Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 961: All of the following are features of myositis ossificans except -

A. Commonly occurs around the elbow
B. Can be post traumatic or occur without trauma also
C. Massaging is a known associated factor
D. It matures from inside out (Correct Answer)

Explanation: ***It matures from inside out*** - This statement is incorrect; **myositis ossificans** characteristically matures from the **outside in**, meaning the periphery ossifies first, creating a distinct radiologic appearance. - The mature bone is found at the periphery of the lesion, while the more immature, cellular components are centrally located. *Commonly occurs around the elbow* - Myositis ossificans is frequently observed around joints, with the **elbow** being one of the most common sites due to its vulnerability to trauma. - Other common locations include the **thigh** and **shoulder**. *Can be post traumatic or occur without trauma also* - While most commonly **post-traumatic**, myositis ossificans can also occur atraumatically, sometimes referred to as **myositis ossificans progressiva** or fibrodysplasia ossificans progressiva, a rare genetic disorder. - The traumatic form is often preceded by a significant contusion or muscle injury. *Massaging is a known associated factor* - **Aggressive massage** or manipulation following muscle trauma can exacerbate local tissue injury and enhance the conditions conducive to heterotopic ossification, including myositis ossificans. - This is why gentle management of muscle contusions is crucial to prevent its development.

Question 962: Maximum weight for skin traction -

A. 1-2 kg
B. 15-20 kg
C. 4-5 kg (Correct Answer)
D. 10-15 kg

Explanation: ***4-5 kg*** - The maximum effective and safe weight for **skin traction** in adults is generally considered to be 4.5-5 kg (approximately 10-11 lbs). - Exceeding this weight can cause **skin damage**, blistering, and neurovascular compromise due to excessive pressure and shearing forces. *1-2 kg* - While 1-2 kg may be used, it is often insufficient to achieve significant **reduction** or **stabilization of fractures** in adults, especially for limb traction. - This weight range might be appropriate for very **young children** or for very gentle, temporary traction. *15-20 kg* - This amount of weight is far too high for **skin traction** and would almost certainly lead to severe **skin breakdown**, pressure sores, and potentially neurovascular injury. - Weights in this range are typically reserved for **skeletal traction**, where the force is applied directly to the bone. *10-15 kg* - Similar to 15-20 kg, this weight range is too high for **skin traction** and carries a significant risk of **complications** such as skin necrosis, nerve damage, and vascular compromise. - It would be ineffective and harmful if not applied directly to the bone.

Question 963: Volkmann's ischaemic contracture due to external compression is commonly caused by

A. Tight plaster
B. Tight plaster and tight splint (Correct Answer)
C. Supracondylar fractures
D. Tight splint

Explanation: ***Tight plaster and tight splint*** - Both a **tight plaster cast** and a **tight splint** can cause Volkmann's ischaemic contracture by increasing pressure within the fascial compartments, leading to **compartment syndrome**. - This elevated pressure compromises **arterial inflow** and **venous outflow**, resulting in muscle and nerve ischaemia, which if prolonged, causes contracture. *Tight plaster* - While a **tight plaster** alone can contribute to Volkmann's ischaemic contracture, the combination with a **tight splint** is a more comprehensive answer for external compression. - A tight plaster applies circumferential pressure, which can restrict venous return and lead to swelling and increased intracompartmental pressure. *Supracondylar fractures* - **Supracondylar fractures** are a significant intrinsic cause of Volkmann's ischaemic contracture due to direct injury to the **brachial artery** or local swelling. - However, the question specifically asks for external compression causes, making a fracture an intrinsic rather than external factor. *Tight splint* - A **tight splint** can certainly cause Volkmann's ischaemic contracture by exerting external compression, leading to compromised blood flow. - However, when paired with a tight plaster, the risk of developing compartment syndrome leading to contracture is significantly higher due to compounded external pressure.

Question 964: Among the following options, which is the most common site of avascular necrosis?

A. Talus (Correct Answer)
B. Head of the radius
C. Olecranon
D. Medial condyle of femur

Explanation: ***Talus*** - The **talus** is highly susceptible to **avascular necrosis** due to its precarious blood supply, which primarily enters via the **tarsal canal** and **deltoid artery**. - Its large articular surface, about 60% covered by cartilage, limits direct soft tissue attachment and additional vascularity. *Head of the radius* - The **head of the radius** has a relatively robust blood supply from branches of the **radial recurrent artery**, making avascular necrosis less common. - While fractures can compromise local blood flow, it is not considered a primary site for idiopathic avascular necrosis. *Olecranon* - The **olecranon**, part of the ulna, receives a good collateral blood supply from anastomosing branches around the elbow, including the **posterior ulnar recurrent artery**. - Avascular necrosis here is rare and usually associated with severe trauma or specific medical conditions. *Medial condyle of femur* - Avascular necrosis of the **medial femoral condyle** primarily affects the subchondral bone and is often referred to as **osteonecrosis of the knee**. - While it can occur, particularly in older adults, it is less common than avascular necrosis of the talus or femoral head.

Question 965: True regarding Hangman's fracture is:

A. Bilateral fractures of pars interarticularis of C2 (Correct Answer)
B. Whiplash injury
C. Odontoid process fracture of C2
D. Fracture of hyoid bone

Explanation: ***Bilateral fractures of pars interarticularis of C2*** - A **Hangman's fracture** specifically refers to a **traumatic spondylolysis** of the C2 vertebral body, involving bilateral fractures through the **pars interarticularis** or pedicles of the axis. - This injury is typically caused by a forceful **hyperextension-distraction** mechanism, often associated with rapid deceleration trauma. *Whiplash injury* - A **whiplash injury** is a general term for a range of neck injuries caused by sudden, forceful back-and-forth movement of the head. - While it can result in various soft tissue damage and ligamentous injuries, it is not a specific fracture type like a Hangman's fracture. *Odontoid process fracture of C2* - An **odontoid fracture** involves the **dens**, a superior projection from the C2 vertebral body, and is distinct from a Hangman's fracture. - Odontoid fractures are classified into three types (I, II, III) based on the location of the fracture line and typically result from flexion or extension forces on the neck. *Fracture of hyoid bone* - The **hyoid bone** is located in the neck above the larynx and is typically fractured due to direct trauma to the neck, often associated with manual strangulation or hanging. - A hyoid fracture is entirely unrelated to injuries of the cervical spine or C2 vertebra.

Question 966: The following classification is used to estimate nerve injury:

A. Seddons classification (Correct Answer)
B. Seddon's and Sunderland classification
C. Sunderland classification
D. None of the options

Explanation: ***Seddons classification*** - The **Seddons classification** is a well-established system for classifying the severity of nerve injuries. - It categorizes nerve injuries into three main types: **neurapraxia**, **axonotmesis**, and **neurotmesis**. *Seddon's and Sunderland classification* - While both **Seddon's** and **Sunderland's classifications** are used for nerve injury, the question asks for "the following classification" implying a single, primary classification. - **Sunderland's classification** is a more detailed, five-grade system, often considered an extension of Seddon's. *Sunderland classification* - The **Sunderland classification** is a valid and widely used system, but it is not the *only* classification and the question implies a single, specific classification in its phrasing. - Sunderland's system provides more granular detail on the extent of nerve damage compared to Seddon's, with five degrees of injury. *None of the options* - This option is incorrect because the **Seddons classification** is indeed a valid and frequently used method for estimating nerve injury. - There are established classification systems for nerve injuries.

Question 967: Which of the following is false regarding clavicle?

A. First bone to ossify
B. Membranous ossification
C. Fracture can be treated with figure of 8 bandage
D. Non-union is the commonest complication of clavicle fractures (Correct Answer)

Explanation: ***Non-union is the commonest complication of clavicle fractures*** - While clavicle fractures are relatively common, **malunion** (healing in an imperfect position) is more frequent than non-union. - **Non-union** typically occurs in less than 5% of all clavicle fractures, making it a rare complication rather than the commonest. *First bone to ossify* - The clavicle is indeed the **first bone to ossify** in the human embryo, beginning around the 5th to 6th week of gestation. - This characteristic highlights its unique developmental pathway compared to most other bones. *Membranous ossification* - The clavicle develops primarily through **intramembranous ossification**, which involves direct ossification of mesenchymal tissue without a cartilaginous precursor. - It's one of the few bones in the body, along with some bones of the skull, that ossifies this way. *Fracture can be treated with figure of 8 bandage* - A **figure-of-eight bandage** was historically used for clavicle fractures to provide reduction and immobilization. - However, current evidence suggests that a **simple sling** is equally effective and often more comfortable, with less risk of complications like neurovascular compression.

Question 968: All of the following can be the complications of a malunited Colles fracture except:

A. Rupture of flexor pollicis longus tendon (Correct Answer)
B. Carpal instability
C. Carpal tunnel syndrome
D. Reflex sympathetic dystrophy (RSD)

Explanation: ***Rupture of flexor pollicis longus tendon*** - Malunion of a Colles fracture typically involves dorsal displacement of the distal radius, which can lead to friction and rupture of the **extensor pollicis longus (EPL)** tendon due to irritation over the dorsal bony prominence. - The **flexor pollicis longus (FPL)** tendon is on the palmar side of the wrist and is generally not at risk for rupture from a dorsally malunited Colles fracture. *Carpal instability* - **Malunion of a Colles fracture** can significantly alter the normal anatomy and mechanics of the radiocarpal joint, leading to **carpal instability**. - Changes in radial inclination, volar tilt, and radial length can disrupt load bearing and ligamentous integrity, predisposing to carpal collapse or dissociation. *Carpal tunnel syndrome* - Malunion can lead to **decreased carpal tunnel volume** and angulation of the carpal bones, increasing pressure on the **median nerve**. - This anatomical alteration can lead to symptoms of **carpal tunnel syndrome**, such as numbness, tingling, and pain in the median nerve distribution. *Reflex sympathetic dystrophy (RSD)* - Also known as **Complex Regional Pain Syndrome (CRPS) Type I**, RSD is a well-recognized complication following trauma or surgery to an extremity, including Colles fractures. - It presents with pain, swelling, *trophic skin changes*, and vasomotor dysfunction, and can be severely incapacitating.

Question 969: The proximal fragment of scaphoid after fracture is predisposed for Avascular Necrosis because:

A. Difficulty in immobilizing the proximal fragment
B. Retrograde blood flow to the proximal fragment (Correct Answer)
C. Fracture configuration of the proximal fragment is usually comminuted
D. Proximal Fragment articulates with the radius

Explanation: ***Retrograde blood flow to the proximal fragment*** - The **scaphoid** receives its blood supply predominantly from the **radial artery** via branches entering the distal pole and waist. - This anatomical arrangement means blood flows in a **retrograde direction** towards the proximal pole, making the proximal fragment vulnerable to **avascular necrosis** if its blood supply is interrupted by a fracture at the waist or proximal pole. *Difficulty in immobilizing the proximal fragment* - While immobilization can be challenging for some fractures, it is not the primary reason for **avascular necrosis** in scaphoid fractures. - The risk of **avascular necrosis** is more closely related to the anatomical **blood supply** rather than the effectiveness of immobilization. *Fracture configuration of the proximal fragment is usually comminuted* - **Comminuted fractures** of the scaphoid are less common in the proximal fragment compared to the waist or distal pole. - While comminution can complicate healing, the inherent **blood supply pattern** is the overriding factor for AVN in the proximal fragment, not the fracture pattern itself. *Proximal Fragment articulates with the radius* - The **proximal pole of the scaphoid** articulates with the radius as part of the radiocarpal joint. - This articulation is a normal anatomical feature and does not predispose the fragment to **avascular necrosis** following a fracture.

Question 970: In major/unstable pelvic fractures with vascular injury, the amount of blood loss is around?

A. 2-4 units
B. 4-8 units (Correct Answer)
C. 1-4 units
D. 2-6 units

Explanation: ***4-8 units*** - Unstable pelvic fractures with associated vascular injury are recognized sources of significant hemorrhage due to the rich vascular supply of the pelvis and the potential for **venous plexus disruption** and **arterial damage**. - This range represents a substantial blood loss that commonly requires **transfusion** and often aggressive hemostatic interventions. *2-4 units* - This amount of blood loss, while significant, is more typical of **isolated unstable pelvic fractures** without major vascular involvement. - While bleeding can be substantial, it often does not reach the higher threshold seen with direct vascular injuries. *1-4 units* - This range of blood loss is relatively less severe and might be seen in **stable or minimally displaced pelvic fractures**. - It does not accurately reflect the major hemorrhage expected in an **unstable pelvic fracture** complicated by vascular injury. *2-6 units* - This option presents an overlap with the more accurate range but still underestimates the potential severity of blood loss in a **major/unstable pelvic fracture** with established vascular injury. - The upper limit often falls short of the true extent of hemorrhage observed in such critical injuries.

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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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