Trauma Practice Questions

Q: 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?

Acromioclavicular ligament. ***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.

Q: 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?

Fracture scaphoid. ### 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).

Q: Which bone is commonly associated with a 'runner's fracture'?

Fibula. **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).

Q: A boxer's fracture is a fracture through which part of the bone?

5th metacarpal neck. **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).

Q: 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?

Vastus medialis. ### 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.

Q: In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?

Within 6 hours. **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.

Q: In a subcondylar fracture, in which direction does the condyle move?

Anterior — medial direction. 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.

Question 1

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?

Accepted Answer

Acromioclavicular ligament

Answer

Glenohumeral ligament

Answer

Coracoacromial ligament

Answer

Tendon of long head of biceps

Question 2

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?

Accepted Answer

Extensor carpi radialis longus

Answer

Biceps

Answer

Flexor carpi radialis

Answer

Flexor carpi ulnaris

Question 3

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?

Accepted Answer

Fracture scaphoid

Answer

Fracture Colles'

Answer

Fracture pisiform

Answer

Wrist osteoarthritis

Question 4

Which bone is commonly associated with a 'runner's fracture'?

Accepted Answer

Fibula

Answer

Femur

Answer

Tibia

Answer

All of the above

Question 5

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?

Accepted Answer

Displacement and comminution

Answer

Sling treatment

Answer

Figure-of-eight bandage treatment

Answer

Male sex

Question 6

A boxer's fracture is a fracture through which part of the bone?

Accepted Answer

5th metacarpal neck

Answer

5th metacarpal base

Answer

5th metatarsal base

Answer

5th metatarsal neck

Question 7

What is a floating knee?

Accepted Answer

Femoral shaft fracture with proximal tibia metaphyseal fracture

Answer

Damage to both anterior and posterior cruciate ligaments

Answer

Condition of the knee due to a tear in the medial and lateral collateral ligaments

Answer

Advanced tuberculosis of the knee joint

Question 8

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?

Accepted Answer

Vastus medialis

Answer

Vastus lateralis

Answer

Vastus intermedius

Answer

Rectus femoris

Question 9

In Volkmann's ischemic contracture, what is the recommended timeframe for surgical intervention?

Accepted Answer

Within 6 hours

Answer

Within 1 hour

Answer

Within 24 hours

Answer

Within 72 hours

Question 10

In a subcondylar fracture, in which direction does the condyle move?

Accepted Answer

Anterior — medial direction

Answer

Anterior — lateral direction

Answer

Posterior — medial direction

Answer

Posterior — lateral direction

Trauma — MCQs

Trauma — MCQs

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