Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 791: A 43-year-old man sustains a fracture of the tibia. Following application of an above-knee cast, and its removal after 6 weeks, he develops a foot drop and is unable to extend his ankle. This is due to a pressure injury to which of the following nerves?

A. Posterior tibial nerve
B. Saphenous nerve
C. Femoral nerve
D. Deep fibular (peroneal) nerve (Correct Answer)

Explanation: **Explanation:** The clinical presentation of **foot drop** (inability to dorsiflex the ankle) following a tight cast or pressure near the knee is a classic sign of **Common Peroneal Nerve (CPN)** or its branch, the **Deep Peroneal Nerve**, injury. **Why the correct answer is right:** The Common Peroneal Nerve is highly vulnerable to compression as it winds around the **neck of the fibula**. In this case, a tight above-knee cast or improper padding at the proximal end of the cast exerts direct pressure on this superficial site. The **Deep Peroneal Nerve** specifically innervates the muscles of the anterior compartment of the leg (Tibialis anterior, EHL, EDL), which are responsible for **dorsiflexion** of the foot and extension of the toes. Damage leads to "foot drop." **Why the incorrect options are wrong:** * **Posterior Tibial Nerve:** It supplies the posterior compartment (plantarflexors). Injury would result in an inability to tip-toe and loss of sensation on the sole, not foot drop. * **Saphenous Nerve:** This is a purely sensory branch of the femoral nerve. Injury causes numbness along the medial aspect of the leg/foot but no motor deficit. * **Femoral Nerve:** This nerve supplies the quadriceps (knee extension) and hip flexors. It is located much higher in the femoral triangle and is not affected by pressure at the fibular neck. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of CPN injury:** Neck of the fibula. * **Clinical Triad of CPN Palsy:** Foot drop, loss of toe extension, and sensory loss over the first dorsal web space (Deep branch) or lateral leg/dorsum of foot (Superficial branch). * **Gait:** Patients with foot drop exhibit a **High Steppage Gait** to prevent the toes from dragging. * **Splinting:** A **Foot Drop Splint (AFO - Ankle Foot Orthosis)** is used to maintain the foot in neutral position.

Question 792: Which of the following is NOT true about Jefferson's fracture?

A. It is a fracture of the C1 vertebra.
B. It is a vertical compression fracture.
C. It is a common type of fracture of the C1 vertebra. (Correct Answer)
D. It has a 50% association with concomitant injury in the cervical spine elsewhere.

Explanation: **Explanation** **Jefferson’s fracture** is a specific type of burst fracture involving the **C1 vertebra (Atlas)**. 1. **Why Option C is the correct answer (The False Statement):** While Jefferson’s fracture is the most "famous" or classically described fracture of the atlas, it is **not the most common**. In clinical practice, isolated fractures of the posterior arch of C1 are more frequent than the classic four-part burst fracture (Jefferson’s) described by the mechanism of axial loading. 2. **Analysis of other options:** * **Option A (True):** It is specifically a fracture of the C1 vertebra, typically involving bilateral fractures of both the anterior and posterior arches. * **Option B (True):** The primary mechanism of injury is **axial loading** (vertical compression), such as a heavy object falling on the head or diving into a shallow pool. This force drives the occipital condyles into the lateral masses of C1, causing them to "burst" outward. * **Option D (True):** Approximately **50%** of patients with a Jefferson fracture have a concomitant cervical spine injury, most commonly a fracture of the C2 vertebra (Axis). **High-Yield Clinical Pearls for NEET-PG:** * **Stability:** It is often neurologically stable because the burst mechanism increases the diameter of the spinal canal (the fragments move outward). * **Radiology:** Diagnosis is made using the **Open-mouth (Odontoid) view** X-ray. A "lateral displacement of lateral masses" of >7mm (combined) indicates a rupture of the **Transverse Axial Ligament (TAL)**, signifying an unstable fracture. * **Treatment:** Stable fractures are treated with a hard cervical collar; unstable fractures require a Halo vest or surgical stabilization.

Question 793: Which of the following is NOT a component of O'Donoghue's unhappy triad?

A. Anterior cruciate ligament (ACL) injury
B. Medial meniscus injury
C. Medial collateral ligament (MCL) injury
D. Fibular collateral ligament (FCL) injury (Correct Answer)

Explanation: **Explanation:** The **O'Donoghue’s Unhappy Triad** (also known as the "blown knee") is a classic knee injury pattern typically resulting from a high-impact lateral blow to the knee while the foot is fixed on the ground (valgus stress with external rotation). **1. Why Option D is correct:** The **Fibular Collateral Ligament (FCL)**, also known as the Lateral Collateral Ligament (LCL), is located on the lateral aspect of the knee. The Unhappy Triad specifically involves structures on the **medial** side of the knee due to the valgus mechanism of injury. Therefore, an FCL injury is not part of this triad. **2. Why the other options are incorrect:** The classic triad consists of the following three structures: * **Anterior Cruciate Ligament (ACL) injury (Option A):** This is the most common ligamentous component of the triad, resulting from the rotational force. * **Medial Meniscus injury (Option B):** In O'Donoghue’s original description, the medial meniscus was included. However, modern sports medicine studies (using MRI) suggest that **lateral meniscus** tears are actually more common in acute ACL injuries, though the "classic" definition for exams remains the medial meniscus. * **Medial Collateral Ligament (MCL) injury (Option C):** The valgus stress directly stretches and tears the MCL on the medial side. **Clinical Pearls for NEET-PG:** * **Mechanism:** Valgus stress + External rotation + Fixed foot. * **Clinical Sign:** Positive Lachman’s test (for ACL) and opening of the medial joint line on valgus stress (for MCL). * **Modern Update:** While the "Classic Triad" includes the Medial Meniscus, the "Modern Triad" often cites the **Lateral Meniscus** as being more frequently injured in acute cases. Always follow the classic definition (Medial Meniscus) unless the question specifically asks for modern epidemiological findings.

Question 794: The Thompson and Epstein classification is used for which of the following conditions?

A. Anterior dislocation of the hip
B. Posterior dislocation of the hip (Correct Answer)
C. Central dislocation of the hip
D. Fracture of the neck of the femur

Explanation: ### Explanation **1. Why Posterior Dislocation of the Hip is Correct:** The **Thompson and Epstein classification** is the most widely used system for **Posterior Dislocation of the Hip**. It categorizes the injury based on radiographic findings and the presence or severity of an associated acetabular rim fracture. * **Type I:** Simple dislocation with or without an insignificant bone fragment. * **Type II:** Dislocation with a large single fracture fragment of the posterior acetabular rim. * **Type III:** Dislocation with a comminuted fracture of the posterior acetabular rim. * **Type IV:** Dislocation with a fracture of the acetabular floor. * **Type V:** Dislocation with a fracture of the femoral head (Pipkin classification is also used here). **2. Why Other Options are Incorrect:** * **Anterior Dislocation of the Hip:** These are typically classified by the **Epstein classification** (distinct from Thompson-Epstein), which divides them into Superior (Pubic) and Inferior (Obturator) types. * **Central Dislocation of the Hip:** This is essentially a fracture-dislocation where the femoral head is driven through the acetabulum into the pelvis. It is classified under **Acetabular fractures** (e.g., Letournel and Judet classification). * **Fracture of the Neck of Femur:** These are classified using the **Garden classification** (based on displacement) or the **Pauwels classification** (based on the angle of the fracture line). **3. Clinical Pearls for NEET-PG:** * **Mechanism:** Posterior dislocation usually occurs due to a "dashboard injury" (force applied to a flexed knee). * **Clinical Presentation:** The limb is typically **shortened, adducted, and internally rotated** (Position of deformity). * **Emergency:** Hip dislocation is an orthopedic emergency due to the high risk of **Avascular Necrosis (AVN)** of the femoral head. * **Nerve Injury:** The **Sciatic nerve** (specifically the peroneal division) is the most commonly injured nerve in posterior dislocations.

Question 795: What is the most common complication of shoulder joint dislocation?

A. Injury to the brachial plexus
B. Injury to the circumflex nerve (Correct Answer)
C. Rupture of the supraspinatus muscle
D. Rupture of the deltoid muscle

Explanation: **Explanation:** The shoulder joint is the most commonly dislocated joint in the body, with **anterior dislocation** accounting for over 95% of cases. **Why the Axillary (Circumflex) Nerve is the correct answer:** The axillary nerve (C5-C6) winds around the surgical neck of the humerus, passing through the quadrangular space. Due to its close anatomical proximity to the inferior aspect of the glenohumeral joint capsule, it is highly susceptible to traction or compression injuries when the humeral head is displaced anteroinferiorly. Clinically, this manifests as **weakness in shoulder abduction** (deltoid paralysis) and **sensory loss over the "regimental badge area"** (lateral aspect of the upper arm). **Analysis of Incorrect Options:** * **A. Injury to the brachial plexus:** While the posterior cord or the entire plexus can be injured in high-energy trauma or violent reductions, it is far less common than isolated axillary nerve palsy. * **C. Rupture of the supraspinatus muscle:** This is a common complication in **elderly patients** (rotator cuff tears), but across all age groups, neurological injury (specifically the axillary nerve) is statistically more frequent as an immediate complication. * **D. Rupture of the deltoid muscle:** The deltoid muscle itself is rarely ruptured; its dysfunction is almost always secondary to axillary nerve injury. **NEET-PG High-Yield Pearls:** * **Most common nerve injured:** Axillary nerve (Circumflex nerve). * **Most common overall complication:** Recurrence (especially in patients <20 years old). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (seen in anterior dislocation). * **Bankart’s Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Kocher’s Method:** A classic reduction technique (Mnemonic: **TEAM** – Traction, External rotation, Adduction, Internal rotation/Medial rotation).

Question 796: A positive Adson's test is seen in which of the following conditions?

A. Thoracic outlet syndrome (Correct Answer)
B. Buerger's disease
C. Varicose veins
D. Radial nerve injury

Explanation: **Explanation:** **1. Why Thoracic Outlet Syndrome (TOS) is correct:** Adson’s test is a clinical maneuver used to assess for **Thoracic Outlet Syndrome**, specifically compression of the subclavian artery by a cervical rib or a tight scalenus anterior muscle. * **Mechanism:** The patient’s arm is slightly abducted, and the clinician palpates the radial pulse. The patient is then asked to extend their neck and rotate the head toward the symptomatic side while taking a deep breath. * **Positive Result:** A significant decrease or disappearance of the radial pulse indicates arterial compression within the scalene triangle. **2. Why the incorrect options are wrong:** * **Buerger’s Disease (Thromboangiitis Obliterans):** This is an inflammatory occlusive disease of small and medium-sized arteries, typically in smokers. It is assessed using **Allen’s test** (for palmar circulation) or **Buerger’s test** (postural color changes in the feet). * **Varicose Veins:** These are dilated, tortuous superficial veins due to valvular incompetence. Clinical tests include the **Trendelenburg test** and **Perthes’ test**. * **Radial Nerve Injury:** This leads to motor deficits like "wrist drop." It is assessed by testing the extension of the wrist and metacarpophalangeal joints, not by provocative vascular maneuvers. **3. High-Yield Clinical Pearls for NEET-PG:** * **Roos Test (Elevated Arm Stress Test):** Considered the most sensitive clinical test for TOS. * **Cervical Rib:** The most common anatomical cause of neurovascular compression in TOS; it arises from the **C7 vertebra**. * **Differential Diagnosis:** Always differentiate TOS from **Pancoast tumor** (which involves the lower brachial plexus) and **Cervical Spondylosis**. * **Military Brace Position (Eden's Test):** Another test for TOS where the shoulders are drawn back and down to compress the neurovascular bundle between the clavicle and the first rib.

Question 797: What is the most common complication of a supracondylar fracture?

A. Osteosarcoma
B. Genu valgum
C. Blood vessel injury
D. Malunion with gunstock deformity (Correct Answer)

Explanation: **Explanation:** Supracondylar fractures of the humerus are the most common pediatric elbow fractures. **1. Why Malunion (Gunstock Deformity) is correct:** The most common complication of this fracture is **malunion**, specifically resulting in **Cubitus Varus** (also known as **Gunstock Deformity**). This occurs due to inadequate reduction or loss of fixation, leading to a collapse of the medial column or internal rotation of the distal fragment. While it is primarily a cosmetic deformity with minimal functional impairment, it remains the most frequent late complication. **2. Analysis of Incorrect Options:** * **A. Osteosarcoma:** This is a primary malignant bone tumor and is not a complication of trauma or fractures. * **B. Genu valgum:** This refers to "knock-knees," a deformity of the lower limb (knee joint), unrelated to the humerus or elbow. * **C. Blood vessel injury:** While **Brachial artery injury** is the most common *vascular* complication (occurring in about 5-10% of cases), it is less frequent than malunion. It is a serious acute complication but not the "most common" overall. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Median nerve (specifically the **Anterior Interosseous Nerve/AIN**) in extension-type fractures; Ulnar nerve in flexion-type or iatrogenic (K-wire) cases. * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to compartment syndrome. * **Radiographic Sign:** Look for the **Fat Pad Sign** (Sail sign) indicating intra-articular effusion and the **Anterior Humeral Line** (which should normally bisect the middle third of the capitellum). * **Management:** Displaced fractures (Gartland Type II & III) typically require Closed Reduction and Internal Fixation (CRIF) with K-wires.

Question 798: What is a Lisfranc fracture-dislocation?

A. Fracture-dislocation through the tarso-metatarsal joints. (Correct Answer)
B. Fracture-dislocation through the ankle joint.
C. Fracture-dislocation through the subtalar joints.
D. Fracture-dislocation through the mid-tarsal joints.

Explanation: **Explanation:** A **Lisfranc fracture-dislocation** involves an injury to the **tarso-metatarsal (TMT) joint complex**, which serves as the anatomical junction between the forefoot and the midfoot. The "Lisfranc joint" specifically refers to the articulation between the five metatarsal bases and the three cuneiforms plus the cuboid. The stability of this joint is primarily maintained by the **Lisfranc ligament**, which connects the medial cuneiform to the base of the second metatarsal. Because there is no transverse ligament between the first and second metatarsal bases, this ligament is the key stabilizer; its disruption leads to the characteristic lateral displacement of the metatarsals. **Analysis of Options:** * **Option A (Correct):** Lisfranc injuries are defined by disruption at the tarso-metatarsal level. * **Option B (Incorrect):** Injuries to the ankle joint usually involve malleolar fractures or pilon fractures. * **Option C (Incorrect):** Subtalar dislocations (peritalar dislocations) involve the articulations between the talus, calcaneus, and navicular. * **Option D (Incorrect):** Mid-tarsal joint injuries (Chopart’s fracture-dislocation) occur at the talonavicular and calcaneocuboid joints, separating the hindfoot from the midfoot. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Often caused by high-energy trauma (RTA) or indirect axial loading on a plantar-flexed foot (e.g., a fall). * **Radiological Sign:** The **"Fleck Sign"**—a small bony avulsion fragment seen between the bases of the 1st and 2nd metatarsals—is pathognomonic for a Lisfranc ligament tear. * **Alignment:** On an AP view, the medial border of the 2nd metatarsal should always align with the medial border of the middle cuneiform. * **Management:** Displaced injuries require anatomical reduction and internal fixation (ORIF) with screws or K-wires to prevent long-term midfoot instability and secondary osteoarthritis.

Question 799: Posada's fracture is defined as:

A. Supracondylar fracture of humerus (Correct Answer)
B. Fracture of the lateral condyle of humerus
C. Fracture of the medial condyle of humerus
D. Fracture of the anatomical neck of humerus

Explanation: **Explanation:** **Posada's fracture** is a historical eponym specifically used to describe a **transcondylar or supracondylar fracture of the humerus** where the distal fragment is displaced anteriorly. In modern orthopaedics, it is synonymous with the **anteriorly displaced (flexion-type) supracondylar fracture**. 1. **Why Option A is Correct:** Supracondylar fractures are the most common elbow fractures in children. While the extension type (posterior displacement) is more frequent (95%), the **Posada's variant** refers to the flexion type where the distal fragment moves anterior to the humeral shaft. This occurs typically from a fall on the point of the flexed elbow. 2. **Why Other Options are Incorrect:** * **Option B & C:** Fractures of the lateral or medial condyles are intra-articular fractures involving the growth plate (Salter-Harris Type IV). They are distinct from supracondylar fractures, which are extra-articular. Lateral condyle fractures are the second most common elbow fractures in children but are not associated with Posada's name. * **Option D:** Fracture of the anatomical neck is rare and usually occurs in the elderly as part of proximal humerus fractures, unrelated to the distal humeral anatomy of Posada's fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Gartland Classification:** Used for supracondylar fractures (Type I: Undisplaced; Type II: Displaced with intact posterior cortex; Type III: Completely displaced). * **Complications:** The most dreaded complication is **Volkmann’s Ischemic Contracture (VIC)** due to brachial artery injury or compartment syndrome. * **Nerve Injury:** The **Median nerve** (specifically the Anterior Interosseous Nerve) is most commonly injured in extension-type fractures, while the **Ulnar nerve** is more commonly injured in flexion-type (Posada's) fractures. * **Deformity:** Malunion often leads to **Cubitus Varus** (Gun-stock deformity).

Question 800: What is the most common fracture in the elderly following a fall on an outstretched hand?

A. Colles' fracture (Correct Answer)
B. Bennett's fracture
C. Galeazzi fracture
D. Monteggia fracture

Explanation: **Explanation:** **Colles’ fracture** is the most common fracture in the elderly, particularly in post-menopausal women with osteoporosis. The mechanism of injury is a **fall on an outstretched hand (FOOSH)** with the wrist in extension. It is a fracture of the distal radius (within 2.5 cm of the articular surface) with characteristic **dorsal displacement** and angulation, leading to the classic "Dinner Fork Deformity." **Analysis of Incorrect Options:** * **Bennett’s fracture:** This is an intra-articular fracture-dislocation at the base of the first metacarpal (thumb). It typically occurs due to axial loading along the thumb (e.g., punching), not a simple FOOSH in the elderly. * **Galeazzi fracture:** This involves a fracture of the distal third of the **radius** with dislocation of the **distal radioulnar joint (DRUJ)**. It is less common and usually results from high-energy trauma. * **Monteggia fracture:** This involves a fracture of the proximal third of the **ulna** with dislocation of the **radial head**. Like Galeazzi, it is more common in younger patients following significant trauma. **Clinical Pearls for NEET-PG:** * **Deformities:** Colles' = Dinner Fork; Smith’s (Reverse Colles') = Garden Spade. * **Displacements in Colles' (6):** Dorsal displacement, Dorsal tilt, Lateral displacement, Lateral tilt, Impaction, and Supination. * **Most common complication:** Stiffness of fingers and shoulder (most common); Malunion (leading to dinner fork deformity); Sudeck’s osteodystrophy (CRPS); and late rupture of the Extensor Pollicis Longus (EPL) tendon.

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Open Fractures

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Fractures in Children

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Fracture Complications

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Nonunion and Malunion

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Trauma — MCQs

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