Trauma Practice Questions

Q: A "Jumper's fracture" is a common term for a fracture of which of the following bones?

Pelvis. **Explanation:** A **Jumper’s Fracture** refers specifically to a **transverse fracture of the sacrum** (usually at the S1 or S2 level). It is a high-energy injury typically caused by a vertical fall from a significant height where the patient lands on their feet. The axial loading force is transmitted through the spine, causing the sacrum to buckle or fracture transversely, often resulting in "spinopelvic dissociation." **Analysis of Options:** * **Option C (Pelvis): Correct.** The sacrum is anatomically part of the posterior pelvic ring. Therefore, a sacral fracture is classified as a pelvic fracture. * **Option A (Calcaneus):** While the calcaneus is the most common bone fractured in a fall from height (often called a "Lover’s fracture" or "Don Juan fracture"), it is not the "Jumper’s fracture." * **Option B (Tibia):** Falls from height can cause tibial pilon fractures or tibial plateau fractures, but these carry specific anatomical names. * **Option D (Femoral neck):** These are common in elderly patients due to low-energy trauma (trips) or in young patients due to high-energy trauma, but are not associated with this specific eponym. **Clinical Pearls for NEET-PG:** 1. **Associated Injuries:** Always look for **L5 nerve root injury** or cauda equina syndrome in Jumper’s fractures due to the proximity of the sacral foramina. 2. **Don Juan Syndrome:** A clinical triad seen in jumpers consisting of bilateral calcaneal fractures, lower limb fractures, and thoracolumbar compression fractures (Chance fractures). 3. **Radiology:** Jumper's fractures are often missed on routine AP pelvic X-rays; a **lateral view of the sacrum** or a CT scan is the gold standard for diagnosis.

Q: Posterior dislocation of the hip is characterized by which of the following findings?

Marked shortening of the limb. **Explanation:** Posterior dislocation of the hip is the most common type of hip dislocation (approx. 90%), typically resulting from a high-energy "dashboard injury" where a force is applied to the knee while the hip is flexed. **1. Why "Marked shortening of the limb" is correct:** In a posterior dislocation, the femoral head is forced out of the acetabulum and driven superiorly and posteriorly onto the ilium. This superior displacement of the femoral head relative to the acetabulum results in significant **true shortening** of the affected limb. **2. Analysis of Incorrect Options:** * **B & C (Lengthening/No change):** These are incorrect because the femoral head does not remain at the level of the acetabulum. **Lengthening** is a classic feature of **Anterior Dislocation** (specifically the obturator type), where the head sits lower than the acetabulum. * **D (Extension deformity):** Posterior dislocation is characterized by a **Flexion** deformity. The classic clinical posture is **FADIR**: **F**lexion, **Ad**duction, and **I**nternal **R**otation. Extension is seen in anterior dislocations. **NEET-PG High-Yield Pearls:** * **Clinical Attitude:** * *Posterior Dislocation:* Flexion, Adduction, Internal Rotation (FADIR). * *Anterior Dislocation:* Flexion, Abduction, External Rotation (FABER). * **Most Common Nerve Injury:** Sciatic nerve (specifically the peroneal division) is involved in ~10% of posterior dislocations. * **Radiology:** On AP view, the femoral head appears smaller than the contralateral side (due to being closer to the film/posterior). Shenton’s line is broken. * **Management:** It is an **orthopaedic emergency**. Reduction should be performed within 6 hours to minimize the risk of **Avascular Necrosis (AVN)** of the femoral head. Common reduction techniques include Allis, Stimson, and Bigelow methods.

Q: What does the Hawkin sign denote?

Retained vascularity. **Explanation:** The **Hawkins sign** is a radiologic indicator used to assess the viability of the talar body following a fracture of the **talar neck**. It is typically seen on an anteroposterior (AP) radiograph of the ankle approximately **6 to 8 weeks** post-injury. 1. **Why "Retained Vascularity" is correct:** The sign appears as a subchondral radiolucent (dark) line in the dome of the talus. This radiolucency represents **disuse osteopenia**. For bone resorption (osteopenia) to occur, there must be an active blood supply to the bone. Therefore, the presence of this subchondral lucency indicates that the bone is vascularized and is undergoing normal remodeling, effectively ruling out Avascular Necrosis (AVN). 2. **Why other options are incorrect:** * **Avascular Necrosis (AVN):** The *absence* of the Hawkins sign (where the talar dome remains sclerotic or dense) suggests AVN, as dead bone cannot undergo resorption. * **Non-union:** This refers to the failure of the fracture fragments to heal, which is a different complication unrelated to the subchondral lucency of the talar dome. * **Decreased vascularity:** The sign specifically denotes sufficient blood flow to allow for metabolic bone activity; decreased vascularity would result in a lack of radiolucency. **Clinical Pearls for NEET-PG:** * **Hawkins Classification:** Used for talar neck fractures (Type I to IV). The risk of AVN increases with the type (Type I: 0-15%, Type IV: ~100%). * **Sensitivity:** Hawkins sign is a highly sensitive indicator of talar viability. * **Blood Supply of Talus:** Primarily from the **Artery of the Tarsal Canal** (branch of Posterior Tibial Artery). The talus is prone to AVN because 60% of its surface is covered by articular cartilage, limiting the areas for vascular entry (retrograde blood supply).

Q: Which of the following is/are not included in the management of an intra-articular fracture?

None of the above. ### Explanation The primary goal in managing an **intra-articular fracture** is to achieve anatomical reduction and stable internal fixation to restore joint congruity and allow early range of motion. However, management strategies vary depending on the severity, joint involved, and patient factors. **Why "None of the above" is correct:** All three options (A, B, and C) are recognized components of managing intra-articular injuries under specific clinical circumstances. Therefore, none of them can be excluded from the potential management spectrum. * **Aspiration (Option C):** This is often the immediate step in managing a tense **haemarthrosis** (blood in the joint) associated with a fracture. It relieves pain, reduces pressure, and aids in diagnosis (e.g., seeing fat globules/lipohemarthrosis indicates an intra-articular fracture). * **Excision (Option B):** In certain joints where the fragment is small, comminuted, or non-essential for stability, excision is preferred. A classic example is the **excision of the radial head** in Mason Type III fractures or excision of a comminuted patella (pole excision). * **Arthrodesis (Option A):** While usually a salvage procedure, primary or delayed arthrodesis (joint fusion) is a management option for severely comminuted intra-articular fractures where reconstruction is impossible, particularly in the weight-bearing joints of the foot (e.g., **Calcaneal fractures** or Lisfranc injuries). ### High-Yield Clinical Pearls for NEET-PG: * **Lipohemarthrosis:** The presence of fat droplets in aspirated joint fluid is pathognomonic for an intra-articular fracture (fat escapes from the bone marrow). * **AO Principles:** The gold standard for intra-articular fractures is **Absolute Stability** (Anatomical reduction + Compression). * **Complications:** The most common long-term complication of an intra-articular fracture is **Secondary Osteoarthritis** due to joint surface irregularity.

Q: What is the most common type of shoulder dislocation that leads to axillary nerve injury?

Anterior dislocation. **Explanation:** **1. Why Anterior Dislocation is Correct:** Anterior shoulder dislocation is the most common type of shoulder dislocation (accounting for >95% of cases). Due to the anatomical proximity of the **axillary nerve** as it winds around the surgical neck of the humerus, it is highly susceptible to traction or compression injury during the humeral head's displacement. The axillary nerve is the most frequently injured nerve in this condition, occurring in approximately 5–15% of cases. **2. Analysis of Incorrect Options:** * **B. Posterior Dislocation:** This is much rarer (2–5%) and is typically associated with seizures or electric shocks. While it can cause nerve injury, it is statistically less likely to result in axillary nerve damage compared to the sheer volume of anterior dislocations. * **C. Recurrent Instability:** While chronic instability can lead to microtrauma, acute axillary nerve palsy is a hallmark of an acute traumatic event rather than the state of chronic laxity itself. * **D. Inferior Dislocation (Luxatio Erecta):** This is the rarest form of dislocation. Although it has the *highest percentage risk* of neurovascular injury (including the brachial plexus and axillary artery) per case, it is not the "most common type" to lead to these injuries because the incidence of the dislocation itself is extremely low. **3. Clinical Pearls for NEET-PG:** * **Regimental Badge Sign:** Loss of sensation over the lateral aspect of the deltoid indicates axillary nerve palsy. * **Motor Deficit:** Weakness in shoulder abduction (Deltoid) and external rotation (Teres minor). * **Most common mechanism:** Forced abduction, extension, and external rotation. * **Associated Injury:** Always look for a **Hill-Sachs lesion** (compression fracture of the posterolateral humeral head) and a **Bankart lesion** (avulsion of the anteroinferior labrum) in anterior dislocations.

Question 1

A "Jumper's fracture" is a common term for a fracture of which of the following bones?

Accepted Answer

Pelvis

Answer

Calcaneus

Answer

Tibia

Answer

Femoral neck

Question 2

Posterior dislocation of the hip is characterized by which of the following findings?

Accepted Answer

Marked shortening of the limb

Answer

Lengthening of the limb

Answer

No change in limb length

Answer

Extension deformity

Question 3

What does the Hawkin sign denote?

Accepted Answer

Retained vascularity

Answer

Non-union

Answer

Decreased vascularity

Answer

Avascular necrosis

Question 4

A patient presents with a history of trauma and X-ray findings of a fracture of the proximal medial bone of the forearm with dislocation. Which muscles may become paralyzed?

Accepted Answer

Extensor pollicis longus

Answer

Flexor carpi ulnaris

Answer

Adductor pollicis

Answer

Opponens pollicis

Question 5

An 88-year-old woman with a history of osteoporosis presents after a fall with pain and deformity in her left wrist, lower back tenderness, and a left lower extremity that is shortened and externally rotated. Radiographs reveal a distal radius fracture, a T12 vertebral compression fracture, and a left femur fracture. What is the basic abnormality affecting this patient's bones?

Accepted Answer

Reduction in bone mass with normal bone mineralization

Answer

Abnormal collagen synthesis and failure of crosslinking

Answer

Abnormal collagen synthesis with normal crosslinking

Answer

Reduction in bone formation with defective bone mineralization

Question 6

Traumatic glenohumeral instability with a Bankart lesion is treated by which of the following methods?

Accepted Answer

Surgery

Answer

Conservative methods

Answer

Rehabilitation

Answer

Observation followed by inferior capsule shift

Question 7

Which of the following is/are not included in the management of an intra-articular fracture?

Accepted Answer

None of the above

Answer

Arthrodesis

Answer

Excision

Answer

Aspiration

Question 8

Variants of Monteggia fracture include all except?

Accepted Answer

Fracture of ulnar shaft and radial shaft

Answer

Isolated dislocation of radial head

Answer

Fracture of ulnar shaft and neck of radius

Answer

Fracture of ulnar head

Question 9

What is the most common type of shoulder dislocation that leads to axillary nerve injury?

Accepted Answer

Anterior dislocation

Answer

Posterior dislocation

Answer

Recurrent instability

Answer

Inferior dislocation

Question 10

Which of the following are true about fat embolism?

Accepted Answer

Petechiae

Answer

Seen one week after injury

Answer

Bradycardia

Answer

Tachycardia

Trauma — MCQs

Trauma — MCQs

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