Trauma Practice Questions

Q: Volkmann's ischemic contracture is associated with which of the following conditions?

Supracondylar fracture of the humerus. **Explanation:** **Volkmann’s Ischemic Contracture (VIC)** is the late-stage sequela of untreated **Acute Compartment Syndrome**, typically occurring in the forearm. **Why Option B is Correct:** The **Supracondylar fracture of the humerus** (specifically the extension type) is the most common cause of VIC in children. The mechanism involves injury to the **brachial artery** or intense swelling within the tight fascial compartments of the forearm. Ischemia leads to muscle infarction and subsequent fibrosis. The classic clinical picture is a permanent flexion deformity of the wrist and fingers (claw-hand) due to the shortening of the fibrotic flexor muscles (primarily Flexor Digitorum Profundus and Flexor Pollicis Longus). **Why Other Options are Incorrect:** * **Option A:** Intertrochanteric fractures occur in a large space with significant volume capacity; while they cause blood loss, they rarely lead to compartment syndrome or ischemic contracture. * **Option C:** Posterior dislocation of the knee can damage the **popliteal artery**, leading to limb ischemia or compartment syndrome of the leg, but the specific eponymous term "Volkmann’s Ischemic Contracture" is traditionally reserved for the forearm. * **Option D:** Traumatic shoulder separation (Acromioclavicular joint injury) involves ligamentous damage and does not compromise the distal neurovascular status of the limb. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and pain on passive stretching of muscles. * **The 5 P’s:** Pain, Pallor, Pulselessness, Paresthesia, and Paralysis (Note: Pulselessness is a *late* sign). * **Nerve Involvement:** The **Median nerve** is the most commonly affected nerve in VIC. * **Treatment:** Immediate removal of tight bandages/casts; if no improvement, urgent **fasciotomy** is required to prevent permanent contracture.

Q: McMurray's test is positive in which of the following injuries?

Medial meniscus injury. **Explanation:** **McMurray’s test** is a clinical provocative maneuver used to diagnose **meniscal tears**. The test relies on the principle that rotating the tibia while extending the knee traps the torn meniscal fragment between the femoral condyle and the tibial plateau, eliciting a painful "click" or "thud." * **Why Option C is correct:** To test the **medial meniscus**, the examiner flexes the patient's knee, applies a **valgus stress** (to open the joint space), and **externally rotates** the tibia while slowly extending the knee. A positive test is indicated by a palpable or audible click over the medial joint line. * **Why Options A & B are incorrect:** Ligamentous injuries are assessed using different maneuvers. The **Anterior Cruciate Ligament (ACL)** is evaluated via the Lachman test (most sensitive), Anterior Drawer test, and Pivot Shift test. The **Posterior Cruciate Ligament (PCL)** is evaluated via the Posterior Drawer test and the Sag sign. * **Why Option D is incorrect:** Popliteal bursitis (Baker’s cyst) typically presents as a swelling in the popliteal fossa and is not diagnosed through rotational provocative maneuvers. **Clinical Pearls for NEET-PG:** 1. **Rotation Rule:** **E**xternal rotation tests the **M**edial meniscus (**EM**), while **I**nternal rotation tests the **L**ateral meniscus (**IL**). 2. **Thessaly Test:** Currently considered the most clinically accurate physical exam test for meniscal tears (performed with the patient standing on one leg at 20° flexion). 3. **Apley’s Grinding Test:** Another common test for meniscal injury; distraction relieves pain in meniscal tears but increases pain in ligamentous injuries. 4. **Gold Standard:** MRI is the investigation of choice, but Arthroscopy remains the gold standard for diagnosis.

Q: Vascular necrosis can be a possible sequelae of fracture of all of the following bones, EXCEPT:

Calcaneum. **Explanation:** Avascular Necrosis (AVN) occurs when the blood supply to a bone is disrupted, leading to bone cell death. This typically occurs in bones that have a **precarious blood supply**, often characterized by a retrograde flow or a lack of significant muscular attachments and collateral circulation. **Why Calcaneum is the Correct Answer:** The **Calcaneum** is a highly vascular bone with a rich blood supply derived from multiple sources (medial and lateral plantar arteries and the calcaneal anastomosis). It is composed primarily of cancellous bone. Due to this robust vascularity, AVN is virtually never seen following a calcaneal fracture. Instead, the most common complication of calcaneal fractures is post-traumatic arthritis of the subtalar joint. **Analysis of Other Options:** * **Talus:** The talus is notorious for AVN (Hawkins’ Sign is used to predict it). It is 60% covered by articular cartilage and has no muscular attachments. The blood supply (mainly via the artery of the tarsal canal) is easily disrupted in neck fractures. * **Femur Neck:** The femoral head relies on the retrograde flow from the medial circumflex femoral artery. Intracapsular fractures disrupt these vessels, making AVN a very high-risk complication. * **Scaphoid:** The scaphoid has a retrograde blood supply entering through the distal pole. A fracture at the waist or proximal pole cuts off the blood to the proximal fragment, leading to a high incidence of AVN. **NEET-PG Clinical Pearls:** * **Common sites for AVN:** Head of femur (most common), proximal pole of scaphoid, body of talus, and capitate. * **Hawkins’ Sign:** Subchondral lucency in the talus seen 6–8 weeks post-fracture; its presence indicates intact vascularity (a good prognostic sign). * **Preiser’s Disease:** Idiopathic AVN of the scaphoid. * **Kohler’s Disease:** AVN of the navicular bone in children.

Q: Which of the following tests is positive in anterior dislocation of the shoulder?

Duga's test. **Explanation:** **Duga’s Test** is a classic clinical sign used to diagnose **Anterior Dislocation of the Shoulder**. In a normal shoulder, a person can touch the opposite shoulder with their hand while the elbow is in contact with the chest wall. In anterior dislocation, the humeral head is displaced from the glenoid cavity, making it mechanically impossible to touch the opposite shoulder while the elbow is adducted against the chest. **Analysis of Incorrect Options:** * **Thomas Test:** Used to assess **fixed flexion deformity (FFD) of the hip**. It involves flexing the contralateral hip to flatten lumbar lordosis; if the affected thigh rises off the table, the test is positive. * **Barlow’s Test:** A provocative maneuver used in **Developmental Dysplasia of the Hip (DDH)**. It attempts to dislocate a reducible hip by adducting the hip and applying a posterior force. * **McMurray’s Test:** Used to diagnose **meniscal tears** in the knee. It involves rotation of the tibia on the femur while extending the knee from a flexed position. **High-Yield Clinical Pearls for NEET-PG:** 1. **Other Tests for Shoulder Dislocation:** * **Hamilton Ruler Test:** A straight ruler can touch both the acromion and the lateral epicondyle simultaneously (impossible in a normal shoulder). * **Callaway’s Test:** The vertical axillary girth is increased. 2. **Most Common Type:** Anterior dislocation is the most common (Subcoracoid is the most frequent subtype). 3. **Nerve Injury:** The **Axillary nerve** is the most commonly injured nerve in anterior shoulder dislocations (tested by checking sensation over the "Regimental Badge" area). 4. **Radiology:** Look for the **Hill-Sachs lesion** (posterolateral humeral head defect) and **Bankart’s lesion** (anteroinferior glenoid labrum tear).

Q: Recurrent dislocations are common in which joint?

Shoulder. **Explanation:** The **Shoulder (Glenohumeral) joint** is the most common joint in the body to undergo recurrent dislocation. This is primarily due to its unique anatomy: it is a "ball-and-socket" joint characterized by a large humeral head articulating with a small, shallow glenoid cavity (often compared to a golf ball on a tee). While this allows for an extraordinary range of motion, it inherently sacrifices stability. Recurrence is frequently driven by the failure of soft tissue stabilizers to heal, specifically the **Bankart lesion** (avulsion of the anterior-inferior labrum) and the **Hill-Sachs lesion** (compression fracture of the posterolateral humeral head). Age is the most significant predictor of recurrence; the younger the patient at the time of the first dislocation, the higher the risk of recurrence. **Analysis of Incorrect Options:** * **Patella:** While patellar dislocations can be recurrent (often due to trochlear dysplasia or ligamentous laxity), they are statistically less common than shoulder recurrences in the general population. * **Hip Joint:** The hip is a highly stable, deep socket joint with strong ligamentous support. Dislocation usually requires high-energy trauma (e.g., dashboard injuries), and recurrence is rare unless there is significant bony destruction. * **Elbow Joint:** The elbow is the second most common joint to dislocate in adults, but it possesses high bony stability. Once reduced, it rarely becomes recurrent unless there is an associated fracture (e.g., "Terrible Triad"). **High-Yield Clinical Pearls for NEET-PG:** * **Most common direction:** Anterior (95%), specifically the subcoracoid type. * **Nerve at risk:** Axillary nerve (tested by sensation over the "regimental badge" area). * **Key Radiographic View:** Axillary view or Stryker notch view (for Hill-Sachs). * **Gold Standard Surgery:** Arthroscopic Bankart repair.

Question 1

Resolving arthroplasty is seen in which of the following?

Accepted Answer

Shoulder dislocation

Answer

Elbow dislocation

Answer

Knee dislocation

Answer

Hip dislocation

Question 2

Traumatic dislocation of the hip is characterized by which of the following deformities?

Accepted Answer

Adduction and internal rotation deformity

Answer

Abduction and external rotation deformity

Answer

Adduction and external rotation deformity

Answer

Abduction and internal rotation deformity

Question 3

Volkmann's ischemic contracture is associated with which of the following conditions?

Accepted Answer

Supracondylar fracture of the humerus

Answer

Intertrochanteric femoral fracture

Answer

Posterior dislocation of the knee

Answer

Traumatic shoulder separation

Question 4

McMurray's test is positive in which of the following injuries?

Accepted Answer

Medial meniscus injury

Answer

Anterior cruciate ligament

Answer

Posterior cruciate ligament

Answer

Popliteal bursitis

Question 5

Vascular necrosis can be a possible sequelae of fracture of all of the following bones, EXCEPT:

Accepted Answer

Calcaneum

Answer

Talus

Answer

Femur neck

Answer

Scaphoid

Question 6

Which of the following tests is positive in anterior dislocation of the shoulder?

Accepted Answer

Duga's test

Answer

Thomas test

Answer

Barlow's test

Answer

McMurry's test

Question 7

A 40-year-old man presents to the orthopedics emergency with a deformity following lifting a heavy load. Ultrasonography reveals a specific finding. Which of the following structures is affected?

Accepted Answer

Structure C

Answer

Structure B

Answer

Structure A

Answer

Structure D

Question 8

Recurrent dislocations are common in which joint?

Accepted Answer

Shoulder

Answer

Patella

Answer

Hip joint

Answer

Elbow joint

Question 9

A compound fracture is initially treated by antibiotics and wound toilet. What is the next appropriate step in management?

Accepted Answer

External splintage

Answer

Skin cover

Answer

Prosthesis

Answer

Internal fixation

Question 10

A 44-year-old woman suffers a right tibial plateau fracture after a motor vehicle accident. She is neurovascularly intact with soft compartments and has no other significant injuries apart from a minor concussion and several broken ribs. Which of the following, if present, is an indication for operative fixation?

Accepted Answer

Articular step-off of 5 mm

Answer

ACL tear on follow-up MRI

Answer

Condylar widening less than 3 mm

Answer

Lateral meniscal tear on follow-up MRI

Trauma — MCQs

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