Trauma Practice Questions

Q: Initially, compression osteosynthesis was used for:

Non union. ***Non union*** - Compression osteosynthesis was developed to address **non-union** of fractures by providing mechanical stability and promoting bone healing through direct contact and compression at the fracture site. - The compression stimulates an osteogenic response, improving the chances of union even in cases where previous attempts at healing failed. *Malunion* - **Malunion** refers to a fracture that has healed in an incorrect anatomical position. Compression osteosynthesis is primarily for promoting healing contact, not for realigning already united but malpositioned bone fragments. - Correcting a malunion usually requires an osteotomy to re-break the bone and then fix it in the proper alignment, which may or may not involve compression. *Correct alignment of bone* - While maintaining **correct alignment** is crucial in fracture management, compression osteosynthesis is a technique applied *after* initial alignment has been achieved. It serves to stabilize the aligned fragments and promote healing, rather than being the primary method for initial alignment itself. - Techniques like traction or manipulation are typically used for initial alignment before fixation with compression. *Improper alignment of bone* - **Improper alignment** of bone refers to a fracture where the bone fragments are not in their anatomical position. Compression osteosynthesis is not designed to correct improper alignment; instead, alignment must be corrected *before* compression is applied. - Applying compression to improperly aligned fragments would stabilize the malalignment, hindering proper healing and function.

Q: Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?

Tongue-type fracture. ***Tongue-type fracture*** - This fracture pattern involves a **vertical fracture line** extending posteriorly through the body of the calcaneus, creating a "tongue"-shaped fragment that includes the posterior facet. - The superior portion of this fragment is **displaced superiorly**, leading to a characteristic increase in **Gissane's angle**. *Joint depression-type fracture* - This fracture involves the **depression of the articular surface** of the posterior facet into the body of the calcaneus. - In this type, the **Gissane's angle** is typically **decreased**, not increased, due to the collapse of the articular surface. *Extra-articular fracture* - An **extra-articular fracture** does not involve the articular surfaces of the calcaneus, meaning the **Gissane's angle** (which describes the relationship of the articular surfaces) is generally **preserved** or minimally affected. - These fractures occur outside the subtalar joint and are classified differently than intra-articular types. *Avulsion fracture* - An **avulsion fracture** typically occurs when a ligament or tendon pulls a piece of bone away from the main bone mass, often at muscle insertions like the Achilles tendon. - While it can occur in the calcaneus, it does not involve the characteristic displacement of the posterior facet that would lead to an **increased Gissane's angle** in the way a tongue-type fracture does.

Q: Least common complication of a fall from height is -

Fracture fibula. ***Fracture fibula*** - A fibula fracture is the **least common** with a fall from height because the force is typically axial, impacting the lower limbs. - The fibula is a **non-weight-bearing bone**, making it less susceptible to direct axial compression trauma from a fall. *Fracture base of skull* - **Basilar skull fractures** can occur from significant head trauma in a fall, especially when the head strikes a surface. - While not as common as extremity fractures, they are a serious and known complication of falls from height. *Fracture 12th thoracic vertebra* - **Vertebral compression fractures**, particularly in the thoracolumbar region (like T12), are common due to axial loading upon landing on the buttocks or feet. - This is a frequent injury in falls from height due to the **compressive forces** transmitted through the spine. *Fracture calcaneum* - **Heel bone fractures** (calcaneum) are very common in falls from height, as direct impact often occurs on the feet. - The calcaneus bears the initial and substantial impact, making it highly vulnerable to **crush injuries** in such falls.

Q: Which maneuver is used in the reduction of shoulder dislocation?

Kocher's manoeuvre. ***Kocher's manoeuvre*** - **Kocher's manoeuvre** is a classic technique used for the **reduction of anterior shoulder dislocations**, involving external rotation, adduction, and internal rotation. - This method aims to safely guide the humeral head back into the glenoid fossa with a series of controlled movements. *Allis manoeuvre* - The **Allis manoeuvre** is primarily used for the **reduction of posterior hip dislocations**, involving hip flexion, adduction, and internal rotation with axial traction. - It is not indicated for shoulder dislocations. *Sultanpur technique* - The "Sultanpur technique" is **not a recognized medical term** or maneuver for reducing dislocations. - This option appears to be a distractor. *Intramedullary nail* - An **intramedullary nail** is a surgical device used for **fixing long bone fractures**, such as those in the femur or tibia. - It is an orthopedic implant and not a reduction maneuver for dislocations.

Q: Most common nerve to be damaged in dislocation of the shoulder is:

Axillary nerve. ***Axillary nerve*** - The **axillary nerve** is the most commonly injured nerve in **shoulder dislocations** due to its anatomical course around the surgical neck of the humerus. - Damage to the axillary nerve can lead to weakness in **deltoid abduction** and sensory loss over the **regimental badge area**. *Radial nerve* - The **radial nerve** is more commonly injured in mid-shaft humeral fractures or prolonged compression, not typically shoulder dislocations. - Injury to the radial nerve primarily affects **wrist extension** and sensation in the dorsal hand. *Median nerve* - The **median nerve** is less frequently injured in isolated shoulder dislocations and is more often associated with injuries closer to the elbow or wrist. - Damage to the median nerve causes deficits in **thumb opposition** and sensation over the palmar aspect of the first three and a half digits. *Musculocutaneous nerve* - The **musculocutaneous nerve** is relatively protected in shoulder dislocations, as it pierces the coracobrachialis muscle. - Injury to this nerve would primarily impair **forearm flexion** and sensation over the lateral forearm.

Q: Hill-Sach's lesion is seen in:

Recurrent dislocation of shoulder. ***Recurrent dislocation of shoulder*** - A **Hill-Sach's lesion** is a **compression fracture** of the posterolateral part of the humeral head, occurring as the humeral head impacts the anterior rim of the glenoid during **anterior shoulder dislocation**. - It is particularly associated with **recurrent anterior shoulder dislocations** due to repeated impaction. *Anterior dislocation of hip* - This condition involves the femoral head moving anteriorly out of the acetabulum and is not associated with a Hill-Sach's lesion. - While it causes significant pain and immobility, the specific bone lesion known as Hill-Sach's involves the humerus, not the femur. *Posterior dislocation of hip* - A posterior hip dislocation involves the femoral head moving posteriorly out of the acetabulum and is not linked to a Hill-Sach's lesion. - This type of injury is often seen in high-impact trauma, such as car accidents, and can be associated with acetabular fractures or sciatic nerve injury. *Posterior dislocation of shoulder* - This involves the humeral head dislocating posteriorly relative to the glenoid, and while bone lesions can occur, they are typically **reverse Hill-Sach's lesions** (on the anterior aspect of the humeral head) or **bony Bankart lesions** of the posterior glenoid. - A standard Hill-Sach's lesion specifically refers to the posterolateral humeral head defect seen in **anterior dislocations**.

Q: Bankart's lesion is associated with which anatomical structure?

Anterior surface of the glenoid labrum. ***Anterior surface of the glenoid labrum*** - A **Bankart lesion** is an injury to the **anterior-inferior glenoid labrum** of the shoulder. - It frequently occurs after an **anterior shoulder dislocation** when the humeral head avulses the labrum from the glenoid rim. *Posterior surface of the glenoid labrum* - An injury to the posterior labrum is known as a **posterior Bankart lesion** or a **reverse Bankart lesion**, which is less common. - This type of injury is typically associated with **posterior shoulder dislocations**. *Posterior part of the head of the humerus* - A **Hill-Sachs lesion** involves an impression fracture on the **posterolateral aspect of the humeral head**. - This lesion occurs as the humeral head impacts the anterior glenoid rim during an **anterior shoulder dislocation**. *Anterior part of the head of the humerus* - Injury to the anterior part of the humeral head is less common in typical shoulder dislocations. - While it could theoretically be involved in very specific trauma, it's not the primary anatomical location for a Bankart lesion.

Q: Which of the following statements is true about crescent fracture?

Fracture of the iliac bone with sacroiliac disruption. ***Fracture of the iliac bone with sacroiliac disruption*** - A **crescent fracture** is characterized by an **oblique fracture of the iliac bone** extending into the posterior superior iliac spine, often associated with a **sacroiliac joint disruption**. - This specific injury pattern suggests **vertical instability of the posterior pelvic ring**, as the sacroiliac ligamentous complex is compromised. *Diastasis of the pubis with associated pubic rami fractures* - This description typically refers to **anterior pelvic ring injuries**, often seen in **open-book fractures** or vertical shear injuries, which are distinct from crescent fractures. - While pubic rami fractures can coexist with crescent fractures as part of a more complex pelvic injury, crescent fracture primarily defines the **posterior injury pattern**. *Anteroposterior instability with rotational stability in the pelvis* - **Anteroposterior instability** often results from disruption of the **anterior pelvic ring**, such as pubic symphysis diastasis, and is less about the rotational stability. - A crescent fracture specifically conveys **vertical instability** of the posterior pelvis due to the compromised sacroiliac joint and iliac fracture. *Associated with stable pelvic ring injuries* - **Crescent fractures** involve disruption of the **posterior pelvic ring**, specifically the sacroiliac joint, and are inherently **unstable**. - This type of injury requires surgical intervention due to the significant risk of hemorrhage and displacement.

Question 1

Initially, compression osteosynthesis was used for:

Accepted Answer

Non union

Answer

Malunion

Answer

Correct alignment of bone

Answer

Improper alignment of bone

Question 2

Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?

Accepted Answer

Tongue-type fracture

Answer

Extra-articular fracture

Answer

Joint depression-type fracture

Answer

Avulsion fracture

Question 3

Least common complication of a fall from height is -

Accepted Answer

Fracture fibula

Answer

Fracture base of skull

Answer

Fracture 12th thoracic vertebra

Answer

Fracture calcaneum

Question 4

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

Accepted Answer

Extra-articular fracture of distal radius with dorsal displacement

Answer

Intra-articular fracture of distal radius with palmar displacement

Answer

Intra-articular fracture of distal radius with dorsal displacement

Answer

Extra-articular fracture of distal radius with palmar displacement

Question 5

Which maneuver is used in the reduction of shoulder dislocation?

Accepted Answer

Kocher's manoeuvre

Answer

Allis manoeuvre

Answer

Sultanpur technique

Answer

Intramedullary nail

Question 6

Most common nerve to be damaged in dislocation of the shoulder is:

Accepted Answer

Axillary nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 7

Hill-Sach's lesion is seen in:

Accepted Answer

Recurrent dislocation of shoulder

Answer

Anterior dislocation of hip

Answer

Posterior dislocation of hip

Answer

Posterior dislocation of shoulder

Question 8

Bankart's lesion is associated with which anatomical structure?

Accepted Answer

Anterior surface of the glenoid labrum

Answer

Posterior surface of the glenoid labrum

Answer

Posterior part of the head of the humerus

Answer

Anterior part of the head of the humerus

Question 9

Which of the following statements about intracapsular fractures of the femoral neck is true?

Accepted Answer

Malunion is rare, with avascular necrosis and nonunion being more common complications.

Answer

The contour of the greater trochanter remains unaffected in most cases.

Answer

Displacement occurs less frequently compared to extracapsular fractures.

Answer

Tenderness is mainly present over the anterior joint line

Question 10

Which of the following statements is true about crescent fracture?

Accepted Answer

Fracture of the iliac bone with sacroiliac disruption

Answer

Diastasis of the pubis with associated pubic rami fractures.

Answer

Anteroposterior instability with rotational stability in the pelvis.

Answer

Associated with stable pelvic ring injuries.

Trauma — MCQs

Trauma — MCQs

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