Trauma Practice Questions

Q: All of the following are associated with supracondylar fracture of humerus, except?

Ulnar nerve is most commonly involved. **Explanation:** Supracondylar fracture of the humerus is the most common pediatric elbow fracture. Understanding its complications and anatomy is crucial for NEET-PG. **Why Option D is the correct answer (The Exception):** In supracondylar fractures, the **Median nerve** (specifically the **Anterior Interosseous Nerve branch**) is the most commonly injured nerve in the extension type, followed by the Radial nerve. The **Ulnar nerve** is rarely injured in the primary trauma; it is more commonly associated with the rare **flexion-type** fracture or occurs iatrogenically during medial percutaneous pinning. **Analysis of other options:** * **Option A:** This fracture is primarily seen in children (peak age 5–8 years) because the supracondylar area is thin and weak during skeletal development. After age 15, the physis closes and the bone strengthens, making dislocations more common than fractures. * **Option B:** **Extension type** accounts for approximately **95-98%** of cases, usually resulting from a fall on an outstretched hand. Flexion type is rare (2-5%). * **Option C:** **Cubitus varus** (Gunstock deformity) is the most common late complication due to malunion (specifically due to uncorrected coronal tilt or internal rotation). While it is a cosmetic deformity, it rarely affects function. **Clinical Pearls for NEET-PG:** * **Most common complication:** Cubitus varus (Malunion). * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Gartland Classification:** Used to grade displacement (Type I: Undisplaced; Type II: Displaced with intact posterior cortex; Type III: Completely displaced). * **Radiological Sign:** Look for the **"Fat pad sign"** (occult fracture) and the **Anterior Humeral Line** (which should normally bisect the middle third of the capitellum).

Q: What is the best imaging modality to distinguish acute osteomyelitis from a soft tissue infection?

MRI. **Explanation:** The gold standard and most accurate imaging modality for distinguishing acute osteomyelitis from a soft tissue infection (like cellulitis or abscess) is **MRI**. **Why MRI is the Correct Answer:** MRI offers superior soft-tissue contrast and high sensitivity (90-100%) for detecting early bone marrow changes. In acute osteomyelitis, MRI can detect **bone marrow edema** (low signal on T1, high signal on T2/STIR) as early as 1–2 days after the onset of infection. It clearly demarcates whether the inflammatory process is confined to the soft tissues or has breached the cortex to involve the marrow, which is critical for diagnosis. **Why Other Options are Incorrect:** * **Clinical Examination:** While essential for initial suspicion (rubor, tumor, calor, dolor), it cannot definitively differentiate between deep cellulitis and underlying bone involvement. * **X-ray:** Plain radiographs are insensitive in the early stages. Bone changes (periosteal reaction or bone destruction) typically do not appear until **10–14 days** after infection begins and require at least 30-50% bone mineral loss to be visible. * **CT Scan:** While excellent for identifying sequestrum (dead bone) in chronic osteomyelitis or cortical destruction, it is less sensitive than MRI for early marrow edema and involves significant radiation. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign on X-ray:** Soft tissue swelling. * **Earliest sign on MRI:** Bone marrow edema. * **Triple Phase Bone Scan (Technetium-99m):** Highly sensitive but lacks the anatomical detail of MRI; it is often used if MRI is contraindicated. * **Gold Standard for Diagnosis:** Bone biopsy and culture (though MRI is the best *imaging*).

Q: A fracture of the talus without displacement is visualized on X-ray. What is the most likely complication?

Osteoarthritis of the ankle. **Explanation:** Fractures of the talus are notorious for their high complication rates due to the bone's unique anatomy—it is 60% covered by articular cartilage and has a precarious retrograde blood supply. **Why Option A is Correct:** While Avascular Necrosis (AVN) is a feared complication of talar neck fractures, **Osteoarthritis (OA)** of the ankle or subtalar joint is actually the **most common** overall complication, even in undisplaced fractures. This occurs because the talus is an intra-articular bone; any fracture, even without displacement, can cause chondral damage or subtle joint incongruity, leading to secondary degenerative changes over time. **Analysis of Incorrect Options:** * **B, C, and D (AVN):** AVN is a classic complication of talar neck fractures (Hawkins Classification). However, in **undisplaced** fractures (Hawkins Type I), the risk of AVN is relatively low (0–15%). When AVN does occur, it typically involves the **body** of the talus because the blood supply enters through the neck and flows retrogradely to the body. AVN of the "head" or "neck" specifically is anatomically incorrect in this clinical context. **NEET-PG High-Yield Pearls:** * **Hawkins Sign:** A subchondral radiolucent line in the talar dome seen on X-ray 6–8 weeks post-injury. Its presence indicates intact vascularity (excludes AVN). * **Blood Supply:** Primarily from the **Artery of the Tarsal Canal** (branch of the posterior tibial artery). * **Most common site of fracture:** Talar Neck. * **Aviator’s Astragalus:** Historical term for talar fractures caused by high-energy dorsiflexion.

Q: Which of the following radiographic views is NOT important in the assessment of a scaphoid fracture?

Cone view. **Explanation:** The scaphoid is the most commonly fractured carpal bone, and its complex anatomy requires a specific "Scaphoid Series" for accurate diagnosis. **Why "Cone View" is the correct answer:** A **Cone view** is a specialized radiographic technique used to improve detail in a localized area (often used in dental imaging or for specific skull/sinus pathologies) by narrowing the X-ray beam. It is **not** a standard or recognized view for evaluating carpal fractures. In the context of the wrist, it provides no diagnostic advantage over standard orthopedic views. **Analysis of Incorrect Options:** * **Anteroposterior (AP):** A standard view to assess general carpal alignment and identify transverse fractures. * **Lateral:** Essential for evaluating the "spilled teacup" sign (lunate dislocation) and checking for dorsal/palmar displacement or angulation (humpback deformity) of the scaphoid. * **Oblique (usually 45°):** This view shifts the other carpal bones out of the way, providing a clearer profile of the scaphoid body. * **Note on the "Scaphoid View":** The most critical view (not listed above but often tested) is the **PA view with Ulnar Deviation**. This maneuvers the scaphoid out of its foreshortened position, placing it parallel to the film to better visualize the waist. **Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid receives its blood supply distally from the radial artery. Therefore, **proximal pole fractures** have the highest risk of **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox** is the most sensitive clinical finding. * **Management:** If X-rays are negative but clinical suspicion is high, the wrist should be immobilized in a **Thumb Spica cast** and re-imaged in 10–14 days. MRI is the gold standard for early detection.

Q: What is an Ator fracture?

Fracture of the neck of the talus. **Explanation:** **Aviator’s Fracture (Ator Fracture)** refers to a fracture of the **neck of the talus**. The term originated during World War I when pilots would crash-land; the sudden forceful dorsiflexion of the foot against the rudder pedal caused the neck of the talus to be driven against the anterior edge of the distal tibia, leading to a fracture. **Why the correct answer is right:** * **Option A:** The talus neck is the most common site for talar fractures. Because the talus has a retrograde blood supply (entering mainly through the neck and distal body), fractures here carry a high risk of **Avascular Necrosis (AVN)** of the talar body. **Why the incorrect options are wrong:** * **Option B (Scaphoid):** While also prone to AVN, scaphoid fractures are typically caused by a fall on an outstretched hand (FOOSH), not dorsiflexion of the foot. * **Option C (Calcaneum):** Known as "Lover’s Fracture" or "Don Juan Fracture," usually caused by a fall from a height onto the heels. * **Option D (5th Metatarsal):** Fractures here are classified as Jones fractures (base of the 5th metatarsal) or Dancer’s fractures (avulsion of the styloid process). **Clinical Pearls for NEET-PG:** 1. **Hawkins Classification:** Used to grade talar neck fractures and predict the risk of AVN (Type I to IV). 2. **Hawkins Sign:** A subcortical radiolucent line seen on X-ray 6–8 weeks post-injury, indicating intact vascularity (a good prognostic sign). 3. **Blood Supply:** The **Artery of the Tarsal Canal** (branch of the posterior tibial artery) is the most important vessel supplying the body of the talus.

Q: Regarding Sudeck's osteodystrophy, all are true except?

Self-limiting and good prognosis. **Explanation:** Sudeck’s osteodystrophy, also known as **Complex Regional Pain Syndrome (CRPS) Type 1**, is a post-traumatic reflex sympathetic dystrophy characterized by autonomic dysfunction. **Why Option D is the correct answer:** Contrary to being self-limiting, Sudeck’s osteodystrophy often follows a **chronic, progressive course** and has a **guarded prognosis**. If not treated early with aggressive physiotherapy and pain management, it can lead to permanent joint contractures, muscle atrophy, and severe functional disability. It is notoriously difficult to treat once established. **Analysis of Incorrect Options:** * **Option A (Burning pain):** This is the hallmark symptom. The pain is typically "out of proportion" to the initial injury and has a distinct neuropathic (burning) quality. * **Option B (Stiffness and swelling):** Vasomotor instability leads to exudation, causing soft tissue swelling. This eventually results in periarticular fibrosis and significant joint stiffness. * **Option C (Erythematous and cyanotic discoloration):** In the early (acute) stage, the limb is often red (erythematous) and warm. As it progresses to the dystrophic stage, it becomes cold, pale, or cyanotic due to vasoconstriction. **NEET-PG High-Yield Pearls:** * **X-ray finding:** Classic "patchy" or "moth-eaten" osteoporosis (sudden demineralization) of the distal bones. * **Common trigger:** Often follows Colles’ fracture or tight plaster casts. * **Clinical Stages:** 1. Acute (Hyperemic), 2. Dystrophic (Ischemic), 3. Atrophic (Final stage with contractures). * **Management:** The most important preventive and therapeutic measure is **active mobilization** and physiotherapy. Sympathetic blocks (e.g., Stellate ganglion block) may be used in refractory cases.

Question 1

All of the following are associated with supracondylar fracture of humerus, except?

Accepted Answer

Ulnar nerve is most commonly involved

Answer

It is uncommon after 15 years of age

Answer

Extension type fracture is more common than the flexion type

Answer

Cubitus varus deformity commonly results following malunion

Question 2

A 40-year-old patient presents with an inability to keep the arm in contact with the chest. When the arm is forcibly brought into contact with the chest, there is winging of the scapula. There is a history of repeated intramuscular injections into the deltoid muscle. What is the diagnosis?

Accepted Answer

Deltoid contracture

Answer

Serratus anterior muscle palsy

Answer

Poliomyelitis

Answer

Neglected anterior dislocation of the shoulder

Question 3

What is the best imaging modality to distinguish acute osteomyelitis from a soft tissue infection?

Accepted Answer

MRI

Answer

Clinical examination

Answer

X-ray

Answer

CT scan

Question 4

Careless handling of a suspected case of cervical spine injury may result in what complication?

Accepted Answer

Injury to the spinal cord leading to quadriparesis or quadriplegia

Answer

Intracranial haemorrhage with cerebral irritation or unconsciousness

Answer

Cervical haematoma with compression of brachial vessels

Answer

Complete paralysis of the affected upper extremity

Question 5

A fracture of the talus without displacement is visualized on X-ray. What is the most likely complication?

Accepted Answer

Osteoarthritis of the ankle

Answer

Osteonecrosis of the head of the talus

Answer

Avascular necrosis of the body of the talus

Answer

Avascular necrosis of the neck of the talus

Question 6

Which of the following radiographic views is NOT important in the assessment of a scaphoid fracture?

Accepted Answer

Cone view

Answer

Anteroposterior (AP)

Answer

Lateral

Answer

Oblique

Question 7

A K-nail works on the principle of which type of fixation?

Accepted Answer

Three-point fixation

Answer

One-point fixation

Answer

Two-point fixation

Answer

Four-point fixation

Question 8

Which of the following is a factor contributing to fat embolism in a patient with major trauma?

Accepted Answer

Mobility of the fractured bone

Answer

Hypovolemic shock

Answer

Respiratory failure

Answer

All of the above

Question 9

What is an Ator fracture?

Accepted Answer

Fracture of the neck of the talus

Answer

Fracture of the scaphoid

Answer

Fracture of the calcaneum

Answer

Fracture of the 5th metatarsal

Question 10

Regarding Sudeck's osteodystrophy, all are true except?

Accepted Answer

Self-limiting and good prognosis

Answer

Burning pain

Answer

Stiffness and swelling

Answer

Erythematous and cyanotic discoloration

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?