Trauma Practice Questions

Q: All of the following are features of myositis ossificans except -

It matures from inside out. ***It matures from inside out*** - This statement is incorrect; **myositis ossificans** characteristically matures from the **outside in**, meaning the periphery ossifies first, creating a distinct radiologic appearance. - The mature bone is found at the periphery of the lesion, while the more immature, cellular components are centrally located. *Commonly occurs around the elbow* - Myositis ossificans is frequently observed around joints, with the **elbow** being one of the most common sites due to its vulnerability to trauma. - Other common locations include the **thigh** and **shoulder**. *Can be post traumatic or occur without trauma also* - While most commonly **post-traumatic**, myositis ossificans can also occur atraumatically, sometimes referred to as **myositis ossificans progressiva** or fibrodysplasia ossificans progressiva, a rare genetic disorder. - The traumatic form is often preceded by a significant contusion or muscle injury. *Massaging is a known associated factor* - **Aggressive massage** or manipulation following muscle trauma can exacerbate local tissue injury and enhance the conditions conducive to heterotopic ossification, including myositis ossificans. - This is why gentle management of muscle contusions is crucial to prevent its development.

Q: Maximum weight for skin traction -

4-5 kg. ***4-5 kg*** - The maximum effective and safe weight for **skin traction** in adults is generally considered to be 4.5-5 kg (approximately 10-11 lbs). - Exceeding this weight can cause **skin damage**, blistering, and neurovascular compromise due to excessive pressure and shearing forces. *1-2 kg* - While 1-2 kg may be used, it is often insufficient to achieve significant **reduction** or **stabilization of fractures** in adults, especially for limb traction. - This weight range might be appropriate for very **young children** or for very gentle, temporary traction. *15-20 kg* - This amount of weight is far too high for **skin traction** and would almost certainly lead to severe **skin breakdown**, pressure sores, and potentially neurovascular injury. - Weights in this range are typically reserved for **skeletal traction**, where the force is applied directly to the bone. *10-15 kg* - Similar to 15-20 kg, this weight range is too high for **skin traction** and carries a significant risk of **complications** such as skin necrosis, nerve damage, and vascular compromise. - It would be ineffective and harmful if not applied directly to the bone.

Q: Volkmann's ischaemic contracture due to external compression is commonly caused by

Tight plaster and tight splint. ***Tight plaster and tight splint*** - Both a **tight plaster cast** and a **tight splint** can cause Volkmann's ischaemic contracture by increasing pressure within the fascial compartments, leading to **compartment syndrome**. - This elevated pressure compromises **arterial inflow** and **venous outflow**, resulting in muscle and nerve ischaemia, which if prolonged, causes contracture. *Tight plaster* - While a **tight plaster** alone can contribute to Volkmann's ischaemic contracture, the combination with a **tight splint** is a more comprehensive answer for external compression. - A tight plaster applies circumferential pressure, which can restrict venous return and lead to swelling and increased intracompartmental pressure. *Supracondylar fractures* - **Supracondylar fractures** are a significant intrinsic cause of Volkmann's ischaemic contracture due to direct injury to the **brachial artery** or local swelling. - However, the question specifically asks for external compression causes, making a fracture an intrinsic rather than external factor. *Tight splint* - A **tight splint** can certainly cause Volkmann's ischaemic contracture by exerting external compression, leading to compromised blood flow. - However, when paired with a tight plaster, the risk of developing compartment syndrome leading to contracture is significantly higher due to compounded external pressure.

Q: All of the following can be the complications of a malunited Colles fracture except:

Rupture of flexor pollicis longus tendon. ***Rupture of flexor pollicis longus tendon*** - Malunion of a Colles fracture typically involves dorsal displacement of the distal radius, which can lead to friction and rupture of the **extensor pollicis longus (EPL)** tendon due to irritation over the dorsal bony prominence. - The **flexor pollicis longus (FPL)** tendon is on the palmar side of the wrist and is generally not at risk for rupture from a dorsally malunited Colles fracture. *Carpal instability* - **Malunion of a Colles fracture** can significantly alter the normal anatomy and mechanics of the radiocarpal joint, leading to **carpal instability**. - Changes in radial inclination, volar tilt, and radial length can disrupt load bearing and ligamentous integrity, predisposing to carpal collapse or dissociation. *Carpal tunnel syndrome* - Malunion can lead to **decreased carpal tunnel volume** and angulation of the carpal bones, increasing pressure on the **median nerve**. - This anatomical alteration can lead to symptoms of **carpal tunnel syndrome**, such as numbness, tingling, and pain in the median nerve distribution. *Reflex sympathetic dystrophy (RSD)* - Also known as **Complex Regional Pain Syndrome (CRPS) Type I**, RSD is a well-recognized complication following trauma or surgery to an extremity, including Colles fractures. - It presents with pain, swelling, *trophic skin changes*, and vasomotor dysfunction, and can be severely incapacitating.

Q: In major/unstable pelvic fractures with vascular injury, the amount of blood loss is around?

4-8 units. ***4-8 units*** - Unstable pelvic fractures with associated vascular injury are recognized sources of significant hemorrhage due to the rich vascular supply of the pelvis and the potential for **venous plexus disruption** and **arterial damage**. - This range represents a substantial blood loss that commonly requires **transfusion** and often aggressive hemostatic interventions. *2-4 units* - This amount of blood loss, while significant, is more typical of **isolated unstable pelvic fractures** without major vascular involvement. - While bleeding can be substantial, it often does not reach the higher threshold seen with direct vascular injuries. *1-4 units* - This range of blood loss is relatively less severe and might be seen in **stable or minimally displaced pelvic fractures**. - It does not accurately reflect the major hemorrhage expected in an **unstable pelvic fracture** complicated by vascular injury. *2-6 units* - This option presents an overlap with the more accurate range but still underestimates the potential severity of blood loss in a **major/unstable pelvic fracture** with established vascular injury. - The upper limit often falls short of the true extent of hemorrhage observed in such critical injuries.

Q: AVN of femoral head is most common in-

Intracapsular fracture neck of femur. ***Intracapsular fracture neck of femur*** - **Intracapsular fractures** disrupt the blood supply to the femoral head, particularly the **retinacular arteries**, leading to **avascular necrosis (AVN)**. - The femoral head receives most of its blood supply from within the capsule, making it highly susceptible to **ischemia** when these vessels are damaged. *Extracapsular fracture neck of femur* - These fractures occur **outside the joint capsule**, preserving the critical retinacular arterial blood supply to the femoral head. - While they can lead to other complications, **avascular necrosis** is rare because the blood flow to the femoral head is largely uninterrupted. *Fracture shaft humerus* - This type of fracture involves the **upper arm bone** and has no direct anatomical or vascular connection to the femoral head. - It does not interfere with the blood supply to the femoral head, and thus, **AVN of the femoral head** is not a complication. *Subtrochanteric fracture* - **Subtrochanteric fractures** occur in the proximal femur, but **below the trochanters** and outside the joint capsule. - Like extracapsular fractures, they typically do not compromise the **retinacular arteries** supplying the femoral head, making AVN an unlikely complication.

Q: Rupture of extensor pollicis longus occurs four weeks after:

Colles' fracture. **Colles' fracture** - **Extensor pollicis longus (EPL)** rupture is a known complication of Colles' fracture, often occurring several weeks after the injury. - The tendon can be damaged due to **attrition over a bony spicule** from the distal radius fracture or due to **ischemia** in its compartment. *Smith's fracture* - A Smith's fracture involves **volar displacement** of the distal radius fragment, while EPL rupture is more commonly associated with dorsal displacement. - While complications can occur, EPL rupture is less characteristic of Smith's fracture compared to Colles' fracture. *Scaphoid fracture* - A scaphoid fracture primarily affects the **carpal bone** and can lead to complications like **non-union** or **avascular necrosis**. - Rupture of the EPL tendon is not a typical direct complication of a scaphoid fracture. *Radial styloid fracture* - A radial styloid fracture involves only the **lateral aspect of the distal radius**. - Although it's a wrist fracture, it is less commonly associated with EPL rupture than a complete Colles' fracture which involves a more extensive injury to the distal radius.

Q: Recurrent dislocation is least common in

Knee. ***Knee*** - While knee dislocations are **severe injuries**, they are relatively **rare** in terms of recurrent dislocation compared to other joints listed. - The knee joint's strong ligamentous support and bony configuration make primary dislocation difficult, and recurrent dislocation usually implies significant underlying pathology or trauma. *Patella* - **Patellar dislocation** is quite common, especially in young active individuals, and has a high rate of recurrence due to factors like **patella alta** or **trochlear dysplasia**. - The **medial patellofemoral ligament (MPFL)** plays a crucial role in patellar stability, and its injury often leads to recurrent episodes. *Shoulder* - The **shoulder joint** is the **most commonly dislocated major joint** in the body, largely due to its wide range of motion and relatively shallow glenoid fossa. - Recurrent shoulder dislocations are frequent, particularly in younger patients, often necessitating surgical stabilization to prevent further episodes and progression to **osteoarthritis**. *Hip* - **Hip dislocations** are typically high-energy injuries and are generally **less common** than shoulder or patellar dislocations. - However, once a hip has dislocated, there is an increased risk of **recurrent instability**, especially in cases with associated labral tears or bony defects, though the absolute frequency remains lower than for the shoulder or patella.

Q: First-line treatment for non-displaced scaphoid fracture

Conservative. ***Conservative*** - Non-displaced scaphoid fractures are typically managed conservatively with **cast immobilization** due to the bone's precarious blood supply. - This approach aims for sufficient **healing without operative risks**, with a long casting period (often 6-12 weeks) to ensure union. *Compression Plating* - **Compression plating** is generally reserved for **complex or displaced scaphoid fractures** that require more robust fixation. - It is an **invasive surgical option** that carries risks beyond what is typically necessary for a non-displaced fracture. *Compression Screws* - **Compression screws** (e.g., Herbert screw) are used for **surgical fixation** of scaphoid fractures, particularly displaced or unstable types. - This method is more invasive than conservative management and involves risks like **avascular necrosis** or **non-union** if not properly performed. *Traction* - **Traction** is rarely used as a primary treatment for scaphoid fractures; its application is more common in **dislocations** or **certain complex fractures** to maintain alignment. - Applying traction to a scaphoid fracture could potentially exacerbate instability rather than promote union.

Question 1

All of the following are features of myositis ossificans except -

Accepted Answer

It matures from inside out

Answer

Commonly occurs around the elbow

Answer

Can be post traumatic or occur without trauma also

Answer

Massaging is a known associated factor

Question 2

Maximum weight for skin traction -

Accepted Answer

4-5 kg

Answer

1-2 kg

Answer

15-20 kg

Answer

10-15 kg

Question 3

Volkmann's ischaemic contracture due to external compression is commonly caused by

Accepted Answer

Tight plaster and tight splint

Answer

Tight plaster

Answer

Supracondylar fractures

Answer

Tight splint

Question 4

Which of the following is false regarding clavicle?

Accepted Answer

Non-union is the commonest complication of clavicle fractures

Answer

First bone to ossify

Answer

Membranous ossification

Answer

Fracture can be treated with figure of 8 bandage

Question 5

All of the following can be the complications of a malunited Colles fracture except:

Accepted Answer

Rupture of flexor pollicis longus tendon

Answer

Carpal instability

Answer

Carpal tunnel syndrome

Answer

Reflex sympathetic dystrophy (RSD)

Question 6

In major/unstable pelvic fractures with vascular injury, the amount of blood loss is around?

Accepted Answer

4-8 units

Answer

2-4 units

Answer

1-4 units

Answer

2-6 units

Question 7

AVN of femoral head is most common in-

Accepted Answer

Intracapsular fracture neck of femur

Answer

Extracapsular fracture neck of femur

Answer

Fracture shaft humerus

Answer

Subtrochanteric fracture

Question 8

Rupture of extensor pollicis longus occurs four weeks after:

Accepted Answer

Colles' fracture

Answer

Smith's fracture

Answer

Scaphoid fracture

Answer

Radial styloid fracture

Question 9

Recurrent dislocation is least common in

Accepted Answer

Knee

Answer

Patella

Answer

Shoulder

Answer

Hip

Question 10

First-line treatment for non-displaced scaphoid fracture

Accepted Answer

Conservative

Answer

Compression Plating

Answer

Compression Screws

Answer

Traction

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?