Trauma Practice Questions

Q: A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Posterior dislocation. ***Posterior dislocation*** - An **electric shock** or **seizure** can cause strong muscle contractions, leading to a posterior shoulder dislocation. - Inability to perform **external rotation** and limited arm movement are classic signs of a posterior shoulder dislocation. *Clavicle fracture* - While a fall can cause a **clavicle fracture**, the primary symptoms would be pain over the clavicle and a visible deformity, not specifically limited external rotation or global arm immobility. - A clavicle fracture typically doesn't present with the specific inability to externally rotate the arm. *Luxation erecta* - **Luxatio erecta** is an inferior shoulder dislocation where the arm is held in an abducted and externally rotated position, pointing upwards, which is contrary to the described symptoms of inability to move the arm and external rotation. - It is a specific type of dislocation with a distinct presentation. *Anterior dislocation* - An **anterior dislocation** is the most common type of shoulder dislocation, but it usually presents with the arm held in slight abduction and external rotation, not an inability to externally rotate. - Typically results in a visible flattening of the deltoid contour and a prominent humeral head anteriorly.

Q: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Hemiahroplasty. ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.

Q: A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Axillary. ***Axillary*** - A fall forward onto the shoulder often results in an **anterior shoulder dislocation**, which commonly injures the **axillary nerve** due to its close proximity to the humeral head. - Injury to the axillary nerve would manifest as **deltoid muscle weakness** (impaired shoulder abduction) and **sensory loss over the lateral shoulder**. *Radial* - The radial nerve is more commonly injured in **midshaft humeral fractures** or compression injuries in the axilla (e.g., "crutch palsy"), not typically from a direct shoulder dislocation. - Radial nerve injury leads to **wrist drop** and difficulty extending the fingers and thumb. *Median* - The median nerve is generally protected in shoulder dislocations but can be affected by more severe trauma or **distal humeral fractures**, specifically around the elbow or wrist. - Injury to the median nerve affects **flexion of the wrist and fingers** and **thumb opposition**, along with sensory deficits in the first 3.5 digits. *Ulnar* - The ulnar nerve is most vulnerable at the **medial epicondyle of the humerus** (funny bone) or in compression injuries at the wrist (Guyon's canal). - Ulnar nerve injury results in **weakness of intrinsic hand muscles** (e.g., abducting/adducting fingers) and sensory loss to the little finger and half of the ring finger.

Q: In fracture of upper 1/3 of forearm, it is immobilized in:

Supination. ***Supination*** - In a fracture of the **proximal third of the forearm**, the **biceps brachii** and **supinator muscles**, which are still attached to the proximal fragment, will cause it to **supinate**. - To align the distal fragment with the proximal fragment and ensure proper healing, the forearm must be immobilized in **full supination**. *Pronation* - **Pronation** would cause malalignment of the fracture fragments, as the proximal fragment would remain supinated while the distal fragment is pronated. - This position is only used for fractures of the **distal third of the forearm** where the **pronator quadratus** and **pronator teres** dominate. *Any position* - Immobilizing in **any position** would risk **malunion** or nonunion due to the unopposed muscle forces acting on the proximal and distal fragments. - Correct anatomical alignment is crucial for restoring function and preventing long-term complications. *Mid prone* - The **mid-prone** position is typically used for fractures of the **middle third of the forearm**, where the pronator and supinator muscle forces are more balanced. - In a proximal third fracture, the stronger supinator muscles would still pull the proximal fragment into supination, causing misalignment in the mid-prone position.

Q: A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Fat embolism. ***Fat embolism*** - A **femur fracture** significantly increases the risk of **fat embolism**, where fat globules from the bone marrow enter the bloodstream and lodge in the pulmonary capillaries. - The classic triad of **fat embolism syndrome** includes respiratory distress, neurological symptoms, and a petechial rash, but respiratory symptoms (pulmonary infiltration and distress) are usually the first to appear. *Obstruction* - While an obstruction could cause respiratory distress, it typically wouldn't be associated with diffuse **pulmonary infiltrates** following a long bone fracture. - **Airway obstruction** would present with stridor or wheezing, and is usually localized rather than systemic. *Pulmonary embolism* - A **pulmonary embolism** (PE) can cause respiratory distress and infiltrates, but given the context of a recent femur fracture, fat embolism is a more specific and likely diagnosis. - PE is usually due to a **venous thromboembolism** and can be suspected in immobilized patients, but the question points more strongly to fat release. *Air embolism* - **Air embolism** usually results from iatrogenic causes (e.g., central line insertion, surgery) or trauma to large veins, allowing a significant amount of air into the circulation. - While it can cause respiratory distress, it doesn't typically cause the diffuse **pulmonary infiltrates** described, which are characteristic of fat embolism.

Q: Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Colles fracture. ***Colles fracture*** - This fracture commonly occurs in **post-menopausal women** due to **osteoporosis** and typically results from a fall onto an **outstretched hand**. - It involves a **distal radius fracture** with **dorsal displacement** and often radial angulation. *Smith fracture* - A Smith fracture involves a **distal radius fracture** with **volar displacement**, usually caused by a fall onto the back of the hand. - While it can occur in post-menopausal women, it is less common than a Colles fracture in such a scenario. *Monteggia's fracture* - This fracture involves a **fracture of the ulna** with **dislocation of the radial head**. - It usually results from a direct blow to the forearm or a fall with extreme pronation, which is less typical for a simple fall in a post-menopausal woman. *Galeazzi fracture* - A Galeazzi fracture involves a **fracture of the radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This injury is less common and typically results from a fall onto an outstretched hand with the forearm in pronation, and it is not the most common fracture in this demographic.

Q: Lauge - Hansen classification belongs to:-

Ankle fracture. ***Ankle fracture*** - The **Lauge-Hansen classification system** is specifically used to categorize **ankle fractures** based on the position of the foot at the time of injury and the deforming force. - This system describes the mechanism of injury (e.g., supination-adduction, pronation-abduction) and the resulting fracture patterns of the **distal fibula, medial malleolus, and posterior malleolus**. *Femur fracture* - **Femur fractures** are typically classified by other systems, such as the **AO/OTA classification** for long bone fractures or specific patterns like **intertrochanteric** or **subtrochanteric fractures**. - The Lauge-Hansen system is **not applicable** to injuries of the femur. *Shoulder fracture* - **Shoulder fractures** (e.g., proximal humerus fractures) are commonly classified using systems like the **Neer classification**, which describes the number of displaced parts. - The Lauge-Hansen system is **not used** for classifying shoulder injuries. *Elbow fracture* - **Elbow fractures** involve the distal humerus, proximal ulna, or radial head and are classified by various systems depending on the specific bone involved (e.g., **Mason classification for radial head fractures**). - The Lauge-Hansen system is **irrelevant** to elbow an injuries.

Q: Posterior interosseous nerve is injured in

Monteggia fracture dislocation. ***Monteggia fracture dislocation*** - A Monteggia fracture dislocation involves a fracture of the **proximal ulna** with **dislocation of the radial head**. - The **posterior interosseous nerve (PIN)**, a deep branch of the radial nerve, is particularly vulnerable to injury due to its close proximity to the radial head and the forces involved in this type of injury, leading to **wrist drop** and **finger extensor weakness**. *Reversed monteggia fracture dislocation* - This is an older term sometimes used to describe a **Galeazzi fracture**, which is a fracture of the **distal radius** with dislocation of the **distal radioulnar joint**. - While other nerves might be at risk, the PIN is less commonly injured in a typical Galeazzi fracture compared to a Monteggia injury. *Supracondylar fracture of humerus* - Supracondylar fractures are common in children and involve the **distal humerus**. - The most commonly injured nerves are the **median nerve** and **anterior interosseous nerve**, and sometimes the ulnar nerve, but not typically the posterior interosseous nerve. *Posterior dislocation of elbow* - A posterior dislocation of the elbow involves displacement of the ulna and radius posteriorly in relation to the humerus. - While nerve injuries can occur, the **ulnar nerve** is most frequently affected due to its superficial position behind the medial epicondyle, with the PIN being less commonly affected in an isolated posterior dislocation.

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Femur fracture with soft tissue injury. ***Femur fracture with soft tissue injury*** - A **femur fracture** can lead to significant internal bleeding due to the large size of the bone and the surrounding highly vascular muscle tissue, potentially causing **1-2 liters of blood loss**. - When combined with **soft tissue injury**, the risk of **exsanguinating hemorrhage** is greatly increased as vessels are directly damaged and hemorrhage is less contained. *Humerus fracture without soft tissue injury* - While a **humerus fracture** can cause bleeding, the blood loss is generally contained within the muscle and fascia, and is typically not as severe, usually around **0.5-1 liter**. - Without significant **soft tissue injury**, major vascular disruption leading to exsanguination is less likely. *Humerus fracture with soft tissue injury* - A **humerus fracture** with **soft tissue injury** does increase the potential for blood loss compared to a simple fracture, but the total volume of potential hemorrhage in the upper arm is still significantly less than in the thigh. - The risk of **exsanguination** is lower due to the smaller size of the limb and less extensive surrounding musculature. *Tibia fracture without soft tissue injury* - A **tibia fracture** can result in moderate blood loss, typically **0.5-1.5 liters**, especially if the bone is comminuted. - However, without **soft tissue injury**, the blood often extravasates into the relatively confined fascial compartments of the lower leg, limiting immediate massive external or uncontrolled internal bleeding.

Q: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

Stable closed fracture. ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.

Question 1

A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Accepted Answer

Posterior dislocation

Answer

Clavicle fracture

Answer

Luxation erecta

Answer

Anterior dislocation

Question 2

79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Accepted Answer

Hemiahroplasty

Answer

Hip spica

Answer

Nailing

Answer

Total Hip Replacement

Question 3

A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Accepted Answer

Axillary

Answer

Radial

Answer

Median

Answer

Ulnar

Question 4

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 5

A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Obstruction

Answer

Pulmonary embolism

Answer

Air embolism

Question 6

Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Accepted Answer

Colles fracture

Answer

Smith fracture

Answer

Monteggia's fracture

Answer

Galeazzi fracture

Question 7

Lauge - Hansen classification belongs to:-

Accepted Answer

Ankle fracture

Answer

Femur fracture

Answer

Shoulder fracture

Answer

Elbow fracture

Question 8

Posterior interosseous nerve is injured in

Accepted Answer

Monteggia fracture dislocation

Answer

Reversed monteggia fracture dislocation

Answer

Supracondylar fracture of humerus

Answer

Posterior dislocation of elbow

Question 9

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Femur fracture with soft tissue injury

Answer

Humerus fracture without soft tissue injury

Answer

Humerus fracture with soft tissue injury

Answer

Tibia fracture without soft tissue injury

Question 10

All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

Accepted Answer

Stable closed fracture

Answer

Multiple trauma

Answer

Compound fracture

Answer

Intra-articular fracture

Trauma — MCQs

Trauma — MCQs

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