Trauma Practice Questions

Q: What type of fracture is shown in X-ray of left shoulder?

Ideberg classification grade 4. ***Ideberg classification grade 4*** - The X-ray shows a **scapular fracture**, specifically involving the glenoid. Ideberg classification is used for **glenoid fractures**. - An Ideberg grade 4 fracture involves a **transverse fracture below the scapular notch**, separating the load-bearing part of the glenoid from the rest of the scapula, which appears consistent with the image. *Neer classification grade 4* - The **Neer classification** system is used for **proximal humerus fractures**, not scapular fractures. - A grade 4 Neer fracture involves **four part displacement** of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. *Garden classification grade 3* - The **Garden classification** system is specifically used for **femoral neck fractures**, which are fractures of the hip. - A Garden grade 3 fracture represents a **complete, displaced fracture of the femoral neck**, distinct from the shoulder injury shown. *Schatzker classification grade 5* - The **Schatzker classification** system is used for **tibial plateau fractures**, which are fractures of the knee joint. - A Schatzker grade 5 fracture involves a **bicondylar fracture** of the tibial plateau, which is severe and impacts the knee, not the shoulder.

Q: Consider the following : 1. Pain relief 2. Prevention of infection 3. Anaesthesia 4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

1, 3 and 4. **1, 3 and 4** - **Priorities in fracture treatment** always include alleviating pain, which can be severe and debilitating. - **Restoration of normal anatomy** is crucial for proper healing and optimal function of the fractured limb. - **Anesthesia** is often required to facilitate reduction and fixation of a fracture, as well as to manage pain during the procedure. *2, 3 and 4* - While **anesthesia** and **restoration of anatomy** are priorities, **prevention of infection** is primarily a concern for **open fractures** or surgical interventions. - **Pain relief** is a fundamental and immediate concern in all fracture cases, which is omitted in this option. *1, 2 and 3* - **Pain relief** and **anesthesia** are critical, and **prevention of infection** is important, but this option neglects the essential goal of **restoring anatomical alignment**. - **Restoring anatomy** directly impacts the long-term functional outcome and is a major goal of fracture management. *1, 2 and 4* - This option correctly identifies **pain relief**, **prevention of infection**, and **restoration of anatomy** as important. - However, it overlooks the immediate necessity of **anesthesia** to effectively manage pain during treatment procedures and allow for fracture reduction.

Q: The commonest complication of fracture of clavicle is :

malunion. ***malunion*** - **Malunion** is the most frequent complication following a clavicle fracture, meaning the bone heals in an anatomically incorrect or deformed position. - This often results in a palpable bump or cosmetic deformity, and can occasionally cause functional impairment. *non union* - **Non-union** occurs when the fracture fails to heal completely, leaving a persistent gap between the bone fragments. - While possible, it is less common than malunion in clavicle fractures, especially with appropriate management. *avascular necrosis* - **Avascular necrosis** is rare in clavicle fractures because the clavicle has a rich blood supply. - It typically affects bones with precarious blood supply, such as the femoral head or scaphoid. *Neurovascular injury* - **Neurovascular injury** involving the subclavian vessels or brachial plexus is a serious but relatively rare complication of clavicle fractures. - While possible, especially with displaced fractures, it is not the most common adverse outcome.

Q: The nerve most likely to get injured in patients with fracture of upper end of radius is :

Posterior interosseous. ***Posterior interosseous*** - The **posterior interosseous nerve** (deep branch of radial nerve) winds around the **neck of radius** through the **radial tunnel** between the heads of the supinator muscle, making it most vulnerable to injury with upper radial fractures. - Injury results in weakness of **finger and thumb extensors** with no sensory loss, as it is a purely **motor nerve** branch. *Ulnar* - The **ulnar nerve** passes behind the **medial epicondyle** of the humerus, making it vulnerable to elbow injuries but not typically affected by upper radial fractures. - Injury leads to **claw hand deformity** and sensory loss in the **medial hand**, which is anatomically distant from the radius. *Median* - The **median nerve** travels through the **cubital fossa** and is anatomically protected from direct trauma by upper radial fractures. - More commonly injured by **distal radial fractures** (Colles' fracture) causing **carpal tunnel compression**, not upper end fractures. *Radial* - The **radial nerve trunk** courses around the **spiral groove** of the humerus, making it susceptible to **humeral shaft fractures**, not upper radial fractures. - Injury causes **wrist drop** and sensory loss over the **posterior forearm**, but the main trunk is anatomically distant from the upper radius.

Q: Which one of the following fractures is most often complicated by fat embolism ?

Shaft of femur. ***Shaft of femur*** - **Long bone fractures**, especially those involving the **femur**, are classic causes of **fat embolism syndrome (FES)** due to the large amount of fatty marrow released into the circulation. - The **intraosseous pressure** increases at the fracture site, pushing fat globules into the bloodstream, which then travel to the lungs and other organs. *Shaft of tibia* - While the tibia is also a long bone and can cause fat emboli, it contains less marrow than the femur, making **tibial shaft fractures** less frequently associated with severe **fat embolism syndrome** compared to femoral fractures. - The **mechanical disruption** is generally less extensive than in a femoral fracture, reducing the volume of fatty material released. *Supra condyler humerus* - This fracture involves the **distal humerus**, which is a long bone, but its **marrow content is significantly less** than that of the femur. - While any long bone fracture can theoretically cause a **fat embolism**, the risk is much lower for **supracondylar humerus fractures** due to the smaller amount of fatty marrow. *Lumbar vertebrae* - Vertebral fractures, particularly those in the lumbar region, are primarily associated with the release of **bone marrow cells** and potentially spinal cord injury, but not typically with significant **fat embolism syndrome**. - The **marrow in vertebrae** is predominantly hematopoietic and much less fatty compared to the large medullary cavities of long bones like the femur.

Q: Avascular necrosis may develop in the following fractures except

Fracture of the calcaneum. ***Fracture of the calcaneum*** - The **calcaneum** (heel bone) has a rich and robust blood supply from multiple arteries, making it highly resistant to avascular necrosis (AVN) even after significant fractures. - While calcaneal fractures can lead to other complications like **subtalar arthritis** or wound issues, AVN is exceedingly rare due to its excellent vascularity. *Fracture of the talus* - The **talus** has a precarious blood supply, primarily from branches off the dorsalis pedis artery, peroneal artery, and posterior tibial artery, which enter at specific non-articular areas. - Fractures, especially those involving the **talus neck**, can disrupt these vital vascular channels, frequently leading to **avascular necrosis** of the talar body. *Subcapital fracture of the femoral neck* - **Subcapital fractures** occur within the hip joint capsule and often disrupt the **retinacular arteries** (medial and lateral circumflex femoral arteries), which are the main blood supply to the femoral head. - This interruption of blood flow to the femoral head is a very common cause of **avascular necrosis**, particularly in displaced fractures. *Fracture of the scaphoid* - The **scaphoid bone** has a unique blood supply where arteries typically enter the distal pole and travel proximally. - A fracture, especially in the **waist** or **proximal pole**, can easily disrupt this retrograde blood flow, leading to a high incidence of **avascular necrosis** in the proximal fragment.

Q: What is the most common injury sustained due to fall on outstretched hand by a person aged 65 years?

Colles' fracture. ***Colles' fracture*** - A **Colles' fracture** is a common injury in older adults, particularly post-menopausal women, due to **osteoporosis** weakening the bones. - It involves a **distal radius fracture** with dorsal displacement of the distal fragment, occurring typically from a fall onto an **outstretched hand**. *Shoulder dislocation* - While shoulder dislocations can occur from falls, they are less common than wrist fractures in the elderly following a fall on an outstretched hand, especially given the prevalence of **osteoporosis**. - A shoulder dislocation typically involves the **humeral head** coming out of the glenoid fossa. *Fracture of metacarpals* - Metacarpal fractures can result from direct trauma to the hand or a fall, but they are generally less frequent than **distal radius fractures** in the elderly after a fall on an outstretched hand. - These fractures involve the bones within the hand itself and are often caused by **punching injuries** or direct impact. *Supracondylar fracture* - **Supracondylar fractures** are more common in children due to their bone structure and are typically associated with falls on an outstretched hand. - In adults, particularly the elderly, this type of fracture is much less common than a **Colles' fracture** following such a mechanism.

Q: An 18 year old boy had a closed lower limb injury while riding his motorbike. He was brought to hospital where on examination he had severe pain which increased on passive movement of affected limb with distal sensory disturbances. What is the probable diagnosis?

Compartment syndrome. ***Compartment syndrome*** - This diagnosis is strongly suggested by the presence of **severe pain out of proportion to injury**, pain with **passive stretch** of muscles, **paresthesia** (sensory disturbances), and a history of **closed lower limb injury**. These are classic signs of increased pressure within a confined fascial compartment. - The elevated pressure compromises **perfusion**, leading to muscle and nerve ischemia. Prompt recognition and treatment (fasciotomy) are crucial to prevent permanent damage. *Deep Vein thrombosis* - While DVT can cause lower limb pain and swelling, it is typically associated with **venous stasis**, endothelial injury, and hypercoagulability, not immediate severe pain with passive movement and sensory deficits following acute trauma. - The pain in DVT is usually described as a **dull ache** and not typically out of proportion to what would be expected, nor does it typically present with acute sensory loss without major vascular compromise. *Degloving Injury* - A degloving injury involves the **separation of skin and subcutaneous tissue** from deeper structures, often with significant visible skin avulsion. - While it can cause severe pain, the key diagnostic features in this scenario (closed injury, pain on passive movement, and distal sensory disturbances) are more classic for compartment syndrome rather than a primary external soft tissue avulsion. *High Pressure Injection injury* - This type of injury results from the **introduction of foreign material** under high pressure into tissues, often leading to rapid swelling, pain, and tissue necrosis. - It usually has a distinct history of exposure to high-pressure equipment (e.g., paint gun, grease gun), which is not mentioned here, and while severe, the precise constellation of symptoms points away from this specific mechanism.

Q: An 8 year old girl sustained a fall on the outstretched right hand 6 hours ago and was treated with egg albumen bandages by a village bone setter. She presented with gross swelling of the right elbow and forearm. The first essential intervention in this case would be to

completely remove all encircling bandages.. ***completely remove all encircling bandages.*** - An 8-year-old with a fall on an outstretched hand and gross swelling of the elbow and forearm points to a **supracondylar fracture of the humerus**, which can lead to **compartment syndrome**. - **Tight bandages** (like egg albumen) will exacerbate swelling, impede venous return, and compromise arterial inflow, making their immediate removal essential to prevent **ischemia** and potential **nerve damage**. *elevate the right hand.* - While elevation helps reduce swelling, it is **secondary** to relieving any constricting external pressure caused by the bandages, which are the more immediate threat. - Elevating a limb with compromised circulation due to external compression would be insufficient and could delay proper management. *immerse the hand in warm water to increase the circulation.* - Immersing an injured limb in warm water can **increase swelling** and potentially aggravate bleeding into the tissues, which is counterproductive in a situation with suspected compartment syndrome. - This intervention would **worsen the clinical picture** and is inappropriate for acute trauma with significant swelling. *order urgent radiographs of both elbows.* - While radiographs are crucial for diagnosing the underlying fracture, they are **not the first essential intervention** in a limb with gross swelling and potential vascular compromise from tight bandages. - Addressing the immediate threat of **compartment syndrome** and relieving external compression takes priority over diagnostic imaging.

Question 1

What type of fracture is shown in X-ray of left shoulder?

Accepted Answer

Ideberg classification grade 4

Answer

Neer classification grade 4

Answer

Garden classification grade 3

Answer

Schatzker classification grade 5

Question 2

Consider the following :

1. Pain relief
2. Prevention of infection
3. Anaesthesia
4. Restoration of anatomy Which of the features given above are priorities for fracture treatment?

Accepted Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 3

The commonest complication of fracture of clavicle is :

Accepted Answer

malunion

Answer

non union

Answer

avascular necrosis

Answer

Neurovascular injury

Question 4

The nerve most likely to get injured in patients with fracture of upper end of radius is :

Accepted Answer

Posterior interosseous

Answer

Ulnar

Answer

Median

Answer

Radial

Question 5

Which one of the following fractures is most often complicated by fat embolism ?

Accepted Answer

Shaft of femur

Answer

Shaft of tibia

Answer

Supra condyler humerus

Answer

Lumbar vertebrae

Question 6

Avascular necrosis may develop in the following fractures except

Accepted Answer

Fracture of the calcaneum

Answer

Fracture of the talus

Answer

Subcapital fracture of the femoral neck

Answer

Fracture of the scaphoid

Question 7

What is the most common injury sustained due to fall on outstretched hand by a person aged 65 years?

Accepted Answer

Colles' fracture

Answer

Shoulder dislocation

Answer

Fracture of metacarpals

Answer

Supracondylar fracture

Question 8

An 18 year old boy had a closed lower limb injury while riding his motorbike. He was brought to hospital where on examination he had severe pain which increased on passive movement of affected limb with distal sensory disturbances. What is the probable diagnosis?

Accepted Answer

Compartment syndrome

Answer

Deep Vein thrombosis

Answer

Degloving Injury

Answer

High Pressure Injection injury

Question 9

An 8 year old girl sustained a fall on the outstretched right hand 6 hours ago and was treated with egg albumen bandages by a village bone setter. She presented with gross swelling of the right elbow and forearm. The first essential intervention in this case would be to

Accepted Answer

completely remove all encircling bandages.

Answer

elevate the right hand.

Answer

immerse the hand in warm water to increase the circulation.

Answer

order urgent radiographs of both elbows.

Question 10

Which one of the following statements about Compartment Syndrome is NOT correct?

Accepted Answer

Pain is on active movement but not on passive movement of muscles

Answer

Fasciotomy is the treatment of choice

Answer

It is commonest in a closed fracture

Answer

Volkmann's Ischaemic contracture is a late complication

Trauma — MCQs

Trauma — MCQs

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