Trauma Practice Questions

Q: What does the given image show?

Kessel's plate. ***Kessel's plate*** - The image clearly labels the items on the right side as "b. Kessel's plate," which is a type of **osteosynthesis plate** used for fixing bone fractures. - Kessel's plates are designed to provide **stable fixation** for specific types of fractures, often in the distal femur or tibia. *Dynamic hip screw* - The image labels the items on the left side as "a. Dynamic hip screw," which is a different orthopedic implant than the one in question. - A dynamic hip screw (DHS) is primarily used for the fixation of **intertrochanteric hip fractures** and has a distinct design with a sliding screw. *Amp rasp* - An Amp rasp is a surgical tool used in **hip arthroplasty** to prepare the femoral canal for the stem of a hip prosthesis. - The items shown in the image are **implants** for fixation, not surgical rasps. *Bipolar hip prosthesis* - A bipolar hip prosthesis is a type of **hip replacement implant** used in hemiarthroplasty, consisting of two articulating components. - The image displays **fixation plates and screws**, not a joint replacement prosthesis.

Q: Identify the traction show in the image:

$90-90$ traction. ***$90-90$ traction*** - In this traction, hips and knees are bent at **$90$-degree angles**, and the lower leg is suspended with a traction device, often used for **femur fractures** in young children. - This position helps in aligning bone fragments and providing stable fixation. *Gallow's traction* - **Gallow's traction** involves suspending both legs vertically, with the hips flexed to **$90$ degrees**, and the child's buttocks slightly off the bed. - It is typically used for **femoral shaft fractures** in infants weighing less than **$12$ kg**. *Russell traction* - **Russell traction** involves a sling under the knee and weights applied in longitudinal and vertical directions. - This setup creates a **horizontal force** to align **femoral shaft fractures**. *Smith's traction* - **Smith's traction** is a type of skeletal traction for femoral shaft fractures, usually involving a **pin inserted into the distal femur** or proximal tibia. - This method is characterized by a direct pull on the bone for more effective reduction and stabilization.

Q: Identify the instrument:

Crutchfield tongs. ***Crutchfield tongs*** - These tongs are used for **skeletal traction** in cases of **cervical spine injuries**, particularly cervical dislocations. - They are specifically designed for insertion into the temporal bones of the skull to apply continuous traction, as seen with the pointed ends and adjustable bar. *Boyle-Davis gag* - A Boyle-Davis gag is a type of **mouth gag** used to hold the mouth open during oral and pharyngeal surgeries, and it does not resemble the instrument shown. - It usually features a tongue depressor and often a method for suction, which are absent here. *Decapitator* - A decapitator is a historical surgical instrument used for **fetal decapitation** during difficult childbirth, and it has a very different morphology, usually involving a sharp cutting or crushing mechanism. - Its design is entirely distinct from the traction device pictured. *Jewett nail* - A Jewett nail is an **intramedullary nail** used in orthopedic surgery to fix **intertrochanteric hip fractures**. - It is an internal fixation device, not an external traction tong, and bears no resemblance to the instrument shown.

Q: Identify the fracture shown in the image below:

Fracture tibia. ***Fracture tibia*** - The image displays a **long bone fracture** in the lower leg, characterized by a visible fracture line (indicated by the arrow) through the shaft. - The upper part of the image clearly shows the **knee joint**, confirming this as a view of the tibia (shin bone). *Fracture radius* - The radius is a bone in the **forearm**, not the lower leg. - The image clearly depicts the **lower extremity** with a knee joint visible. *Colle's fracture* - A Colles' fracture is a specific type of fracture of the **distal radius** (near the wrist), which is in the forearm. - The fracture shown is in the **tibia**, a bone of the lower leg, and the location is not characteristic of a Colles' fracture. *Supracondylar fracture humerus* - The humerus is the **upper arm bone**, and a supracondylar fracture occurs near the elbow joint. - The image shows a fracture in the **lower leg**, specifically the tibia, not the upper arm.

Q: Which of the following classifications is used to assess the fracture shown below?

Pipkins classification. ***Pipkins classification*** - The image shows a **femoral head fracture**, indicated by the arrow, with internal fixation. The Pipkins classification system specifically categorizes fractures of the **femoral head**. - This system helps guide treatment and prognostication for these particular hip injuries, differentiating based on location and associated injuries. *Gustilo classification* - The Gustilo classification is used for **open fractures**, assessing the extent of soft tissue damage and contamination. - The image displays a post-operative X-ray of a surgically fixed fracture, and the classification is not applicable here as it pertains to the initial presentation of an open fracture. *Salter and Harris classification* - The Salter-Harris classification system is used for **growth plate (physeal) fractures** in children. - The image shows a fracture in an adult bone (as evidenced by the fused growth plates and the morphology of the bone), making this classification irrelevant. *Weber classification* - The Weber classification is used for **ankle fractures**, specifically those involving the distal fibula. - The fracture shown in the image is of the **femoral head**, not the ankle, hence the Weber classification is not appropriate.

Q: The X-ray was taken 8 weeks after sustaining fracture. What is the diagnosis?

Nonunion. ***Nonunion*** - The X-ray image shows a clear **gap** between the two bone fragments, and the bone ends appear **sclerotic** and rounded, indicating that the bone has failed to heal after 8 weeks. - Nonunion is the failure for a fracture to heal after a reasonable period, often defined by the absence of signs of healing for 3-6 months depending on the bone and site, but after 8 weeks with clearly visible sclerotic fragment ends suggests this condition. *Malunion* - **Malunion** occurs when a fracture heals, but in a **deformed** or anatomically incorrect position, which is not evident in the provided image as the fragments are still separate. - The primary problem here is the *absence* of healing, not the healing in a misaligned fashion. *Myositis ossificans* - **Myositis ossificans** is the formation of **heterotopic bone** within muscle or soft tissue, typically following trauma, and would appear as calcification *outside* the bone shaft. - The image clearly depicts unhealed bone fragments, not new bone formation within surrounding soft tissues. *Avascular necrosis* - **Avascular necrosis** (AVN) is the death of bone tissue due to interruption of blood supply, often leading to **collapse of the bone**, which is usually seen in particular bones like the femoral head or scaphoid. - While AVN can complicate fractures, the image primarily shows a lack of bony bridging rather than changes indicative of bone death and collapse.

Q: Which of the following is most commonly seen after the accident shown?

Posterior hip dislocation. ***Posterior hip dislocation*** - The image depicts a classic mechanism of injury in a dashboard injury, where the **knee strikes the dashboard**, driving the femur posteriorly. - This force, especially when the hip is flexed and adducted, can eject the femoral head **posteriorly out of the acetabulum**. *Anterior hip dislocation* - This type of dislocation typically occurs with the hip in **flexion, abduction, and external rotation**, a mechanism not suggested by the diagram. - It is much **less common** than posterior hip dislocation in dashboard injuries. *Posterior tibial dislocation* - While a dashboard injury can affect the knee, a direct posterior force on the tibia itself is more likely to cause a **tibial plateau fracture** or **ligamentous injury** (e.g., PCL tear) than a complete tibiofemoral dislocation in this context. - A posterior tibial dislocation results from severe hyperextension or a direct blow to the anterior tibia when the knee is flexed, which is a different vector of force than the one illustrated. *Anterior tibial dislocation* - This injury typically results from a **hyperextension injury** of the knee or a force applied to the posterior aspect of the proximal tibia. - The image shows a force specifically directed towards the *anterior* aspect of the knee (dashboard impact), making posterior displacement of the femur relative to the pelvis more likely.

Q: Comment on the diagnosis:

Jones fracture. ***Jones fracture*** - The image indicates a fracture located at the **proximal metaphyseal-diaphyseal junction of the fifth metatarsal**, which is characteristic of a **Jones fracture**. - This fracture involves the **base of the fifth metatarsal** and is often associated with a higher risk of nonunion due to limited blood supply. *March fracture* - A **March fracture** is a type of stress fracture, typically affecting the **shaft of the second, third, or fourth metatarsals**, often seen in military recruits or those who engage in prolonged walking or running. - It results from repetitive stress rather than an acute injury, and its location is distinct from the proximal fifth metatarsal. *Shepherd's fracture* - A **Shepherd's fracture** refers to an avulsion fracture of the **posterolateral tubercle of the talus**, also known as an os trigonum fracture. - This fracture is located in the ankle region, distinct from the metatarsals. *Cotton's fracture* - A **Cotton's fracture** is a trimalleolar fracture of the ankle, involving the **medial malleolus**, **lateral malleolus**, and the **posterior malleolus** of the tibia. - This is a complex ankle injury, entirely unrelated to fractures of the metatarsals.

Q: What is the name of the splint shown here?

Bohler Braun splint. ***Bohler Braun splint*** - The image displays a **Bohler Braun splint**, characterized by its **trapezoidal shape** and often used for lower extremity fractures. - It features a frame designed to provide **traction and support**, with a U-shaped or ring component at one end and a tapering support surface. *Aeroplane splint* - An aeroplane splint positions the arm in **abduction** (away from the body) and often **external rotation**, resembling an airplane wing. - It is typically used for shoulder and upper arm injuries, which is distinct from the lower limb support seen in the image. *Von Rosen splint* - The Von Rosen splint is a **hip abduction brace** used in infants for congenital hip dislocation. - It positions the hips in **flexion and abduction**, which is entirely different from the long, tapering splint shown. *Thomas splint* - A Thomas splint is a **traction splint** used for femoral shaft fractures, characterized by a large ring that fits around the groin and long sidebars. - While it provides traction like the Bohler Braun splint, its design, particularly the **prominent thigh ring**, is distinctly different from the broad, tapering shape in the image.

Q: Comment on the diagnosis:

March fracture. ***March fracture*** - The image indicates a **stress fracture** of a metatarsal bone, which is characteristic of a **March fracture**. - This type of fracture commonly affects the **2nd or 3rd metatarsal** and is often seen in individuals who engage in strenuous physical activity. *June's fracture* - This is not a recognized eponym for a specific type of fracture in the foot. - The term "June's fracture" does not correspond to any known medical diagnosis related to metatarsal stress fractures. *Shepherd's fracture* - A Shepherd's fracture refers to a **fracture of the posterior process of the talus**. - It is distinct from a metatarsal stress fracture and typically results from forced plantarflexion. *Cotton's fracture* - A Cotton's fracture is a **trimalleolar ankle fracture**, involving the medial, lateral, and posterior malleoli of the ankle. - This is a complex ankle injury, unrelated to a metatarsal stress fracture.

Question 1

What does the given image show?

Accepted Answer

Kessel's plate

Answer

Dynamic hip screw

Answer

Amp rasp

Answer

Bipolar hip prosthesis

Question 2

Identify the traction show in the image:

Accepted Answer

$90-90$ traction

Answer

Gallow's traction

Answer

Russell traction

Answer

Smith's traction

Question 3

Identify the instrument:

Accepted Answer

Crutchfield tongs

Answer

Boyle-Davis gag

Answer

Decapitator

Answer

Jewett nail

Question 4

Identify the fracture shown in the image below:

Accepted Answer

Fracture tibia

Answer

Fracture radius

Answer

Colle's fracture

Answer

Supracondylar fracture humerus

Question 5

Which of the following classifications is used to assess the fracture shown below?

Accepted Answer

Pipkins classification

Answer

Gustilo classification

Answer

Salter and Harris classification

Answer

Weber classification

Question 6

The X-ray was taken 8 weeks after sustaining fracture. What is the diagnosis?

Accepted Answer

Nonunion

Answer

Malunion

Answer

Myositis ossificans

Answer

Avascular necrosis

Question 7

Which of the following is most commonly seen after the accident shown?

Accepted Answer

Posterior hip dislocation

Answer

Anterior hip dislocation

Answer

Posterior tibial dislocation

Answer

Anterior tibial dislocation

Question 8

Comment on the diagnosis:

Accepted Answer

Jones fracture

Answer

March fracture

Answer

Shepherd's fracture

Answer

Cotton's fracture

Question 9

What is the name of the splint shown here?

Accepted Answer

Bohler Braun splint

Answer

Aeroplane splint

Answer

Von Rosen splint

Answer

Thomas splint

Question 10

Comment on the diagnosis:

Accepted Answer

March fracture

Answer

June's fracture

Answer

Shepherd's fracture

Answer

Cotton's fracture

Trauma — MCQs

Trauma — MCQs

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