Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 951: False among the following

A. Teardrop fracture involves C5-C6 vertebrae
B. Hangman fracture involves Axis
C. Clay Shoveler's fracture involves C6 vertebrae (Correct Answer)
D. Jefferson's fracture involves Atlas

Explanation: ***Clay Shoveler's fracture involves C6 vertebrae*** - A **Clay Shoveler's fracture** typically involves the **spinous processes of C6, C7 or T1**, meaning C6 is often involved. - This fracture is usually stable and results from forced neck flexion or direct trauma, often affecting lower cervical or upper thoracic vertebrae. *Teardrop fracture involves C5-C6 vertebrae* - **Teardrop fractures** are severe and unstable fractures of the cervical spine, often occurring at **C2 or C5-C7 (not exclusively C5-C6)**. - They are named for the characteristic triangular fragment of bone detached from the anterior aspect of the vertebral body and can be either flexion or extension type, with flexion teardrop fractures being particularly unstable due to posterior ligamentous disruption. *Hangman fracture involves Axis* - A **Hangman's fracture** is a fracture of the **C2 (Axis) pedicles**, typically due to hyperextension and distraction. - While it involves C2, the statement implies it solely involves the "Axis" which is broad, but specifically it's the pedicles of C2. *Jefferson's fracture involves Atlas* - A **Jefferson's fracture** is a burst fracture of the **C1 (Atlas) ring**, typically caused by an axial load on the head. - This fracture involves the Atlas, as stated, and is often unstable due to disruption of the transverse atlantal ligament in severe cases.

Question 952: Regarding Hangman's fracture, which of the following statements are correct? 1) Fracture of either pedicles or lamina of C2 cervical vertebra 2) Bilateral in nature

A. Both are false
B. 2 is true, 1 is false
C. 1 is true, 2 is false
D. Both are true (Correct Answer)

Explanation: ***Both are true*** - A **Hangman's fracture** is specifically a fracture through the **pedicles** (or pars interarticularis) of the **C2 vertebra**, which can also involve the lamina. - This fracture is inherently **bilateral** across both pedicles, classifying it as a spondylolisthesis of C2 on C3. *Both are false* - This option is incorrect because both presented statements are accurate descriptions of a Hangman's fracture. - The definition and typical presentation of this fracture align with both points. *1 is true, 2 is false* - This is incorrect because the fracture of the C2 pedicles/lamina is indeed the hallmark (statement 1), but the bilateral nature across the pedicles is also a defining characteristic, making statement 2 true as well. - A Hangman's fracture is a **traumatic spondylolisthesis** of C2 on C3 due to bilateral pedicle fractures. *2 is true, 1 is false* - This is incorrect because statement 1 accurately defines the location of the fracture at the **C2 pedicles/lamina**. - While it is **bilateral**, the primary anatomical location in C2 is foundational to the diagnosis.

Question 953: Most common complication of Colles' fracture is:

A. Malunion (Correct Answer)
B. Gunstock deformity
C. Non-union
D. Sudek's osteodystrophy

Explanation: ***Malunion*** - **Malunion** is the most common complication of Colles' fracture, occurring when the fracture heals in a **deformed position**. - This typically results in residual **dorsal tilt**, **radial shortening**, and a **"dinner fork" deformity** of the wrist. *Gunstock deformity* - **Gunstock deformity** is an angular deformity of the elbow, usually associated with **supracondylar humeral fractures**, not Colles' fracture. - It results in the forearm deviating away from the body when the elbow is extended. *Non-union* - **Non-union** refers to the failure of a fracture to heal after a sufficient period, which is **rare** in distal radial fractures like Colles' fracture due to their excellent blood supply. - It typically requires surgical intervention and is not the most common complication. *Sudek's osteodystrophy* - **Sudek's osteodystrophy**, also known as **Complex Regional Pain Syndrome (CRPS) Type I**, is a less common but severe complication characterized by chronic pain, swelling, and changes in skin temperature/color. - While it can occur after Colles' fracture, its incidence is lower than malunion.

Question 954: Internal splints (fixation devices) are used in all except:

A. Fractures in elderly patients
B. Multiple fractures
C. Fracture of neck of femur
D. Compound fractures (Correct Answer)

Explanation: ***Compound fractures*** - **Internal splints** are generally avoided in **compound (open)** fractures due to the increased risk of **infection** and the difficulties in maintaining sterility around the exposed hardware. - The primary management of compound fractures involves thorough **debridement**, irrigation, and often **external fixation** or plaster immobilization followed by delayed internal fixation once soft tissue conditions allow. *Fractures in elderly patients* - **Internal fixation** is often the preferred method for fractures in elderly patients, especially hip fractures, as it allows for **early mobilization**, reducing complications like pneumonia, bed sores, and DVT. - It stabilizes the fracture site, promoting comfort and facilitating a faster return to function. *Multiple fractures* - In cases of **multiple fractures (polytrauma)**, internal fixation is crucial for stabilizing different fracture sites, reducing pain, and allowing for comprehensive patient care and rehabilitation. - It helps manage systemic effects of trauma like **fat embolism** and allows earlier mobilization compared to external methods for multiple sites. *Fracture of neck of femur* - **Internal fixation** (e.g., cannulated screws, dynamic hip screw) or **arthroplasty** (hemiarthroplasty or total hip replacement) are the standard treatments for **femoral neck fractures**. - This approach aims to restore stability, allow for **early weight-bearing**, and prevent complications such as **avascular necrosis** and non-union.

Question 955: Teardrop fracture of lower cervical spine implies -

A. Wedge compression fracture
B. Axial compression fractures
C. Flexion-rotation injury with failure of anterior body
D. Flexion compression failure of body (Correct Answer)

Explanation: ***Flexion compression failure of body*** - A **teardrop fracture** of the lower cervical spine is typically caused by a **flexion-compression mechanism**, leading to a fracture of the anteroinferior vertebral body. - This results in a small, triangular fragment (the "teardrop") separated from the main vertebral body, often associated with **cervical instability** and potential neurological deficits. *Wedge compression fracture* - A **wedge compression fracture** primarily involves anterior vertebral body collapse due to **axial loading** and flexion, but without the distinct separation of an anteroinferior fragment characteristic of a teardrop. - While it involves compression, it lacks the specific force vector and resulting fragment morphology seen in a teardrop fracture. *Axial compression fractures* - **Axial compression fractures** (e.g., burst fractures) typically result from a force directly along the spinal axis, causing the vertebral body to **explode outwards** and potentially into the spinal canal. - These fractures show widening of the interpedicular distance and posterior element involvement, which are not primary features of a simple teardrop fracture. *Flexion-rotation injury with failure of anterior body* - A **flexion-rotation injury** often leads to more complex patterns, such as **facet dislocation** or unilateral/bilateral interfacetal dislocation. - While it can involve anterior vertebral body failure, the primary mechanism of a classical teardrop fracture is **pure flexion-compression**, not significant rotation.

Question 956: Hill-Sachs lesion is seen in?

A. Glenoid labrum tear
B. Anterior dislocation of shoulder joint (Correct Answer)
C. Posterolateral humerus
D. Posterior dislocation of shoulder joint

Explanation: ***Anterior dislocation of shoulder joint*** - A **Hill-Sachs lesion** is a **cortical depression** in the posterolateral head of the humerus. - It occurs when the humeral head impacts the **anterior glenoid rim** during an anterior shoulder dislocation. *Glenoid labrum tear* - A **glenoid labrum tear** refers to damage to the cartilage rim around the glenoid socket. - While it can coexist with dislocations and contribute to instability, it is not the direct site of a Hill-Sachs lesion. *Posterolateral humerus* - The **posterolateral humerus** is the specific location where the Hill-Sachs lesion occurs on the humeral head. - However, the lesion itself is *caused by* the anterior dislocation, not an independent finding listed this way. *Posterior dislocation of shoulder joint* - A **posterior shoulder dislocation** is typically associated with a **reverse Hill-Sachs lesion** (also known as a trough line fracture or medial humeral head compression fracture), which occurs on the anteromedial aspect of the humeral head. - The classic Hill-Sachs lesion is specific to anterior dislocations.

Question 957: High velocity gunshot injury with periosteal denudation & comminuted fracture is best treated as

A. Immediate reconstruction & grafting
B. 'Bag of bones' & IMF
C. Reconstruction plates & closure of fracture
D. Initially debridement is done, then load bearing reconstruction plates, and grafting in secondary procedure (Correct Answer)

Explanation: ***Initially debridement is done, then load bearing reconstruction plates, and grafting in secondary procedure*** - **High-velocity gunshot wounds** often cause extensive tissue damage, periosteal stripping, and comminuted fractures, which necessitate thorough **debridement** of devitalized tissue and foreign bodies to prevent infection. - Due to the nature of the injury, a **staged approach** is preferred: initial debridement to achieve a clean wound,followed by **load-bearing reconstruction plates** for stability, and then delayed **grafting** if necessary, once the infection risk is minimized and soft tissue coverage is achieved. *Immediate reconstruction & grafting* - Performing immediate reconstruction and grafting in a **dirty, high-energy trauma wound** carries an extremely high risk of **infection** and graft failure. - The extent of tissue damage and contamination from a gunshot wound makes immediate closure and grafting unwise without prior debridement. *'Bag of bones' & IMF* - While **intermaxillary fixation (IMF)** ("bag of bones" technique) can be used for certain mandibular fractures, it does not provide sufficient stability for complex, comminuted fractures with significant bone loss and periosteal denudation caused by a high-velocity gunshot wound . - The "bag of bones" approach mainly applies to facial trauma with multiple bone fragments and often requires subsequent reconstruction, but it is not the primary treatment for these type of fractures immediately. *Reconstruction plates & closure of fracture* - Simply closing the fracture with reconstruction plates without initial **debridement** is inappropriate for a high-velocity gunshot wound as it traps contaminated and devitalized tissue, leading to a high risk of **osteomyelitis** and non-union. - This approach fails to address the underlying tissue damage and potential for infection, which are critical considerations for such injuries.

Question 958: Maximum shortening of lower limb is seen in:

A. intertrochanteric (Correct Answer)
B. shaft femur
C. Neck femur
D. Transcervical

Explanation: ***intertrochanteric*** - **Intertrochanteric fractures** often lead to significant leg shortening due to the pull of strong hip muscles on the distal fragment, causing displacement and overriding. - The fracture location between the greater and lesser trochanters allows for considerable muscle-driven impaction and proximal migration of the shaft relative to the pelvis. *shaft femur* - **Femoral shaft fractures** can cause shortening, but the degree is often less severe than with intertrochanteric fractures because muscle spasm may be somewhat contained by the surrounding musculature. - While significant displacement can occur, the extensive muscle attachments around the shaft tend to stabilize it more in comparison to the rotational and upward pull seen in intertrochanteric fractures. *Neck femur* - **Femoral neck fractures** primarily cause pain and inability to bear weight, but they typically result in less significant leg shortening compared to intertrochanteric fractures. - Shortening in femoral neck fractures is often due to impaction or slight collapse, not the extensive overriding seen with intertrochanteric breaks. *Transcervical* - **Transcervical fractures** are a type of femoral neck fracture, and thus, they share similar characteristics where shortening is usually less pronounced and primarily due to impaction at the fracture site. - The shortening is often more subtle and related to the degree of collapse at the fracture margin rather than gross displacement of the entire shaft.

Question 959: The contraindication to internal fixation -

A. Fracture dislocation
B. Intraarticular fracture
C. Physeal injury
D. Active infection (Correct Answer)

Explanation: ***Active infection*** - **Active infection** is a strong contraindication to internal fixation because introducing foreign material (implants) into an infected area can spread the infection, make it chronic, and lead to implant failure, osteomyelitis, or sepsis. - The presence of bacteria can colonize the implant surface, forming **biofilms** that are highly resistant to antibiotics and host immune responses, severely complicating treatment. *Fracture dislocation* - **Fracture dislocations** are often a strong *indication* for internal fixation to achieve anatomical reduction and stable fixation, allowing for early mobilization and preventing avascular necrosis or persistent instability. - The goal is to restore joint congruity and maintain reduction, which is difficult to achieve and maintain with non-operative methods. *Intraarticular fracture* - **Intraarticular fractures** are frequently *managed with* internal fixation to restore articular surface congruity, minimize post-traumatic arthritis, and allow for early range of motion. - Precise reduction and stable fixation are crucial to prevent long-term complications such as joint stiffness and osteoarthritis. *Physeal injury* - **Physeal injuries** (growth plate fractures) are often *treated with* surgical fixation, particularly unstable or displaced fractures, to ensure anatomical reduction and prevent growth disturbances. - The fixation technique must be chosen carefully to avoid damaging the physis itself, often using smooth pins or screws that do not cross the growth plate.

Question 960: Which of the following is the appropriate treatment for atrophic non-union?

A. External fixation
B. Application of cast
C. Stabilization and bone grafting (Correct Answer)
D. Internal fixation

Explanation: ***Stabilization and bone grafting*** - Atrophic non-union is characterized by a **lack of biological activity** and an **absence of callus formation**, requiring both **biological stimulation** (bone graft) and **mechanical stability** (stabilization). - Bone grafting provides **osteogenic cells**, **osteoconductive scaffold**, and **osteoinductive growth factors** to promote healing, while stabilization ensures the fracture fragments remain in apposition. *External fixation* - While providing stability, external fixation alone does not address the **biological deficiency** inherent in atrophic non-union. - It's mainly used for **open fractures**, **comminuted fractures**, or when internal fixation is not feasible, often as a temporary measure. *Application of cast* - A cast provides some immobilization but is generally insufficient for non-union, especially atrophic types, due to its **limited stability** and inability to compress the fracture site effectively. - It also does not contribute to the **biological stimulation** needed for healing in atrophic non-unions. *Internal fixation* - Internal fixation provides stability, but in atrophic non-union, the primary issue is a **lack of healing potential**, not just instability. - Without a concomitant **bone graft**, internal fixation alone is unlikely to achieve union in atrophic non-unions.

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Principles of Fracture Management

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Upper Limb Fractures

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Lower Limb Fractures

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Spinal Trauma

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Pelvic and Acetabular Fractures

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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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Polytrauma Management

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Joint Dislocations

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Soft Tissue Injuries

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Trauma — MCQs

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