Trauma Practice Questions

Q: Prosthetic replacement of the femoral head is indicated for which of the following fracture sites of the femur?

Subcapital fracture of the neck of femur. **Explanation:** The primary indication for prosthetic replacement (Hemiarthroplasty) in femoral neck fractures is the high risk of **Avascular Necrosis (AVN)** and **Non-union**. **1. Why Subcapital Fracture is the Correct Answer:** The femoral head receives its blood supply mainly through the **retinacular vessels** (branches of the medial circumflex femoral artery) which run along the neck. A **subcapital fracture** occurs just below the femoral head, where the fracture line is intracapsular. This frequently disrupts the blood supply, leading to a high incidence of AVN. In elderly patients with low functional demands, primary prosthetic replacement is preferred over internal fixation to avoid the complications of re-operation. **2. Analysis of Incorrect Options:** * **Inter-trochanteric (A) and Transtrochanteric (C) Fractures:** These are **extracapsular** fractures. This region has a rich blood supply and a large surface area of cancellous bone, leading to excellent healing potential. The treatment of choice is internal fixation (e.g., DHS or Cephalomedullary nail), not replacement. * **Basal Fracture of the Neck (D):** This occurs at the junction of the neck and the trochanter. Being further away from the head, the blood supply is often preserved compared to subcapital fractures. These are usually treated with internal fixation. **Clinical Pearls for NEET-PG:** * **Garden’s Classification:** Used for intracapsular fractures. Stage III and IV (displaced) in elderly patients are the classic indications for Hemiarthroplasty. * **Pauwels’ Classification:** Based on the angle of the fracture line; higher angles (Type III) indicate greater shear forces and higher risk of non-union. * **Choice of Surgery:** In young patients, always attempt **Internal Fixation** (Head salvage) regardless of displacement. In active elderly patients, **Total Hip Arthroplasty (THA)** is superior to Hemiarthroplasty.

Q: What is the preferred treatment for cubitus varus?

Lateral closing wedge osteotomy. **Explanation:** **Cubitus varus**, commonly known as "Gunstock deformity," is the most frequent late complication of malunited supracondylar fractures of the humerus. It is a three-dimensional deformity involving varus angulation, internal rotation, and hyperextension. **Why Lateral Closing Wedge Osteotomy (French Osteotomy) is the Correct Choice:** The **Lateral Closing Wedge Osteotomy** is the gold standard treatment for correcting cubitus varus. In this procedure, a wedge of bone is removed from the lateral aspect of the distal humerus. This allows the surgeon to tilt the distal fragment laterally, effectively correcting the varus angle. It is preferred because: 1. **Stability:** Closing a wedge provides better bone-on-bone contact, leading to faster healing and inherent stability. 2. **Simplicity:** It avoids the need for bone grafting and minimizes tension on the ulnar nerve. **Analysis of Incorrect Options:** * **Medial Closing Wedge Osteotomy:** This would worsen the varus deformity by further tilting the forearm toward the midline. * **Medial/Lateral Opening Wedge Osteotomies:** These require bone grafting to fill the gap, carry a higher risk of non-union, and can lead to increased tension on neurovascular structures (especially the ulnar nerve in medial opening procedures). **Clinical Pearls for NEET-PG:** * **Most common cause:** Malunited supracondylar fracture (specifically, failure to correct the medial tilt). * **Indication for surgery:** Primarily cosmetic; functional impairment is rare. * **French Osteotomy:** A specific type of lateral closing wedge osteotomy using two screws and a tension band wire. * **Ulnar Nerve:** While cubitus varus is usually asymptomatic, it can occasionally lead to **tardy ulnar nerve palsy** or posterolateral rotatory instability in adulthood.

Q: Which of the following is NOT a type of healthy bone healing?

Fibrous healing. **Explanation:** In orthopaedics, healthy bone healing is categorized into **Primary (Direct)** and **Secondary (Indirect)** healing. The goal of both is the restoration of bony continuity through mineralized tissue. **Why Fibrous Healing is the correct answer:** **Fibrous healing** (or fibrous union) is considered a form of **impaired healing** or non-union. Instead of forming a bony bridge, the fracture gap is filled with dense fibrous connective tissue. This results in a lack of structural stability and clinical "false motion" at the fracture site. It is not a healthy physiological end-point of bone repair. **Analysis of Incorrect Options:** * **A. Contact Healing:** A type of **Primary Healing**. It occurs when there is absolute stability (compression plating) and the gap is <0.01 mm. Osteoclasts create "cutting cones" that cross the fracture line, followed by osteoblasts laying down lamellar bone immediately. There is no callus formation. * **B. Gap Healing:** Also a type of **Primary Healing**. It occurs when the gap is small (<1 mm) and stable. The gap is first filled by woven bone, which is later remodeled into lamellar bone. Like contact healing, this occurs without external callus. * **C. Healing with Callus Formation:** This is **Secondary Healing**, the most common type of natural bone healing. It occurs in the presence of relative micromotion (e.g., casts, intramedullary nails). It involves a sequential process: Hematoma → Soft Callus (cartilage) → Hard Callus (woven bone) → Remodeling. **NEET-PG High-Yield Pearls:** * **Absolute Stability** (Plating) → Primary Healing → **No Callus.** * **Relative Stability** (Nailing/Casting) → Secondary Healing → **Callus present.** * **Cutting Cones** are the hallmark of primary bone healing. * **Strain Theory (Perren):** Bone formation requires low strain (<2%). If strain is too high, fibrous tissue forms instead of bone.

Q: Uncomplicated shoulder dislocation most commonly occurs in which direction?

Anterior. **Explanation:** The shoulder (glenohumeral) joint is the most commonly dislocated joint in the body due to the inherent instability provided by a shallow glenoid cavity and a large humeral head. **1. Why Anterior is Correct:** **Anterior dislocation** accounts for approximately **95-97%** of all shoulder dislocations. It typically occurs when the arm is in a position of **abduction and external rotation**. The anatomical weakness of the anterior capsule, specifically between the superior and middle glenohumeral ligaments (Foramen of Weitbrecht), makes the joint prone to displacement in this direction. **2. Why Other Options are Incorrect:** * **Posterior (B):** Accounts for only 2-5% of cases. It is classically associated with **seizures, electric shocks**, or direct trauma to the front of the shoulder. It is often missed on initial X-rays (look for the "Light bulb sign"). * **Superior (C):** Extremely rare. It usually involves a high-energy upward force and is typically associated with fractures of the acromion, clavicle, or coracoid process. * **Medially (D):** This is not a standard anatomical direction for shoulder dislocation. Displacement occurs relative to the glenoid fossa (Anterior, Posterior, or Inferior/Luxatio Erecta). **Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Axillary nerve (tested via sensation over the "Regimental Badge" area). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head. * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Kocher’s Method:** A historical reduction technique (though no longer preferred due to high complication rates like humeral fractures). * **Hippocratic Method:** The oldest described reduction technique using foot-in-axilla traction.

Q: Fracture of the base of the first metacarpal joint without associated dislocation is called?

Rolando fracture. **Explanation:** The correct answer is **Rolando fracture**. This is a **comminuted intra-articular fracture** at the base of the first metacarpal. Classically, it presents as a T-shaped or Y-shaped fracture pattern. Unlike a Bennett fracture, the fragments often remain relatively in place without a gross dislocation of the shaft, although the joint surface is severely disrupted. **Analysis of Options:** * **Bennett fracture:** This is an oblique, intra-articular fracture-dislocation at the base of the first metacarpal. The hallmark is the **dislocation** of the metacarpal shaft proximally and radially due to the pull of the Abductor Pollicis Longus (APL) muscle, while a small volar fragment remains attached to the trapezium. * **Jones fracture:** This occurs at the **base of the fifth metatarsal** (foot), specifically at the junction of the diaphysis and metaphysis (Zone 2). It is notorious for poor healing due to a watershed blood supply. * **Boxer's fracture:** This is a fracture of the **neck of the fifth metacarpal**, typically caused by striking a hard object with a closed fist. **High-Yield Pearls for NEET-PG:** * **Mechanism:** Both Bennett and Rolando fractures result from axial loading along the first metacarpal (e.g., a punch). * **Prognosis:** Rolando fractures have a **worse prognosis** than Bennett fractures because the comminution makes anatomical reduction difficult, leading to early-onset osteoarthritis. * **Treatment:** Bennett fractures usually require K-wire fixation (CRIF/ORIF), while Rolando fractures often require open reduction with a T-plate or external fixation if highly comminuted. * **Gamekeeper’s Thumb:** An injury to the Ulnar Collateral Ligament (UCL) of the first MCP joint, often associated with an avulsion fracture.

Q: A 56-year-old woman visits the emergency department after falling on wet pavement. Radiographic examination reveals osteoporosis and a Colles' fracture. Which of the following carpal bones are often fractured or dislocated with a Colles' fracture?

Scaphoid and lunate. **Explanation:** **1. Why Scaphoid and Lunate are correct:** A Colles' fracture is a distal radius fracture (within 2.5 cm of the wrist joint) occurring due to a fall on an outstretched hand (FOOSH) with the wrist in dorsiflexion. The mechanism of injury involves the transmission of force from the ground through the carpal bones to the distal radius. The **Scaphoid** and **Lunate** are the two primary carpal bones that articulate directly with the distal radius (at the scaphoid and lunate fossae). During the impact, these bones act as a wedge against the radial articular surface, making them the most susceptible to concomitant fractures or ligamentous dislocations (such as scapholunate dissociation) alongside the radial fracture. **2. Analysis of Incorrect Options:** * **A & B (Triquetrum):** The triquetrum articulates with the TFCC (Triangular Fibrocartilage Complex) rather than the radius itself. While it can be injured in wrist trauma, it is not as frequently associated with the direct axial loading mechanism of a Colles' fracture compared to the scaphoid and lunate. * **D (Triquetrum, Lunate, and Scaphoid):** While multiple carpal injuries can occur in high-energy trauma, the standard clinical association for a typical Colles' fracture specifically highlights the two bones forming the primary radiocarpal joint. **3. NEET-PG High-Yield Pearls:** * **Colles' Fracture:** Characterized by **dorsal displacement**, dorsal tilt, and radial deviation ("Dinner Fork Deformity"). * **Smith’s Fracture:** The "Reverse Colles," involving volar displacement (Garden Spade Deformity). * **Associated Injury:** The most common associated fracture in a Colles' case is the **Ulnar Styloid process** (60% of cases). * **Complication:** The most common late complication is **Secondary Osteoarthritis**, while the most common tendon rupture is the **Extensor Pollicis Longus (EPL)**.

Q: A child develops severe forearm pain after a supracondylar fracture reduction and POP cast application. The child describes the pain as worse than the fracture pain and has limited finger movement. Volkmann's ischemic contracture is suspected. Which muscle is most commonly affected in Volkmann's ischemia?

Flexor digitorum profundus. **Explanation:** Volkmann’s Ischemic Contracture (VIC) is the sequela of untreated **Compartment Syndrome**, most commonly occurring after supracondylar fractures of the humerus. When tissue pressure within the deep fascia of the forearm exceeds capillary perfusion pressure, ischemia occurs. **Why Flexor Digitorum Profundus (FDP) is the correct answer:** The muscles located deepest in the compartment and closest to the bone are the most vulnerable to increased pressure and ischemia. The **Flexor Digitorum Profundus (FDP)** and the **Flexor Pollicis Longus (FPL)** are the deepest muscles in the volar compartment of the forearm. Among these, the FDP is considered the "watershed" area of perfusion and is the **most commonly and severely affected muscle** in Volkmann’s ischemia. **Analysis of Incorrect Options:** * **A. Pronator teres:** This is a superficial muscle. While it can be involved in severe cases, it is not the primary or most common site of ischemia. * **B. Flexor carpi radialis:** This is a superficial flexor. Ischemia typically progresses from the deep to the superficial layers. * **D. Flexor digitorum superficialis (FDS):** Although frequently involved as the condition progresses, it lies superficial to the FDP and is generally less affected than the deep layer in the early stages. **Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and **pain on passive extension** of fingers. * **Infarct Shape:** The ischemic zone is typically **ellipsoid-shaped**, with the center located at the FDP. * **Nerve Involvement:** The **Median nerve** is the most commonly affected nerve in the forearm compartment. * **Management:** Immediate removal of the cast/dressings. If no improvement within 30–60 minutes, urgent **fasciotomy** is indicated.

Q: Whiplash injury is damage to?

Spine. **Explanation:** **Whiplash injury** refers to a mechanism of acceleration-deceleration forces where energy is transferred to the **cervical spine**. It most commonly occurs during rear-end or side-impact motor vehicle collisions. 1. **Why the Spine is correct:** The term "whiplash" describes the rapid "whip-like" motion of the neck. When a vehicle is struck from behind, the torso is accelerated forward while the head lags behind, causing sudden **hyperextension** followed by rapid **rebound flexion**. This motion strains the soft tissues (ligaments, tendons, and muscles) of the cervical spine and can lead to facet joint injuries or disc herniation. 2. **Why other options are incorrect:** * **Skull:** While a head injury (concussion) can coexist with whiplash, the primary site of mechanical strain in whiplash is the neck, not the cranium. * **Rib cage:** Rib fractures typically require direct blunt trauma or compression, which is not the mechanism of a whiplash injury. * **Long bones:** These are injured in high-velocity impacts or direct falls, but they are not involved in the specific acceleration-deceleration mechanism defining whiplash. **Clinical Pearls for NEET-PG:** * **Quebec Classification:** Used to grade the severity of Whiplash-Associated Disorders (WAD), ranging from Grade 0 (no symptoms) to Grade 4 (fracture/dislocation). * **Common Symptom:** The most frequent symptom is neck pain/stiffness, often appearing **12–24 hours after** the injury (delayed onset). * **Radiology:** X-rays are often normal, but may show a "loss of cervical lordosis" due to muscle spasms. * **Treatment:** Early mobilization and NSAIDs are preferred over prolonged immobilization with a cervical collar.

Question 1

Prosthetic replacement of the femoral head is indicated for which of the following fracture sites of the femur?

Accepted Answer

Subcapital fracture of the neck of femur

Answer

Inter-trochanteric fracture

Answer

Transtrochanteric fracture

Answer

Basal fracture of the neck of femur

Question 2

A 40-year-old male with a history of road traffic accident (RTA) and multiple long bone fractures develops tachypnea, periumbilical rashes, and has urinary fat globules. What is the most likely diagnosis?

Accepted Answer

Fat embolism syndrome

Answer

Proximal urethral injury

Answer

Bladder injury

Answer

Bacterial pneumonitis

Question 3

What is the preferred treatment for cubitus varus?

Accepted Answer

Lateral closing wedge osteotomy

Answer

Medial closing wedge osteotomy

Answer

Medial opening wedge osteotomy

Answer

Lateral opening wedge osteotomy

Question 4

Which of the following is NOT a type of healthy bone healing?

Accepted Answer

Fibrous healing

Answer

Contact healing

Answer

Gap healing

Answer

Healing with callus formation

Question 5

Uncomplicated shoulder dislocation most commonly occurs in which direction?

Accepted Answer

Answer

Posterior

Answer

Superior

Answer

Medially

Question 6

Fracture of the base of the first metacarpal joint without associated dislocation is called?

Accepted Answer

Rolando fracture

Answer

Bennett fracture

Answer

Jones fracture

Answer

Boxer's fracture

Question 7

Which of the following associations between clinical angles and their corresponding conditions is incorrect?

Accepted Answer

Baumann's angle - fracture of the lateral condyle of the femur

Answer

Kite's angle - club foot

Answer

Gissan's angle - calcaneus fracture

Answer

Cobb's angle - scoliosis

Question 8

A 56-year-old woman visits the emergency department after falling on wet pavement. Radiographic examination reveals osteoporosis and a Colles' fracture. Which of the following carpal bones are often fractured or dislocated with a Colles' fracture?

Accepted Answer

Scaphoid and lunate

Answer

Triquetrum and scaphoid

Answer

Triquetrum and lunate

Answer

Triquetrum, lunate, and scaphoid

Question 9

A child develops severe forearm pain after a supracondylar fracture reduction and POP cast application. The child describes the pain as worse than the fracture pain and has limited finger movement. Volkmann's ischemic contracture is suspected. Which muscle is most commonly affected in Volkmann's ischemia?

Accepted Answer

Flexor digitorum profundus

Answer

Pronator teres

Answer

Flexor carpi radialis longus

Answer

Flexor digitorum superficialis

Question 10

Whiplash injury is damage to?

Accepted Answer

Spine

Answer

Skull

Answer

Rib cage

Answer

Long bones

Trauma — MCQs

Trauma — MCQs

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