Trauma Practice Questions

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.

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: The most common complication of intracapsular fracture neck of femur is

Non-Union. ***Non-Union*** - **Intracapsular fractures** of the femoral neck often disrupt the blood supply to the femoral head, increasing the risk of **avascular necrosis** and impaired healing. - Due to the limited blood supply and mechanical forces, the bone fragments may fail to unite, leading to **non-union**. *Mal union* - **Malunion** implies that the fracture has healed but in an anatomically incorrect or deformed position. - While it can occur, **non-union** is a more prevalent and severe complication in intracapsular femoral neck fractures due to the specific anatomical challenges. *Osteoarthritis* - **Osteoarthritis** can develop as a long-term complication if the fracture heals with altered joint mechanics or secondary to avascular necrosis. - However, it is a delayed consequence, whereas **non-union** is an early and direct failure of the healing process. *Shortening* - **Shortening** of the limb can occur due to fracture displacement or subsequent collapse, especially if the fracture is unstable or undergoes malunion. - It is a symptom or consequence that can be associated with failed healing or non-union, but **non-union** itself is the primary failure of bone repair.

Q: Cubitus valgus develops as a complication of which type of fracture?

Supracondylar fracture of humerus. ***Supracondylar fracture of humerus*** - **Cubitus valgus** is a common late complication of a **supracondylar fracture of the humerus**, especially if not properly reduced or fixed. - This deformity results from growth disturbance, malunion, or physeal damage at the **distal humerus**, leading to an increased carrying angle of the elbow. *Smith's fracture* - A **Smith's fracture** is a fracture of the **distal radius** with volar displacement of the distal fragment. - This fracture primarily affects the wrist and does not lead to cubitus valgus deformity, which is an elbow pathology. *Malgaigne fracture* - A **Malgaigne fracture** is an unstable pelvic fracture involving vertical shear forces affecting both anterior and posterior pelvic rings. - This fracture is located in the pelvis and has no anatomical or biomechanical connection to the elbow joint or the development of cubitus valgus. *Saddle fracture* - The term **saddle fracture** is not a standard or recognized orthopedic classification for a specific bone fracture. - This term does not correspond to a known fracture pattern that would lead to cubitus valgus.

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: Treatment of choice in Acute myositis ossificans is:

Immobilization of the affected area. ***Immobilization of the affected area*** - Initial treatment for **acute myositis ossificans** focuses on conservative measures, primarily **rest and immobilization**. - This helps to **reduce inflammation**, prevent further injury, and minimize the risk of ossification progression. *Early mobilization and active exercises* - **Early mobilization** and aggressive exercises can **aggravate the condition** and promote further heterotopic ossification during the acute inflammatory phase. - While physical therapy is important later, it must be introduced cautiously and gently **after the acute phase** has subsided. *Immediate surgical excision of ossified tissue* - **Surgical excision** during the acute phase is **contraindicated** due to a high risk of **recurrence** and increased bleeding. - Surgery is typically reserved for **mature, symptomatic lesions** causing functional impairment, and is usually performed at least 6 to 12 months after onset. *High-dose corticosteroids and NSAIDs* - While **NSAIDs** might be used to manage pain and inflammation in some cases, **high-dose corticosteroids** are generally not the primary treatment of choice for acute myositis ossificans. - The effectiveness of corticosteroids in preventing or treating myositis ossificans is **not well-established**, and prolonged use carries significant side effects.

Q: What is the treatment for patient with hypertrophic nonunion with deformity at fracture site?

Fixation with bone grafting. ***Fixation with bone grafting*** - In a **hypertrophic nonunion**, there is biological activity and callus formation, indicating that the problem is primarily mechanical instability, which requires **fixation**. - Since a **deformity** is present, **bone grafting** may also be necessary to correct the alignment and fill any bone defects, thus providing additional structural support and osteogenic potential. *No treatment required* - A **hypertrophic nonunion** with **deformity** indicates a persistent problem that will not resolve spontaneously and requires intervention due to instability and malalignment. - Doing nothing would lead to continued pain, functional impairment, and potential long-term complications from the uncorrected deformity. *Fixation with possible bone grafting* - While fixation is crucial for hypertrophic nonunions, the presence of a **deformity** strongly suggests that bone grafting will likely be necessary, rather than just "possible," to address the morphological defect and promote union. - This option understates the probable need for grafting when a deformity is a key feature of the nonunion. *Bone grafting only* - **Bone grafting** alone does not address the fundamental issue of **mechanical instability** in a hypertrophic nonunion, which is characterized by adequate biological response but insufficient stability for healing. - Without stable **fixation**, the grafted bone would likely fail to incorporate, and the nonunion would persist or worsen.

Q: Chauffeur fracture is -

Intra-articular fracture of the radial styloid process. ***Intra-articular fracture of the radial styloid process*** - A **chauffeur fracture**, also known as a **Hutchinson fracture**, is an **intra-articular fracture** of the distal radius involving the radial styloid process. - This fracture often results from a **direct impact** or **compressive force** on the wrist, historically seen in individuals cranking early automobiles. *Intra-articular fracture of the base of the 1st metacarpal* - This description refers to a **Bennett's fracture**, which is a **two-part intra-articular fracture** of the base of the first metacarpal. - It is typically caused by **axial force** directed along the metacarpal, often from a punch, rather than a wrist-level injury. *Extra-articular fracture of the base of the 1st metacarpal* - An **extra-articular fracture** of the base of the 1st metacarpal is known as a **Rolando fracture** if comminuted, or a simpler extra-articular fracture. - These fractures do not involve the joint surface, distinguishing them from intra-articular fractures. *Extra-articular fracture of the styloid process* - While it involves the styloid process, an **extra-articular fracture of the styloid process** would imply a fracture not extending into the joint space. - A Chauffeur's fracture specifically involves the **articular surface** of the radial styloid, making this option incorrect.

Q: Functional cast bracing not used in fracture of ?

Thoracolumbar spine fracture. ***Thoracolumbar spine fracture*** - **Functional cast bracing** is unsuitable for **thoracolumbar spine fractures** because it cannot adequately immobilize this segment of the spine due to the complex anatomy and motion involved. - These fractures often require rigid external immobilization or **surgical stabilization** to prevent neurological compromise and ensure proper healing. *Humerus fracture* - **Functional bracing** for **humerus fractures** allows for limited, controlled motion at the shoulder and elbow joints while supporting the fracture site. - This approach helps to prevent joint stiffness and promote **early rehabilitation**, which is beneficial for humeral healing. *Tibia fracture* - **Functional cast bracing** is often used for **tibia shaft fractures** to allow weight-bearing and controlled ankle and knee motion. - This helps to stimulate bone healing (Wolff's Law) and maintain muscle strength while providing adequate **fracture stability**. *Ulna fracture* - Depending on the specific type and location, **functional bracing** for **ulna fractures** can permit some wrist and elbow movement while stabilizing the fracture. - This method helps to preserve **range of motion** and facilitate earlier return to normal activities.

Q: Garden's classification used for which fracture?

Neck of femur. ***Neck of femur*** - **Garden's classification** is a widely used system to categorize **femoral neck fractures** based on displacement. - This classification helps guide treatment decisions, as different grades of displacement have varying prognoses for **avascular necrosis** and **non-union**. *Fracture of the surgical neck of the humerus* - Fractures of the surgical neck of the humerus are typically classified using the **Neer classification system**. - The Neer classification is based on the number of displaced parts, such as the **humeral head**, **greater tuberosity**, **lesser tuberosity**, and **humeral shaft**. *Fracture of the shaft of the humerus* - Fractures of the humeral shaft are generally classified by their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., spiral, transverse, oblique, comminuted), and the presence of **open vs. closed injuries**. - There is no specific, widely recognized classification system comparable to Garden's used exclusively for these fractures. *Fracture of the shaft of the femur* - Fractures of the femoral shaft are commonly classified based on their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., transverse, oblique, spiral, comminuted), and the presence of **segmental or open fractures**. - The **Winquist and Hansen classification** is sometimes used for comminuted femoral shaft fractures, but Garden's classification is not applicable here.

Question 1

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

Question 2

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 3

The most common complication of intracapsular fracture neck of femur is

Accepted Answer

Non-Union

Answer

Mal union

Answer

Osteoarthritis

Answer

Shortening

Question 4

Cubitus valgus develops as a complication of which type of fracture?

Accepted Answer

Supracondylar fracture of humerus

Answer

Smiths fracture

Answer

Malgaigne fracture

Answer

Saddle fracture

Question 5

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 6

Treatment of choice in Acute myositis ossificans is:

Accepted Answer

Immobilization of the affected area

Answer

Early mobilization and active exercises

Answer

Immediate surgical excision of ossified tissue

Answer

High-dose corticosteroids and NSAIDs

Question 7

What is the treatment for patient with hypertrophic nonunion with deformity at fracture site?

Accepted Answer

Fixation with bone grafting

Answer

No treatment required

Answer

Bone grafting only

Answer

Fixation with possible bone grafting

Question 8

Chauffeur fracture is -

Accepted Answer

Intra-articular fracture of the radial styloid process

Answer

Intra-articular fracture of the base of the 1st metacarpal

Answer

Extra-articular fracture of the base of the 1st metacarpal

Answer

Extra-articular fracture of the styloid process

Question 9

Functional cast bracing not used in fracture of ?

Accepted Answer

Thoracolumbar spine fracture

Answer

Humerus fracture

Answer

Tibia fracture

Answer

Ulna fracture

Question 10

Garden's classification used for which fracture?

Accepted Answer

Neck of femur

Answer

Fracture of the surgical neck of the humerus

Answer

Fracture of the shaft of the humerus

Answer

Fracture of the shaft of the femur

Trauma — MCQs

Trauma — MCQs

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