Trauma Practice Questions

Q: Most common type of spinal injury is:

Flexion injury. **Flexion injury** - **Flexion injuries** are the most common type of spinal injury, particularly affecting the **cervical spine**. - These injuries often result from forceful forward bending of the spine, such as in **whiplash** or falls, leading to vertebral body compression or ligamentous tears. *Compression injury* - While **compression injuries** can occur, they are generally less common than flexion injuries across all spinal segments. - They primarily involve an axial load being applied to the spine, leading to **vertebral body fractures**. *Rotation injury* - **Rotation injuries** are relatively uncommon and often occur in combination with other forces, such as flexion or extension. - These injuries involve twisting of the spine, which can lead to **ligamentous damage** or **facet joint dislocation**. *Extension injury* - **Extension injuries** occur when the spine is forcefully bent backward, often seen in hyperextension trauma. - They are less common than flexion injuries and can result in **posterior element fractures** or **ligamentous avulsions**.

Q: AVN of femoral head is most common in-

Intracapsular fracture neck of femur. ***Intracapsular fracture neck of femur*** - **Intracapsular fractures** disrupt the blood supply to the femoral head, particularly the **retinacular arteries**, leading to **avascular necrosis (AVN)**. - The femoral head receives most of its blood supply from within the capsule, making it highly susceptible to **ischemia** when these vessels are damaged. *Extracapsular fracture neck of femur* - These fractures occur **outside the joint capsule**, preserving the critical retinacular arterial blood supply to the femoral head. - While they can lead to other complications, **avascular necrosis** is rare because the blood flow to the femoral head is largely uninterrupted. *Fracture shaft humerus* - This type of fracture involves the **upper arm bone** and has no direct anatomical or vascular connection to the femoral head. - It does not interfere with the blood supply to the femoral head, and thus, **AVN of the femoral head** is not a complication. *Subtrochanteric fracture* - **Subtrochanteric fractures** occur in the proximal femur, but **below the trochanters** and outside the joint capsule. - Like extracapsular fractures, they typically do not compromise the **retinacular arteries** supplying the femoral head, making AVN an unlikely complication.

Q: Rupture of extensor pollicis longus occurs four weeks after:

Colles' fracture. **Colles' fracture** - **Extensor pollicis longus (EPL)** rupture is a known complication of Colles' fracture, often occurring several weeks after the injury. - The tendon can be damaged due to **attrition over a bony spicule** from the distal radius fracture or due to **ischemia** in its compartment. *Smith's fracture* - A Smith's fracture involves **volar displacement** of the distal radius fragment, while EPL rupture is more commonly associated with dorsal displacement. - While complications can occur, EPL rupture is less characteristic of Smith's fracture compared to Colles' fracture. *Scaphoid fracture* - A scaphoid fracture primarily affects the **carpal bone** and can lead to complications like **non-union** or **avascular necrosis**. - Rupture of the EPL tendon is not a typical direct complication of a scaphoid fracture. *Radial styloid fracture* - A radial styloid fracture involves only the **lateral aspect of the distal radius**. - Although it's a wrist fracture, it is less commonly associated with EPL rupture than a complete Colles' fracture which involves a more extensive injury to the distal radius.

Q: First-line treatment for non-displaced scaphoid fracture

Conservative. ***Conservative*** - Non-displaced scaphoid fractures are typically managed conservatively with **cast immobilization** due to the bone's precarious blood supply. - This approach aims for sufficient **healing without operative risks**, with a long casting period (often 6-12 weeks) to ensure union. *Compression Plating* - **Compression plating** is generally reserved for **complex or displaced scaphoid fractures** that require more robust fixation. - It is an **invasive surgical option** that carries risks beyond what is typically necessary for a non-displaced fracture. *Compression Screws* - **Compression screws** (e.g., Herbert screw) are used for **surgical fixation** of scaphoid fractures, particularly displaced or unstable types. - This method is more invasive than conservative management and involves risks like **avascular necrosis** or **non-union** if not properly performed. *Traction* - **Traction** is rarely used as a primary treatment for scaphoid fractures; its application is more common in **dislocations** or **certain complex fractures** to maintain alignment. - Applying traction to a scaphoid fracture could potentially exacerbate instability rather than promote union.

Q: A 30 year old previously healthy man presented to the emergency department immediately after being involved in a road traffic accident. After clinical examination, scaphoid injury was suspected. A radiograph of the left wrist was obtained and found to be equivocal. What is the best next step?

Presumptive Casting. ***Presumptive Casting*** - When scaphoid fracture is suspected clinically but **radiographs are equivocal**, conservative management with **presumptive casting** is appropriate. - This prevents potential avascular necrosis and allows for healing if a fracture is present but not yet visible. *MRI Scan* - While an **MRI** is highly sensitive for detecting scaphoid fractures, it is not always immediately available or cost-effective as the very first step following equivocal X-rays in a stable patient. - Delaying immobilization to obtain an immediate MRI could lead to further displacement or complications if a fracture is indeed present. *Bone scintigraphy of wrist* - **Bone scintigraphy** (bone scan) can detect subtle fractures, but it is not typically performed immediately after injury due to its lower specificity and relatively longer time frame to show changes compared to other modalities like MRI. - It involves radiation and is usually reserved for cases where MRI is contraindicated or unavailable and earlier imaging was inconclusive. *CT Scan* - A **CT scan** is excellent for visualizing cortical bone and complex fractures but is less sensitive than MRI for detecting occult scaphoid fractures or soft tissue injuries. - It also involves significant radiation exposure, making it a secondary option to MRI or conservative management for initial detection.

Q: Which of the following is true about Colles' Fracture?

It is associated with dorsal angulation. ***It is associated with dorsal angulation*** - A **Colles' fracture** is a **distal radius fracture** with **dorsal displacement** and **dorsal angulation** of the distal fragment. - This classic presentation gives rise to the characteristic **"dinner fork" deformity** seen in Colles' fractures. *It may lead to gunstock deformity due to malunion* - **Gunstock deformity** (cubitus varus) is a common complication of **supracondylar fractures of the humerus**, not Colles' fractures. - It results from **malunion** of the humerus, leading to a decreased carrying angle of the elbow. *It is an intra-articular fracture* - A Colles' fracture is typically an **extra-articular fracture**, meaning the fracture line does not extend into the **radiocarpal joint**. - Fractures that extend into the joint are generally classified as **Barton's fractures** or **Chauffeur's fractures**. *Volar angulation with Radial deviation occurs* - **Volar angulation** of the distal fragment is characteristic of a **Smith's (or reverse Colles') fracture**, which is a different type of distal radius fracture. - Colles' fracture involves **dorsal displacement** and angulation.

Q: Position of wrist in cast of colle's fracture is:

Palmar deviation & pronation. ***Palmar deviation & pronation*** - This position helps to **reduce the fracture** by counteracting the typical **dorsal displacement** and **supination deformity** seen in a Colles' fracture. - **Pronation** is essential to correct the supination malposition of the distal fragment, achieving the **Cotton-Loder position** for optimal healing. *Palmar deviation & supination* - While **palmar deviation** correctly addresses the dorsal displacement, **supination** would worsen the existing supination deformity of the distal fragment. - This position fails to achieve proper **anatomical alignment** and may lead to malunion. *Dorsal deviation & pronation* - **Dorsal deviation** would exacerbate the typical **dorsal displacement** already present in a Colles' fracture. - Although pronation is correct for forearm positioning, dorsal deviation prevents proper **fracture reduction**. *Dorsal deviation & supination* - **Dorsal deviation** worsens the characteristic **dinner fork deformity** by increasing dorsal angulation. - **Supination** compounds the supination malposition of the distal fragment, leading to poor functional outcomes.

Q: Regarding Hangman's fracture true is:

Union almost always occurs. ***Union almost always occurs*** - Hangman's fracture (bilateral pedicle fracture of C2) is generally stable due to preservation of the **atlanto-axial joint**, allowing for high rates of bony union with conservative management. - The **ligamentous integrity often remains intact**, providing stability and promoting healing. *Surgical treatment is necessary* - Most Hangman's fractures **do not require surgery** due to their inherent stability and high potential for union with non-operative treatment like a cervical collar or halo vest. - Surgical intervention is typically reserved for **unstable fractures** or those with significant displacement that fail conservative management. *High post-admission mortality* - Despite being a C2 fracture, Hangman's fracture usually has a **relatively low mortality rate** because the spinal cord is often spared from severe injury. - The primary mechanism (**hyperextension-distraction**) often decompresses the spinal canal rather than compressing it, reducing neurological deficit risk. *One of the most common axis fractures* - **Odontoid fractures** are the most common type of axis (C2) fracture, accounting for a higher percentage than Hangman's fractures. - Hangman's fractures are still significant but occur less frequently than fractures involving the **dens**.

Q: Open reduction (OR) is not required in which fracture?

Fracture of the outer one-third of the radius. ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.

Q: Nonunion is most common in fracture of the:

Neck femur. ***Neck femur*** - Fractures of the **femoral neck** are highly prone to **nonunion** due to the precarious and often-disrupted blood supply to the femoral head, particularly the **retinacular arteries**. - The high biomechanical stress and difficulty in achieving stable fixation in this region further contribute to the increased risk of nonunion. *Talus* - While talar fractures, especially those of the **talar neck**, can have a high incidence of complications like **avascular necrosis** due to limited blood supply, nonunion is less common than in femoral neck fractures. - The talus has a complex vascular network that, while vulnerable, often allows for healing. *Scapula* - **Scapular fractures** are generally uncommon and, when they occur, typically heal well without surgical intervention. - Due to the surrounding musculature and rich vascular supply, nonunion of the scapula is extremely rare. *None of the options* - This option is incorrect because **nonunion is indeed a significant problem** in specific fractures, particularly those of the femoral neck, making it a viable answer.

Question 1

Most common type of spinal injury is:

Accepted Answer

Flexion injury

Answer

Compression injury

Answer

Rotation injury

Answer

Extension injury

Question 2

AVN of femoral head is most common in-

Accepted Answer

Intracapsular fracture neck of femur

Answer

Extracapsular fracture neck of femur

Answer

Fracture shaft humerus

Answer

Subtrochanteric fracture

Question 3

Rupture of extensor pollicis longus occurs four weeks after:

Accepted Answer

Colles' fracture

Answer

Smith's fracture

Answer

Scaphoid fracture

Answer

Radial styloid fracture

Question 4

First-line treatment for non-displaced scaphoid fracture

Accepted Answer

Conservative

Answer

Compression Plating

Answer

Compression Screws

Answer

Traction

Question 5

A 30 year old previously healthy man presented to the emergency department immediately after being involved in a road traffic accident. After clinical examination, scaphoid injury was suspected. A radiograph of the left wrist was obtained and found to be equivocal. What is the best next step?

Accepted Answer

Presumptive Casting

Answer

MRI Scan

Answer

Bone scintigraphy of wrist

Answer

CT Scan

Question 6

Which of the following is true about Colles' Fracture?

Accepted Answer

It is associated with dorsal angulation

Answer

It may lead to gunstock deformity due to malunion

Answer

It is an intra-articular fracture

Answer

Volar angulation with Radial deviation occurs

Question 7

Position of wrist in cast of colle's fracture is:

Accepted Answer

Palmar deviation & pronation

Answer

Dorsal deviation & supination

Answer

Palmar deviation & supination

Answer

Dorsal deviation & pronation

Question 8

Regarding Hangman's fracture true is:

Accepted Answer

Union almost always occurs

Answer

Surgical treatment is necessary

Answer

High post-admission mortality

Answer

One of the most common axis fractures

Question 9

Open reduction (OR) is not required in which fracture?

Accepted Answer

Fracture of the outer one-third of the radius

Answer

Fracture of the patella

Answer

Displaced fracture of the olecranon

Answer

Fracture of the condyle of the humerus

Question 10

Nonunion is most common in fracture of the:

Accepted Answer

Neck femur

Answer

Talus

Answer

Scapula

Answer

None of the options

Trauma — MCQs

Trauma — MCQs

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