Trauma Practice Questions

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

Axillary nerve. ***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.

Q: Whiplash injury is caused due to:

Acute hyperextension of the spine. ***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.

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

Fracture extending to coronoid process. ***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.

Q: Displaced transverse patella; what is the treatment?

Tension band wiring. ***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.

Q: Initially, compression osteosynthesis was used for:

Non union. ***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.

Q: Least common complication of a fall from height is -

Fracture fibula. ***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.

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

Tongue-type fracture. ***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.

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

Kocher's manoeuvre. ***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 1

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

Accepted Answer

Axillary nerve

Answer

Median nerve

Answer

Ulnar nerve

Answer

Radial nerve

Question 2

Whiplash injury is caused due to:

Accepted Answer

Acute hyperextension of the spine

Answer

A fall from a height

Answer

A blow on top to head

Answer

Acute hyperflexion of the spine

Question 3

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

Accepted Answer

Fracture extending to coronoid process

Answer

Elderly patient

Answer

Old ununited fractures

Answer

Comminuted fracture

Question 4

Displaced transverse patella; what is the treatment?

Accepted Answer

Tension band wiring

Answer

POP cast

Answer

Non operative

Answer

Patellectomy

Question 5

Initially, compression osteosynthesis was used for:

Accepted Answer

Non union

Answer

Malunion

Answer

Correct alignment of bone

Answer

Improper alignment of bone

Question 6

Least common complication of a fall from height is -

Accepted Answer

Fracture fibula

Answer

Fracture base of skull

Answer

Fracture 12th thoracic vertebra

Answer

Fracture calcaneum

Question 7

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

Accepted Answer

Tongue-type fracture

Answer

Extra-articular fracture

Answer

Joint depression-type fracture

Answer

Avulsion fracture

Question 8

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

Accepted Answer

Extra-articular fracture of distal radius with dorsal displacement

Answer

Intra-articular fracture of distal radius with palmar displacement

Answer

Intra-articular fracture of distal radius with dorsal displacement

Answer

Extra-articular fracture of distal radius with palmar displacement

Question 9

Which maneuver is used in the reduction of shoulder dislocation?

Accepted Answer

Kocher's manoeuvre

Answer

Allis manoeuvre

Answer

Sultanpur technique

Answer

Intramedullary nail

Question 10

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

Accepted Answer

Malunion is rare, with avascular necrosis and nonunion being more common complications.

Answer

The contour of the greater trochanter remains unaffected in most cases.

Answer

Displacement occurs less frequently compared to extracapsular fractures.

Answer

Tenderness is mainly present over the anterior joint line

Trauma — MCQs

Trauma — MCQs

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