Trauma Practice Questions

Q: In osteosynthesis, which of the following is NOT used?

Eyelet wiring. **Explanation:** **Osteosynthesis** refers to the surgical reduction and internal fixation of a bone fracture using mechanical devices (implants) to achieve stable fixation and promote healing. **Why Option D is Correct:** **Eyelet wiring** (also known as Ivy loops) is a technique used in **Maxillofacial surgery** for **Intermaxillary Fixation (IMF)**. It involves wiring the upper and lower teeth together to stabilize the jaw. While it stabilizes a fracture site, it is a form of external/dental stabilization rather than osteosynthesis, which specifically refers to the internal fixation of the bone fragments themselves using plates, screws, or nails. **Why Other Options are Incorrect:** * **A. Lag Screw:** This is a fundamental tool in osteosynthesis. It produces **interfragmentary compression** by gliding through the near cortex and engaging only the far cortex, squeezing the bone fragments together. * **B. Wires:** Cerclage wires or K-wires (Kirschner wires) are frequently used in osteosynthesis, especially in tension band wiring (e.g., patella or olecranon fractures) or to hold fragments in place temporarily. * **C. Clamp Bone Plate:** Various types of plates (Dynamic Compression Plates, Locking Plates) are the hallmark of internal fixation. They "clamp" or bridge the fracture to provide rigid stability. **NEET-PG High-Yield Pearls:** * **Gold Standard for Osteosynthesis:** The **AO (Arbeitsgemeinschaft für Osteosynthesefragen)** principles focus on anatomical reduction, stable fixation, preservation of blood supply, and early mobilization. * **Primary Bone Healing:** Occurs only with absolute stability (e.g., compression plating/lag screws) without callus formation. * **Secondary Bone Healing:** Occurs with relative stability (e.g., intramedullary nailing or casts) and involves callus formation.

Q: What is the most common site for avascular necrosis of the femur?

Subcapital. **Explanation:** The risk of **Avascular Necrosis (AVN)** in femoral neck fractures is primarily determined by the proximity of the fracture line to the femoral head and the degree of disruption to the blood supply. **1. Why Subcapital is Correct:** The femoral head receives its primary blood supply from the **retinacular vessels** (branches of the medial circumflex femoral artery). These vessels run along the neck of the femur to reach the head. In a **subcapital fracture**, the fracture line occurs immediately below the articular surface of the head. This location is most likely to completely sever the retinacular vessels, leaving the head dependent solely on the meager supply from the *ligamentum teres*. Consequently, subcapital fractures have the highest incidence of AVN (up to 30-40%). **2. Analysis of Incorrect Options:** * **Transcervical:** The fracture occurs through the mid-portion of the neck. While the risk of AVN is high, it is statistically lower than subcapital fractures because some distal retinacular branches may remain intact. * **Basal (Basocervical):** These occur at the junction of the neck and the trochanteric region. Being further from the head, the vascular compromise is less severe. * **Trochanteric:** These are **extracapsular** fractures. Because they occur distal to the insertion of the joint capsule where the blood supply enters, the risk of AVN is negligible. **Clinical Pearls for NEET-PG:** * **Garden’s Classification:** Used for subcapital fractures; Stage III and IV have the highest risk of AVN and non-union. * **Pauwels' Classification:** Based on the angle of the fracture line; higher angles (Type III) indicate greater instability and higher risk of complications. * **Management:** In elderly patients with displaced subcapital fractures, **Arthroplasty** (Hemi or Total) is preferred over internal fixation due to the high risk of AVN.

Q: Which of the following are key components of fracture treatment?

Reduction, Retention, Rehabilitation. The management of fractures follows a fundamental triad often referred to as the **"Three R’s" of Fracture Treatment**. This systematic approach ensures the restoration of anatomy and function. ### 1. Why Option A is Correct: The correct sequence is **Reduction, Retention, and Rehabilitation**: * **Reduction:** This is the first step, involving the restoration of the displaced bone fragments to their normal anatomical alignment. It can be **Closed** (manual manipulation) or **Open** (surgical). * **Retention (Immobilization):** Once reduced, the fragments must be held in place to prevent displacement while healing occurs. This is achieved through external means (plaster casts, splints) or internal/external fixation. * **Rehabilitation:** This is the final, crucial phase. It involves physiotherapy and joint mobilization to prevent stiffness, muscle atrophy, and to restore the patient to their pre-injury functional state. ### 2. Why Other Options are Incorrect: * **Reunion (Options B, C, and D):** While "union" (healing of the bone) is the desired *outcome* of fracture treatment, it is a biological process, not a treatment component performed by the surgeon. The surgeon provides the environment (Reduction and Retention) for union to occur naturally. ### 3. Clinical Pearls for NEET-PG: * **Primary Goal:** The ultimate goal of fracture management is to return the injured part to maximal functional capacity. * **Emergency Rule:** Always check the **Distal Neurovascular Status** before and after any reduction maneuver. * **The 4th 'R':** In some modern texts, **Recognition** (Diagnosis via clinical exam and X-rays) is considered the "Zero-th" step before Reduction. * **High-Yield Fact:** For intra-articular fractures, **Anatomical Reduction** is mandatory to prevent early-onset secondary osteoarthritis.

Q: Trimalleolar fracture is:

Cotton's fracture. **Explanation:** A **Trimalleolar fracture** involves fractures of the medial malleolus, lateral malleolus, and the posterior lip of the tibia (often referred to as the "posterior malleolus"). * **Cotton’s Fracture (Correct Answer):** This is the eponymous name for a trimalleolar fracture. It was described by Frederic Jay Cotton in 1915. The inclusion of the posterior malleolus makes the ankle joint significantly more unstable compared to bimalleolar injuries, often requiring surgical fixation of all three components to restore the articular surface of the tibial plafond. **Analysis of Incorrect Options:** * **Pott’s Fracture:** A general term for fractures around the ankle involving at least two malleoli (bimalleolar). While often used interchangeably with ankle fractures, it specifically refers to a fracture-dislocation caused by eversion forces. * **Tillaux Fracture:** An avulsion fracture of the **anterolateral** aspect of the distal tibial epiphysis. It is caused by the pull of the anterior inferior tibiofibular ligament (AITFL) and is typically seen in adolescents during the period of growth plate closure. * **Jones Fracture:** A transverse fracture through the **base of the fifth metatarsal** (specifically at the junction of the diaphysis and metaphysis, Zone 2). It is notorious for high rates of non-union due to a watershed blood supply. **High-Yield Clinical Pearls for NEET-PG:** 1. **Lauge-Hansen Classification:** The most common system used to describe ankle fractures based on the foot position and the direction of the deforming force. 2. **Maisonneuve Fracture:** A high fibular fracture associated with a medial malleolus fracture or deltoid ligament tear; always palpate the proximal fibula in ankle injuries. 3. **Pilon Fracture:** A comminuted intra-articular fracture of the distal tibia caused by high-energy axial loading (e.g., fall from height).

Question 1

In osteosynthesis, which of the following is NOT used?

Accepted Answer

Eyelet wiring

Answer

Lag screw

Answer

Wires

Answer

Clamp bone plate

Question 2

What is the most common site for avascular necrosis of the femur?

Accepted Answer

Subcapital

Answer

Transcervical

Answer

Trochanteric

Answer

Basal

Question 3

Patella commonly dislocates:

Accepted Answer

Laterally

Answer

Medially

Answer

Superiorly

Answer

Inferiorly

Question 4

All of the following can occur as complications of fracture of the neck of femur except?

Accepted Answer

Mal-union

Answer

Shortening

Answer

Non-union

Answer

Avascular necrosis

Question 5

A fall on an outstretched hand can lead to a fracture of which of the following bones?

Accepted Answer

Scaphoid bone, capitate, and clavicle

Answer

Scaphoid and clavicle

Answer

Head of the ulna

Answer

Radial styloid process

Question 6

Which of the following are key components of fracture treatment?

Accepted Answer

Reduction, Retention, Rehabilitation

Answer

Reduction, Rehabilitation, Reunion

Answer

Reduction, Retention, Reunion

Answer

Retention, Rehabilitation, Reunion

Question 7

Trimalleolar fracture is:

Accepted Answer

Cotton's fracture

Answer

Pott's fracture

Answer

Tillaux fracture

Answer

Jones fracture

Question 8

A patient presents with painful Myositis Ossificans around the elbow. What is the preferred treatment option in this case?

Accepted Answer

Immobilization

Answer

Active mobilization

Answer

Passive mobilization

Answer

Infra-Red Therapy

Question 9

Volkmann's ischemic contracture is commonly caused by which of the following?

Accepted Answer

Both a tight plaster cast and a tight splint

Answer

A tight plaster cast

Answer

A tight splint

Answer

Neither a tight plaster cast nor a tight splint

Question 10

What is the classically described position of the hand during the application of a POP cast for a scaphoid fracture?

Accepted Answer

Tumbler holding position

Answer

Boat shaped position

Answer

Clenched fist position

Answer

Boxing position

Trauma — MCQs

Trauma — MCQs

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