Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 281: A Bankart's lesion involves which part of the glenoid labrum?

A. Anterior lip
B. Superior lip
C. Antero-superior lip
D. Antero-inferior lip (Correct Answer)

Explanation: **Explanation:** A **Bankart’s lesion** is the most common pathological finding in recurrent anterior shoulder dislocations. It involves an avulsion of the **antero-inferior** part of the glenoid labrum from the underlying glenoid rim. This occurs because, during an anterior dislocation, the humeral head is forced forward and downward, tearing the labrum and the attached inferior glenohumeral ligament (IGHL) complex. This loss of integrity compromises the "chock-block" effect of the labrum, leading to joint instability. **Analysis of Options:** * **Antero-inferior lip (Correct):** This is the specific site (typically between the 3 o'clock and 6 o'clock positions for a right shoulder) where the labrum detaches in traumatic anterior instability. * **Anterior lip:** While technically anterior, it is too non-specific. The lesion specifically involves the inferior quadrant where the IGHL attaches. * **Superior lip:** This is the site for **SLAP lesions** (Superior Labrum from Anterior to Posterior), often involving the long head of the biceps tendon. * **Antero-superior lip:** This area is typically associated with subscapularis tears or "Sublabral holes" (a normal anatomical variant), but not classic Bankart’s. **High-Yield Clinical Pearls for NEET-PG:** 1. **Soft Bankart vs. Bony Bankart:** A "Soft Bankart" involves only the labrum, while a "Bony Bankart" involves a fracture of the antero-inferior glenoid rim. 2. **Hill-Sachs Lesion:** Often co-exists with Bankart’s; it is a compression fracture of the **postero-lateral** aspect of the humeral head. 3. **Gold Standard Investigation:** MRI Arthrography (MRA) is the investigation of choice to visualize labral tears. 4. **Surgery:** Recurrent cases often require a **Bankart Repair** (reattaching the labrum) or a **Latarjet procedure** if significant bone loss is present.

Question 282: A patient is brought to the emergency following a road traffic accident (dashboard injury). Examination reveals the affected limb is held in flexion, adduction, and internal rotation with apparent shortening. What type of hip dislocation is most likely?

A. Anterior
B. Posterior (Correct Answer)
C. Inferior
D. None of the above

Explanation: ***Posterior*** - **Posterior hip dislocation** accounts for **85-90%** of all traumatic hip dislocations, typically caused by **dashboard injuries** during motor vehicle accidents. - Classic deformity includes **hip flexion**, **adduction**, **internal rotation**, and **apparent leg shortening** with the knee pointing toward the midline. *Anterior* - **Anterior hip dislocation** is rare (5-10% of cases) and typically occurs with **forced abduction** and **external rotation**. - Clinical presentation shows **hip flexion**, **abduction**, **external rotation**, and **apparent leg lengthening** - opposite to posterior dislocation. *Inferior* - **Inferior hip dislocation** (obturator type) is extremely rare and occurs with **severe trauma** involving **hip abduction** and **flexion**. - Patient presents with **severe hip flexion**, **abduction**, and **external rotation** with the femoral head palpable in the **obturator foramen**. *None of the above* - This option is incorrect as **posterior hip dislocation** is clearly the most common type following trauma. - The question describes a typical traumatic hip dislocation scenario where posterior displacement is statistically most likely.

Question 283: A pregnant woman presents with a 6-week history of right hip pain. On examination, she has guarding on passive hip movements. Plain X-ray showed osteoporosis of the proximal femur. What is the most likely diagnosis?

A. Acute chondrolysis of pregnancy
B. Avascular necrosis of the femoral head
C. Transient osteoporosis (Correct Answer)
D. Septic arthritis

Explanation: **Explanation:** **Transient Osteoporosis of the Hip (TOH)** is a self-limiting clinical syndrome characterized by sudden onset hip pain and radiographic evidence of localized bone loss. It most commonly affects **middle-aged men** and **women in the third trimester of pregnancy**. 1. **Why the correct answer is right:** The clinical presentation is classic: a pregnant woman in her third trimester (implied by the timeline) presenting with hip pain and functional limitation (guarding). The hallmark radiographic finding is **diffuse osteopenia/osteoporosis of the femoral head and neck**, while the joint space remains preserved. MRI (the gold standard) would typically show bone marrow edema. The condition is "transient" because it usually resolves spontaneously within 6–12 months with conservative management. 2. **Why the incorrect options are wrong:** * **Acute Chondrolysis:** This involves the rapid destruction of articular cartilage, leading to **joint space narrowing** on X-ray, which is absent here. * **Avascular Necrosis (AVN):** While pregnancy is a risk factor, early AVN usually shows normal X-rays or specific signs like the "crescent sign" and subchondral collapse. It does not typically present with diffuse osteoporosis of the entire proximal femur. * **Septic Arthritis:** This is an acute emergency presenting with high-grade fever, systemic toxicity, and elevated inflammatory markers (ESR/CRP), which are not mentioned. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** "M" for Middle-aged Men; "M" for Mothers (3rd trimester). * **Imaging:** X-ray shows "Ghost-like" appearance of the femoral head. MRI shows decreased T1 and increased T2 signal (Bone Marrow Edema Syndrome). * **Management:** Conservative (protected weight-bearing and analgesics). * **Key Differentiator:** Unlike AVN, TOH usually resolves completely without surgical intervention.

Question 284: Hangman's fracture is a fracture of which cervical vertebra?

A. C1
B. C2 (Correct Answer)
C. C3
D. None of the above

Explanation: **Explanation:** **Hangman’s fracture** is the clinical name for a **traumatic spondylolisthesis of the axis (C2)**. It specifically involves a bilateral fracture through the **pars interarticularis** of the C2 vertebra. 1. **Why C2 is Correct:** The mechanism of injury typically involves forceful **hyperextension and distraction** (classically seen in judicial hanging or high-impact motor vehicle accidents where the chin hits the dashboard). This force causes the pars interarticularis of C2 to snap, leading to the anterior displacement of the C2 vertebral body on C3. 2. **Why Incorrect Options are Wrong:** * **C1 (Atlas):** A fracture of the C1 vertebra is known as a **Jefferson fracture**, which is a burst fracture caused by axial loading (e.g., diving into a shallow pool). * **C3:** While C3 can be involved in complex cervical injuries, it is not the site of a Hangman’s fracture. The C2-C3 junction is the site of displacement, but the primary bony break is in C2. **High-Yield Clinical Pearls for NEET-PG:** * **Neurological Sparing:** Interestingly, Hangman’s fracture is often not associated with immediate spinal cord injury because the fracture actually increases the diameter of the spinal canal at that level ("auto-decompression"). * **Radiology:** Look for the anterior displacement of C2 on C3 on a lateral X-ray. * **Classification:** The **Levine and Edwards classification** is used to grade the severity and stability of this fracture. * **Management:** Most stable cases (Type I) are managed with a cervical collar or Halo vest; unstable cases may require surgical fusion.

Question 285: Which of the following is NOT true about calcaneum fracture?

A. The BoWLER'S angle is decreased.
B. It is the most commonly injured tarsal bone.
C. GISSEN'S angle in intra-articular fracture is decreased. (Correct Answer)
D. Also known as Loveri fracture.

Explanation: **Explanation:** Calcaneum fractures are the most common tarsal bone fractures, typically resulting from high-energy axial loading (e.g., falling from a height). **1. Why Option C is the correct answer (The False Statement):** In intra-articular calcaneal fractures, the **Gissane’s Angle** (Critical Angle) actually **increases** (becomes more obtuse), while the **Bohler’s Angle decreases**. Gissane’s angle is formed by the downward slope of the lateral process of the talus and the upward slope of the calcaneal posterior facet. When the calcaneum is crushed, this angle widens. **2. Analysis of other options:** * **Option A (Bohler’s Angle):** This is the angle between two lines (highest point of anterior process to highest point of posterior facet, and highest point of posterior facet to superior edge of tuberosity). The normal range is **20°–40°**. In fractures, this angle **decreases** or may even become negative, indicating a loss of height. * **Option B (Commonality):** The calcaneum is indeed the **most commonly fractured tarsal bone**, accounting for approximately 60% of all tarsal fractures. * **Option D (Lover’s Fracture):** Calcaneal fractures are classically called **"Don Juan" or "Lover’s" fractures**, as they often occur when a "lover" jumps from a height (like a balcony) to escape a spouse. **Clinical Pearls for NEET-PG:** * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot; highly suggestive of calcaneal fracture. * **Associated Injuries:** Always rule out **compression fractures of the Lumbar spine (L1)** (10% association) and contralateral calcaneal fractures. * **Classification:** The **Sanders Classification** (based on CT scan) is the gold standard for intra-articular fractures. * **Treatment:** Undisplaced fractures are treated conservatively; displaced intra-articular fractures usually require **ORIF**.

Question 286: Which of the following statements regarding recurrent dislocation of the shoulder is false?

A. All traumatic dislocations will be recurrent. (Correct Answer)
B. Recurrent dislocation results when the capsule is stripped, not torn.
C. The humeral head is always within the capsule.
D. All of these statements are false.

Explanation: **Explanation:** The shoulder is the most commonly dislocated joint in the body due to the shallow nature of the glenoid labrum. However, the statement that **all traumatic dislocations will be recurrent is false**. While trauma is a major risk factor, recurrence depends heavily on the age of the patient at the time of the first dislocation; younger patients (under 20) have a recurrence rate of up to 90%, whereas in patients over 40, the rate drops significantly to less than 15% [1]. **Analysis of Options:** * **Option A (Correct):** As explained, recurrence is not a universal outcome [1]. Many traumatic dislocations heal completely with proper immobilization and rehabilitation. * **Option B:** This is a **true** statement regarding the pathology of recurrence. In recurrent cases, the capsule and labrum are often stripped from the anterior glenoid neck (Bankart lesion) rather than being mid-substance tears. This creates a "pouch" that allows the head to slip out repeatedly [2]. * **Option C:** This is **true**. In recurrent dislocations, the humeral head typically remains within the "stripped-up" capsular sleeve (subcapsular dislocation). This distinguishes it from an acute traumatic dislocation where the capsule may be completely ruptured. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bankart Lesion:** Avulsion of the anterior-inferior glenoid labrum; it is the most common cause of recurrent instability [2]. 2. **Hill-Sachs Lesion:** A compression fracture (indentation) on the posterosuperolateral aspect of the humeral head [2]. 3. **Gold Standard Investigation:** MRI Arthrography is the investigation of choice for labral tears [2]. 4. **Surgery:** The **Bankart Repair** (reattaching the labrum) is the standard treatment, while the **Latarjet procedure** (coracoid transfer) is used if there is significant glenoid bone loss [2].

Question 287: Malgaigne's fracture involves which of the following anatomical structures?

A. Pelvis (Correct Answer)
B. Femur head
C. Tibial spine
D. Proximal humerus

Explanation: **Explanation:** **Malgaigne’s fracture** is a classic, high-energy injury of the **pelvis**. It is defined as a vertical shear fracture-dislocation of the pelvic ring. Specifically, it involves a double vertical fracture: 1. **Anteriorly:** Ipsilateral superior and inferior pubic rami fractures (or pubic symphysis diastasis). 2. **Posteriorly:** Ipsilateral sacroiliac joint disruption or a fracture of the ilium/sacrum. This injury results in an unstable pelvic segment that can shift cranially (superiorly), often leading to limb length discrepancy and significant internal hemorrhage. **Analysis of Incorrect Options:** * **B. Femur head:** Fractures here are typically associated with hip dislocations (e.g., Pipkin classification), not Malgaigne’s. * **C. Tibial spine:** This is an avulsion fracture at the attachment of the Anterior Cruciate Ligament (ACL), common in pediatric populations. * **D. Proximal humerus:** Common fractures here include Neer’s classification types (surgical neck, greater tuberosity, etc.), usually seen in elderly patients following a fall. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Usually a vertical shear force (e.g., a fall from height landing on one leg). * **Stability:** It is a **vertically and rotationally unstable** fracture (Tile Type C). * **Complications:** High risk of massive retroperitoneal hemorrhage, urogenital injuries, and lumbosacral plexus (L5 nerve root) injury. * **Radiology:** Look for the "upward shift" of the hemipelvis on an AP X-ray.

Question 288: Chance fracture is/are:

A. Mainly ligamentous injury
B. Neurological involvement is common
C. Flexion compression injury
D. Seat belt injury (Correct Answer)

Explanation: **Explanation:** **Chance Fracture** is a classic high-yield topic in NEET-PG Orthopaedics. It is a **distraction-type injury** of the spine, typically occurring at the thoracolumbar junction (T12-L2). 1. **Why Option D is Correct:** It is famously known as a **"Seat Belt Injury."** It occurs when a person wearing only a lap-type seat belt undergoes sudden deceleration (e.g., a head-on collision). The belt acts as a fulcrum; the upper body is thrown forward, causing the spine to bend acutely over the belt, leading to a horizontal failure of the posterior and middle columns. 2. **Why Options A, B, and C are Incorrect:** * **Option A:** While it can involve ligaments, it is primarily a **bony fracture** (horizontal splitting of the vertebral body, pedicles, and spinous process). * **Option B:** Neurological involvement is **rare**. Because it is a distraction injury (pulling apart) rather than a burst injury, the spinal canal is usually decompressed rather than compromised. * **Option C:** It is a **Flexion-Distraction injury**, not flexion-compression. Compression injuries lead to wedge or burst fractures. **Clinical Pearls for NEET-PG:** * **Mechanism:** Pure distraction around a transverse axis. * **Associated Injury:** Up to 50% of cases are associated with **intra-abdominal visceral injuries** (e.g., rupture of the spleen, liver, or hollow viscus) due to the compression of the lap belt. * **Radiology:** Look for the **"Empty Jacket Sign"** on AP X-rays (widening of the interspinous distance). * **Classification:** It is a Type B injury in the AO classification.

Question 289: A hanging cast is used for which of the following fractures?

A. Femur
B. Radius
C. Tibia
D. Humerus (Correct Answer)

Explanation: **Explanation:** A **Hanging Cast** is a specialized orthopedic cast used primarily for the management of **displaced mid-shaft fractures of the humerus**. The underlying medical concept is **traction**. Unlike standard casts that provide immobilization through rigid support, a hanging cast utilizes the **weight of the cast and the limb** itself to provide continuous dependent traction. This gravitational pull helps in maintaining the alignment of the humeral fragments and correcting angulation. For it to be effective, the patient must remain upright or semi-reclined, and the sling must be attached to a loop at the wrist to maintain the traction vector. **Why other options are incorrect:** * **Femur:** Femoral fractures require significant force for reduction and are typically managed with intramedullary nailing or skin/skeletal traction (e.g., Thomas splint), as a hanging cast cannot provide sufficient traction against the powerful thigh muscles. * **Radius:** Distal radius fractures are managed with Colles' or sugar-tong casts, which focus on immobilization rather than traction. * **Tibia:** Tibial fractures are treated with long-leg or patellar tendon-bearing (PTB) casts to allow for weight-bearing and stability. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Best for oblique or spiral mid-shaft humeral fractures with shortening. * **Contraindications:** Transverse fractures (risk of distraction and non-union) and distracted fractures. * **Positioning:** The patient must not support the elbow on a table or armrest, as this neutralizes the traction. * **Common Complication:** The most common nerve injured in humeral shaft fractures is the **Radial Nerve** (causing wrist drop).

Question 290: A Hill-Sachs lesion is typically seen in which of the following conditions?

A. Recurrent dislocation of the elbow
B. Recurrent dislocation of the patella
C. Recurrent dislocation of the hip
D. Recurrent dislocation of the shoulder (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Recurrent dislocation of the shoulder** **Mechanism and Pathophysiology:** A **Hill-Sachs lesion** is a classic radiological finding in **recurrent anterior shoulder dislocations**. It is a compression fracture (indentation) of the **posterosuperolateral aspect of the humeral head**. This occurs when the humeral head is displaced anteriorly and inferiorly, causing its soft cancellous bone to strike against the hard, sharp edge of the **anterior glenoid rim**. It is considered a hallmark of shoulder instability and is often associated with a **Bankart lesion** (avulsion of the anterior-inferior glenoid labrum). **Analysis of Incorrect Options:** * **A. Recurrent dislocation of the elbow:** This typically involves injuries to the Coronoid process or the Radial head (e.g., "Terrible Triad"), but does not involve a Hill-Sachs lesion. * **B. Recurrent dislocation of the patella:** This is associated with a **bone bruise** on the lateral femoral condyle and the medial patellar facet, often involving a tear of the Medial Patellofemoral Ligament (MPFL). * **C. Recurrent dislocation of the hip:** This is rare and usually associated with acetabular fractures or labral tears, but the specific "Hill-Sachs" nomenclature is exclusive to the shoulder. **Clinical Pearls for NEET-PG:** * **Reverse Hill-Sachs Lesion:** An indentation on the **anterior** aspect of the humeral head, seen in **posterior** shoulder dislocations. * **Imaging:** The Hill-Sachs lesion is best visualized on a **Stryker Notch view** X-ray or an Internal Rotation view. * **Engaging vs. Non-engaging:** A "Large" or "Engaging" Hill-Sachs lesion (occupying >25-30% of the articular surface) often requires surgical intervention like the **Remplissage procedure** to prevent further instability. * **Bankart Lesion:** The most common associated soft tissue injury in anterior dislocation.

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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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Trauma — MCQs

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