Trauma Practice Questions

Q: A 22-year-old man is brought to the emergency department following a rugby injury. Which of the following statements is false regarding the fracture shown?

Closed fracture. ***Closed fracture*** - This statement is **FALSE** - the fracture is actually an **open (compound) fracture** with visible bone fragments through the skin. - Open fractures require immediate **surgical debridement** and **antibiotic prophylaxis** to prevent infection and are classified using the **Gustilo-Anderson system**. *Comminuted fracture of the tibia* - This statement is **TRUE** - the fracture shows **multiple bone fragments** characteristic of a comminuted pattern. - Common in **high-energy trauma** like sports injuries, requiring complex surgical fixation with **intramedullary nailing** or **external fixation**. *Does not involve the articular surface* - This statement is **TRUE** - the fracture is located in the **mid-shaft (diaphysis)** of the tibia, sparing the joint surfaces. - **Diaphyseal fractures** have better healing potential compared to **intra-articular fractures** which can lead to post-traumatic arthritis. *Posteriorly displaced fracture* - This statement is **TRUE** - the **distal fragment** is displaced posteriorly relative to the proximal fragment. - Posterior displacement can compromise the **popliteal artery** and **posterior tibial nerve**, requiring vascular and neurological assessment.

Q: A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?

Acromioclavicular ligament. ***Acromioclavicular ligament*** - **AC joint separation** is common in young athletes, especially basketball players, following direct trauma or falls onto the shoulder. - Typical **radiographic findings** include **AC joint widening** or **distal clavicle elevation**, confirming ligament rupture. *Glenohumeral ligament* - Tears typically cause **shoulder instability** and **recurrent dislocations**, not the acute trauma pattern seen here. - **MRI** would be needed for diagnosis as standard radiographs rarely show glenohumeral ligament injuries clearly. *Coracoacromial ligament* - This ligament forms the **coracoacromial arch** and rarely tears in acute trauma scenarios. - Injury would cause **subacromial impingement** symptoms rather than the typical presentation of AC joint pathology. *Tendon of long head of biceps* - **Biceps tendon rupture** presents with characteristic **"Popeye sign"** (visible muscle bulging) and weakness in flexion. - More common in **older patients** and typically associated with **chronic rotator cuff disease**, not acute sports trauma.

Q: A 34-year-old woman sustained a direct blow to the patella from the dashboard during an automobile crash. Radiographic examination reveals patellofemoral syndrome, characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening through physical rehabilitation to prevent future dislocations?

Vastus medialis. ### Explanation **1. Why Vastus Medialis is Correct:** The patella has a natural tendency to dislocate **laterally** due to the "Q-angle" (the angle between the quadriceps tendon and the patellar ligament). To counteract this lateral pull, the body relies on dynamic and static stabilizers. The **Vastus Medialis**, specifically its horizontal fibers known as the **Vastus Medialis Obliquus (VMO)**, is the primary dynamic stabilizer that pulls the patella medially. In cases of patellofemoral syndrome or recurrent lateral dislocations, strengthening the VMO is the cornerstone of conservative management to realign the patella within the trochlear groove. **2. Why the Other Options are Incorrect:** * **Vastus Lateralis (A):** This muscle is located on the outer aspect of the thigh. Strengthening it would increase the lateral pull on the patella, potentially worsening the lateral maltracking or dislocation. * **Vastus Intermedius (C) & Rectus Femoris (D):** These muscles primarily contribute to the superior pull of the patella for knee extension. While they are part of the quadriceps mechanism, they do not provide the specific medial vector force required to prevent lateral displacement. **3. Clinical Pearls for NEET-PG:** * **Q-Angle:** A higher Q-angle (common in females due to a wider pelvis) increases the risk of lateral patellar subluxation. * **Patellar Dislocation:** Almost always occurs **laterally**. The most common mechanism is a twisting injury or direct lateral force. * **Apprehension Test (Fairbank’s Sign):** The clinical test used to diagnose patellar instability; the patient becomes anxious when the examiner attempts to push the patella laterally. * **Radiology:** The **Merchant view** or **Sunrise view** X-ray is best for evaluating the patellofemoral joint.

Q: In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?

Within 6 hours. **Explanation:** Volkmann’s Ischemic Contracture (VIC) is the permanent end-stage sequela of untreated **Acute Compartment Syndrome**, most commonly following supracondylar fractures of the humerus. **1. Why "Within 6 Hours" is Correct:** The underlying pathophysiology is muscle and nerve ischemia due to increased intracompartmental pressure. Muscle tissue can tolerate ischemia for approximately **4 to 6 hours** before irreversible necrosis begins. Surgical decompression via **fasciotomy** must be performed within this "golden window" to restore perfusion and prevent the replacement of contractile muscle fibers with non-contractile fibrous tissue (infarction). **2. Analysis of Incorrect Options:** * **Within 1 hour (A):** While immediate intervention is ideal, 1 hour is clinically impractical for diagnosis and surgical prep, and tissue remains viable beyond this point. * **Within 24 hours (C) & 72 hours (D):** These timeframes are far beyond the threshold of muscle viability. By 12–24 hours, myonecrosis is usually complete, leading to permanent contracture, claw hand deformity, and sensory loss. **3. NEET-PG High-Yield Pearls:** * **Earliest Sign:** Severe pain out of proportion to the injury and **pain on passive stretching** of muscles. * **The 5 P’s:** Pain, Pallor, Paresthesia, Paralysis, and Pulselessness (Note: Pulselessness is a *late* sign). * **Most Common Muscle Involved:** Flexor Digitorum Profundus (FDP) and Flexor Pollicis Longus (FPL). * **Classic Deformity:** A "claw-like" hand with wrist flexion, metacarpophalangeal (MCP) joint hyperextension, and interphalangeal (IP) joint flexion. * **Diagnosis:** Primarily clinical, but can be confirmed by measuring intracompartmental pressure (e.g., Stryker monitor); a Delta pressure (Diastolic BP – Compartment pressure) **< 30 mmHg** is diagnostic.

Q: Which of the following arteries is affected in anterior shoulder dislocation?

Axillary. **Explanation:** **Anterior shoulder dislocation** is the most common type of joint dislocation (approx. 95%). The correct answer is **Axillary artery** because of its close anatomical proximity to the glenohumeral joint. 1. **Why Axillary Artery is Correct:** The axillary artery passes directly anterior to the shoulder joint. When the humeral head is displaced anteriorly and inferiorly (subcoracoid or subglenoid), it can compress or stretch the third part of the axillary artery. While vascular injury is less common than nerve injury, it is a critical complication, especially in elderly patients with atherosclerotic vessels. 2. **Why Other Options are Incorrect:** * **Radial, Median, and Ulnar:** These are not arteries; they are **nerves**. Even if the question implied the *nerves* of the same name, the Radial and Ulnar nerves are less commonly involved in shoulder dislocations compared to the Axillary nerve. The Median nerve is located more medially and is rarely affected at this level. **Clinical Pearls for NEET-PG:** * **Most Common Nerve Injured:** The **Axillary Nerve** (Regimental badge anesthesia and deltoid paralysis). * **Most Common Vascular Injury:** The **Axillary Artery** (Look for absent distal pulses or expanding hematoma). * **Hill-Sachs Lesion:** A compression fracture of the posterosuperolateral humeral head (occurs during anterior dislocation). * **Bankart Lesion:** Avulsion of the anterior-inferior glenoid labrum. * **Kocher’s Method:** A classic reduction technique (though no longer preferred due to high complication rates like humeral fractures). **Milch** and **Stimson** are safer alternatives.

Question 1

Which of the following are considered non-rigid fixation devices?

Accepted Answer

Both transosseous wire and Kirschner wire

Answer

Transosseous wire

Answer

Kirschner wire

Answer

None of the above

Question 2

A 22-year-old man is brought to the emergency department following a rugby injury. Which of the following statements is false regarding the fracture shown?

Accepted Answer

Closed fracture

Answer

Comminuted fracture of the tibia

Answer

Does not involve the articular surface

Answer

Posteriorly displaced fracture

Question 3

What is the maximum weight typically allowed in skeletal traction?

Accepted Answer

20 kg

Answer

5 kg

Answer

10 kg

Answer

30 kg

Question 4

A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?

Accepted Answer

Acromioclavicular ligament

Answer

Glenohumeral ligament

Answer

Coracoacromial ligament

Answer

Tendon of long head of biceps

Question 5

A 23-year-old man involved in an accident is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side, he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in both arms and the inability to move parts of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal. Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?

Accepted Answer

Extensor carpi radialis longus

Answer

Biceps

Answer

Flexor carpi radialis

Answer

Flexor carpi ulnaris

Question 6

A 17-year-old high school tennis player sustains a right midshaft clavicle fracture. Which of the following increases the risk of nonunion in non-operative treatment of clavicle fractures?

Accepted Answer

Displacement and comminution

Answer

Sling treatment

Answer

Figure-of-eight bandage treatment

Answer

Male sex

Question 7

What is a floating knee?

Accepted Answer

Femoral shaft fracture with proximal tibia metaphyseal fracture

Answer

Damage to both anterior and posterior cruciate ligaments

Answer

Condition of the knee due to a tear in the medial and lateral collateral ligaments

Answer

Advanced tuberculosis of the knee joint

Question 8

A 34-year-old woman sustained a direct blow to the patella from the dashboard during an automobile crash. Radiographic examination reveals patellofemoral syndrome, characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening through physical rehabilitation to prevent future dislocations?

Accepted Answer

Vastus medialis

Answer

Vastus lateralis

Answer

Vastus intermedius

Answer

Rectus femoris

Question 9

In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?

Accepted Answer

Within 6 hours

Answer

Within 1 hour

Answer

Within 24 hours

Answer

Within 72 hours

Question 10

Which of the following arteries is affected in anterior shoulder dislocation?

Accepted Answer

Axillary

Answer

Radial

Answer

Median

Answer

Ulnar

Trauma — MCQs

Trauma — MCQs

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