Trauma Practice Questions

Q: In children, which type of fracture displacement demonstrates the best remodelling potential?

Angulation in the metaphysis. ### Explanation The ability of a pediatric fracture to remodel depends on the child's remaining growth potential and the proximity of the fracture to the physis (growth plate). **Why Option B is Correct:** Remodelling is most effective when the fracture is located in the **metaphysis** and the displacement is **angulation** in the plane of motion of the adjacent joint. The metaphysis is highly vascular and located close to the physis; according to **Heuter-Volkmann’s Law**, the physis responds to asymmetrical pressure by altering growth to "straighten" the bone. The closer a fracture is to the growth plate, the greater the potential for spontaneous correction. **Why Other Options are Incorrect:** * **Options A & C (Diaphysis):** The mid-shaft (diaphysis) is further from the physis. Remodelling potential decreases significantly as you move away from the growth plate toward the center of the bone. * **Options C & D (Rotation):** Rotational deformities (torsion) **do not remodel** regardless of age or location. Unlike angulation, the physis cannot compensate for a twist in the long axis of the bone. These must be corrected anatomically during reduction. **High-Yield Clinical Pearls for NEET-PG:** * **Factors favoring remodelling:** Young age (more growth remaining), proximity to the physis, and angulation in the plane of joint motion. * **Exceptions to the rule:** Displaced **intra-articular fractures** and **rotational deformities** never remodel and require precise reduction. * **Overgrowth Phenomenon:** In femoral shaft fractures of children (2–10 years), the hyperemia of healing can cause 1–2 cm of longitudinal overgrowth. Therefore, a small amount of "bayonet apposition" (shortening) is often acceptable.

Q: The "Apprehension sign" is seen in dislocation of which joint?

Shoulder joint. **Explanation:** The **Apprehension Test** is the hallmark clinical examination for **recurrent anterior instability of the shoulder joint**. 1. **Why Shoulder Joint is Correct:** In patients with a history of anterior shoulder dislocation, placing the arm in a position of **abduction and external rotation** (the most vulnerable position) mimics the mechanism of dislocation. The patient becomes anxious or "apprehensive," fearing the humeral head will slip out of the glenoid cavity. They may resist further movement or contract the pectoralis major to stabilize the joint. This is a positive Apprehension sign, often followed by the **Relocation Test (Jobe’s test)**, where posterior pressure on the humerus relieves the anxiety. 2. **Why Other Options are Incorrect:** * **Hip Joint:** Dislocation is usually traumatic and stable once reduced. Clinical signs focus on limb shortening and rotation (internal for posterior, external for anterior). * **Elbow Joint:** Stability is assessed via varus/valgus stress tests or the Pivot-shift test for posterolateral rotatory instability. * **Patella:** While there is a specific **Fairbank’s Apprehension Test** for recurrent patellar dislocation (lateral displacement of the patella causes apprehension), the standard "Apprehension sign" without qualification traditionally refers to the shoulder in orthopedic nomenclature. **High-Yield Clinical Pearls for NEET-PG:** * **Bankart Lesion:** Avulsion of the anterior-inferior glenoid labrum; the most common cause of recurrent shoulder dislocation. * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head. * **Nerve Injury:** The **Axillary nerve** is the most commonly injured nerve in anterior shoulder dislocations (look for "regimental badge" anesthesia). * **Most Common Dislocation:** Anterior shoulder dislocation is the most common joint dislocation in the body.

Q: Clavicular fracture is usually treated by

Figure of eight bandage. **Explanation:** The clavicle is the most common bone to fracture in the human body, typically occurring at the **middle third** (junction of the medial 2/3 and lateral 1/3). **Why Figure-of-Eight Bandage is Correct:** The vast majority of clavicular fractures are managed **conservatively**. The primary goal of treatment is to counteract the displacement caused by the weight of the arm and the pull of the sternocleidomastoid muscle. A **Figure-of-eight bandage** (or a simple triangular sling) provides sufficient immobilization by pulling the shoulders back, aligning the fragments, and allowing for secondary bone healing via callus formation. Functional outcomes for conservative management are generally excellent. **Analysis of Incorrect Options:** * **Traction (A):** Traction is used for long bone fractures (like the femur) to overcome muscle spasm. It has no role in the management of clavicular fractures. * **Open Reduction and Internal Fixation (B) & Plate and Screw Fixation (D):** While these are surgical methods, they are **not** the standard first-line treatment. Surgery is reserved for specific indications such as neurovascular injury, skin tenting (threatened compound fracture), non-union, or widely displaced fractures in high-demand athletes. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Middle third (80%). * **Mechanism of injury:** Fall on an outstretched hand (FOOSH) or direct blow to the shoulder. * **Deformity:** The medial fragment is displaced **upward** (by the sternocleidomastoid) and the lateral fragment is displaced **downward** (by the weight of the arm). * **Complication:** Malunion is common but usually clinically insignificant; **Non-union** is rare. * **Nerve involvement:** If neurovascular injury occurs, the **subclavian vessels** or **brachial plexus** are most at risk.

Q: A 6-year-old boy has a history of recurrent dislocation of the right shoulder. On examination, the orthopedician puts the patient in the supine position, abducts his arm to 90 degrees with the bed as the fulcrum, and then externally rotates it. However, the boy does not allow the test to be performed. What is the name of the test performed by the orthopedician?

Apprehension test. The clinical scenario describes the **Apprehension Test**, which is the gold standard for diagnosing **Anterior Shoulder Instability**. ### Why the Correct Answer is Right The test is performed by placing the patient in a supine position, abducting the arm to 90°, and then applying external rotation. This maneuver mimics the position of most frequent dislocations (anteroinferior). In a patient with recurrent instability, this movement causes the humeral head to glide anteriorly, creating a sensation of impending dislocation. The "positive" sign is not pain, but rather the patient’s **apprehension** (anxiety or resistance) and refusal to allow further movement. ### Explanation of Incorrect Options * **B. Sulcus test:** Used to assess **inferior or multidirectional instability**. It is performed by pulling the arm downward (inferior traction); a positive result is a visible "gap" or sulcus between the acromion and the humeral head. * **C. Dugas test:** Used to diagnose **acute shoulder dislocation**. A patient with a dislocated shoulder cannot touch the opposite shoulder with their hand while the elbow is touching the chest. * **D. McMurray's test:** A physical exam maneuver used to identify **meniscal tears in the knee**, involving rotation of the tibia on the femur. It is irrelevant to shoulder trauma. ### NEET-PG High-Yield Pearls * **Relocation Test (Jobe’s Test):** If the apprehension test is positive, applying a posterior pressure on the humeral head relieves the apprehension, confirming anterior instability. * **Bankart Lesion:** The most common cause of recurrent anterior dislocation, involving an avulsion of the anteroinferior labrum. * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head, often seen on X-ray (Stryker notch view) in these patients.

Q: The term Bennett's fracture is used to describe which of the following?

Fracture-dislocation of the trapezometacarpal joint. **Explanation:** **Bennett’s fracture** is an intra-articular fracture-dislocation occurring at the **base of the first metacarpal**. The correct answer is **D** because the base of the first metacarpal articulates with the trapezium to form the **trapezometacarpal (TMC) joint**. **Mechanism and Anatomy:** The fracture occurs when a small volar-ulnar fragment remains attached to the strong **anterior oblique ligament**, while the rest of the metacarpal shaft is displaced proximally, radially, and posteriorly by the pull of the **Abductor Pollicis Longus (APL)** muscle. This results in the characteristic "fracture-dislocation." **Analysis of Incorrect Options:** * **Option A & B:** Bennett’s fracture specifically involves the base of the metacarpal (TMC joint), not the metacarpophalangeal (MCP) or interphalangeal (IP) joints. * **Option C:** An anterior (volar) marginal fracture of the distal radius is known as a **Volar Barton’s fracture**, not Bennett’s. **High-Yield Clinical Pearls for NEET-PG:** * **Rolando Fracture:** A comminuted, T- or Y-shaped intra-articular fracture at the base of the first metacarpal (worse prognosis than Bennett's). * **Gamekeeper’s Thumb:** An injury to the Ulnar Collateral Ligament (UCL) of the thumb MCP joint. * **Management:** Bennett’s fracture is inherently unstable due to muscle pull (APL); therefore, it usually requires **Closed Reduction and Internal Fixation (CRIF)** with K-wires or Open Reduction (ORIF). * **Radiology:** Best visualized on a "Robert’s view" (AP view of the thumb).

Q: The Trendelenburg test is positive in which of the following conditions?

All the above. The **Trendelenburg test** is a clinical assessment used to evaluate the integrity of the hip abductor mechanism, primarily the **Gluteus medius and Gluteus minimus** muscles. ### **The Underlying Concept** For a negative (normal) Trendelenburg test, three components must be intact: 1. **The Power:** Intact nerve supply (Superior Gluteal Nerve) and muscle strength. 2. **The Fulcrum:** A stable, painless hip joint (Head of the femur in the acetabulum). 3. **The Lever:** A normal length and angle of the femoral neck (the distance between the fulcrum and the insertion of the muscles). If any of these components are compromised, the pelvis drops on the **unsupported (swing) side** when the patient stands on the affected limb. ### **Explanation of Options** * **A. Dislocation of the hip:** The **fulcrum** is lost because the femoral head is no longer stable within the acetabulum. * **B. Fracture of the neck of the femur:** The **lever** is broken, and the stability of the fulcrum is lost, preventing the abductors from exerting effective tension. * **C. Coxa vara:** This condition involves a decrease in the neck-shaft angle (<120°). This leads to the shortening of the lever arm and **approximation of the origin and insertion** of the glutei (active insufficiency), weakening their mechanical advantage. Since all three conditions disrupt the abductor mechanism, **Option D (All the above)** is correct. ### **Clinical Pearls for NEET-PG** * **Trendelenburg Gait:** Also known as a "lurching gait." If bilateral, it is called a **Waddling gait** (common in Duchenne Muscular Dystrophy or bilateral CDH). * **False Positive:** Can occur in pain (antalgic hip) or poor balance. * **Nerve Root:** The muscles involved are supplied by roots **L4, L5, S1**. * **Other causes:** Polio (muscle weakness) and Perthes disease.

Question 1

In children, which type of fracture displacement demonstrates the best remodelling potential?

Accepted Answer

Angulation in the metaphysis

Answer

Angulation in the diaphysis

Answer

Rotation in the diaphysis

Answer

Rotation in the metaphysis

Question 2

The "Apprehension sign" is seen in dislocation of which joint?

Accepted Answer

Shoulder joint

Answer

Hip joint

Answer

Elbow joint

Answer

Patella

Question 3

Clavicular fracture is usually treated by

Accepted Answer

Figure of eight bandage

Answer

Traction

Answer

Open reduction and internal fixation

Answer

Plate and screw fixation

Question 4

Avascular necrosis is the commonest following which type of fracture?

Accepted Answer

Garden 3 and 4 fracture of the femoral neck

Answer

Garden 1 and 2 fracture of the femoral neck

Answer

Sub-trochanteric fracture of the femur

Answer

Baso-trochanteric fracture of the femur

Question 5

A 6-year-old boy has a history of recurrent dislocation of the right shoulder. On examination, the orthopedician puts the patient in the supine position, abducts his arm to 90 degrees with the bed as the fulcrum, and then externally rotates it. However, the boy does not allow the test to be performed. What is the name of the test performed by the orthopedician?

Accepted Answer

Apprehension test

Answer

Sulcus test

Answer

Dugas test

Answer

McMurray's test

Question 6

Resolving arthroplasty is seen in which of the following?

Accepted Answer

Shoulder dislocation

Answer

Elbow dislocation

Answer

Knee dislocation

Answer

Hip dislocation

Question 7

The term Bennett's fracture is used to describe which of the following?

Accepted Answer

Fracture-dislocation of the trapezometacarpal joint

Answer

Fracture-dislocation of the metacarpophalangeal joint of the thumb

Answer

Interphalangeal fracture-dislocation of the thumb

Answer

Anterior marginal fracture of the distal end of the radius

Question 8

The Trendelenburg test is positive in which of the following conditions?

Accepted Answer

All the above

Answer

Dislocation of the hip

Answer

Fracture of the neck of the femur

Answer

Coxa vara

Question 9

Traumatic dislocation of the hip is characterized by which of the following deformities?

Accepted Answer

Adduction and internal rotation deformity

Answer

Abduction and external rotation deformity

Answer

Adduction and external rotation deformity

Answer

Abduction and internal rotation deformity

Question 10

Which of the following is not a cause of a positive Trendelenburg sign?

Accepted Answer

Paralysis of the gluteus maximus

Answer

Congenital dislocation of the hip

Answer

Un-united fracture of the femoral neck

Answer

Coxa vara

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?