Trauma Practice Questions

Q: Indications for fasciotomy in compartment syndrome include all EXCEPT:

Palpable distal pulses. ***Palpable distal pulses*** - The presence of **palpable distal pulses is NOT an indication for fasciotomy** and does not rule out compartment syndrome. - **Vascular compromise is a late sign** in compartment syndrome - pulses often remain palpable even with significant nerve and muscle ischemia. - Fasciotomy decisions should be based on **clinical signs** (pain, sensory changes) and **pressure measurements**, not the presence of pulses. - This is the correct answer because it is NOT an indication for the procedure. *Compartment pressure > 30 mm Hg* - **Absolute indication for fasciotomy** when compartment pressure exceeds 30 mmHg, or when the **delta pressure** (diastolic BP minus compartment pressure) is less than 30 mmHg. - This pressure level impairs capillary perfusion and leads to tissue ischemia. *Distal sensory disturbance* - **Early and reliable indication** for fasciotomy showing nerve ischemia. - Paresthesia or numbness in the distribution of nerves running through the affected compartment indicates neurological compromise from elevated intracompartmental pressure. *Pain on passive movement of affected muscles* - **Most sensitive and earliest clinical sign** of compartment syndrome (part of "the 6 P's"). - Pain on passive stretch is typically **out of proportion to the injury** and indicates underlying muscle ischemia. - This is a clear indication for fasciotomy.

Q: Identify the implant shown in the image:

Dynamic hip screw. ***Dynamic hip screw*** - The image shows a **lag screw** inserted into the femoral neck and head, which slides within a **side plate** attached to the femoral shaft with cortical screws. - This construct allows for controlled **dynamic collapse** and impaction at the fracture site, promoting healing and providing stable fixation for **extracapsular hip fractures**. *Cannulated hip screw* - Cannulated screws are typically used in a **parallel configuration** or as a single large screw for hip fractures, particularly **femoral neck fractures**. - They do not feature a **side plate** that extends down the femoral shaft for additional fixation. *Condylar hip screw* - A condylar hip screw (DCS) is used for **distal femur fractures**, often extending into the **condyles**. - It involves a different angulation and design compared to the proximal femoral implant seen, which is fixed to the femoral shaft. *Intramedullary nail* - An intramedullary nail is inserted into the **medullary canal** of the bone, running through its center. - While some hip nails (e.g., trochanteric nails) have a cephalic screw component, they primarily stabilize the shaft from within, unlike the **extracortical side plate** seen here.

Q: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

Posterior dislocation. **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question.

Q: What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Use Pelvic Binders. **Use Pelvic Binders** - **Pelvic binders** apply circumferential compression, which helps to stabilize the fracture and reduce the pelvic volume. - This mechanical stabilization significantly reduces ongoing hemorrhage from venous and bone surface bleeding in unstable pelvic fractures. *Rapid blood transfusion* - While critically important for managing **hemorrhagic shock**, blood transfusion alone does not address the source of ongoing bleeding. - It is a supportive measure, not an immediate means to stop the bleeding from an unstable pelvic fracture. *Internal definitive fixation* - **Internal definitive fixation** is a surgical procedure aimed at permanently stabilizing the fracture and would typically be performed after initial resuscitation and bleeding control. - It is not an immediate measure for **ongoing life-threatening hemorrhage** and carries procedural risks. *External fixation* - **External fixation** can stabilize an unstable pelvic fracture and helps in controlling bleeding, but applying a **pelvic binder** is a quicker and less invasive initial step. - External fixation is usually performed by a surgeon in a controlled environment, not as the very first immediate bedside measure to stop bleeding.

Q: A 40 year male patient presented to the ER with a history of fall and C/O pain and swelling in right shoulder region. The x-ray of the patients suggests tear in which of the following ligament?

Acromioclavicular ligament. ***Acromioclavicular ligament*** - A fall on an outstretched arm or direct trauma to the shoulder can cause an **acromioclavicular joint separation**, leading to a tear in the acromioclavicular ligament. - Pain and swelling in the right shoulder region are classic symptoms, and an X-ray can confirm the **widening of the AC joint space**. *Coracoacromial ligament* - This ligament forms the roof of the **subacromial space** and is rarely torn in isolation from trauma. - Tears are more commonly associated with **impingement syndrome** or **rotator cuff pathology**, not primarily with a traumatic fall leading to joint pain and swelling. *Coracoclavicular ligament* - While it helps stabilize the acromioclavicular joint, a tear of the **coracoclavicular ligament** is usually present in more severe acromioclavicular joint dislocations (Type III and above). - Its rupture would result in a more pronounced **superior displacement of the clavicle** compared to an isolated AC ligament tear. *Glenohumeral ligament* - These ligaments reinforce the **glenohumeral joint capsule** and are primarily involved in stabilizing the shoulder against dislocation. - A tear would typically present with symptoms of **shoulder instability** or a **dislocation**, rather than just pain and swelling from a fall focused on the AC joint.

Q: Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint

$3,5,6$. ***3,5,6*** - For **tibia traction** in a femoral shaft fracture, you would need a **Steinmann pin** for skeletal traction, a **Bohler's stirrup** to apply the traction force, and a **Bohler-Braun splint** to support the limb. - The **Steinmann pin** is inserted into the proximal tibia, the **Bohler's stirrup** attaches to the pin, and the **Bohler-Braun splint** provides a fixed structure for the traction system. *1,2,3,4,5,6* - This option incorrectly includes items not specifically used for applying **tibia traction** (e.g., K-wire is for internal fixation, Thomas splint is for early femur fracture management but not specifically for tibia traction application). - While some components might be used in general fracture management, not all are directly involved in setting up tibia traction as requested. *3,4,5* - This option correctly includes the **Steinmann pin** and **Bohler's stirrup** but incorrectly replaces the **Bohler-Braun splint** with a **Denham's pin**. - A **Denham's pin** is an alternative to a Steinmann pin for skeletal traction, but a **Bohler-Braun splint** is crucial for supporting the limb in this setup, which is missing here. *1,2,4* - This option includes a **Thomas splint** (used for femur fracture support, not tibia traction application), a **K-wire** (used for internal fixation, not traction), and a **Denham's pin** (an alternative to Steinmann pin, but lacks the necessary support and traction application equipment). - These items are not suitable for setting up comprehensive **tibia traction** for a femoral shaft fracture.

Q: Which of the following findings appear late in compartment syndrome?

Pulselessness. ***Pulselessness*** - **Pulselessness** is a very late and ominous sign in compartment syndrome, indicating severe arterial compromise that has progressed beyond simple venous and lymphatic outflow obstruction. - Its presence suggests **irreversible tissue damage** has likely already occurred due to prolonged ischemia. *Paralysis* - **Paralysis** is a late sign, indicating significant nerve ischemia and damage due to sustained pressure within the compartment. - While it's a serious finding, it typically appears before pulselessness, as nerves are sensitive to ischemia but arteries are more resistant to complete occlusion until very high pressures are reached. *Pain on passive stretch* - **Pain on passive stretch** is considered one of the earliest and most reliable clinical signs of early compartment syndrome. - It results from the stretching of ischemic muscle fibers within the confined compartment. *Pallor* - **Pallor** (skin paleness) is also a relatively late sign, occurring when capillary perfusion is significantly reduced due to rising intracompartmental pressure. - It usually manifests when the pressure is high enough to restrict blood flow but often precedes the complete absence of pulses.

Q: A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?

Anterior inferior glenohumeral ligament. ***Anterior inferior glenohumeral ligament*** - This ligament is a primary static stabilizer against **anterior dislocation** of the shoulder; thus, it is frequently stretched or torn during such an event. - Damage to this ligament is often associated with a **Bankart lesion**, which is an injury to the anterior inferior labrum that can lead to recurrent dislocations. *Long head of biceps tendon* - While the **long head of the biceps tendon** can be injured in shoulder trauma, it is more commonly associated with chronic overuse or superior labral tears (**SLAP lesions**), rather than primary anterior dislocation. - Injuries to this tendon might occur as a secondary complication but are not the most likely primary soft tissue damage in an acute anterior dislocation. *Acromioclavicular ligament* - The **acromioclavicular ligament** stabilizes the **acromioclavicular (AC) joint**, which is distinct from the glenohumeral joint. - Injuries to this ligament typically result from direct trauma to the top of the shoulder, causing AC joint separation, not glenohumeral dislocation. *Supraspinatus tendon* - The **supraspinatus tendon** is part of the rotator cuff and is most commonly injured in impingement syndrome or rotator cuff tears, which can result from falls but are not the primary structure damaged in an **anterior glenohumeral dislocation**. - Its role is mainly in abduction of the arm, and while it can be involved in large tears associated with advanced age, it is not the initial or most common structure to fail in this specific injury. *Coracoclavicular ligament* - The **coracoclavicular ligament** is composed of the conoid and trapezoid ligaments, which are crucial for the stability of the **acromioclavicular (AC) joint**. - Injury to this ligament is indicative of a more severe AC joint separation (usually **type III or higher**) and is not the primary structure damaged in a glenohumeral dislocation.

Q: Most common complication of extra capsular fracture of neck of femur is:

Non union. ***Non union*** - **Non-union** is a common complication in extracapsular femoral neck fractures due to the **disrupted blood supply** and mechanical forces across the fracture site. - The **fracture fragments** may fail to heal properly, leading to persistent pain, instability, and functional impairment. *Malunion* - **Malunion** occurs when the fracture heals in an **unacceptable anatomical position**, causing deformity or altered biomechanics. - While it can be a complication, **non-union** is generally more prevalent and problematic in extracapsular femoral neck fractures. *Ischemic necrosis* - **Ischemic necrosis** (or avascular necrosis) is less common in extracapsular femoral neck fractures compared to intracapsular fractures. - This is because the **extracapsular location** often spares the crucial blood supply to the femoral head, which is frequently compromised in intracapsular injuries. *Pulmonary complications* - **Pulmonary complications** (e.g., pneumonia, pulmonary embolism) are significant risks in elderly patients with hip fractures due to prolonged immobility and surgery. - However, direct fracture-related complications like **non-union** are distinct and represent issues specifically with bone healing.

Q: Which nerve is commonly damaged in fracture of neck of fibula?

Common peroneal. ***Common peroneal*** - The **common peroneal nerve** (also known as the **common fibular nerve**) wraps superficially around the **neck of the fibula**, making it highly vulnerable to injury in fractures of this region. - Damage to this nerve typically results in **foot drop** and sensory loss over the dorsum of the foot and lateral leg, due to impaired dorsiflexion and eversion. *Tibial* - The **tibial nerve** lies in the posterior compartment of the leg and is generally well-protected, making it less susceptible to injury from a fibular neck fracture. - Injury to the tibial nerve would primarily affect plantarflexion of the foot and sensation to the sole. *Superficial peroneal* - The **superficial peroneal nerve** is a branch of the common peroneal nerve that descends along the lateral compartment of the leg. - While it originates from the common peroneal, a direct fracture of the fibular neck is more likely to injure the main common peroneal trunk rather than just this specific branch, leading to a broader deficit. *Deep peroneal* - The **deep peroneal nerve** is another branch of the common peroneal nerve that runs through the anterior compartment of the leg. - Similar to the superficial peroneal nerve, a fracture at the fibular neck is more likely to affect the main **common peroneal nerve** directly.

Question 1

Indications for fasciotomy in compartment syndrome include all EXCEPT:

Accepted Answer

Palpable distal pulses

Answer

Compartment pressure > 30 mm Hg

Answer

Distal sensory disturbance

Answer

Pain on passive movement of affected muscles

Question 2

Identify the implant shown in the image:

Accepted Answer

Dynamic hip screw

Answer

Cannulated hip screw

Answer

Condylar hip screw

Answer

Intramedullary nail

Question 3

A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?

Accepted Answer

Posterior dislocation

Answer

Intertrochanteric fracture (IT fracture)

Answer

Transcervical fracture

Answer

Anterior dislocation

Question 4

What should be done as an immediate measure for ongoing bleeding in a patient with pelvic bone fracture?

Accepted Answer

Use Pelvic Binders

Answer

Rapid blood transfusion

Answer

External fixation

Answer

Internal definitive fixation

Question 5

A 40 year male patient presented to the ER with a history of fall and C/O pain and swelling in right shoulder region. The x-ray of the patients suggests tear in which of the following ligament?

Accepted Answer

Acromioclavicular ligament

Answer

Coracoacromial ligament

Answer

Coracoclavicular ligament

Answer

Glenohumeral ligament

Question 6

Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse?

1. Thomas splint
2. K-wire
3. Steinmann pin
4. Denham's pin
5. Bohler's stirrup
6. Bohler Braun splint

Accepted Answer

$3,5,6$

Answer

$1,2,3,4,5,6$

Answer

$3,4,5$

Answer

$1,2,4$

Question 7

Which of the following findings appear late in compartment syndrome?

Accepted Answer

Pulselessness

Answer

Paralysis

Answer

Pain on passive stretch

Answer

Pallor

Question 8

A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?

Accepted Answer

Anterior inferior glenohumeral ligament

Answer

Long head of biceps tendon

Answer

Acromioclavicular ligament

Answer

Supraspinatus tendon

Answer

Coracoclavicular ligament

Question 9

Most common complication of extra capsular fracture of neck of femur is:

Accepted Answer

Non union

Answer

Malunion

Answer

Ischemic necrosis

Answer

Pulmonary complications

Question 10

Which nerve is commonly damaged in fracture of neck of fibula?

Accepted Answer

Common peroneal

Answer

Tibial

Answer

Superficial peroneal

Answer

Deep peroneal

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?