Trauma Practice Questions

Q: A 28-year-old male presents with a crush injury to the leg. His leg is swollen, and he experiences severe pain with passive stretching of the toes. What is the next best step in management?

Immediate fasciotomy. ***Immediate fasciotomy*** - The combination of a **crush injury**, **swollen leg**, and **severe pain with passive stretching of the toes** is highly indicative of **acute compartment syndrome**, which requires immediate surgical intervention to prevent irreversible tissue damage. - A fasciotomy rapidly relieves pressure within the muscle compartments, restoring blood flow and saving threatened muscle and nerve tissue. *MRI of the leg* - While an MRI can provide detailed images of soft tissues, it is a time-consuming diagnostic tool that would delay critical treatment for acute compartment syndrome. - The clinical presentation is sufficiently clear to proceed directly to surgical management. *Elevation of the limb* - In suspected **acute compartment syndrome**, the limb should be kept at **heart level** to optimize perfusion pressure. - Elevating the limb above heart level can reduce arterial inflow and potentially worsen ischemia, while keeping it dependent can increase venous pressure and compartment pressure. - This is not a definitive treatment and delays the necessary surgical intervention. *Administer IV antibiotics* - Although crush injuries carry a risk of infection, antibiotics are not the primary or immediate treatment for the life-threatening condition of **acute compartment syndrome**. - Delaying surgical decompression to administer antibiotics would result in irreversible muscle and nerve damage.

Q: What is the most common complication of a posterior shoulder dislocation?

Reverse Hill-Sachs lesion. ***Reverse Hill-Sachs lesion*** - A **reverse Hill-Sachs lesion** (also known as a **McLaughlin lesion**) is an impaction fracture on the anterior aspect of the humeral head, occurring when the humeral head strikes the posterior glenoid rim during a posterior dislocation. - It is the most common bony complication of a posterior shoulder dislocation due to the direct impact of the humeral head against the glenoid. *Bankart lesion* - A **Bankart lesion** is an injury to the anterior inferior glenoid labrum, often with an associated bony fragment, and is characteristic of **anterior shoulder dislocations**. - It results from the humeral head being forced anteriorly, tearing the labrum and capsule from the anterior glenoid, which is not the mechanism in posterior dislocations. *Rotator cuff tear* - While rotator cuff tears can occur with any shoulder dislocation, they are more commonly associated with **anterior dislocations**, especially in older patients. - They are also often seen with chronic instability or significant trauma, but a specific lesion like a reverse Hill-Sachs is more pathognomonic for a posterior dislocation. *Fracture of the scapula* - A **scapular fracture** is relatively uncommon with isolated shoulder dislocations and typically requires a significant, direct high-energy trauma. - Such fractures are less directly caused by the dislocation mechanism itself, compared to the impaction injury that creates a reverse Hill-Sachs lesion.

Q: A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Posterior displacement of the distal radius. ***Posterior displacement of the distal radius*** - The "dinner fork" deformity, or **Colles' fracture**, is characterized by **dorsal (posterior) displacement and angulation** of the distal fragment of the radius. - This posterior displacement, combined with supination and impaction, gives the wrist its characteristic shape resembling a dinner fork. *Anterior displacement of the distal radius* - This describes a **Smith's fracture (or reverse Colles' fracture)**, where the distal fragment of the radius is displaced volarly (anteriorly). - While also a common distal radial fracture, it presents with a different deformity than the "dinner fork." *Lateral angulation of the distal radius* - Angulation away from the midline (laterally or radially) can occur in various distal radius fractures but is **not the primary defining feature** of the classic "dinner fork" deformity. - The most prominent and characteristic deformity is the dorsal displacement, which contributes to the "dinner fork" appearance. *Medial angulation of the distal radius* - This refers to angulation towards the midline (medially or ulnarly) and is **less common as a primary component** of the classic Colles' fracture "dinner fork" deformity. - While some degree of angulation can be present, the distinctive shape of the "dinner fork" is mainly due to dorsal displacement and angulation.

Q: Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Distal radius. ***Distal radius*** - A fracture of the **distal radius** is the most common fracture of the upper extremity, typically occurring when a person falls on an **outstretched hand (FOOSH)**. - The force transmitted through the hand and wrist often causes the bone to break just above the wrist joint, resulting in what is commonly known as a **Colles fracture** if the fragment is displaced dorsally. *Scaphoid* - While a **scaphoid fracture** can occur with a FOOSH injury, it is less common than a distal radius fracture. - Scaphoid fractures are often challenging to diagnose immediately and require specific clinical suspicion due to potential complications like **avascular necrosis**. *Lunate* - The **lunate bone** is one of the carpal bones and is rarely fractured in isolation, particularly from a FOOSH injury. - More commonly, it is involved in dislocations or other severe carpal injuries, rather than a simple fracture. *Capitate* - The **capitate** is the largest carpal bone but is well-protected by surrounding bones, making isolated fractures from a FOOSH injury uncommon. - Fractures of the capitate typically occur in high-energy trauma and are often associated with other carpal injuries.

Q: Palpable femur head on per rectal exam is a feature of which of the following conditions?

Posterior hip dislocation. ***Posterior hip dislocation*** - In **posterior hip dislocation**, the femoral head is displaced posteriorly, often coming to rest on the **ischium**. - This posterior displacement can make the **femoral head palpable** through the rectum, particularly in thin individuals. *Anterior hip dislocation* - Involves the femoral head displacing **anteriorly**, usually into the **obturator foramen** or onto the **pubis**. - The femoral head would be palpable in the **groin region**, not rectally. *Central hip dislocation* - Occurs when the femoral head is driven **centrally** through the **acetabulum** into the pelvis. - While it involves intrapelvic displacement, the femoral head is typically covered by pelvic bone and not directly palpable per rectally. *Inferior hip dislocation* - This is a rare form of dislocation where the femoral head is forced **inferiorly** from the acetabulum. - The femoral head would typically be palpable in the **perineal region**, not through the rectum.

Q: What is the absolute pressure threshold for surgical intervention in compartment syndrome?

30 mm Hg. ***30 mm Hg*** - A definitive **absolute compartment pressure** of **30 mmHg** or more is a clear indication for **surgical fasciotomy** to relieve pressure and prevent irreversible tissue damage. - This threshold directly reflects the pressure at which capillary perfusion becomes significantly compromised, leading to **ischemia** and potential **necrosis**. - This is the classical **absolute pressure criterion** widely taught for compartment syndrome management. *15 mm Hg* - A pressure of **15 mmHg** is generally considered within the normal range for tissue compartments and does not warrant surgical intervention. - This value is well below the threshold for microcirculatory compromise and typically indicates no immediate danger of **compartment syndrome**. *20 mm Hg* - While elevated above normal, **20 mmHg** is usually not sufficiently high on its own to mandate immediate surgical fasciotomy. - Clinical signs and symptoms, along with trending pressures, would be more critical at this level to determine the need for intervention. *40 mm Hg* - While fasciotomy is certainly indicated at **40 mmHg**, this is not the **threshold** value—it is already significantly above the critical point. - The question asks for the **absolute pressure threshold**, which is the minimum value at which intervention becomes mandatory, not a value well beyond it.

Q: Management of displaced non comminuted intercondylar humerus fracture is?

Open reduction and internal fixation. ***Open reduction and internal fixation*** - **Displaced intra-articular fractures** of the humeral condyles, even if non-comminuted, require **anatomic reduction** and **stable fixation** to restore joint congruity and function. - ORIF allows direct visualization for accurate reduction and provides excellent stability, crucial for early range of motion and preventing long-term complications like **post-traumatic arthritis**. *Above elbow plaster cast application* - This method is typically reserved for **stable, non-displaced fractures** or as a temporary measure. - It would not achieve or maintain adequate reduction for a **displaced intra-articular fracture**, potentially leading to malunion, stiffness, and pain. *Olecranon pin traction method* - Traction methods are generally less precise for achieving **anatomic reduction** of complex articular fractures compared to ORIF. - While it can be used for some complex elbow fractures, its role in **displaced non-comminuted intercondylar fractures** is limited due to the need for precise articular alignment. *External fixation method* - External fixation is often used for **open fractures**, **severely comminuted fractures**, or when internal fixation is not feasible due to soft tissue compromise. - While it provides stability, it does not allow for the same level of **anatomic reduction** of the articular surface as ORIF for a displaced intercondylar fracture and can limit early motion.

Q: Which of the following statements about Galeazzi fracture dislocation is incorrect?

Ulna dislocates dorsally at DRUJ. ***Ulna dislocates dorsally at DRUJ*** - This statement is incorrect because in a **Galeazzi fracture-dislocation**, the **ulna typically dislocates volarly (anteriorly)** relative to the radius at the **distal radio-ulnar joint (DRUJ)**. - The DRUJ dislocation is usually in a volar direction due to the force of injury. *Fracture of distal third of radius and dislocation of DRUJ* - This is a hallmark of a **Galeazzi fracture-dislocation**, explicitly defining the two main components of the injury. - The **distal third of the radius** is the most common site of fracture, coupled with the disruption of the DRUJ. *Radius is angulated laterally and posteriorly* - This describes the typical displacement pattern of the **radial fracture fragment** in a Galeazzi injury. - The angulation often results from the forces acting on the forearm during the injury, with the pronator quadratus pulling the distal fragment volarly and an abduction force causing lateral angulation. *Results from fall on outstretched hand* - This is the most common mechanism of injury for a **Galeazzi fracture-dislocation**, similar to many other forearm and wrist fractures. - The axial load and pronation forces generated during a fall on an **outstretched hand** contribute to the characteristic fracture and dislocation.

Q: Dunlop traction is a type of traction used in the management of?

Fracture of the humerus. ***Fracture of the humerus*** - **Dunlop traction** is specifically designed for the management of **supracondylar fractures** of the humerus in children. - It involves traction applied to the arm, often in conjunction with skin or skeletal traction to maintain reduction and alignment. *Fracture of the radius* - Fractures of the radius, particularly distal radius fractures, are typically managed with **closed reduction and casting** or **surgical fixation**, not Dunlop traction. - Traction methods for forearm fractures are less common and usually involve specialized techniques for specific fracture patterns. *Fracture of the femur* - Femur fractures, especially in children, are commonly managed with **Bryant's traction** or **femoral skeletal traction** in younger children, or surgical intervention. - Dunlop traction is not suitable due to the significant muscle mass and bone size of the femur requiring stronger, more robust traction. *Fracture of the tibia* - Tibia fractures are generally managed with **casting**, **external fixation**, or **intramedullary nailing**. - While traction can be used initially for severely displaced or open tibial fractures, it typically involves **skeletal traction** rather than Dunlop traction.

Question 1

A 28-year-old male presents with a crush injury to the leg. His leg is swollen, and he experiences severe pain with passive stretching of the toes. What is the next best step in management?

Accepted Answer

Immediate fasciotomy

Answer

MRI of the leg

Answer

Elevation of the limb

Answer

Administer IV antibiotics

Question 2

What is the most common complication of a posterior shoulder dislocation?

Accepted Answer

Reverse Hill-Sachs lesion

Answer

Bankart lesion

Answer

Rotator cuff tear

Answer

Fracture of the scapula

Question 3

What factors should be considered when deciding between limb salvage surgery and amputation for a patient with a severe traumatic injury to the lower extremity?

Accepted Answer

Extent of tissue damage, potential for functional recovery, and patient's lifestyle considerations.

Answer

Surgeon's skill level as the primary factor.

Answer

Cosmetic appearance alone.

Answer

Patient's immediate decision during trauma.

Question 4

A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Accepted Answer

Posterior displacement of the distal radius

Answer

Anterior displacement of the distal radius

Answer

Lateral angulation of the distal radius

Answer

Medial angulation of the distal radius

Question 5

Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Accepted Answer

Distal radius

Answer

Scaphoid

Answer

Lunate

Answer

Capitate

Question 6

Palpable femur head on per rectal exam is a feature of which of the following conditions?

Accepted Answer

Posterior hip dislocation

Answer

Anterior hip dislocation

Answer

Central hip dislocation

Answer

Inferior hip dislocation

Question 7

What is the absolute pressure threshold for surgical intervention in compartment syndrome?

Accepted Answer

30 mm Hg

Answer

15 mm Hg

Answer

20 mm Hg

Answer

40 mm Hg

Question 8

Management of displaced non comminuted intercondylar humerus fracture is?

Accepted Answer

Open reduction and internal fixation

Answer

Above elbow plaster cast application

Answer

Olecranon pin traction method

Answer

External fixation method

Question 9

Which of the following statements about Galeazzi fracture dislocation is incorrect?

Accepted Answer

Ulna dislocates dorsally at DRUJ

Answer

Results from fall on outstretched hand

Answer

Fracture of distal third of radius and dislocation of DRUJ

Answer

Radius is angulated laterally and posteriorly

Question 10

Dunlop traction is a type of traction used in the management of?

Accepted Answer

Fracture of the humerus

Answer

Fracture of the radius

Answer

Fracture of the femur

Answer

Fracture of the tibia

Trauma — MCQs

Trauma — MCQs

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