Trauma Practice Questions

Q: Tenderness in the anatomical snuff box is characteristic of which carpal bone fracture?

Scaphoid. **Explanation:** **Scaphoid fracture** is the most common carpal bone fracture, typically resulting from a fall on an outstretched hand (FOOSH). The scaphoid forms the floor of the **anatomical snuff box**. Therefore, localized tenderness in this area is considered pathognomonic for a scaphoid injury until proven otherwise. **Why the other options are incorrect:** * **Capitate:** This is the largest carpal bone, located centrally in the distal row. Fractures are rare and usually associated with complex perilunate injuries; tenderness would be deep and central, not in the snuff box. * **Lunate:** Located medial to the scaphoid, it is more prone to dislocation (leading to Median nerve compression) or avascular necrosis (Kienböck's disease) rather than isolated fractures. Tenderness is typically over the dorsum of the wrist, distal to Lister’s tubercle. * **Triquetrum:** This is the second most common carpal fracture (often a dorsal chip fracture). Tenderness is localized to the ulnar (medial) aspect of the wrist, distal to the ulnar styloid. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid has a **retrograde blood supply** (from the distal pole to the proximal pole). This makes the proximal pole highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Radiology:** Fractures may not appear on initial X-rays. If clinical suspicion is high despite a normal X-ray, the wrist should be immobilized in a **Scaphoid cast** (thumb spica) and re-imaged after 10–14 days. * **Anatomical Snuff Box Boundaries:** Lateral (Abductor pollicis longus, Extensor pollicis brevis) and Medial (Extensor pollicis longus).

Q: What is the physiological interruption of nerve transmission?

Neuropraxia. The classification of nerve injuries is a high-yield topic for NEET-PG, primarily based on the **Seddon Classification**. ### **Explanation of the Correct Answer** **A. Neuropraxia** is the correct answer because it represents the mildest form of nerve injury. It is a **physiological interruption** of nerve conduction without any anatomical disruption of the axon or the connective tissue sheath. It is typically caused by local compression or ischemia (e.g., Saturday Night Palsy). Since the axon remains intact, there is no Wallerian degeneration, and recovery is complete and rapid (usually within days to weeks) once the pressure is relieved. ### **Analysis of Incorrect Options** * **B. Neurotmesis:** This is the most severe grade. It involves complete anatomical disruption of the entire nerve trunk (axon and all supporting connective tissue sheaths). Recovery is impossible without surgical intervention. * **C. Axonotmesis:** This involves anatomical disruption of the **axon** itself, but the supporting connective tissue frameworks (endoneurium, perineurium, and epineurium) remain intact. Wallerian degeneration occurs distal to the injury, and recovery is slow (1 mm/day) but possible because the intact sheaths guide regenerating sprouts. ### **Clinical Pearls for NEET-PG** * **Wallerian Degeneration:** Occurs in Axonotmesis and Neurotmesis, but **never** in Neuropraxia. * **Tinel’s Sign:** This is **absent** in Neuropraxia (as there is no axonal regeneration) but becomes **positive** in Axonotmesis as the nerve begins to heal. * **Sunderland Classification:** An expansion of Seddon’s; Neuropraxia corresponds to Grade I, Axonotmesis to Grades II-IV, and Neurotmesis to Grade V. * **Recovery Sequence:** In nerve injuries, **Motor** function is the first to go and last to return; **Pain** is the last to go and first to return.

Q: Complications of Colles' fracture include the following except:

Rupture of Extensor Pollicis Brevis tendon. **Explanation:** The correct answer is **A. Rupture of Extensor Pollicis Brevis (EPB) tendon**. In Colles' fracture, the most common tendon injury is the rupture of the **Extensor Pollicis Longus (EPL)**, not the EPB. This occurs because the EPL tendon winds around **Lister’s tubercle** on the dorsal aspect of the radius. Following a fracture, the tendon can undergo attrition due to friction against irregular bone fragments or ischemia caused by pressure within the intact extensor retinaculum. This typically occurs 4–8 weeks post-injury (delayed rupture). **Analysis of other options:** * **B. Rupture of Extensor Pollicis Longus:** This is a classic late complication. It is often painless and results in the inability to extend the distal phalanx of the thumb. * **C. Malunion:** This is the **most common complication** of Colles' fracture. It leads to the characteristic "Dinner Fork Deformity" due to residual dorsal tilt and radial shortening. * **D. Sudeck’s Osteodystrophy (CRPS Type 1):** This is a well-known complication characterized by pain, swelling, and vasomotor instability. It is often triggered by a tight cast or excessive pain during immobilization. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Malunion. * **Most common nerve involved:** Median nerve (Carpal Tunnel Syndrome). * **Surgical treatment for EPL rupture:** Tendon transfer (usually using the Extensor Indicis Proprius). * **Dinner Fork Deformity:** Caused by dorsal displacement, dorsal tilt, and lateral tilt of the distal fragment.

Q: A 65-year-old male presents with a history of distal radius fracture treated surgically one year ago. He now complains of decreased range of motion and pain in his metacarpophalangeal joints. What is the most likely diagnosis causing stiffness of the finger?

Stiffness of fingers due to immobilization or scarring. **Explanation:** The correct answer is **Stiffness of fingers due to immobilization or scarring**. In elderly patients, distal radius fractures (like Colles' fracture) are frequently complicated by finger stiffness. This occurs due to prolonged immobilization, edema, or scarring of the extensor tendons and joint capsules. Even if the fracture is treated surgically, failure to initiate early active finger mobilization leads to adhesions. The metacarpophalangeal (MCP) joints are particularly prone to stiffness in extension if not exercised regularly during the healing phase. **Analysis of Incorrect Options:** * **A & B (Malunion/Non-union):** While these are complications of distal radius fractures, they primarily affect the wrist joint's alignment and strength. They do not directly cause MCP joint stiffness unless associated with prolonged disuse. * **C (Sudeck’s Osteodystrophy/CRPS):** While CRPS causes finger stiffness, it is typically characterized by intense, out-of-proportion pain, vasomotor changes (swelling, temperature changes, sweating), and trophic skin changes. The question describes a more localized stiffness and pain typical of post-traumatic/post-surgical immobilization. **Clinical Pearls for NEET-PG:** * **Prevention:** The most important step in managing distal radius fractures is to encourage **"full range of finger movements"** from day one, regardless of the treatment modality (cast or surgery). * **Shoulder-Hand Syndrome:** A known complication where stiffness involves the shoulder and the hand simultaneously following a wrist fracture. * **Colles' Fracture Complications:** The most common complication is **stiffness** (shoulder, elbow, or fingers), while the most common "deformity" is malunion (Dinner fork deformity). The most common nerve involved is the **Median nerve**.

Question 1

What is the treatment of choice in acute myositis ossificans?

Accepted Answer

Immobilization of the elbow

Answer

Shock wave diathermy

Answer

Passive movements of the arm

Answer

Active exercises

Question 2

Which of the following statements about eponymous fractures are true?

Accepted Answer

Pott's fracture is a trimalleolar ankle fracture.

Answer

Monteggia fracture is a fracture of the proximal third of the ulna with radial head dislocation.

Answer

Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radio-ulnar joint.

Answer

Colles fracture is a fracture at the cortico-cancellous junction of the distal end of the radius with dorsal tilt.

Question 3

In which of the following clinical scenarios is a prosthesis at the head of the femur typically applied?

Accepted Answer

A 65-year-old male with a non-united fracture of the femoral neck.

Answer

A 40-year-old male with a fracture of the femoral head.

Answer

A 40-year-old male with a fracture of the femoral neck.

Answer

A 40-year-old male with a posterior dislocation of the hip.

Question 4

A 50-year-old female presents with pain in the left hip and inability to walk following a fall. On examination, there is tenderness in the Scaepa's triangle. What is the most likely diagnosis?

Accepted Answer

Intracapsular neck of femur fracture

Answer

Intertrochanteric fracture femur

Answer

Transervical fracture neck of femur

Answer

Ischial tuberosity fracture

Question 5

Limb salvage can be done in all except?

Accepted Answer

Vascular injury

Answer

Nerve injury

Answer

Bone injury

Answer

Muscle injury

Question 6

Tenderness in the anatomical snuff box is characteristic of which carpal bone fracture?

Accepted Answer

Scaphoid

Answer

Capitate

Answer

Lunate

Answer

Triquetrum

Question 7

What is the physiological interruption of nerve transmission?

Accepted Answer

Neuropraxia

Answer

Neurotmesis

Answer

Axonotmesis

Answer

None of the above

Question 8

What is the best treatment for a 3-week-old fracture of the femoral shaft with nonunion?

Accepted Answer

Bone graft with internal fixation

Answer

External fixation

Answer

Internal fixation only

Answer

Prosthesis

Question 9

Complications of Colles' fracture include the following except:

Accepted Answer

Rupture of Extensor Pollicis Brevis tendon

Answer

Rupture of Extensor Pollicis Longus Tendon

Answer

Malunion

Answer

Sudek's osteodystrophy

Question 10

A 65-year-old male presents with a history of distal radius fracture treated surgically one year ago. He now complains of decreased range of motion and pain in his metacarpophalangeal joints. What is the most likely diagnosis causing stiffness of the finger?

Accepted Answer

Stiffness of fingers due to immobilization or scarring

Answer

Malunion of the distal radius fracture

Answer

Non-union of the distal radius fracture

Answer

Sudeck's osteodystrophy (Complex Regional Pain Syndrome)

Trauma — MCQs

Trauma — MCQs

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