Trauma Practice Questions

Q: Which of the following is a major risk factor for fat embolism syndrome in a patient with major trauma?

Long bone fractures (femur or tibia). ***Long bone fractures (femur or tibia)*** - **Long bone fractures**, particularly of the **femur and tibia**, are the **most common cause** of fat embolism syndrome, accounting for 90% of cases - Fat globules from the bone marrow enter the venous circulation through disrupted medullary vessels - Multiple fractures increase the risk significantly - Early fracture stabilization reduces the risk of fat embolism syndrome *Increased mobility after trauma* - Early mobilization is actually **protective** against complications like DVT and does not cause fat embolism - Fat embolism occurs due to the initial trauma itself, not subsequent mobility *Isolated soft tissue injury* - Soft tissue injuries alone rarely cause clinically significant fat embolism - Fat embolism syndrome requires release of bone marrow fat, which occurs with skeletal trauma *Hypovolemic shock* - While hypovolemic shock can occur concurrently with trauma, it is **not a causative factor** for fat embolism - Both may result from the same traumatic event but represent different pathophysiological processes

Q: Which of the following is a treatment option for Volkmann's ischemia?

Fasciotomy. ***Fasciotomy*** - **Fasciotomy** is the **emergency surgical treatment** for **acute Volkmann's ischemia** caused by compartment syndrome. - This procedure involves making incisions through the fascia to relieve elevated compartment pressure and restore blood flow, preventing irreversible muscle and nerve damage. - Must be performed urgently to prevent progression to **Volkmann's contracture** (established muscle necrosis and fibrosis). *Bone shortening* - **Bone shortening** is a reconstructive procedure used in **late/established Volkmann's contracture**, not for acute ischemia. - It may be used to facilitate soft tissue reconstruction or correct deformities after muscle necrosis has occurred. - Does not address the acute ischemic emergency. *Cock up splint* - A **cock-up splint** maintains the wrist in extension and is used for **rehabilitation** in chronic/established Volkmann's contracture. - May help prevent further deformity or support weakened extensors after muscle damage has occurred. - Does not treat the acute compartment syndrome or restore blood flow. *Turn buckle splint* - A **turnbuckle splint** is used for **gradual correction of joint contractures** in established Volkmann's contracture. - This is a rehabilitative device for chronic cases, not for acute treatment. - Does not address the acute circulatory compromise or compartment syndrome.

Q: Which of the following is true about reflex sympathetic dystrophy?

Osteoporosis. ***Osteoporosis*** - **Osteoporosis** is a characteristic feature of reflex sympathetic dystrophy (RSD), also known as **complex regional pain syndrome (CRPS)** type 1, often visible on imaging as patchy bone demineralization in the affected limb. - This bone loss is thought to be due to increased osteoclast activity and altered local blood flow and nerve supply in the affected region. *Increased skin temp* - While initial stages of RSD can involve **increased skin temperature** due to vasodilation, later stages often show **decreased skin temperature** and cyanosis. - The temperature changes are often asymmetric and can fluctuate, but a constant increase is not universally true or defining. *Vasoconstriction* - RSD can present with both **vasodilation** in the acute phase and **vasoconstriction** in the chronic phase, leading to diverse vascular symptoms. - Therefore, stating only vasoconstriction as a universal truth for RSD isn't accurate, as the condition involves a dysregulation of blood vessel control. *Common in athletes* - RSD is not specifically more common in athletes; it can affect anyone after **trauma (e.g., fracture, surgery)**, nerve injury, or even without an identifiable cause. - While athletes can experience trauma leading to RSD, no specific predisposition exists in this population compared to others experiencing similar injuries.

Q: Most common complication of intertrochanteric fracture femur is:

Malunion. ***Malunion*** - **Malunion** is the most common complication of intertrochanteric fractures, particularly with unstable fracture patterns or inadequate reduction and fixation. - This typically results in leg length discrepancy, gait disturbance, and persistent pain due to abnormal alignment. *Nerve injury* - **Nerve injury** is a rare complication of intertrochanteric fractures, as the major nerves (e.g., sciatic, femoral) are not in close proximity to the fracture site. - While possible with severe trauma or surgical errors, it is not considered the most common complication. *Osteoarthritis* - **Osteoarthritis** can develop years after an intertrochanteric fracture due to altered biomechanics, but it is a long-term sequela, not an immediate or most common post-fracture complication. - Early complications like malunion or infection are more prevalent. *Non-union* - **Non-union** is relatively uncommon in intertrochanteric fractures because this area of the femur has an excellent blood supply, which promotes healing. - This complication is more frequently seen in femoral neck fractures due to their tenuous blood supply.

Q: In acute quadriceps tendon rupture, which radiographic finding is most specific?

Patella Alta. ***Patella Alta*** - **Patella alta**, or a high-riding patella, is a classic radiographic sign of acute quadriceps tendon rupture because the **patella** is no longer tethered inferiorly by the intact quadriceps tendon. - The unopposed pull of the patellar tendon elevates the patella, making this a highly **specific finding**. *Joint Space Narrowing* - **Joint space narrowing** is indicative of cartilage loss and is commonly seen in degenerative conditions like **osteoarthritis**. - It does not directly reflect soft tissue injury such as a quadriceps tendon rupture. *Osteophytes* - **Osteophytes**, or bone spurs, are a sign of **degenerative joint disease** and chronic stress on joints, often seen in osteoarthritis. - They are not specific to acute traumatic injuries like tendon ruptures. *Patella Baja* - **Patella baja**, or a low-riding patella, is typically associated with **patellar tendon rupture**, not quadriceps tendon rupture. - In a patellar tendon rupture, the patella *drops* due to the loss of its inferior anchor, which is the opposite of a quadriceps rupture.

Q: Which fracture is most commonly associated with fat embolism?

Femoral shaft fracture. ***Femoral shaft fracture*** - **Femoral shaft fractures** are highly associated with **fat embolism syndrome (FES)** due to the large amount of **yellow marrow** released from the long bone into the circulation following trauma. - The risk of FES is particularly high with **multiple fractures** or **delayed stabilization** of long bone fractures. *Humeral shaft fracture* - While humeral shaft fractures can potentially lead to fat embolism, they are **less common** sources compared to lower limb long bone fractures due to a smaller bone marrow volume. - The incidence of **fat embolism syndrome** with isolated upper limb fractures is generally lower. *Distal radius fracture* - **Distal radius fractures** are typically **low-energy injuries** involving a smaller bone and less marrow, making them a very rare cause of significant fat embolism. - **Fat embolism syndrome** is exceptionally uncommon following fractures of the small bones of the forearm. *Clavicle fracture* - **Clavicle fractures** involve a flat bone with a limited quantity of marrow, and hence they are **not typically associated** with fat embolism. - The risk of **fat embolism syndrome** is negligible with clavicular injuries.

Q: Which treatment is best for a severely displaced and comminuted distal radius fracture in an elderly patient?

Open reduction and plating. ***Open reduction and plating*** - This method provides **stable fixation** for displaced fractures, especially in elderly patients with potentially poorer bone quality, allowing for earlier mobilization and better functional outcomes. - **Open reduction** ensures accurate anatomical alignment, and **plating** offers strong internal support to resist displacement. *External fixation* - While it can stabilize fractures, external fixation may have a higher risk of complications such as **pin track infections** and **joint stiffness**, which can be particularly problematic for elderly patients. - It might not provide the same degree of stability as internal plating, potentially leading to less optimal reduction in **comminuted fractures**. *Hemiarthroplasty* - **Hemiarthroplasty** is a joint replacement procedure and is generally reserved for severe, irreparable fractures affecting the joint surface or for cases of **arthritic conditions**, not typically for a standard displaced distal radius fracture. - This option is **overly invasive** for the described injury and is not considered a primary treatment for distal radius fractures. *Closed reduction and casting* - While a common treatment for distal radius fractures, **closed reduction and casting** has a higher risk of **redisplacement** in significantly displaced fractures, especially in elderly patients with osteoporotic bone. - It often requires longer immobilization, potentially leading to **stiffness** and **muscle atrophy**, which can be challenging for older individuals.

Q: Which is true regarding acute compartment syndrome?

Pain is out of proportion to injury. ***Pain is out of proportion to injury*** - A hallmark symptom of **acute compartment syndrome** is severe, unrelenting pain that is often much greater than expected for the inciting injury. - This disproportionate pain is due to increasing pressure within a confined fascial compartment, causing **ischemia** and nerve compression. - This is the **earliest and most sensitive clinical sign** of compartment syndrome. *Pulses are always absent* - **Pulses are typically present**, even in severe compartment syndrome, as the compartment pressure rarely exceeds systolic pressure enough to abolish a palpable pulse. - Pulselessness is a **late finding** indicating severe vascular compromise. - **Capillary refill** may be diminished, but the presence of a pulse should not be used to rule out compartment syndrome. *Common in elderly patients* - Acute compartment syndrome is more commonly seen in **younger individuals**, particularly those engaged in high-impact sports or following high-energy trauma. - **Fractures of the tibia and forearm** are common predisposing factors. - While it can occur at any age, it is less common in elderly patients. *No need for surgical intervention* - **Acute compartment syndrome is a surgical emergency** requiring immediate **fasciotomy** to relieve pressure and prevent irreversible tissue damage. - Delay in surgical intervention can lead to permanent muscle necrosis, nerve damage, and limb loss. - Normal compartment pressure is 0-8 mmHg; fasciotomy is indicated when pressure exceeds 30 mmHg or within 30 mmHg of diastolic pressure.

Question 1

Which of the following is a major risk factor for fat embolism syndrome in a patient with major trauma?

Accepted Answer

Long bone fractures (femur or tibia)

Answer

Isolated soft tissue injury

Answer

Hypovolemic shock

Answer

Increased mobility after trauma

Question 2

Which of the following is a treatment option for Volkmann's ischemia?

Accepted Answer

Fasciotomy

Answer

Bone shortening

Answer

Cock up splint

Answer

Turn buckle splint

Question 3

Which of the following is true about reflex sympathetic dystrophy?

Accepted Answer

Osteoporosis

Answer

Increased skin temp

Answer

Vasoconstriction

Answer

Common in athletes

Question 4

Most common complication of intertrochanteric fracture femur is:

Accepted Answer

Malunion

Answer

Nerve injury

Answer

Osteoarthritis

Answer

Non-union

Question 5

In acute quadriceps tendon rupture, which radiographic finding is most specific?

Accepted Answer

Patella Alta

Answer

Joint Space Narrowing

Answer

Osteophytes

Answer

Patella Baja

Question 6

Which fracture is most commonly associated with fat embolism?

Accepted Answer

Femoral shaft fracture

Answer

Humeral shaft fracture

Answer

Distal radius fracture

Answer

Clavicle fracture

Question 7

Which treatment is best for a severely displaced and comminuted distal radius fracture in an elderly patient?

Accepted Answer

Open reduction and plating

Answer

External fixation

Answer

Hemiarthroplasty

Answer

Closed reduction and casting

Question 8

Which is true regarding acute compartment syndrome?

Accepted Answer

Pain is out of proportion to injury

Answer

Pulses are always absent

Answer

Common in elderly patients

Answer

No need for surgical intervention

Question 9

A 26-year-old male presented with proximal 1/3rd fracture shaft of the femur. What is the treatment of choice in this patient?

Accepted Answer

Interlocking Nail

Answer

Hip Spica

Answer

Above knee Cast

Answer

Above knee Slab

Question 10

A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?

Accepted Answer

Hemiarthroplasty

Answer

Total Hip Replacement

Answer

Dynamic Hip Screw

Answer

Conservative Management

Trauma — MCQs

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