Trauma Practice Questions

Q: An epilepsy patient presents in postictal period with inability to touch opposite shoulder. What is incorrect about the diagnosis?

Head of humerus fixed in external rotation. ***Head of humerus fixed in external rotation*** - In a **posterior shoulder dislocation**, which is common after epileptic seizures, the humeral head is typically **adducted and internally rotated**. - The patient's inability to touch the opposite shoulder suggests an injury preventing **internal rotation and adduction**, which is consistent with a posterior dislocation where the humerus is fixed in internal rotation. *Empty glenoid sign* - The **empty glenoid sign** on an AP X-ray view is indicative of a **posterior shoulder dislocation**, where the humeral head is displaced posteriorly, leaving the glenoid cavity appearing "empty." - This is a correct observation for posterior shoulder dislocation, which is suggested by the clinical scenario. *Stryker notch view is necessary for X-ray* - The **Stryker notch view** is a specialized radiographic projection useful for visualizing **Hill-Sachs lesions**, which are compression fractures of the posterolateral humeral head often associated with anterior shoulder dislocations. - While it might be used to rule out associated injuries, a **posterior shoulder dislocation** often requires trans-scapular Y view or axillary view for confirmation. However, an **anterior-inferior glenoid rim fracture** (Bankart lesion) or impression fracture on the humeral head (Hill-Sachs lesion) due to repeated dislocations would make this view relevant for evaluating bony defects. *Regimental batch anesthesia* - **Regimental badge anesthesia** refers to a loss of sensation over the lateral aspect of the shoulder, an area supplied by the **axillary nerve**. - The axillary nerve is commonly injured in shoulder dislocations due to its close proximity to the humeral head, making this a correct potential finding.

Q: A 65-year-old woman falls on an extended and outstretched hand while walking her grandchild to school. She presents to the emergency department in severe pain and is holding her left wrist. On examination, there is swelling, tenderness, and deformity of the wrist. Which of the following is the most likely diagnosis?

Colle's fracture. ***Colle's fracture*** - A **Colle's fracture** is a fracture of the distal **radius** with **dorsal displacement** of the distal fragment, often occurring when falling on an **outstretched hand (FOOSH)**. - The characteristic "dinner fork" deformity, showing dorsal displacement, is a classic sign seen in the provided image and described scenario. *Barton fracture* - A Barton fracture is an **intra-articular fracture** of the distal radius with an associated **subluxation of the carpus**. - While it can result from a FOOSH injury, it specifically involves the joint surface and carpal displacement, which is not the primary diagnostic feature described or visually implied. *Chauffer fracture* - A Chauffeur fracture, also known as a **radial styloid fracture**, is an **oblique intra-articular fracture** of the radial styloid. - This type of fracture is typically caused by direct trauma or impaction of the scaphoid against the radial styloid, not the widespread dorsal displacement seen in the image. *Shepherd fracture* - There is no consistently recognized medical term for a "Shepherd fracture" in the context of wrist injuries. - This option is likely a distractor and does not correspond to a known fracture pattern related to the given clinical presentation.

Q: Which is incorrect about the image shown below?

Bayonet deformity. ***Bayonet deformity*** - **Bayonet deformity** describes side-by-side alignment of fracture fragments typically seen in **diaphyseal fractures**, not the dorsal angulation pattern of distal radial fractures. - The image shows a **dinner fork deformity** with dorsal displacement, not the lateral offset characteristic of bayonet deformity. *Dinner fork deformity* - The image clearly demonstrates a classic **dinner fork deformity**, which is the characteristic appearance of **Colles fractures** and similar distal radial fractures. - This deformity results from **dorsal displacement** and angulation of the distal radial fragment, creating the distinctive fork-like silhouette. *Distal fragment dorsally angulated* - The **distal radial fragment** is indeed **dorsally angulated** in the image, which is the hallmark feature of Colles fractures. - This dorsal angulation is precisely what creates the **dinner fork deformity** appearance seen clinically and radiographically. *Nonunited distal radial fracture* - A **nonunited fracture** would show specific radiological signs of **failed healing** over time, including sclerotic bone ends and gap persistence. - The image appears to show an **acute fracture** with characteristic deformity rather than signs of established nonunion.

Q: A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Monteggia fracture. ***Monteggia fracture*** - This classic injury pattern shows **fracture of the ulnar shaft** with **dislocation of the radial head**, more commonly seen in children due to their ligamentous laxity and softer bones. - Diagnosis is confirmed using the **radiocapitellar line test** - a line drawn through the center of the radial head should pass through the capitellum on all X-ray views; disruption indicates radial head dislocation. *Colles fracture* - A Colles fracture involves a **fracture of the distal radius** with **dorsal displacement** of the distal fragment, typically occurring from a fall on an outstretched hand in elderly patients. - The X-ray findings clearly show an **ulnar shaft fracture** with **radial head dislocation**, not a distal radial fracture pattern. *Smith's fracture* - A Smith's fracture is a **distal radius fracture** with **volar (palmar) displacement** of the distal fragment, sometimes called a "reverse Colles fracture." - This diagnosis is incorrect because the image demonstrates a **midshaft ulnar fracture** with **proximal radioulnar joint disruption**, not distal radial pathology. *Galeazzi's fracture* - A Galeazzi fracture involves a **fracture of the radius** (usually distal third) combined with **dislocation of the distal radioulnar joint (DRUJ)**. - This pattern is distinct from the current case, which shows **ulnar fracture** with **radial head dislocation** at the **proximal radioulnar joint**, making it a Monteggia rather than Galeazzi injury.

Q: Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Volkmann ischemic contracture. ***Volkmann ischemic contracture*** - The images show a **fixed flexion deformity of the wrist and fingers**, along with **forearm pronation**, which is characteristic of Volkmann's ischemic contracture. - This condition results from **ischemia to the forearm muscles**, leading to muscle necrosis and subsequent fibrosis and contracture. *Ulnar tunnel syndrome* - This syndrome involves compression of the **ulnar nerve** at the wrist. - Symptoms typically include **numbness and tingling in the ring and little fingers**, and hand weakness, which are not depicted as the primary finding here. *Cubital tunnel syndrome* - This condition involves compression of the **ulnar nerve** at the elbow. - It presents with similar sensory and motor deficits to ulnar tunnel syndrome but specifically related to the elbow, not the characteristic fixed deformity shown. *Wartenberg's syndrome* - Also known as **superficial radial nerve entrapment**, it involves compression of the superficial branch of the radial nerve. - This typically causes **sensory symptoms** (pain, numbness, paresthesia) on the back of the hand and thumb, without the gross motor contracture seen in the images.

Q: A 55-year-old woman tripped over a piece of banana and sustained a fracture shown below. Diagnosis is:

Colle's fracture. ***Smith's fracture*** - The radiological image demonstrates a distal **radius fracture** with **volar (palmar) angulation** and displacement of the distal fragment, creating the characteristic "garden spade" deformity of Smith's fracture. - Although the mechanism of tripping typically causes **FOOSH injuries**, the specific position of the wrist at impact and the resulting **volar displacement** confirms this as a Smith's fracture, also known as a **reverse Colles' fracture**. *Colle's fracture* - A Colles' fracture would show **dorsal angulation** and displacement of the distal fragment, creating a "dinner fork" deformity, which is not present in this image. - The **volar displacement** seen here is opposite to the dorsal displacement characteristic of Colles' fractures. *Galeazzi's fracture* - This fracture involves a **radial shaft fracture** combined with **dislocation of the distal radioulnar joint (DRUJ)**. - The image shows an **isolated distal radius fracture** without evidence of DRUJ dislocation or proximal radial involvement. *Barton's fracture* - A Barton's fracture is an **intra-articular fracture** of the distal radius with **radiocarpal joint subluxation**. - The fracture shown is **extra-articular** and does not involve the joint surface or show radiocarpal subluxation.

Q: A 50-year-old orthopaedics doctor went for sky diving while vacationing abroad. On return he had the following physical finding. What is the diagnosis?

Rupture of long head of biceps muscle. ***Rupture of long head of biceps muscle*** - The image clearly shows a sudden, prominent bulge (often described as a "**Popeye sign**") in the mid-arm, which is a classic clinical manifestation of a ruptured long head of the biceps tendon. - This typically occurs from a sudden, forceful contraction or eccentric loading of the biceps, often seen in older individuals or with trauma/falls, consistent with a skydiving incident. *Brachial plexus injury* - Brachial plexus injuries typically present with **neurological deficits** such as weakness, numbness, or paralysis in the arm and hand, rather than a distinct muscle bulge. - While a severe injury could result from a skydiving accident, the primary physical finding in the image does not align with a typical brachial plexus injury. *Upper extremity deep vein thrombosis* - Deep vein thrombosis (DVT) in the upper extremity would present with **swelling, pain, redness**, and warmth of the entire arm, or a significant portion of it, not an isolated muscle bulge. - This condition is usually associated with venous stasis, hypercoagulability, or endothelial injury, which are not suggested by the image or history. *Calcific tendinopathy* - Calcific tendinopathy involves **calcium deposits** within a tendon, leading to pain and limited range of motion, often in the shoulder in this anatomical region. - It would not manifest as a sudden, distinct muscle bulge and is primarily diagnosed through imaging like X-rays or ultrasound, not by visual inspection alone.

Q: Comment on the diagnosis:

Hill-Sachs lesion. ***Hill-Sachs lesion*** - The image shows a **compression fracture** or **dent** in the **posterolateral aspect of the humeral head**. - This lesion is characteristic of an **anterior shoulder dislocation**, occurring when the humeral head impacts the anterior glenoid rim. *Bankart lesion* - A Bankart lesion involves an avulsion of the **anterior inferior labrum** from the glenoid rim. - It is often seen in conjunction with a Hill-Sachs lesion following an anterior shoulder dislocation but refers to damage to the labrum, not the humeral head itself. *Reverse Hill-Sachs lesion* - A reverse Hill-Sachs lesion is a compression fracture on the **anteromedial aspect of the humeral head**. - This lesion is typically associated with a **posterior shoulder dislocation**, which is the opposite mechanism to the injury suggested by the visualized humeral head defect. *Posterior Bankart lesion* - A posterior Bankart lesion involves an avulsion of the **posterior inferior labrum** from the glenoid rim. - This lesion is associated with **posterior shoulder dislocations** and relates to labral injury, not the bony defect on the humeral head shown.

Q: Which is the suggested treatment of the lesion shown in the X-ray?

Tension band wiring. ***Tension band wiring*** - The X-ray image shows a **transverse patellar fracture** with some displacement, which is well-suited for tension band wiring. - This technique converts tensile forces on the anterior surface of the patella into compressive forces at the fracture site during knee flexion. *Intramedullary nail* - **Intramedullary nailing** is primarily used for **long bone fractures** (e.g., femur, tibia, humerus) and is not appropriate for patellar fractures. - This method is designed to stabilize diaphyseal or metaphyseal fractures in load-bearing long bones by placing a rod within the medullary canal. *Patellectomy* - **Patellectomy** (surgical removal of the patella) is typically reserved for **severely comminuted** or irreparable patellar fractures, or in cases of infection, which is not indicated by the X-ray. - This procedure can lead to significant functional impairment, including reduced quadriceps strength and increased tibiofemoral joint stress. *Above knee cast* - While an **above-knee cast** can provide - An above-knee cast does not provide **sufficient reduction and compression** for displaced patellar fractures, which are subjected to significant tensile forces. - Conservative management is generally reserved for **non-displaced or minimally displaced** patellar fractures where the extensor mechanism remains intact.

Q: An elderly patient slipped in the bathroom and sustained injury over the hip joint. X- Ray is shown below. Her attitude of leg will be?

Shortened, abducted and externally rotated. ***Shortened, abducted and externally rotated*** - The X-ray image reveals an **intertrochanteric fracture** of the right hip, characterized by a fracture line between the greater and lesser trochanters. - Due to the pull of strong muscles acting on the fractured fragments (e.g., iliopsoas, gluteal muscles), the limb typically assumes a position of **shortening, abduction, and external rotation**. *Shortened and abducted* - While **shortening** and **abduction** are present in intertrochanteric fractures, this answer is incomplete as it misses the crucial component of **external rotation**. - The powerful **external rotators** and the **gravity** acting on the unstable distal fragment contribute significantly to the external rotation. *Lengthened and internally rotated* - This attitude is characteristic of a **posterior hip dislocation**, where the femoral head is driven posteriorly and superiorly, typically leading to limb lengthening and internal rotation. - This is opposite to the typical presentation of an intertrochanteric fracture as seen in the X-ray. *Flexed and adducted and internally rotated* - A flexed, adducted, and internally rotated position is also seen in **posterior hip dislocations**, which is not consistent with the X-ray findings of an intertrochanteric hip fracture. - Hip fractures usually result in some degree of **external rotation** due to the muscle forces.

Question 1

An epilepsy patient presents in postictal period with inability to touch opposite shoulder. What is incorrect about the diagnosis?

Accepted Answer

Head of humerus fixed in external rotation

Answer

Empty glenoid sign

Answer

Stryker notch view is necessary for X-ray

Answer

Regimental batch anesthesia

Question 2

A 65-year-old woman falls on an extended and outstretched hand while walking her grandchild to school. She presents to the emergency department in severe pain and is holding her left wrist. On examination, there is swelling, tenderness, and deformity of the wrist. Which of the following is the most likely diagnosis?

Accepted Answer

Colle's fracture

Answer

Barton fracture

Answer

Chauffer fracture

Answer

Shepherd fracture

Question 3

Which is incorrect about the image shown below?

Accepted Answer

Bayonet deformity

Answer

Distal fragment dorsally angulated

Answer

Nonunited distal radial fracture

Answer

Dinner fork deformity

Question 4

A child presented with pain in the forearm following a trauma. An AP and lateral X-ray of the forearm reveal the findings as shown. What is the most likely diagnosis? (Recent NEET Pattern 2016-17)

Accepted Answer

Monteggia fracture

Answer

Colles fracture

Answer

Smith's fracture

Answer

Galeazzi's fracture

Question 5

Comment on the diagnosis based on examination findings shown below: (Recent NEET Pattern 2016-17)

Accepted Answer

Volkmann ischemic contracture

Answer

Ulnar tunnel syndrome

Answer

Cubital tunnel syndrome

Answer

Wartenberg's syndrome

Question 6

A 55-year-old woman tripped over a piece of banana and sustained a fracture shown below. Diagnosis is:

Accepted Answer

Colle's fracture

Answer

Smith's fracture

Answer

Galeazzi's fracture

Answer

Barton's fracture

Question 7

A 50-year-old orthopaedics doctor went for sky diving while vacationing abroad. On return he had the following physical finding. What is the diagnosis?

Accepted Answer

Rupture of long head of biceps muscle

Answer

Brachial plexus injury

Answer

Upper extremity deep vein thrombosis

Answer

Calcific tendinopathy

Question 8

Comment on the diagnosis:

Accepted Answer

Hill-Sachs lesion

Answer

Bankart lesion

Answer

Reverse Hill-Sachs lesion

Answer

Posterior Bankart lesion

Question 9

Which is the suggested treatment of the lesion shown in the X-ray?

Accepted Answer

Tension band wiring

Answer

Intramedullary nail

Answer

Patellectomy

Answer

Above knee cast

Question 10

An elderly patient slipped in the bathroom and sustained injury over the hip joint. X- Ray is shown below. Her attitude of leg will be?

Accepted Answer

Shortened, abducted and externally rotated

Answer

Shortened and abducted

Answer

Lengthened and internally rotated

Answer

Flexed and adducted and internally rotated

Trauma — MCQs

Trauma — MCQs

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