Trauma Practice Questions

Q: In an extension type of supracondylar fracture, what is the usual direction of displacement?

Posterolateral. ***Posterolateral*** - In an **extension type supracondylar fracture**, the distal fragment (forearm and hand) is typically displaced **posteriorly and laterally**. - This common displacement pattern is often caused by a **fall on an outstretched hand** with the elbow in extension, forcing the olecranon against the humerus. *Anteromedial* - This is an **uncommon displacement** in supracondylar fractures and is not characteristic of the extension type. - While displacement can have a medial or lateral component, the primary displacement in extension type is posterior. *Anterolateral* - Displacement in an anterior direction is typically seen in **flexion-type supracondylar fractures**, which are much rarer. - Even in flexion-type fractures, the lateral component of displacement is less common than medial. *Posteromedial* - While posterior displacement is characteristic of extension supracondylar fractures, a **posteromedial displacement** is encountered, but **posterolateral** is the *most common* pattern. - The varus force often involved in these injuries tends to promote lateral displacement of the distal fragment.

Q: Garden spade deformity is seen in ?

Smith's fracture. ***Smith's fracture*** - This fracture involves **volar displacement** of the distal radial fragment, causing the characteristic **garden spade deformity** or **reverse Colles' fracture**. - It typically results from a fall onto a **flexed wrist** or a direct blow to the back of the wrist. *Colle’s fracture* - This fracture is characterized by **dorsal displacement** of the distal radial fragment, leading to a **dinner fork deformity**. - It usually occurs from a fall onto an **extended wrist**. *Bennett’s fracture* - This is an **intra-articular fracture** of the base of the **first metacarpal bone**, involving the carpometacarpal joint. - It is often caused by axial loading on a partially flexed thumb. *Barton’s fracture* - This is an **intra-articular fracture** of the distal radius involving either the **dorsal or volar rim**. - It is essentially a **shear fracture** with associated carpal displacement.

Q: Proximal humerus fracture which has maximum chances of avascular necrosis

Four part. ***Four part fracture*** - A **four-part proximal humerus fracture** typically involves displacement of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. - This extensive displacement significantly disrupts the **blood supply** to the humeral head, specifically the **arcuate artery** and its branches, leading to a high risk of **avascular necrosis**. *One part fracture* - A **one-part fracture** indicates that the fracture fragments are minimally displaced (<1 cm or <45° angulation). - The **blood supply** to the humeral head remains largely intact, resulting in a very low risk of avascular necrosis. *Two part fracture* - A **two-part fracture** involves displacement of one major fragment (e.g., surgical neck or tuberosity) from the humeral head. - While there is some disruption, the overall risk of **avascular necrosis** is lower compared to more complex fractures. *Three part fracture* - A **three-part fracture** involves separate displacement of the humeral head and two tuberosities. - This fracture pattern causes more significant disruption to the **vascularity** of the humeral head than two-part fractures but generally less than four-part fractures.

Q: What is the most common type of dislocation of the elbow joint?

Posterolateral dislocation. ***Posterolateral dislocation*** - This is the **most common type of elbow dislocation**, accounting for over 90% of cases. - The **radius and ulna displace posterior and lateral** relative to the humerus. *Posterior dislocation* - While common, **pure posterior dislocations are less frequent** than posterolateral disruptions. - In a pure posterior dislocation, the **forearm bones move directly backward**, without a significant lateral component. *Posteromedial dislocation* - This is a **less common type of elbow dislocation**, involving the ulna and radius displacing posterior and medial. - Often associated with **more complex soft tissue and bony injuries**. *Lateral dislocation* - **Pure lateral dislocations of the elbow are rare** and usually involve significant disruption of the medial collateral ligament. - It occurs when the **forearm bones move directly lateral** to the humerus.

Q: Treatment of choice for displaced fracture neck femur in a 40 years old female

Multiple screw fixation. ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.

Q: Tension band wiring is indicated in fracture of which of the following ?

Olecranon. ***Olecranon*** - **Tension band wiring** is a widely used and effective technique for fixing transverse and short oblique **olecranon fractures**. - This method converts **distractive forces**, typically exerted by the triceps muscle, into **compressive forces** at the fracture site, promoting healing and stability. *Fracture of the humerus* - While various fixation methods exist for humeral fractures, **tension band wiring** is not a primary or common technique due to the complex anatomy and diverse fracture patterns of the humerus. - Humerus fractures often require **plates, screws, or intramedullary nails** for stable fixation, especially in diaphyseal or intricate joint fractures. *Fracture of the tibia* - **Tibial fractures** typically involve significant weight-bearing forces and often require strong internal fixation like **intramedullary nailing** or **plate and screw constructs**. - **Tension band wiring** is generally not suitable for the robust forces across the tibia and is rarely used alone for these fracture types. *Fracture of the spine* - **Spinal fractures** require highly specialized surgical approaches, often involving **pedicle screws, rods, or anterior instrumentation**, depending on the fracture stability and neurological involvement. - **Tension band wiring** is not an appropriate technique for stabilizing spinal fractures due to the complex biomechanics and critical neural structures involved.

Q: Which of the following describes grade 2 fracture neck femur?

Complete fracture with undisplaced neck. ***Complete fracture with undisplaced neck*** - A **Garden Type II fracture** of the femoral neck is characterized by a **complete fracture line** through the femoral neck. - Despite the complete fracture, the **femoral head remains undisplaced** and in its anatomical position, indicating an intact or minimally disrupted posteromedial soft-tissue hinge. *Incomplete fracture, medial trabeculae intact* - This description corresponds to a **Garden Type I fracture**, which is an **incomplete fracture** of the femoral neck, usually impacted in valgus. - In such cases, the medial trabeculae are often intact, or show buckling on the lateral side, indicating a stable fracture. *Complete fracture with ischemic head* - The presence of an **ischemic head** is a complication that can occur with any displaced femoral neck fracture (Garden Type III or IV), but it's not a primary defining characteristic of a specific Garden grade. - **Avascular necrosis (AVN)** of the femoral head is a risk, especially with displacement, due to disruption of the blood supply. *Moderate displacement of neck, vascularity damaged* - This description is more consistent with a **Garden Type III fracture**, where there is a **complete fracture with moderate displacement** of the femoral head, usually with some varus angulation. - Such displacement significantly increases the risk of **vascular injury** to the femoral head, predisposing to avascular necrosis.

Q: What is seen on x-ray with posterior elbow dislocation

Coronoid process appears posterior to humerus. ***Coronoid process appears posterior to humerus*** - In a **posterior elbow dislocation**, the ulna and radius (including the coronoid process) are displaced **posteriorly** relative to the distal humerus. - This posterior displacement means the coronoid process, which normally articulates with the trochlea of the humerus, will be located behind the humerus on a lateral X-ray view. *Coronoid process appears anterior to humerus* - This position would typically be seen in an **anterior elbow dislocation**, which is rare. - In a normal elbow, the coronoid process is anterior to the elbow joint's axis but maintains articulation with the trochlea. *Coronoid process appears below humerus* - The term "below" is imprecise in this context and does not accurately describe the characteristic displacement in a posterior dislocation. - Displacement in dislocations is typically described in relation to the main bone involved (humerus) in an anterior-posterior or medial-lateral plane. *No visible coronoid process* - The coronoid process is an integral part of the ulna and is almost always visible on plain X-rays, even in dislocations. - Its presence is key to identifying the ulna's position relative to the humerus.

Q: Most common bone for which nailing is done

Tibia. ***Tibia*** - The **tibia** is the most common long bone for which **intramedullary nailing** (IM nailing) is performed, particularly for fractures of the **tibial shaft**. - Its subcutaneous location and strong cortical bone make it amenable to this type of internal fixation, promoting stability and healing. *Radius* - Fractures of the **radius**, especially distal radial fractures, are more commonly treated with **plate and screw fixation** or external fixation, rather than intramedullary nailing. - While IM nailing can be used for some radial shaft fractures, it is not the most common bone for this procedure. *Ulna* - Like the radius, the **ulna** is less frequently fixed with intramedullary nails; **plate and screw fixation** is generally preferred for ulnar shaft fractures. - Its triangular cross-section and the presence of the interosseous membrane complicate IM nailing in some cases. *Humerus* - While **humeral shaft fractures** can be treated with intramedullary nailing, especially in comminuted or pathological fractures, it is overall less common than tibial nailing. - The risk of shoulder and elbow stiffness, as well as radial nerve injury, are considerations with humeral nailing.

Question 1

In an extension type of supracondylar fracture, what is the usual direction of displacement?

Accepted Answer

Posterolateral

Answer

Anteromedial

Answer

Anterolateral

Answer

Posteromedial

Question 2

Garden spade deformity is seen in ?

Accepted Answer

Smith's fracture

Answer

Colle’s fracture

Answer

Bennett’s fracture

Answer

Barton’s fracture

Question 3

Proximal humerus fracture which has maximum chances of avascular necrosis

Accepted Answer

Four part

Answer

One part

Answer

Two part

Answer

Three part

Question 4

What is the most common type of dislocation of the elbow joint?

Accepted Answer

Posterolateral dislocation

Answer

Posterior dislocation

Answer

Posteromedial dislocation

Answer

Lateral dislocation

Question 5

Treatment of choice for displaced fracture neck femur in a 40 years old female

Accepted Answer

Multiple screw fixation

Answer

None of the options

Answer

Bipolar hemiarthroplasty

Answer

THR

Question 6

Tension band wiring is indicated in fracture of which of the following ?

Accepted Answer

Olecranon

Answer

Fracture of the humerus

Answer

Fracture of the tibia

Answer

Fracture of the spine

Question 7

Which of the following describes grade 2 fracture neck femur?

Accepted Answer

Complete fracture with undisplaced neck

Answer

Incomplete fracture, medial trabeculae intact

Answer

Complete fracture with ischemic head

Answer

Moderate displacement of neck, vascularity damaged

Question 8

What is seen on x-ray with posterior elbow dislocation

Accepted Answer

Coronoid process appears posterior to humerus

Answer

Coronoid process appears anterior to humerus

Answer

Coronoid process appears below humerus

Answer

No visible coronoid process

Question 9

Volkmann's contracture: which artery is involved in this condition?

Accepted Answer

Brachial artery

Answer

Radial

Answer

Ulnar

Answer

Anterior interosseous artery

Question 10

Most common bone for which nailing is done

Accepted Answer

Tibia

Answer

Radius

Answer

Ulna

Answer

Humerus

Trauma — MCQs

Trauma — MCQs

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