Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 391: Posterior dislocation of the hip typically results in which of the following positions?

A. Abduction, internal rotation, extension
B. Adduction, internal rotation, extension
C. Adduction, internal rotation, flexion (Correct Answer)
D. Abduction, external rotation, flexion

Explanation: **Explanation:** The hip joint is a stable ball-and-socket joint; however, **Posterior Dislocation** is the most common type (approx. 90%), typically occurring during a "dashboard injury" where a force is applied to the knee while the hip is flexed. **1. Why Option C is Correct:** In a posterior dislocation, the femoral head is forced out of the acetabulum posteriorly and superiorly. Because the femoral head now lies behind and above the acetabulum, the tension of the surrounding muscles and the iliofemoral ligament pulls the limb into a characteristic deformity: **Flexion, Adduction, and Internal Rotation (FADIR).** The limb also appears clinically **shortened**. **2. Analysis of Incorrect Options:** * **Option A & B (Extension):** Dislocated hips (both anterior and posterior) are almost always held in **flexion**. Extension is not a feature of acute hip dislocations. * **Option D (Abduction, External Rotation, Flexion):** This triad (FABER) is characteristic of **Anterior Dislocation** of the hip. In anterior dislocations, the limb is classically abducted and externally rotated, which is the exact opposite of the posterior presentation. **3. NEET-PG High-Yield Pearls:** * **Most Common Nerve Injury:** Sciatic nerve (specifically the peroneal division) is injured in 10-20% of posterior dislocations. * **Most Common Complication:** Avascular Necrosis (AVN) of the femoral head (risk increases if not reduced within 6 hours). * **Radiology:** On an AP X-ray, the femoral head appears **smaller** than the contralateral side in posterior dislocation and **larger** in anterior dislocation. * **Management:** Emergency closed reduction (e.g., Allis method or Stimson maneuver) under sedation.

Question 392: All are true about Barton's fracture except?

A. Intra-articular fracture
B. Radiocarpal subluxation
C. Dorsal Barton's fracture is the most common type (Correct Answer)
D. Requires open reduction and internal fixation

Explanation: **Explanation:** Barton’s fracture is a specific type of distal radius fracture characterized by an **intra-articular shear fracture** of the radial rim with associated **radiocarpal subluxation** or dislocation. **1. Why Option C is the correct answer (The Exception):** Contrary to common belief, **Volar Barton’s fracture is much more common** than the Dorsal type. In clinical practice, Volar Barton’s is frequently encountered and is often considered a variant of Smith’s fracture (Type II). Therefore, the statement that Dorsal Barton's is the most common is incorrect. **2. Analysis of other options:** * **Option A (Intra-articular fracture):** This is true. Unlike Colles' or Smith's fractures, which are typically extra-articular, Barton’s specifically involves the articular surface of the distal radius. * **Option B (Radiocarpal subluxation):** This is a hallmark feature. The carpal bones follow the fractured articular fragment, leading to subluxation of the wrist joint. * **Option D (Requires ORIF):** Because Barton’s fracture is intra-articular and inherently unstable (due to the oblique fracture line and muscle pull), conservative management with a cast usually fails. **Open Reduction and Internal Fixation (ORIF)** with a Volar/Dorsal locking plate is the gold standard treatment. **Clinical Pearls for NEET-PG:** * **Mechanism:** Usually a fall on an outstretched hand (Dorsal) or a fall on the back of the wrist (Volar). * **Eponym Check:** * **Colles’:** Extra-articular, dorsal displacement (Dinner fork deformity). * **Smith’s:** Extra-articular, volar displacement (Garden spade deformity). * **Chauffeur’s:** Intra-articular fracture of the **Radial Styloid**. * **Management:** Barton’s fractures are "unstable" by definition; always look for "Buttress Plate" or "ORIF" in management questions.

Question 393: Colles fracture is characterized by which of the following?

A. Fracture line is at the radioulnar joint
B. Fracture line extends to the carpal joint
C. Fracture line is approximately 2 cm proximal to the radiocarpal joint (Correct Answer)
D. Distal fragment is ulnar deviated

Explanation: **Explanation:** **Colles’ fracture** is a classic "dinner fork" deformity resulting from a fall on an outstretched hand (FOOSH). It is defined as an extra-articular fracture of the distal radius. 1. **Why Option C is Correct:** The anatomical definition of a Colles’ fracture specifies that the fracture line is transverse and located approximately **2 cm (or 1 inch) proximal to the radiocarpal (wrist) joint**. This location is critical because it occurs at the corticocancellous junction of the distal radius, a common site of weakness, especially in osteoporotic elderly individuals. 2. **Why the Other Options are Incorrect:** * **Option A & B:** Colles’ fracture is strictly **extra-articular**. If the fracture line extends into the radioulnar or radiocarpal (carpal) joints, it is no longer a Colles’ fracture but may be classified as a Barton’s fracture or a complex intra-articular distal radius fracture. * **Option D:** In a Colles’ fracture, the distal fragment undergoes **radial deviation** (along with dorsal displacement, dorsal tilt, lateral displacement, and supination). Ulnar deviation is not a feature of this injury. **High-Yield Clinical Pearls for NEET-PG:** * **Deformity:** Characterized by the **"Dinner Fork Deformity"** due to dorsal displacement. * **Displacements (6):** Dorsal displacement, Dorsal tilt, Lateral (Radial) displacement, Lateral (Radial) tilt, Supination, and Impaction. * **Most Common Complication:** Stiffness of the fingers and shoulder (often due to neglect during casting). * **Most Common Late Complication:** Malunion. * **Specific Tendon Rupture:** Spontaneous rupture of the **Extensor Pollicis Longus (EPL)** can occur weeks later due to ischemia or attrition at Lister’s tubercle. * **Reverse Colles:** Known as **Smith’s fracture**, where the distal fragment is displaced volarly (Garden spade deformity).

Question 394: Volkmann's ischemic contracture is typically seen in which of the following fractures?

A. Supracondylar fracture of the humerus (Correct Answer)
B. Tibial plateau fracture
C. Clavicle fracture
D. Colles' fracture

Explanation: **Explanation:** **Volkmann’s Ischemic Contracture (VIC)** is the permanent end-stage sequela of untreated or inadequately managed **Compartment Syndrome**. It occurs due to prolonged ischemia of the forearm muscles (especially the Flexor Digitorum Profundus and Flexor Pollicis Longus), leading to muscle infarction and subsequent fibrosis. 1. **Why Supracondylar Fracture is Correct:** This is the most common cause of VIC in children. The displaced fracture fragments (especially in the extension type) can cause direct injury or kinking of the **Brachial Artery** or lead to massive soft tissue swelling. This increases pressure within the tight fascial compartments of the forearm, triggering compartment syndrome. If not decompressed, the necrotic muscle is replaced by fibrous tissue, resulting in the classic "claw-like" deformity. 2. **Why Other Options are Incorrect:** * **Tibial Plateau Fracture:** While these can cause compartment syndrome of the leg, VIC specifically refers to the contracture of the forearm. * **Clavicle Fracture:** These are rarely associated with vascular compromise or compartment syndrome. * **Colles' Fracture:** Though it involves the distal radius, it is rarely associated with the high-pressure compartment syndrome required to produce VIC. **Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and pain on passive stretching of fingers. * **The 5 P’s:** Pain, Pallor, Pulselessness, Paresthesia, and Paralysis (Note: Pulselessness is a late sign). * **Classic Deformity:** Flexion at the wrist, hyperextension at MCP joints, and flexion at IP joints. * **Volkmann’s Sign:** The finger deformity can be partially corrected by flexing the wrist (which relaxes the fibrotic flexor tendons).

Question 395: Dawbarn sign is seen in which of the following conditions?

A. Infraspinatus tendinitis
B. Subacromial bursitis (Correct Answer)
C. Achilles tendon injury
D. Rotator cuff tear

Explanation: **Explanation:** **Dawbarn’s Sign** is a classic clinical test used to diagnose **Subacromial Bursitis**. The underlying medical concept relies on the anatomical location of the subacromial bursa, which lies between the acromion process and the rotator cuff. * **Why it is correct:** In a patient with subacromial bursitis, there is a localized point of exquisite tenderness just below the acromion process when the arm is by the side. When the arm is **abducted**, the deltoid muscle contracts and the bursa slides beneath the acromion. This "hides" the inflamed bursa under the bone, protecting it from the examiner's finger, which results in the **disappearance of tenderness**. This disappearance of pain upon abduction is a positive Dawbarn’s sign. **Analysis of Incorrect Options:** * **Infraspinatus tendinitis:** Presents with pain during resisted external rotation; it does not demonstrate the specific disappearance of tenderness characteristic of Dawbarn’s sign. * **Achilles tendon injury:** This involves the ankle. Clinical tests include the Simmonds/Thompson test (calf squeeze). * **Rotator cuff tear:** While often associated with bursitis, a tear typically presents with weakness in abduction (Drop Arm test) and a painful arc, but not the specific "vanishing tenderness" of Dawbarn’s sign. **High-Yield Clinical Pearls for NEET-PG:** * **Painful Arc Syndrome:** Pain felt between 60°–120° of abduction; seen in both subacromial bursitis and supraspinatus tendinitis. * **Neer’s and Hawkins-Kennedy Tests:** Used to identify shoulder impingement syndrome. * **Ludington’s Test:** Used to detect a rupture of the long head of the biceps tendon.

Question 396: What is the treatment for a transverse fracture of the patella?

A. Excision of a small fragment
B. Wire fixation (Correct Answer)
C. Plaster cylinder
D. Patellectomy

Explanation: **Explanation:** The patella is a sesamoid bone within the quadriceps tendon, and its primary function is to increase the mechanical advantage of the extensor mechanism. **Why Wire Fixation is Correct:** A transverse fracture of the patella is typically caused by indirect trauma (sudden forceful contraction of the quadriceps), leading to a **distraction injury**. This results in a gap between fragments and a loss of the active extensor mechanism. The gold standard treatment is **Tension Band Wiring (TBW)**. This technique converts the distracting tensile forces of the quadriceps into compressive forces across the fracture site, promoting primary bone healing and allowing for early range of motion. **Analysis of Incorrect Options:** * **Excision of a small fragment:** This is indicated only in comminuted fractures involving the inferior pole where the fragment is too small to fix. It is not the primary choice for a standard transverse fracture. * **Plaster cylinder:** This is used for **undisplaced fractures** where the extensor mechanism is intact. In a transverse fracture, the fragments are usually displaced, making conservative management inappropriate. * **Patellectomy:** This is a "salvage" procedure reserved for severely comminuted (shattered) fractures where reconstruction is impossible. It is avoided when possible because it significantly weakens the power of knee extension. **NEET-PG High-Yield Pearls:** * **Indication for Surgery:** Displacement >3mm or articular step-off >2mm. * **TBW Principle:** Converts tensile force to compressive force. * **Clinical Sign:** Inability to perform a **Straight Leg Raise (SLR)** indicates a disrupted extensor mechanism and necessitates surgical intervention. * **K-wires:** In TBW, two parallel Kirschner wires are used to provide rotational stability.

Question 397: A twisting injury of the knee in a flexed position would result in injury to all of the following structures EXCEPT:

A. Meniscal tear
B. Capsular tear
C. Anterior cruciate ligament
D. Fibular collateral ligament (Correct Answer)

Explanation: **Explanation:** The mechanism of injury described—**twisting of the knee in a flexed position**—is the classic mechanism for injuries to the internal structures of the knee. When the knee is flexed, the ligaments and capsule are under specific stresses that predispose them to injury. **Why Fibular Collateral Ligament (FCL/LCL) is the correct answer:** The **Fibular Collateral Ligament** is a cord-like structure on the lateral aspect of the knee. Crucially, the LCL becomes **relaxed (lax) during flexion** and is only taut in full extension. Because it is slack when the knee is flexed, a twisting force in this position is unlikely to cause it to tear. In contrast, the LCL is typically injured by a varus stress applied to an extended knee. **Analysis of Incorrect Options:** * **Meniscal tear:** Rotation (twisting) while weight-bearing on a flexed knee is the most common cause of meniscal injuries, as the meniscus gets trapped between the femoral condyles and the tibial plateau. * **Anterior Cruciate Ligament (ACL):** The ACL is frequently injured during a "pivot-shift" mechanism (sudden deceleration + twisting in slight flexion). It is the primary stabilizer against rotational stress. * **Capsular tear:** The joint capsule is intimately attached to the menisci and the coronary ligaments; rotational forces that tear the meniscus or ligaments often involve concomitant capsular disruption. **NEET-PG High-Yield Pearls:** * **O’Donoghue’s Unhappy Triad:** Consists of injuries to the **ACL, MCL, and Medial Meniscus** (though recent studies suggest the Lateral Meniscus is more commonly injured in acute ACL tears). * **MCL vs. LCL:** The MCL is more commonly injured than the LCL. The MCL is attached to the medial meniscus, whereas the LCL is **not** attached to the lateral meniscus (separated by the popliteus tendon). * **Most common meniscus injured:** Medial meniscus (due to its fixity to the capsule and MCL).

Question 398: Which nerve is commonly damaged in a fracture of the shaft of the humerus?

A. Axillary nerve
B. Radial nerve (Correct Answer)
C. Ulnar nerve
D. Median nerve

Explanation: **Explanation:** The **radial nerve** is the most commonly injured nerve in fractures of the humeral shaft, particularly those involving the **middle and distal thirds**. This is due to the intimate anatomical relationship where the nerve winds around the posterior aspect of the humerus in the **spiral groove**. In this location, the nerve is fixed against the bone, making it highly susceptible to injury from direct trauma or entrapment between fracture fragments (Holstein-Lewis fracture). **Analysis of Incorrect Options:** * **Axillary Nerve:** Typically injured in fractures of the **surgical neck of the humerus** or anterior dislocations of the shoulder joint. * **Ulnar Nerve:** Most commonly injured in fractures of the **medial epicondyle** of the humerus or supracondylar fractures (though less common than median nerve injury in the latter). * **Median Nerve:** Frequently associated with **supracondylar fractures** of the humerus (specifically the anterior interosseous nerve branch) or penetrating injuries to the arm. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Radial nerve injury leads to **Wrist Drop**, finger drop, and sensory loss over the first dorsal web space. * **Holstein-Lewis Fracture:** A spiral fracture of the distal 1/3rd of the humerus specifically associated with radial nerve palsy. * **Management:** Most radial nerve palsies associated with closed humeral shaft fractures are neuropraxias and resolve spontaneously (85-90% recovery rate). Immediate exploration is only indicated in open fractures or if the palsy develops *after* manipulation.

Question 399: Pulled elbow is

A. A sprain of extensor tendons
B. Dislocation of head of radius (Correct Answer)
C. Fracture of lateral condyle of humerus
D. Dislocation of elbow

Explanation: ### Explanation **Pulled Elbow** (also known as **Nursemaid’s Elbow** or Temper Tantrum Elbow) is a common pediatric injury occurring typically in children aged 1–4 years. **1. Why the correct answer is right:** The underlying mechanism is a sudden **longitudinal traction** on an extended, pronated forearm (e.g., pulling a child up a curb). Because the **annular ligament** is relatively lax in young children, the radial head is pulled distally, allowing the ligament to slip over the head and become trapped in the radio-capitellar joint. Technically, this is a **subluxation/dislocation of the radial head** from the annular ligament. **2. Why the incorrect options are wrong:** * **Option A:** A sprain of extensor tendons (Lateral Epicondylitis/Tennis Elbow) is an overuse injury seen in adults, not a traction injury in children. * **Option C:** Fracture of the lateral condyle is a common pediatric fracture, but it involves bony disruption and significant swelling/ecchymosis, which are absent in pulled elbow. * **Option D:** Dislocation of the elbow involves the disruption of the entire ulnohumeral joint (usually posterior), presenting with gross deformity and severe swelling. **3. Clinical Pearls for NEET-PG:** * **Clinical Presentation:** The child holds the arm in a **pronated and slightly flexed** position, refusing to use it (pseudoparalysis). There is no swelling or redness. * **X-ray:** Usually normal; not required unless a fracture is suspected. * **Management:** Reduction via **Supination-Flexion maneuver** or the Hyperpronation maneuver. A palpable "click" signifies successful reduction, and the child usually resumes using the arm within minutes. * **Anatomy:** The annular ligament is the primary structure involved.

Question 400: Supracondylar fracture is usually caused by what type of injury?

A. Hyperflexion injury
B. Axial rotation
C. Extension injury
D. Hyperextension injury (Correct Answer)

Explanation: **Explanation:** Supracondylar fractures of the humerus are the most common elbow fractures in the pediatric population. The mechanism of injury is the primary basis for classifying these fractures into two types: Extension and Flexion. **Why Hyperextension is correct:** Approximately **95-98%** of supracondylar fractures are of the **Extension type**. This occurs due to a fall on an outstretched hand (FOOSH) with the elbow in hyperextension. In this position, the olecranon process of the ulna is forced into the olecranon fossa, acting as a fulcrum that levers the distal humerus forward, causing the fracture. The proximal fragment typically displaces anteriorly, potentially injuring the brachial artery or median nerve. **Why other options are incorrect:** * **Extension injury:** While "Extension type" is the clinical name, the specific mechanical force causing the failure is **hyperextension**. In a standard extension position, the bone is stable; the fracture occurs only when the physiological limit is exceeded (hyperextension). * **Hyperflexion injury:** This accounts for only **2-5%** of cases (Flexion type). It occurs from a direct blow to the posterior aspect of the flexed elbow. * **Axial rotation:** While rotation can influence the displacement pattern (posteromedial vs. posterolateral), it is a secondary force and not the primary cause of the fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Anterior Interosseous Nerve (AIN)—a branch of the Median nerve (specifically in extension type). * **Most common vascular complication:** Brachial artery injury. * **Gartland Classification:** Used to grade displacement (Type I: Undisplaced; Type II: Angulated but posterior cortex intact; Type III: Completely displaced). * **Late Complication:** Cubitus varus deformity (Gunstock deformity) due to malunion.

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Principles of Fracture Management

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Upper Limb Fractures

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Lower Limb Fractures

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Spinal Trauma

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Pelvic and Acetabular Fractures

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Open Fractures

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Fractures in Children

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Fracture Complications

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Nonunion and Malunion

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Polytrauma Management

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Joint Dislocations

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Soft Tissue Injuries

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Trauma — MCQs

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