Trauma Practice Questions

Q: What is the most serious complication of a fracture of a long bone?

Fat embolism. ### Explanation **Correct Option: A. Fat Embolism** Fat Embolism Syndrome (FES) is considered the most serious and life-threatening systemic complication specifically associated with long bone fractures (especially the femur and tibia). When a long bone breaks, fat globules from the bone marrow are released into the systemic circulation. These globules can cause mechanical obstruction and trigger a biochemical inflammatory response (via free fatty acids), leading to acute respiratory distress, neurological dysfunction, and petechial rashes. Its rapid onset (24–72 hours) and high mortality rate make it the most dreaded acute complication. **Why other options are incorrect:** * **B. Pulmonary Embolism (PE):** While life-threatening, PE is usually a secondary complication of DVT and occurs later in the recovery phase (often after a week of immobilization). In the context of the *fracture event itself*, fat embolism is the more direct and classic "serious" complication. * **C. Deep Vein Thrombosis (DVT):** DVT is a common complication due to stasis and immobilization, but it is not as acutely fatal as a massive fat embolism. * **D. Associated Joint Injuries:** These are common and can lead to long-term morbidity (like stiffness or arthritis), but they are rarely life-threatening. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosing FES. Major criteria include **respiratory insufficiency**, **cerebral involvement** (confusion/coma), and **petechial rash** (typically over the chest, axilla, and conjunctiva). * **Snowstorm Appearance:** The classic finding on a chest X-ray in a patient with FES. * **Prevention:** Early internal fixation and stabilization of the fracture is the most effective way to prevent FES. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Corticosteroids are controversial but sometimes mentioned.

Q: Aseptic necrosis is common in which of the following bones?

Scaphoid. **Explanation:** The correct answer is **Scaphoid**. The primary reason for the high incidence of aseptic necrosis (Avascular Necrosis - AVN) in the scaphoid is its **retrograde blood supply**. Approximately 70-80% of the scaphoid's blood supply enters through the dorsal ridge and distal pole via the radial artery. Consequently, a fracture through the waist or proximal pole interrupts the blood flow to the proximal fragment, leaving it ischemic. Since the scaphoid is largely covered by articular cartilage, it has limited areas for vascular entry, further predisposing it to AVN and non-union. **Analysis of Incorrect Options:** * **B. Calcaneum:** This is a large, cancellous bone with a robust, multi-directional blood supply. Fractures here typically heal well, though they may lead to subtalar arthritis. * **C. Cuboid:** Like most tarsal bones, it has a rich vascular network and is rarely subject to isolated ischemic necrosis. * **D. Trapezium:** While located in the carpus, it does not share the precarious retrograde vascular anatomy of the scaphoid and thus has a low risk of AVN. **High-Yield Clinical Pearls for NEET-PG:** * **Common Sites for AVN:** Remember the mnemonic **"S-F-A-T"** (Scaphoid, Femur head, Astragalus/Talus, Tally/Capitate). * **Talus:** Similar to the scaphoid, the talus has a retrograde blood supply (entering through the neck), making the body prone to AVN after neck fractures (**Hawkins’ Sign** on X-ray indicates a good prognosis/revascularization). * **Preiser’s Disease:** This refers to idiopathic AVN of the scaphoid (without a preceding fracture). * **Kienbock’s Disease:** AVN of the **Lunate** bone. * **Kohler’s Disease:** AVN of the **Navicular** bone in children.

Q: A 68-year-old female presents with a posterior displacement of the left distal wrist and hand after a fall. Radiographic examination reveals an oblique fracture of the radius. Which of the following is the most likely fracture involved in this case?

Colles' fracture. ### Explanation **Correct Option: A. Colles' fracture** A **Colles' fracture** is a distal radius fracture (usually within 2.5 cm of the wrist joint) characterized by **dorsal (posterior) displacement** and angulation of the distal fragment. It typically occurs in elderly, osteoporotic women following a fall on an outstretched hand (FOOSH). The classic clinical appearance is the **"Dinner Fork Deformity."** In this case, the patient’s age, mechanism of injury, and posterior displacement of the distal wrist are pathognomonic for Colles' fracture. **Why the other options are incorrect:** * **B. Scaphoid fracture:** This is the most common carpal bone fracture. It presents with tenderness in the **anatomical snuffbox**, not a gross posterior displacement of the distal radius. * **C. Bennett's fracture:** This is an intra-articular fracture-subluxation at the **base of the first metacarpal** (thumb). It does not involve the distal radius or cause a dinner fork deformity. * **D. Volkmann's ischemic contracture (VIC):** This is a **sequela (complication)** of untreated compartment syndrome, often following supracondylar fractures of the humerus. It is a permanent flexion deformity of the wrist and fingers due to muscle ischemia, not an acute fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Smith’s Fracture:** Often called a "Reverse Colles," it involves **ventral (palmar)** displacement of the distal radius fragment. * **Barton’s Fracture:** An intra-articular oblique fracture of the distal radius with associated subluxation of the carpus. * **Chauffeur’s Fracture:** An intra-articular fracture of the **radial styloid process**. * **Eponymous Deformity:** Remember, Colles = Dinner Fork; Smith = Garden Spade.

Q: Which of the following factors favor fat embolism in a trauma patient?

Hypovolemic shock. **Explanation:** Fat Embolism Syndrome (FES) typically occurs following fractures of long bones (like the femur) or the pelvis. The pathophysiology involves the release of fat globules from the bone marrow into the systemic circulation. **Why Hypovolemic Shock is the correct answer:** Hypovolemic shock is a major predisposing factor for fat embolism. In a state of shock, there is **decreased systemic blood flow and stasis** in the microcirculation. This sluggish flow allows fat globules to coalesce and obstruct small capillaries more easily. Furthermore, shock triggers a systemic inflammatory response that increases the permeability of the lung capillaries, exacerbating the damage caused by the biochemical breakdown of fat into free fatty acids (the "Chemical Theory" of FES). **Analysis of Incorrect Options:** * **A. Diabetes Mellitus:** While DM affects bone healing and vascular health, it is not a direct predisposing factor for the mechanical release or systemic manifestation of fat emboli. * **B. Mobility of joint:** While movement of the *fracture site* (not the joint specifically) can theoretically increase marrow pressure, the gold standard for preventing FES is **early stabilization/fixation** of the fracture. Joint mobility itself is not a recognized risk factor. * **C. Respiratory failure:** This is a **consequence** (clinical feature) of fat embolism, not a factor that favors its occurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major signs include **Petechial rash** (vest distribution/axilla), respiratory insufficiency, and cerebral involvement (confusion). * **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse pulmonary infiltrates). * **Management:** Primarily supportive (Oxygenation/Ventilation). Early splintage and operative fixation of fractures are the most effective preventive measures.

Q: Bohler's angle is reduced in which of the following fractures?

Fracture Calcaneus. **Explanation:** **Bohler’s Angle** (also known as the Tuber-joint angle) is a crucial radiographic measurement used to assess the integrity of the **calcaneus**. It is formed by drawing two lines on a lateral foot X-ray: 1. From the highest point of the anterior process to the highest point of the posterior facet. 2. From the highest point of the posterior facet to the highest point of the calcaneal tuberosity. The **normal range is 20° to 40°**. In a **calcaneal fracture** (typically caused by an axial load, such as falling from a height), the calcaneal body is compressed or flattened, causing the angle to **decrease or even become negative**. **Analysis of Incorrect Options:** * **Supracondylar fracture of humerus:** Assessed using the *Baumann angle* or the *Anterior Humeral Line*. * **Fracture neck of femur:** Evaluated using *Garden’s classification* or *Pauwels' classification*; Bohler’s angle has no anatomical relevance here. * **Colles fracture:** This is a distal radius fracture. Radiographic assessment focuses on *radial inclination, radial height,* and *palmar tilt*. **High-Yield Clinical Pearls for NEET-PG:** * **Gissane’s Angle (Crucial Angle):** Also used for calcaneal fractures; it is the angle between the downward slope of the thalami regalis and the upward slope of the anterior process (Normal: 120°–145°). In fractures, this angle **increases**. * **Don Juan Syndrome:** Calcaneal fractures are often associated with compression fractures of the **lumbar spine** (L1-L2) due to the same axial loading mechanism. Always screen the spine in these patients. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot, pathognomonic for calcaneal fracture.

Q: Essex-Lopresti is a fracture of what?

Radial head with interosseous membrane. **Explanation:** The **Essex-Lopresti fracture-dislocation** is a complex injury of the forearm characterized by a longitudinal disruption of the forearm's stability. It involves a triad of injuries: 1. **Comminuted fracture of the radial head.** 2. **Rupture of the interosseous membrane (IOM).** 3. **Dislocation of the Distal Radioulnar Joint (DRUJ).** The underlying mechanism is usually a high-energy fall on an outstretched hand. The force is transmitted proximally from the wrist, tearing the IOM and fracturing the radial head. Because the IOM is torn, the radius migrates proximally (proximal migration of the radius), leading to incongruity and dislocation at the DRUJ. **Analysis of Options:** * **Option B (Correct):** Accurately identifies the involvement of the radial head and the interosseous membrane, which is the hallmark of this longitudinal instability. * **Option A & C:** While the ulnar head or styloid may occasionally be involved in complex trauma, they are not the defining components of an Essex-Lopresti injury. * **Option D:** A radial head fracture alone is a simple fracture; it lacks the longitudinal instability and IOM involvement required for this eponym. **High-Yield Clinical Pearls for NEET-PG:** * **The "Don't Miss" Rule:** Always palpate the wrist in every radial head fracture. Pain at the DRUJ suggests an Essex-Lopresti injury. * **Management:** Excision of the radial head is **contraindicated** as it leads to further proximal migration of the radius. Treatment usually involves ORIF or replacement of the radial head to maintain forearm length. * **Comparison:** * **Galeazzi:** Distal radius fracture + DRUJ dislocation. * **Monteggia:** Proximal ulnar fracture + Radial head dislocation. * **Essex-Lopresti:** Radial head fracture + IOM tear + DRUJ dislocation.

Q: Which of the following statements regarding dislocation of the hip joint is true?

All of the above.. Hip dislocations are high-energy traumatic injuries, most commonly occurring during motor vehicle accidents (e.g., dashboard injuries). **Explanation of Options:** * **Option A:** **Posterior dislocation** is the most common type, accounting for approximately **90%** of all hip dislocations. It typically occurs when the knee strikes the dashboard while the hip is flexed and adducted. * **Option B:** In **posterior dislocation**, the characteristic clinical deformity is **flexion, adduction, and internal (medial) rotation**. The femoral head is forced behind the acetabulum, and the tension of the external rotators is lost, leading to medial rotation. * **Option C:** In **anterior dislocation**, the limb is held in **flexion, abduction, and external (lateral) rotation**. This occurs when the hip is forced into extension and abduction (e.g., a fall from height). Since all three statements are anatomically and clinically accurate, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** 1. **The "Shortening" Rule:** The limb appears shortened in both anterior and posterior dislocations, but the rotation is the key differentiator (Posterior = Internal; Anterior = External). 2. **Nerve Injury:** The **Sciatic nerve** (specifically the peroneal division) is most commonly injured in posterior dislocations. 3. **Vascular Complication:** **Avascular Necrosis (AVN)** of the femoral head is the most dreaded complication. The risk increases significantly if the dislocation is not reduced within **6 hours**. 4. **X-ray Sign:** On an AP view, the femoral head appears **smaller** than the contralateral side in posterior dislocation and **larger** in anterior dislocation (due to magnification).

Question 1

What is the most serious complication of a fracture of a long bone?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Deep vein thrombosis

Answer

Associated joint injuries

Question 2

Aseptic necrosis is common in which of the following bones?

Accepted Answer

Scaphoid

Answer

Calcaneum

Answer

Cuboid

Answer

Trapezium

Question 3

A 45-year-old driver involved in a motor vehicle collision sustains a posterior dislocation of the left hip. What is the most likely concomitant injury?

Accepted Answer

Left knee anterior cruciate ligament tear

Answer

Right knee meniscus tear

Answer

Subdural hematoma

Answer

Lumbar burst fracture

Question 4

A 68-year-old female presents with a posterior displacement of the left distal wrist and hand after a fall. Radiographic examination reveals an oblique fracture of the radius. Which of the following is the most likely fracture involved in this case?

Accepted Answer

Colles' fracture

Answer

Scaphoid fracture

Answer

Bennett's fracture

Answer

Volkmann's ischemic contracture

Question 5

Which of the following factors favor fat embolism in a trauma patient?

Accepted Answer

Hypovolemic shock

Answer

Diabetes Mellitus

Answer

Mobility of joint

Answer

Respiratory failure

Question 6

A patient with a history of road traffic accident (RTA) presents to the emergency department with an open injury classified as Gustilo-Anderson type III B. What does this classification indicate?

Accepted Answer

Limb wound greater than 10 cm with extensive soft tissue damage and periosteal stripping

Answer

Limb wound greater than 10 cm with extensive laceration

Answer

Limb wound less than 1 cm

Answer

Wound between 1 and 10 cm in length, without extensive soft tissue damage, flaps, or avulsion

Question 7

Bohler's angle is reduced in which of the following fractures?

Accepted Answer

Fracture Calcaneus

Answer

Supracondylar fracture of humerus

Answer

Fracture neck of femur

Answer

Colles fracture

Question 8

Essex-Lopresti is a fracture of what?

Accepted Answer

Radial head with interosseous membrane

Answer

Radial head with ulnar styloid

Answer

Radial head with ulnar head

Answer

Radial head alone

Question 9

Which of the following statements regarding dislocation of the hip joint is true?

Accepted Answer

All of the above.

Answer

Posterior dislocation is commoner.

Answer

In posterior dislocation, the whole lower limb is rotated medially.

Answer

In anterior dislocation, the whole lower limb is rotated laterally.

Question 10

After a joint injury, an 8-year-old child developed joint stiffness. Radiographs show the development of myositis ossificans. Which joint is most commonly involved?

Accepted Answer

Elbow

Answer

Knee

Answer

Shoulder

Answer

Hip

Trauma — MCQs

Trauma — MCQs

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