Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 821: Which of the following is NOT true about a Colles fracture?

A. Common in old age
B. Results in dorsal displacement of the distal fragment
C. Occurs at the radio-carpal joint
D. Characterized by a garden spade deformity (Correct Answer)

Explanation: **Explanation:** A **Colles fracture** is a distal radius fracture occurring approximately 2.5 cm proximal to the wrist joint. The hallmark clinical presentation is a **"Dinner Fork Deformity,"** not a garden spade deformity. 1. **Why Option D is the Correct Answer (False Statement):** The **Garden Spade Deformity** is characteristic of a **Smith’s fracture** (also known as a Reverse Colles). In a Smith’s fracture, the distal fragment is displaced volarly (ventrally). In contrast, a Colles fracture causes dorsal displacement, resembling the curve of a dinner fork. 2. **Analysis of Other Options:** * **Option A (True):** It is most common in elderly post-menopausal women due to osteoporosis. It typically results from a fall on an outstretched hand (FOOSH). * **Option B (True):** The classic displacement pattern in Colles includes **dorsal** displacement, dorsal tilt, lateral displacement, lateral tilt, impaction, and supination. * **Option C (True/Contextual):** While the fracture line is extra-articular (proximal to the joint), it is clinically categorized as a fracture "at the wrist" or involving the distal radial metaphysis. **High-Yield Clinical Pearls for NEET-PG:** * **Deformity Mnemonic:** **C**olles = **D**inner Fork (CD); **S**mith = **G**arden Spade (SG). * **Most common complication:** Stiffness of fingers and shoulder (Frozen shoulder). * **Most common nerve involved:** Median nerve (Carpal Tunnel Syndrome). * **Late complication:** Rupture of the **Extensor Pollicis Longus (EPL)** tendon due to ischemia or attrition at Lister’s tubercle. * **Treatment:** Most are managed by closed reduction and a "Colles cast" (below-elbow cast with the wrist in slight flexion and ulnar deviation).

Question 822: Which of the following fractures is known for malunion?

A. Femur neck
B. Supracondylar Humerus (Correct Answer)
C. Scaphoid
D. Lateral condyle of humerus

Explanation: ### Explanation **Correct Answer: B. Supracondylar Humerus** The **Supracondylar fracture of the humerus** is notorious for **malunion**, specifically resulting in a **Cubitus Varus deformity** (also known as "Gunstock deformity"). This occurs due to the failure to correct the rotational or coronal tilt of the distal fragment during reduction. Unlike many other fractures, the supracondylar region has a high remodeling potential in children for sagittal plane deformities (extension/flexion), but it has **zero remodeling potential** for rotational or varus/valgus malalignment. Therefore, any residual varus tilt persists and leads to a permanent cosmetic deformity. **Why the other options are incorrect:** * **A. Femur Neck:** This fracture is primarily known for **Non-union** and **Avascular Necrosis (AVN)**. This is due to the precarious retrograde blood supply and the lack of a periosteal layer (intracapsular), which prevents callus formation. * **C. Scaphoid:** Similar to the femoral neck, the scaphoid is prone to **Non-union** and **AVN** (specifically of the proximal pole) because of its tenuous distal-to-proximal blood supply. * **D. Lateral Condyle of Humerus:** This is a "fracture of necessity" (requires ORIF). It is famous for **Non-union** (due to the pull of extensor muscles and synovial fluid interference), which subsequently leads to **Cubitus Valgus** and **Tardy Ulnar Nerve Palsy**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of Supracondylar Fracture:** Malunion (Cubitus Varus). * **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. * **Reverse Gunstock Deformity:** Refers to Cubitus Valgus, typically seen following lateral condyle non-union.

Question 823: Which of the following scaphoid fractures is most prone to develop avascular necrosis?

A. Fracture of the waist of the scaphoid (Correct Answer)
B. Fracture of the tubercle
C. Fracture of the distal pole
D. All of the above

Explanation: **Explanation:** The risk of **Avascular Necrosis (AVN)** in scaphoid fractures is primarily determined by its unique **retrograde blood supply**. 1. **Why the Waist is the Correct Answer:** The scaphoid receives approximately 70-80% of its blood supply from the **dorsal carpal branch of the radial artery**. These vessels enter the bone at the dorsal ridge (near the waist) and flow in a **retrograde (distal-to-proximal) direction**. When a fracture occurs at the **waist** or the **proximal pole**, it interrupts this blood flow to the proximal fragment. Since the proximal fragment is left without a direct blood supply, it is highly susceptible to ischemia and subsequent AVN. 2. **Why Other Options are Incorrect:** * **Fracture of the Tubercle:** The tubercle is located at the distal end and has an independent, rich blood supply. It heals well with conservative management and rarely develops AVN. * **Fracture of the Distal Pole:** Similar to the tubercle, the distal pole is closer to the entry points of the primary vessels. The blood supply remains intact or minimally disturbed, making AVN unlikely. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** The **waist** is the most common site of scaphoid fractures (approx. 70%). * **Most Common Complication:** **Non-union** is the most common complication, while AVN is the most serious. * **Radiology:** Fractures may not be visible on initial X-rays. If clinical suspicion exists (tenderness in the **Anatomical Snuffbox**), repeat X-rays in 10-14 days or perform an MRI (most sensitive). * **Preiser’s Disease:** Idiopathic avascular necrosis of the scaphoid (without a fracture).

Question 824: Which of the following signs is used to assess nerve regeneration?

A. Severity of nerve damage
B. Type of nerve injury
C. Location of nerve injury
D. Nerve regeneration (Correct Answer)

Explanation: **Explanation:** The correct answer is **Tinel’s Sign** (implied by the context of assessing nerve regeneration). In clinical practice, the progression of a positive Tinel’s sign is the most reliable bedside indicator of axonal regrowth following a nerve injury. **1. Why the Correct Answer is Right:** Nerve regeneration occurs at a rate of approximately **1 mm per day** (or 1 inch per month). As the regenerating axonal sprouts (which are unmyelinated and hypersensitive) advance along the distal endoneurial tube, mechanical percussion over the nerve trunk elicits a "pins and needles" sensation or tingling in the distal distribution of the nerve. If this point of sensitivity moves distally over time, it confirms active nerve regeneration. **2. Why the Other Options are Incorrect:** * **Severity of nerve damage:** This is classified using the **Seddon** (Neuropraxia, Axonotmesis, Neurotmesis) or **Sunderland** classifications. While severity dictates the *prognosis* of regeneration, it is a classification, not a clinical sign used to track ongoing recovery. * **Type of nerve injury:** Similar to severity, the "type" (e.g., crush vs. laceration) determines the management plan but does not serve as a clinical sign of progress. * **Location of nerve injury:** The level of the lesion (proximal vs. distal) affects the time required for recovery but is a static anatomical fact, not a dynamic sign of regeneration. **High-Yield Clinical Pearls for NEET-PG:** * **Hoffmann-Tinel Sign:** A "distal" tingling sign indicates regeneration; however, if the sign remains fixed at the site of injury, it suggests a **neuroma** and failed regeneration. * **Order of Recovery:** Following nerve repair, functions typically return in this order: **Sudomotor (sweating) → Deep pressure → Pain → Temperature → Touch → Proprioception → Motor function.** * **Neuropraxia:** Characterized by a conduction block without axonal continuity disruption; Tinel’s sign is typically **negative** because there is no axonal regrowth required.

Question 825: What is the commonest site of a march fracture?

A. Involves the shaft of the 2nd and 3rd metatarsals (Correct Answer)
B. Avulsion of the 5th metatarsal
C. Involves the calcaneus
D. Involves the olecranon

Explanation: **Explanation:** A **March fracture** is a type of fatigue/stress fracture that occurs due to repetitive submaximal stress on the bone, typically seen in individuals who have recently increased their physical activity (e.g., military recruits, athletes, or long-distance walkers). **1. Why Option A is Correct:** The **neck or shaft of the 2nd and 3rd metatarsals** is the most common site. This is because these metatarsals are relatively fixed and rigid compared to the others. During the toe-off phase of walking, the 2nd metatarsal acts as a primary lever, absorbing significant stress. Since it is thinner and less mobile than the 1st metatarsal, it is more prone to stress failure. **2. Why Other Options are Incorrect:** * **Option B (5th Metatarsal):** Fractures here are usually traumatic. An avulsion fracture of the base (styloid process) is called a **Pseudo-Jones fracture**, while a fracture at the meta-diaphyseal junction is a **Jones fracture**. * **Option C (Calcaneus):** While the calcaneus is the second most common site for stress fractures in the foot, it is not the "March fracture" specifically described in classic literature. * **Option D (Olecranon):** This is a site for traumatic fractures (often due to direct falls) or triceps avulsion, not a common site for weight-bearing stress fractures. **Clinical Pearls for NEET-PG:** * **Radiology:** Initial X-rays are often **negative** for the first 2–3 weeks. Diagnosis is later confirmed by the appearance of a **periosteal reaction** or callus formation. * **Gold Standard Investigation:** **MRI** is the most sensitive investigation for early detection (shows bone marrow edema). * **Management:** Most cases are managed conservatively with rest, activity modification, and a stiff-soled shoe or walking boot.

Question 826: Hill Sach's lesion is seen in:

A. Recurrent dislocation of shoulder (Correct Answer)
B. Recurrent dislocation of patella
C. Pehe's disease
D. Slipped capital femoral epiphyses

Explanation: **Explanation:** **Hill-Sachs lesion** is a classic radiological finding in **recurrent anterior dislocation of the shoulder**. It is a compression fracture (indentation) of the **posterosuperolateral aspect of the humeral head**. It occurs when the humeral head is forced against the sharp anterior edge of the glenoid labrum during an anterior dislocation episode. * **Option A (Correct):** In recurrent shoulder dislocations, repeated trauma leads to this "hatchet-shaped" defect. It is often associated with a **Bankart lesion** (avulsion of the anterior-inferior glenoid labrum). * **Option B:** Recurrent patellar dislocation is associated with a shallow trochlear groove or ligamentous laxity, but not Hill-Sachs lesions. * **Option C:** Perthes disease (Legg-Calvé-Perthes) is avascular necrosis of the femoral head in children; it presents with flattening of the femoral head, not a compression fracture from dislocation. * **Option D:** SCFE involves the displacement of the femoral epiphysis from the metaphysis, typically in obese adolescents, unrelated to shoulder pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Reverse Hill-Sachs Lesion:** An indentation on the *anterior* aspect of the humeral head, seen in **posterior shoulder dislocations**. * **Bankart Lesion:** The most common associated soft tissue injury in anterior dislocation (detachment of the anteroinferior labrum). * **Imaging:** The Hill-Sachs lesion is best visualized on an **AP view with internal rotation** or a **Stryker Notch view**. * **Hermodsson’s Lesion:** Another name for the Hill-Sachs defect.

Question 827: Which of the following methods is an example of rigid fixation?

A. Miniplate osteosynthesis
B. Transosseous wiring
C. Lag screw fixation (Correct Answer)
D. None of the above

Explanation: ### Explanation In orthopaedic trauma, fixation methods are classified based on the stability they provide to the fracture site. **1. Why Lag Screw Fixation is Correct:** **Lag screw fixation** is the classic example of **rigid (absolute) stability**. A lag screw works by compressing the two fracture fragments together. This interfragmentary compression creates high friction between the bone ends, abolishing all movement at the fracture site. This leads to **primary (direct) bone healing**, where Haversian remodeling occurs without the formation of a visible external callus. **2. Why the Other Options are Incorrect:** * **Miniplate Osteosynthesis (Option A):** While plates can provide stability, miniplates (often used in maxillofacial or hand surgery) typically provide **functional or semi-rigid stability**. Unless applied with specific compression techniques (like a DCP), they often allow microscopic movement, leading to secondary bone healing. * **Transosseous Wiring (Option B):** This is a form of **flexible/non-rigid fixation**. It holds fragments in apposition but does not provide enough stability to resist rotation or shear forces. It is often used as a supplement to other fixation methods or in tension-band constructs. **3. High-Yield Clinical Pearls for NEET-PG:** * **Absolute Stability:** Achieved by Lag screws and Compression plates. Results in **Primary bone healing** (No callus). * **Relative Stability:** Achieved by Intramedullary (IM) nails, External fixators, and Bridge plates. Results in **Secondary bone healing** (Callus formation). * **The "Lag" Principle:** A screw acts as a lag screw when it grips only the far (opposite) cortex, while the near cortex is over-drilled (gliding hole), allowing the screw head to pull the fragments together. * **Gold Standard for Articular Fractures:** Absolute stability (Rigid fixation) is mandatory for intra-articular fractures to ensure anatomical reduction and prevent post-traumatic arthritis.

Question 828: The pivot shift test is used to assess the integrity of which ligament?

A. Anterior cruciate ligament (Correct Answer)
B. Posterior cruciate ligament
C. Medial meniscus
D. Lateral meniscus

Explanation: **Explanation:** The **Pivot Shift Test** is the most specific clinical test for diagnosing an **Anterior Cruciate Ligament (ACL)** deficiency. It assesses **rotational instability**, specifically the anterolateral subluxation of the tibia on the femur. **Mechanism:** When the ACL is torn, the tibia subluxates anteriorly in extension. During the test, the knee is moved from extension to flexion while applying a valgus stress and internal rotation. At approximately 20–30° of flexion, the **Iliotibial (IT) band** (which acts as an extensor in extension and a flexor after 30° flexion) pulls the tibia back into its normal position. This sudden reduction is felt as a "clunk" or "shift," confirming ACL insufficiency. **Analysis of Options:** * **Option A (Correct):** The test specifically evaluates the ACL's role in controlling rotational and translational stability. * **Option B (Incorrect):** The **Posterior Drawer Test** and **Sag Sign** are used for PCL injuries. * **Options C & D (Incorrect):** Meniscal injuries are evaluated using **McMurray’s Test**, **Apley’s Grind Test**, or the **Thessaly Test**. **NEET-PG High-Yield Pearls:** * **Lachman Test:** The most *sensitive* test for acute ACL injury. * **Pivot Shift Test:** The most *specific* test for ACL injury (often difficult to perform in acute settings due to pain/guarding; best done under anesthesia). * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Unhappy Triad (O'Donoghue):** Injury involving the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly involved in acute tears).

Question 829: What is the immediate treatment of an unstable tibial plateau fracture?

A. Internal fixation with plate and screw (Correct Answer)
B. Internal fixation with nail
C. External fixator
D. Complete bed rest

Explanation: **Explanation:** Tibial plateau fractures are intra-articular injuries that disrupt the weight-bearing surface of the knee. The primary goal of treatment is to achieve **anatomical reduction** of the articular surface and provide **rigid internal fixation** to allow for early range of motion, thereby preventing joint stiffness and post-traumatic osteoarthritis. **Why Option A is Correct:** Internal fixation with a **plate and screws** (often using a locking compression plate) is the gold standard for unstable tibial plateau fractures. Plates provide the necessary stability to resist the axial and shear forces acting on the proximal tibia, ensuring the articular fragments remain aligned during healing. **Analysis of Incorrect Options:** * **Option B (Nail):** Intramedullary nailing is the treatment of choice for tibial *shaft* fractures. In plateau fractures, nails do not provide adequate stability for articular fragments and may further damage the joint surface. * **Option C (External Fixator):** While used in "damage control orthopaedics" for open fractures or severe soft-tissue swelling (to allow the "wrinkle sign" to appear), it is generally a temporary measure. Definitive treatment remains internal fixation once the soft tissue envelope is safe. * **Option D (Bed Rest):** This is contraindicated as it leads to fracture malunion, joint stiffness, and systemic complications like DVT. **High-Yield Clinical Pearls for NEET-PG:** * **Schatzker Classification:** The most common system used to categorize these fractures (Types I-VI). * **Associated Injury:** Always check for **Peroneal nerve** injury (foot drop) and **Popliteal artery** damage. * **Complication:** The most common early complication is **Compartment Syndrome**; the most common late complication is **Osteoarthritis**. * **Lipohemarthrosis:** Presence of fat globules in joint aspirate (seen on X-ray as the FBI sign) is pathognomonic for an intra-articular fracture.

Question 830: Fracture of the scaphoid bone is most commonly seen in which patient population?

A. Elderly male
B. Elderly postmenopausal female
C. Young active adult (Correct Answer)
D. Children

Explanation: **Explanation:** The **scaphoid** is the most commonly fractured carpal bone (approx. 60–70%). The mechanism of injury is typically a **fall on an outstretched hand (FOOSH)** with the wrist in dorsiflexion and radial deviation. **1. Why "Young Active Adult" is correct:** This population is most frequently involved in high-energy activities, sports, and motor vehicle accidents. In young adults, the bone density is high, but the force of impact is sufficient to snap the scaphoid across its waist. In contrast, similar trauma in other age groups often results in different fracture patterns due to varying bone strengths. **2. Why the other options are incorrect:** * **Elderly (Male/Postmenopausal Female):** In the elderly, the distal radius is relatively weaker due to osteoporosis. Therefore, a FOOSH more commonly results in a **Colles' fracture** rather than a scaphoid fracture. * **Children:** The scaphoid is largely cartilaginous in young children and does not ossify completely until mid-adolescence. Consequently, a FOOSH in children typically results in a **greenstick fracture of the distal radius** or a supracondylar fracture of the humerus. **Clinical Pearls for NEET-PG:** * **Most common site:** The **waist** of the scaphoid (70%). * **Blood Supply:** Supplied by the radial artery (retrograde flow). This makes the **proximal pole** highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox**. * **Radiology:** If initial X-rays are negative but clinical suspicion is high, repeat X-rays in 10–14 days or perform an MRI (most sensitive). * **Management:** Undisplaced fractures are treated with a **Scaphoid cast** (Glass-holding position).

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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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