Trauma Practice Questions

Q: Bankart lesion occurs in patients with which of the following?

Anterior shoulder dislocation. **Explanation:** A **Bankart lesion** is the most common pathological finding in recurrent **anterior shoulder dislocation**. It involves an avulsion of the **anteroinferior glenoid labrum** from the underlying glenoid bone. This occurs when the humeral head is forced anteriorly and inferiorly, tearing the labrum and the attached inferior glenohumeral ligament (IGHL) complex. If a fragment of the glenoid bone is also fractured, it is termed a "Bony Bankart." **Analysis of Options:** * **Anterior shoulder dislocation (Correct):** This is the most common type of shoulder dislocation (95%). The mechanism involves forced abduction and external rotation, leading to the Bankart lesion and the associated **Hill-Sachs lesion** (compression fracture of the posterolateral humeral head). * **Posterior shoulder dislocation:** This is associated with a **Reverse Bankart lesion** (detachment of the posterior labrum) and a **Reverse Hill-Sachs lesion** (McLaughlin lesion), typically seen after seizures or electric shocks. * **Posterior elbow dislocation:** This typically involves injury to the medial collateral ligament and potential fractures of the coronoid process or radial head (Terrible Triad), but not a Bankart lesion. * **Posterior hip dislocation:** This is associated with acetabular posterior wall fractures and sciatic nerve injuries. **NEET-PG High-Yield Pearls:** * **Gold Standard Investigation:** MRI Arthrography is the best modality to visualize a Bankart lesion. * **Associated Lesion:** Hill-Sachs lesion (found in ~80% of cases). * **Treatment:** Recurrent cases often require surgical repair (Bankart repair), which can be done arthroscopically or via open surgery (e.g., Putti-Platt or Bristow-Latarjet procedure if there is significant bone loss).

Q: Traumatic myositis ossificans is also known as:

All of the above. **Explanation:** **Traumatic Myositis Ossificans (MO)** refers to the formation of heterotopic lamellar bone within soft tissues (usually muscles) following trauma. It is a non-neoplastic condition where a hematoma undergoes organization and subsequent ossification rather than resorption. The correct answer is **D (All of the above)** because the condition is often named based on the specific occupational or repetitive trauma that triggers it: 1. **Drill Bone:** Occurs in the **deltoid** or pectoral muscles of infantry soldiers due to the repetitive recoil of a rifle during drill practice. 2. **Rider’s Bone:** Occurs in the **adductor muscles** of the thigh (specifically Adductor Longus) in horseback riders due to chronic friction and strain against the saddle. 3. **Exercise Bone:** A general term used when ossification occurs in muscles subjected to heavy, repetitive athletic strain or acute injury during vigorous exercise. **Clinical Pearls for NEET-PG:** * **Common Site:** The most common site for traumatic MO is the **Brachialis** muscle (following supracondylar fracture or elbow dislocation) and the **Quadriceps**. * **Pathophysiology:** It follows the "Zoning Phenomenon"—the lesion is more mature (calcified) at the periphery and immature (cellular) in the center. This distinguishes it from Osteosarcoma, which is more mature at the center. * **Management:** The most important rule is **never to massage** a recent injury or perform forceful passive stretching, as this increases the risk of MO. * **Treatment:** Initial management is rest and NSAIDs (Indomethacin). Surgery is only indicated after the bone has "matured" (usually 6–12 months), evidenced by a well-defined cortex on X-ray and a cold bone scan.

Q: All of the following are true about intertrochanteric fracture of the femur except:

Intracapsular.. ### Explanation **Intertrochanteric (IT) fractures** are extracapsular fractures occurring between the greater and lesser trochanters. **1. Why Option D is the Correct Answer (The "Except"):** The hip joint capsule attaches anteriorly to the intertrochanteric line and posteriorly to the femoral neck (medial to the intertrochanteric crest). Therefore, IT fractures occur **outside the joint capsule (extracapsular)**. This is a critical distinction because, unlike intracapsular neck of femur fractures, IT fractures have a rich blood supply and do not typically lead to avascular necrosis (AVN). **2. Analysis of Other Options:** * **Option A (Commoner than neck of femur):** IT fractures are generally more common than neck of femur fractures, especially in the elderly population with osteoporosis. * **Option B (Treatment):** The gold standard for stable IT fractures is the **Dynamic Hip Screw (DHS)**. For unstable or reverse oblique patterns, the **Proximal Femoral Nail (PFN)** is preferred as it is an intramedullary device providing better biomechanical stability. * **Option C (Malunion):** Because the trochanteric region is composed of cancellous bone with an excellent blood supply, these fractures almost always heal (non-union is rare). However, they frequently heal in a deformed position, most commonly **coxa vara** and shortening, leading to malunion. **Clinical Pearls for NEET-PG:** * **Clinical Presentation:** The affected limb shows marked **shortening and external rotation** (often up to 90 degrees, touching the bed), which is more pronounced than in neck of femur fractures. * **Blood Loss:** Being extracapsular and involving cancellous bone, IT fractures are associated with significant concealed blood loss (up to 1–1.5 liters). * **Evans Classification:** Used to grade the stability of IT fractures. * **Complication:** The most common complication is **malunion**; the rarest is AVN.

Q: Fracture of the upper third of the ulna with proximal radioulnar dislocation is known as:

Monteggia fracture. **Explanation:** The correct answer is **Monteggia fracture**. This injury is defined as a fracture of the proximal third (upper third) of the ulna shaft associated with a dislocation of the radial head at the proximal radioulnar joint (PRUJ). **Understanding the Concept:** In the forearm, the radius and ulna are linked like a closed chain. A significant displaced fracture in one bone usually necessitates a dislocation or fracture in the other. In Monteggia's injury, the ulnar fracture provides the force that displaces the radial head. **Analysis of Incorrect Options:** * **Galeazzi fracture:** This is the "reverse" of a Monteggia. It involves a fracture of the **distal third of the radius** with dislocation of the **distal radioulnar joint (DRUJ)**. * **Barton fracture:** An intra-articular fracture of the distal radius with dislocation/subluxation of the radiocarpal joint. It can be volar (more common) or dorsal. * **Colles fracture:** An extra-articular fracture of the distal radius (within 2 cm of the joint) with characteristic **dorsal displacement** (Dinner fork deformity). It does not involve radioulnar dislocation. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic (MUGR):** **M**onteggia = **U**lna fracture; **G**aleazzi = **R**adius fracture. (The fracture site is the bone named). * **Bado Classification:** Used to classify Monteggia fractures based on the direction of radial head dislocation (Type I/Anterior is the most common). * **Nerve Injury:** The **Posterior Interosseous Nerve (PIN)**, a branch of the radial nerve, is the most commonly injured nerve in Monteggia fractures. * **Management:** In adults, these are unstable injuries requiring **ORIF (Open Reduction and Internal Fixation)** with a plate and screw for the ulna; the radial head usually reduces spontaneously once the ulna length is restored.

Q: Malgaigne feature is associated with which type of fracture?

Pelvis fracture. **Explanation:** **Malgaigne fracture** is a classic, high-energy injury of the **pelvis**. It is defined as a vertical shear fracture-dislocation of the pelvic ring. Specifically, it involves a double vertical fracture: one occurring anteriorly (through the pubic rami) and one occurring posteriorly (through the sacroiliac joint, sacrum, or ilium) on the same side (ipsilateral). This results in an unstable "vertical shear" pattern where one hemipelvis is displaced superiorly. **Analysis of Options:** * **B. Pelvis fracture (Correct):** The mechanism involves a vertical force (like a fall from height onto one leg), causing disruption of both the anterior and posterior pelvic arches. * **A. Shoulder fracture:** While the shoulder can suffer various eponymous fractures (like Hill-Sachs or Bankart lesions), Malgaigne is strictly pelvic. * **C. Spine fracture:** Spine fractures are often associated with pelvic trauma (e.g., Chance fractures or burst fractures), but Malgaigne refers specifically to the pelvic ring. * **D. Scapular fracture:** These are typically caused by direct high-energy trauma to the chest wall but are unrelated to the Malgaigne description. **Clinical Pearls for NEET-PG:** * **Mechanism:** Vertical shear (most unstable pelvic injury). * **Clinical Sign:** Shortening of the affected lower limb (due to superior migration of the hemipelvis) without a hip fracture. * **Radiology:** Look for superior displacement of the hemipelvis and disruption of the sacroiliac joint. * **Complications:** High risk of massive retroperitoneal hemorrhage and internal organ injury. * **Note:** Do not confuse this with **Malgaigne’s Luxation**, which is an older term for an elbow dislocation (Monteggia-like variant), though in modern exams, "Malgaigne" almost exclusively refers to the pelvis.

Q: Nonunion is common in which of the following fracture locations?

Neck femur. **Explanation:** **Neck of femur** fractures are notorious for high rates of nonunion and avascular necrosis (AVN). This is primarily due to three factors: 1. **Intracapsular Nature:** The fracture is bathed in synovial fluid, which contains fibrinolysins that dissolve the initial blood clot, hindering the formation of a primary callus. 2. **Blood Supply:** The femoral head relies on the retrograde blood supply (mainly the medial circumflex femoral artery). Fractures often disrupt these vessels, leading to ischemia. 3. **Lack of Periosteum:** The femoral neck lacks a cambium layer of periosteum, meaning healing occurs only through endosteal repair, which is slower and less robust. **Analysis of Other Options:** * **Scapula:** These fractures are surrounded by thick, well-vascularized muscle bulk (rotator cuff, subscapularis). They almost always heal with conservative management; nonunion is extremely rare. * **Talus:** While the talus has a high risk of **AVN** (due to its retrograde blood supply), the rate of nonunion is generally lower than that of the femoral neck. * **Tibial Fracture:** The lower third of the tibia is a common site for delayed union due to poor soft tissue cover and nutrient artery distribution, but the absolute incidence of nonunion is statistically lower than in intracapsular femoral neck fractures. **High-Yield Pearls for NEET-PG:** * **Pauwels’ Classification:** Higher angles (Type III > 50°) indicate high shear forces and a higher risk of nonunion. * **Garden’s Classification:** Used for displacement; Stage III and IV have the highest risk of AVN and nonunion. * **Commonest sites for Nonunion:** Neck of femur, Scaphoid, and Talus (often due to precarious blood supply). * **Commonest site for Malunion:** Colles’ fracture and Supracondylar fracture of the humerus.

Q: Prosthetic replacement of the femoral head is indicated for which of the following fracture sites of the femur?

Subcapital fracture of the neck of femur. **Explanation:** The primary indication for prosthetic replacement (Hemiarthroplasty) in femoral neck fractures is the high risk of **Avascular Necrosis (AVN)** and **Non-union**. **1. Why Subcapital Fracture is the Correct Answer:** The femoral head receives its blood supply mainly through the **retinacular vessels** (branches of the medial circumflex femoral artery) which run along the neck. A **subcapital fracture** occurs just below the femoral head, where the fracture line is intracapsular. This frequently disrupts the blood supply, leading to a high incidence of AVN. In elderly patients with low functional demands, primary prosthetic replacement is preferred over internal fixation to avoid the complications of re-operation. **2. Analysis of Incorrect Options:** * **Inter-trochanteric (A) and Transtrochanteric (C) Fractures:** These are **extracapsular** fractures. This region has a rich blood supply and a large surface area of cancellous bone, leading to excellent healing potential. The treatment of choice is internal fixation (e.g., DHS or Cephalomedullary nail), not replacement. * **Basal Fracture of the Neck (D):** This occurs at the junction of the neck and the trochanter. Being further away from the head, the blood supply is often preserved compared to subcapital fractures. These are usually treated with internal fixation. **Clinical Pearls for NEET-PG:** * **Garden’s Classification:** Used for intracapsular fractures. Stage III and IV (displaced) in elderly patients are the classic indications for Hemiarthroplasty. * **Pauwels’ Classification:** Based on the angle of the fracture line; higher angles (Type III) indicate greater shear forces and higher risk of non-union. * **Choice of Surgery:** In young patients, always attempt **Internal Fixation** (Head salvage) regardless of displacement. In active elderly patients, **Total Hip Arthroplasty (THA)** is superior to Hemiarthroplasty.

Question 1

Bankart lesion occurs in patients with which of the following?

Accepted Answer

Anterior shoulder dislocation

Answer

Posterior shoulder dislocation

Answer

Posterior elbow dislocation

Answer

Posterior hip dislocation

Question 2

Traumatic myositis ossificans is also known as:

Accepted Answer

All of the above

Answer

Drill bone

Answer

Rider's bone

Answer

Exercise bone

Question 3

All of the following are true about intertrochanteric fracture of the femur except:

Accepted Answer

Intracapsular.

Answer

Commoner than fracture of the neck of the femur.

Answer

Treatment is proximal femoral nail or dynamic hip screw.

Answer

Associated with malunion.

Question 4

Fracture of the upper third of the ulna with proximal radioulnar dislocation is known as:

Accepted Answer

Monteggia fracture

Answer

Galeazzi fracture

Answer

Barton fracture

Answer

Colles fracture

Question 5

A 66-year-old female developed pain while walking, with shortening and external rotation of the limb and broadening of the greater trochanter. What is the possible diagnosis?

Accepted Answer

Fracture of the intertrochanteric femur

Answer

Fracture of the neck of the femur

Answer

Acetabular fracture

Answer

Central dislocation of the hip

Question 6

Malgaigne feature is associated with which type of fracture?

Accepted Answer

Pelvis fracture

Answer

Shoulder fracture

Answer

Spine fracture

Answer

Scapular fracture

Question 7

All are true statements regarding Volkmann's ischemic contracture, except?

Accepted Answer

Flexion deformity of the wrist and fingers.

Answer

Ischemic muscle is replaced by fibrous tissue.

Answer

Ulnar nerve palsy may be present.

Answer

Extension at the metacarpophalangeal joints.

Question 8

Perkin's traction is used in which part of the femur?

Accepted Answer

Shaft of femur in adults

Answer

Shaft of femur in children < 2 years

Answer

Shaft of femur in children 2-10 years

Answer

Shaft of femur in children > 10 years

Question 9

Nonunion is common in which of the following fracture locations?

Accepted Answer

Neck femur

Answer

Scapula

Answer

Talus

Answer

Tibial fracture

Question 10

Prosthetic replacement of the femoral head is indicated for which of the following fracture sites of the femur?

Accepted Answer

Subcapital fracture of the neck of femur

Answer

Inter-trochanteric fracture

Answer

Transtrochanteric fracture

Answer

Basal fracture of the neck of femur

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?