Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 801: Which of the following are associated with supracondylar fracture of humerus?

A. It is uncommon after 15 years of age.
B. Extension type fracture is more common than the flexion type.
C. Cubitus varus deformity commonly results following malunion.
D. All of the above. (Correct Answer)

Explanation: **Explanation:** Supracondylar fractures of the humerus are the most common elbow fractures in the pediatric population, typically occurring between the ages of 5 and 10 years. * **Option A:** These fractures are **uncommon after 15 years of age** because the physis (growth plate) closes and the supracondylar area becomes thicker and stronger. In adults, trauma to this region more commonly results in intercondylar fractures or dislocations. * **Option B:** **Extension type** is significantly more common, accounting for approximately **95-98%** of cases. It occurs due to a fall on an outstretched hand with the elbow in hyperextension. Flexion type (2-5%) occurs from a direct blow to the posterior aspect of the flexed elbow. * **Option C:** **Cubitus varus** (Gunstock deformity) is the most common late complication. It results from **malunion** (specifically due to inadequate reduction of medial tilt, internal rotation, or posterior displacement), rather than a growth disturbance. While cosmetically displeasing, it rarely affects functional range of motion. **Clinical Pearls for NEET-PG:** * **Gartland Classification:** Used to grade extension-type fractures (Type I: Undisplaced; Type II: Displaced with intact posterior cortex; Type III: Completely displaced). * **Neurological Injury:** The **Anterior Interosseous Nerve (AIN)** is the most commonly injured nerve in extension-type fractures (specifically posterolateral displacement). The **Ulnar nerve** is most commonly injured in flexion-type fractures or during iatrogenic medial pinning. * **Vascular Emergency:** Absence of radial pulse indicates brachial artery involvement. **Volkmann’s Ischemic Contracture (VIC)** is the most dreaded vascular complication. * **Radiology:** Look for the **"Fat Pad Sign"** (suggests occult fracture) and the **Anterior Humeral Line**, which should normally bisect the middle third of the capitellum.

Question 802: The Sultanpur technique is used for which of the following conditions?

A. Shoulder dislocation
B. Lateral condyle humerus fracture (Correct Answer)
C. Elbow dislocation
D. Monteggia fracture

Explanation: **Explanation:** The **Sultanpur technique** is a specialized surgical maneuver used for the management of **Lateral Condyle Humerus Fractures** in children. These fractures are the second most common elbow fractures in the pediatric population (after supracondylar fractures) and are notoriously unstable. The technique involves a **percutaneous "joy-stick" maneuver** using K-wires. Under image intensification (C-arm), a K-wire is inserted into the displaced fragment to manipulate, rotate, and reduce it into its anatomical position without the need for a large open incision. This minimally invasive approach helps preserve the blood supply to the lateral condyle, reducing the risk of avascular necrosis and non-union. **Analysis of Incorrect Options:** * **A. Shoulder dislocation:** Common reduction techniques include Kocher’s, Milch’s, and Stimson’s. The Sultanpur technique is specific to the elbow. * **C. Elbow dislocation:** Reduction usually involves traction and counter-traction (Meyn and Quigley or Parvin’s technique). * **D. Monteggia fracture:** This involves a proximal third ulna fracture with a radial head dislocation. Management typically involves ORIF of the ulna (Bado classification). **Clinical Pearls for NEET-PG:** * **Milch Classification:** Used for lateral condyle fractures (Type I: through the epiphysis; Type II: through the physis—more common). * **Complications:** If missed or poorly treated, lateral condyle fractures lead to **Cubitus Valgus** deformity, which can cause **Tardy Ulnar Nerve Palsy** years later. * **Fish-tail deformity:** A common radiological sequela following lateral condyle fracture healing.

Question 803: What is the commonest complication of a Colles' fracture?

A. Nonunion
B. Malunion (Correct Answer)
C. Vascular injury
D. Sudeck's osteodystrophy

Explanation: **Explanation:** **Colles' fracture** is a distal radius fracture occurring within 2.5 cm of the wrist joint, characterized by dorsal displacement and angulation (Dinner Fork deformity). **1. Why Malunion is the Correct Answer:** Malunion is the **most common complication** of a Colles' fracture. It occurs due to the difficulty in maintaining anatomical reduction in a cast, especially in elderly patients with osteoporotic bone. This typically results in a "residual dinner fork deformity" and radial shortening, though it often remains functionally acceptable despite the cosmetic defect. **2. Why the Other Options are Incorrect:** * **Nonunion (A):** Extremely rare in Colles' fractures because the distal radius is made of cancellous bone, which has an excellent blood supply and high osteogenic potential. * **Vascular injury (C):** Rare in this fracture. Nerve injuries (specifically Median nerve compression) are more common than vascular ones. * **Sudeck's osteodystrophy (D):** Also known as Complex Regional Pain Syndrome (CRPS). While it is a well-known and debilitating complication of Colles' fracture, it is not the *most common*. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common late complication:** Malunion. * **Most common associated nerve injury:** Median nerve (Carpal Tunnel Syndrome). * **Most common tendon rupture:** Extensor Pollicis Longus (EPL) rupture (usually occurs 4–8 weeks post-injury due to ischemia or attrition at Lister’s tubercle). * **Stiffness:** Shoulder-hand syndrome is a frequent complication where the patient develops a stiff shoulder due to lack of mobilization while the wrist is in a cast. * **Deformities in Colles':** Dorsal tilt, Dorsal displacement, Radial tilt, Radial displacement, Supination, and Impaction.

Question 804: A young male, after sudden unconsciousness following an episode of seizure, on awakening, finds that both of his arms were adducted and internally rotated. What is the most probable diagnosis?

A. Anterior dislocation
B. Posterior dislocation (Correct Answer)
C. Greater tuberosity fracture
D. Rotator cuff injury

Explanation: ### Explanation **Correct Option: B. Posterior Dislocation** The clinical presentation of bilateral shoulder pain with the arms locked in **adduction and internal rotation** following a **seizure** is the classic "textbook" description of a posterior shoulder dislocation. * **Mechanism:** During a seizure (or electric shock), the powerful internal rotators (Latissimus dorsi, Pectoralis major, and Subscapularis) overpower the weaker external rotators. This forceful contraction drives the humeral head posteriorly out of the glenoid fossa. * **Clinical Presentation:** The patient cannot externally rotate the arm. On examination, there is a palpable gap anteriorly and a prominence posteriorly. **Why other options are incorrect:** * **Anterior Dislocation:** This is the most common type of shoulder dislocation (95%), but it typically occurs due to trauma (fall on outstretched hand) and presents with the arm in **abduction and external rotation**. * **Greater Tuberosity Fracture:** While this can occur alongside an anterior dislocation, it does not typically cause the classic "locked internal rotation" seen after a seizure. * **Rotator Cuff Injury:** This usually presents with weakness in initiating abduction or pain during the painful arc (60°–120°), but it does not result in a fixed rotational deformity. **NEET-PG High-Yield Pearls:** 1. **Triple E's:** Posterior dislocation is associated with **E**pilepsy (seizures), **E**lectricity (accidental shock/ECT), and **E**thanol (withdrawal seizures). 2. **Radiology:** Look for the **"Light Bulb Sign"** on AP view (humeral head appears symmetrical/rounded due to internal rotation) and the **"Rim Sign"** (increased space between the glenoid rim and humeral head). 3. **Gold Standard View:** The **Axillary view** is the best X-ray view to confirm a posterior dislocation. 4. **Associated Lesion:** A **Reverse Hill-Sachs lesion** (impaction fracture of the anteromedial humeral head) is often seen in posterior dislocations.

Question 805: Which of the following conditions does not disturb 3-point symmetry?

A. Fracture of the ulna only
B. Fracture of the radius only (Correct Answer)
C. Fracture of both radius and ulna
D. Weak posterior capsule

Explanation: ### Explanation **The Concept of 3-Point Symmetry** In the elbow, 3-point symmetry refers to the anatomical relationship between the **medial epicondyle**, the **lateral epicondyle**, and the **tip of the olecranon**. * When the elbow is **extended**, these three points form a straight horizontal line. * When the elbow is **flexed to 90°**, they form an equilateral (or isosceles) triangle. Any condition that displaces the olecranon process relative to the humeral epicondyles will disturb this symmetry. **Why "Fracture of the radius only" is the Correct Answer:** The radius (specifically the radial head) articulates with the capitellum of the humerus but is **not** a component of the 3-point relationship. A fracture of the radius (e.g., radial head or neck) does not alter the position of the olecranon or the epicondyles; therefore, the 3-point symmetry remains intact. **Analysis of Incorrect Options:** * **Fracture of the ulna only:** If the fracture involves the proximal ulna or the olecranon process, the bony landmark (olecranon tip) shifts, disrupting the triangle. * **Fracture of both radius and ulna:** Similar to the above, the involvement of the ulna typically leads to a loss of the normal anatomical relationship at the elbow. * **Weak posterior capsule:** A weak capsule can lead to **posterior dislocation of the elbow**. In any elbow dislocation, the olecranon is displaced from its humeral articulation, which is a classic cause of disturbed 3-point symmetry. **High-Yield Clinical Pearls for NEET-PG:** * **Symmetry Maintained:** 3-point symmetry is **preserved** in **Supracondylar fractures of the humerus** (because the entire distal fragment, including both epicondyles and the olecranon, moves together). * **Symmetry Disturbed:** It is **lost** in **Elbow Dislocation** and **Intercondylar fractures**. * This clinical test is the primary bedside method to differentiate a supracondylar fracture from an elbow dislocation.

Question 806: The most common deformity seen in supracondylar fracture of humerus is?

A. Inability to supinate and pronate
B. Varus deformity (Correct Answer)
C. Valgus deformity
D. None of the above

Explanation: **Explanation:** Supracondylar fracture of the humerus is the most common pediatric elbow fracture. The most frequent late complication associated with this injury is a malunion resulting in **Cubitus Varus deformity**, also known as the **"Gunstock deformity."** **Why Varus Deformity is Correct:** The deformity occurs due to the malunion of the distal fragment, primarily caused by **coronal tilt (medial tilt)** and **internal rotation**. If the fracture is not anatomically reduced or if the reduction is lost, the distal fragment tilts medially, decreasing the carrying angle of the elbow and leading to a varus alignment. While it is primarily a cosmetic issue and rarely affects the range of motion, it is the most common deformity seen post-injury. **Analysis of Incorrect Options:** * **A. Inability to supinate and pronate:** Supination and pronation occur at the proximal and distal radioulnar joints. A supracondylar fracture involves the distal humerus (extra-articular); therefore, unless there is an associated forearm fracture or severe compartment syndrome (Volkmann’s Ischemic Contracture), these movements remain intact. * **C. Valgus deformity:** While a lateral tilt could theoretically cause a valgus deformity (Cubitus Valgus), it is clinically rare in supracondylar fractures. Cubitus valgus is more characteristically associated with a malunion or non-union of a **Lateral Condyle fracture** of the humerus. **NEET-PG High-Yield Pearls:** * **Most common complication:** Cubitus Varus (Gunstock deformity). * **Most common nerve injured:** Anterior Interosseous Nerve (AIN)—a branch of the Median nerve (specifically in extension-type fractures). * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Baumann’s Angle:** Used radiologically to assess the adequacy of reduction and predict future varus deformity.

Question 807: Green stick fractures are most common in which age group?

A. Older individuals
B. Adults
C. Children (Correct Answer)
D. Soldiers

Explanation: **Explanation:** **Greenstick fractures** are incomplete fractures where the bone cortex is broken on one side (the convex side) but remains intact on the other (the concave side), similar to breaking a young, moist branch of a tree. **1. Why Children?** The primary reason this occurs in children is the **high elasticity and thick periosteum** of pediatric bones. Children’s bones are less mineralized and more collagenous than adult bones. When a bending force is applied, the bone undergoes plastic deformation; the tension side fails (fractures), while the compression side merely bends or buckles without a complete break. **2. Analysis of Incorrect Options:** * **Older individuals (A):** Their bones are often osteoporotic, brittle, and have low elasticity. Stress leads to complete or comminuted fractures rather than bending. * **Adults (B):** Mature bones are fully mineralized and rigid. The periosteum is thinner and less osteogenic, making incomplete "bending" fractures nearly impossible. * **Soldiers (D):** This group is classically associated with **March fractures** (stress fractures of the metatarsals) due to repetitive loading, not greenstick fractures. **3. Clinical Pearls for NEET-PG:** * **Management:** These fractures often require "completing the fracture" (breaking the intact cortex) during reduction to prevent the elastic recoil of the bone from causing a deformity recurrence. * **Plastic Deformation:** A related pediatric condition where the bone bows without any visible cortical disruption on X-ray. * **Torus (Buckle) Fracture:** Another pediatric-specific fracture where the cortex bulges due to axial loading, usually at the distal radius metaphysis. * **Remodeling:** Children have a high potential for remodeling, but rotational deformities in greenstick fractures do not self-correct and must be reduced.

Question 808: All are true about supracondylar fracture of humerus except?

A. Posterior shift of distal fragment
B. Median nerve is the most common nerve damaged
C. Injury of brachial artery may occur
D. Common in the elderly (Correct Answer)

Explanation: ### Explanation Supracondylar fracture of the humerus is a classic pediatric injury, most commonly occurring in children aged **5–10 years**. It is rarely seen in the elderly, where distal humerus fractures are more likely to be intercondylar or comminuted due to osteoporosis. **Analysis of Options:** * **D. Common in the elderly (Correct Answer):** This is false. The supracondylar area is the weakest part of the adolescent humerus (due to remodeling), making it highly susceptible to injury from a fall on an outstretched hand (FOOSH). In adults, the bone is stronger here, and injuries typically involve the joint surface. * **A. Posterior shift of distal fragment:** In the **extension type** (95% of cases), the distal fragment is displaced posteriorly and proximally. This is the most common displacement pattern. * **B. Median nerve is the most common nerve damaged:** Overall, the **Median nerve** (specifically the Anterior Interosseous Nerve branch) is the most frequently injured nerve in extension-type fractures. However, in posterolateral displacement, the median nerve is at risk, while posteromedial displacement often affects the radial nerve. * **C. Injury of brachial artery may occur:** The sharp proximal fragment can easily pierce or entrap the brachial artery, leading to pulselessness or the limb-threatening **Volkmann’s Ischemic Contracture**. ### Clinical Pearls for NEET-PG: * **Gartland Classification:** Used to grade displacement (Type I: Undisplaced; Type II: Angulated but intact posterior cortex; Type III: Completely displaced). * **Baumann’s Angle:** Used radiologically to assess the adequacy of reduction. * **Fat Pad Sign:** A "Sail sign" (anterior fat pad elevation) or the presence of a posterior fat pad on X-ray indicates an occult fracture. * **Complication:** The most common late complication is **Cubitus Varus** (Gunstock deformity) due to malunion.

Question 809: Volkmann's ischemic contracture mostly involves which compartment?

A. Flexor digitorum superficialis
B. Pronator teres
C. Flexor digitorum profundus (Correct Answer)
D. Flexor carpi radialis longus

Explanation: **Explanation:** Volkmann’s Ischemic Contracture (VIC) is the permanent sequela of untreated **Acute Compartment Syndrome**, most commonly following supracondylar fractures of the humerus in children. The underlying pathology involves ischemia and subsequent necrosis of the muscles within the tight fascial compartments of the forearm. **Why Flexor Digitorum Profundus (FDP) is correct:** The forearm is divided into superficial and deep compartments. The **deep flexor compartment** is the most vulnerable to increased intracompartmental pressure because it lies closest to the bone (radius and ulna) and has the least distensible fascia. Within this compartment, the **Flexor Digitorum Profundus (FDP)** and **Flexor Pollicis Longus (FPL)** are the most deeply situated muscles. Consequently, they are the first to undergo ischemic necrosis and subsequent fibrosis, leading to the characteristic "claw-like" deformity. **Analysis of Incorrect Options:** * **A & D (FDS and FCR):** These are muscles of the **superficial flexor compartment**. While they can be involved in severe, late-stage VIC, they are typically less affected than the deep muscles because they are further from the "watershed" zone of highest pressure near the bone. * **B (Pronator Teres):** This is a superficial muscle of the proximal forearm. While it may be involved, it is not the primary or most common site of contracture compared to the long finger flexors. **NEET-PG High-Yield Pearls:** * **Classic Deformity:** Wrist flexion, MCP joint hyperextension, and IP joint flexion (Claw hand). * **The "Volkmann’s Sign":** Passive extension of the fingers is restricted and painful unless the wrist is flexed (which relaxes the fibrotic FDP tendons). * **Most common nerve involved:** Median nerve (due to its deep anatomical position). * **Earliest Sign of Compartment Syndrome:** Pain out of proportion to the injury and pain on passive stretching of muscles.

Question 810: Which carpal bone fractures commonly?

A. Scaphoid (Correct Answer)
B. Lunate
C. Hammate
D. Pisciform

Explanation: **Explanation:** The **Scaphoid** is the most commonly fractured carpal bone, accounting for approximately 60–70% of all carpal injuries. This high incidence is due to its unique anatomy and position; it acts as a "mechanical bridge" between the proximal and distal carpal rows. When a person falls on an outstretched hand (**FOOSH**) with the wrist in extension and radial deviation, the scaphoid is compressed against the radius, leading to a fracture—most frequently at the **waist**. **Analysis of Options:** * **Lunate (B):** While it is the most commonly **dislocated** carpal bone (associated with Perilunate dislocations), it is rarely fractured. * **Hamate (C):** Fractures are uncommon and usually involve the "hook of the hamate," often seen in athletes (golfers or baseball players) due to direct trauma from a club or bat. * **Pisiform (D):** This is a sesamoid bone within the Flexor Carpi Ulnaris tendon; fractures are rare and typically result from direct impact to the hypothenar eminence. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid receives its blood supply distally via the dorsal carpal branch of the radial artery. Therefore, fractures at the waist or proximal pole are at high risk for **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox** is the classic diagnostic finding. * **Radiology:** Fractures may not appear on initial X-rays. If clinical suspicion is high, the wrist should be immobilized in a **thumb spica cast** and re-imaged after 10–14 days. MRI is the gold standard for early detection.

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Trauma — MCQs

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