Trauma Practice Questions

Q: Which of the following is an uncommon complication of Colles' fracture?

Non-union. **Explanation:** **Colles' fracture** is a fracture of the distal radius with dorsal displacement, occurring through the cancellous bone. 1. **Why Non-union is the correct answer:** Non-union is **extremely rare** in Colles' fracture. This is because the fracture occurs through **cancellous bone**, which has a rich blood supply and a large surface area, facilitating rapid and reliable healing. Even if the fracture is poorly reduced, it almost always unites (though it may result in mal-union). 2. **Analysis of Incorrect Options:** * **Mal-union:** This is the **most common complication**. It results in the classic "Dinner Fork Deformity" due to residual dorsal tilt and radial shortening. * **Rupture of Extensor Pollicis Longus (EPL):** This is a well-known late complication. It occurs due to attrition (friction) of the tendon against the irregular bony surface at Lister’s tubercle or due to ischemia of the tendon. * **Reflex Sympathetic Dystrophy (Sudeck’s Atrophy):** This is a common complication characterized by pain, swelling, and vasomotor instability of the hand, often triggered by a tight cast or excessive pain. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Mal-union. * **Most common joint involvement:** Secondary Osteoarthritis of the distal radio-ulnar joint. * **EPL Rupture:** Usually occurs 4–8 weeks post-injury; treated with **Extensor Indicis Proprius (EIP) transfer**. * **Median Nerve Palsy:** Can occur acutely due to carpal tunnel compression. * **Sudeck’s Atrophy:** Clinically presents with "shoulder-hand syndrome" and radiographic evidence of patchy osteoporosis.

Q: What is the most common site of a stress fracture?

2nd metatarsal. **Explanation:** Stress fractures (also known as fatigue fractures) occur due to repetitive submaximal loading on a bone that exceeds its remodeling capacity. **Why the 2nd Metatarsal is correct:** The **2nd metatarsal shaft** is the most common site for a stress fracture in the general population and athletes. This is primarily because the second metatarsal is the longest, thinnest, and most rigid of the metatarsals. During the "toe-off" phase of the gait cycle, it acts as a fixed fulcrum, subjecting it to significant mechanical stress. When this occurs in military recruits or long-distance hikers, it is classically referred to as a **"March Fracture."** **Analysis of Incorrect Options:** * **A. 2nd Metacarpal:** Stress fractures of the upper limb are rare because it is not a weight-bearing extremity. They are occasionally seen in specific athletes (e.g., tennis players) but are far less common than lower limb sites. * **C. Fibula:** While the distal third of the fibula is a common site for stress fractures (especially in runners), it ranks behind the metatarsals and the tibia in overall frequency. * **D. Ribs:** Rib stress fractures are rare and typically associated with specific repetitive actions like heavy rowing or chronic coughing. **High-Yield Clinical Pearls for NEET-PG:** * **Most common bone overall:** While the 2nd metatarsal is the most common *specific site*, some literature cites the **Tibia** as the most common *bone* involved in athletes. * **Investigation of choice:** **MRI** is the most sensitive and gold-standard investigation (shows marrow edema). * **X-ray findings:** Often negative in the first 2–3 weeks; later shows a periosteal reaction or a faint transverse lucent line. * **Female Athlete Triad:** Always consider this in young females with stress fractures (Amenorrhea, Disordered eating, Osteoporosis).

Q: Which of the following conditions requires the most immediate priority in the management of a fracture?

All of the above. In orthopaedic trauma, the management priority is determined by the risk to **life** and **limb**. While many fractures can be managed electively, certain conditions constitute **orthopaedic emergencies** that require immediate intervention to prevent permanent disability, amputation, or systemic sepsis. **Explanation of the Correct Answer:** The correct answer is **All of the above** because each option represents a critical threat that demands urgent surgical or manipulative intervention: * **Vascular Injury (Option C):** This is the highest priority. Ischemia from a compromised artery (e.g., popliteal artery in knee dislocation) can lead to irreversible muscle necrosis within 6 hours. "Life over limb, but limb over disability" is the rule. * **Open Fracture (Option A):** These are surgical emergencies due to the high risk of contamination and subsequent osteomyelitis or gas gangrene. They require immediate irrigation, debridement, and antibiotic administration (the "Golden Period" is usually within 6 hours). * **Dislocated Fracture (Option B):** A dislocation (especially when associated with a fracture) can cause immediate pressure on overlying skin (leading to necrosis) or adjacent neurovascular structures. Prompt reduction is mandatory to restore perfusion and relieve tension. **Clinical Pearls for NEET-PG:** 1. **Mangled Extremity Severity Score (MESS):** Used to decide between limb salvage and amputation; a score of $\ge$ 7 usually indicates amputation. 2. **Gustilo-Anderson Classification:** The standard for grading open fractures (Type IIIA, B, and C are high-energy). 3. **Rule of 6s:** Irreversible nerve damage starts at 6 hours of ischemia; open fractures should ideally be debrided within 6 hours. 4. **Priority in Trauma (ATLS):** Always follow **ABCDE**. Once the patient is hemodynamically stable, vascular injuries and compartment syndrome become the top orthopaedic priorities.

Q: Fracture of both bones of the forearm at the same level requires the limb to be immobilized in plaster in which position?

Mid-pronation. **Explanation:** The position of immobilization for forearm fractures is determined by the **level of the fracture** relative to the insertions of the forearm rotators (the Biceps brachii, Supinator, and Pronator teres). 1. **Why Mid-pronation is correct:** When both bones are fractured at the **same level** (usually the middle third), the proximal fragment is acted upon by the Pronator teres, which pulls it into a neutral position. To maintain alignment and prevent rotational deformity, the distal fragment must be aligned with the proximal fragment. Therefore, the limb is immobilized in **mid-pronation (neutral position)**. This position also maintains the maximum interosseous space, preventing synostosis. 2. **Analysis of Incorrect Options:** * **Full Supination (A):** This is indicated for fractures in the **proximal third** (above the insertion of Pronator teres). In such cases, the proximal fragment is unopposedly supinated by the Biceps and Supinator. * **10 degrees Supination (B):** While some texts suggest slight supination for mid-shaft fractures, "Mid-pronation" is the standard textbook answer for fractures at the same level. * **Full Pronation (C):** This is generally avoided as it narrows the interosseous space and is only occasionally considered for distal third fractures, though neutral is still preferred. **High-Yield Clinical Pearls for NEET-PG:** * **Proximal 1/3rd fracture:** Immobilize in **Supination**. * **Middle 1/3rd fracture:** Immobilize in **Neutral/Mid-pronation**. * **Distal 1/3rd fracture:** Immobilize in **Pronation** (though neutral is often used). * **Management Gold Standard:** In adults, "both bone" forearm fractures are considered "articular fractures of necessity" and usually require **ORIF with Dynamic Compression Plates (DCP)**. Cast immobilization is primarily for pediatric cases.

Q: Increased intercondylar distance is seen in fracture of all except:

Olecranon. **Explanation:** The **intercondylar distance** refers to the width between the medial and lateral humeral condyles. An increase in this distance occurs when a fracture line separates the condyles from each other or from the humeral shaft, causing them to splay apart. **1. Why Olecranon is the correct answer:** The **Olecranon** is part of the proximal **ulna**, not the humerus. A fracture of the olecranon involves the joint surface of the elbow but does not disrupt the anatomical relationship or the distance between the medial and lateral condyles of the humerus. Therefore, the intercondylar distance remains unchanged. **2. Analysis of incorrect options:** * **Medial/Lateral Epicondyle & Condyle Fractures:** These are components of the distal humerus. In fractures involving these structures (especially T-shaped or Y-shaped intercondylar fractures), the bony fragments are displaced by the pull of the forearm muscles (flexors from the medial side, extensors from the lateral side). This muscle pull causes the fragments to diverge, leading to a measurable **increase in intercondylar width**. **High-Yield Clinical Pearls for NEET-PG:** * **Three-Point Bony Relationship:** In an extended elbow, the medial epicondyle, lateral epicondyle, and the tip of the olecranon form a straight line. In a flexed elbow (90°), they form an **isosceles triangle**. * **Supracondylar Fracture:** This is an extra-articular fracture; therefore, the three-point relationship remains **maintained**, and the intercondylar distance is **normal**. * **Elbow Dislocation:** The three-point relationship is **disturbed**, which helps clinically differentiate it from a supracondylar fracture. * **Milch Classification:** Used specifically for fractures of the lateral condyle of the humerus.

Q: Tinel's sign is used to assess what?

Nerve regeneration. **Explanation:** **Tinel’s sign** (or the Hoffmann-Tinel sign) is a clinical test used to identify regenerating axonal sprouts. It is elicited by percussing along the course of a damaged nerve. A positive sign is characterized by a "pins and needles" or tingling sensation in the cutaneous distribution of the nerve. 1. **Why Nerve Regeneration is Correct:** Following a nerve injury, axons undergo Wallerian degeneration. As the nerve heals, new axons sprout from the proximal stump and grow distally (typically at a rate of **1 mm/day**). These immature, regenerating axons are hypersensitive to mechanical stimulation. If percussion over the nerve trunk distal to the site of injury produces tingling, it indicates that regenerating fibers have reached that specific point. A "distally progressing" Tinel’s sign is a strong clinical indicator of active nerve recovery. 2. **Why Other Options are Incorrect:** * **Spinal shock:** This is a physiological state of loss of all reflex activity below the level of a spinal cord injury; it is assessed via the Bulbocavernosus reflex. * **Severity/Type of nerve damage:** Tinel’s sign does not distinguish between Seddon’s classifications (Neuropraxia, Axonotmesis, or Neurotmesis) at the time of injury. In fact, a positive Tinel’s sign can occur in both Axonotmesis (good prognosis) and Neurotmesis (requires surgery), though it will not "advance" in the latter. **High-Yield Clinical Pearls for NEET-PG:** * **Rate of Nerve Growth:** 1 mm per day (or 1 inch per month). * **Tinel’s vs. Phalen’s:** While Tinel’s is used for regeneration, it is also used to diagnose **Carpal Tunnel Syndrome** (compression of the Median nerve), though Phalen’s test is more sensitive. * **Wartenberg’s Sign:** Specific for Ulnar nerve palsy (abduction of the little finger). * **Froment’s Sign:** Specific for Adductor Pollicis paralysis (Ulnar nerve).

Q: Which type represents a true supracondylar fracture of the femur?

Type A. This question refers to the **AO/OTA Classification** of fractures, which is the gold standard for categorizing long bone injuries in orthopaedics. ### **Explanation of the Correct Answer** **Type A** fractures are defined as **extra-articular** fractures. In the context of the distal femur, a "true" supracondylar fracture is one where the fracture line occurs above the femoral condyles without extending into the knee joint surface. Because Type A fractures involve the metaphysis but spare the joint entirely, they represent the classic definition of a supracondylar fracture. ### **Analysis of Incorrect Options** * **Type B (Partial Articular):** These involve only a part of the articular surface (e.g., a unicondylar fracture like a Hoffa fracture). One condyle remains attached to the shaft, so it is not a true supracondylar (above-condyle) pattern. * **Type C (Complete Articular):** These are **intercondylar** fractures (often T or Y-shaped). The fracture line extends between the condyles and separates them from the diaphysis. While they involve the supracondylar area, they are classified as intra-articular injuries. * **Type D:** This is not a standard category in the AO classification for distal femoral fractures (which uses A, B, and C). ### **NEET-PG High-Yield Pearls** * **Deforming Forces:** In supracondylar fractures, the distal fragment is typically **tilted posteriorly** due to the pull of the **Gastrocnemius** muscle. This poses a high risk of injury to the **Popliteal artery**. * **Classification System:** Remember the AO mnemonic: **A** = Extra-articular, **B** = Partial articular, **C** = Complete articular. * **Hoffa Fracture:** A specific Type B fracture involving a coronal plane fracture of the femoral condyle (usually lateral). * **Management:** Most adult supracondylar fractures require ORIF (Open Reduction Internal Fixation) using a Distal Femoral Nail (DFN) or a Locking Compression Plate (LCP).

Q: Which of the following is NOT a feature of fat embolism?

Hypotension. **Explanation:** Fat Embolism Syndrome (FES) typically follows fractures of long bones (like the femur) or pelvic fractures. The pathophysiology involves the release of fat globules from the bone marrow into the systemic circulation, leading to mechanical obstruction and a secondary inflammatory response. **Why Hypotension is the correct answer:** Fat Embolism is characterized by a classic triad of **Respiratory distress, Neurological symptoms, and Petechial rashes.** While FES affects the pulmonary vasculature, it typically presents with **normotension or hypertension** (due to sympathetic overactivity). Hypotension is not a standard feature of FES; its presence should instead raise suspicion for **hypovolemic shock** (due to blood loss from the fracture itself) or a massive pulmonary embolism. **Analysis of Incorrect Options:** * **Tachycardia & Tachypnoea:** These are the earliest and most common signs. They occur as a compensatory response to pulmonary micro-vascular obstruction and the resulting hypoxia (V/Q mismatch). * **Petechial Rashes:** This is a pathognomonic sign, usually appearing 24–72 hours after injury. They are typically found in a "vest-like" distribution (chest, axilla, neck, and conjunctiva) due to fat globules obstructing dermal capillaries. **High-Yield Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include axillary/subconjunctival petechiae, hypoxemia ($PaO_2 < 60$ mmHg), and CNS depression. * **Snowstorm Appearance:** The characteristic finding on a Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early stabilization and internal fixation of fractures are the best preventive measures. * **Free Fatty Acids:** The biochemical theory suggests that lipase breaks down neutral fat into toxic free fatty acids, causing endothelial damage (ARDS).

Q: The Gustilo-Anderson classification is used for which type of fracture?

Compound fractures. **Explanation:** The **Gustilo-Anderson classification** is the most widely used system for grading **open (compound) fractures**. It is designed to assess the severity of soft tissue injury, the degree of contamination, and the energy of the mechanism, which helps in predicting the risk of infection and guiding surgical management. * **Type I:** Clean wound 10 cm or high-energy trauma (includes segmental fractures, farm injuries, or vascular injuries). * **IIIA:** Adequate soft tissue coverage of the bone. * **IIIB:** Extensive soft tissue loss; requires a flap for coverage. * **IIIC:** Associated with arterial injury requiring repair. **Analysis of Incorrect Options:** * **B. Closed fractures:** These are classified using systems like the **Tscherne classification**, which focuses on internal soft tissue edema and compartment pressure. * **C. Distal end radius fractures:** These are specifically classified using the **Frykman** or **Fernandez** systems. * **D. Femur head fractures:** These are classified using the **Pipkin classification**. **Clinical Pearls for NEET-PG:** * **Antibiotic Choice:** Type I/II usually require 1st generation cephalosporins; Type III requires the addition of an aminoglycoside. * **Golden Period:** Debridement should ideally occur within 6–8 hours to minimize infection risk. * **High-Yield Fact:** Any open fracture sustained in a **farm/soil environment** is automatically classified as **Type IIIA** regardless of wound size due to high contamination.

Q: Which of the following is the characteristic posture in a posterior dislocation of the hip joint?

Posterior dislocation of hip joint. ### Explanation **Posterior Dislocation of the Hip Joint** is the most common type of hip dislocation (accounting for ~90% of cases), typically resulting from high-energy trauma like a "dashboard injury." #### 1. Why the Correct Answer is Right The characteristic clinical posture of a posterior hip dislocation is **Flexion, Adduction, and Internal Rotation (FADIR)**. * **Mechanism:** When the femoral head is forced posteriorly out of the acetabulum, the tension of the iliofemoral ligament and the surrounding musculature pulls the limb into this specific position. The affected limb also appears **shortened**. #### 2. Analysis of Incorrect Options * **Anterior Dislocation of Hip Joint:** This presents with the opposite deformity: **Flexion, Abduction, and External Rotation (FABER)**. The limb is held away from the midline, unlike the "crossed-leg" appearance of posterior dislocation. * **Fracture of the Femoral Neck/Shaft:** These fractures typically present with **Shortening and External Rotation**. In a neck of femur fracture, the psoas muscle pulls the distal fragment into external rotation, which is a key clinical differentiator from posterior dislocation. #### 3. Clinical Pearls for NEET-PG * **Most Common Nerve Injury:** The **Sciatic Nerve** (specifically the common peroneal component) is at risk in posterior dislocations. * **Radiology:** On an AP X-ray, the femoral head appears smaller than the contralateral side in posterior dislocation (due to being further from the film) and larger in anterior dislocation. * **Emergency:** Hip dislocation is an orthopedic emergency. Reduction must be performed within **6 hours** to minimize the risk of **Avascular Necrosis (AVN)** of the femoral head. * **Reduction Maneuvers:** Bigelow’s, Stimson’s, and Allis’ maneuvers are commonly used for reduction.

Question 1

Which of the following is an uncommon complication of Colles' fracture?

Accepted Answer

Non-union

Answer

Mal-union

Answer

Rupture of the Extensor Pollicis Longus (EPL) tendon

Answer

Reflex sympathetic dystrophy

Question 2

What is the most common site of a stress fracture?

Accepted Answer

2nd metatarsal

Answer

2nd metacarpal

Answer

Fibula

Answer

Ribs

Question 3

Which of the following conditions requires the most immediate priority in the management of a fracture?

Accepted Answer

All of the above

Answer

Open fracture

Answer

Dislocated fracture

Answer

Vascular injury

Question 4

Fracture of both bones of the forearm at the same level requires the limb to be immobilized in plaster in which position?

Accepted Answer

Mid-pronation

Answer

Full supination

Answer

10 degrees supination

Answer

Full pronation

Question 5

Increased intercondylar distance is seen in fracture of all except:

Accepted Answer

Olecranon

Answer

Medial epicondyle

Answer

Lateral epicondyle

Answer

Lateral condyle

Question 6

Tinel's sign is used to assess what?

Accepted Answer

Nerve regeneration

Answer

Spinal shock

Answer

Severity of nerve damage

Answer

Type of nerve injury

Question 7

Which type represents a true supracondylar fracture of the femur?

Accepted Answer

Type A

Answer

Type B

Answer

Type C

Answer

Type D

Question 8

Which of the following is NOT a feature of fat embolism?

Accepted Answer

Hypotension

Answer

Tachycardia

Answer

Petechial Rashes

Answer

Tachypnoea

Question 9

The Gustilo-Anderson classification is used for which type of fracture?

Accepted Answer

Compound fractures

Answer

Closed fractures

Answer

Distal end radius fractures

Answer

Femur head fractures

Question 10

Which of the following is the characteristic posture in a posterior dislocation of the hip joint?

Accepted Answer

Posterior dislocation of hip joint

Answer

Anterior dislocation of hip joint

Answer

Fracture of the femoral head

Answer

Fracture of the shaft of the femur

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?