Trauma Practice Questions

Q: In which of the following femoral fractures is avascular necrosis common?

Transcervical. **Explanation:** The risk of **Avascular Necrosis (AVN)** in femoral fractures is primarily determined by the anatomical location of the fracture relative to the joint capsule and the blood supply to the femoral head. **Why Transcervical is Correct:** The femoral head receives its primary blood supply from the **medial circumflex femoral artery** via the **retinacular vessels**. A transcervical fracture is an **intracapsular** fracture. Because these vessels run along the surface of the femoral neck, a fracture in this region frequently shears or compresses them. Furthermore, the intracapsular environment lacks a periosteal layer (limiting healing) and is bathed in synovial fluid, which contains fibrinolysins that inhibit clot formation, further predisposing the head to ischemia and subsequent AVN. **Why Other Options are Incorrect:** * **Perotrochanteric & Subtrochanteric:** These are **extracapsular** fractures. The blood supply to the femoral head remains proximal to these fracture lines and is generally undisturbed. These areas have a rich cancellous bone supply and a thick periosteum, leading to high union rates but no significant risk of AVN. * **Shaft of Femur:** This is far distal to the femoral head's vascular supply. While it carries risks of fat embolism or malunion, it has no association with AVN of the femoral head. **NEET-PG High-Yield Pearls:** * **Garden’s Classification:** Used for subcapital/transcervical fractures; Stages III and IV have the highest risk of AVN. * **Pauwels’ Classification:** Based on the angle of the fracture line; higher angles (Type III) indicate greater instability and shear force. * **Clinical Sign:** In neck of femur fractures, the limb is typically **shortened and externally rotated.** * **Management:** In elderly patients with displaced transcervical fractures, **Hemiarthroplasty or Total Hip Replacement** is preferred over fixation due to the high risk of AVN and non-union.

Q: The Hawkins Classification is used for which type of fracture?

Talus fracture. The **Hawkins Classification** is the gold-standard system used to categorize **talar neck fractures**. It is clinically significant because it predicts the risk of **Avascular Necrosis (AVN)** of the talus, which has a tenuous retrograde blood supply (primarily via the artery of the tarsal canal). ### **Classification Breakdown:** * **Type I:** Undisplaced fracture (AVN risk: 0–15%). * **Type II:** Displaced fracture with subluxation/dislocation of the **subtalar joint** (AVN risk: 20–50%). * **Type III:** Displaced fracture with dislocation of both **subtalar and tibiotalar joints** (AVN risk: nearly 100%). * **Type IV:** Type III plus dislocation of the **talonavicular joint** (Canale and Kelly modification). ### **Analysis of Incorrect Options:** * **A. Tibial fracture:** Commonly classified by the **Schatzker** system (for tibial plateau) or **Lauge-Hansen/Danis-Weber** (for distal tibia/malleoli). * **B. Calcaneum fracture:** The most common classification used is the **Sanders Classification** (based on CT findings) or **Essex-Lopresti**. * **C. Radius head fracture:** Categorized using the **Mason Classification**. ### **High-Yield Clinical Pearls for NEET-PG:** * **Hawkins Sign:** A subcortical radiolucency (osteopenia) seen on X-ray 6–8 weeks post-injury. Its presence indicates intact vascularity (no AVN), while its absence suggests AVN. * **Aviator’s Astragalus:** Another name for talus fractures, historically caused by sudden dorsiflexion during plane crashes. * **Blood Supply:** The **Posterior Tibial Artery** (via the artery of the tarsal canal) provides the major blood supply to the talar body.

Q: What is the earliest ischemic feature following a supracondylar fracture reduction?

Pain. **Explanation:** The correct answer is **Pain**. This question refers to the early detection of **Volkmann’s Ischemia** or **Compartment Syndrome**, which are the most dreaded complications following a supracondylar fracture of the humerus. **1. Why Pain is the Correct Answer:** Pain is the **earliest and most reliable** clinical indicator of ischemia. Specifically, it is characterized as "pain out of proportion" to the injury and **pain on passive extension** of the fingers (stretch sign). This occurs because ischemic muscle tissue becomes highly sensitive to stretching long before nerves or vessels are completely compromised. **2. Analysis of Incorrect Options:** * **Coldness (A):** This is a late sign of vascular compromise (Poikilothermia). By the time the limb is cold, significant irreversible damage may have already occurred. * **Swelling (C):** While swelling is a common finding in trauma and contributes to increased compartmental pressure, it is a physical finding rather than a primary "ischemic feature" used for early diagnosis. * **Tingling (D):** Paresthesia (tingling/numbness) indicates nerve ischemia. While it is an early sign, it typically follows the onset of severe, unremitting pain. **Clinical Pearls for NEET-PG:** * **The 5 P’s of Compartment Syndrome:** Pain (earliest), Pallor, Paresthesia, Pulselessness (late), and Paralysis (very late). * **Pulselessness:** The presence of a radial pulse **does not** rule out compartment syndrome. * **Management:** If ischemia is suspected post-reduction, the first step is to remove all tight bandages and extend the elbow. If symptoms persist, urgent fasciotomy is indicated. * **Contracture:** If untreated, this leads to **Volkmann’s Ischemic Contracture (VIC)**, characterized by a "claw-like" hand deformity.

Q: The time necessary for fracture healing depends on which of the following factors?

All of the above. **Explanation:** Fracture healing is a complex biological process influenced by both systemic and local factors. The correct answer is **All of the above** because each factor plays a critical role in determining the rate of union. 1. **Age of the Patient:** This is a primary systemic factor. Fractures heal significantly faster in children due to a thick, active periosteum and high osteogenic potential. For example, a femoral shaft fracture may heal in 3–4 weeks in a newborn, whereas it takes 12–16 weeks in an adult. 2. **Location of the Fracture:** Bone type and blood supply vary by location. Cancellous bone (e.g., metaphyseal regions) has a rich blood supply and a large contact area, leading to faster healing than cortical bone (e.g., diaphyseal shafts). Furthermore, fractures in areas with poor blood supply (e.g., scaphoid waist or femoral neck) are prone to delayed union. 3. **Type of the Fracture:** The nature of the injury dictates the healing environment. Comminuted or displaced fractures take longer to heal than simple, undisplaced ones. Open fractures often involve soft tissue damage and compromised vascularity, further slowing the process. **Why other options are incorrect:** Options A, B, and C are individual components of the healing process. Selecting only one would be incomplete, as they all interact simultaneously to determine the final healing time. **High-Yield Clinical Pearls for NEET-PG:** * **Perkins’ Timetable:** A classic rule of thumb for fracture union in adults: Upper limb (Callus in 2-3 weeks, Union in 4-6 weeks, Consolidation in 6-8 weeks); Lower limb takes double this time. * **Most important local factor:** Blood supply to the fracture fragments. * **Negative factors:** Smoking, diabetes, malnutrition, and corticosteroids significantly delay fracture healing.

Q: A 30-year-old man sustained a femur fracture in a road traffic accident. Two days later, he developed sudden breathlessness. What is the most probable cause?

Fat embolism. **Explanation:** The clinical presentation of sudden breathlessness following a long bone fracture (like the femur) after an asymptomatic interval of 24–72 hours is a classic hallmark of **Fat Embolism Syndrome (FES)**. **Why Fat Embolism is correct:** FES occurs when fat globules are released from the bone marrow of a fractured long bone into the systemic circulation. These globules cause mechanical obstruction in the pulmonary capillaries and trigger a biochemical inflammatory response. The "lucid interval" (typically 24–48 hours) followed by the triad of **dyspnea, confusion (neurological symptoms), and a petechial rash** (usually over the chest and axilla) is pathognomonic for this condition. **Why other options are incorrect:** * **Pneumonia:** While it causes breathlessness, it typically presents with fever, productive cough, and takes longer than 48 hours to develop post-trauma. * **Congestive Heart Failure:** This is unlikely in a young 30-year-old patient without a prior cardiac history or massive fluid overload. * **Bronchial Asthma:** This would present with wheezing and usually a known prior history of atopy or triggers, rather than being a direct complication of a femur fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis (Major: Petechial rash, respiratory insufficiency, CNS depression). * **Snowstorm Appearance:** The characteristic finding on a Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Early Fixation:** The most effective way to prevent FES is the early stabilization/internal fixation of the fracture. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Steroids are controversial but sometimes mentioned.

Q: What is the term for an incomplete fracture?

Greenstick fractures. **Explanation:** **Greenstick fractures** are the classic example of an **incomplete fracture**, occurring primarily in children. Because pediatric bones are more resilient, flexible, and have a thick, active periosteum, they tend to bend rather than snap completely. In a Greenstick fracture, the bone cortex breaks on the convex (tension) side while the concave side remains intact or merely buckled, mimicking the way a young, "green" branch breaks. **Analysis of Incorrect Options:** * **Woodcrumble fractures:** This is a distractor term and does not exist in standard orthopedic nomenclature. * **Compression fractures:** These occur when the bone is crushed or flattened (common in vertebral bodies due to osteoporosis). While the cortex may remain intact, it is classified by mechanism rather than the "incomplete" nature of the break. * **Salter fractures:** This refers to the **Salter-Harris classification**, which categorizes injuries involving the **epiphyseal growth plate** in children. These can be complete or incomplete but specifically involve the physis. **High-Yield Clinical Pearls for NEET-PG:** * **Torus (Buckle) Fracture:** Another type of incomplete pediatric fracture where the cortex "buckles" due to axial loading, typically at the distal radius. * **Plastic Deformation:** A unique pediatric condition where the bone bends permanently without any visible cortical break on X-ray. * **Management:** Greenstick fractures often require reduction to complete the break (to prevent gradual bowing) followed by immobilization. * **Remodeling:** Children have a high potential for spontaneous correction of angulation due to the active periosteum, especially if the fracture is near a joint.

Question 1

In which of the following femoral fractures is avascular necrosis common?

Accepted Answer

Transcervical

Answer

Perotrochanteric

Answer

Subtrochanteric

Answer

Shaft of femur

Question 2

The Hawkins Classification is used for which type of fracture?

Accepted Answer

Talus fracture

Answer

Tibial fracture

Answer

Calcaneum fracture

Answer

Radius head fracture

Question 3

What is the earliest ischemic feature following a supracondylar fracture reduction?

Accepted Answer

Pain

Answer

Coldness

Answer

Swelling

Answer

Tingling

Question 4

The time necessary for fracture healing depends on which of the following factors?

Accepted Answer

All of the above

Answer

Age of the patient

Answer

Location of the fracture

Answer

Type of the fracture

Question 5

Trendelenburg's sign is negative in an Inter-Trochanteric fracture because of which structure?

Accepted Answer

Tensor fascia lata

Answer

Gluteus medius

Answer

Gluteus maximus

Answer

Gluteus minimus

Question 6

A 30-year-old man sustained a femur fracture in a road traffic accident. Two days later, he developed sudden breathlessness. What is the most probable cause?

Accepted Answer

Fat embolism

Answer

Pneumonia

Answer

Congestive heart failure

Answer

Bronchial asthma

Question 7

In nonunion of scaphoid, which vascularized muscle pedicle graft is taken from?

Accepted Answer

Pronator quadratus

Answer

Pronator teres

Answer

Brachioradialis

Answer

Extensor pollicis longus

Question 8

What is the recommended position for the arm in a cast when a fracture of both forearm bones occurs at the same level?

Accepted Answer

Mid-pronation

Answer

Full supination

Answer

10 degrees of supination

Answer

Full pronation

Question 9

What is the term for an incomplete fracture?

Accepted Answer

Greenstick fractures

Answer

Woodcrumble fractures

Answer

Compression fractures

Answer

Salter fractures

Question 10

A 50-year-old male with a fracture neck of femur presents after 3 days. What is the treatment of choice?

Accepted Answer

Closed reduction and internal fixation (CR & IF)

Answer

Hemiarthroplasty

Answer

Total hip replacement

Answer

Hip spika

Trauma — MCQs

Trauma — MCQs

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