Trauma Practice Questions

Q: A Hill-Sachs lesion in recurrent shoulder dislocation is:

Injury to the humeral head. **Explanation:** A **Hill-Sachs lesion** is a classic radiological finding in recurrent anterior shoulder dislocations. It is a **compression fracture** of the posterolateral aspect of the **humeral head**. **1. Why Option A is Correct:** During an anterior dislocation, the humeral head is forced out of the glenoid fossa and strikes against the sharp anterior-inferior edge of the glenoid. This impact causes a "dent" or compression fracture on the posterolateral humeral head. Because it involves the bone of the humerus, it is classified as an injury to the humeral head. **2. Why Other Options are Incorrect:** * **Option B:** Rupture of the supraspinatus tendon is a Rotator Cuff tear. While common in older patients with shoulder trauma, it is not the definition of a Hill-Sachs lesion. * **Option C:** Avulsion of the anterior-inferior glenoid labrum is known as a **Bankart lesion**. This is the most common cause of shoulder instability, whereas Hill-Sachs is the associated "kissing lesion" on the humerus. **Clinical Pearls for NEET-PG:** * **Mechanism:** Impact of the humeral head against the anterior glenoid rim. * **Best X-ray View:** The **Stryker Notch view** is the most sensitive radiographic view to visualize a Hill-Sachs lesion. * **Reverse Hill-Sachs:** A compression fracture of the *anterior* humeral head, seen in **posterior** shoulder dislocations (associated with a Reverse Bankart lesion). * **Inverted Pear Appearance:** Seen in "Bony Bankart" lesions where there is significant bone loss from the anterior-inferior glenoid.

Q: A Bankart's lesion involves which part of the glenoid labrum?

Antero-inferior lip. **Explanation:** A **Bankart’s lesion** is the most common pathological finding in recurrent anterior shoulder dislocations. It involves an avulsion of the **antero-inferior** part of the glenoid labrum from the underlying glenoid rim. This occurs because, during an anterior dislocation, the humeral head is forced forward and downward, tearing the labrum and the attached inferior glenohumeral ligament (IGHL) complex. This loss of integrity compromises the "chock-block" effect of the labrum, leading to joint instability. **Analysis of Options:** * **Antero-inferior lip (Correct):** This is the specific site (typically between the 3 o'clock and 6 o'clock positions for a right shoulder) where the labrum detaches in traumatic anterior instability. * **Anterior lip:** While technically anterior, it is too non-specific. The lesion specifically involves the inferior quadrant where the IGHL attaches. * **Superior lip:** This is the site for **SLAP lesions** (Superior Labrum from Anterior to Posterior), often involving the long head of the biceps tendon. * **Antero-superior lip:** This area is typically associated with subscapularis tears or "Sublabral holes" (a normal anatomical variant), but not classic Bankart’s. **High-Yield Clinical Pearls for NEET-PG:** 1. **Soft Bankart vs. Bony Bankart:** A "Soft Bankart" involves only the labrum, while a "Bony Bankart" involves a fracture of the antero-inferior glenoid rim. 2. **Hill-Sachs Lesion:** Often co-exists with Bankart’s; it is a compression fracture of the **postero-lateral** aspect of the humeral head. 3. **Gold Standard Investigation:** MRI Arthrography (MRA) is the investigation of choice to visualize labral tears. 4. **Surgery:** Recurrent cases often require a **Bankart Repair** (reattaching the labrum) or a **Latarjet procedure** if significant bone loss is present.

Q: A patient is brought to the emergency following a road traffic accident (dashboard injury). Examination reveals the affected limb is held in flexion, adduction, and internal rotation with apparent shortening. What type of hip dislocation is most likely?

Posterior. ***Posterior*** - **Posterior hip dislocation** accounts for **85-90%** of all traumatic hip dislocations, typically caused by **dashboard injuries** during motor vehicle accidents. - Classic deformity includes **hip flexion**, **adduction**, **internal rotation**, and **apparent leg shortening** with the knee pointing toward the midline. *Anterior* - **Anterior hip dislocation** is rare (5-10% of cases) and typically occurs with **forced abduction** and **external rotation**. - Clinical presentation shows **hip flexion**, **abduction**, **external rotation**, and **apparent leg lengthening** - opposite to posterior dislocation. *Inferior* - **Inferior hip dislocation** (obturator type) is extremely rare and occurs with **severe trauma** involving **hip abduction** and **flexion**. - Patient presents with **severe hip flexion**, **abduction**, and **external rotation** with the femoral head palpable in the **obturator foramen**. *None of the above* - This option is incorrect as **posterior hip dislocation** is clearly the most common type following trauma. - The question describes a typical traumatic hip dislocation scenario where posterior displacement is statistically most likely.

Q: Which of the following is NOT true about calcaneum fracture?

GISSEN'S angle in intra-articular fracture is decreased.. **Explanation:** Calcaneum fractures are the most common tarsal bone fractures, typically resulting from high-energy axial loading (e.g., falling from a height). **1. Why Option C is the correct answer (The False Statement):** In intra-articular calcaneal fractures, the **Gissane’s Angle** (Critical Angle) actually **increases** (becomes more obtuse), while the **Bohler’s Angle decreases**. Gissane’s angle is formed by the downward slope of the lateral process of the talus and the upward slope of the calcaneal posterior facet. When the calcaneum is crushed, this angle widens. **2. Analysis of other options:** * **Option A (Bohler’s Angle):** This is the angle between two lines (highest point of anterior process to highest point of posterior facet, and highest point of posterior facet to superior edge of tuberosity). The normal range is **20°–40°**. In fractures, this angle **decreases** or may even become negative, indicating a loss of height. * **Option B (Commonality):** The calcaneum is indeed the **most commonly fractured tarsal bone**, accounting for approximately 60% of all tarsal fractures. * **Option D (Lover’s Fracture):** Calcaneal fractures are classically called **"Don Juan" or "Lover’s" fractures**, as they often occur when a "lover" jumps from a height (like a balcony) to escape a spouse. **Clinical Pearls for NEET-PG:** * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot; highly suggestive of calcaneal fracture. * **Associated Injuries:** Always rule out **compression fractures of the Lumbar spine (L1)** (10% association) and contralateral calcaneal fractures. * **Classification:** The **Sanders Classification** (based on CT scan) is the gold standard for intra-articular fractures. * **Treatment:** Undisplaced fractures are treated conservatively; displaced intra-articular fractures usually require **ORIF**.

Q: Malgaigne's fracture involves which of the following anatomical structures?

Pelvis. **Explanation:** **Malgaigne’s fracture** is a classic, high-energy injury of the **pelvis**. It is defined as a vertical shear fracture-dislocation of the pelvic ring. Specifically, it involves a double vertical fracture: 1. **Anteriorly:** Ipsilateral superior and inferior pubic rami fractures (or pubic symphysis diastasis). 2. **Posteriorly:** Ipsilateral sacroiliac joint disruption or a fracture of the ilium/sacrum. This injury results in an unstable pelvic segment that can shift cranially (superiorly), often leading to limb length discrepancy and significant internal hemorrhage. **Analysis of Incorrect Options:** * **B. Femur head:** Fractures here are typically associated with hip dislocations (e.g., Pipkin classification), not Malgaigne’s. * **C. Tibial spine:** This is an avulsion fracture at the attachment of the Anterior Cruciate Ligament (ACL), common in pediatric populations. * **D. Proximal humerus:** Common fractures here include Neer’s classification types (surgical neck, greater tuberosity, etc.), usually seen in elderly patients following a fall. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Usually a vertical shear force (e.g., a fall from height landing on one leg). * **Stability:** It is a **vertically and rotationally unstable** fracture (Tile Type C). * **Complications:** High risk of massive retroperitoneal hemorrhage, urogenital injuries, and lumbosacral plexus (L5 nerve root) injury. * **Radiology:** Look for the "upward shift" of the hemipelvis on an AP X-ray.

Q: A 13-year-old male presents with forearm pain and deformity after a fall onto his palm. Examination reveals an obvious angulation at the mid-forearm, with intact finger movement, circulation, and sensation. X-rays of the forearm are obtained. What is the most likely diagnosis?

Galeazzi's fracture. ***Galeazzi's fracture*** - **Fall onto outstretched hand (FOOSH)** mechanism with mid-forearm angulation suggests **radius shaft fracture** at the middle/distal third with **distal radioulnar joint (DRUJ) disruption**. - Common in **adolescents** and presents with obvious **forearm deformity** and preserved neurovascular function, as described in this case. *Night-stick fracture* - Results from **direct blow** to the forearm, typically causing an **isolated ulnar shaft fracture** without radial involvement. - Does not typically cause the **obvious angulation** seen in this case, as the radius remains intact to maintain some structural support. *Monteggia's fracture* - Involves **proximal ulnar fracture** with **radial head dislocation**, not mid-forearm deformity. - Typically occurs from **fall on extended arm** but presents with **elbow deformity** and limited **elbow flexion**, not mid-forearm angulation. *Colles' fracture* - **Distal radius fracture** near the **wrist joint** causing characteristic **dinner fork deformity** at the wrist. - Occurs from FOOSH mechanism but affects the **distal radius metaphysis**, not the mid-forearm shaft as described.

Q: What type of Monteggia fracture is commonly associated with nerve injuries?

Type II. **Explanation:** The **Monteggia fracture-dislocation** is classified using the **Bado Classification**, which is based on the direction of the radial head dislocation. **Why Type II is correct:** Bado Type II involves a fracture of the ulnar shaft with **posterior or posterolateral dislocation** of the radial head. This specific subtype is most commonly associated with nerve injuries, specifically the **Posterior Interosseous Nerve (PIN)**, a branch of the radial nerve. The mechanism involves the radial head being displaced posteriorly, where it directly compresses or stretches the PIN as it passes through the supinator muscle (Arcade of Frohse). This is particularly common in adults. **Analysis of Incorrect Options:** * **Type I (Anterior):** The most common type overall (especially in children). The radial head dislocates anteriorly. While nerve injuries can occur, they are statistically less frequent than in Type II. * **Type III (Lateral):** Involves ulnar metaphyseal fractures with lateral radial head dislocation. This is more common in the pediatric population and is less frequently associated with nerve palsy compared to Type II. * **Type IV:** Involves fractures of both the radius and ulnar shafts with anterior dislocation of the radial head. It is rare and complex, but Type II remains the classic association for nerve injury in exams. **Clinical Pearls for NEET-PG:** * **Nerve involved:** Posterior Interosseous Nerve (PIN). Note that PIN injury causes **finger drop** (loss of MCP extension) but **no sensory loss**. * **Management:** Most PIN injuries are neuropraxias; hence, observation for 2–3 months is usually recommended before considering exploration. * **Mnemonic (MUGR):** **M**onteggia: **U**lna fracture; **G**aleazzi: **R**adius fracture.

Q: Which of the following is NOT relevant in the management of compartment syndrome?

Exercise. **Explanation:** Compartment syndrome is a surgical emergency characterized by increased pressure within a closed osteofascial space, leading to impaired local circulation and potential tissue necrosis. **Why Exercise is NOT relevant:** **Exercise** is contraindicated in the acute phase of compartment syndrome. Physical activity increases metabolic demand and blood flow to the muscles, which further elevates intracompartmental pressure and exacerbates ischemia. Management focuses on **reducing** pressure, not increasing muscle activity. **Analysis of other options:** * **Fasciotomy:** This is the definitive surgical treatment. It involves incising the fascia to decompress the compartment and restore distal perfusion. * **Splitting of a tight cast:** This is the immediate first step in management. Removing or "bivalving" a restrictive cast/dressing can reduce intracompartmental pressure by up to 30–65%. * **Reexploration:** After a fasciotomy, the wound is left open and requires reexploration (usually within 48–72 hours) for debridement of necrotic tissue and eventual closure or skin grafting. **Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and pain on passive stretching of muscles. * **Late Sign:** Pulselessness (indicates irreversible damage; do not wait for this to diagnose). * **Pressure Threshold:** A Delta pressure ($\Delta P$) of **$\leq$ 30 mmHg** (Diastolic BP minus Compartment Pressure) is often used as an indication for fasciotomy. * **Positioning:** Keep the limb at the **level of the heart**. Elevating the limb above the heart reduces arterial inflow and worsens ischemia.

Q: What is commonly referred to as a Potts fracture?

Bimalleolar ankle fracture. **Explanation:** **Potts fracture** (also known as Dupuytren’s fracture) is a classic eponym used to describe a **bimalleolar ankle fracture**. It occurs due to a combination of abduction and external rotation forces at the ankle joint. In this injury, there is typically a fracture of the lateral malleolus (fibula) above the syndesmosis and a fracture of the medial malleolus (tibia) or a tear of the deltoid ligament. This disruption compromises the "ankle mortise," leading to joint instability. **Analysis of Options:** * **Option A (Correct):** Percivall Potts originally described this as a bimalleolar injury. It is the standard definition used in orthopaedic examinations. * **Option B:** A **Trimalleolar fracture** (Cotton’s fracture) involves the medial malleolus, lateral malleolus, and the posterior malleolus (posterior lip of the tibia). * **Option C:** A fracture of the distal end of the radius is most commonly a **Colles’ fracture** (dorsal displacement) or a **Smith’s fracture** (volar displacement). * **Option D:** Pathological fractures in osteomalacia are typically referred to as **Looser’s zones** or Milkman’s fractures (pseudofractures). **High-Yield Clinical Pearls for NEET-PG:** * **Lauge-Hansen Classification:** The most widely used system for ankle fractures based on the foot position and the direction of the deforming force. * **Danis-Weber Classification:** Categorizes ankle fractures based on the level of the fibular fracture relative to the syndesmosis (Type A, B, and C). * **Management:** Stable fractures are treated with a below-knee cast; however, most Potts fractures are unstable and require **Open Reduction and Internal Fixation (ORIF)** to restore the anatomy of the ankle mortise. * **Maisonneuve Fracture:** A high-yield variant involving a proximal fibular fracture associated with a medial malleolar break or deltoid ligament rupture.

Question 1

A Hill-Sachs lesion in recurrent shoulder dislocation is:

Accepted Answer

Injury to the humeral head

Answer

Rupture of the tendon of the supraspinatus muscle

Answer

Avulsion of the glenoid labrum

Answer

None of the above

Question 2

A Bankart's lesion involves which part of the glenoid labrum?

Accepted Answer

Antero-inferior lip

Answer

Anterior lip

Answer

Superior lip

Answer

Antero-superior lip

Question 3

A patient is brought to the emergency following a road traffic accident (dashboard injury). Examination reveals the affected limb is held in flexion, adduction, and internal rotation with apparent shortening. What type of hip dislocation is most likely?

Accepted Answer

Posterior

Answer

Answer

Inferior

Answer

None of the above

Question 4

Which of the following is NOT true about calcaneum fracture?

Accepted Answer

GISSEN'S angle in intra-articular fracture is decreased.

Answer

The BoWLER'S angle is decreased.

Answer

It is the most commonly injured tarsal bone.

Answer

Also known as Loveri fracture.

Question 5

Malgaigne's fracture involves which of the following anatomical structures?

Accepted Answer

Pelvis

Answer

Femur head

Answer

Tibial spine

Answer

Proximal humerus

Question 6

Which of the following statements regarding dislocation of the shoulder is FALSE?

Accepted Answer

In posterior dislocation, the appearance of the shoulder is abnormal.

Answer

The head of the humerus usually dislocates anteriorly from the shoulder joint.

Answer

The injury is produced by forced extension and external rotation of an abducted arm.

Answer

None of the above

Question 7

A 13-year-old male presents with forearm pain and deformity after a fall onto his palm. Examination reveals an obvious angulation at the mid-forearm, with intact finger movement, circulation, and sensation. X-rays of the forearm are obtained. What is the most likely diagnosis?

Accepted Answer

Galeazzi's fracture

Answer

Night-stick fracture

Answer

Monteggia's fracture

Answer

Colles' fracture

Question 8

What type of Monteggia fracture is commonly associated with nerve injuries?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 9

Which of the following is NOT relevant in the management of compartment syndrome?

Accepted Answer

Exercise

Answer

Fasciotomy

Answer

Splitting of a tight cast

Answer

Reexploration

Question 10

What is commonly referred to as a Potts fracture?

Accepted Answer

Bimalleolar ankle fracture

Answer

Trimalleolar ankle fracture

Answer

Fracture of distal end radius

Answer

Pathological fracture in osteomalacia

Trauma — MCQs

Trauma — MCQs

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