Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 161: A 30-year-old biker sustained a compound fracture of the leg following a road traffic accident. The fracture has been classified as Gustilo-Anderson type IIIB. Which of the following best represents this injury classification?

A. Fracture with an open wound less than 1 cm
B. Fracture with an open wound of 1-10 cm with soft tissue coverage possible
C. Open wound more than 10 cm with extensive soft tissue damage and coverage not possible (Correct Answer)
D. Open wound more than 10 cm with arterial injury

Explanation: The **Gustilo-Anderson Classification** is the most widely used system for grading open fractures, primarily based on the energy of trauma, the extent of soft tissue damage, and the degree of contamination. ### **Explanation of the Correct Answer** **Option C** is correct because **Type IIIB** is defined by extensive soft tissue injury with **periosteal stripping** and bone exposure. The hallmark of Type IIIB is that the soft tissue defect is so severe that **primary closure is not possible**, and a plastic surgical procedure (like a flap) is required for coverage. While the wound size is often >10 cm, the defining feature is the inadequacy of local soft tissue to cover the bone. ### **Analysis of Incorrect Options** * **Option A (Type I):** Represents a clean wound <1 cm long, usually a "pierce-through" injury from within. * **Option B (Type II):** Represents a wound 1–10 cm long without extensive soft tissue damage or flaps. Soft tissue coverage of the bone is adequate. * **Option D (Type IIIC):** Represents any open fracture associated with an **arterial injury** requiring repair, regardless of the wound size or soft tissue status. ### **High-Yield Clinical Pearls for NEET-PG** * **Type IIIA:** Extensive soft tissue laceration but has **adequate soft tissue coverage** of the bone (unlike IIIB). * **Special Type III Categories:** Regardless of wound size, the following are automatically classified as **Type III**: 1. Segmental fractures. 2. High-velocity injuries (e.g., gunshot wounds). 3. Farm/soil-contaminated injuries. 4. Traumatic amputations. * **Management:** All open fractures require immediate IV antibiotics (usually a cephalosporin) and urgent surgical debridement. Type IIIB and IIIC carry a high risk of osteomyelitis and non-union.

Question 162: Fracture of the neck of the humerus is common in:

A. Elderly woman (Correct Answer)
B. Young lady
C. Elderly man
D. All of these

Explanation: **Explanation:** **1. Why "Elderly woman" is correct:** Fractures of the surgical neck of the humerus are classic **osteoporotic fragility fractures**. They typically occur due to a low-energy mechanism, such as a fall on an outstretched hand (FOOSH) from a standing height. Elderly women are the most susceptible demographic because of the rapid decline in bone mineral density following **menopause** (Type I Osteoporosis). The surgical neck is a site of transition from the dense cortical bone of the shaft to the more cancellous bone of the head, making it a structural weak point in osteoporotic patients. **2. Why other options are incorrect:** * **Young lady:** In younger populations, the bone density is high. A fracture in this region would require high-energy trauma (e.g., motor vehicle accidents) rather than a simple fall, making it much less common. * **Elderly man:** While elderly men can suffer from osteoporosis (Type II), the incidence is significantly lower and occurs later in life compared to post-menopausal women. * **All of these:** This is incorrect because the epidemiological peak is specifically skewed toward the elderly female population. **3. Clinical Pearls for NEET-PG:** * **Nerve Injury:** The **Axillary nerve** is the most commonly injured nerve in surgical neck fractures (check for "regimental badge" anesthesia over the deltoid). * **Vascular Injury:** The **Posterior circumflex humeral artery** is the most common vascular structure at risk. * **Neer’s Classification:** This is the standard classification system for proximal humerus fractures, based on the number of displaced "parts" (Greater tuberosity, Lesser tuberosity, Shaft, and Head). * **Treatment:** Most (approx. 80%) are minimally displaced and managed conservatively with a **U-slab or shoulder immobilizer**. Displaced fractures may require ORIF or Hemiarthroplasty.

Question 163: Trauma to a nerve resulting in paresthesia is termed as:

A. Neuropraxia (Correct Answer)
B. Axonotmesis
C. Neurotmesis
D. None of the above

Explanation: This question tests your knowledge of the **Seddon Classification** of nerve injuries, which is a high-yield topic for NEET-PG. ### **Explanation of the Correct Answer** **Neuropraxia** is the mildest form of nerve injury. It involves a physiological block of nerve conduction (usually due to focal ischemia or compression) without any anatomical disruption of the axon or the connective tissue sheath. * **Mechanism:** There is localized demyelination, but the axon remains intact. * **Clinical Presentation:** It manifests as temporary motor weakness or sensory changes like **paresthesia** (numbness/tingling). * **Recovery:** Since there is no Wallerian degeneration, recovery is spontaneous and complete, usually within days to a few weeks. ### **Analysis of Incorrect Options** * **B. Axonotmesis:** This involves the disruption of the **axon**, but the supporting connective tissue (endoneurium, perineurium, and epineurium) remains intact. It leads to Wallerian degeneration distal to the injury. Recovery is possible but slow (1 mm/day) as the axon must regrow. * **C. Neurotmesis:** This is the most severe grade, where the **entire nerve trunk** (axon and all connective tissue sheaths) is completely severed. Spontaneous recovery is impossible; surgical intervention is required. ### **NEET-PG High-Yield Pearls** 1. **Wallerian Degeneration:** Occurs in Axonotmesis and Neurotmesis, but **NOT** in Neuropraxia. 2. **Tinel’s Sign:** It is **absent** in Neuropraxia (because the axon is intact) but becomes **positive** in Axonotmesis as the nerve regenerates. 3. **Sunderland Classification:** An expansion of Seddon’s. * Grade 1 = Neuropraxia * Grade 2 = Axonotmesis * Grade 3-5 = Varying degrees of Neurotmesis (Grade 5 is complete transection). 4. **Common Example:** "Saturday Night Palsy" (Radial nerve compression) is a classic clinical example of Neuropraxia.

Question 164: In fracture shaft of femur, which nail is commonly used for ORIF?

A. Kuntscher nail (Correct Answer)
B. Austin Moore pin
C. K-wire
D. Smith-Peterson nail

Explanation: **Explanation:** The **Kuntscher nail (K-nail)** is the correct answer as it was historically the gold standard and remains a classic textbook answer for the intramedullary nailing of femoral shaft fractures. It is a cloverleaf-shaped, hollow stainless steel nail that works on the principle of **"three-point fixation."** It is a non-locking nail, meaning it relies on endosteal friction to provide stability, making it most suitable for transverse or short oblique fractures of the mid-shaft. **Analysis of Incorrect Options:** * **Austin Moore Pin:** These are used for the internal fixation of **fractures of the neck of the femur**, particularly in elderly patients (though now largely replaced by cannulated screws or hemiarthroplasty). * **K-wire (Kirschner wire):** These are thin, flexible wires used for temporary fixation, stabilizing small bone fragments (like phalanges or distal radius), or as a guide for larger implants. They lack the structural rigidity required for a weight-bearing bone like the femur. * **Smith-Peterson (S-P) Nail:** This is a triflanged nail historically used for **intracapsular femoral neck fractures**. It has been largely superseded by the Dynamic Hip Screw (DHS). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Today:** While the K-nail is the classic answer, the modern "Gold Standard" for femoral shaft fractures is the **Interlocking Intramedullary Nail**, which allows for rotational stability and can be used for comminuted fractures. * **Cloverleaf Cross-section:** The K-nail’s unique shape allows it to compress slightly during insertion and expand against the medullary canal for a snug fit. * **Ideal Site:** The K-nail is best suited for fractures in the **isthmus** (the narrowest part of the femoral canal).

Question 165: Which nerve is involved in this deformity?

A. Musculocutaneous nerve
B. Long thoracic nerve (Correct Answer)
C. Radial nerve
D. Thoracodorsal nerve

Explanation: ***Long thoracic nerve*** - **Winged scapula** occurs due to paralysis of the **serratus anterior muscle**, which is innervated by the long thoracic nerve. - The **serratus anterior** normally keeps the scapula flat against the chest wall; its weakness causes the **medial border** of the scapula to protrude outward. *Musculocutaneous nerve* - Innervates the **biceps**, **brachialis**, and **coracobrachialis muscles** in the anterior arm compartment. - Injury causes weakness in **elbow flexion** and **supination**, not scapular winging. *Radial nerve* - Innervates the **triceps** and **extensor muscles** of the forearm, controlling **wrist extension**. - Injury typically causes **wrist drop** and weakness in **finger extension**, not scapular abnormalities. *Thoracodorsal nerve* - Innervates the **latissimus dorsi muscle**, which is responsible for **shoulder adduction** and **internal rotation**. - Injury causes weakness in **pulling movements** and **swimming stroke**, but does not cause scapular winging.

Question 166: Open book and bucket handle injuries are seen in which anatomical region?

A. Spine
B. Pelvis (Correct Answer)
C. Femur
D. Knee

Explanation: **Explanation:** The correct answer is **Pelvis**. These terms describe specific patterns of pelvic ring disruptions caused by high-energy trauma. 1. **Open Book Injury:** This occurs due to **Anteroposterior (AP) Compression** forces. It involves a disruption of the pubic symphysis (diastasis >2.5 cm) and tearing of the anterior sacroiliac (SI) ligaments. The pelvis "opens" like a book, significantly increasing the pelvic volume, which often leads to life-threatening retroperitoneal hemorrhage. 2. **Bucket Handle Injury:** This is a type of **Lateral Compression** injury. It involves a fracture of the pubic rami on one side and a fracture/dislocation of the SI joint on the *contralateral* (opposite) side. The fractured hemipelvis rotates superiorly and medially, resembling the movement of a bucket handle. **Why other options are incorrect:** * **Spine:** Spinal injuries are classified by mechanisms like flexion-distraction (Chance fractures) or burst fractures, but do not use these specific descriptors. * **Femur:** Femoral fractures are classified by location (neck, intertrochanteric, shaft) or morphology (transverse, spiral), not by "open book" mechanisms. * **Knee:** While the knee has a "bucket handle" tear, it refers specifically to a **meniscal injury**, not a bony fracture pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Young-Burgess Classification:** The standard system for pelvic fractures based on mechanism (AP Compression, Lateral Compression, Vertical Shear). * **Initial Management:** The most critical step in an unstable open book fracture is applying a **Pelvic Binder** at the level of the greater trochanters to reduce pelvic volume and tamponade bleeding. * **Associated Injury:** Urethral and bladder injuries are highly associated with pelvic ring disruptions.

Question 167: In ankle sprain, which is the most commonly torn ligament?

A. Tibio-talar ligament
B. Deltoid ligament
C. Posterior talo-fibular ligament
D. Anterior talo-fibular ligament (Correct Answer)

Explanation: **Explanation:** Ankle sprains are among the most common musculoskeletal injuries, typically occurring due to an **inversion stress** on a plantar-flexed foot. **1. Why Option D is Correct:** The lateral ligament complex consists of three ligaments: the **Anterior Talo-Fibular Ligament (ATFL)**, the Calcaneofibular Ligament (CFL), and the Posterior Talo-Fibular Ligament (PTFL). The **ATFL** is the weakest of these three and is the first to be stretched or torn during an inversion injury. It is specifically taut during plantar flexion, which is the most unstable position of the ankle. Therefore, it is the **most commonly injured ligament** in the body. **2. Why Other Options are Incorrect:** * **Option A (Tibio-talar ligament):** This is a component of the medial (deltoid) ligament complex. It is very strong and rarely injured in isolated sprains. * **Option B (Deltoid ligament):** Located on the medial side, this ligament is extremely thick and strong. It is usually injured during eversion, which is less common than inversion. Often, the medial malleolus fractures before this ligament tears. * **Option C (Posterior talo-fibular ligament):** The PTFL is the strongest of the lateral ligaments and is only injured in severe, high-grade sprains or total ankle dislocations. **Clinical Pearls for NEET-PG:** * **Sequence of Injury:** In lateral ankle sprains, the sequence of tearing is usually **ATFL → CFL → PTFL**. * **Ottawa Ankle Rules:** Used to determine if an X-ray is required (tenderness at the posterior edge of malleoli or inability to bear weight). * **Special Tests:** The **Anterior Drawer Test** assesses the integrity of the ATFL, while the **Talar Tilt Test** assesses the CFL. * **Management:** Most sprains are managed conservatively using the **RICE** protocol (Rest, Ice, Compression, Elevation).

Question 168: The Judet and Lectournal classification is used for which type of fracture?

A. Supracondylar humerus fracture
B. Acetabulum fracture (Correct Answer)
C. Shaft femur fracture
D. Patella fracture

Explanation: The **Judet and Letournel classification** is the gold standard system for classifying **acetabular fractures**. It is based on the anatomical concept of the "Two-Column Theory" proposed by Raymond Letournel. ### **Explanation of the Correct Answer** The acetabulum is viewed as an inverted 'Y' formed by two columns: * **Anterior Column:** Extends from the iliac crest to the pubic symphysis. * **Posterior Column:** Extends from the sciatic notch to the ischial tuberosity. The classification divides fractures into **5 Elementary patterns** (e.g., posterior wall, transverse) and **5 Associated patterns** (e.g., T-shaped, both columns). This system is crucial for surgical planning and determining the approach (Ilioinguinal vs. Kocher-Langenbeck). ### **Why Other Options are Incorrect** * **A. Supracondylar Humerus Fracture:** Commonly classified using the **Gartland Classification** (based on displacement). * **C. Shaft Femur Fracture:** Usually classified by the **Winquist and Hansen Classification** (based on comminution) or the AO/OTA system. * **D. Patella Fracture:** Classified based on morphology (transverse, stellate, vertical) or the **Descriptive Classification**. ### **High-Yield Clinical Pearls for NEET-PG** * **Radiology:** The classification requires three views (Judet Views): AP view of the pelvis, **Iliac oblique**, and **Obturator oblique**. * **Associated Injury:** Acetabular fractures are often associated with **posterior hip dislocation** (especially posterior wall fractures). * **Central Dislocation:** A fracture of the acetabular floor where the femoral head is driven medially is termed a central dislocation of the hip.

Question 169: What is the most common fracture in childhood?

A. Femur
B. Distal humerus
C. Clavicle (Correct Answer)
D. Radius

Explanation: **Explanation:** The **clavicle** is the most common bone fractured in childhood. This is primarily due to its anatomical position and the mechanism of injury. It is the first bone to ossify in the fetus (via intramembranous ossification) but among the last to fuse, making it vulnerable during falls onto an outstretched hand or direct trauma to the shoulder. Most pediatric clavicle fractures occur in the **middle third** (80%) because this is the thinnest part of the bone and lacks ligamentous support. **Analysis of Options:** * **A. Femur:** While common in high-energy trauma (like motor vehicle accidents), it is not the most frequent overall. In infants, a femur fracture should raise suspicion for non-accidental injury (child abuse). * **B. Distal Humerus:** This is a very common site for fractures in children (specifically **Supracondylar fractures**), but it ranks second to the clavicle. Supracondylar fractures are the most common fractures *around the elbow* in children. * **C. Clavicle (Correct):** Statistically the most frequent fracture in both neonates (during birth) and older children. * **D. Radius:** Distal radius fractures (like Greenstick or Torus fractures) are extremely common in older children and adolescents, but across the entire pediatric age spectrum, the clavicle remains the most frequent. **High-Yield Clinical Pearls for NEET-PG:** * **Birth Trauma:** The clavicle is the most common bone fractured during labor (often associated with shoulder dystocia). * **Management:** Most pediatric clavicle fractures are managed conservatively with a **Figure-of-eight bandage** or a simple triangular sling. * **Ossification:** Remember, the clavicle is the only long bone that ossifies in membrane and has two primary ossification centers. * **Remodeling:** Children have a thick periosteum and high osteogenic potential, leading to excellent remodeling; hence, significant malunion is rare.

Question 170: Which of the following is a false statement regarding Patellofemoral stress syndrome?

A. Movie sign positive
B. Difficulty in climbing stairs
C. Positive Patellofemoral grinding test
D. Decreased Q angle (Correct Answer)

Explanation: **Explanation:** Patellofemoral Stress Syndrome (PFSS), often referred to as **Chondromalacia Patellae** in its later stages, is a common cause of anterior knee pain caused by abnormal tracking of the patella within the femoral groove. **Why "Decreased Q angle" is the correct (false) statement:** The Q-angle (Quadriceps angle) represents the lateral pull of the quadriceps on the patella. An **increased Q-angle** (normal is ~13° for men and ~18° for women) is a major predisposing factor for PFSS. A high Q-angle causes the patella to track laterally, leading to increased pressure on the lateral facet and subsequent retropatellar pain. Therefore, a *decreased* Q-angle is not associated with this syndrome. **Analysis of other options:** * **Movie sign (Theatre sign):** Patients experience dull, aching pain when sitting with knees flexed for prolonged periods (e.g., in a cinema). This occurs because prolonged flexion increases the contact pressure between the patella and the femur. * **Difficulty in climbing stairs:** Activities that involve eccentric loading of the quadriceps or deep knee flexion (like climbing stairs or squatting) significantly increase patellofemoral joint reaction forces, exacerbating the pain. * **Patellofemoral grinding test (Clarke’s test):** This is a classic physical exam finding where pain is elicited when the patient contracts the quadriceps while the examiner applies downward pressure on the patella. **Clinical Pearls for NEET-PG:** * **Epidemiology:** Most common in young female athletes ("Runner's knee"). * **Management:** Primarily conservative, focusing on **Vastus Medialis Obliquus (VMO) strengthening** and hamstring stretching. * **Radiology:** The **Skyline view** (Laurin or Merchant view) is the best X-ray projection to visualize the patellofemoral joint space.

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Principles of Fracture Management

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Upper Limb Fractures

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Lower Limb Fractures

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Spinal Trauma

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Pelvic and Acetabular Fractures

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Open Fractures

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Fractures in Children

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Fracture Complications

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Nonunion and Malunion

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Polytrauma Management

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Joint Dislocations

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Soft Tissue Injuries

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Trauma — MCQs

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