Trauma Practice Questions

Q: A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Posterior dislocation. ***Posterior dislocation*** - An **electric shock** or **seizure** can cause strong muscle contractions, leading to a posterior shoulder dislocation. - Inability to perform **external rotation** and limited arm movement are classic signs of a posterior shoulder dislocation. *Clavicle fracture* - While a fall can cause a **clavicle fracture**, the primary symptoms would be pain over the clavicle and a visible deformity, not specifically limited external rotation or global arm immobility. - A clavicle fracture typically doesn't present with the specific inability to externally rotate the arm. *Luxation erecta* - **Luxatio erecta** is an inferior shoulder dislocation where the arm is held in an abducted and externally rotated position, pointing upwards, which is contrary to the described symptoms of inability to move the arm and external rotation. - It is a specific type of dislocation with a distinct presentation. *Anterior dislocation* - An **anterior dislocation** is the most common type of shoulder dislocation, but it usually presents with the arm held in slight abduction and external rotation, not an inability to externally rotate. - Typically results in a visible flattening of the deltoid contour and a prominent humeral head anteriorly.

Q: Blow out fracture can be due to:

Tennis ball injury. ***Tennis ball injury*** - A tennis ball injury to the orbit can cause a **blowout fracture** due to either direct impact compressing the globe or hydraulic pressure from the ball transmission of force, leading to a fracture of the orbital floor or medial wall. - The impact forces the orbital contents posteriorly, increasing intraorbital pressure which in turn causes the weakest bony walls (usually the floor or medial wall) to fracture outwards into the maxillary or ethmoid sinuses, respectively. *Punch at the chin from below* - A punch to the chin from below typically results in fractures of the **mandible**, particularly the condyles or angle. - This mechanism does not directly transmit force to the orbital rim or globe in a way that would cause a classic blowout fracture. *Sudden fall* - A sudden fall can cause various types of fractures depending on the impact site, but it is not a specific or common mechanism for a **blowout fracture**. - Falls usually lead to fractures of the extremities, hips, or skull other than the orbit, depending on how the body impacts the ground. *Chisel and hammer injury* - A chisel and hammer injury would more likely cause a **localized, penetrating injury** or a focal fracture at the point of impact on the face or skull. - This type of injury does not typically generate the diffuse hydraulic pressure within the orbit needed to cause a **blowout fracture** of the orbital floor or medial wall.

Q: In fracture of upper 1/3 of forearm, it is immobilized in:

Supination. ***Supination*** - In a fracture of the **proximal third of the forearm**, the **biceps brachii** and **supinator muscles**, which are still attached to the proximal fragment, will cause it to **supinate**. - To align the distal fragment with the proximal fragment and ensure proper healing, the forearm must be immobilized in **full supination**. *Pronation* - **Pronation** would cause malalignment of the fracture fragments, as the proximal fragment would remain supinated while the distal fragment is pronated. - This position is only used for fractures of the **distal third of the forearm** where the **pronator quadratus** and **pronator teres** dominate. *Any position* - Immobilizing in **any position** would risk **malunion** or nonunion due to the unopposed muscle forces acting on the proximal and distal fragments. - Correct anatomical alignment is crucial for restoring function and preventing long-term complications. *Mid prone* - The **mid-prone** position is typically used for fractures of the **middle third of the forearm**, where the pronator and supinator muscle forces are more balanced. - In a proximal third fracture, the stronger supinator muscles would still pull the proximal fragment into supination, causing misalignment in the mid-prone position.

Q: Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Colles fracture. ***Colles fracture*** - This fracture commonly occurs in **post-menopausal women** due to **osteoporosis** and typically results from a fall onto an **outstretched hand**. - It involves a **distal radius fracture** with **dorsal displacement** and often radial angulation. *Smith fracture* - A Smith fracture involves a **distal radius fracture** with **volar displacement**, usually caused by a fall onto the back of the hand. - While it can occur in post-menopausal women, it is less common than a Colles fracture in such a scenario. *Monteggia's fracture* - This fracture involves a **fracture of the ulna** with **dislocation of the radial head**. - It usually results from a direct blow to the forearm or a fall with extreme pronation, which is less typical for a simple fall in a post-menopausal woman. *Galeazzi fracture* - A Galeazzi fracture involves a **fracture of the radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This injury is less common and typically results from a fall onto an outstretched hand with the forearm in pronation, and it is not the most common fracture in this demographic.

Q: Lauge - Hansen classification belongs to:-

Ankle fracture. ***Ankle fracture*** - The **Lauge-Hansen classification system** is specifically used to categorize **ankle fractures** based on the position of the foot at the time of injury and the deforming force. - This system describes the mechanism of injury (e.g., supination-adduction, pronation-abduction) and the resulting fracture patterns of the **distal fibula, medial malleolus, and posterior malleolus**. *Femur fracture* - **Femur fractures** are typically classified by other systems, such as the **AO/OTA classification** for long bone fractures or specific patterns like **intertrochanteric** or **subtrochanteric fractures**. - The Lauge-Hansen system is **not applicable** to injuries of the femur. *Shoulder fracture* - **Shoulder fractures** (e.g., proximal humerus fractures) are commonly classified using systems like the **Neer classification**, which describes the number of displaced parts. - The Lauge-Hansen system is **not used** for classifying shoulder injuries. *Elbow fracture* - **Elbow fractures** involve the distal humerus, proximal ulna, or radial head and are classified by various systems depending on the specific bone involved (e.g., **Mason classification for radial head fractures**). - The Lauge-Hansen system is **irrelevant** to elbow an injuries.

Q: Posterior interosseous nerve is injured in

Monteggia fracture dislocation. ***Monteggia fracture dislocation*** - A Monteggia fracture dislocation involves a fracture of the **proximal ulna** with **dislocation of the radial head**. - The **posterior interosseous nerve (PIN)**, a deep branch of the radial nerve, is particularly vulnerable to injury due to its close proximity to the radial head and the forces involved in this type of injury, leading to **wrist drop** and **finger extensor weakness**. *Reversed monteggia fracture dislocation* - This is an older term sometimes used to describe a **Galeazzi fracture**, which is a fracture of the **distal radius** with dislocation of the **distal radioulnar joint**. - While other nerves might be at risk, the PIN is less commonly injured in a typical Galeazzi fracture compared to a Monteggia injury. *Supracondylar fracture of humerus* - Supracondylar fractures are common in children and involve the **distal humerus**. - The most commonly injured nerves are the **median nerve** and **anterior interosseous nerve**, and sometimes the ulnar nerve, but not typically the posterior interosseous nerve. *Posterior dislocation of elbow* - A posterior dislocation of the elbow involves displacement of the ulna and radius posteriorly in relation to the humerus. - While nerve injuries can occur, the **ulnar nerve** is most frequently affected due to its superficial position behind the medial epicondyle, with the PIN being less commonly affected in an isolated posterior dislocation.

Q: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

Stable closed fracture. ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.

Q: The most common bone involved in facial fractures is:

Mandible. ***Mandible*** - The **mandible** is the most frequently fractured facial bone due to its prominent and exposed position, making it highly susceptible to trauma. - Common mechanisms of injury include **motor vehicle accidents**, falls, and assaults. *Zygomatic* - Although the **zygoma** (cheekbone) is commonly fractured, it ranks second or third after the mandible and nasal bones. - Fractures of the zygoma often involve displacement of the **zygomaticomaxillary complex (ZMC)**. *Nasal bones* - **Nasal bone fractures** are very common due to their delicate structure and exposed location on the face. - However, in terms of overall facial fractures, the **mandible** is more frequently involved. *Maxilla* - **Maxillary fractures**, often classified by Le Fort patterns, are less common than mandibular or nasal bone fractures. - These fractures typically result from **high-impact trauma** and can involve significant midfacial disruption.

Q: Most common muscle involved in Volkmann's ischemic contracture is

Flexor-digitorum profundus. ***Flexor-digitorum profundus*** - The **flexor digitorum profundus (FDP)** is the most commonly involved muscle in Volkmann's ischemic contracture due to its deep location and long course, making it highly susceptible to **ischemia** in the forearm compartment. - Its involvement leads to the characteristic **flexion deformities** of the digits at the interphalangeal joints. *Flexor-indicis* - The **flexor indicis** is not a formally recognized muscle, and while finger flexors are involved, the FDP is explicitly the most common. - This option likely refers to muscles that flex the index finger, but the primary pathology affects the entire FDP muscle group. *Flexor pollicis longus* - While the **flexor pollicis longus (FPL)** can be affected in Volkmann's contracture, it is not the *most common* muscle involved compared to the FDP. - The FPL is responsible for **thumb flexion**, and its involvement would manifest primarily in thumb deformities. *Abductor pollicis* - The **abductor pollicis** muscles (e.g., abductor pollicis longus, abductor pollicis brevis) are involved in **thumb abduction**, not flexion, and are typically less affected by the ischemia that causes Volkmann's contracture. - These muscles are generally located in different compartments or are more superficial, offering them some protection.

Q: Pathognomonic sign of traumatic fracture is

Crepitus. - ***Crepitus*** - Crepitus, the **grating or crunching sound** or sensation produced by the friction of bone fragments, is the most specific and **pathognomonic sign** of a fracture. - It occurs when the rough surfaces of bone ends rub against each other due to movement. - *Tenderness* - While **tenderness** is a common sign of a fracture, it is not pathognomonic, as it can occur with many other injuries, such as sprains or contusions. - **Localized pain** upon palpation is a general indicator of injury but lacks specificity for bone fracture. - *Redness* - **Redness (erythema)** is a sign of inflammation and can be present in various injuries or infections but is not typically a direct indicator of a traumatic fracture unless accompanied by significant soft tissue damage or infection. - It is a non-specific sign and doesn't confirm bone disruption. - *Swelling* - **Swelling (edema)** commonly accompanies fractures due to hematoma formation and inflammation but is also a general response to many types of injury and is not unique to fractures. - It indicates tissue damage but does not specifically differentiate a fracture from a sprain or severe contusion.

Question 1

A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Accepted Answer

Posterior dislocation

Answer

Clavicle fracture

Answer

Luxation erecta

Answer

Anterior dislocation

Question 2

Blow out fracture can be due to:

Accepted Answer

Tennis ball injury

Answer

Punch at the chin from below

Answer

Sudden fall

Answer

Chisel and hammer injury

Question 3

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 4

Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Accepted Answer

Colles fracture

Answer

Smith fracture

Answer

Monteggia's fracture

Answer

Galeazzi fracture

Question 5

Lauge - Hansen classification belongs to:-

Accepted Answer

Ankle fracture

Answer

Femur fracture

Answer

Shoulder fracture

Answer

Elbow fracture

Question 6

Posterior interosseous nerve is injured in

Accepted Answer

Monteggia fracture dislocation

Answer

Reversed monteggia fracture dislocation

Answer

Supracondylar fracture of humerus

Answer

Posterior dislocation of elbow

Question 7

All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

Accepted Answer

Stable closed fracture

Answer

Multiple trauma

Answer

Compound fracture

Answer

Intra-articular fracture

Question 8

The most common bone involved in facial fractures is:

Accepted Answer

Mandible

Answer

Zygomatic

Answer

Nasal bones

Answer

Maxilla

Question 9

Most common muscle involved in Volkmann's ischemic contracture is

Accepted Answer

Flexor-digitorum profundus

Answer

Flexor-indicis

Answer

Flexor pollicis longus

Answer

Abductor pollicis

Question 10

Pathognomonic sign of traumatic fracture is

Accepted Answer

Crepitus

Answer

Tenderness

Answer

Redness

Answer

Swelling

Trauma — MCQs

Trauma — MCQs

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