Trauma Practice Questions

Q: Gun stock deformity is seen in?

Supracondylar fracture humerus. **Explanation:** **Gun stock deformity** (also known as **Cubitus Varus**) is the most common late complication of a **Supracondylar fracture of the humerus**, particularly when the fracture is displaced or inadequately reduced. ### Why Supracondylar Fracture is Correct: The deformity occurs due to the **malunion** of the distal humerus fragment. Specifically, it results from a combination of **medial tilt, medial rotation, and posterior displacement** of the distal fragment. This leads to a decrease in the normal carrying angle of the elbow (which is usually 5-15° of valgus), causing the forearm to deviate toward the midline, resembling the stock of a gun. While it is primarily a cosmetic deformity, it rarely affects the functional range of motion. ### Why Other Options are Incorrect: * **Lateral Condylar Fracture:** This injury is more commonly associated with **Cubitus Valgus** (an increase in the carrying angle) due to non-union or growth arrest of the lateral physis. Cubitus valgus can lead to a "Tardy Ulnar Nerve Palsy." * **Medial Condylar Fracture:** While rare, these are more likely to cause cubitus varus if there is a growth arrest, but they are not the classic or most frequent cause associated with the term "Gun stock deformity" in clinical exams. ### High-Yield Clinical Pearls for NEET-PG: * **Most common complication:** Stiffness (overall); **Most common deformity:** Cubitus Varus. * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Nerve most commonly involved:** Median nerve (specifically the Anterior Interosseous Nerve - AIN) in extension-type fractures; however, the Radial nerve is also frequently cited. * **Treatment of choice for Cubitus Varus:** French Osteotomy (Modified step-cut osteotomy).

Q: Complications of elbow dislocation are all EXCEPT:

Volkmann's ischemic contracture. **Explanation:** The question asks for the complication that is **NOT** typically associated with elbow dislocation. While elbow dislocations are serious injuries, **Volkmann’s Ischemic Contracture (VIC)** is classically a late sequela of **Supracondylar fractures of the humerus** (due to brachial artery injury or compartment syndrome), rather than simple elbow dislocations. **Why Option D is the correct answer:** Volkmann’s Ischemic Contracture is the end-stage result of untreated compartment syndrome. While vascular compromise can occur in dislocations, the mechanical obstruction or arterial spasm required to produce the full-blown ischemic contracture is overwhelmingly linked to pediatric supracondylar fractures. In the context of "all except" questions in NEET-PG, VIC is the "most distal" or least common primary complication compared to the others listed. **Analysis of Incorrect Options:** * **Vascular Injury (A):** The **Brachial artery** is at high risk during posterior dislocations as it gets stretched over the displaced distal humerus. * **Median Nerve Injury (B):** Along with the Ulnar nerve, the Median nerve is frequently tethered or compressed during the displacement of the radius and ulna. * **Myositis Ossificans (C):** This is a **very common** complication of elbow trauma. It is often exacerbated by forceful passive stretching or massage following the reduction of a dislocation. **Clinical Pearls for NEET-PG:** * **Most common type:** Posterior/Posterolateral dislocation is the most frequent. * **Terrible Triad of Elbow:** Elbow dislocation + Coronoid fracture + Radial head fracture. * **Management:** Emergency closed reduction under sedation followed by brief immobilization (not exceeding 3 weeks to avoid stiffness). * **Rule of Thumb:** If a question asks for the most common complication of elbow dislocation, the answer is **Stiffness** (decreased range of motion).

Q: A 62-year-old woman presents with a 3-month history of progressive right shoulder pain, limiting her ability to lift her arm for daily activities. She denies neurological symptoms. Physical examination reveals weakness in abduction and external rotation with a normal passive range of motion. She cannot maintain 90 degrees of abduction. There is no motor deficit in the forearm or hand, and pulses and sensation are normal. Which of the following muscles constitute the injured structure?

Supraspinatus, infraspinatus, teres minor, subscapularis. **Explanation:** The clinical presentation describes a classic case of a **Rotator Cuff Tear**. The patient exhibits the "Drop Arm Sign" (inability to maintain 90 degrees of abduction) and weakness in external rotation, while maintaining a normal passive range of motion. This dissociation between active and passive movement is hallmark for a tendon/muscle tear rather than adhesive capsulitis (where both are restricted). The **Rotator Cuff** is a functional unit of four muscles that stabilize the glenohumeral joint. The correct anatomical components are: 1. **Supraspinatus:** Initiates abduction (0-15°). 2. **Infraspinatus:** Primary external rotator. 3. **Teres Minor:** External rotator and adductor. 4. **Subscapularis:** Primary internal rotator. **Analysis of Options:** * **Option D (Correct):** Correctly identifies the four SITS muscles (Supraspinatus, Infraspinatus, Teres minor, Subscapularis). * **Options A & B:** Incorrect because they include the **Teres Major**. While the Teres Major helps in adduction and internal rotation, it is *not* part of the rotator cuff. * **Options A & C:** Incorrect because they include the **Deltoid**. The deltoid is the primary abductor of the arm (after 15°) but is a superficial muscle, not part of the stabilizing rotator cuff. **High-Yield NEET-PG Pearls:** * **Most common muscle injured:** Supraspinatus (due to its location under the acromion). * **Investigation of Choice:** MRI is the gold standard for diagnosing rotator cuff tears. * **Clinical Tests:** Jobe’s Test (Empty Can) for Supraspinatus; Hornblower’s Sign for Teres Minor; Lift-off/Gerber’s test for Subscapularis. * **Nerve Supply:** Suprascapular nerve (Supra/Infraspinatus), Axillary nerve (Teres minor), Upper and Lower Subscapular nerves (Subscapularis).

Q: Which of the following best describes the patient's wrist fracture?

Colles fracture. ***Colles fracture*** - Affects the **distal radius** with **dorsal displacement** and **dorsal angulation**, creating the characteristic **"dinner fork" deformity** on clinical examination. - Most commonly occurs from a **fall on outstretched hand (FOOSH)** mechanism, particularly in elderly patients with **osteoporosis**. *Bennett's fracture* - This is a fracture-dislocation at the **base of the first metacarpal** (thumb), not involving the wrist or radius. - Requires **surgical fixation** due to instability at the **carpometacarpal joint** of the thumb. *Jones fracture* - Occurs at the **5th metatarsal** in the **foot**, specifically at the **metaphyseal-diaphyseal junction**. - Has poor healing potential due to **watershed blood supply** and often requires **surgical intervention**. *Salter-Harris fracture* - This classification applies to **growth plate injuries** in **pediatric patients** with open physes. - Would not be applicable to typical wrist fractures in adults where **growth plates are closed**.

Q: What is the typical position of the distal fragment in a fracture of the upper third of the femur shaft?

Adducted. In a fracture of the **upper third of the femur shaft**, the displacement of fragments is determined by the powerful muscle groups attached to them. **1. Why Adducted is Correct:** The position of the **distal fragment** is primarily influenced by the **Adductor group of muscles** (Adductor longus, brevis, and magnus). These muscles originate from the pelvis and insert along the linea aspera of the femoral shaft. When the bone is fractured in the upper third, these muscles pull the distal fragment medially, resulting in **Adduction**. **2. Analysis of Other Options:** * **Abducted:** This describes the **proximal fragment**. The proximal fragment is abducted by the Gluteus medius and minimus, and flexed by the Iliopsoas. * **Posteriorly displaced:** While the distal fragment may have some posterior tilt due to the pull of the gastrocnemius (more common in supracondylar fractures), the primary characteristic displacement in upper-third fractures is medial/adduction. * **Anteriorly displaced:** The proximal fragment is the one that appears anteriorly displaced (flexed) due to the Iliopsoas muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Proximal Fragment Position:** Flexed (Iliopsoas), Abducted (Glutei), and Externally Rotated (Short rotators). * **Distal Fragment Position:** Adducted (Adductors) and pulled proximally (Shortening due to Hamstrings and Quadriceps). * **Winquist-Hansen Classification:** Used to grade the comminution of femoral shaft fractures. * **Management:** The gold standard treatment for adult femoral shaft fractures is **Intramedullary (IM) Nailing** (antegrade or retrograde).

Q: All of the following are true about dashboard injuries EXCEPT?

The point of impact is on the greater trochanter.. ### Explanation **1. Why Option D is the Correct Answer (The Exception)** In a **dashboard injury**, the point of impact is **not** the greater trochanter. Instead, the force is applied to the **proximal tibia (knee)** while the hip and knee are flexed (as seen in a seated passenger during a head-on collision). This longitudinal force is transmitted along the shaft of the femur toward the hip joint. Because the hip is flexed and adducted in this position, the femoral head is driven posteriorly, out of the acetabulum. Impact on the greater trochanter is typically associated with lateral compression injuries or femoral neck fractures, not classic dashboard dislocations. **2. Analysis of Other Options** * **Option A:** Dashboard injuries are the classic mechanism for **posterior dislocation of the hip** (the most common type of hip dislocation). * **Option B:** The **sciatic nerve** (specifically the peroneal division) lies immediately posterior to the acetabulum. During a posterior dislocation, the femoral head can compress or stretch the nerve, resulting in **foot drop**. * **Option C:** **Avascular Necrosis (AVN)** is a dreaded late complication. The blood supply to the femoral head (via the retinacular vessels) is disrupted during dislocation. The risk of AVN increases significantly if the dislocation is not reduced within 6 hours. **3. NEET-PG Clinical Pearls** * **Position of the Limb:** In posterior hip dislocation, the limb is typically **shortened, adducted, and internally rotated**. (Contrast this with anterior dislocation: abducted and externally rotated). * **Associated Fracture:** Often associated with a fracture of the **posterior lip of the acetabulum**. * **Management:** It is an **orthopaedic emergency**. The first-line treatment is closed reduction (e.g., Allis maneuver or Bigelow's maneuver) under sedation. * **Most Common Nerve Injured:** Sciatic nerve (10-20% of cases).

Q: Which test is used for posterior dislocation of the glenohumeral joint?

Jerk test. The **Jerk test** is the specific clinical maneuver used to assess **posterior instability** and posterior labral tears of the glenohumeral joint. ### **Explanation of Options** * **A. Jerk Test (Correct):** To perform this, the patient’s arm is placed in 90° of abduction and internal rotation. The examiner applies an axial load to the humerus while moving the arm into horizontal adduction. A positive result is a sudden "jerk" or "clunk" as the humeral head subluxates posteriorly over the glenoid rim. * **B. Fulcrum Test:** This is used to diagnose **stress fractures of the femoral shaft**. The examiner’s arm acts as a fulcrum under the patient's thigh while downward pressure is applied to the knee. * **C. Crank Test:** This is used to identify **SLAP (Superior Labrum Anterior to Posterior) lesions**. It involves axial loading and rotation of the humerus in an elevated position. * **D. McMurray’s Test:** A classic physical exam maneuver used to diagnose **meniscal tears** in the knee joint, not the shoulder. ### **High-Yield Clinical Pearls for NEET-PG** * **Posterior Dislocation:** Often associated with **seizures** or **electric shocks**. On X-ray, look for the **"Light bulb sign"** (due to internal rotation) and the **"Rim sign"**. * **Kim Test:** Another specific test for posteroinferior labral tears, often performed in conjunction with the Jerk test. * **Anterior Instability:** The most common type of shoulder dislocation. Key tests include the **Apprehension test**, **Relocation test**, and **Surprise test**. * **Bankart Lesion:** Avulsion of the anteroinferior labrum; **Hill-Sachs Lesion:** Compression fracture of the posterolateral humeral head (both seen in anterior dislocations).

Question 1

Gun stock deformity is seen in?

Accepted Answer

Supracondylar fracture humerus

Answer

Lateral condylar fracture of humerus

Answer

Medial condylar fracture of humerus

Answer

All of the above

Question 2

Complications of elbow dislocation are all EXCEPT:

Accepted Answer

Volkmann's ischemic contracture

Answer

Vascular injury

Answer

Median nerve injury

Answer

Myositis ossificans

Question 3

What is the primary action of an intramedullary 'K' nail?

Accepted Answer

Three-point fixation

Answer

Two-point fixation

Answer

Compression

Answer

Weight concentration

Question 4

An 8-year-old boy falls on a flexed left elbow and suffers a closed, fully displaced flexion type supracondylar fracture. He complains of finger numbness, but will not allow examination of his arm. Which of the following is most likely injured in this fracture?

Accepted Answer

Ulnar nerve

Answer

Anterior interosseous nerve

Answer

Radial nerve

Answer

Radial artery

Question 5

A 62-year-old woman presents with a 3-month history of progressive right shoulder pain, limiting her ability to lift her arm for daily activities. She denies neurological symptoms. Physical examination reveals weakness in abduction and external rotation with a normal passive range of motion. She cannot maintain 90 degrees of abduction. There is no motor deficit in the forearm or hand, and pulses and sensation are normal. Which of the following muscles constitute the injured structure?

Accepted Answer

Supraspinatus, infraspinatus, teres minor, subscapularis

Answer

Supraspinatus, infraspinatus, teres major, deltoid

Answer

Supraspinatus, infraspinatus, teres major, subscapularis

Answer

Supraspinatus, infraspinatus, teres minor, deltoid

Question 6

Which of the following best describes the patient's wrist fracture?

Accepted Answer

Colles fracture

Answer

Bennett's fracture

Answer

Jones fracture

Answer

Salter-Harris fracture

Question 7

What is the typical position of the distal fragment in a fracture of the upper third of the femur shaft?

Accepted Answer

Adducted

Answer

Abducted

Answer

Posteriorly displaced

Answer

Anteriorly displaced

Question 8

All of the following are true about dashboard injuries EXCEPT?

Accepted Answer

The point of impact is on the greater trochanter.

Answer

It is associated with posterior dislocation of the hip.

Answer

Sciatic nerve may be involved, leading to foot drop.

Answer

Avascular necrosis of the hip could be a late complication.

Question 9

A 55-year-old woman presents with severe pain in the flexor muscles of the forearm, fixed flexion of the fingers, and swelling, cyanosis, and anesthesia of the fingers following a car crash. Which of the following is the most likely diagnosis?

Accepted Answer

Volkmann's ischemic contracture

Answer

Colles' fracture

Answer

Scaphoid fracture

Answer

Bennett's fracture

Question 10

Which test is used for posterior dislocation of the glenohumeral joint?

Accepted Answer

Jerk test

Answer

Fulcrum test

Answer

Crank test

Answer

McMurray's test

Trauma — MCQs

Trauma — MCQs

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