Trauma Practice Questions

Q: Which of the following is NOT a clinical feature of fat embolism?

Fat globules in urine are diagnostic. ***Fat globules in urine are diagnostic*** - While **fat globules** can sometimes be found in the urine of patients with fat embolism syndrome (FES), their presence is **not diagnostic** for FES. - The diagnosis of FES is primarily clinical, based on a constellation of symptoms rather than a single definitive laboratory test. *Tachypnoea* - **Tachypnoea** (rapid breathing) is a common clinical feature of fat embolism, often indicating **pulmonary involvement** and respiratory distress. - This symptom arises from **fat emboli** lodging in the pulmonary capillaries, leading to inflammation and impaired gas exchange. *Systemic hypoxia may occur* - **Systemic hypoxia**, characterized by low oxygen levels in the blood, is a significant complication of fat embolism, particularly due to **pulmonary dysfunction**. - **Impaired gas exchange** in the lungs caused by fat emboli leads to a reduction in oxygen saturation throughout the body. *Has a latent period of 1-3 days after trauma* - Fat embolism syndrome typically presents with a **latent period** of **12 to 72 hours (1-3 days)** following the initial traumatic event, such as a long bone fracture. - This delay is characteristic and helps differentiate FES from other immediate post-traumatic complications.

Q: True about proximal fragment in subtrochanteric fracture is?

All of the options. ***All of the options*** - In a subtrochanteric fracture, the **proximal fragment** is under the influence of several strong muscle groups, leading to a characteristic displacement. - The **iliopsoas muscle** causes **flexion**, the **gluteus medius and minimus** cause **abduction**, and the **short external rotators** cause **external rotation**. *Flexion* - The powerful **iliopsoas muscle** inserts on the lesser trochanter and acts to flex the hip. - This muscle pulls the proximal fragment anteriorly and superiorly, resulting in a **flexion deformity**. *Abduction* - The **gluteus medius and minimus muscles** attach to the greater trochanter and exert a strong abducting force. - This action pulls the proximal fragment away from the midline, causing **abduction**. *External rotation* - The **short external rotators** (e.g., piriformis, obturators, gemelli) insert around the greater trochanter. - These muscles collectively cause the proximal fragment to rotate outwards, resulting in **external rotation**.

Q: The treatment of choice for a 65-year-old man who presented with a fracture of the neck of femur three days after injury is:

Hemiarthroplasty. ***Hemiarthroplasty*** - For a 65-year-old patient with a **femoral neck fracture** recognized three days post-injury, **hemiarthroplasty** is the treatment of choice due to the high risk of **avascular necrosis** (AVN) of the femoral head and non-union. - The delay in presentation increases the likelihood of compromised blood supply to the femoral head, making internal fixation less reliable. *Multiple screw fixation* - This method is typically preferred for **younger patients** (under 60-65 years) with femoral neck fractures where the blood supply to the femoral head is still largely preserved. - The three-day delay and the patient's age in this case significantly increase the risk of **femoral head avascular necrosis**, making internal fixation unsuitable. *Mc-Murray osteotomy* - **McMurray osteotomy** is an older procedure primarily used for treating **osteoarthritis of the hip** or non-union of femoral neck fractures in active individuals, rather than as an acute treatment for a fresh fracture. - It involves reshaping the bone to shift weight-bearing forces and is not indicated for the immediate management of a femoral neck fracture in a 65-year-old. *Total hip replacement* - While a **total hip replacement** (THR) is an excellent option for older, more active patients with femoral neck fractures or severe osteoarthritis, it is generally considered a more extensive surgery with a higher risk of complications compared to hemiarthroplasty for this patient profile. - **Hemiarthroplasty** is often favored for elderly patients with lower functional demands and higher morbidity risks, as it offers quicker recovery and less operative time, addressing the acute fracture effectively.

Q: Which clinical sign is consistently present in all bone fractures?

Tenderness. ***Tenderness*** - **Tenderness** is the most consistently present sign in all bone fractures due to the rich **periosteal innervation** that responds to trauma and inflammation. - Even in **hairline fractures**, **stress fractures**, or **impacted fractures** where other signs may be absent, localized tenderness is virtually always present in conscious patients. *None of the options* - This option incorrectly suggests no universal sign exists, when **tenderness** is actually the most reliable constant finding. - While fracture presentations can vary, the **rich nerve supply** of the periosteum ensures tenderness is present even in subtle fractures. *Crepitus* - **Crepitus** (grating sensation) occurs only when fractured bone ends rub against each other and requires displacement. - It is absent in **impacted fractures**, **hairline fractures**, and **greenstick fractures** where bone ends remain aligned or incomplete. *Abnormal mobility* - **Abnormal mobility** indicates complete fracture with significant displacement and loss of structural integrity. - It is absent in **incomplete fractures** (greenstick), **impacted fractures**, and fractures that are well-stabilized by surrounding soft tissues.

Q: Which of the following attitudes will be seen in a patient with posterior dislocation of the hip?

Flexion, Adduction, Internal rotation. ***Flexion, Adduction, Internal rotation*** - In a posterior hip dislocation, the femoral head is forced posteriorly and superiorly, causing the limb to assume a characteristic position of **flexion**, **adduction**, and **internal rotation**. - This position is due to the **unresisted pull of hip adductors and internal rotators** when the femoral head is out of the acetabulum posteriorly. *Flexion, Adduction, External rotation* - While **flexion** and **adduction** can be present, **external rotation** is characteristic of an **anterior hip dislocation**, where the femoral head dislocates anteriorly and inferiorly. - This attitude is also commonly seen in patients with an **acetabular fracture** since the muscles that externally rotate the hip are unopposed. *Flexion, Abduction, Internal rotation* - **Flexion** and **internal rotation** can be seen in posterior dislocations, but **abduction** is typically not present; instead, the hip is adducted. - **Abduction** would indicate that the limb is moved away from the midline, which is contrary to the typical posture in posterior dislocation. *Flexion, Abduction, External rotation* - This combination is characteristic of an **anterior hip dislocation**, where the femoral head dislocates anteriorly and is often associated with the limb being in **flexion**, **abduction**, and **external rotation**. - The patient's leg is held away from the body (abduction) and turned outwards (external rotation), which is not consistent with a posterior dislocation.

Q: Which of the following classifications is used to assess the fracture shown in the provided image?

Garden classification. ***Garden classification*** - The Garden classification is specifically used to classify **femoral neck fractures** based on displacement, which is a common and important fracture type to categorize. - While the provided image depicts an **elbow fracture**, the question asks to identify a classification system for fractures in general. Among the given options, Garden classification is correctly associated with a specific type of fracture (femoral neck) and is a well-known system. The image is a distracter on its own and isn't relevant to the question. *Gustilo classification* - The Gustilo-Anderson classification is used for **open fractures** to assess the severity of soft tissue damage and contamination. - It does not apply to the type of fracture shown in the image, nor is it a general classification for all fractures. *Weber classification* - The Weber classification is used for **ankle fractures**, specifically evaluating the level of the fibular fracture in relation to the syndesmosis. - This classification is not applicable to fractures at other anatomical sites, such as the elbow or femoral neck. *Salter and Harris classification* - The Salter-Harris classification is used for **growth plate (physeal) fractures** in children. - It is crucial for predicting growth disturbances but is not relevant for adult fractures or the specific fracture shown in the image.

Q: Which of the following statements is false regarding Colles' fracture?

Not associated with dorsal angulation of the wrist. ***Not associated with dorsal angulation of the wrist*** - This statement is **false** because a Colles' fracture is classically defined by **dorsal displacement** and **dorsal angulation** of the distal radial fragment, often leading to a "dinner fork" deformity. - The fracture typically occurs with the hand in **forced dorsiflexion**, causing the distal fragment to tip dorsally. *In old age* - Colles' fractures are common in **older individuals**, particularly postmenopausal women, due to **osteoporosis** which weakens bone density. - The reduced bone strength makes the distal radius susceptible to fracture during falls onto an outstretched hand. *Dorsal shift* - A key characteristic of a Colles' fracture is the **dorsal displacement** of the distal radial fragment. - This posterior shift contributes to the classic "dinner fork" deformity seen clinically. *At cortico-cancellous junction* - The fracture usually occurs approximately **2.5 cm proximal to the radiocarpal joint** in the distal radius. - This region is where the denser cortical bone transitions to the more porous cancellous bone, making it a common site for fracture.

Q: A 42-year-old man is brought to the trauma center after a fall from a ladder. Physical examination reveals a slightly deformed left lower extremity with a 0.5 cm soft tissue defect over the anterolateral aspect of his leg. The wound appears relatively clean with no gross contaminants present. Radiographs depict a short oblique proximal one-third diaphyseal tibia fracture. What is his Gustilo open fracture classification grade?

I. ***I*** - A **Gustilo Grade I** open fracture is characterized by a wound size of less than 1 cm, with minimal soft tissue damage and a relatively clean wound. - The description of a **0.5 cm soft tissue defect**, a "relatively clean" wound, and a "short oblique" fracture fits these criteria. *II* - A **Gustilo Grade II** open fracture involves a wound greater than 1 cm but less than 10 cm, with moderate soft tissue damage and contamination. - This patient's wound is only **0.5 cm**, indicating less extensive soft tissue involvement than a Grade II injury. *IIIa* - **Gustilo Grade IIIa** fractures involve extensive soft tissue damage, a wound greater than 10 cm, and significant contamination, but with adequate soft tissue coverage of the bone. - The patient's **small, clean wound** and lack of extensive damage rule out Grade IIIa. *IIIb* - **Gustilo Grade IIIb** fractures are characterized by massive soft tissue damage, significant contamination, and periosteal stripping, typically requiring reconstructive procedures. - This definition clearly deviates from the presented case, which describes a **minimal wound** and no significant soft tissue loss.

Q: Velpeau bandage and Sling and Swathe splint are used in?

Shoulder dislocation. ***Shoulder dislocation*** - Both the **Velpeau bandage** and the **Sling and Swathe splint** immobilize the shoulder in adduction and internal rotation, which is the preferred position for **anterior glenohumeral dislocations**. - These devices help prevent **re-dislocation** and promote healing of the soft tissues damaged during the dislocation event. *Fracture scapula* - While sometimes requiring immobilization, a **scapular fracture** typically requires different stabilization methods depending on the fracture pattern, given its close proximity to the chest wall. - Immobilization for scapular fractures may involve a simple sling to support the arm, but the specific **Velpeau or Sling and Swathe** is not the primary or universal choice. *Acromioclavicular dislocation* - **AC joint dislocations** involve injury to the ligaments connecting the acromion and clavicle. - Treatment often involves a simple sling for comfort and support, allowing gravity to reduce the displacement, and not the specific restrictive immobilization of a **Velpeau or Sling and Swathe**, which maintains internal rotation. *Fracture clavicle* - A **clavicle fracture** typically requires immobilizing the arm and shoulder for pain relief and alignment. - A **figure-of-eight bandage** or a simple arm sling is more commonly used to support the arm and retract the shoulders, rather than the specific immobilization provided by a Velpeau or Sling and Swathe.

Question 1

Which of the following is NOT a clinical feature of fat embolism?

Accepted Answer

Fat globules in urine are diagnostic

Answer

Systemic hypoxia may occur

Answer

Tachypnoea

Answer

Has a latent period of 1-3 days after trauma

Question 2

True about proximal fragment in subtrochanteric fracture is?

Accepted Answer

All of the options

Answer

Flexion

Answer

Abduction

Answer

External rotation

Question 3

The treatment of choice for a 65-year-old man who presented with a fracture of the neck of femur three days after injury is:

Accepted Answer

Hemiarthroplasty

Answer

Multiple screw fixation

Answer

Mc-Murray osteotomy

Answer

Total hip replacement

Question 4

Which of the following injuries can be classified as Gustilo-Anderson Grade III injuries?

Accepted Answer

Open segmental fractures, open fractures with extensive soft tissue damage, or traumatic amputation.

Answer

Open fracture with clean wounds less than 1 cm long

Answer

Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions

Answer

Compartment syndrome with an open fracture

Question 5

Which clinical sign is consistently present in all bone fractures?

Accepted Answer

Tenderness

Answer

None of the options

Answer

Crepitus

Answer

Abnormal mobility

Question 6

Which of the following attitudes will be seen in a patient with posterior dislocation of the hip?

Accepted Answer

Flexion, Adduction, Internal rotation

Answer

Flexion, Adduction, External rotation

Answer

Flexion, Abduction, Internal rotation

Answer

Flexion, Abduction, External rotation

Question 7

Which of the following classifications is used to assess the fracture shown in the provided image?

Accepted Answer

Garden classification

Answer

Gustilo classification

Answer

Weber classification

Answer

Salter and Harris classification

Question 8

Which of the following statements is false regarding Colles' fracture?

Accepted Answer

Not associated with dorsal angulation of the wrist

Answer

Dorsal shift

Answer

At cortico-cancellous junction

Answer

In old age

Question 9

A 42-year-old man is brought to the trauma center after a fall from a ladder. Physical examination reveals a slightly deformed left lower extremity with a 0.5 cm soft tissue defect over the anterolateral aspect of his leg. The wound appears relatively clean with no gross contaminants present. Radiographs depict a short oblique proximal one-third diaphyseal tibia fracture. What is his Gustilo open fracture classification grade?

Accepted Answer

I

Answer

II

Answer

IIIa

Answer

IIIb

Question 10

Velpeau bandage and Sling and Swathe splint are used in?

Accepted Answer

Shoulder dislocation

Answer

Fracture scapula

Answer

Acromioclavicular dislocation

Answer

Fracture clavicle

Trauma — MCQs

Trauma — MCQs

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