Trauma Practice Questions

Q: Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Sub Capital fractures. ***Sub Capital fractures*** - These fractures occur at the anatomical **neck of the femur**, very close to the femoral head. - Due to their location, they disrupt the main blood supply to the femoral head, primarily from the **retinacular arteries**, leading to a high risk of **avascular necrosis**. *Trans cervical fracture* - This fracture occurs through the **midneck of the femur**, which is still within the intracapsular region. - While it has a significant risk of **ischemia**, the compromise is generally less severe than in subcapital fractures. *Intertrochanteric fractures* - These are **extracapsular fractures** occurring between the greater and lesser trochanters. - They tend to have an **excellent blood supply** and thus a low risk of avascular necrosis, but are associated with more significant blood loss and malunion issues. *Basicervical fracture* - This is an **intracapsular fracture** that occurs at the base of the femoral neck, near the junction with the trochanters. - Although intracapsular, its position is slightly more proximal than subcapital fractures, potentially leaving more of the **retinacular vessels** intact, resulting in a somewhat lower risk of avascular necrosis compared to subcapital fractures.

Q: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Hemiarthroplasty. ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.

Q: The K nail can be used for all of the following types of fractures except -

Intertrochanteric fractures. ***Intertrochanteric fractures*** - The K nail (specifically, the Kuntscher nail) is a **straight intramedullary nail** primarily designed for diaphyseal fractures. - It is **not suitable for intertrochanteric fractures** as these are metaphyseal and involve the proximal femur, requiring implants that offer greater stability in this region, such as cephalomedullary nails or plates. *Isthmic femur shaft fractures* - The **Kuntscher nail** was originally developed for and is well-suited for **isthmic femur shaft fractures** due to the narrow canal providing good cortical fixation. - Its design as a straight, broad nail fits snugly in the isthmus, providing excellent stability. *Low subtrochanteric fractures* - While more challenging, **K nails can be used for low subtrochanteric fractures**, especially if the fracture extends into the diaphyseal region. - However, newer implants like **cephalomedullary nails** are often preferred due to better biomechanical stability in this region. *Distal femur shaft fractures* - **K nails can be employed for distal femoral shaft fractures** if the fracture pattern allows for adequate fixation distal to the isthmus without compromising knee joint function. - The nail must be long enough to achieve stability, and the lack of proper locking mechanisms in traditional K nails may be a limiting factor compared to locked intramedullary nails.

Q: What is the term used to describe an inferior dislocation of the shoulder joint?

Luxatio erecta. **Luxatio erecta** - **Luxatio erecta** is a rare but distinct type of shoulder dislocation characterized by the arm being fixed in an **abducted** and **externally rotated** position (arm pointing upwards). - This specific posture indicates an **inferior dislocation** where the humeral head is displaced below the glenoid fossa. *Anterior Dislocation of the shoulder joint* - An **anterior dislocation** is the most common type, where the humeral head moves forward and medially in relation to the glenoid. - The arm is typically held in slight **abduction** and **external rotation**, not fixed in an erect position. *Posterior Dislocation of the shoulder joint* - A **posterior dislocation** is rare and often results from seizures or electrocution, where the humeral head displaces posteriorly. - The arm is typically held in **adduction** and **internal rotation**, which is distinct from an inferior dislocation. *Superior Dislocation of the shoulder joint* - **Superior dislocations** of the shoulder are extremely rare and usually involve significant trauma, often with associated fractures of the acromion or clavicle. - The humeral head displaces upwards, typically causing the arm to be held in an adducted position, not the characteristic "arms up" posture of luxatio erecta.

Q: In which condition is the Hamilton Ruler test sign positive?

Anterior dislocation of shoulder. ***Anterior dislocation of shoulder*** - The **Hamilton Ruler test** is positive when a straight edge, like a ruler, can be laid across the **lateral aspect of the deltoid prominence** from the acromion to the lateral epicondyle. - This is indicative of the **loss of the normal rounded contour of the shoulder**, which occurs due to the humeral head dislocating anteriorly. *Acromioclavicular joint dislocation* - This condition presents with a **"step-off" deformity** at the AC joint and pain directly over the joint, but the overall contour of the shoulder glenohumeral joint is preserved. - The deltoid prominence remains intact, making the Hamilton Ruler test negative. *Posterior dislocation of shoulder* - In posterior dislocation, the **humeral head moves posteriorly**, and the anterior contour of the shoulder might appear flattened, but the characteristic prominent anterior bulge seen in anterior dislocation is absent. - The Hamilton Ruler test specifically assesses for the loss of the lateral deltoid prominence, which is more typical of anterior displacement. *Luxatio erecta* - **Luxatio erecta** is an inferior dislocation of the shoulder where the arm is fixed in an **abducted and externally rotated position**, making it appear "erect". - While a severe type of shoulder dislocation, the specific anatomical changes that lead to a positive Hamilton Ruler test (loss of lateral deltoid prominence with the humeral head moving anteriorly and medially) are not typically present in this configuration.

Q: Which of the following statements is true regarding a Monteggia fracture?

Upper ulnar fracture with dislocated radial head.. ***Upper ulnar fracture with dislocated radial head.*** - A Monteggia fracture is classically defined as a fracture of the **proximal or middle third of the ulna** accompanied by an **anterior dislocation of the radial head**. - This injury pattern disrupts the alignment of the **forearm bones** and the **elbow joint**, requiring careful reduction and stabilization. *Upper radial fracture with dislocated ulna.* - This statement incorrectly identifies the fractured bone as the radius and the dislocated bone as the ulna. - The defining characteristic of a Monteggia fracture is the **ulnar fracture** and **radial head dislocation**. *Lower radial fracture with dislocated ulna.* - This describes a different type of injury, such as a **Galeazzi fracture**, which involves a **radial shaft fracture** with dislocation of the **distal radioulnar joint**. - It does not fit the criteria for a Monteggia fracture pattern. *Lower ulnar fracture with dislocated radius.* - This description is not consistent with a Monteggia fracture, which specifically involves the **proximal ulna** and **radial head dislocation**. - A lower ulnar fracture with distal radius dislocation is a distinct injury pattern.

Q: Which of the following fractures is least likely associated with vascular injury?

Fracture shaft of humerus. ***Fracture shaft of humerus*** - While any fracture can theoretically cause vascular injury, **mid-shaft humeral fractures** are less commonly associated with significant **vascular compromise** compared to those around major joints or near critical neurovascular bundles. - The **brachial artery** and its branches are often sufficiently mobile and protected by surrounding musculature in the mid-shaft region, reducing the incidence of direct laceration or entrapment. *Fracture supracondylar femur* - **Supracondylar femur fractures** are in close proximity to the **femoral artery** and its branches in the popliteal fossa. - Displacement of these fractures can easily **lacerate or compress** these vital vessels, leading to high rates of vascular injury. *Fracture supracondylar humerus* - **Supracondylar humerus fractures** in children are notoriously associated with **brachial artery injury** due to the artery's close proximity and fixated position over the joint. - The acute angulation and displacement often seen in these fractures put the artery at significant risk of **kinking, compression, or transection**. *Fracture shaft of femur* - **Femoral shaft fractures** can be associated with significant vascular injury, particularly from **large displaced fragments** or high-energy trauma. - The **superficial femoral artery** and its perforating branches can be torn, leading to substantial hemorrhage or arterial compromise.

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Open femoral fracture. ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.

Q: What is the generally recommended maximum weight for skeletal traction in adult patients?

15 kg. ***15 kg*** - While the specific weight can vary based on the bone and patient, 10-15 kg is generally the **maximum recommended weight for skeletal traction** in adults to avoid complications. - Applying too much weight risks **damage to the bone, soft tissues, and nerves**, as well as potential pin site infections and neurovascular compromise. *5 kg* - This weight is typically more appropriate for **skin traction**, where the pulling force is applied externally to the skin, limiting the amount of weight that can be safely used without causing skin damage. - In skeletal traction, 5 kg is often used for **initial alignment or very tenuous fractures**, but it is generally insufficient for significant reduction or long-term stabilization. *10 kg* - 10 kg is a common starting point or moderate weight used in skeletal traction, particularly for **femur or tibia fractures**. - While often effective, it is not consistently the maximum safe weight, as some situations may allow or require slightly more weight up to 15 kg for optimal reduction. *20 kg* - Applying 20 kg of weight in skeletal traction is generally considered **excessive and dangerous** in most adult applications. - This high amount of weight significantly increases the risk of **pin loosening, osteomyelitis, neurovascular injury, and avascular necrosis**, especially in areas like the cervical spine or tibia.

Q: Most common site of myositis ossificans ?

Quadriceps/Thigh. ***Quadriceps/Thigh*** - The **quadriceps and thigh** muscles are frequently affected due to their common involvement in sports injuries and trauma. - This region is prone to **hematoma formation** after contusions, which can predispose to ectopic bone formation. *Shoulder* - While the shoulder can be affected by myositis ossificans, it is **less common** than the quadriceps. - Traumatic myositis ossificans in the shoulder typically involves the **deltoid muscle**. *Wrist* - Myositis ossificans of the **wrist is rare** and usually occurs after severe trauma or crush injuries. - The small muscle mass and limited direct trauma to the wrist muscles make it an **unlikely primary site**. *Elbow* - Myositis ossificans can occur around the elbow, particularly in the **brachialis muscle**, often following dislocations or fractures. - However, the elbow is still **less commonly affected overall** compared to the large muscle groups of the thigh.

Question 1

Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?

Accepted Answer

Sub Capital fractures

Answer

Basicervical fracture

Answer

Trans cervical fracture

Answer

Intertrochanteric fractures

Question 2

Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Accepted Answer

Hemiarthroplasty

Answer

Closed reduction and fixation with three cancellous screws

Answer

Longitudinal skin traction for 6 weeks

Answer

Excision arthroplasty

Question 3

The K nail can be used for all of the following types of fractures except -

Accepted Answer

Intertrochanteric fractures

Answer

Isthmic femur shaft fractures

Answer

Low subtrochanteric fractures

Answer

Distal femur shaft fractures

Question 4

What is the term used to describe an inferior dislocation of the shoulder joint?

Accepted Answer

Luxatio erecta

Answer

Anterior Dislocation of the shoulder joint

Answer

Posterior Dislocation of the shoulder joint

Answer

Superior Dislocation of the shoulder joint

Question 5

In which condition is the Hamilton Ruler test sign positive?

Accepted Answer

Anterior dislocation of shoulder

Answer

Posterior dislocation of shoulder

Answer

Luxatio erecta

Answer

Acromioclavicular joint dislocation

Question 6

Which of the following statements is true regarding a Monteggia fracture?

Accepted Answer

Upper ulnar fracture with dislocated radial head.

Answer

Upper radial fracture with dislocated ulna.

Answer

Lower radial fracture with dislocated ulna.

Answer

Lower ulnar fracture with dislocated radius.

Question 7

Which of the following fractures is least likely associated with vascular injury?

Accepted Answer

Fracture shaft of humerus

Answer

Fracture supracondylar femur

Answer

Fracture supracondylar humerus

Answer

Fracture shaft of femur

Question 8

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Open femoral fracture

Answer

Closed tibial fracture

Answer

Open humeral fracture

Answer

Closed humeral fracture

Question 9

What is the generally recommended maximum weight for skeletal traction in adult patients?

Accepted Answer

15 kg

Answer

5 kg

Answer

10 kg

Answer

20 kg

Question 10

Most common site of myositis ossificans ?

Accepted Answer

Quadriceps/Thigh

Answer

Shoulder

Answer

Wrist

Answer

Elbow

Trauma — MCQs

Trauma — MCQs

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