Trauma — MCQs
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Russell's traction is indicated for which of the following conditions?
Which nerve repair has the worst prognosis?
A 12-year-old child presents with tingling sensation and numbness in the little finger and gives a history of fracture in the elbow region 4 years back. What is the probable previous injury?
A 45-year-old woman with a history of pemphigus vulgaris, on regular treatment with a controlled primary disease, presented with pain in the right hip and knee. Examination revealed no limb length discrepancy but showed tenderness in Scarpa's triangle and limitation of abduction and internal rotation of the right hip joint compared to the other side. What is the most probable diagnosis?
McMurray's test is a useful clinical test to assess injury to which structure?
A 31-year-old male with nephrotic syndrome complains of pain in the right hip joint of 2 months' duration. The movements at the hip are free but painful terminally. What is the most likely diagnosis?
Axillary nerve injury is most likely to be seen in which of the following conditions?
If an adolescent boy falls on an outstretched hand, which is the most common bone to be injured?
Gunstock deformity is seen in which of the following fractures?
Chauffeur's fracture involves which part of the bone?
Trauma Indian Medical PG Practice Questions and MCQs
Question 21: Russell's traction is indicated for which of the following conditions?
- A. Inter-trochanteric fracture (Correct Answer)
- B. Fracture of the shaft of femur
- C. Low back ache
- D. Flexion deformity of the hip
Explanation: **Russell’s Traction** is a type of skin traction that utilizes a system of pulleys and weights to provide both a longitudinal pull and an upward lift. ### **Explanation of the Correct Option** **A. Inter-trochanteric fracture:** This is the classic indication for Russell’s traction. It is particularly useful for stabilizing extracapsular hip fractures (like inter-trochanteric fractures) before surgery. The traction works by applying a resultant force that aligns with the long axis of the femur while simultaneously supporting the knee in slight flexion via a sling. This helps in reducing muscle spasms and maintaining limb length. ### **Explanation of Incorrect Options** * **B. Fracture of the shaft of femur:** While skin traction can be used as a temporary measure, **Thomas Splint** (fixed traction) or **Gallows traction** (for children <2 years) is more characteristic. For definitive management in adults, skeletal traction or internal fixation is preferred. * **C. Low back ache:** This is typically managed with **Pelvic traction**, which applies a longitudinal pull on the lumbar spine to relieve nerve root compression. * **D. Flexion deformity of the hip:** This is specifically managed using **Thomas’s splint** or **Girdlestone’s traction**. Russell's traction is not designed to correct fixed deformities but rather to stabilize acute fractures. ### **High-Yield Clinical Pearls for NEET-PG** * **The Principle:** Russell’s traction uses the **"Parallelogram of Forces"** principle. Two forces (one horizontal and one vertical) create a resultant force directed along the axis of the femur. * **Key Feature:** It allows for some knee movement, which prevents joint stiffness compared to rigid splinting. * **Weight Limit:** Since it is a form of skin traction, the weight applied should generally not exceed **3–4 kg** to avoid skin excoriation or nerve damage (Common Peroneal Nerve). * **Hamilton-Russell Traction:** This is a variation often used to manage femoral shaft fractures in older children.
Question 22: Which nerve repair has the worst prognosis?
- A. Ulnar
- B. Radial
- C. Median
- D. Lateral popliteal (Correct Answer)
Explanation: **Explanation:** The prognosis of nerve repair depends on several factors, including the distance from the target muscle, the complexity of the nerve's function (sensory vs. motor), and the anatomical environment. **Why Lateral Popliteal (Common Peroneal) Nerve is the worst:** The **Lateral Popliteal nerve** has the poorest prognosis for recovery following repair due to several factors: 1. **Long Distance to Target:** The nerve must regenerate over a long distance to reach the distal leg muscles (e.g., Tibialis Anterior). 2. **Large Motor Units:** It supplies large, complex motor units that are less likely to be re-innervated effectively before muscle atrophy occurs. 3. **Anatomical Tension:** It is often subject to significant tension and has a relatively poor blood supply compared to upper limb nerves. 4. **Gravity:** Recovery of dorsiflexion must work against gravity, making even partial recovery clinically less effective. **Analysis of Incorrect Options:** * **Radial Nerve:** Has the **best prognosis** among major limb nerves. It is primarily a motor nerve with a short distance to its target muscles (brachioradialis, extensors) and minimal sensory overlap. * **Median Nerve:** Generally has a good prognosis, especially for sensory recovery, though fine motor recovery in the hand can be variable. * **Ulnar Nerve:** Has a poorer prognosis than the Median or Radial nerves due to the distance to the intrinsic hand muscles, but it still typically fares better than the Lateral Popliteal nerve. **NEET-PG High-Yield Pearls:** * **Best Prognosis for Repair:** Radial Nerve. * **Worst Prognosis for Repair:** Lateral Popliteal (Common Peroneal) Nerve. * **Most Common Nerve Injured in Lower Limb:** Common Peroneal Nerve (often at the neck of the fibula). * **Order of Recovery:** Sensory fibers usually recover before motor fibers. * **Sunderland Classification:** Grade V (Neurotmesis) always requires surgical repair for any chance of recovery.
Question 23: A 12-year-old child presents with tingling sensation and numbness in the little finger and gives a history of fracture in the elbow region 4 years back. What is the probable previous injury?
- A. Lateral condyle fracture humerus (Correct Answer)
- B. Injury to ulnar nerve
- C. Supracondylar fracture humerus
- D. Dislocation of elbow
Explanation: ### Explanation The clinical presentation of delayed ulnar nerve symptoms (tingling and numbness in the little finger) years after an elbow injury is a classic description of **Tardy Ulnar Nerve Palsy**. **1. Why Lateral Condyle Fracture is Correct:** Lateral condyle fractures in children are prone to **non-union**. If the fracture fails to unite, it leads to a progressive **Cubitus Valgus** (increased carrying angle) deformity. As the valgus deformity increases over years, the ulnar nerve is chronically stretched as it passes behind the medial epicondyle. This "tardy" (late) stretching results in ulnar neuropathy, typically appearing 3–20 years after the initial injury. **2. Why Other Options are Incorrect:** * **Injury to ulnar nerve:** While the symptoms are ulnar nerve-related, the question asks for the *previous injury* (the fracture) that led to this state. * **Supracondylar fracture humerus:** This is the most common elbow fracture in children, but it typically leads to **Cubitus Varus** (Gunstock deformity). Cubitus varus does not stretch the ulnar nerve and is rarely associated with tardy ulnar palsy. * **Dislocation of elbow:** Acute dislocations can cause immediate nerve injuries (usually median or ulnar), but they do not typically cause progressive valgus deformities leading to delayed palsy years later. **3. NEET-PG High-Yield Pearls:** * **Lateral Condyle Fracture:** Known as the "Fracture of Necessity" because it almost always requires open reduction and internal fixation (ORIF) to prevent non-union. * **Milch Classification:** Used for lateral condyle fractures. * **Tardy Ulnar Nerve Palsy Treatment:** Surgical **anterior transposition** of the ulnar nerve. * **Most common complication of Lateral Condyle Fracture:** Non-union and Cubitus Valgus. * **Most common complication of Supracondylar Fracture:** Cubitus Varus (Malunion) and Volkmann’s Ischemic Contracture (Vascular).
Question 24: A 45-year-old woman with a history of pemphigus vulgaris, on regular treatment with a controlled primary disease, presented with pain in the right hip and knee. Examination revealed no limb length discrepancy but showed tenderness in Scarpa's triangle and limitation of abduction and internal rotation of the right hip joint compared to the other side. What is the most probable diagnosis?
- A. Stress fracture of the neck of the femur
- B. Avascular necrosis of the femoral head (Correct Answer)
- C. Perthes disease
- D. Transient synovitis of the hip
Explanation: **Explanation:** The correct diagnosis is **Avascular Necrosis (AVN) of the femoral head**. The key clinical clue is the patient’s history of **Pemphigus Vulgaris**, an autoimmune condition typically treated with long-term **corticosteroids**. Steroid use is a leading non-traumatic cause of AVN due to increased intraosseous pressure and fat emboli compromising the blood supply (primarily the medial circumflex femoral artery) to the femoral head. **Clinical Presentation:** AVN typically presents with deep-seated groin pain (referred to the knee) and tenderness in **Scarpa’s triangle**. The characteristic physical finding is the early loss of **internal rotation and abduction**, as seen in this patient. **Why other options are incorrect:** * **Stress fracture of the neck of femur:** While it presents with hip pain, it is more common in athletes or elderly patients with osteoporosis. It lacks the strong association with systemic steroid use seen in AVN. * **Perthes Disease:** This is an idiopathic AVN of the femoral head, but it occurs exclusively in the **pediatric age group** (typically 4–8 years), not in a 45-year-old adult. * **Transient Synovitis:** This is a self-limiting inflammatory condition, most common in **children** following a viral infection. It does not correlate with chronic steroid therapy. **High-Yield Pearls for NEET-PG:** * **Most sensitive investigation:** MRI (shows "Double Line Sign" on T2WI). * **Earliest X-ray sign:** Sclerosis or "Snow-capping." * **Pathognomonic X-ray sign:** "Crescent sign" (indicates subchondral collapse). * **Staging System:** Ficat and Arlet Classification. * **Treatment:** Core decompression is the treatment of choice for early stages (Stage I & II).
Question 25: McMurray's test is a useful clinical test to assess injury to which structure?
- A. Medial collateral ligament
- B. Lateral collateral ligament
- C. Meniscus (Correct Answer)
- D. Cruciate ligament
Explanation: **Explanation:** **McMurray’s Test** is a classic clinical maneuver used to diagnose tears in the **menisci** (fibrocartilaginous structures) of the knee. The test works by trapping a torn meniscal fragment between the femoral condyles and the tibial plateau. When the knee is rotated and extended, the displaced fragment causes a palpable or audible **"thud" or "click,"** often accompanied by pain. * **Medial Meniscus:** Tested by externally rotating the foot and applying valgus stress while extending the knee. * **Lateral Meniscus:** Tested by internally rotating the foot and applying varus stress while extending the knee. **Why other options are incorrect:** * **Collateral Ligaments (A & B):** These are assessed using the **Valgus Stress Test** (for Medial Collateral Ligament) and **Varus Stress Test** (for Lateral Collateral Ligament) at 0° and 30° of knee flexion. * **Cruciate Ligaments (D):** The Anterior Cruciate Ligament (ACL) is assessed via the **Lachman test** (most sensitive), Anterior Drawer test, and Pivot Shift test. The Posterior Cruciate Ligament (PCL) is assessed via the **Posterior Drawer test** and the Sag sign. **High-Yield Clinical Pearls for NEET-PG:** 1. **Apley’s Grinding Test:** Another specific test for meniscal injuries (Distraction helps differentiate ligamentous from meniscal pain). 2. **Thessaly Test:** Performed by having the patient stand on one leg and rotate; it is considered more sensitive than McMurray’s in some clinical settings. 3. **Triad of O'Donoghue:** Includes injury to the ACL, MCL, and Medial Meniscus. 4. **Gold Standard Diagnosis:** While McMurray’s is a high-yield clinical test, **MRI** is the investigation of choice for meniscal tears.
Question 26: A 31-year-old male with nephrotic syndrome complains of pain in the right hip joint of 2 months' duration. The movements at the hip are free but painful terminally. What is the most likely diagnosis?
- A. Tuberculosis of the hip
- B. Avascular necrosis of the femoral head (Correct Answer)
- C. Chondrolysis of the hip
- D. Pathological fracture of the femoral neck
Explanation: ### Explanation **Correct Option: B. Avascular Necrosis (AVN) of the femoral head** The key to this diagnosis lies in the association between **Nephrotic Syndrome** and AVN. Patients with nephrotic syndrome are frequently treated with long-term **corticosteroids**, which is a leading cause of non-traumatic AVN. Additionally, the hypercoagulable state inherent in nephrotic syndrome (due to loss of Antithrombin III) can lead to intravascular thrombosis, further compromising the blood supply to the femoral head. Clinically, early-stage AVN presents with groin pain and a characteristic physical finding: **movements are free (full range) but painful at the extremes (terminally painful)**. This occurs because the articular cartilage remains intact initially, unlike in inflammatory or infectious arthritis where the range of motion is severely restricted early on. **Why other options are incorrect:** * **Tuberculosis of the hip:** Typically presents with a "cold abscess," constitutional symptoms (fever, weight loss), and a significant, painful reduction in all planes of motion (starting with abduction and internal rotation). * **Chondrolysis:** This involves the rapid destruction of articular cartilage, leading to severe stiffness and a marked decrease in the range of motion, not "free" movements. * **Pathological fracture:** While nephrotic syndrome can cause osteopenia, a fracture would result in an acute inability to bear weight and a gross deformity/loss of movement, rather than a 2-month history of terminal pain. **NEET-PG High-Yield Pearls:** * **Most common site for AVN:** Femoral head (due to retrograde blood supply via the medial circumflex femoral artery). * **Earliest Sign on MRI:** "Double line sign" (T2-weighted image). * **Staging System:** Ficat and Arlet classification is most commonly used. * **Crescent Sign:** Seen on X-ray; indicates subchondral collapse (Stage III).
Question 27: Axillary nerve injury is most likely to be seen in which of the following conditions?
- A. Shoulder dislocation (Correct Answer)
- B. Coracoid process fracture
- C. Humerus shaft fracture
- D. Brachial plexus injury
Explanation: **Explanation:** The **Axillary nerve (C5, C6)** is the most commonly injured nerve in **Anterior Shoulder Dislocation**. This occurs because the nerve winds around the surgical neck of the humerus in the quadrangular space, placing it in close proximity to the inferior aspect of the glenohumeral joint capsule. When the humeral head displaces antero-inferiorly, it can stretch or compress the nerve (neuropraxia). **Analysis of Options:** * **A. Shoulder Dislocation (Correct):** Specifically, anterior dislocation is the most common cause. Clinical signs include loss of the rounded contour of the shoulder (deltoid atrophy) and sensory loss over the "Regimental Badge" area. * **B. Coracoid Process Fracture:** This is a rare injury usually associated with acromioclavicular joint disruptions. While the musculocutaneous nerve is nearby, axillary nerve involvement is not typical. * **C. Humerus Shaft Fracture:** This is classically associated with **Radial nerve injury** (especially in Holstein-Lewis fractures of the distal third), as the nerve lies in the spiral groove. * **D. Brachial Plexus Injury:** While the axillary nerve is a branch of the posterior cord of the brachial plexus, a global plexus injury involves multiple nerves (e.g., Erb’s or Klumpke’s palsy). Shoulder dislocation is a more specific and frequent cause of isolated axillary nerve palsy. **NEET-PG High-Yield Pearls:** * **Test for Axillary Nerve:** Check for sensation over the lateral aspect of the upper arm (Regimental Badge area) and isometric contraction of the **Deltoid**. * **Surgical Neck Fracture:** This is the second most common cause of axillary nerve injury. * **Most common type of shoulder dislocation:** Anterior (95%). * **Associated Injury:** Always rule out a **Bankart lesion** or **Hill-Sachs lesion** in recurrent dislocations.
Question 28: If an adolescent boy falls on an outstretched hand, which is the most common bone to be injured?
- A. Fracture of the lower end of the radius
- B. Fracture of both bones of the forearm
- C. Scaphoid fracture (Correct Answer)
- D. Supracondylar fracture of the humerus
Explanation: **Explanation:** The mechanism of injury—falling on an outstretched hand (FOOSH)—is a classic presentation in orthopaedics, but the specific injury pattern varies significantly with the patient's age. **Why Scaphoid Fracture is correct:** In **adolescents and young adults**, the scaphoid is the most commonly fractured carpal bone. During this developmental stage, the physis (growth plate) of the distal radius is often stronger than the scaphoid bone itself. When force is transmitted through the radial side of the wrist in extension, the scaphoid bears the brunt of the impact, leading to a fracture. **Analysis of Incorrect Options:** * **A. Fracture of the lower end of the radius (Colles’):** This is the most common FOOSH injury in **elderly patients** (especially post-menopausal women) due to osteoporotic changes. * **B. Fracture of both bones of the forearm:** While common in children, it is less frequent than specific physeal or carpal injuries in the adolescent age group. * **C. Supracondylar fracture of the humerus:** This is the most common FOOSH injury in **children (ages 5–10)** because the supracondylar area is the thinnest part of the distal humerus during early childhood. **High-Yield Clinical Pearls for NEET-PG:** * **Age-wise FOOSH injuries:** * Child: Supracondylar fracture. * Adolescent/Young Adult: Scaphoid fracture. * Elderly: Colles’ fracture. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox** is the hallmark of a scaphoid fracture. * **Complication:** The scaphoid has a **retrograde blood supply** (distal to proximal), making the proximal pole highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Radiology:** Initial X-rays may be negative; if clinical suspicion persists, repeat X-ray in 10–14 days or perform an MRI.
Question 29: Gunstock deformity is seen in which of the following fractures?
- A. Lateral condyle fracture
- B. Radial head fracture
- C. Ulnar head fracture
- D. Supracondylar fracture of humerus (Correct Answer)
Explanation: **Explanation:** **Gunstock deformity (Cubitus Varus)** is the most common late complication of a **Supracondylar fracture of the humerus (Option D)**. It occurs due to the malunion of the fracture, specifically when there is a failure to correct the **medial tilt**, internal rotation, or posterior displacement of the distal fragment. This results in a decrease in the normal carrying angle of the elbow, leading to a varus alignment where the forearm deviates toward the midline, resembling the stock of a gun. **Analysis of Incorrect Options:** * **Lateral condyle fracture (Option A):** This typically leads to **Cubitus Valgus** (an increase in the carrying angle) due to non-union or growth arrest of the lateral physis. This can eventually cause delayed ulnar nerve palsy (Tardy Ulnar Nerve Palsy). * **Radial head fracture (Option B):** These fractures usually result in restricted forearm rotation (pronation/supination) or chronic elbow pain, but do not cause a gross varus/valgus deformity of the elbow joint. * **Ulnar head fracture (Option C):** Isolated ulnar head fractures are rare and typically affect the distal radioulnar joint (DRUJ) stability at the wrist, not the elbow alignment. **Clinical Pearls for NEET-PG:** * **Most common cause of Gunstock deformity:** Malunion (specifically medial tilt). * **Most common nerve injured in Supracondylar fracture:** Anterior Interosseous Nerve (AIN) — a branch of the Median nerve. * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Management:** Gunstock deformity is primarily a cosmetic issue; if functional correction is needed, a **French Osteotomy** (closing wedge osteotomy) is performed.
Question 30: Chauffeur's fracture involves which part of the bone?
- A. Radial head
- B. Radial styloid process (Correct Answer)
- C. Ulnar styloid process
- D. Base of 1st metacarpal
Explanation: **Explanation:** **Chauffeur’s fracture** (also known as a **Backfire fracture** or **Hutchinson’s fracture**) is an intra-articular oblique fracture of the **radial styloid process**. The injury occurs due to a forceful impact on the scaphoid bone, which is driven against the radial styloid, acting like a wedge. Historically, this occurred when a hand-cranked car engine "backfired," forcing the crank handle into the palm of the chauffeur. In modern clinical practice, it is more commonly seen following a fall on an outstretched hand with the wrist in radial deviation and supination. **Analysis of Options:** * **Option A (Radial head):** Fractures here are common in falls on an outstretched hand but involve the proximal radius at the elbow, not the wrist. * **Option C (Ulnar styloid process):** While often fractured alongside a Colles' fracture, an isolated ulnar styloid fracture is not termed a Chauffeur’s fracture. * **Option D (Base of 1st metacarpal):** Fractures here are known as **Bennett’s fracture** (intra-articular) or **Rolando’s fracture** (comminuted). **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Compression of the scaphoid against the radial styloid. * **Management:** Because it is an intra-articular fracture, anatomical reduction is crucial. Displaced fractures usually require **Open Reduction and Internal Fixation (ORIF)** with percutaneous K-wires or a headless compression screw. * **Associated Injuries:** Often associated with intercarpal ligamentous injuries, most commonly the **scapholunate dissociation**. * **Named Fractures of Distal Radius:** * **Colles’:** Extra-articular, dorsal displacement (Dinner fork deformity). * **Smith’s:** Extra-articular, volar displacement (Garden spade deformity). * **Barton’s:** Intra-articular fracture-dislocation (Volar or Dorsal).
Practice by Chapter
Principles of Fracture Management
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Upper Limb Fractures
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Lower Limb Fractures
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Spinal Trauma
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Pelvic and Acetabular Fractures
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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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Polytrauma Management
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Joint Dislocations
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Soft Tissue Injuries
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