Trauma Practice Questions

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: 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 condition is associated with the absence of femoral artery pulsation in the affected limb?

Posterior dislocation of the hip. ***Posterior dislocation of the hip*** - A **posterior hip dislocation** can compress or injure the **femoral artery** due to the displacement of the femoral head posteriorly, leading to a diminished or absent pulse. - This is a **medical emergency** as vascular compromise can lead to **ischemia and necrosis** of the affected limb. *Fracture of the neck of femur* - While a **femoral neck fracture** can cause significant pain and may sometimes be associated with a compromised blood supply to the femoral head, it typically does not directly compress or injure the **femoral artery** itself. - The main vascular concern with femoral neck fractures is often the **avascular necrosis** of the femoral head due to disruption of its nutrient arteries. *Legg-Calvé-Perthes disease* - This condition involves **avascular necrosis of the femoral head** in children, primarily affecting the blood supply to the epiphysis, not the main femoral artery. - Though it affects hip vascularity, it does not typically manifest with an **absent femoral pulse**. *None of the options* - This option is incorrect because a **posterior dislocation of the hip** is a recognized cause of compromised femoral artery pulsation.

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: 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: Most common complication of fracture of tibia

Delayed union. ***Delayed union*** - The **tibia** has a relatively **poor blood supply** compared to other long bones, especially in its distal third, making it prone to delayed healing. - Delayed union is defined as a fracture that takes **longer than expected** to heal, but still has the potential to unite. *Infection* - While possible, especially with **open fractures**, infection is not the most common complication of all tibia fractures. - Infections can lead to **osteomyelitis**, but this specific complication is less frequent than delayed union. *Compartment syndrome* - This is a **serious complication** resulting from increased pressure within a closed fascial compartment, often of the lower leg. - While it is a significant risk with tibia fractures and requires immediate attention, it is **not the most common** complication overall. *Vascular injury* - Significant **vascular injury** is a rare but severe complication, particularly with high-energy trauma or displaced fractures. - Such injuries can lead to limb ischemia and require urgent surgical intervention, but occur **less frequently** than delayed union.

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: The Kocher maneuver is primarily indicated for which of the following conditions?

Shoulder reduction. ***Shoulder reduction*** - The **Kocher maneuver** is a classic technique used to reduce an anterior shoulder dislocation. - It involves a specific sequence of **external rotation, adduction, and internal rotation** of the arm. *Elbow reduction* - Elbow dislocations are typically reduced using **traction-countertraction** techniques, not the Kocher maneuver. - These methods focus on overcoming muscle spasm and restoring the alignment of the **ulna and radius** with the humerus. *Ankle dislocation* - Ankle dislocations usually require **traction and direct manipulation** to realign the talus within the ankle mortise. - These reductions often address associated fractures or ligamentous injuries of the **tibiotalar joint**. *Knee dislocation* - Knee dislocations are serious injuries involving complete disruption of the **tibiofemoral joint**, and their reduction primarily involves **gentle longitudinal traction** and direct manipulation. - Prompt reduction is crucial due to the high risk of **neurovascular compromise**.

Q: Most common complication of mid shaft humerus fracture is ?

Radial nerve palsy. ***Radial nerve palsy*** - The **radial nerve** runs in close proximity to the **spiral groove** of the humerus, making it highly vulnerable to injury in mid-shaft fractures. - This results in the characteristic **wrist drop** and loss of sensation over the dorsal aspect of the hand. *Median nerve palsy* - The **median nerve** is not typically affected by mid-shaft humeral fractures as it is located more medially and anteriorly. - Injury to the median nerve is more common with supracondylar fractures of the humerus or carpal tunnel syndrome. *Nonunion* - While **nonunion** (failure of bone healing) occasionally occurs after mid-shaft humerus fractures, **radial nerve palsy** is a more immediate and frequent complication observed at the time of injury. - Risks for nonunion include severe trauma, soft tissue interposition, and inadequate immobilization. *Malunion* - **Malunion** (healing in an unacceptable alignment) can occur, especially with conservative management, but like nonunion, it is a complication of the healing process rather than an acute injury presentation. - Functional outcomes are generally good even with some degree of angulation in humeral shaft fractures.

Q: Thomas splint is used for immobilizing fractures of ?

Femur. ***Femur*** - The **Thomas splint** is primarily designed for the temporary immobilization and traction of **femoral shaft fractures**. - Its design allows for effective stabilization and helps reduce muscle spasms and pain associated with these types of fractures. *Tibia* - While it can be used in some lower limb injuries, the Thomas splint is not the primary or most effective device for isolated **tibial fractures**. - Other splints, such as a **long leg posterior splint** or an air splint, are typically preferred for tibial immobilization. *Radius* - The **radius** is a bone in the forearm, and its fractures are typically managed with a variety of **short arm casts** or splints. - The Thomas splint is specifically designed for the much longer and larger **femur** and would be completely unsuitable for a forearm injury. *Ulna* - Similar to the radius, the **ulna** is a forearm bone, and its fractures require immobilization techniques appropriate for the upper limb. - The **Thomas splint's bulk** and mechanism are inappropriate for the immobilization of forearm bones.

Question 1

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 2

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 3

What condition is associated with the absence of femoral artery pulsation in the affected limb?

Accepted Answer

Posterior dislocation of the hip

Answer

Fracture of the neck of femur

Answer

Legg-Calvé-Perthes disease

Answer

None of the options

Question 4

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 5

The most common complication of intracapsular fracture neck of femur is

Accepted Answer

Non-Union

Answer

Mal union

Answer

Osteoarthritis

Answer

Shortening

Question 6

Most common complication of fracture of tibia

Accepted Answer

Delayed union

Answer

Infection

Answer

Compartment syndrome

Answer

Vascular injury

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

The Kocher maneuver is primarily indicated for which of the following conditions?

Accepted Answer

Shoulder reduction

Answer

Elbow reduction

Answer

Ankle dislocation

Answer

Knee dislocation

Question 9

Most common complication of mid shaft humerus fracture is ?

Accepted Answer

Radial nerve palsy

Answer

Median nerve palsy

Answer

Nonunion

Answer

Malunion

Question 10

Thomas splint is used for immobilizing fractures of ?

Accepted Answer

Femur

Answer

Tibia

Answer

Radius

Answer

Ulna

Trauma — MCQs

Trauma — MCQs

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