Trauma Practice Questions

Q: A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?

Stiffness of the wrist joint. ### Explanation **1. Why Option A is Correct:** Stiffness of the wrist and fingers is the **most common late complication** of a Colles fracture. It typically results from prolonged immobilization in a Plaster of Paris (POP) cast, lack of physiotherapy, or persistent post-traumatic edema. In elderly patients or children, failure to perform active finger exercises during the casting period leads to adhesions in the tendon sheaths and joint capsules, resulting in significant functional impairment. **2. Why the Other Options are Incorrect:** * **Option B (Ulnar Nerve Palsy):** This is rarely associated with Colles fractures. Ulnar nerve injury is more commonly seen in fractures of the medial epicondyle of the humerus or distal ulnar shaft fractures. * **Option C (Median Nerve Palsy):** While the median nerve can be involved, it is typically an **early/acute complication** (due to direct trauma or carpal tunnel compression from edema) rather than a late complication. If it occurs late, it is usually due to secondary Carpal Tunnel Syndrome, but stiffness remains the more universally recognized and frequent late sequela. **3. Clinical Pearls for NEET-PG:** * **Eponymous Deformity:** Colles fracture presents with a "Dinner Fork Deformity" (dorsal displacement). * **Rupture of Extensor Pollicis Longus (EPL):** This is a classic, high-yield **late complication** caused by ischemia or attrition of the tendon at Lister’s tubercle. * **Sudeck’s Osteodystrophy (CRPS):** Another important late complication characterized by pain, swelling, and "patchy osteoporosis" on X-ray. * **Malunion:** Leads to a permanent dinner fork deformity but often remains functionally acceptable in the elderly.

Q: Pipkin classification is used for which type of fracture?

Femoral head fracture. **Explanation:** The **Pipkin Classification** is the standard system used to categorize **Femoral Head Fractures**, which typically occur as a result of high-energy trauma (like dashboard injuries) often associated with posterior hip dislocations. **1. Why the Correct Answer is Right:** The classification is based on the location of the fracture line relative to the **fovea capitis** and the presence of associated injuries to the acetabular rim or femoral neck. * **Type I:** Fracture inferior to the fovea capitis (small fragment). * **Type II:** Fracture superior to the fovea capitis (large fragment). * **Type III:** Type I or II fracture associated with a **femoral neck fracture** (high risk of AVN). * **Type IV:** Type I or II fracture associated with an **acetabular rim fracture**. **2. Why Incorrect Options are Wrong:** * **Acetabular Fractures:** These are most commonly classified using the **Judet-Letournel Classification** (based on columns and walls). * **Pelvis Ring Fractures:** These use the **Tile Classification** (based on stability) or the **Young-Burgess Classification** (based on mechanism of injury like APC or LC). * **Femoral Shaft Fractures:** These are typically classified using the **Winquist-Hansen Classification** (based on the degree of comminution). **Clinical Pearls for NEET-PG:** * **Mechanism:** Most femoral head fractures occur during **posterior hip dislocation**. * **Prognosis:** Pipkin Type III has the worst prognosis due to the high risk of **Avascular Necrosis (AVN)**. * **Management:** Type I and II are often treated with ORIF if displaced; Type III and IV usually require surgical intervention and carry a high risk of secondary osteoarthritis.

Q: An injury to the shown area can lead to fracture of which bone?

Scaphoid. ***Scaphoid*** - The **anatomical snuffbox** is the most vulnerable area for scaphoid fractures, typically occurring after a **fall on outstretched hand (FOOSH)** injury. - **Tenderness in the anatomical snuffbox** and pain with **radial deviation** of the wrist are classic clinical findings of scaphoid fracture. *Lunate* - Lunate fractures are much **rarer** and typically occur with **high-energy trauma** or **perilunate dislocations**. - The lunate is **not directly palpable** in the anatomical snuffbox area, making it less susceptible to injury from this mechanism. *Hamate* - Hamate fractures commonly occur from **direct trauma** to the **hypothenar eminence** or **hook of hamate**. - The hamate is located on the **ulnar side** of the wrist and is not anatomically related to the snuffbox area. *Trapezium* - Trapezium fractures are typically associated with **Bennett's fracture** involving the **first metacarpal base**. - Located at the **base of the thumb**, the trapezium is not directly involved in anatomical snuffbox injuries.

Q: Non-union is a complication of which of the following fractures?

Scaphoid fracture. ### **Explanation** The correct answer is **A. Scaphoid fracture**. **1. Why Scaphoid Fracture is the Correct Answer:** Non-union is a notorious complication of scaphoid fractures primarily due to its **precarious blood supply**. The scaphoid receives its blood supply in a **retrograde fashion** (from distal to proximal) via the dorsal carpal branch of the radial artery. A fracture across the waist or proximal pole can easily interrupt this supply, leading to ischemia of the proximal fragment. This results in a high incidence of **Avascular Necrosis (AVN)** and subsequent **non-union**. **2. Why the Other Options are Incorrect:** * **B. Colles' Fracture:** This occurs at the distal radius, which has a rich blood supply and cancellous bone. It typically heals well; the most common complication is **Mal-union** (dinner fork deformity), not non-union. * **C. Intertrochanteric Fracture:** This region is extracapsular and consists of highly vascular cancellous bone. These fractures heal readily; the primary complication is **Mal-union** (coxa vara). In contrast, *Neck of Femur* fractures (intracapsular) are prone to non-union. * **D. Supracondylar Fracture (Humerus):** This is common in children. The most frequent complications are **Mal-union** (Cubitus varus/Gunstock deformity) and vascular injury (Volkmann’s Ischemic Contracture). Non-union is extremely rare here. **3. High-Yield Clinical Pearls for NEET-PG:** * **Common sites for Non-union:** Scaphoid (waist), Neck of Femur, Talus (neck), and Lower 1/3rd of Tibia. * **Scaphoid Fact:** The most common site of fracture is the **waist (70%)**. The more proximal the fracture, the higher the risk of AVN and non-union. * **Radiology:** If a scaphoid fracture is clinically suspected (tenderness in the anatomical snuffbox) but X-rays are negative, the wrist should be immobilized and re-imaged after **10–14 days**.

Q: All of the following statements about dislocation of the shoulder are true, except?

The commonest position for the head of the humerus to move into is the subglenoid.. **Explanation:** **1. Why Option B is the Correct Answer (The False Statement):** While the shoulder is the most commonly dislocated joint in the body, the most frequent anatomical position for the humeral head in an anterior dislocation is **Subcoracoid**, not subglenoid. In anterior dislocations (which account for >95% of cases), the head usually settles beneath the coracoid process. Subglenoid is the second most common position. **2. Analysis of Other Options:** * **Option A:** The classic mechanism of injury is a fall on an outstretched hand with the arm in **abduction, extension, and external rotation**. This forces the humeral head against the weak anterior capsule. * **Option C:** The **Axillary nerve** (C5-C6) is the most commonly injured nerve in shoulder dislocations due to its proximity to the surgical neck of the humerus. Clinically, this presents as "regimental badge" anesthesia over the lateral deltoid. * **Option D:** While many maneuvers exist (e.g., Hippocratic, Kocher’s, Stimson), the safest and easiest way to reduce a dislocation is using gentle traction/pressure under **General Anesthesia (GA)** with muscle relaxation. This overcomes muscle spasms (especially the subscapularis) and minimizes the risk of iatrogenic fractures. **3. NEET-PG High-Yield Pearls:** * **Most common type:** Anterior (Subcoracoid). * **Posterior Dislocation:** Associated with **seizures or electric shocks**. Look for the "Light bulb sign" on X-ray. * **Hill-Sachs Lesion:** Compression fracture of the posterosuperolateral humeral head. * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Luxatio Erecta:** A rare inferior dislocation where the arm is held fixed in an overhead position.

Q: A 45-year-old female has a history of a slip in the bathroom, complaining of right hip pain and tenderness in Scarpa's triangle. The X-ray is normal. What is the next investigation?

MRI. ### Explanation **1. Why MRI is the Correct Choice:** The clinical presentation (slip in a bathroom, hip pain, and tenderness in Scarpa’s triangle) is highly suspicious of a **fracture of the neck of the femur**. In elderly or osteoporotic patients, these fractures can be **occult** (not visible on initial X-rays). **MRI is the gold standard** and the investigation of choice for occult hip fractures. It has a sensitivity and specificity of nearly 100%. It can detect bone marrow edema within 24 hours of injury, which indicates a fracture even when the cortical lines appear intact on a radiograph. **2. Why Other Options are Incorrect:** * **USG-guided aspiration:** This is primarily used to diagnose septic arthritis or to relieve a tense joint effusion. It has no role in diagnosing an occult fracture. * **CT Scan:** While CT is excellent for evaluating complex fracture patterns and cortical detail, it is less sensitive than MRI for detecting early trabecular microfractures or bone marrow edema. It is usually the second-line choice if MRI is contraindicated. * **Bone Scan (Technetium-99m):** Historically used for occult fractures, but it may take 48–72 hours to become positive in the elderly (delayed osteoblastic activity). It is less specific and has been largely replaced by MRI. **3. Clinical Pearls for NEET-PG:** * **Tenderness in Scarpa’s Triangle:** A classic clinical sign of a hip fracture or hip joint pathology. * **Occult Fracture Definition:** A fracture that is clinically suspected but not visible on initial plain radiographs. * **Management Rule:** If a patient has a high clinical suspicion of a hip fracture but normal X-rays, they **must not** be discharged. They require an MRI to rule out the fracture. * **MRI Contraindication:** If the patient has a pacemaker or metallic implants, a **CT scan** becomes the next best investigation.

Q: Which is the most commonly injured tarsal bone?

Calcaneus. **Explanation:** The **calcaneus** (heel bone) is the most commonly fractured tarsal bone, accounting for approximately **60% of all tarsal fractures** and about 2% of all fractures in the body. Its vulnerability is primarily due to its weight-bearing function and its position as the first point of contact during axial loading. **Why Calcaneus is correct:** Most calcaneal fractures occur due to high-energy axial loading, such as a **fall from a height** landing on the feet (often associated with "Don Juan Syndrome"). Because it consists of a thin cortical shell surrounding cancellous bone, it is highly susceptible to compression and comminution under sudden force. **Why other options are incorrect:** * **Talus:** It is the second most common tarsal bone to be fractured. It is protected within the ankle mortise and requires significant force to fracture, often leading to avascular necrosis (AVN) due to its unique retrograde blood supply. * **Navicular:** Fractures are relatively rare and usually occur as stress fractures in athletes or due to direct trauma/twisting. * **Cuneiform:** These are rarely injured in isolation because they are tightly bound by strong interosseous ligaments within the midfoot complex. **Clinical Pearls for NEET-PG:** * **Don Juan Syndrome (Lover’s Fracture):** Calcaneal fractures are frequently associated with concurrent **compression fractures of the lumbar spine** (L1-L2) and bilateral calcaneal injuries. Always screen the spine in these patients. * **Bohler’s Angle:** A decrease in this angle (normal = 25°–40°) on a lateral X-ray suggests a calcaneal compression fracture. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot is a pathognomonic physical finding for calcaneal fractures.

Q: The posterolateral lesion in the head of humerus in cases of recurrent anterior shoulder dislocation is:

Hill-Sachs lesion. ### Explanation **Correct Option: B. Hill-Sachs lesion** **Mechanism and Pathophysiology:** In **recurrent anterior shoulder dislocation**, the humeral head is displaced anteriorly and inferiorly. As it exits the glenoid labrum, the soft **posterolateral** aspect of the humeral head strikes against the hard **anteroinferior** rim of the glenoid. This compression results in a "bookshelf" deformity or an impaction fracture on the humeral head. This specific bony defect is known as the **Hill-Sachs lesion**. It is a hallmark of recurrent instability and increases the risk of future dislocations. **Analysis of Incorrect Options:** * **A. Bankart’s lesion:** This is an injury to the **anteroinferior glenoid labrum** (and sometimes the bony rim). While it also occurs in anterior dislocations, it involves the glenoid, not the humeral head. * **C. Reverse Hill-Sachs lesion:** This is an impaction fracture on the **anterior** aspect of the humeral head, occurring during **posterior** shoulder dislocations (often seen in seizures or electric shocks). * **D. Greater tuberosity avulsion fracture:** This typically occurs in older patients during an initial traumatic dislocation due to the pull of the rotator cuff muscles, but it is not the characteristic "posterolateral lesion" associated with recurrent instability. **High-Yield Clinical Pearls for NEET-PG:** * **Bankart’s Lesion:** Most common cause of shoulder instability; involves the 3 o'clock to 6 o'clock position (right shoulder). * **Imaging:** Hill-Sachs lesions are best visualized on the **Stryker Notch view** (X-ray) or MRI. * **Engaging Hill-Sachs:** A lesion is "engaging" if it drops over the glenoid rim during functional range of motion, necessitating surgical intervention (e.g., **Remplissage procedure**). * **ALPSA Lesion:** Anterior Labral Periosteal Sleeve Avulsion (a variant of Bankart’s).

Q: Which of the following statements regarding this diagnosis is true?

Recurrence is a common complication. ***Recurrence is a common complication*** - **Anterior shoulder dislocation** has a high recurrence rate, especially in **young adults under 30 years**, where recurrence can exceed 80-90%. - **Recurrent dislocations** occur due to damage to the **glenoid labrum** (Bankart lesion) and capsular structures during the initial injury. *Common in children and rare in adults* - Anterior shoulder dislocation is **most common in adults**, particularly in the **20-40 year age group**. - In children, shoulder dislocations are relatively **rare** due to the greater elasticity of their joint capsules and ligaments. *May be overlooked as clinically occult* - Anterior shoulder dislocation presents with **obvious clinical signs** including loss of normal shoulder contour and severe pain. - The **squared-off shoulder** appearance and inability to move the arm make this injury readily apparent, not occult. *Is not associated with other bony or cartilaginous injury* - Anterior shoulder dislocation is commonly associated with **Hill-Sachs lesion** (compression fracture of the humeral head). - Also frequently involves **Bankart lesion** (tear of the anterior glenoid labrum) and potential **greater tuberosity fractures**.

Question 1

A 37-year-old male is brought to the emergency room after a road traffic accident. On examination, the capillary refilling time is delayed in the left lower limb. Which of the following is NOT an indication for amputation in this patient?

Accepted Answer

Transcutaneous Oxygen Tension - 40mmHg

Answer

Severe Peripheral Vascular disease

Answer

Ankle-Brachial Index < 0.45

Answer

Fulminant Gas Gangrene

Question 2

A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?

Accepted Answer

Stiffness of the wrist joint

Answer

Ulnar nerve palsy

Answer

Median nerve palsy

Answer

None of the above

Question 3

Pipkin classification is used for which type of fracture?

Accepted Answer

Femoral head fracture

Answer

Acetabular fractures

Answer

Pelvis ring fracture

Answer

Femoral shaft fracture

Question 4

An injury to the shown area can lead to fracture of which bone?

Accepted Answer

Scaphoid

Answer

Lunate

Answer

Hamate

Answer

Trapezium

Question 5

Non-union is a complication of which of the following fractures?

Accepted Answer

Scaphoid fracture

Answer

Colles' fracture

Answer

Intertrochanteric fracture of the hip

Answer

Supracondylar fracture of the humerus

Question 6

All of the following statements about dislocation of the shoulder are true, except?

Accepted Answer

The commonest position for the head of the humerus to move into is the subglenoid.

Answer

The injury is produced by a fall with the arm fully abducted.

Answer

The axillary nerve is likely to be injured.

Answer

The easiest way to reduce it is by simple pressure with the patient under general anesthesia with muscle relaxation.

Question 7

A 45-year-old female has a history of a slip in the bathroom, complaining of right hip pain and tenderness in Scarpa's triangle. The X-ray is normal. What is the next investigation?

Accepted Answer

MRI

Answer

USG-guided aspiration

Answer

CT scan

Answer

Bone scan

Question 8

Which is the most commonly injured tarsal bone?

Accepted Answer

Calcaneus

Answer

Talus

Answer

Navicular

Answer

Cuneiform

Question 9

The posterolateral lesion in the head of humerus in cases of recurrent anterior shoulder dislocation is:

Accepted Answer

Hill-Sachs lesion

Answer

Banka's lesion

Answer

Reverse Hill-Sachs lesion

Answer

Greater tuberosity avulsion fracture

Question 10

Which of the following statements regarding this diagnosis is true?

Accepted Answer

Recurrence is a common complication

Answer

Common in children and rare in adults

Answer

May be overlooked as clinically occult

Answer

Is not associated with other bony or cartilaginous injury

Trauma — MCQs

Trauma — MCQs

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