Trauma Practice Questions

Q: What is the best treatment for a fracture neck of femur in a 65-year-old lady?

Hemireplacement arthroplasty. **Explanation:** The management of a fracture of the neck of the femur is primarily determined by the **age of the patient** and the **displacement of the fracture**. In an elderly patient (typically >60–65 years), the blood supply to the femoral head (via the retinacular vessels) is highly precarious. Displaced fractures carry a high risk of **Avascular Necrosis (AVN)** and non-union. **Why Hemireplacement Arthroplasty is correct:** For a 65-year-old patient, the goal is early mobilization to prevent complications of prolonged bed rest (like DVT or pneumonia). Hemireplacement arthroplasty (e.g., Austin Moore or Bipolar prosthesis) allows for immediate weight-bearing and avoids the high failure rate associated with internal fixation in osteoporotic elderly bone. **Analysis of Incorrect Options:** * **A. Pop cast:** Hip fractures are "unstable" and cannot be managed by immobilization in a cast. This leads to malunion and fatal complications of recumbency. * **B. Gleohy:** This appears to be a typographical error (likely intended to be Girdlestone excision arthroplasty or a similar term). Regardless, excision arthroplasty is a salvage procedure, not a primary treatment. * **C. Bone grafting and compression:** This is generally reserved for younger patients ( 65 yrs) & Sedentary:** Hemireplacement Arthroplasty. * **Elderly (>65 yrs) & Active:** Total Hip Arthroplasty (THA) is preferred over Hemireplacement to provide better long-term functional outcomes. * **Garden Classification:** Used to grade displacement; Stages III and IV have the highest risk of AVN.

Q: The Telescopic test is useful in the diagnosis of which condition?

Intracapsular fracture neck of femur. **Explanation:** The **Telescopic Test** (also known as the "Telescoping Sign") is a clinical maneuver used to detect **abnormal mobility** along the long axis of the femur. It is performed by flexing the hip and knee to 90 degrees and applying alternating upward and downward pressure (pushing and pulling) on the thigh. **1. Why Option B is Correct:** In an **Intracapsular fracture of the neck of femur** (specifically unimpacted or non-union cases), the continuity between the femoral head and the shaft is lost. Since the head remains fixed in the acetabulum while the shaft is free to move, the clinician can feel the femur "sliding" up and down. This axial instability is the hallmark of a positive telescopic test. **2. Why Other Options are Incorrect:** * **Perthes Disease:** This is an avascular necrosis of the femoral head. The joint remains intact and stable; the primary clinical findings are a painful limp and restricted internal rotation/abduction, not axial instability. * **Malunited Trochanteric Fracture:** In malunion, the bone has healed, albeit in a deformed position (usually coxa vara). Because the bone is continuous, there is no "telescoping" movement. * **Ankylosis of the Hip:** Ankylosis refers to joint stiffness or fusion. The hip is immobile, making a telescopic test impossible to perform. **Clinical Pearls for NEET-PG:** * **Developmental Dysplasia of the Hip (DDH):** The Telescopic test is also classically positive in DDH (dislocated hip), where the femoral head can be moved in and out of the acetabulum. * **Differential:** If a question mentions "Telescoping" in a pediatric context, think **DDH**; in an adult trauma context, think **Fracture Neck of Femur**. * **Other Hip Tests:** Remember to differentiate this from **Trendelenburg’s sign** (abductor weakness) and **Thomas Test** (fixed flexion deformity).

Q: Vascular injury is common in which fracture of the following?

Lower end of humerus. **Explanation:** The correct answer is **A. Lower end of humerus**. **1. Why it is correct:** Fractures of the lower end of the humerus, specifically **Supracondylar fractures (Extension type)**, are notorious for vascular complications. The proximal fracture fragment is displaced anteriorly, where it can easily impinge upon or lacerate the **Brachial Artery**. This injury can lead to arterial spasm or thrombosis, potentially resulting in **Volkmann’s Ischemic Contracture (VIC)**—a surgical emergency. **2. Analysis of incorrect options:** * **Lower end of radius (Colles’ fracture):** While common, it is more frequently associated with nerve injuries (Median nerve) or tendon ruptures (Extensor Pollicis Longus) rather than major vascular compromise. * **Upper end of femur:** These fractures (Neck of femur or Intertrochanteric) are associated with **Avascular Necrosis (AVN)** of the femoral head due to disruption of the retinacular vessels, but acute major limb-threatening vascular injury is rare compared to the humerus. * **Upper end of radius:** Fractures of the radial head or neck are more likely to cause restricted forearm rotation or injury to the **Posterior Interosseous Nerve (PIN)**. **3. Clinical Pearls for NEET-PG:** * **Most common vascular injury in Supracondylar fracture:** Brachial Artery. * **Most common nerve injury in Supracondylar fracture:** Median nerve (specifically the Anterior Interosseous Nerve/AIN). * **The "5 Ps" of Ischemia:** Pain (earliest sign), Pallor, Pulselessness, Paresthesia, and Paralysis. * **High-yield association:** Knee dislocation is the lower limb equivalent most commonly associated with vascular injury (**Popliteal Artery**).

Q: A "Jumper's fracture" is a common term for a fracture of which of the following bones?

Pelvis. **Explanation:** A **Jumper’s Fracture** refers specifically to a **transverse fracture of the sacrum** (usually at the S1 or S2 level). It is a high-energy injury typically caused by a vertical fall from a significant height where the patient lands on their feet. The axial loading force is transmitted through the spine, causing the sacrum to buckle or fracture transversely, often resulting in "spinopelvic dissociation." **Analysis of Options:** * **Option C (Pelvis): Correct.** The sacrum is anatomically part of the posterior pelvic ring. Therefore, a sacral fracture is classified as a pelvic fracture. * **Option A (Calcaneus):** While the calcaneus is the most common bone fractured in a fall from height (often called a "Lover’s fracture" or "Don Juan fracture"), it is not the "Jumper’s fracture." * **Option B (Tibia):** Falls from height can cause tibial pilon fractures or tibial plateau fractures, but these carry specific anatomical names. * **Option D (Femoral neck):** These are common in elderly patients due to low-energy trauma (trips) or in young patients due to high-energy trauma, but are not associated with this specific eponym. **Clinical Pearls for NEET-PG:** 1. **Associated Injuries:** Always look for **L5 nerve root injury** or cauda equina syndrome in Jumper’s fractures due to the proximity of the sacral foramina. 2. **Don Juan Syndrome:** A clinical triad seen in jumpers consisting of bilateral calcaneal fractures, lower limb fractures, and thoracolumbar compression fractures (Chance fractures). 3. **Radiology:** Jumper's fractures are often missed on routine AP pelvic X-rays; a **lateral view of the sacrum** or a CT scan is the gold standard for diagnosis.

Q: Posterior dislocation of the hip is characterized by which of the following findings?

Marked shortening of the limb. **Explanation:** Posterior dislocation of the hip is the most common type of hip dislocation (approx. 90%), typically resulting from a high-energy "dashboard injury" where a force is applied to the knee while the hip is flexed. **1. Why "Marked shortening of the limb" is correct:** In a posterior dislocation, the femoral head is forced out of the acetabulum and driven superiorly and posteriorly onto the ilium. This superior displacement of the femoral head relative to the acetabulum results in significant **true shortening** of the affected limb. **2. Analysis of Incorrect Options:** * **B & C (Lengthening/No change):** These are incorrect because the femoral head does not remain at the level of the acetabulum. **Lengthening** is a classic feature of **Anterior Dislocation** (specifically the obturator type), where the head sits lower than the acetabulum. * **D (Extension deformity):** Posterior dislocation is characterized by a **Flexion** deformity. The classic clinical posture is **FADIR**: **F**lexion, **Ad**duction, and **I**nternal **R**otation. Extension is seen in anterior dislocations. **NEET-PG High-Yield Pearls:** * **Clinical Attitude:** * *Posterior Dislocation:* Flexion, Adduction, Internal Rotation (FADIR). * *Anterior Dislocation:* Flexion, Abduction, External Rotation (FABER). * **Most Common Nerve Injury:** Sciatic nerve (specifically the peroneal division) is involved in ~10% of posterior dislocations. * **Radiology:** On AP view, the femoral head appears smaller than the contralateral side (due to being closer to the film/posterior). Shenton’s line is broken. * **Management:** It is an **orthopaedic emergency**. Reduction should be performed within 6 hours to minimize the risk of **Avascular Necrosis (AVN)** of the femoral head. Common reduction techniques include Allis, Stimson, and Bigelow methods.

Q: What does the Hawkin sign denote?

Retained vascularity. **Explanation:** The **Hawkins sign** is a radiologic indicator used to assess the viability of the talar body following a fracture of the **talar neck**. It is typically seen on an anteroposterior (AP) radiograph of the ankle approximately **6 to 8 weeks** post-injury. 1. **Why "Retained Vascularity" is correct:** The sign appears as a subchondral radiolucent (dark) line in the dome of the talus. This radiolucency represents **disuse osteopenia**. For bone resorption (osteopenia) to occur, there must be an active blood supply to the bone. Therefore, the presence of this subchondral lucency indicates that the bone is vascularized and is undergoing normal remodeling, effectively ruling out Avascular Necrosis (AVN). 2. **Why other options are incorrect:** * **Avascular Necrosis (AVN):** The *absence* of the Hawkins sign (where the talar dome remains sclerotic or dense) suggests AVN, as dead bone cannot undergo resorption. * **Non-union:** This refers to the failure of the fracture fragments to heal, which is a different complication unrelated to the subchondral lucency of the talar dome. * **Decreased vascularity:** The sign specifically denotes sufficient blood flow to allow for metabolic bone activity; decreased vascularity would result in a lack of radiolucency. **Clinical Pearls for NEET-PG:** * **Hawkins Classification:** Used for talar neck fractures (Type I to IV). The risk of AVN increases with the type (Type I: 0-15%, Type IV: ~100%). * **Sensitivity:** Hawkins sign is a highly sensitive indicator of talar viability. * **Blood Supply of Talus:** Primarily from the **Artery of the Tarsal Canal** (branch of Posterior Tibial Artery). The talus is prone to AVN because 60% of its surface is covered by articular cartilage, limiting the areas for vascular entry (retrograde blood supply).

Q: Which of the following is/are not included in the management of an intra-articular fracture?

None of the above. ### Explanation The primary goal in managing an **intra-articular fracture** is to achieve anatomical reduction and stable internal fixation to restore joint congruity and allow early range of motion. However, management strategies vary depending on the severity, joint involved, and patient factors. **Why "None of the above" is correct:** All three options (A, B, and C) are recognized components of managing intra-articular injuries under specific clinical circumstances. Therefore, none of them can be excluded from the potential management spectrum. * **Aspiration (Option C):** This is often the immediate step in managing a tense **haemarthrosis** (blood in the joint) associated with a fracture. It relieves pain, reduces pressure, and aids in diagnosis (e.g., seeing fat globules/lipohemarthrosis indicates an intra-articular fracture). * **Excision (Option B):** In certain joints where the fragment is small, comminuted, or non-essential for stability, excision is preferred. A classic example is the **excision of the radial head** in Mason Type III fractures or excision of a comminuted patella (pole excision). * **Arthrodesis (Option A):** While usually a salvage procedure, primary or delayed arthrodesis (joint fusion) is a management option for severely comminuted intra-articular fractures where reconstruction is impossible, particularly in the weight-bearing joints of the foot (e.g., **Calcaneal fractures** or Lisfranc injuries). ### High-Yield Clinical Pearls for NEET-PG: * **Lipohemarthrosis:** The presence of fat droplets in aspirated joint fluid is pathognomonic for an intra-articular fracture (fat escapes from the bone marrow). * **AO Principles:** The gold standard for intra-articular fractures is **Absolute Stability** (Anatomical reduction + Compression). * **Complications:** The most common long-term complication of an intra-articular fracture is **Secondary Osteoarthritis** due to joint surface irregularity.

Question 1

What is the best treatment for a fracture neck of femur in a 65-year-old lady?

Accepted Answer

Hemireplacement arthroplasty

Answer

Pop cast

Answer

Gleohy - I suspect this is a typo and should be 'Galeal tendon' which doesn't fit here, or potentially a less common fracture treatment term. I will assume it's a typo and leave it as is for now, but it is highly suspect.

Answer

Bone grafting and compression

Question 2

Kocher Langenbeck approach for emergency acetabular fixation is indicated in all of the following situations, EXCEPT:

Accepted Answer

Progressive sciatic nerve injury

Answer

Open fracture

Answer

Recurrent dislocation in spite of closed reduction and traction

Answer

Open irrigation and debridement of the hip joint

Question 3

The Telescopic test is useful in the diagnosis of which condition?

Accepted Answer

Intracapsular fracture neck of femur

Answer

Perthes disease

Answer

Malunited trochanteric fracture

Answer

Ankylosis of the hip joint

Question 4

Vascular injury is common in which fracture of the following?

Accepted Answer

Lower end of humerus

Answer

Lower end of radius

Answer

Upper end of femur

Answer

Upper end of radius

Question 5

A "Jumper's fracture" is a common term for a fracture of which of the following bones?

Accepted Answer

Pelvis

Answer

Calcaneus

Answer

Tibia

Answer

Femoral neck

Question 6

Posterior dislocation of the hip is characterized by which of the following findings?

Accepted Answer

Marked shortening of the limb

Answer

Lengthening of the limb

Answer

No change in limb length

Answer

Extension deformity

Question 7

What does the Hawkin sign denote?

Accepted Answer

Retained vascularity

Answer

Non-union

Answer

Decreased vascularity

Answer

Avascular necrosis

Question 8

A patient presents with a history of trauma and X-ray findings of a fracture of the proximal medial bone of the forearm with dislocation. Which muscles may become paralyzed?

Accepted Answer

Extensor pollicis longus

Answer

Flexor carpi ulnaris

Answer

Adductor pollicis

Answer

Opponens pollicis

Question 9

Traumatic glenohumeral instability with a Bankart lesion is treated by which of the following methods?

Accepted Answer

Surgery

Answer

Conservative methods

Answer

Rehabilitation

Answer

Observation followed by inferior capsule shift

Question 10

Which of the following is/are not included in the management of an intra-articular fracture?

Accepted Answer

None of the above

Answer

Arthrodesis

Answer

Excision

Answer

Aspiration

Trauma — MCQs

Trauma — MCQs

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