Trauma Practice Questions

Q: Which of the following is not a type of fracture?

Anatomical. ### Explanation Fractures are classified based on the mechanism of injury and the state of the underlying bone. The term **"Anatomical"** refers to the structure or location of a body part (e.g., anatomical neck of the humerus) but is not a functional or pathological classification of a fracture type. #### Analysis of Options: * **A. Traumatic Fracture:** This is the most common type, occurring when a sudden, high-magnitude force (like a fall or RTA) is applied to a normal bone, exceeding its elastic resistance. * **B. Pathological Fracture:** This occurs when a fracture happens through a bone already weakened by an underlying disease (e.g., Osteoporosis, Bone Cyst, Giant Cell Tumor, or Metastasis). The force required is often trivial or minimal. * **D. Stress Fracture:** Also known as "Fatigue fractures," these occur due to repetitive, sub-maximal mechanical loading over time. They are common in athletes and military recruits (e.g., March fracture of the 2nd metatarsal). #### NEET-PG High-Yield Pearls: 1. **March Fracture:** A classic stress fracture involving the shaft of the **2nd metatarsal**. 2. **Insufficiency Fracture:** A subtype of pathological fracture where normal stress is applied to bone with deficient elastic resistance (e.g., Osteomalacia). 3. **Commonest site for Pathological Fracture:** The **Vertebra** (often due to osteoporosis or secondary deposits). 4. **Milkman’s Fracture (Looser’s Zones):** Pseudofractures seen in Osteomalacia; these are not true fractures but cortical radiolucencies.

Q: What is the commonest site of fracture leading to fat embolism?

Femur. **Explanation:** **Fat Embolism Syndrome (FES)** occurs when fat globules from the bone marrow enter the systemic circulation following a fracture. The **Femur** is the correct answer because it is the largest long bone in the body with the most extensive medullary canal containing a high volume of fatty marrow. 1. **Why Femur is Correct:** The risk of fat embolism is directly proportional to the volume of marrow involved and the degree of intramedullary pressure elevation during trauma or surgery. Being the largest weight-bearing bone, fractures of the femur (especially the shaft) release the highest amount of fat emboli into the venous sinusoids. 2. **Why others are incorrect:** * **Tibia:** While the tibia is the second most common site for fat embolism, its medullary cavity is smaller than that of the femur. * **Humerus and Ulna:** These are smaller long bones with significantly less marrow volume, making the systemic "fat load" released during a fracture insufficient to typically cause clinical Fat Embolism Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major features include **Petechial rashes** (typically over the chest, axilla, and conjunctiva), **Respiratory distress** (hypoxemia), and **Cerebral involvement** (confusion/altered sensorium). * **Classic Triad:** Dyspnea, Confusion, and Petechiae (appearing 24–72 hours post-injury). * **Snowstorm Appearance:** Characteristically seen on Chest X-ray. * **Management:** Primarily supportive (Oxygenation). Early stabilization/fixation of the fracture is the most effective way to **prevent** FES.

Q: What is a Tripod fracture?

Zygomaticomaxillary fracture. ### Explanation **Correct Answer: B. Zygomaticomaxillary fracture** A **Tripod fracture**, also known as a **Zygomaticomaxillary Complex (ZMC) fracture**, is a common facial injury typically resulting from a direct blow to the cheek. It is called a "tripod" fracture because it involves the disruption of the three primary cortical attachments of the zygoma to the rest of the face: 1. **Zygomaticofrontal suture** (Superiorly) 2. **Zygomaticomaxillary suture** (Medially) 3. **Zygomaticotemporal suture** (Laterally at the zygomatic arch) *Note: Modern anatomy often includes the fourth attachment—the zygomaticosphenoid suture—leading some to prefer the term "tetrapod fracture."* **Analysis of Incorrect Options:** * **A. Displaced fracture of calcaneum:** These are often referred to as "Don Juan fractures" or "Lover’s fractures" (associated with axial loading/falls from height). * **C. Sphenoid wing fracture:** These are usually part of complex skull base fractures or Le Fort III injuries, but are not termed tripod fractures. * **D. Coronal shear pilon fracture:** This refers to a specific pattern of distal tibial fracture involving the articular surface, often requiring specialized plating. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Flattening of the malar prominence (cheek), infraorbital nerve anesthesia (numbness of the upper lip/cheek), and diplopia (due to orbital floor involvement). * **Trismus:** Difficulty opening the mouth may occur if the zygomatic arch impinges on the coronoid process of the mandible. * **Imaging:** The **Water’s View** (Occipitomental projection) is the classic X-ray used to visualize ZMC fractures, though CT is the gold standard.

Q: A transverse fracture of the medial malleolus is most commonly caused by which of the following forces?

Abduction force. **Explanation:** The morphology of a medial malleolus fracture is determined by the mechanism of injury, specifically the direction of the talar movement within the mortise. 1. **Why Abduction is correct:** In an **abduction (eversion) injury**, the talus tilts laterally, putting the strong deltoid ligament under extreme tension. This results in an **avulsion fracture** of the medial malleolus. Because it is an avulsion injury, the fracture line is typically **transverse** (horizontal) and located at or below the level of the tibial plafond. This is a classic feature of Lauge-Hansen’s Pronation-Abduction injuries. 2. **Why other options are incorrect:** * **Adduction (Inversion) force:** This causes the talus to push against the medial malleolus. This "push-off" mechanism results in a **vertical or oblique fracture** line, often associated with impaction of the supramalleolar purlieu. * **Flexion force:** While plantar or dorsiflexion can occur during ankle trauma, they typically result in anterior or posterior lip fractures (Pott’s fracture variants) rather than a pure transverse medial malleolar fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Lauge-Hansen Classification:** The most common mechanism of ankle fracture is **Supination-External Rotation (SER)**. * **Transverse = Avulsion:** Always remember that transverse fractures in the ankle are generally avulsion injuries (tension), while vertical/oblique fractures are due to impaction (compression). * **Mortise View:** The best X-ray view to assess the distal tibiofibular syndesmosis and the medial clear space. * **Danis-Weber Classification:** Based on the level of the **fibula** fracture relative to the syndesmosis (A: below, B: at, C: above).

Q: Which carpal bone is commonly injured and is adjacent to the scaphoid?

Trapezium. **Explanation:** The correct answer is **Trapezium**. The scaphoid is the most commonly fractured carpal bone. When considering injuries involving the scaphoid and its adjacent structures, the **Trapezium** is the most clinically relevant neighbor. Anatomically, the scaphoid articulates distally with the Trapezium and Trapezoid. However, the Trapezium is more frequently involved in combined injury patterns (like axial loading) and is the site of the clinically significant **scaphoid-trapezium-trapezoid (STT) joint**, which is a common site for osteoarthritis. **Analysis of Options:** * **Trapezium (Correct):** It sits directly distal to the scaphoid. It is a frequent site of injury and degenerative changes alongside the scaphoid. * **Trapezoid:** While it also articulates with the scaphoid, it is the least commonly injured carpal bone due to its protected position and strong ligamentous attachments. * **Lunate:** It is medial to the scaphoid. While the scaphoid and lunate are frequently involved in dissociative injuries (Scapholunate dissociation), the question specifically points toward the bone most commonly associated with adjacent injury/articulation in this context. * **Capitate:** It is the largest carpal bone and lies medial to the scaphoid. While it articulates with the scaphoid, it is not the primary "adjacent" bone associated with common distal scaphoid injury patterns. **High-Yield Clinical Pearls for NEET-PG:** 1. **Scaphoid Fracture:** Most common carpal fracture; risk of **Avascular Necrosis (AVN)** because the blood supply enters distally (retrograde flow). 2. **Tenderness:** Always check the **Anatomical Snuffbox** for scaphoid injury. 3. **Terry Thomas Sign:** A gap >3mm between the scaphoid and lunate on X-ray, indicating scapholunate dissociation. 4. **Kienbock’s Disease:** Avascular necrosis of the Lunate.

Q: What is the recommended treatment for a fracture of the neck of the humerus in a female patient?

Triangular sling. **Explanation:** Fractures of the proximal humerus (neck of the humerus) are common in elderly individuals, particularly post-menopausal females, due to osteoporosis. The management depends on the **Neer Classification**, which assesses the displacement of the four anatomical segments (head, greater tuberosity, lesser tuberosity, and shaft). **Why Option A is Correct:** The vast majority (approx. 80%) of proximal humerus fractures are **undisplaced or minimally displaced**. For these stable fractures, conservative management is the gold standard. A **triangular sling** (or U-slab/Velpeau bandage) provides sufficient immobilization to allow for secondary bone healing. Early mobilization (pendulum exercises) is usually started within 1–2 weeks to prevent adhesive capsulitis (frozen shoulder). **Why Other Options are Incorrect:** * **B. Hemiarthroplasty:** Reserved for complex, comminuted 4-part fractures or head-splitting fractures where the blood supply to the humeral head is compromised (risk of avascular necrosis). * **C. Chest arm bandage:** While it provides immobilization, it is cumbersome and less commonly used than a simple triangular sling for standard neck fractures. * **D. Internal fixation (ORIF):** Indicated for displaced 2-part, 3-part, or 4-part fractures in active individuals where closed reduction is unsuccessful. **Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Axillary nerve (test sensation over the "regimental badge" area). * **Most common artery injured:** Anterior circumflex humeral artery (though the posterior circumflex provides more blood supply to the head). * **Neer’s Definition of Displacement:** A segment is considered displaced if it is separated by **>1 cm** or angulated **>45 degrees**. * **Commonest Complication:** Stiffness of the shoulder joint.

Question 1

Which of the following is not a type of fracture?

Accepted Answer

Anatomical

Answer

Traumatic

Answer

Pathological

Answer

Stress

Question 2

What is the commonest site of fracture leading to fat embolism?

Accepted Answer

Femur

Answer

Tibia

Answer

Humerus

Answer

Ulna

Question 3

What is the most common cause of fracture in hemophilic arthropathy?

Accepted Answer

Osteoporosis and restrictive joint movement

Answer

Cartilage destruction

Answer

Inflammatory arthropathy

Answer

Osteosclerosis

Question 4

Which of the following fractures in children, if left untreated, is known for nonunion?

Accepted Answer

Fracture shaft of humerus

Answer

Intercondylar fracture of humerus

Answer

Fracture shaft of femur

Answer

Fracture distal 1/3rd of tibia

Question 5

What is a Tripod fracture?

Accepted Answer

Zygomaticomaxillary fracture

Answer

Displaced fracture of calcaneum

Answer

Sphenoid wing fracture

Answer

Coronal shear pilon fracture

Question 6

A transverse fracture of the medial malleolus is most commonly caused by which of the following forces?

Accepted Answer

Abduction force

Answer

Adduction force

Answer

Inversion force

Answer

Flexion force

Question 7

In high ulnar nerve lesions, such as those resulting from elbow fractures or dislocations, the degree of clawing is markedly less than in low ulnar nerve lesions. This phenomenon is called the ulnar paradox. What is the reason for the ulnar paradox?

Accepted Answer

The ulnar half of the flexor digitorum profundus (FDP) is paralyzed, leading to no active flexion at the interphalangeal (IP) joints.

Answer

The lumbrical muscles are spared, preventing the development of clawing.

Answer

The median nerve compensates for the function of the ulnar nerve.

Answer

The interosseous muscles increase their tone and extend the IP joints.

Question 8

Which carpal bone is commonly injured and is adjacent to the scaphoid?

Accepted Answer

Trapezium

Answer

Trapezoid

Answer

Lunate

Answer

Capitate

Question 9

Which of the following are features of common peroneal nerve injury?

Accepted Answer

Foot drop, Loss of extension of great toe, Seen in fibular neck fracture

Answer

Inversion inability, Loss of sensation of sole, Foot drop

Answer

Loss of sensation of sole, Foot drop, Loss of extension of great toe

Answer

Inversion inability, Loss of sensation of sole, Foot drop, Loss of extension of great toe, Seen in fibular neck fracture

Question 10

What is the recommended treatment for a fracture of the neck of the humerus in a female patient?

Accepted Answer

Triangular sling

Answer

Hemiarthroplasty

Answer

Chest arm bandage

Answer

Internal fixation

Trauma — MCQs

Trauma — MCQs

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