Trauma — MCQs
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A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?
A 23-year-old man involved in an accident is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side, he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in both arms and the inability to move parts of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal. Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?
A patient presented with a history of fall on an outstretched hand. There is pain and swelling over the radial aspect of the wrist without any obvious deformity. The radial styloid process is at a lower level than the ulnar styloid process. Tenderness can be elicited in the anatomical snuff box. Which of the following is the most likely diagnosis?
Which bone is commonly associated with a 'runner's fracture'?
A 17-year-old high school tennis player sustains a right midshaft clavicle fracture. Which of the following increases the risk of nonunion in non-operative treatment of clavicle fractures?
A boxer's fracture is a fracture through which part of the bone?
What is a floating knee?
A 34-year-old woman sustained a direct blow to the patella from the dashboard during an automobile crash. Radiographic examination reveals patellofemoral syndrome, characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening through physical rehabilitation to prevent future dislocations?
In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?
In a subcondylar fracture, in which direction does the condyle move?
Trauma Indian Medical PG Practice Questions and MCQs
Question 661: A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?
- A. Glenohumeral ligament
- B. Coracoacromial ligament
- C. Tendon of long head of biceps
- D. Acromioclavicular ligament (Correct Answer)
Explanation: ***Acromioclavicular ligament*** - **AC joint separation** is common in young athletes, especially basketball players, following direct trauma or falls onto the shoulder. - Typical **radiographic findings** include **AC joint widening** or **distal clavicle elevation**, confirming ligament rupture. *Glenohumeral ligament* - Tears typically cause **shoulder instability** and **recurrent dislocations**, not the acute trauma pattern seen here. - **MRI** would be needed for diagnosis as standard radiographs rarely show glenohumeral ligament injuries clearly. *Coracoacromial ligament* - This ligament forms the **coracoacromial arch** and rarely tears in acute trauma scenarios. - Injury would cause **subacromial impingement** symptoms rather than the typical presentation of AC joint pathology. *Tendon of long head of biceps* - **Biceps tendon rupture** presents with characteristic **"Popeye sign"** (visible muscle bulging) and weakness in flexion. - More common in **older patients** and typically associated with **chronic rotator cuff disease**, not acute sports trauma.
Question 662: A 23-year-old man involved in an accident is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side, he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in both arms and the inability to move parts of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal. Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?
- A. Biceps
- B. Extensor carpi radialis longus (Correct Answer)
- C. Flexor carpi radialis
- D. Flexor carpi ulnaris
Explanation: ### Explanation The correct answer is **Extensor carpi radialis longus (B)**. This question tests your knowledge of nerve-bone relationships in the humerus. The patient has three distinct fractures: 1. **Left distal third humeral shaft (Holstein-Lewis fracture):** This is classically associated with **Radial nerve** injury as the nerve spirals around the humerus and pierces the lateral intermuscular septum. 2. **Right surgical neck of humerus:** This is associated with **Axillary nerve** injury. 3. **Right medial epicondyle:** This is associated with **Ulnar nerve** injury. The **Radial nerve** supplies the extensors of the wrist and fingers. The **Extensor carpi radialis longus (ECRL)** is innervated by the radial nerve (C6, C7) just proximal to the elbow joint. A fracture of the distal third of the humeral shaft is the most common site for a radial nerve palsy, leading to "wrist drop" and inability to use the ECRL. #### Why the other options are incorrect: * **A. Biceps:** Innervated by the **Musculocutaneous nerve**. This nerve is rarely injured in humeral shaft or epicondylar fractures. * **C. Flexor carpi radialis:** Innervated by the **Median nerve**. The median nerve is typically injured in supracondylar fractures (especially posterolateral displacement) or carpal tunnel syndrome, not usually in the fractures described here. * **D. Flexor carpi ulnaris:** Innervated by the **Ulnar nerve**. While the patient has a medial epicondyle fracture (ulnar nerve risk), the question asks which muscle the patient will "most likely" have trouble using. In clinical vignettes involving humeral shaft fractures, radial nerve deficits are the highest-yield association. #### NEET-PG High-Yield Pearls: * **Holstein-Lewis Fracture:** A spiral fracture of the distal 1/3 of the humerus resulting in radial nerve palsy. * **Nerve-Bone Map:** * Surgical Neck → Axillary Nerve * Spiral Groove (Midshaft) → Radial Nerve * Distal 1/3 (Holstein-Lewis) → Radial Nerve * Supracondylar (Extension type) → Median Nerve (AION) * Medial Epicondyle → Ulnar Nerve * **Management:** Most radial nerve palsies in closed humeral fractures are neuropraxias and are managed **expectantly** (observation) as they often recover spontaneously.
Question 663: A patient presented with a history of fall on an outstretched hand. There is pain and swelling over the radial aspect of the wrist without any obvious deformity. The radial styloid process is at a lower level than the ulnar styloid process. Tenderness can be elicited in the anatomical snuff box. Which of the following is the most likely diagnosis?
- A. Fracture scaphoid (Correct Answer)
- B. Fracture Colles'
- C. Fracture pisiform
- D. Wrist osteoarthritis
Explanation: ### Explanation **1. Why Scaphoid Fracture is Correct:** The scaphoid is the most commonly fractured carpal bone, typically resulting from a **fall on an outstretched hand (FOOSH)**. The hallmark clinical finding is **tenderness in the anatomical snuffbox**. A crucial detail in this question is that the **radial styloid remains at a lower level than the ulnar styloid**. This indicates that the normal anatomy of the distal radius is intact, effectively ruling out a distal radius fracture (like Colles') where the radial styloid would shift proximally. **2. Why Other Options are Incorrect:** * **Colles' Fracture:** While also caused by FOOSH, it presents with a classic "dinner fork deformity" and a change in the styloid relationship (the radial styloid moves up to the level of or above the ulnar styloid). * **Fracture Pisiform:** The pisiform is located on the **ulnar (medial) aspect** of the wrist. Tenderness would be localized to the hypothenar area, not the radial anatomical snuffbox. * **Wrist Osteoarthritis:** This is a chronic degenerative condition. While it causes pain, it does not typically present with acute post-traumatic swelling and localized snuffbox tenderness following a fall. **3. High-Yield NEET-PG Pearls:** * **Blood Supply:** The scaphoid has a retrograde blood supply (distal to proximal). Fractures at the **proximal pole** have the highest risk of **Avascular Necrosis (AVN)** and non-union. * **Radiology:** Scaphoid fractures may not appear on initial X-rays. If clinical suspicion is high despite normal X-rays, the wrist should be immobilized in a **thumb spica cast** and re-imaged after 10–14 days. * **View of Choice:** Scaphoid view (PA view with the wrist in ulnar deviation).
Question 664: Which bone is commonly associated with a 'runner's fracture'?
- A. Fibula (Correct Answer)
- B. Femur
- C. Tibia
- D. All of the above
Explanation: **Explanation:** A **Runner’s Fracture** refers specifically to a stress fracture of the **distal third of the fibula**, typically occurring 3–5 cm above the lateral malleolus. While the tibia bears the majority of the body's weight, the fibula acts as a site for muscle attachment and helps in dissipating torsional forces. In long-distance runners, repetitive rhythmic stress leads to bone resorption outpacing bone formation, resulting in a micro-fracture. **Analysis of Options:** * **A. Fibula (Correct):** The distal fibula is the classic site for this eponym. It is caused by repetitive muscle pull (specifically the flexors and peroneals) and repetitive ankle loading during the gait cycle. * **B. Femur (Incorrect):** While stress fractures can occur in the femoral neck or shaft (often seen in military recruits or athletes), they are not termed "runner’s fracture." * **C. Tibia (Incorrect):** The tibia is actually the *most common* site for stress fractures in athletes overall (often presenting as "shin splints" progressing to cortical breaks), but the specific clinical eponym "runner’s fracture" is reserved for the fibula. * **D. All of the above (Incorrect):** The term is specific to the fibular site. **High-Yield Clinical Pearls for NEET-PG:** 1. **March Fracture:** A stress fracture of the shaft of the **2nd or 3rd metatarsal**, commonly seen in military recruits. 2. **Dancer’s Fracture:** An avulsion fracture of the base of the **5th metatarsal** (insertion of Peroneus brevis). 3. **Jones Fracture:** A fracture at the **meta-diaphyseal junction** of the 5th metatarsal (Zone 2), notorious for high rates of non-union. 4. **Investigation of Choice:** While X-rays may be negative in the first 2–3 weeks, **MRI** is the most sensitive gold standard for early detection of stress fractures (showing marrow edema).
Question 665: A 17-year-old high school tennis player sustains a right midshaft clavicle fracture. Which of the following increases the risk of nonunion in non-operative treatment of clavicle fractures?
- A. Sling treatment
- B. Figure-of-eight bandage treatment
- C. Displacement and comminution (Correct Answer)
- D. Male sex
Explanation: **Explanation:** Clavicle fractures are common orthopedic injuries, traditionally managed non-operatively. However, identifying risk factors for **nonunion** (failure of the bone to heal) is crucial for deciding between conservative management and surgical fixation. **1. Why "Displacement and Comminution" is correct:** The most significant predictors of nonunion in midshaft clavicle fractures are mechanical and biological. * **Displacement:** Complete lack of cortical apposition (100% displacement) significantly increases the risk of nonunion (up to 15-20%) compared to minimally displaced fractures (<1%). * **Comminution:** The presence of multiple fragments indicates a high-energy mechanism, leading to greater soft tissue envelope disruption and compromised local blood supply, both of which hinder secondary bone healing. * **Shortening:** Clinical studies also highlight that initial shortening of **>2 cm** is a strong predictor of poor functional outcomes and nonunion. **2. Why the other options are incorrect:** * **A & B (Sling vs. Figure-of-eight):** Multiple randomized controlled trials have shown no significant difference in union rates or functional outcomes between these two methods. The figure-of-eight bandage is often less tolerated due to skin irritation and axillary pressure. * **D (Male sex):** Epidemiologically, **female sex** and **advanced age** are actually associated with higher rates of nonunion, likely due to lower bone mineral density. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Middle third (80%), as it is the thinnest part and lacks muscular/ligamentous support. * **Deforming forces:** The proximal fragment is pulled **superoposteriorly** by the Sternocleidomastoid; the distal fragment is pulled **inferomedially** by gravity and the Pectoralis major. * **Indications for Surgery:** Open fractures, neurovascular injury, skin tenting, >2cm shortening, and 100% displacement. * **Most common complication:** Malunion (healing with deformity), though often asymptomatic. Nonunion is less common but more symptomatic.
Question 666: A boxer's fracture is a fracture through which part of the bone?
- A. 5th metacarpal base
- B. 5th metacarpal neck (Correct Answer)
- C. 5th metatarsal base
- D. 5th metatarsal neck
Explanation: **Explanation:** A **Boxer’s fracture** is a fracture of the **neck of the 5th metacarpal**. It typically occurs when a person strikes a hard object with a clenched fist. The force is transmitted axially through the metacarpal, leading to a fracture at its weakest point—the distal neck. This often results in volar (palmar) angulation of the metacarpal head due to the pull of the interosseous muscles. **Analysis of Options:** * **Option B (Correct):** The 5th metacarpal neck is the classic site. It is frequently seen in inexperienced "fighters" who punch with the ulnar side of the hand rather than the 2nd and 3rd metacarpals. * **Option A:** A fracture at the **5th metacarpal base** is often associated with a "Reverse Bennett’s fracture-dislocation," which is unstable due to the pull of the Extensor Carpi Ulnaris (ECU) tendon. * **Option C:** A fracture at the **5th metatarsal base** (foot) is known as a **Jones fracture** (at the metaphyseal-diaphyseal junction) or a **Pseudo-Jones fracture** (avulsion of the styloid process). * **Option D:** The 5th metatarsal neck is not a common eponym-associated fracture site. **Clinical Pearls for NEET-PG:** 1. **Acceptable Angulation:** The 5th metacarpal allows for more compensatory angulation (up to 40-50 degrees) than the 2nd or 3rd metacarpals because of the mobility of the CMC joint. 2. **Management:** Most are treated closed with an **Ulnar Gutter Splint**. 3. **Physical Exam:** Look for the "loss of the 5th knuckle" and check for rotational deformity (fingers should point toward the scaphoid tubercle when flexed).
Question 667: What is a floating knee?
- A. Damage to both anterior and posterior cruciate ligaments
- B. Condition of the knee due to a tear in the medial and lateral collateral ligaments
- C. Femoral shaft fracture with proximal tibia metaphyseal fracture (Correct Answer)
- D. Advanced tuberculosis of the knee joint
Explanation: **Explanation:** **Floating Knee** is a clinical entity where there are fractures of both the **femur and the tibia** in the same limb. This effectively "isolates" the knee joint from the rest of the skeletal axis, making it unstable and non-weight-bearing—hence the term "floating." 1. **Why Option C is correct:** The classic definition involves a fracture of the femoral shaft combined with a fracture of the tibia (either the shaft or the metaphyseal region). This double-level fracture pattern disrupts the structural continuity above and below the knee. 2. **Why other options are incorrect:** * **Options A & B:** These describe multi-ligamentous knee injuries. While these cause severe joint instability, they do not involve the long bone shafts required to define a "floating" segment. * **Option D:** Advanced tuberculosis leads to "triple deformity" (flexion, posterior subluxation, and external rotation) or a "fibrous ankylosis," but not a floating knee. **Clinical Pearls for NEET-PG:** * **Fraser Classification:** This is the most commonly used system to classify floating knees based on intra-articular involvement. * **Mechanism:** Usually results from high-energy trauma (e.g., motor vehicle accidents). * **Associated Risks:** There is a very high incidence of **fat embolism syndrome**, vascular injury (popliteal artery), and compartment syndrome. * **Management:** The standard of care is early total care with **surgical stabilization (internal fixation)** of both fractures to allow early mobilization.
Question 668: A 34-year-old woman sustained a direct blow to the patella from the dashboard during an automobile crash. Radiographic examination reveals patellofemoral syndrome, characterized by lateral dislocation of the patella. Which of the following muscles requires strengthening through physical rehabilitation to prevent future dislocations?
- A. Vastus lateralis
- B. Vastus medialis (Correct Answer)
- C. Vastus intermedius
- D. Rectus femoris
Explanation: ### Explanation **1. Why Vastus Medialis is Correct:** The patella has a natural tendency to dislocate **laterally** due to the "Q-angle" (the angle between the quadriceps tendon and the patellar ligament). To counteract this lateral pull, the body relies on dynamic and static stabilizers. The **Vastus Medialis**, specifically its horizontal fibers known as the **Vastus Medialis Obliquus (VMO)**, is the primary dynamic stabilizer that pulls the patella medially. In cases of patellofemoral syndrome or recurrent lateral dislocations, strengthening the VMO is the cornerstone of conservative management to realign the patella within the trochlear groove. **2. Why the Other Options are Incorrect:** * **Vastus Lateralis (A):** This muscle is located on the outer aspect of the thigh. Strengthening it would increase the lateral pull on the patella, potentially worsening the lateral maltracking or dislocation. * **Vastus Intermedius (C) & Rectus Femoris (D):** These muscles primarily contribute to the superior pull of the patella for knee extension. While they are part of the quadriceps mechanism, they do not provide the specific medial vector force required to prevent lateral displacement. **3. Clinical Pearls for NEET-PG:** * **Q-Angle:** A higher Q-angle (common in females due to a wider pelvis) increases the risk of lateral patellar subluxation. * **Patellar Dislocation:** Almost always occurs **laterally**. The most common mechanism is a twisting injury or direct lateral force. * **Apprehension Test (Fairbank’s Sign):** The clinical test used to diagnose patellar instability; the patient becomes anxious when the examiner attempts to push the patella laterally. * **Radiology:** The **Merchant view** or **Sunrise view** X-ray is best for evaluating the patellofemoral joint.
Question 669: In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?
- A. Within 1 hour
- B. Within 6 hours (Correct Answer)
- C. Within 24 hours
- D. Within 72 hours
Explanation: **Explanation:** Volkmann’s Ischemic Contracture (VIC) is the permanent end-stage sequela of untreated **Acute Compartment Syndrome**, most commonly following supracondylar fractures of the humerus. **1. Why "Within 6 Hours" is Correct:** The underlying pathophysiology is muscle and nerve ischemia due to increased intracompartmental pressure. Muscle tissue can tolerate ischemia for approximately **4 to 6 hours** before irreversible necrosis begins. Surgical decompression via **fasciotomy** must be performed within this "golden window" to restore perfusion and prevent the replacement of contractile muscle fibers with non-contractile fibrous tissue (infarction). **2. Analysis of Incorrect Options:** * **Within 1 hour (A):** While immediate intervention is ideal, 1 hour is clinically impractical for diagnosis and surgical prep, and tissue remains viable beyond this point. * **Within 24 hours (C) & 72 hours (D):** These timeframes are far beyond the threshold of muscle viability. By 12–24 hours, myonecrosis is usually complete, leading to permanent contracture, claw hand deformity, and sensory loss. **3. NEET-PG High-Yield Pearls:** * **Earliest Sign:** Severe pain out of proportion to the injury and **pain on passive stretching** of muscles. * **The 5 P’s:** Pain, Pallor, Paresthesia, Paralysis, and Pulselessness (Note: Pulselessness is a *late* sign). * **Most Common Muscle Involved:** Flexor Digitorum Profundus (FDP) and Flexor Pollicis Longus (FPL). * **Classic Deformity:** A "claw-like" hand with wrist flexion, metacarpophalangeal (MCP) joint hyperextension, and interphalangeal (IP) joint flexion. * **Diagnosis:** Primarily clinical, but can be confirmed by measuring intracompartmental pressure (e.g., Stryker monitor); a Delta pressure (Diastolic BP – Compartment pressure) **< 30 mmHg** is diagnostic.
Question 670: In a subcondylar fracture, in which direction does the condyle move?
- A. Anterior — lateral direction
- B. Posterior — medial direction
- C. Posterior — lateral direction
- D. Anterior — medial direction (Correct Answer)
Explanation: In subcondylar fractures of the mandible, the displacement of the condylar head is primarily determined by the pull of the **Lateral Pterygoid muscle**. ### Why the Correct Answer is Right The lateral pterygoid muscle originates from the lateral pterygoid plate and the greater wing of the sphenoid, and it inserts into the **pterygoid fovea** on the anterior surface of the condylar neck and the articular disc. When a fracture occurs in the subcondylar region, the condyle is no longer stabilized by the mandibular body. The tonic contraction or spasm of the lateral pterygoid muscle pulls the proximal fragment (the condyle) in an **Anterior and Medial** direction. ### Why the Other Options are Wrong * **Anterior-Lateral:** While there is an anterior pull, there are no significant muscles pulling the condyle laterally. The lateral pterygoid fibers converge medially toward their origin. * **Posterior-Medial/Lateral:** Posterior displacement is rare because the temporomandibular joint (TMJ) is anatomically bounded posteriorly by the external auditory canal and the post-glenoid tubercle. Furthermore, no major masticatory muscle pulls the condyle posteriorly. ### High-Yield Clinical Pearls for NEET-PG * **Deviation of Jaw:** On opening the mouth, the mandible deviates **towards the side of the fracture** because the lateral pterygoid on the fractured side is non-functional, while the contralateral muscle pushes the jaw toward the injured side. * **Bilateral Fractures:** If both condyles are fractured, it often results in an **Anterior Open Bite** due to the upward and backward pull of the elevator muscles (masseter, medial pterygoid, and temporalis) on the ramus. * **Most Common Site:** The subcondylar region is the most common site of mandibular fractures (indirect injury from a blow to the chin). * **Guardsman Fracture:** A midline symphysis fracture combined with bilateral subcondylar fractures.
Practice by Chapter
Principles of Fracture Management
Practice Questions
Upper Limb Fractures
Practice Questions
Lower Limb Fractures
Practice Questions
Spinal Trauma
Practice Questions
Pelvic and Acetabular Fractures
Practice Questions
Open Fractures
Practice Questions
Fractures in Children
Practice Questions
Fracture Complications
Practice Questions
Nonunion and Malunion
Practice Questions
Polytrauma Management
Practice Questions
Joint Dislocations
Practice Questions
Soft Tissue Injuries
Practice Questions
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