Trauma Practice Questions

Q: What is commonly referred to as a Potts fracture?

Bimalleolar ankle fracture. **Explanation:** **Potts fracture** (also known as Dupuytren’s fracture) is a classic eponym used to describe a **bimalleolar ankle fracture**. It occurs due to a combination of abduction and external rotation forces at the ankle joint. In this injury, there is typically a fracture of the lateral malleolus (fibula) above the syndesmosis and a fracture of the medial malleolus (tibia) or a tear of the deltoid ligament. This disruption compromises the "ankle mortise," leading to joint instability. **Analysis of Options:** * **Option A (Correct):** Percivall Potts originally described this as a bimalleolar injury. It is the standard definition used in orthopaedic examinations. * **Option B:** A **Trimalleolar fracture** (Cotton’s fracture) involves the medial malleolus, lateral malleolus, and the posterior malleolus (posterior lip of the tibia). * **Option C:** A fracture of the distal end of the radius is most commonly a **Colles’ fracture** (dorsal displacement) or a **Smith’s fracture** (volar displacement). * **Option D:** Pathological fractures in osteomalacia are typically referred to as **Looser’s zones** or Milkman’s fractures (pseudofractures). **High-Yield Clinical Pearls for NEET-PG:** * **Lauge-Hansen Classification:** The most widely used system for ankle fractures based on the foot position and the direction of the deforming force. * **Danis-Weber Classification:** Categorizes ankle fractures based on the level of the fibular fracture relative to the syndesmosis (Type A, B, and C). * **Management:** Stable fractures are treated with a below-knee cast; however, most Potts fractures are unstable and require **Open Reduction and Internal Fixation (ORIF)** to restore the anatomy of the ankle mortise. * **Maisonneuve Fracture:** A high-yield variant involving a proximal fibular fracture associated with a medial malleolar break or deltoid ligament rupture.

Q: Which of the following carries a higher risk of DVT and pulmonary thromboembolism?

Hip surgeries. **Explanation:** The risk of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) is governed by **Virchow’s Triad**: endothelial injury, stasis, and hypercoagulability. **Hip surgeries** (such as Total Hip Arthroplasty or Hip Fracture surgery) carry one of the highest risks for venous thromboembolism (VTE) in surgical practice. This is due to several factors: 1. **Extensive Tissue Trauma:** Major orthopedic procedures release significant amounts of thromboplastin, inducing a hypercoagulable state. 2. **Venous Stasis:** Post-operative immobilization and the use of tourniquets or intraoperative positioning lead to blood pooling. 3. **Direct Vessel Injury:** Manipulation of the femur can cause direct thermal or mechanical injury to the femoral vein. **Analysis of Incorrect Options:** * **Hand and Breast Surgery:** These are generally considered "low-risk" procedures. They involve shorter operative times, minimal blood loss, and allow for early mobilization, which prevents stasis. * **Obesity:** While obesity is a significant **patient-related risk factor** for DVT, the question asks which option carries a *higher* risk. Major orthopedic surgery (a procedure-related factor) is a much stronger independent trigger for acute VTE than obesity alone. **Clinical Pearls for NEET-PG:** * **Highest Risk Procedures:** Hip arthroplasty, Knee arthroplasty, and Pelvic fractures. * **Prophylaxis:** Low Molecular Weight Heparin (LMWH), Fondaparinux, or Rivaroxaban are standard. Mechanical prophylaxis (IPC pumps) is used as an adjunct. * **Gold Standard Diagnosis:** Contrast Venography (historically), but **Duplex Ultrasonography** is the investigation of choice in clinical practice. * **Fatal PE:** This is the most common cause of sudden death following major orthopedic surgery.

Q: Bohler's angle is measured in fractures involving which tarsal bone?

Calcaneum. **Explanation:** **Bohler’s Angle** (also known as the Tuber-joint angle) is a crucial radiological parameter used in the assessment of **Calcaneum fractures**. It is formed by the intersection of two lines: 1. A line drawn from the highest point of the anterior process to the highest point of the posterior facet. 2. A line drawn from the highest point of the posterior facet to the highest point of the calcaneal tuberosity. The **normal range is 25° to 40°**. In intra-articular calcaneal fractures (the most common tarsal bone fracture), the angle **decreases** or may even become negative, signifying a collapse of the posterior facet and loss of calcaneal height. **Analysis of Incorrect Options:** * **Talus:** Fractures here are assessed using Hawkins’ classification. The key radiological sign is "Hawkins’ Sign" (subchondral lucency indicating intact vascularity). * **Navicular:** Fractures are often stress-related or part of midfoot injuries (Kohler’s disease in children). Bohler’s angle does not involve this bone. * **Cuboid:** Fractures (like "Nutcracker fractures") are rare and evaluated for lateral column shortening, not by Bohler’s angle. **NEET-PG High-Yield Pearls:** * **Gissane’s Angle:** Also called the "Critical Angle," it is the other major angle measured in calcaneal fractures (Normal: 120°–145°). It *increases* in fractures. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot, pathognomonic for calcaneal fracture. * **Associated Injuries:** Always rule out **compression fractures of the Lumbar spine (L1)** in patients with calcaneal fractures (Don Juan Syndrome/Lover's High Leap fracture) due to axial loading. * **Gold Standard Investigation:** CT scan (Broden’s views are the specific X-ray views).

Q: What is a trimalleolar fracture of the ankle commonly referred to as?

Cotton's fracture. **Explanation:** **Cotton’s fracture** is the eponymous name for a **trimalleolar fracture** of the ankle. It involves fractures of three components: 1. **Medial malleolus** (Tibia) 2. **Lateral malleolus** (Fibula) 3. **Posterior malleolus** (the posterior lip of the distal tibia) This injury typically results from high-energy trauma involving external rotation and abduction forces. It is inherently unstable because the bony constraints of the ankle mortise are disrupted in three planes, often requiring open reduction and internal fixation (ORIF). **Analysis of Incorrect Options:** * **B. Barton fracture:** An intra-articular fracture of the distal radius with associated dislocation/subluxation of the radiocarpal joint. It can be Volar (more common) or Dorsal. * **C. Malgaigne fracture:** A vertical shear injury of the pelvis involving a double break in the pelvic ring (typically through the pubic rami anteriorly and the SI joint or ilium posteriorly). * **D. Smith's fracture:** A fracture of the distal radius with **volar** (palmar) displacement of the distal fragment, often called a "Reverse Colles" fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Pott’s Fracture:** A general term for bimalleolar ankle fractures. * **Lauge-Hansen Classification:** The most common system used to describe ankle fractures based on the position of the foot and the direction of the deforming force. * **Maisonneuve Fracture:** A high fibular fracture associated with a medial malleolus fracture or deltoid ligament tear; always palpate the proximal fibula in ankle injuries. * **Radiographic Sign:** On a lateral X-ray, the posterior malleolus fracture is best visualized; if it involves >25-30% of the articular surface, surgical fixation is usually mandatory.

Q: Which of the following is a feature of the triple deformity of the knee joint?

Posterior subluxation of tibia. The **Triple Deformity of the Knee** is a classic clinical presentation typically seen in advanced cases of **Tuberculosis (TB) of the knee joint** or chronic untreated arthritis. It occurs due to the powerful pull of the hamstring muscles overcoming the weakened joint structures. ### **Explanation of the Correct Option** The "Triple Deformity" consists of three specific anatomical displacements of the tibia relative to the femur: 1. **Flexion:** Due to the predominant action of the hamstrings. 2. **Posterior Subluxation of the Tibia:** The hamstrings pull the proximal tibia backward behind the femoral condyles. 3. **External Rotation of the Tibia:** The biceps femoris (the lateral hamstring) is stronger than the medial hamstrings, causing the tibia to rotate laterally. Therefore, **Posterior subluxation of the tibia** is a hallmark feature of this triad. ### **Explanation of Incorrect Options** * **B. Internal rotation of tibia:** Incorrect. The tibia undergoes **external rotation** because the biceps femoris exerts a stronger rotational pull than the semimembranosus/semitendinosus. * **C. Medial angulation of tibia:** Incorrect. While some valgus (lateral angulation) may occur, medial angulation (varus) is not a standard component of the classic triple deformity description. * **D. Recurvatum:** Incorrect. Recurvatum refers to hyperextension. The triple deformity is characterized by fixed **flexion**, not extension. ### **High-Yield Clinical Pearls for NEET-PG** * **Most common cause:** Tuberculosis of the knee (Stage of Destruction). * **Muscle Dynamics:** The deformity occurs because the knee flexors (hamstrings) are stronger than the extensors (quadriceps). * **Management:** Early stages require traction and splinting; advanced stages with triple deformity often require surgical intervention like arthrodesis (joint fusion) to provide a stable, painless limb.

Q: What is the best treatment for a fracture and dislocation of the lateral clavicle?

Surgical repair. **Explanation:** Fractures of the lateral (distal) third of the clavicle are classified using the **Neer Classification**. When a fracture is associated with a dislocation or instability (specifically Neer Type II), it indicates that the coracoclavicular (CC) ligaments are detached from the proximal fragment. **1. Why Surgical Repair is Correct:** In lateral clavicle fractures with dislocation, the weight of the arm pulls the distal fragment downward, while the sternocleidomastoid muscle pulls the proximal fragment upward. This significant displacement and the loss of ligamentous stability lead to a **high rate of non-union (up to 30-40%)** if treated conservatively. Therefore, **Surgical Repair** (using techniques like hook plates, tension band wiring, or CC ligament reconstruction) is the treatment of choice to ensure anatomical reduction and bone healing. **2. Why Incorrect Options are Wrong:** * **A & C (Figure of 8 splint / Normal sling):** These are conservative management options. While appropriate for undisplaced mid-shaft fractures (Neer Type I or III), they cannot counteract the strong deforming forces in unstable lateral fractures, leading to malunion or persistent non-union. * **B (Open reduction):** While open reduction is a *step* in the procedure, "Surgical repair" is the more comprehensive term that includes both reduction and the necessary internal fixation/ligamentous stabilization required for this specific injury. **Clinical Pearls for NEET-PG:** * **Neer Type II** is the most common lateral clavicle fracture requiring surgery. * **Most common site of clavicle fracture:** Middle third (80%), usually treated conservatively with a U-slab or triangular sling. * **Allman Classification:** Group I (Mid-shaft), Group II (Lateral), Group III (Medial). * **Complication:** The most common complication of clavicle fractures is **malunion**, but for lateral Type II fractures, it is **non-union**.

Question 1

Functional bracing is now the gold standard in the nonoperative management of which fractures?

Accepted Answer

Fracture shaft of the humerus

Answer

Fracture of both bones of the forearm

Answer

Fracture shaft of the tibia

Answer

Fracture shaft of the femur

Question 2

What is commonly referred to as a Potts fracture?

Accepted Answer

Bimalleolar ankle fracture

Answer

Trimalleolar ankle fracture

Answer

Fracture of distal end radius

Answer

Pathological fracture in osteomalacia

Question 3

What is the most common type of spinal cord injury?

Accepted Answer

Flexion-rotation

Answer

Flexion

Answer

Extension

Answer

Compression

Question 4

A Morel-Lavallee lesion is typically associated with which type of fracture?

Accepted Answer

Acetabular fracture

Answer

Femoral neck fracture

Answer

Lumbar spine fracture

Answer

Proximal tibia fracture

Question 5

Which of the following carries a higher risk of DVT and pulmonary thromboembolism?

Accepted Answer

Hip surgeries

Answer

Hand surgery

Answer

Breast surgery

Answer

Obesity

Question 6

Bohler's angle is measured in fractures involving which tarsal bone?

Accepted Answer

Calcaneum

Answer

Talus

Answer

Navicular

Answer

Cuboid

Question 7

What is a trimalleolar fracture of the ankle commonly referred to as?

Accepted Answer

Cotton's fracture

Answer

Barton fracture

Answer

Malgaigne fracture

Answer

Smith's fracture

Question 8

What is the treatment of choice to manage a symphyseal fracture in an 8-year-old child?

Accepted Answer

Cap splint with circumferential wiring

Answer

Intermaxillary fixation

Answer

Open reduction

Answer

No treatment indicated

Question 9

Which of the following is a feature of the triple deformity of the knee joint?

Accepted Answer

Posterior subluxation of tibia

Answer

Internal rotation of tibia

Answer

Medial angulation of tibia

Answer

Recurvatum

Question 10

What is the best treatment for a fracture and dislocation of the lateral clavicle?

Accepted Answer

Surgical repair

Answer

Figure of 8 splint

Answer

Open reduction

Answer

Normal sling

Trauma — MCQs

Trauma — MCQs

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