Trauma — MCQs
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A "Jumper's fracture" is a common term for a fracture of which of the following bones?
Posterior dislocation of the hip is characterized by which of the following findings?
What does the Hawkin sign denote?
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?
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?
Traumatic glenohumeral instability with a Bankart lesion is treated by which of the following methods?
Which of the following is/are not included in the management of an intra-articular fracture?
Variants of Monteggia fracture include all except?
What is the most common type of shoulder dislocation that leads to axillary nerve injury?
Which of the following are true about fat embolism?
Trauma Indian Medical PG Practice Questions and MCQs
Question 531: A "Jumper's fracture" is a common term for a fracture of which of the following bones?
- A. Calcaneus
- B. Tibia
- C. Pelvis (Correct Answer)
- D. Femoral neck
Explanation: **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.
Question 532: Posterior dislocation of the hip is characterized by which of the following findings?
- A. Marked shortening of the limb (Correct Answer)
- B. Lengthening of the limb
- C. No change in limb length
- D. Extension deformity
Explanation: **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.
Question 533: What does the Hawkin sign denote?
- A. Retained vascularity (Correct Answer)
- B. Non-union
- C. Decreased vascularity
- D. Avascular necrosis
Explanation: **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).
Question 534: 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?
- A. Flexor carpi ulnaris
- B. Adductor pollicis
- C. Extensor pollicis longus (Correct Answer)
- D. Opponens pollicis
Explanation: ### Explanation **1. Understanding the Injury (Monteggia Fracture-Dislocation)** The question describes a fracture of the **proximal medial bone of the forearm** (Ulna) associated with a **dislocation** (Radial head). This classic injury pattern is known as a **Monteggia Fracture-Dislocation**. **2. Why Extensor Pollicis Longus (EPL) is the Correct Answer** The most common nerve complication associated with a Monteggia fracture (specifically the extension type) is injury to the **Posterior Interosseous Nerve (PIN)**, which is a deep branch of the Radial nerve. The PIN can be stretched or compressed as it passes near the dislocated radial head or through the supinator muscle (Arcade of Frohse). * The PIN supplies the extensors of the forearm. * **Extensor Pollicis Longus (EPL)** is supplied by the PIN. Therefore, PIN palsy leads to the inability to extend the thumb at the interphalangeal joint. **3. Analysis of Incorrect Options** * **Flexor Carpi Ulnaris (A):** Supplied by the **Ulnar nerve**. While the ulna is fractured, the ulnar nerve is rarely involved in proximal Monteggia injuries compared to the PIN. * **Adductor Pollicis (B):** Supplied by the **Deep branch of the Ulnar nerve**. This muscle is located in the hand and would be affected by distal ulnar nerve lesions, not proximal forearm trauma. * **Opponens Pollicis (C):** Supplied by the **Recurrent branch of the Median nerve**. It is involved in carpal tunnel syndrome or distal median nerve injuries, not radial side nerve pathology. **4. High-Yield Clinical Pearls for NEET-PG** * **Monteggia Fracture:** Proximal 1/3rd Ulna fracture + Radial head dislocation. * **Galeazzi Fracture:** Distal 1/3rd Radius fracture + Distal Radio-ulnar joint (DRUJ) dislocation. (Mnemonic: **MU**-**GR**; **M**onteggia-**U**lna, **G**aleazzi-**R**adius). * **PIN Palsy Sign:** "Finger drop" without "Wrist drop" (because Extensor Carpi Radialis Longus is spared as it is supplied by the main Radial nerve before it bifurcates). * **Management:** Most PIN injuries in Monteggia fractures are neuropraxias and are managed expectantly as they usually resolve after closed or open reduction of the dislocation.
Question 535: 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?
- A. Abnormal collagen synthesis and failure of crosslinking
- B. Abnormal collagen synthesis with normal crosslinking
- C. Reduction in bone formation with defective bone mineralization
- D. Reduction in bone mass with normal bone mineralization (Correct Answer)
Explanation: ### Explanation The patient presents with a classic triad of osteoporotic fractures: **Colles’ fracture** (distal radius), **vertebral compression fracture**, and **neck of femur fracture**. Given her age (88) and history, the underlying diagnosis is **Osteoporosis**. #### 1. Why the Correct Answer is Right **Osteoporosis** is characterized by a **reduction in total bone mass** (both mineral and matrix) but the **mineral-to-matrix ratio remains normal**. The bone that remains is chemically normal and adequately mineralized, but there is simply "less of it," leading to decreased structural integrity and increased fragility. This is why Option D is correct. #### 2. Why Incorrect Options are Wrong * **Options A & B:** These describe **Osteogenesis Imperfecta (OI)**. OI involves a genetic defect in Type 1 collagen synthesis. While it leads to fractures, it is typically a pediatric presentation and involves qualitative defects in the bone matrix rather than a simple reduction in mass. * **Option C:** This describes **Osteomalacia** (in adults) or **Rickets** (in children). In these conditions, the bone matrix (osteoid) is produced normally, but there is a failure of mineralization (usually due to Vitamin D deficiency). This results in "soft" bones, not just "thin" bones. #### 3. Clinical Pearls for NEET-PG * **Definition:** Osteoporosis = Normal quality, Decreased quantity. Osteomalacia = Decreased quality (mineralization). * **Diagnosis:** The gold standard is **DEXA Scan**. A **T-score ≤ -2.5** defines osteoporosis. * **Common Fracture Sites:** Vertebra (most common), Hip (highest morbidity), and Distal Radius. * **Biochemical Markers:** In primary osteoporosis, serum Calcium, Phosphate, and Alkaline Phosphatase (ALP) levels are typically **normal**. In Osteomalacia, Calcium/Phosphate are low and ALP is high. * **Physical Sign:** A shortened and externally rotated leg is the classic clinical presentation of a **hip fracture**.
Question 536: Traumatic glenohumeral instability with a Bankart lesion is treated by which of the following methods?
- A. Conservative methods
- B. Surgery (Correct Answer)
- C. Rehabilitation
- D. Observation followed by inferior capsule shift
Explanation: **Explanation:** **Traumatic Anterior Shoulder Instability** typically occurs following an acute injury where the humeral head is forced out of the glenoid cavity. The most common pathology associated with this is a **Bankart lesion**, which is an avulsion of the anterior-inferior labrum from the glenoid rim. **Why Surgery is the Correct Choice:** In young, active individuals (the primary demographic for this injury), the recurrence rate of dislocation following conservative treatment is exceptionally high (up to 80-90%). **Surgery (Bankart Repair)** is the definitive treatment. It involves reattaching the detached labrum to the glenoid rim, either via open surgery or arthroscopically. This restores the "chock-block" effect of the labrum and stabilizes the joint, significantly reducing the risk of future dislocations. **Analysis of Incorrect Options:** * **A & C (Conservative/Rehabilitation):** While physical therapy to strengthen the rotator cuff is part of recovery, it cannot anatomically "heal" a detached labrum. Conservative management is generally reserved for elderly, sedentary patients or first-time dislocations in older age groups where recurrence risk is lower. * **D (Observation followed by Inferior Capsular Shift):** Observation allows for further instability and potential bone loss (Hill-Sachs or Bony Bankart). An inferior capsular shift (Neer’s procedure) is specifically indicated for **Multidirectional Instability (MDI)**, not isolated traumatic Bankart lesions. **High-Yield Clinical Pearls for NEET-PG:** * **Bankart Lesion:** Most common cause of recurrent anterior dislocation. * **Hill-Sachs Lesion:** A compression fracture of the posterosuperior humeral head (often seen alongside Bankart). * **Gold Standard Investigation:** MRI Arthrography (to visualize labral tears). * **Putti-Platt/Magnuson-Stack:** Older surgeries (now largely historical) that limited external rotation to prevent dislocation. * **Latarjet Procedure:** Indicated when there is significant **glenoid bone loss** (>20-25%).
Question 537: Which of the following is/are not included in the management of an intra-articular fracture?
- A. Arthrodesis
- B. Excision
- C. Aspiration
- D. None of the above (Correct Answer)
Explanation: ### 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.
Question 538: Variants of Monteggia fracture include all except?
- A. Isolated dislocation of radial head
- B. Fracture of ulnar shaft and neck of radius
- C. Fracture of ulnar shaft and radial shaft (Correct Answer)
- D. Fracture of ulnar head
Explanation: ### Explanation The **Monteggia fracture-dislocation** is classically defined as a fracture of the proximal third of the ulna associated with a dislocation of the proximal radio-ulnar joint (radial head). To account for various injury patterns involving the radial head and ulna, **Bado** classified these into four types and several variants. **Why Option C is the correct answer:** A fracture of both the **ulnar shaft and radial shaft** is known as a **"Both Bone Forearm Fracture."** This is a distinct clinical entity and is not considered a variant of Monteggia. In Monteggia injuries, the radius must involve the proximal joint (dislocation) or the neck, rather than a simple shaft fracture alongside the ulna. **Analysis of Variants (Incorrect Options):** * **Option A (Isolated dislocation of radial head):** This is considered a Monteggia equivalent/variant, especially in pediatrics, where the ulnar "fracture" may be a plastic deformation (greenstick) that is not obvious on X-ray. * **Option B (Fracture of ulnar shaft and neck of radius):** This is a classic Bado variant. Instead of the radial head dislocating, the energy is dissipated through a fracture of the radial neck. * **Option D (Fracture of ulnar head):** While rare, distal ulnar injuries associated with radial head involvement are categorized under complex forearm instability patterns often grouped with Monteggia variants in broader orthopedic classifications. ### High-Yield Clinical Pearls for NEET-PG: * **Bado Classification:** * **Type I:** Anterior dislocation of radial head (Most common). * **Type II:** Posterior dislocation (Associated with coronoid fractures). * **Type III:** Lateral dislocation (Common in children). * **Type IV:** Fracture of both bones + anterior dislocation of radial head. * **Mnemonic (MU-GR):** **M**onteggia = **U**lna fracture; **G**aleazzi = **R**adius fracture. * **Nerve Injury:** The **Posterior Interosseous Nerve (PIN)**, a branch of the radial nerve, is the most commonly injured nerve in Monteggia fractures.
Question 539: What is the most common type of shoulder dislocation that leads to axillary nerve injury?
- A. Anterior dislocation (Correct Answer)
- B. Posterior dislocation
- C. Recurrent instability
- D. Inferior dislocation
Explanation: **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 540: Which of the following are true about fat embolism?
- A. Seen one week after injury
- B. Petechiae (Correct Answer)
- C. Bradycardia
- D. Tachycardia
Explanation: **Fat Embolism Syndrome (FES)** is a clinical triad of respiratory distress, neurological symptoms, and a petechial rash, typically occurring after fractures of long bones (like the femur) or pelvic fractures. ### **Explanation of Options** * **Petechiae (Correct):** This is the most characteristic clinical sign of FES, occurring in about 20-50% of cases. These are typically found in a **"vest-like distribution"** over the chest, axilla, base of the neck, and conjunctiva. They result from the occlusion of dermal capillaries by fat globules and increased capillary fragility. * **Seen one week after injury (Incorrect):** FES typically presents within **24 to 72 hours** after the initial trauma. A presentation after one week is highly unlikely and suggests other complications like pulmonary embolism or pneumonia. * **Bradycardia (Incorrect):** FES is associated with systemic inflammatory response and hypoxia, which leads to **tachycardia**, not bradycardia. * **Tachycardia (Incorrect in context):** While tachycardia is a common clinical finding in FES, it is a non-specific sign seen in many trauma conditions (pain, shock). **Petechiae** is the "pathognomonic" or hallmark sign that specifically points toward Fat Embolism in a board exam context. ### **High-Yield Clinical Pearls for NEET-PG** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include petechial rash, respiratory insufficiency (PaO2 <60 mmHg), and CNS depression. * **Snowstorm Appearance:** The classic finding on a Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Schonfeld’s Criteria:** A scoring system where a score >5 suggests FES (Petechiae is assigned the highest score of 5). * **Management:** Primarily **supportive** (Oxygenation and hydration). Early stabilization/fixation of fractures is the best preventive measure. * **Free Fatty Acids:** The biochemical theory suggests that the breakdown of neutral fat into toxic free fatty acids causes direct lung injury (ARDS).
Practice by Chapter
Principles of Fracture Management
Practice Questions
Upper Limb Fractures
Practice Questions
Lower Limb Fractures
Practice Questions
Spinal Trauma
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Pelvic and Acetabular Fractures
Practice Questions
Open Fractures
Practice Questions
Fractures in Children
Practice Questions
Fracture Complications
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Nonunion and Malunion
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Polytrauma Management
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Joint Dislocations
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Soft Tissue Injuries
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