Trauma Practice Questions

Q: Which of the following is referred to as Luxatio erecta?

Inferior dislocation of shoulder. **Explanation:** **Luxatio Erecta** is the medical term for **Inferior Dislocation of the Shoulder**. It is the rarest form of shoulder dislocation (accounting for <1%) and occurs when a hyperabduction force is applied to the arm, levering the humeral head against the acromion and displacing it inferiorly out of the glenoid cavity. * **Why Option B is correct:** In this condition, the humeral head is displaced inferior to the glenoid. Clinically, the patient presents in a classic "salute" posture: the arm is locked in fixed abduction, with the forearm resting on or behind the head. * **Why Option A is incorrect:** A tear of the glenoid labrum (e.g., Bankart lesion) is a common consequence of shoulder dislocation but is not a type of dislocation itself. * **Why Option C is incorrect:** Anterior dislocation is the most common type of shoulder dislocation (95%). It presents with the arm held in slight abduction and external rotation, not the vertical "erect" position seen in Luxatio erecta. * **Why Option D is incorrect:** A defect in the posterosuperior humeral head is known as a **Hill-Sachs lesion**, which is a secondary bony injury resulting from anterior instability. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Forceful hyperabduction. * **Clinical Sign:** Arm is locked in fixed abduction (110°–160°). * **Complications:** This type has the highest incidence of **axillary nerve** and **axillary artery** injury among all shoulder dislocations. * **Radiology:** The humeral shaft is parallel to the spine of the scapula on an X-ray.

Q: What is the best treatment for a trochanteric fracture of the femur?

Dynamic hip screw. **Explanation:** Trochanteric (intertrochanteric) fractures are extracapsular fractures that occur in a highly vascular area. The primary goal of treatment is early mobilization to prevent complications of prolonged recumbency (like DVT or pneumonia). **1. Why Dynamic Hip Screw (DHS) is the Correct Answer:** The **Dynamic Hip Screw (DHS)** is the gold standard for stable intertrochanteric fractures. The underlying medical concept is the **"sliding principle."** The DHS allows the femoral head fragment to collapse and slide along the barrel of the plate during weight-bearing. This controlled compression at the fracture site promotes secondary bone healing and increases stability. **2. Why the Other Options are Incorrect:** * **Inlay plates:** These are not used for trochanteric fractures as they do not provide the necessary dynamic compression or angular stability required to withstand the biomechanical stresses of the proximal femur. * **Plaster in abduction / Internal rotation:** Conservative management with hip spica or traction was used historically but is now obsolete. It leads to high rates of malunion (coxa vara) and life-threatening complications due to prolonged immobilization in elderly patients. **Clinical Pearls for NEET-PG:** * **Classification:** Boyd and Griffin or Evans classification is commonly used for these fractures. * **Stable vs. Unstable:** For **stable** fractures, DHS is preferred. For **unstable** fractures (e.g., reverse oblique type or loss of posteromedial cortex), a **Proximal Femoral Nail (PFN)** is the treatment of choice because it is an intramedullary device with a shorter lever arm. * **Complication:** The most common deformity following a poorly treated trochanteric fracture is **Coxa Vara** (decreased neck-shaft angle) leading to a short-limbed gait.

Q: Which complication may arise after a supracondylar fracture?

All of the above. **Explanation:** Supracondylar fractures of the humerus (specifically the extension type, which accounts for 95% of cases) are among the most common pediatric fractures and are notorious for both immediate neurovascular and late structural complications. 1. **Nerve Injury (Option A):** The displaced proximal fragment can stretch or contuse adjacent nerves. The **Median nerve** (specifically the Anterior Interosseous Nerve branch) is the most commonly injured in extension-type fractures. The Radial nerve is the second most common, while the Ulnar nerve is typically injured in flexion-type fractures or during surgical pinning. 2. **Vascular Injury (Option B):** The **Brachial artery** lies in close proximity to the sharp edge of the proximal bone fragment. Injury or spasm can lead to pulselessness and, if untreated, **Volkmann’s Ischemic Contracture (VIC)**. 3. **Deformity (Option C):** **Cubitus varus** (Gunstock deformity) is the most common late complication. It usually results from malunion (inadequate reduction of medial tilt or rotation) rather than physeal arrest. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Anterior Interosseous Nerve (AIN) – test by asking the patient to make an "OK" sign. * **Most common deformity:** Cubitus varus (primarily a cosmetic issue, rarely affects function). * **Gartland Classification:** Used to grade displacement (Type I: Undisplaced; Type II: Angulated but posterior cortex intact; Type III: Completely displaced). * **Urgency:** A "pink pulseless hand" is a surgical emergency requiring immediate reduction.

Q: Which of the following is NOT true about a Colles fracture?

Characterized by a garden spade deformity. **Explanation:** A **Colles fracture** is a distal radius fracture occurring approximately 2.5 cm proximal to the wrist joint. The hallmark clinical presentation is a **"Dinner Fork Deformity,"** not a garden spade deformity. 1. **Why Option D is the Correct Answer (False Statement):** The **Garden Spade Deformity** is characteristic of a **Smith’s fracture** (also known as a Reverse Colles). In a Smith’s fracture, the distal fragment is displaced volarly (ventrally). In contrast, a Colles fracture causes dorsal displacement, resembling the curve of a dinner fork. 2. **Analysis of Other Options:** * **Option A (True):** It is most common in elderly post-menopausal women due to osteoporosis. It typically results from a fall on an outstretched hand (FOOSH). * **Option B (True):** The classic displacement pattern in Colles includes **dorsal** displacement, dorsal tilt, lateral displacement, lateral tilt, impaction, and supination. * **Option C (True/Contextual):** While the fracture line is extra-articular (proximal to the joint), it is clinically categorized as a fracture "at the wrist" or involving the distal radial metaphysis. **High-Yield Clinical Pearls for NEET-PG:** * **Deformity Mnemonic:** **C**olles = **D**inner Fork (CD); **S**mith = **G**arden Spade (SG). * **Most common complication:** Stiffness of fingers and shoulder (Frozen shoulder). * **Most common nerve involved:** Median nerve (Carpal Tunnel Syndrome). * **Late complication:** Rupture of the **Extensor Pollicis Longus (EPL)** tendon due to ischemia or attrition at Lister’s tubercle. * **Treatment:** Most are managed by closed reduction and a "Colles cast" (below-elbow cast with the wrist in slight flexion and ulnar deviation).

Q: Which of the following fractures is known for malunion?

Supracondylar Humerus. ### Explanation **Correct Answer: B. Supracondylar Humerus** The **Supracondylar fracture of the humerus** is notorious for **malunion**, specifically resulting in a **Cubitus Varus deformity** (also known as "Gunstock deformity"). This occurs due to the failure to correct the rotational or coronal tilt of the distal fragment during reduction. Unlike many other fractures, the supracondylar region has a high remodeling potential in children for sagittal plane deformities (extension/flexion), but it has **zero remodeling potential** for rotational or varus/valgus malalignment. Therefore, any residual varus tilt persists and leads to a permanent cosmetic deformity. **Why the other options are incorrect:** * **A. Femur Neck:** This fracture is primarily known for **Non-union** and **Avascular Necrosis (AVN)**. This is due to the precarious retrograde blood supply and the lack of a periosteal layer (intracapsular), which prevents callus formation. * **C. Scaphoid:** Similar to the femoral neck, the scaphoid is prone to **Non-union** and **AVN** (specifically of the proximal pole) because of its tenuous distal-to-proximal blood supply. * **D. Lateral Condyle of Humerus:** This is a "fracture of necessity" (requires ORIF). It is famous for **Non-union** (due to the pull of extensor muscles and synovial fluid interference), which subsequently leads to **Cubitus Valgus** and **Tardy Ulnar Nerve Palsy**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of Supracondylar Fracture:** Malunion (Cubitus Varus). * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Baumann’s Angle:** Used radiologically to assess the adequacy of reduction and predict future varus deformity. * **Reverse Gunstock Deformity:** Refers to Cubitus Valgus, typically seen following lateral condyle non-union.

Q: Fracture of the scaphoid bone is most commonly seen in which patient population?

Young active adult. **Explanation:** The **scaphoid** is the most commonly fractured carpal bone (approx. 60–70%). The mechanism of injury is typically a **fall on an outstretched hand (FOOSH)** with the wrist in dorsiflexion and radial deviation. **1. Why "Young Active Adult" is correct:** This population is most frequently involved in high-energy activities, sports, and motor vehicle accidents. In young adults, the bone density is high, but the force of impact is sufficient to snap the scaphoid across its waist. In contrast, similar trauma in other age groups often results in different fracture patterns due to varying bone strengths. **2. Why the other options are incorrect:** * **Elderly (Male/Postmenopausal Female):** In the elderly, the distal radius is relatively weaker due to osteoporosis. Therefore, a FOOSH more commonly results in a **Colles' fracture** rather than a scaphoid fracture. * **Children:** The scaphoid is largely cartilaginous in young children and does not ossify completely until mid-adolescence. Consequently, a FOOSH in children typically results in a **greenstick fracture of the distal radius** or a supracondylar fracture of the humerus. **Clinical Pearls for NEET-PG:** * **Most common site:** The **waist** of the scaphoid (70%). * **Blood Supply:** Supplied by the radial artery (retrograde flow). This makes the **proximal pole** highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox**. * **Radiology:** If initial X-rays are negative but clinical suspicion is high, repeat X-rays in 10–14 days or perform an MRI (most sensitive). * **Management:** Undisplaced fractures are treated with a **Scaphoid cast** (Glass-holding position).

Q: Which of the following is NOT a principle in the treatment of compound fractures?

Immediate wound closure. **Explanation:** The primary goal in managing compound (open) fractures is to prevent **osteomyelitis** and promote soft tissue healing. **Why "Immediate Wound Closure" is the correct answer:** In compound fractures, the wound is considered contaminated by definition. **Immediate primary closure** is strictly contraindicated because it traps bacteria and debris inside the wound, creating an anaerobic environment that significantly increases the risk of gas gangrene and severe infection. Instead, these wounds are typically managed by **delayed primary closure** or healing by secondary intention once the wound is clinically clean. **Analysis of Incorrect Options:** * **Wound Debridement:** This is the "gold standard" and most critical step. It involves removing all devitalized tissue and foreign bodies to convert a contaminated wound into a clean one. * **Tendon Repair:** While not always the first priority, primary or delayed repair of tendons is a standard principle of reconstructive management once the infection risk is mitigated. * **Aggressive Antibiotic Therapy:** Early administration of intravenous antibiotics (usually a cephalosporin, adding an aminoglycoside for Gustilo-Anderson Type II/III) is mandatory to reduce infection rates. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Period:** Debridement should ideally be performed within **6 hours** of injury. * **Gustilo-Anderson Classification:** This is the most common system used to grade open fractures (Type I to III). * **The "Three Is":** The pillars of management are **I**rrigation (lavage), **I**ncision (debridement), and **I**nternal/External fixation. * **Rule of Thumb:** Never close an open fracture wound primarily if there is any doubt regarding tissue viability or contamination.

Question 1

Which of the following is referred to as Luxatio erecta?

Accepted Answer

Inferior dislocation of shoulder

Answer

Tear of the glenoid labrum

Answer

Anterior dislocation of shoulder

Answer

Defect in the humeral head

Question 2

What is the best treatment for a trochanteric fracture of the femur?

Accepted Answer

Dynamic hip screw

Answer

Inlay plates

Answer

Plaster in abduction

Answer

Plaster in abduction and internal rotation

Question 3

Which complication may arise after a supracondylar fracture?

Accepted Answer

All of the above

Answer

Median nerve injury

Answer

Damage to brachial artery

Answer

Cubitus varus

Question 4

Which of the following is NOT true about a Colles fracture?

Accepted Answer

Characterized by a garden spade deformity

Answer

Common in old age

Answer

Results in dorsal displacement of the distal fragment

Answer

Occurs at the radio-carpal joint

Question 5

Which of the following fractures is known for malunion?

Accepted Answer

Supracondylar Humerus

Answer

Femur neck

Answer

Scaphoid

Answer

Lateral condyle of humerus

Question 6

Which of the following methods is an example of rigid fixation?

Accepted Answer

Lag screw fixation

Answer

Miniplate osteosynthesis

Answer

Transosseous wiring

Answer

None of the above

Question 7

What is the immediate treatment of an unstable tibial plateau fracture?

Accepted Answer

Internal fixation with plate and screw

Answer

Internal fixation with nail

Answer

External fixator

Answer

Complete bed rest

Question 8

Fracture of the scaphoid bone is most commonly seen in which patient population?

Accepted Answer

Young active adult

Answer

Elderly male

Answer

Elderly postmenopausal female

Answer

Children

Question 9

Which of the following is NOT a principle in the treatment of compound fractures?

Accepted Answer

Immediate wound closure

Answer

Wound debridement

Answer

Tendon repair

Answer

Aggressive antibiotic therapy

Question 10

A 75-year-old woman presents with a history of tripping and falling in the bathroom, and is unable to walk or bear weight on her left hip. On examination, her left lower limb was noted to be in an externally rotated position, the hip was tender, and active straight leg raising was not possible. What is the most likely diagnosis?

Accepted Answer

Fracture neck of femur

Answer

Osteoarthritis hip

Answer

Dislocation of hip joint

Answer

Acetabular fracture

Trauma — MCQs

Trauma — MCQs

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