Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1131: Which of the following statements is true about crescent fracture?

A. Fracture of the iliac bone with sacroiliac disruption (Correct Answer)
B. Diastasis of the pubis with associated pubic rami fractures.
C. Anteroposterior instability with rotational stability in the pelvis.
D. Associated with stable pelvic ring injuries.

Explanation: ***Fracture of the iliac bone with sacroiliac disruption*** - A **crescent fracture** is characterized by an **oblique fracture of the iliac bone** extending into the posterior superior iliac spine, often associated with a **sacroiliac joint disruption**. - This specific injury pattern suggests **vertical instability of the posterior pelvic ring**, as the sacroiliac ligamentous complex is compromised. *Diastasis of the pubis with associated pubic rami fractures* - This description typically refers to **anterior pelvic ring injuries**, often seen in **open-book fractures** or vertical shear injuries, which are distinct from crescent fractures. - While pubic rami fractures can coexist with crescent fractures as part of a more complex pelvic injury, crescent fracture primarily defines the **posterior injury pattern**. *Anteroposterior instability with rotational stability in the pelvis* - **Anteroposterior instability** often results from disruption of the **anterior pelvic ring**, such as pubic symphysis diastasis, and is less about the rotational stability. - A crescent fracture specifically conveys **vertical instability** of the posterior pelvis due to the compromised sacroiliac joint and iliac fracture. *Associated with stable pelvic ring injuries* - **Crescent fractures** involve disruption of the **posterior pelvic ring**, specifically the sacroiliac joint, and are inherently **unstable**. - This type of injury requires surgical intervention due to the significant risk of hemorrhage and displacement.

Question 1132: A 70-year-old man presents with a hip fracture after a fall. What type of fracture is most common in this scenario?

A. Intertrochanteric fracture
B. Femoral head fracture
C. Subtrochanteric fracture
D. Femoral neck fracture (Correct Answer)

Explanation: ***Femoral neck fracture*** - **Femoral neck fractures** are exceedingly common in elderly patients, particularly women, after low-energy trauma such as a fall. - This fracture type is due to the **osteoporotic weakening** of the bone in this region, which bears significant weight. *Intertrochanteric fracture* - **Intertrochanteric fractures** occur between the greater and lesser trochanters and are also common in the elderly, but they tend to be extracapsular and have a better vascular supply. - While common, they typically involve higher energy trauma or significant twisting forces compared to the low-energy falls associated with femoral neck fractures in the elderly. *Subtrochanteric fracture* - **Subtrochanteric fractures** are located below the lesser trochanter. While they can occur in older patients, they are less common than femoral neck or intertrochanteric fractures after a simple fall. - These fractures often result from **high-energy trauma** in younger individuals or can be associated with certain medications like bisphosphonates. *Femoral head fracture* - **Femoral head fractures** are rare and typically occur in younger patients from high-energy mechanisms, such as a **dashboard injury** in a car accident, often associated with a hip dislocation. - The patient's presentation of an elderly person with a fall makes a femoral head fracture highly unlikely as the primary injury.

Question 1133: A 45-year-old woman presents with severe shoulder pain after a fall, and examination reveals a dislocated shoulder. What is the initial management?

A. Sling and swathe immobilization
B. Open reduction
C. Closed reduction (Correct Answer)
D. MRI of the shoulder

Explanation: ***Closed reduction*** - **Closed reduction** is the initial and preferred treatment for an anterior shoulder dislocation, aiming to restore the humeral head to the glenoid cavity **without surgical incision**. - This procedure should be performed promptly to minimize pain, muscle spasm, and the risk of **neurovascular compromise** in the affected limb. *Sling and swathe immobilization* - While immobilization is required *after* a successful reduction, it is not the *initial* management for a dislocated shoulder itself. - Immobilization *without* prior reduction would leave the shoulder dislocated, leading to ongoing pain and potential long-term complications. *Open reduction* - **Open reduction**, which involves surgical incision, is generally reserved for cases where **closed reduction fails** or if there are associated complex injuries, such as significant fractures not amenable to closed management. - It is not the initial treatment strategy for an uncomplicated shoulder dislocation. *MRI of the shoulder* - An **MRI** may be indicated to evaluate associated soft tissue injuries (e.g., **rotator cuff tears**, **labral tears**) *after* the shoulder has been reduced and initial radiographs have been obtained. - It is not part of the immediate management for pain relief and joint repositioning in an acute dislocation.

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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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