Trauma Practice Questions

Q: What is the best treatment for a fracture and dislocation of the lateral clavicle?

Surgical repair. **Explanation:** Fractures of the lateral (distal) third of the clavicle are classified using the **Neer Classification**. When a fracture is associated with a dislocation or instability (specifically Neer Type II), it indicates that the coracoclavicular (CC) ligaments are detached from the proximal fragment. **1. Why Surgical Repair is Correct:** In lateral clavicle fractures with dislocation, the weight of the arm pulls the distal fragment downward, while the sternocleidomastoid muscle pulls the proximal fragment upward. This significant displacement and the loss of ligamentous stability lead to a **high rate of non-union (up to 30-40%)** if treated conservatively. Therefore, **Surgical Repair** (using techniques like hook plates, tension band wiring, or CC ligament reconstruction) is the treatment of choice to ensure anatomical reduction and bone healing. **2. Why Incorrect Options are Wrong:** * **A & C (Figure of 8 splint / Normal sling):** These are conservative management options. While appropriate for undisplaced mid-shaft fractures (Neer Type I or III), they cannot counteract the strong deforming forces in unstable lateral fractures, leading to malunion or persistent non-union. * **B (Open reduction):** While open reduction is a *step* in the procedure, "Surgical repair" is the more comprehensive term that includes both reduction and the necessary internal fixation/ligamentous stabilization required for this specific injury. **Clinical Pearls for NEET-PG:** * **Neer Type II** is the most common lateral clavicle fracture requiring surgery. * **Most common site of clavicle fracture:** Middle third (80%), usually treated conservatively with a U-slab or triangular sling. * **Allman Classification:** Group I (Mid-shaft), Group II (Lateral), Group III (Medial). * **Complication:** The most common complication of clavicle fractures is **malunion**, but for lateral Type II fractures, it is **non-union**.

Q: A 40-year-old man was admitted with fracture of the shaft of the femur following a road traffic accident. On the 2nd day, he became disoriented, was found to be tachypnoeic, and had conjunctival petechiae. What is the most likely diagnosis?

Fat embolism. ### Explanation The clinical presentation described is a classic triad of **Fat Embolism Syndrome (FES)**, which typically occurs 24–72 hours after a long bone fracture (most commonly the femur). **Why Fat Embolism is the Correct Answer:** Fat embolism occurs when fat globules from the bone marrow enter the systemic circulation following a fracture. The diagnosis is primarily clinical, based on **Gurd’s Criteria**. This patient exhibits the classic triad: 1. **Respiratory Distress:** Tachypnoea and hypoxia. 2. **Neurological Changes:** Disorientation/confusion (due to cerebral microemboli). 3. **Petechial Rash:** Characteristically found in the conjunctiva, axilla, and neck (pathognomonic but present in only 20-50% of cases). **Why Other Options are Incorrect:** * **Pulmonary Embolism (PE):** While it causes tachypnoea, it usually occurs later (1–2 weeks post-injury) due to DVT. It does not present with petechiae. * **Sepsis Syndrome:** Usually presents with fever, hypotension, and a clear source of infection. The 48-hour window and petechiae are more specific to FES. * **Haemothorax:** This would present immediately after trauma with decreased breath sounds and dullness on percussion, not after a 2-day "latent period." **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Fracture of the shaft of the femur. * **Earliest sign:** Hypoxia (PaO2 < 60 mmHg). * **Pathognomonic sign:** Petechial rash. * **Investigation of choice:** Clinical diagnosis; however, "Snowstorm appearance" may be seen on Chest X-ray. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early splintage and fixation of the fracture are the best preventive measures.

Q: What is the common site of fracture in the tibia?

Junction of upper two-thirds and lower one-third. The tibia is the most commonly fractured long bone in the body. The **junction of the upper two-thirds and lower one-third** of the shaft is the most frequent site of fracture due to two primary anatomical factors: 1. **Change in Cross-sectional Shape:** The tibial shaft transitions from a robust, triangular cross-section in its upper two-thirds to a weaker, cylindrical (circular) cross-section in the lower one-third. This transition zone creates a natural point of mechanical weakness. 2. **Nutrient Artery Entry:** The nutrient artery enters the posterior surface of the tibia in its upper third and runs downwards. Fractures at the junction of the middle and lower thirds often disrupt this blood supply, leading to a high incidence of delayed union or non-union. **Analysis of Options:** * **Option A & D:** While fractures can occur in the upper and middle thirds (often due to direct high-energy trauma), these areas are wider and have better muscular coverage and blood supply compared to the distal junction. * **Option C:** While the lower one-third is vulnerable, the specific point of maximal weakness is the transition zone where the bone morphology changes (the junction). **Clinical Pearls for NEET-PG:** * **Blood Supply:** The lower third of the tibia is notorious for poor blood supply because it lacks significant muscular attachments (it is mostly subcutaneous). * **Compound Fractures:** Because the anteromedial surface of the tibia is subcutaneous throughout its length, tibial fractures are the most common **open (compound) fractures** in the body. * **March Fracture:** This refers to a stress fracture, typically involving the neck of the 2nd or 3rd metatarsal, not the tibia. * **Runner's High-Yield:** Medial Tibial Stress Syndrome (Shin Splints) typically involves the distal two-thirds of the tibial shaft.

Q: What is the treatment of choice for a 65-year-old male with a fracture of the neck of the femur sustained 6 weeks ago?

Hemiarthroplasty. ### Explanation The treatment of choice for a fracture of the neck of the femur depends primarily on the **age of the patient** and the **duration since the injury**. **Why Hemiarthroplasty is Correct:** In an elderly patient (65 years old) with a "neglected" or old fracture (6 weeks duration), the risk of **Avascular Necrosis (AVN)** and **Non-union** is extremely high due to the precarious retrograde blood supply of the femoral head. At 6 weeks, the fracture site is unlikely to heal with internal fixation. Therefore, replacing the femoral head (Hemiarthroplasty) is the standard of care. It allows for immediate weight-bearing and avoids the complications of a second surgery if fixation fails. **Analysis of Incorrect Options:** * **A. SP (Smith-Petersen) Nailing:** This is an obsolete method of internal fixation. Even modern fixation (like Cannulated Cancellous Screws) is generally avoided in elderly patients with old fractures because the biological potential for healing is lost after 3 weeks. * **B. McMurray’s Osteotomy:** This is a displacement osteotomy used historically to convert shearing forces into compressive forces to promote healing in non-union. However, it is rarely performed today and is not the first choice in an elderly patient who requires early mobilization. **High-Yield Clinical Pearls for NEET-PG:** 1. **The "3-Week" Rule:** Neck of femur fractures are considered "neglected" if they are >3 weeks old. 2. **Age-Based Management:** * ** 60 years:** Replacement (Hemiarthroplasty if sedentary; Total Hip Arthroplasty if active/pre-existing arthritis). 3. **Garden Classification:** Used to grade displacement; Garden III and IV have the highest risk of AVN. 4. **Pauwels Classification:** Based on the angle of the fracture line; higher angles indicate greater instability.

Q: Spur sign is/are seen in which of the following conditions?

Acetabulum fracture of pelvis. ### Explanation The **Spur Sign** is a pathognomonic radiological feature of **Both Column Acetabular Fractures**. **1. Why Acetabulum fracture is correct:** In a "both column" fracture, the articular surface is completely detached from the stable posterior ilium (the axial skeleton). On an Obturator Oblique view (Judet view), the **Spur Sign** represents the lowermost part of the intact posterior ilium that remains attached to the sacroiliac joint. Because the acetabular roof has displaced medially and posteriorly, this intact piece of bone "juts out" like a spur. Its presence confirms that no part of the articular surface remains attached to the sciatic buttress. **2. Why other options are incorrect:** * **Supracondylar fracture of humerus:** This is associated with the "Fat Pad sign" (Sail sign) or "Gartland classification," but not a spur sign. * **Radial head fracture:** Common signs include the "Fat Pad sign" due to joint effusion and the "Mason classification." * **Talus fracture:** These are associated with "Hawkins’ Sign" (subchondral lucency indicating intact vascularity), which is a crucial prognostic factor for avascular necrosis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Judet Views:** Essential for acetabular fractures. *Iliac Oblique* shows the posterior column and anterior wall; *Obturator Oblique* shows the anterior column and posterior wall (and the Spur Sign). * **Letournel Classification:** The gold standard for acetabular fractures (divided into 5 simple and 5 associated patterns). * **Both Column Fracture:** The only acetabular fracture where the "Spur Sign" is visualized. * **Floating Acetabulum:** Another term used for both column fractures because the joint is completely disconnected from the ilium.

Question 1

A Morel-Lavallee lesion is typically associated with which type of fracture?

Accepted Answer

Acetabular fracture

Answer

Femoral neck fracture

Answer

Lumbar spine fracture

Answer

Proximal tibia fracture

Question 2

What is the best treatment for a fracture and dislocation of the lateral clavicle?

Accepted Answer

Surgical repair

Answer

Figure of 8 splint

Answer

Open reduction

Answer

Normal sling

Question 3

The fracture of the tooth-bearing segment of the mandible is classified as which type?

Accepted Answer

Compound

Answer

Simple

Answer

Complex

Answer

Comminuted

Question 4

What is the treatment for a displaced proximal olecranon fracture?

Accepted Answer

Tension band wiring

Answer

Excision and resuturing

Answer

Immobilization of the elbow by cast

Answer

Open reduction and external fixation

Question 5

A 40-year-old man was admitted with fracture of the shaft of the femur following a road traffic accident. On the 2nd day, he became disoriented, was found to be tachypnoeic, and had conjunctival petechiae. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Sepsis syndrome

Answer

Haemothorax

Question 6

What is the first muscle to be involved in Volkmann's ischemic contracture of the forearm?

Accepted Answer

Flexor digitorum profundus

Answer

Flexor digitorum superficialis

Answer

Flexor Carpi Radialis

Answer

Extensor carpi radialis brevis

Question 7

What is the common site of fracture in the tibia?

Accepted Answer

Junction of upper two-thirds and lower one-third

Answer

Upper one-third

Answer

Lower one-third

Answer

Middle one-third

Question 8

Prosthetic replacement of the femoral head is usually indicated for which of the following?

Accepted Answer

Untreated femoral neck fracture in a patient over 65 years

Answer

Fresh intracapsular fracture of the head of the femur in elderly patients

Answer

Fresh intracapsular fracture of the femoral neck in a young adult

Answer

Unreduced posterior dislocation of the hip

Question 9

What is the treatment of choice for a 65-year-old male with a fracture of the neck of the femur sustained 6 weeks ago?

Accepted Answer

Hemiarthroplasty

Answer

SP nailing

Answer

Mc Murray's osteotomy

Answer

None of the above

Question 10

Spur sign is/are seen in which of the following conditions?

Accepted Answer

Acetabulum fracture of pelvis

Answer

Supracondylar fracture of humerus

Answer

Radial head fracture

Answer

Talus fracture

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?