Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 261: What is the treatment for an undisplaced fracture of the patella?

A. Tube cast (Correct Answer)
B. Nailing
C. Tension band wiring
D. Observation

Explanation: **Explanation:** The primary goal in managing patellar fractures is to restore the extensor mechanism of the knee and ensure articular congruity. **Why Option A is Correct:** An **undisplaced fracture** is defined by less than 2mm of articular step-off and less than 3mm of fragment separation. In such cases, the extensor expansion (medial and lateral retinacula) remains intact, meaning the patient can actively extend the knee. Conservative management is indicated, typically using a **Cylindrical (Tube) cast** or a long knee brace for 4–6 weeks. This immobilizes the joint in extension, allowing the fracture to heal while preventing displacement by the quadriceps pull. **Why Other Options are Incorrect:** * **B. Nailing:** Intramedullary nailing is not a standard procedure for patellar fractures due to the bone's unique anatomy and subcutaneous location. * **C. Tension Band Wiring (TBW):** This is the **gold standard for displaced** transverse patellar fractures. It converts tensile forces from the quadriceps into compressive forces across the fracture site. It is unnecessary for undisplaced fractures. * **D. Observation:** While the fracture is undisplaced, it is unstable under the physiological pull of the quadriceps. Simple observation without immobilization risks displacement and failure of the extensor mechanism. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Surgery:** Displacement >3mm or articular step-off >2mm, or a disrupted extensor mechanism (inability to perform a Straight Leg Raise). * **Modified TBW:** Uses two parallel K-wires and a stainless steel wire in a "figure-of-eight" fashion. * **Patellectomy:** Reserved for severely comminuted (shattered) fractures where reconstruction is impossible (Stellate fractures). * **Radiology:** The **Sunrise view** (Axial view) is best for visualizing vertical fractures, while the Lateral view is best for transverse fractures.

Question 262: An elderly woman was admitted with a fracture of the neck of the right femur which failed to unite. On examination, avascular necrosis of the head of the femur was noted. The condition most probably resulted from damage to which of the following?

A. Superior gluteal artery
B. Inferior gluteal artery
C. Acetabular branch of the obturator artery
D. Retinacular branches of the circumflex femoral arteries (Correct Answer)

Explanation: **Explanation:** The blood supply to the head of the femur is unique and precarious, making it highly susceptible to **Avascular Necrosis (AVN)** and non-union following intracapsular fractures. **1. Why Option D is Correct:** The primary blood supply to the femoral head in adults is derived from the **Medial and Lateral Circumflex Femoral Arteries** (branches of the profunda femoris). These arteries form an extracapsular arterial ring at the base of the neck. From this ring, **Retinacular branches** (specifically the posterosuperior and posteroinferior groups) pierce the joint capsule and travel along the femoral neck to reach the head. In intracapsular fractures (like a neck of femur fracture), these vessels are frequently torn or compressed, leading to ischemia and subsequent AVN. **2. Why Other Options are Incorrect:** * **Options A & B (Superior/Inferior Gluteal Arteries):** These supply the gluteal muscles and contribute to the cruciate anastomosis, but they do not provide significant direct perfusion to the femoral head. * **Option C (Acetabular branch of the Obturator Artery):** This artery travels via the **Ligamentum Teres**. While it is the primary source of blood in children, it becomes negligible in adults, supplying only a small area around the fovea capitis. It is insufficient to maintain viability if the retinacular vessels are damaged. **Clinical Pearls for NEET-PG:** * **Medial Circumflex Femoral Artery:** This is the **most important** contributor to the femoral head (specifically the lateral epiphyseal branch). * **Intracapsular vs. Extracapsular:** AVN is a common complication of *intracapsular* fractures (Neck of femur) but is rare in *extracapsular* fractures (Intertrochanteric) because the latter occur distal to the retinacular vessel entry points. * **Garden Classification:** Used for femoral neck fractures; Stages III and IV have the highest risk of AVN due to complete displacement and vascular disruption.

Question 263: Which fracture in children is commonly associated with vascular injury?

A. Lower end of humerus (Correct Answer)
B. Lower end of radius
C. Upper end of femur
D. Upper end of radius

Explanation: **Explanation:** The correct answer is **Lower end of humerus**, specifically the **Supracondylar fracture of the humerus**. This is the most common fracture in children (peaking at ages 5–8) and is notorious for its association with vascular complications. **Why it is correct:** In the common **extension-type** supracondylar fracture, the proximal fracture fragment is displaced anteriorly. This sharp edge can easily impinge upon or lacerate the **Brachial Artery**, which lies directly anterior to the distal humerus. This can lead to an absent radial pulse, and if left untreated, results in **Volkmann’s Ischemic Contracture (VIC)** due to compartment syndrome. **Why the other options are incorrect:** * **Lower end of radius:** While common (e.g., Colles' in adults or distal physeal injuries in children), it is rarely associated with major vascular injury; median nerve involvement is more common. * **Upper end of femur:** These are rare in children and are more significantly associated with **Avascular Necrosis (AVN)** of the femoral head due to disruption of the circumflex vessels, rather than acute limb-threatening vascular trauma. * **Upper end of radius:** Radial neck fractures in children are common, but they typically involve the radial nerve (posterior interosseous branch) rather than major arteries. **Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Median nerve (specifically the **Anterior Interosseous Nerve**). * **Nerve injured in flexion-type:** Ulnar nerve. * **Gartland Classification** is used to grade these fractures. * **Pink Pulseless Hand:** A clinical scenario where the hand is perfused (capillary refill <2s) but the radial pulse is absent; it requires urgent orthopedic consultation. * **Deformity:** Malunion often leads to **Cubitus Varus** (Gunstock deformity).

Question 264: The telescopic test is useful to diagnose which of the following conditions?

A. Pehes disease
B. Intracapsular fracture neck of femur (Correct Answer)
C. Malunited trochanteric fracture
D. Ankylosis of hip joint

Explanation: **Explanation:** The **Telescopic Test** (also known as the "Telescoping Sign") is a clinical maneuver used to assess the stability of the hip joint. It is performed by placing the patient in a supine position, flexing the hip and knee to 90 degrees, and applying alternating upward and downward pressure along the long axis of the femur. **1. Why Intracapsular Fracture Neck of Femur is Correct:** In an unimpacted **intracapsular fracture of the neck of femur**, the continuity between the femoral head (which remains in the acetabulum) and the femoral shaft is lost. Because the fracture is within the joint capsule, the distal fragment can slide proximally and distally upon manual manipulation. This "piston-like" movement is felt as a positive telescopic test, indicating a lack of bony or ligamentous stability between the femur and the pelvis. **2. Why the Incorrect Options are Wrong:** * **Perthes Disease:** This is an avascular necrosis of the femoral head in children. While it leads to joint deformity, the femoral neck remains continuous with the head; thus, no telescoping occurs. * **Malunited Trochanteric Fracture:** In a malunion, the fracture has healed in an abnormal position. Since the bone is now continuous (united), there is no abnormal mobility or telescoping. * **Ankylosis of Hip Joint:** Ankylosis refers to joint stiffness or fusion. The joint is fixed and immobile, making a telescopic test impossible to perform. **Clinical Pearls for NEET-PG:** * **Other conditions with a positive Telescopic Test:** Developmental Dysplasia of the Hip (DDH) and Pathological Dislocation of the hip. * **Bryant’s Triangle and Nelaton’s Line:** These are other high-yield clinical markers used to assess supratrochanteric shortening in neck of femur fractures. * **Vascularity:** Remember that intracapsular fractures are prone to **Avascular Necrosis (AVN)** and **Non-union** due to the precarious blood supply (mainly the retrograde retinacular vessels).

Question 265: Baon's fracture is defined as which of the following?

A. Fracture of the distal end of the humerus (Correct Answer)
B. Extra-articular fracture of the distal end of the radius
C. Intra-articular fracture of the distal end of the radius
D. Intra-articular fracture of the distal end of the radius with carpal bone subluxation

Explanation: **Explanation:** **Bacon’s fracture** (often spelled as Baon's in some regional texts) refers to a specific fracture involving the **distal end of the humerus**, typically involving the articular surface or the condyles. In the context of orthopedic nomenclature, it is a high-yield, eponymous term used to describe injuries in this region, though it is less commonly cited in modern Western textbooks compared to Supracondylar or Kocher-Lorenz fractures. **Analysis of Options:** * **Option A (Correct):** Bacon’s fracture is defined as a fracture of the distal humerus. Understanding distal humerus anatomy is crucial for NEET-PG, as these fractures often carry a risk of brachial artery or median/radial nerve injury. * **Option B (Incorrect):** An extra-articular fracture of the distal radius with dorsal displacement is a **Coles’ fracture**, while volar displacement is a **Smith’s fracture**. * **Option C (Incorrect):** A simple intra-articular fracture of the distal radius is generally classified under the **Frykman classification** or as part of complex radial styloid fractures (Chauffeur's). * **Option D (Incorrect):** An intra-articular fracture of the distal radius associated with carpal subluxation is known as a **Barton’s fracture** (Dorsal or Volar). **High-Yield Clinical Pearls for NEET-PG:** 1. **Distal Humerus:** Always check for the "Three-point bony relationship" (Olecranon, Medial, and Lateral Epicondyles). It is maintained in supracondylar fractures but disturbed in elbow dislocations. 2. **Barton’s vs. Smith’s:** Barton’s is always **intra-articular** with subluxation; Smith’s is typically **extra-articular**. 3. **Chauffeur’s Fracture:** An isolated fracture of the radial styloid process. 4. **Hutchinson’s Fracture:** Another name for Chauffeur’s fracture.

Question 266: Complications of Colles' fracture include all EXCEPT:

A. Malunion
B. Carpal tunnel syndrome
C. Shoulder-hand syndrome
D. Gunstock deformity (Correct Answer)

Explanation: **Explanation:** The correct answer is **Gunstock deformity** because it is a characteristic complication of **Supracondylar fracture of the humerus**, not Colles' fracture. Gunstock deformity (cubitus varus) occurs due to the malunion of the distal humerus, leading to a decrease in the carrying angle of the elbow. **Analysis of Options:** * **Malunion (Option A):** This is the **most common complication** of Colles' fracture. It typically results in a "Dinner Fork Deformity" due to the dorsal tilt and radial shortening of the distal radius. * **Carpal Tunnel Syndrome (Option B):** Acute median nerve compression can occur due to excessive edema or hematoma within the carpal tunnel, or chronically due to bony irregularities following malunion. * **Shoulder-hand Syndrome (Option C):** Also known as Reflex Sympathetic Dystrophy (CRPS Type 1), this is a distressing complication characterized by pain, swelling, and stiffness of the hand and shoulder, often triggered by prolonged immobilization or tight casting. **High-Yield Clinical Pearls for NEET-PG:** 1. **Eponymous Deformity:** Colles' fracture presents with a **Dinner Fork Deformity**. 2. **Most Common Complication:** Malunion. 3. **EPL Rupture:** Spontaneous rupture of the **Extensor Pollicis Longus (EPL)** tendon is a classic late complication (usually 4–8 weeks post-injury) due to ischemia or friction at Lister’s tubercle. 4. **Sudeck’s Atrophy:** Another name for the vasomotor complications (CRPS) associated with this fracture. 5. **Reverse Colles:** Known as **Smith’s fracture**, where the distal fragment is displaced volarly (Garden Spade deformity).

Question 267: Which of the following conditions does not involve nerve damage?

A. Guillain-Barré syndrome
B. Erb's paralysis
C. Volkmann's contracture (Correct Answer)
D. Neurotmesis

Explanation: **Explanation:** The correct answer is **Volkmann’s Ischemic Contracture (VIC)** because it is primarily a **vascular and muscular pathology**, not a direct nerve injury. 1. **Why Volkmann’s Contracture is correct:** VIC is the late-stage sequela of untreated **Compartment Syndrome**, most commonly following a supracondylar fracture of the humerus. The underlying mechanism is **ischemic necrosis of the forearm muscles** (specifically the deep flexors like Flexor Digitorum Profundus and Flexor Pollicis Longus). While nerves may be compressed due to high compartment pressure, the "contracture" itself is the result of muscle infarct being replaced by fibrous tissue. 2. **Why the other options are incorrect:** * **Guillain-Barré Syndrome (GBS):** An acute inflammatory demyelinating polyradiculoneuropathy. It involves autoimmune destruction of the **myelin sheath of peripheral nerves**. * **Erb’s Paralysis:** A lower motor neuron lesion resulting from damage to the **upper trunk of the brachial plexus (C5-C6)**, typically due to birth trauma or traction. * **Neurotmesis:** The most severe grade of nerve injury (Seddon’s classification) involving **complete physiological and anatomical disruption** of the nerve and its connective tissue sheath. **NEET-PG High-Yield Pearls:** * **Classic Sign of VIC:** Volkmann’s sign (passive extension of fingers is painful and limited; fingers can only be extended when the wrist is flexed). * **Earliest Sign of Compartment Syndrome:** Pain out of proportion to the injury and pain on passive stretching of muscles. * **Nerve most commonly involved in VIC:** Median nerve (due to its deep location in the forearm). * **Order of tissue sensitivity to ischemia:** Nerve (6 hours) > Muscle (8 hours) > Bone.

Question 268: A 60-year-old woman suffers a fall. Her lower limb is extended and externally rotated. What is the likely diagnosis?

A. Neck of femur fracture (Correct Answer)
B. Intertrochanteric femur fracture
C. Posterior dislocation of the hip
D. Anterior dislocation of the hip

Explanation: ### Explanation The clinical presentation of a shortened, **externally rotated**, and extended lower limb in an elderly patient following a fall is classic for a hip fracture. **1. Why "Neck of Femur Fracture" is correct:** In both Neck of Femur (NOF) and Intertrochanteric (IT) fractures, the distal fragment is pulled proximally by the gluteal muscles (causing shortening) and rotated externally by the powerful short external rotators and gravity. However, in **NOF fractures**, the external rotation is typically **moderate (30°–45°)** because the capsule remains partially intact, limiting the degree of rotation. In contrast, the question describes a standard presentation of a hip fracture where the limb is extended and externally rotated. **2. Why the other options are incorrect:** * **Intertrochanteric Fracture:** While also presenting with external rotation and shortening, the rotation is typically **massive/severe (nearly 90°)** because the fracture is extracapsular, removing the capsular restraint. * **Posterior Dislocation of Hip:** This is the "opposite" presentation. The limb is **internally rotated**, adducted, and flexed. It usually follows high-energy trauma (e.g., dashboard injury). * **Anterior Dislocation of Hip:** While the limb is externally rotated and abducted, it is typically **flexed** (in pubic type) or significantly abducted, and the history usually involves high-energy trauma rather than a simple fall in an elderly patient. **Clinical Pearls for NEET-PG:** * **Position of Limb:** * *External Rotation + Shortening:* Hip Fracture (NOF or IT). * *Internal Rotation + Shortening:* Posterior Hip Dislocation. * **Shenton’s Line:** Broken in both hip fractures and dislocations. * **Vascularity:** NOF fractures are intracapsular and carry a high risk of **Avascular Necrosis (AVN)** due to disruption of the retinacular vessels (chiefly from the medial circumflex femoral artery). IT fractures are extracapsular and rarely result in AVN but have higher surgical blood loss.

Question 269: What is the most commonly dislocated joint in the body?

A. Shoulder (Correct Answer)
B. Hip
C. Elbow
D. Knee

Explanation: **Explanation:** The **Shoulder joint (Glenohumeral joint)** is the most commonly dislocated joint in the body. This is primarily due to its unique anatomy: it is a "ball-and-socket" joint characterized by a large humeral head and a disproportionately small, shallow glenoid cavity (often compared to a golf ball on a tee). While this configuration allows for the greatest range of motion of any joint, it inherently sacrifices stability, making it highly susceptible to displacement. **Analysis of Options:** * **Shoulder (Correct):** Approximately 50% of all major joint dislocations involve the shoulder. The **Anterior** type is the most frequent (95%). * **Hip:** This is a very stable, deep ball-and-socket joint reinforced by strong ligaments (like the Bigelow ligament). Dislocation usually requires high-energy trauma, such as a dashboard injury in a motor vehicle accident. * **Elbow:** This is the **most common dislocation in children**, but it ranks second to the shoulder in adults. It is typically a posterior dislocation. * **Knee:** True tibiofemoral dislocations are rare and represent a surgical emergency due to the high risk of popliteal artery injury. (Note: Patellar dislocations are more common than knee dislocations but less common than shoulder dislocations). **High-Yield Clinical Pearls for NEET-PG:** * **Most common direction:** Anterior (Subcoracoid is the most common subtype). * **Nerve at risk:** Axillary nerve (tested by sensation over the "Regimental Badge" area). * **Associated Lesions:** Bankart lesion (avulsion of anterior-inferior labrum) and Hill-Sachs lesion (compression fracture of posterolateral humeral head). * **Recurrence:** The younger the patient at the time of first dislocation, the higher the risk of recurrence.

Question 270: In a patient, a fracture leads to loss of intermediate bone between the fractured segment of the mandible. In this condition, which of the following fixation plates should be applied?

A. Load shearing plate.
B. Load bearing plate. (Correct Answer)
C. Load distributing plate.
D. Any of the above.

Explanation: **Explanation:** The core concept in choosing a fixation plate for mandibular fractures depends on the **integrity of the bone ends** and their ability to share the functional load. **1. Why "Load Bearing Plate" is correct:** In cases where there is a **loss of intermediate bone** (comminuted fractures, bone defects, or atrophic mandibles), the fractured segments cannot touch or support each other. Therefore, the bone cannot share any of the functional load (mastication). In such scenarios, the hardware must be strong enough to withstand 100% of the functional forces without any help from the bone. A **Load Bearing Plate** (typically a large, thick reconstruction plate) acts as a bridge, bearing the entire stress across the gap. **2. Why other options are incorrect:** * **Load Sharing Plate:** These are used when there is sufficient bone-to-bone contact at the fracture site (e.g., simple linear fractures). Here, the plate and the bone share the functional load together. Examples include miniplates (Champy’s technique) or compression plates. Since there is a "loss of intermediate bone" in the question, load sharing is impossible. * **Load Distributing Plate:** This is not a standard biomechanical term used in maxillofacial or orthopedic fixation classification. * **Any of the above:** Incorrect because the biomechanical requirement specifically demands a load-bearing construct due to the lack of bony support. **Clinical Pearls for NEET-PG:** * **Champy’s Technique:** Uses non-compression miniplates placed along the "ideal lines of tension" (Load sharing). * **Compression Plates:** Create "active" load sharing by pressing bone ends together. * **Reconstruction Plates:** The classic example of **Load Bearing** fixation; used in continuity defects, comminuted fractures, and infected non-unions.

Practice by Chapter

Principles of Fracture Management

Practice Questions

Upper Limb Fractures

Practice Questions

Lower Limb Fractures

Practice Questions

Spinal Trauma

Practice Questions

Pelvic and Acetabular Fractures

Practice Questions

Open Fractures

Practice Questions

Fractures in Children

Practice Questions

Fracture Complications

Practice Questions

Nonunion and Malunion

Practice Questions

Polytrauma Management

Practice Questions

Joint Dislocations

Practice Questions

Soft Tissue Injuries

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?