Trauma Practice Questions

Q: Most common muscle involved in Volkmann's ischemic contracture is

Flexor-digitorum profundus. ***Flexor-digitorum profundus*** - The **flexor digitorum profundus (FDP)** is the most commonly involved muscle in Volkmann's ischemic contracture due to its deep location and long course, making it highly susceptible to **ischemia** in the forearm compartment. - Its involvement leads to the characteristic **flexion deformities** of the digits at the interphalangeal joints. *Flexor-indicis* - The **flexor indicis** is not a formally recognized muscle, and while finger flexors are involved, the FDP is explicitly the most common. - This option likely refers to muscles that flex the index finger, but the primary pathology affects the entire FDP muscle group. *Flexor pollicis longus* - While the **flexor pollicis longus (FPL)** can be affected in Volkmann's contracture, it is not the *most common* muscle involved compared to the FDP. - The FPL is responsible for **thumb flexion**, and its involvement would manifest primarily in thumb deformities. *Abductor pollicis* - The **abductor pollicis** muscles (e.g., abductor pollicis longus, abductor pollicis brevis) are involved in **thumb abduction**, not flexion, and are typically less affected by the ischemia that causes Volkmann's contracture. - These muscles are generally located in different compartments or are more superficial, offering them some protection.

Q: Pathognomonic sign of traumatic fracture is

Crepitus. - ***Crepitus*** - Crepitus, the **grating or crunching sound** or sensation produced by the friction of bone fragments, is the most specific and **pathognomonic sign** of a fracture. - It occurs when the rough surfaces of bone ends rub against each other due to movement. - *Tenderness* - While **tenderness** is a common sign of a fracture, it is not pathognomonic, as it can occur with many other injuries, such as sprains or contusions. - **Localized pain** upon palpation is a general indicator of injury but lacks specificity for bone fracture. - *Redness* - **Redness (erythema)** is a sign of inflammation and can be present in various injuries or infections but is not typically a direct indicator of a traumatic fracture unless accompanied by significant soft tissue damage or infection. - It is a non-specific sign and doesn't confirm bone disruption. - *Swelling* - **Swelling (edema)** commonly accompanies fractures due to hematoma formation and inflammation but is also a general response to many types of injury and is not unique to fractures. - It indicates tissue damage but does not specifically differentiate a fracture from a sprain or severe contusion.

Q: Most common complication of Colles' fracture is:

Malunion. ***Malunion*** - **Malunion** is the most common complication of Colles' fracture, occurring when the fracture heals in a **deformed position**. - This typically results in residual **dorsal tilt**, **radial shortening**, and a **"dinner fork" deformity** of the wrist. *Gunstock deformity* - **Gunstock deformity** is an angular deformity of the elbow, usually associated with **supracondylar humeral fractures**, not Colles' fracture. - It results in the forearm deviating away from the body when the elbow is extended. *Non-union* - **Non-union** refers to the failure of a fracture to heal after a sufficient period, which is **rare** in distal radial fractures like Colles' fracture due to their excellent blood supply. - It typically requires surgical intervention and is not the most common complication. *Sudek's osteodystrophy* - **Sudek's osteodystrophy**, also known as **Complex Regional Pain Syndrome (CRPS) Type I**, is a less common but severe complication characterized by chronic pain, swelling, and changes in skin temperature/color. - While it can occur after Colles' fracture, its incidence is lower than malunion.

Q: Internal splints (fixation devices) are used in all except:

Compound fractures. ***Compound fractures*** - **Internal splints** are generally avoided in **compound (open)** fractures due to the increased risk of **infection** and the difficulties in maintaining sterility around the exposed hardware. - The primary management of compound fractures involves thorough **debridement**, irrigation, and often **external fixation** or plaster immobilization followed by delayed internal fixation once soft tissue conditions allow. *Fractures in elderly patients* - **Internal fixation** is often the preferred method for fractures in elderly patients, especially hip fractures, as it allows for **early mobilization**, reducing complications like pneumonia, bed sores, and DVT. - It stabilizes the fracture site, promoting comfort and facilitating a faster return to function. *Multiple fractures* - In cases of **multiple fractures (polytrauma)**, internal fixation is crucial for stabilizing different fracture sites, reducing pain, and allowing for comprehensive patient care and rehabilitation. - It helps manage systemic effects of trauma like **fat embolism** and allows earlier mobilization compared to external methods for multiple sites. *Fracture of neck of femur* - **Internal fixation** (e.g., cannulated screws, dynamic hip screw) or **arthroplasty** (hemiarthroplasty or total hip replacement) are the standard treatments for **femoral neck fractures**. - This approach aims to restore stability, allow for **early weight-bearing**, and prevent complications such as **avascular necrosis** and non-union.

Q: Hill-Sachs lesion is seen in?

Anterior dislocation of shoulder joint. ***Anterior dislocation of shoulder joint*** - A **Hill-Sachs lesion** is a **cortical depression** in the posterolateral head of the humerus. - It occurs when the humeral head impacts the **anterior glenoid rim** during an anterior shoulder dislocation. *Glenoid labrum tear* - A **glenoid labrum tear** refers to damage to the cartilage rim around the glenoid socket. - While it can coexist with dislocations and contribute to instability, it is not the direct site of a Hill-Sachs lesion. *Posterolateral humerus* - The **posterolateral humerus** is the specific location where the Hill-Sachs lesion occurs on the humeral head. - However, the lesion itself is *caused by* the anterior dislocation, not an independent finding listed this way. *Posterior dislocation of shoulder joint* - A **posterior shoulder dislocation** is typically associated with a **reverse Hill-Sachs lesion** (also known as a trough line fracture or medial humeral head compression fracture), which occurs on the anteromedial aspect of the humeral head. - The classic Hill-Sachs lesion is specific to anterior dislocations.

Q: Maximum shortening of lower limb is seen in:

intertrochanteric. ***intertrochanteric*** - **Intertrochanteric fractures** often lead to significant leg shortening due to the pull of strong hip muscles on the distal fragment, causing displacement and overriding. - The fracture location between the greater and lesser trochanters allows for considerable muscle-driven impaction and proximal migration of the shaft relative to the pelvis. *shaft femur* - **Femoral shaft fractures** can cause shortening, but the degree is often less severe than with intertrochanteric fractures because muscle spasm may be somewhat contained by the surrounding musculature. - While significant displacement can occur, the extensive muscle attachments around the shaft tend to stabilize it more in comparison to the rotational and upward pull seen in intertrochanteric fractures. *Neck femur* - **Femoral neck fractures** primarily cause pain and inability to bear weight, but they typically result in less significant leg shortening compared to intertrochanteric fractures. - Shortening in femoral neck fractures is often due to impaction or slight collapse, not the extensive overriding seen with intertrochanteric breaks. *Transcervical* - **Transcervical fractures** are a type of femoral neck fracture, and thus, they share similar characteristics where shortening is usually less pronounced and primarily due to impaction at the fracture site. - The shortening is often more subtle and related to the degree of collapse at the fracture margin rather than gross displacement of the entire shaft.

Q: The contraindication to internal fixation -

Active infection. ***Active infection*** - **Active infection** is a strong contraindication to internal fixation because introducing foreign material (implants) into an infected area can spread the infection, make it chronic, and lead to implant failure, osteomyelitis, or sepsis. - The presence of bacteria can colonize the implant surface, forming **biofilms** that are highly resistant to antibiotics and host immune responses, severely complicating treatment. *Fracture dislocation* - **Fracture dislocations** are often a strong *indication* for internal fixation to achieve anatomical reduction and stable fixation, allowing for early mobilization and preventing avascular necrosis or persistent instability. - The goal is to restore joint congruity and maintain reduction, which is difficult to achieve and maintain with non-operative methods. *Intraarticular fracture* - **Intraarticular fractures** are frequently *managed with* internal fixation to restore articular surface congruity, minimize post-traumatic arthritis, and allow for early range of motion. - Precise reduction and stable fixation are crucial to prevent long-term complications such as joint stiffness and osteoarthritis. *Physeal injury* - **Physeal injuries** (growth plate fractures) are often *treated with* surgical fixation, particularly unstable or displaced fractures, to ensure anatomical reduction and prevent growth disturbances. - The fixation technique must be chosen carefully to avoid damaging the physis itself, often using smooth pins or screws that do not cross the growth plate.

Q: Treatment of myositis ossificans includes all except -

Vigorous passive massage. ***Vigorous passive massage*** - **Vigorous passive massage** is contraindicated in myositis ossificans as it can exacerbate the condition by causing further trauma and promoting heterotopic bone formation. - The goal of treatment is to prevent progression and reduce inflammation, not to aggressively manipulate the affected area. *Splinting elbow* - **Splinting the elbow** in a functional position is a common treatment to help prevent contractures and allow the heterotopic bone to mature. - This immobilization can reduce microtrauma and facilitate healing in the acute phase. *Indometacin* - **Indomethacin**, a non-steroidal anti-inflammatory drug (NSAID), is often used to prevent and treat myositis ossificans. - It works by inhibiting prostaglandin synthesis, which is believed to play a role in the formation of heterotopic bone. *Gentle active movements* - **Gentle active movements** are generally encouraged once the acute inflammatory phase has subsided and the lesion begins to mature. - These movements help maintain range of motion and prevent stiffness without causing excessive trauma that could worsen the condition.

Q: Which of the following is the appropriate treatment for atrophic non-union?

Stabilization and bone grafting. ***Stabilization and bone grafting*** - Atrophic non-union is characterized by a **lack of biological activity** and an **absence of callus formation**, requiring both **biological stimulation** (bone graft) and **mechanical stability** (stabilization). - Bone grafting provides **osteogenic cells**, **osteoconductive scaffold**, and **osteoinductive growth factors** to promote healing, while stabilization ensures the fracture fragments remain in apposition. *External fixation* - While providing stability, external fixation alone does not address the **biological deficiency** inherent in atrophic non-union. - It's mainly used for **open fractures**, **comminuted fractures**, or when internal fixation is not feasible, often as a temporary measure. *Application of cast* - A cast provides some immobilization but is generally insufficient for non-union, especially atrophic types, due to its **limited stability** and inability to compress the fracture site effectively. - It also does not contribute to the **biological stimulation** needed for healing in atrophic non-unions. *Internal fixation* - Internal fixation provides stability, but in atrophic non-union, the primary issue is a **lack of healing potential**, not just instability. - Without a concomitant **bone graft**, internal fixation alone is unlikely to achieve union in atrophic non-unions.

Q: Which is not true regarding compartment syndrome?

Intracompartmental pressure studies are required. ***Intracompartmental pressure studies are required*** - While **intracompartmental pressure studies** can confirm the diagnosis, the cardinal symptoms of compartment syndrome, such as severe pain disproportionate to injury, pain on passive stretch, and tense swelling, often make the diagnosis clinically. - The decision to perform a **fasciotomy** is primarily based on clinical findings and the severity of symptoms, with pressure measurements serving as supportive evidence, especially in equivocal cases or in uncooperative patients. *Common in soft-tissue crush injury* - **Crush injuries** frequently lead to muscle swelling and hemorrhage within a confined fascial compartment, significantly increasing the risk of compartment syndrome. - The extensive tissue damage and subsequent inflammatory response contribute to a rapid rise in **intracompartmental pressure**. *Pain on passive stretch of the muscles is characteristic* - **Severe pain with passive stretching** of the muscles within the affected compartment is a highly sensitive and often the earliest reliable sign of compartment syndrome. - This pain arises from **ischemia** and pressure on nerve endings as the muscle is stretched. *Common in a closed fracture* - **Closed fractures** are a very common cause of compartment syndrome, particularly in the tibia and forearm, due to bleeding and swelling within the rigid fascial compartment. - The intact skin prevents external decompression, causing **pressure buildup internally** that can compromise blood flow to muscles and nerves.

Question 1

Most common muscle involved in Volkmann's ischemic contracture is

Accepted Answer

Flexor-digitorum profundus

Answer

Flexor-indicis

Answer

Flexor pollicis longus

Answer

Abductor pollicis

Question 2

Pathognomonic sign of traumatic fracture is

Accepted Answer

Crepitus

Answer

Tenderness

Answer

Redness

Answer

Swelling

Question 3

Most common complication of Colles' fracture is:

Accepted Answer

Malunion

Answer

Gunstock deformity

Answer

Non-union

Answer

Sudek's osteodystrophy

Question 4

Internal splints (fixation devices) are used in all except:

Accepted Answer

Compound fractures

Answer

Fractures in elderly patients

Answer

Multiple fractures

Answer

Fracture of neck of femur

Question 5

Hill-Sachs lesion is seen in?

Accepted Answer

Anterior dislocation of shoulder joint

Answer

Glenoid labrum tear

Answer

Posterolateral humerus

Answer

Posterior dislocation of shoulder joint

Question 6

Maximum shortening of lower limb is seen in:

Accepted Answer

intertrochanteric

Answer

shaft femur

Answer

Neck femur

Answer

Transcervical

Question 7

The contraindication to internal fixation -

Accepted Answer

Active infection

Answer

Fracture dislocation

Answer

Intraarticular fracture

Answer

Physeal injury

Question 8

Treatment of myositis ossificans includes all except -

Accepted Answer

Vigorous passive massage

Answer

Splinting elbow

Answer

Indometacin

Answer

Gentle active movements

Question 9

Which of the following is the appropriate treatment for atrophic non-union?

Accepted Answer

Stabilization and bone grafting

Answer

External fixation

Answer

Application of cast

Answer

Internal fixation

Question 10

Which is not true regarding compartment syndrome?

Accepted Answer

Intracompartmental pressure studies are required

Answer

Common in soft-tissue crush injury

Answer

Common in a closed fracture

Answer

Pain on passive stretch of the muscles is characteristic

Trauma — MCQs

Trauma — MCQs

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