Trauma Practice Questions

Q: In anterior dislocation of the shoulder, which nerve is most commonly involved?

Axillary nerve. **Explanation:** **Why Axillary Nerve is the Correct Answer:** The axillary nerve (C5, C6) is the most frequently injured nerve in anterior shoulder dislocations due to its unique anatomical course. It winds around the **surgical neck of the humerus** within the quadrangular space. When the humeral head displaces anteriorly and inferiorly, it stretches or compresses the nerve against the neck of the humerus. Clinically, this manifests as: * **Motor loss:** Weakness in shoulder abduction (Deltoid paralysis). * **Sensory loss:** Numbness over the lateral aspect of the upper arm, known as the **"Regimental Badge area."** **Why Other Options are Incorrect:** * **Radial Nerve:** Typically injured in fractures of the **humeral shaft** (radial groove) or "Saturday Night Palsy," leading to wrist drop. * **Ulnar Nerve:** Most commonly injured at the **elbow** (medial epicondyle) or the wrist (Guyon’s canal). * **Median Nerve:** Usually involved in supracondylar fractures of the humerus (in children) or carpal tunnel syndrome. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common type of shoulder dislocation:** Anterior (95%). 2. **Most common nerve injured:** Axillary nerve (Neuropraxia is the most common type of injury, usually recovering spontaneously). 3. **Associated Vascular Injury:** The **Axillary artery** can be injured, especially in elderly patients with atherosclerotic vessels. 4. **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (seen in anterior dislocation). 5. **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. 6. **Kocher’s Method:** A classic (though now less preferred due to complications) maneuver for reduction.

Q: A child presented with a fall on an outstretched hand with the elbow in full extension. On examination there is pain and swelling over his right elbow. What is the probable diagnosis?

Supracondylar fracture of the humerus. ### Explanation **Correct Option: C. Supracondylar fracture of the humerus** **Mechanism and Concept:** Supracondylar fracture of the humerus is the most common elbow fracture in children (peak age 5–8 years). The classic mechanism is a **fall on an outstretched hand (FOOSH) with the elbow in extension**. In this position, the olecranon process is forced into the olecranon fossa, acting as a fulcrum that causes the thin supracondylar bone to snap. This results in an **extension-type** fracture (95% of cases), where the distal fragment is displaced posteriorly. **Analysis of Incorrect Options:** * **A. Fracture of the olecranon:** Rare in children; usually occurs due to a direct blow to the point of the elbow or a forceful contraction of the triceps. * **B. Posterior dislocation of the elbow:** While the mechanism (FOOSH) is similar, dislocations are much more common in **adults**. In children, the supracondylar area is physiologically weaker than the joint ligaments, making a fracture far more likely than a dislocation. * **D. Fracture of both bones of the forearm:** While FOOSH can cause forearm fractures, the clinical presentation specifically mentions pain and swelling **over the elbow**, pointing toward a periarticular injury. **NEET-PG High-Yield Pearls:** * **Clinical Sign:** On examination, the **three-point bony relationship** (medial epicondyle, lateral epicondyle, and olecranon) is **maintained** in supracondylar fractures but **disturbed** in elbow dislocations. * **Complications:** The most serious acute complication is injury to the **Brachial artery** or **Median nerve** (specifically the Anterior Interosseous Nerve). * **Late Sequel:** **Gunstock deformity** (Cubitus varus) is the most common late complication due to malunion. * **Emergency:** Always check the radial pulse to rule out **Volkmann’s Ischemic Contracture**.

Q: A female on steroids developed hip pain. Investigations show evidence of avascular necrosis of the head of the femur. What is the most common fracture site in this patient?

Subchondral region. **Explanation:** The correct answer is **C. Subchondral region.** **Pathophysiology & Mechanism:** The patient presents with **Avascular Necrosis (AVN)** of the femoral head, likely secondary to long-term steroid use. In AVN, the underlying pathology is the death of osteocytes due to compromised blood supply. As the necrotic bone fails to repair itself, it loses its structural integrity. The mechanical stress of weight-bearing leads to **microfractures** specifically in the **subchondral region** (the layer of bone just beneath the articular cartilage). Radiologically, this manifests as the **"Crescent Sign,"** which represents a subchondral fracture or separation of the cartilage from the necrotic bone. This is a hallmark of Ficat and Arlet Stage II/III AVN and precedes the eventual collapse of the femoral head. **Analysis of Incorrect Options:** * **A & B (Subcapital and Transcervical):** These are types of intracapsular femoral neck fractures. While they can *cause* AVN by disrupting the medial circumflex femoral artery, they are not the *result* of steroid-induced AVN. * **D (Trochanteric region):** This is an extracapsular site. Fractures here are typically related to osteoporosis in the elderly or high-energy trauma, not the localized ischemic necrosis seen in AVN. **Clinical Pearls for NEET-PG:** * **Most common cause of AVN:** Trauma (Fracture neck of femur). * **Most common non-traumatic cause:** Alcoholism and Steroid use. * **Earliest Investigation:** MRI (shows marrow edema; T1-weighted images show low signal intensity). * **Crescent Sign:** Pathognomonic for subchondral collapse in AVN (best seen on X-ray/CT). * **Treatment:** Core decompression is preferred in early stages (Ficat I & II) to reduce intraosseous pressure.

Q: Vascular injury is common in which fracture of the following?

Lower end of humerus. **Explanation:** The correct answer is **A. Lower end of humerus**. **1. Why it is correct:** Fractures of the lower end of the humerus, specifically **Supracondylar fractures (Extension type)**, are notorious for vascular complications. The proximal fracture fragment is displaced anteriorly, where it can easily impinge upon or lacerate the **Brachial Artery**. This injury can lead to arterial spasm or thrombosis, potentially resulting in **Volkmann’s Ischemic Contracture (VIC)**—a surgical emergency. **2. Analysis of incorrect options:** * **Lower end of radius (Colles’ fracture):** While common, it is more frequently associated with nerve injuries (Median nerve) or tendon ruptures (Extensor Pollicis Longus) rather than major vascular compromise. * **Upper end of femur:** These fractures (Neck of femur or Intertrochanteric) are associated with **Avascular Necrosis (AVN)** of the femoral head due to disruption of the retinacular vessels, but acute major limb-threatening vascular injury is rare compared to the humerus. * **Upper end of radius:** Fractures of the radial head or neck are more likely to cause restricted forearm rotation or injury to the **Posterior Interosseous Nerve (PIN)**. **3. Clinical Pearls for NEET-PG:** * **Most common vascular injury in Supracondylar fracture:** Brachial Artery. * **Most common nerve injury in Supracondylar fracture:** Median nerve (specifically the Anterior Interosseous Nerve/AIN). * **The "5 Ps" of Ischemia:** Pain (earliest sign), Pallor, Pulselessness, Paresthesia, and Paralysis. * **High-yield association:** Knee dislocation is the lower limb equivalent most commonly associated with vascular injury (**Popliteal Artery**).

Q: Fracture of the lateral condyle of the humerus is typically seen in which age group?

5-15 years. Fracture of the lateral condyle of the humerus is the **second most common elbow fracture** in children (after supracondylar fractures). **1. Why 5-15 years is correct:** This injury is primarily a pediatric fracture. The peak incidence occurs between **5 and 10 years of age**. During this period, the lateral condyle is largely cartilaginous and represents a weak point in the elbow's structural integrity. The mechanism usually involves a fall on an outstretched hand with the forearm in supination (pull-off injury by the extensor muscles) or a varus force (push-off injury by the radius) [1]. Because it involves the growth plate, it is classified as a **Salter-Harris Type IV injury** [1]. **2. Why other options are incorrect:** * **2-3 years:** While possible, the ossification center of the capitellum (which forms the lateral condyle) is just beginning to appear, and the mechanism of high-energy falls is less common in toddlers compared to school-aged children. * **15-25 years & 35-45 years:** In adolescents and adults, the growth plates have fused. Trauma to the elbow in these age groups more commonly results in radial head fractures, olecranon fractures, or elbow dislocations rather than isolated physeal condylar fractures. **Clinical Pearls for NEET-PG:** * **Milch Classification:** Used to categorize these fractures based on whether the fracture line passes lateral (Type I) or medial (Type II) to the trochlear groove. * **"The Fracture of Wise Men":** It is notoriously difficult to diagnose on X-ray because the fragment is often largely cartilaginous and appears smaller than it actually is [1]. * **Complications:** If missed or inadequately treated, it leads to **Non-union**, which causes **Cubitus Valgus** deformity. This deformity can result in delayed **Tardy Ulnar Nerve Palsy** years later.

Question 1

In anterior dislocation of the shoulder, which nerve is most commonly involved?

Accepted Answer

Axillary nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Median nerve

Question 2

If the head of the radius is removed, what deformity will result?

Accepted Answer

Valgus deformity

Answer

Lengthening of limb

Answer

Varus deformity

Answer

No deformity

Question 3

Fracture of the clavicle is commonest at which location?

Accepted Answer

Junction of the medial two-thirds and lateral third

Answer

Junction of the medial third and lateral two-thirds

Answer

Midpoint

Answer

Scapular end

Question 4

A patient develops Saturday Night Palsy after consuming alcohol and sleeping overnight with an arm in a dependent position. Which of the following best describes the clinical manifestations of this condition?

Accepted Answer

Neuropraxia

Answer

Axonotmesis

Answer

Neurotmesis

Answer

Necroptosis

Question 5

What is the treatment of choice for a fracture neck of humerus in a 70-year-old male?

Accepted Answer

Analgesic with an arm sling

Answer

U-slab

Answer

Arthroplasty

Answer

Open reduction and internal fixation

Question 6

A child presented with a fall on an outstretched hand with the elbow in full extension. On examination there is pain and swelling over his right elbow. What is the probable diagnosis?

Accepted Answer

Supracondylar fracture of the humerus

Answer

Fracture of the olecranon

Answer

Posterior dislocation of the elbow

Answer

Fracture of both bones of the forearm

Question 7

A female on steroids developed hip pain. Investigations show evidence of avascular necrosis of the head of the femur. What is the most common fracture site in this patient?

Accepted Answer

Subchondral region

Answer

Subcapital region

Answer

Transcervical region

Answer

Trochanteric region

Question 8

Kocher Langenbeck approach for emergency acetabular fixation is indicated in all of the following situations, EXCEPT:

Accepted Answer

Progressive sciatic nerve injury

Answer

Open fracture

Answer

Recurrent dislocation in spite of closed reduction and traction

Answer

Open irrigation and debridement of the hip joint

Question 9

Vascular injury is common in which fracture of the following?

Accepted Answer

Lower end of humerus

Answer

Lower end of radius

Answer

Upper end of femur

Answer

Upper end of radius

Question 10

Fracture of the lateral condyle of the humerus is typically seen in which age group?

Accepted Answer

5-15 years

Answer

2-3 years

Answer

15-25 years

Answer

35-45 years

Trauma — MCQs

Trauma — MCQs

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