Trauma Practice Questions

Q: Tenderness in the anatomical snuff box is characteristic of which carpal bone fracture?

Scaphoid. **Explanation:** **Scaphoid fracture** is the most common carpal bone fracture, typically resulting from a fall on an outstretched hand (FOOSH). The scaphoid forms the floor of the **anatomical snuff box**. Therefore, localized tenderness in this area is considered pathognomonic for a scaphoid injury until proven otherwise. **Why the other options are incorrect:** * **Capitate:** This is the largest carpal bone, located centrally in the distal row. Fractures are rare and usually associated with complex perilunate injuries; tenderness would be deep and central, not in the snuff box. * **Lunate:** Located medial to the scaphoid, it is more prone to dislocation (leading to Median nerve compression) or avascular necrosis (Kienböck's disease) rather than isolated fractures. Tenderness is typically over the dorsum of the wrist, distal to Lister’s tubercle. * **Triquetrum:** This is the second most common carpal fracture (often a dorsal chip fracture). Tenderness is localized to the ulnar (medial) aspect of the wrist, distal to the ulnar styloid. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid has a **retrograde blood supply** (from the distal pole to the proximal pole). This makes the proximal pole highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Radiology:** Fractures may not appear on initial X-rays. If clinical suspicion is high despite a normal X-ray, the wrist should be immobilized in a **Scaphoid cast** (thumb spica) and re-imaged after 10–14 days. * **Anatomical Snuff Box Boundaries:** Lateral (Abductor pollicis longus, Extensor pollicis brevis) and Medial (Extensor pollicis longus).

Q: Tardy ulnar nerve palsy is most commonly associated with which type of fracture?

Lateral condyle fracture. **Explanation:** **Tardy Ulnar Nerve Palsy** is a delayed-onset ulnar neuropathy that occurs years after an elbow injury. The correct answer is **Lateral condyle fracture** because it is the most common cause of **Cubitus Valgus** (increased carrying angle). 1. **Pathophysiology:** A fracture of the lateral condyle in childhood often results in **non-union**. As the child grows, the medial side of the humerus continues to grow normally while the lateral side lags, leading to a progressive valgus deformity. This deformity increases the distance the ulnar nerve must travel around the medial epicondyle, causing chronic stretching and frictional neuritis, eventually leading to palsy. 2. **Analysis of Incorrect Options:** * **Medial condyle fracture:** While the ulnar nerve is anatomically closer to the medial condyle, fractures here usually cause acute injury or result in *Cubitus Varus*, which does not stretch the nerve. * **Olecranon fracture:** These may cause acute ulnar nerve irritation but are not typically associated with the progressive valgus deformity required for "tardy" palsy. * **Distal humerus fracture (Supracondylar):** The most common complication here is *Cubitus Varus* (Gunstock deformity), which is associated with **Tardy Radial Nerve palsy** (rarely) rather than ulnar. **Clinical Pearls for NEET-PG:** * **Latency:** The symptoms (wasting of intrinsic hand muscles, clawing) typically appear **10–20 years** after the initial injury. * **Treatment of choice:** Anterior transposition of the ulnar nerve. * **Most common cause of Cubitus Varus:** Malunited Supracondylar fracture. * **Most common cause of Cubitus Valgus:** Non-union of Lateral Condyle fracture.

Q: What is a condylar fracture with tearing of the skin called?

Compound fracture.. ### Explanation The correct answer is **Compound fracture** (also known as an **Open fracture**). **1. Why it is correct:** A fracture is classified as "compound" or "open" when there is a communication between the fracture site (the hematoma) and the external environment through a breach in the skin and underlying soft tissues. In this specific case, a condylar fracture accompanied by tearing of the skin allows for potential bacterial contamination from the outside, which is the hallmark of a compound fracture. **2. Why other options are incorrect:** * **Simple fracture:** Also known as a "closed" fracture, the overlying skin remains intact. There is no communication between the bone and the exterior. * **Complex fracture:** This is a non-specific descriptive term often used for fractures with multiple fragments, difficult reduction, or associated neurovascular injury, but it does not specifically denote skin involvement. * **Comminuted fracture:** This refers to the **pattern** of the break where the bone is splintered or crushed into three or more fragments. A comminuted fracture can be either simple (closed) or compound (open). **3. Clinical Pearls for NEET-PG:** * **Gustilo-Anderson Classification:** The gold standard for grading open fractures (Type I to IIIC) based on wound size, soft tissue damage, and vascular status. * **Golden Period:** Debridement of open fractures should ideally occur within 6 hours to minimize the risk of osteomyelitis. * **Management Priority:** In open fractures, the priority is "Life over Limb" (ATLS protocols), followed by aggressive debridement, antibiotics, and stabilization (often via external fixation). * **Tetanus Prophylaxis:** Always mandatory in the management of any compound fracture.

Q: What is the physiological interruption of nerve transmission?

Neuropraxia. The classification of nerve injuries is a high-yield topic for NEET-PG, primarily based on the **Seddon Classification**. ### **Explanation of the Correct Answer** **A. Neuropraxia** is the correct answer because it represents the mildest form of nerve injury. It is a **physiological interruption** of nerve conduction without any anatomical disruption of the axon or the connective tissue sheath. It is typically caused by local compression or ischemia (e.g., Saturday Night Palsy). Since the axon remains intact, there is no Wallerian degeneration, and recovery is complete and rapid (usually within days to weeks) once the pressure is relieved. ### **Analysis of Incorrect Options** * **B. Neurotmesis:** This is the most severe grade. It involves complete anatomical disruption of the entire nerve trunk (axon and all supporting connective tissue sheaths). Recovery is impossible without surgical intervention. * **C. Axonotmesis:** This involves anatomical disruption of the **axon** itself, but the supporting connective tissue frameworks (endoneurium, perineurium, and epineurium) remain intact. Wallerian degeneration occurs distal to the injury, and recovery is slow (1 mm/day) but possible because the intact sheaths guide regenerating sprouts. ### **Clinical Pearls for NEET-PG** * **Wallerian Degeneration:** Occurs in Axonotmesis and Neurotmesis, but **never** in Neuropraxia. * **Tinel’s Sign:** This is **absent** in Neuropraxia (as there is no axonal regeneration) but becomes **positive** in Axonotmesis as the nerve begins to heal. * **Sunderland Classification:** An expansion of Seddon’s; Neuropraxia corresponds to Grade I, Axonotmesis to Grades II-IV, and Neurotmesis to Grade V. * **Recovery Sequence:** In nerve injuries, **Motor** function is the first to go and last to return; **Pain** is the last to go and first to return.

Q: Complications of Colles' fracture include the following except:

Rupture of Extensor Pollicis Brevis tendon. **Explanation:** The correct answer is **A. Rupture of Extensor Pollicis Brevis (EPB) tendon**. In Colles' fracture, the most common tendon injury is the rupture of the **Extensor Pollicis Longus (EPL)**, not the EPB. This occurs because the EPL tendon winds around **Lister’s tubercle** on the dorsal aspect of the radius. Following a fracture, the tendon can undergo attrition due to friction against irregular bone fragments or ischemia caused by pressure within the intact extensor retinaculum. This typically occurs 4–8 weeks post-injury (delayed rupture). **Analysis of other options:** * **B. Rupture of Extensor Pollicis Longus:** This is a classic late complication. It is often painless and results in the inability to extend the distal phalanx of the thumb. * **C. Malunion:** This is the **most common complication** of Colles' fracture. It leads to the characteristic "Dinner Fork Deformity" due to residual dorsal tilt and radial shortening. * **D. Sudeck’s Osteodystrophy (CRPS Type 1):** This is a well-known complication characterized by pain, swelling, and vasomotor instability. It is often triggered by a tight cast or excessive pain during immobilization. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Malunion. * **Most common nerve involved:** Median nerve (Carpal Tunnel Syndrome). * **Surgical treatment for EPL rupture:** Tendon transfer (usually using the Extensor Indicis Proprius). * **Dinner Fork Deformity:** Caused by dorsal displacement, dorsal tilt, and lateral tilt of the distal fragment.

Q: Duga's test is helpful in which of the following conditions?

Anterior dislocation of shoulder. **Explanation:** **Dugas’ Test** is a classic clinical sign used to diagnose **Anterior Dislocation of the Shoulder**. In a normal shoulder, a person can touch the opposite shoulder with their hand while the elbow is in contact with the chest. In an anterior dislocation, the humeral head is displaced from the glenoid labrum, causing the shoulder to lose its normal contour. Consequently, the patient is **unable to touch the opposite shoulder with the hand of the affected side while the elbow is touching the chest.** If the hand is forced onto the opposite shoulder, the elbow will lift away from the chest, and vice versa. **Analysis of Incorrect Options:** * **Dislocation of Hip:** Diagnosed using tests like the **Allis test** or **Bigelow’s maneuver**. Clinical features include limb shortening and rotation (internal for posterior, external for anterior). * **Scaphoid Fracture:** Characterized by tenderness in the **Anatomical Snuffbox** and pain on axial loading of the thumb. * **Fracture Neck of Femur:** Presents with external rotation and shortening of the limb. Key clinical signs include **Bryant’s triangle** distortion and **Nelaton’s line** abnormality. **Clinical Pearls for NEET-PG:** * **Hamilton’s Ruler Test:** In shoulder dislocation, a ruler can touch both the acromion and the lateral epicondyle simultaneously (impossible in a normal shoulder). * **Callaway’s Test:** The axillary girth is increased in shoulder dislocation. * **Regimental Badge Sign:** Indicates injury to the **Axillary Nerve**, the most common nerve injured in anterior shoulder dislocations. * **Most common type:** Subcoracoid dislocation is the most frequent subtype of anterior dislocation.

Q: What is the most consistent sign of a fresh fracture?

Crepitus. ### Explanation In clinical orthopaedics, signs of a fracture are categorized into **Probable (Suggestive)** and **Definitive (Diagnostic)** signs. **Why Crepitus is the Correct Answer:** Crepitus is defined as the palpable or audible grating sensation produced by the friction of two fractured bone ends rubbing against each other. It is considered the **most consistent and pathognomonic sign** of a fresh fracture. If crepitus is present, a fracture is definitively diagnosed. However, clinicians should not deliberately elicit it as it causes significant pain and potential soft tissue damage. **Analysis of Incorrect Options:** * **Bony Tenderness:** While this is the most common and earliest sign, it is **non-specific**. It can be present in contusions, infections (osteomyelitis), or bone tumors without an actual break in the cortex. * **Deformity:** This is a suggestive sign but not always present (e.g., in undisplaced or impacted fractures). Conversely, deformities can occur in dislocations or congenital anomalies without a fracture. * **Abnormal Mobility:** This is a definitive sign (moving a limb where no joint exists), but it may be absent in **impacted fractures** or greenstick fractures, making it less "consistent" than the presence of crepitus in a fresh, complete break. **Clinical Pearls for NEET-PG:** * **Definitive Signs of Fracture:** Crepitus, Abnormal Mobility, and Radiological evidence. * **Impacted Fractures:** These are unique because they often lack crepitus and abnormal mobility; the only clinical clue may be localized tenderness and loss of function. * **Safety Note:** Always prioritize splinting and imaging over physical maneuvers like eliciting crepitus to prevent secondary neurovascular injury.

Question 1

Limb salvage can be done in all except?

Accepted Answer

Vascular injury

Answer

Nerve injury

Answer

Bone injury

Answer

Muscle injury

Question 2

Tenderness in the anatomical snuff box is characteristic of which carpal bone fracture?

Accepted Answer

Scaphoid

Answer

Capitate

Answer

Lunate

Answer

Triquetrum

Question 3

Tardy ulnar nerve palsy is most commonly associated with which type of fracture?

Accepted Answer

Lateral condyle fracture

Answer

Medial condyle fracture

Answer

Olecranon fracture

Answer

Distal humerus fracture

Question 4

What is a condylar fracture with tearing of the skin called?

Accepted Answer

Compound fracture.

Answer

Simple fracture.

Answer

Complex fracture.

Answer

Comminuted fracture.

Question 5

What is the physiological interruption of nerve transmission?

Accepted Answer

Neuropraxia

Answer

Neurotmesis

Answer

Axonotmesis

Answer

None of the above

Question 6

What is the best treatment for a 3-week-old fracture of the femoral shaft with nonunion?

Accepted Answer

Bone graft with internal fixation

Answer

External fixation

Answer

Internal fixation only

Answer

Prosthesis

Question 7

Complications of Colles' fracture include the following except:

Accepted Answer

Rupture of Extensor Pollicis Brevis tendon

Answer

Rupture of Extensor Pollicis Longus Tendon

Answer

Malunion

Answer

Sudek's osteodystrophy

Question 8

Duga's test is helpful in which of the following conditions?

Accepted Answer

Anterior dislocation of shoulder

Answer

Dislocation of hip

Answer

Scaphoid fracture

Answer

Fracture neck of femur

Question 9

What is the most consistent sign of a fresh fracture?

Accepted Answer

Crepitus

Answer

Bony tenderness

Answer

Deformity

Answer

Abnormal mobility

Question 10

The first sign of Volkman's ischemia is?

Accepted Answer

Pain on passive extension of fingers

Answer

Paresthesia

Answer

Pain on active extension of fingers

Answer

Swelling of fingers

Trauma — MCQs

Trauma — MCQs

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