerve is most commonly injured?

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

Explanation: ***Axillary nerve*** - The **axillary nerve** wraps around the surgical neck of the humerus, making it highly vulnerable to injury during shoulder dislocations, especially **inferior dislocations**. - Injury to this nerve leads to **deltoid muscle weakness** (impaired abduction) and sensory loss over the **regimental badge area** (lateral shoulder). *Median nerve* - The **median nerve** is located more medially and deeper within the axilla and arm, making it less susceptible to injury from a simple shoulder dislocation. - Injury typically results in impaired pronation, wrist flexion, thumb opposition, and sensory deficits in the **first three and a half digits**. *Ulnar nerve* - The **ulnar nerve** runs medially in the arm and is well-protected in the axilla, making it an uncommon site of injury from a shoulder dislocation. - Damage leads to weakness in intrinsic hand muscles (e.g., **interossei, hypothenar muscles**) and sensory loss over the medial 1.5 digits. *Radial nerve* - The **radial nerve** courses posteriorly around the humerus in the spiral groove, making it prone to fracture of the humeral shaft, not typically shoulder dislocations. - Injury results in **wrist drop** due to paralysis of wrist and finger extensors, and sensory loss over the posterior arm, forearm, and dorsal hand.

Question 1122: Whiplash injury is caused due to:

A. A fall from a height
B. Acute hyperextension of the spine (Correct Answer)
C. A blow on top to head
D. Acute hyperflexion of the spine

Explanation: ***Acute hyperextension of the spine*** - Whiplash injury is typically caused by a rapid and forceful **back-and-forth movement** of the neck, often in rear-end car collisions. - This sudden motion can lead to significant **hyperextension** of the cervical spine, stretching and damaging soft tissues. *A fall from a height* - While falls can cause spinal injuries, the specific mechanism of a whiplash injury is the rapid acceleration-deceleration force, not typically a direct impact from a fall. - Falls more commonly result in **compression fractures** or other direct impact-related trauma. *A blow on top to head* - A direct blow to the top of the head ordinarily leads to **compression injuries** of the cervical spine or skull fractures. - This mechanism is different from the shearing and stretching forces characteristic of whiplash. *Acute hyperflexion of the spine* - While acute hyperflexion can cause neck injuries (e.g., in a head-on collision), whiplash specifically refers to the initial and often more damaging **hyperextension** phase. - Excessive flexion can lead to muscle strains or **ligamentous tears** in the posterior neck, but it is not the primary cause of whiplash.

Question 1123: In fracture of the olecranon, excision of the proximal fragment is indicated in all of the following situations, EXCEPT:

A. Elderly patient
B. Fracture extending to coronoid process (Correct Answer)
C. Old ununited fractures
D. Comminuted fracture

Explanation: ***Fracture extending to coronoid process*** - Excision of the proximal fragment of the olecranon is generally contraindicated when the fracture extends to the **coronoid process** because it can compromise the stability and articulation of the elbow joint. - This type of fracture often requires more extensive reconstructive procedures to restore joint integrity. *Old ununited fractures* - For **old ununited olecranon fractures**, excision of the proximal fragment can be a viable option, especially if the fragment is small and does not contribute significantly to joint stability after non-union. - This approach aims to reduce pain and improve function by removing the source of irritation. *Elderly patient* - In **elderly patients**, excision of the fractured olecranon fragment is often favored, particularly if the fragment is small or the patient has low functional demands. - This approach offers a simpler solution compared to complex internal fixation, reducing surgical time and risks of prolonged immobility and complications. *Comminuted fracture* - For **comminuted olecranon fractures**, especially if the fragments are too small or numerous to be effectively fixed, excision of the proximal fragment is a reasonable option. - This can help restore functional range of motion and reduce pain when reconstruction is not feasible.

Question 1124: Displaced transverse patella; what is the treatment?

A. POP cast
B. Non operative
C. Patellectomy
D. Tension band wiring (Correct Answer)

Explanation: ***Tension band wiring*** - This is the standard treatment for **displaced patellar fractures**, especially transverse ones, as it converts distractive forces into compressive ones, promoting healing. - It involves using K-wires and a cerclage wire to achieve **stable fixation** and allow for early range of motion. *POP cast* - A **Plaster of Paris (POP) cast** is typically used for non-displaced or minimally displaced fractures that do not require surgical stabilization. - It would not provide adequate stability for a **displaced transverse patella fracture**, which is prone to further displacement due to quadriceps pull. *Non-operative* - **Non-operative treatment** is reserved for **non-displaced** or minimally displaced patellar fractures where the extensor mechanism remains intact. - A **displaced transverse patella fracture** disrupts the extensor mechanism, making non-operative treatment unsuitable as it would lead to poor functional outcomes and a high risk of nonunion. *Patellectomy* - **Patellectomy** (partial or total removal of the patella) is considered for severely comminuted fractures where reconstruction is not possible or for chronic symptomatic nonunion. - It is generally avoided as a primary treatment for displaced transverse fractures due to the importance of the patella in **knee extension mechanics** and the risk of quadriceps weakness.

Question 1125: Initially, compression osteosynthesis was used for:

A. Malunion
B. Non union (Correct Answer)
C. Correct alignment of bone
D. Improper alignment of bone

Explanation: ***Non union*** - Compression osteosynthesis was developed to address **non-union** of fractures by providing mechanical stability and promoting bone healing through direct contact and compression at the fracture site. - The compression stimulates an osteogenic response, improving the chances of union even in cases where previous attempts at healing failed. *Malunion* - **Malunion** refers to a fracture that has healed in an incorrect anatomical position. Compression osteosynthesis is primarily for promoting healing contact, not for realigning already united but malpositioned bone fragments. - Correcting a malunion usually requires an osteotomy to re-break the bone and then fix it in the proper alignment, which may or may not involve compression. *Correct alignment of bone* - While maintaining **correct alignment** is crucial in fracture management, compression osteosynthesis is a technique applied *after* initial alignment has been achieved. It serves to stabilize the aligned fragments and promote healing, rather than being the primary method for initial alignment itself. - Techniques like traction or manipulation are typically used for initial alignment before fixation with compression. *Improper alignment of bone* - **Improper alignment** of bone refers to a fracture where the bone fragments are not in their anatomical position. Compression osteosynthesis is not designed to correct improper alignment; instead, alignment must be corrected *before* compression is applied. - Applying compression to improperly aligned fragments would stabilize the malalignment, hindering proper healing and function.

Question 1126: Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?

A. Extra-articular fracture
B. Joint depression-type fracture
C. Avulsion fracture
D. Tongue-type fracture (Correct Answer)

Explanation: ***Tongue-type fracture*** - This fracture pattern involves a **vertical fracture line** extending posteriorly through the body of the calcaneus, creating a "tongue"-shaped fragment that includes the posterior facet. - The superior portion of this fragment is **displaced superiorly**, leading to a characteristic increase in **Gissane's angle**. *Joint depression-type fracture* - This fracture involves the **depression of the articular surface** of the posterior facet into the body of the calcaneus. - In this type, the **Gissane's angle** is typically **decreased**, not increased, due to the collapse of the articular surface. *Extra-articular fracture* - An **extra-articular fracture** does not involve the articular surfaces of the calcaneus, meaning the **Gissane's angle** (which describes the relationship of the articular surfaces) is generally **preserved** or minimally affected. - These fractures occur outside the subtalar joint and are classified differently than intra-articular types. *Avulsion fracture* - An **avulsion fracture** typically occurs when a ligament or tendon pulls a piece of bone away from the main bone mass, often at muscle insertions like the Achilles tendon. - While it can occur in the calcaneus, it does not involve the characteristic displacement of the posterior facet that would lead to an **increased Gissane's angle** in the way a tongue-type fracture does.

Question 1127: Least common complication of a fall from height is -

A. Fracture fibula (Correct Answer)
B. Fracture base of skull
C. Fracture 12th thoracic vertebra
D. Fracture calcaneum

Explanation: ***Fracture fibula*** - A fibula fracture is the **least common** with a fall from height because the force is typically axial, impacting the lower limbs. - The fibula is a **non-weight-bearing bone**, making it less susceptible to direct axial compression trauma from a fall. *Fracture base of skull* - **Basilar skull fractures** can occur from significant head trauma in a fall, especially when the head strikes a surface. - While not as common as extremity fractures, they are a serious and known complication of falls from height. *Fracture 12th thoracic vertebra* - **Vertebral compression fractures**, particularly in the thoracolumbar region (like T12), are common due to axial loading upon landing on the buttocks or feet. - This is a frequent injury in falls from height due to the **compressive forces** transmitted through the spine. *Fracture calcaneum* - **Heel bone fractures** (calcaneum) are very common in falls from height, as direct impact often occurs on the feet. - The calcaneus bears the initial and substantial impact, making it highly vulnerable to **crush injuries** in such falls.

Question 1128: Which of the following statements is true regarding Colles' fracture?

A. Intra-articular fracture of distal radius with palmar displacement
B. Intra-articular fracture of distal radius with dorsal displacement
C. Extra-articular fracture of distal radius with palmar displacement
D. Extra-articular fracture of distal radius with dorsal displacement (Correct Answer)

Explanation: ***Extra-articular fracture of distal radius with dorsal displacement*** - A **Colles' fracture** is classically defined as an **extra-articular fracture** of the distal radius, meaning it does not involve the joint surface. - The characteristic feature of a Colles' fracture is the **dorsal displacement** of the distal fracture fragment, often resulting in a "dinner fork" deformity. *Intra-articular fracture of distal radius with palmar displacement* - This description corresponds to a **Smith's (or reverse Colles') fracture** if it were extra-articular or a **Barton's fracture** if it were intra-articular with displacement. - A Colles' fracture is specifically extra-articular, and its displacement is dorsal, not palmar. *Intra-articular fracture of distal radius with dorsal displacement* - This is characteristic of a **dorsal Barton's fracture**, which is by definition an intra-articular injury. - Colles' fractures are considered extra-articular; thus, this statement is incorrect for a Colles' fracture. *Extra-articular fracture of distal radius with palmar displacement* - This description accurately defines a **Smith's fracture**, also known as a reverse Colles' fracture. - While extra-articular, the displacement is palmar, which is opposite to that seen in a Colles' fracture.

Question 1129: Which maneuver is used in the reduction of shoulder dislocation?

A. Allis manoeuvre
B. Sultanpur technique
C. Intramedullary nail
D. Kocher's manoeuvre (Correct Answer)

Explanation: ***Kocher's manoeuvre*** - **Kocher's manoeuvre** is a classic technique used for the **reduction of anterior shoulder dislocations**, involving external rotation, adduction, and internal rotation. - This method aims to safely guide the humeral head back into the glenoid fossa with a series of controlled movements. *Allis manoeuvre* - The **Allis manoeuvre** is primarily used for the **reduction of posterior hip dislocations**, involving hip flexion, adduction, and internal rotation with axial traction. - It is not indicated for shoulder dislocations. *Sultanpur technique* - The "Sultanpur technique" is **not a recognized medical term** or maneuver for reducing dislocations. - This option appears to be a distractor. *Intramedullary nail* - An **intramedullary nail** is a surgical device used for **fixing long bone fractures**, such as those in the femur or tibia. - It is an orthopedic implant and not a reduction maneuver for dislocations.

Question 1130: Which of the following statements about intracapsular fractures of the femoral neck is true?

A. Malunion is rare, with avascular necrosis and nonunion being more common complications. (Correct Answer)
B. The contour of the greater trochanter remains unaffected in most cases.
C. Displacement occurs less frequently compared to extracapsular fractures.
D. Tenderness is mainly present over the anterior joint line

Explanation: ***Malunion is rare, with avascular necrosis and nonunion being more common complications.*** - Intracapsular fractures disrupt the **blood supply** to the femoral head, making **avascular necrosis** and **nonunion** much more likely than malunion. - The inherent instability and poor healing potential due to limited blood flow predispose to these specific complications. *Displacement occurs less frequently compared to extracapsular fractures.* - **Intracapsular fractures** are often highly unstable and prone to significant displacement due to the forces acting on the proximal femur. - In contrast to some stable **extracapsular fractures**, intracapsular fractures frequently present with notable displacement. *The contour of the greater trochanter remains unaffected in most cases.* - The **greater trochanter** is a part of the proximal femur, and **intracapsular fractures** involve the femoral neck, which is distal to the trochanter. - While a fracture of the femoral neck doesn't directly involve the trochanter, the **displacement** of the femoral head can indirectly affect the relationship and perceived contour of the greater trochanter. *Tenderness is mainly present over the anterior joint line* - Tenderness in **femoral neck fractures** is typically found in the **groin region** and over the greater trochanter, reflecting the location of the injury. - Anterior joint line tenderness is more commonly associated with **hip joint pathologies** or conditions like **hip flexor strains**, not isolated femoral neck fractures.

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?