Trauma Practice Questions

Q: Management of Smith's fracture is

Above-elbow cast with forearm in pronation. ***Above-elbow cast with forearm in pronation*** - A Smith's fracture, also known as a **reverse Colles' fracture**, involves dorsal displacement of the distal radial fragment. - Applying an **above-elbow cast with the forearm in pronation** helps to stabilize the fracture by counteracting the deforming forces and maintaining reduction. *Above-elbow cast with forearm in supination* - **Supination** is typically used for a **Colles' fracture**, which involves volar (palmar) displacement. - In a Smith's fracture, supination would exacerbate the dorsal displacement and destabilize the reduction. *Open reduction and fixation* - This is considered for **unstable, highly comminuted, or irreducible fractures**, or when closed reduction fails. - For most Smith's fractures, especially if stable after reduction, conservative management with casting is the first line of treatment. *Closed reduction with below-elbow cast* - A **below-elbow cast** may not provide sufficient immobilization of the forearm, particularly in cases involving pronation/supination instability. - An **above-elbow cast** is generally preferred to control the rotation of the forearm and prevent redisplacement of the fracture fragments.

Q: Treatment of choice in a 65-year-old female with impacted fracture of the neck of the humerus is:

Triangular sling. ***Triangular sling*** - For **impacted fractures** of the humeral neck in elderly patients, non-operative management with a sling is often preferred due to the **stability of the fracture** and the patient's age. - This approach aims for pain control and early mobilization, reducing risks associated with surgery in the elderly. *Observation* - While close monitoring is part of management, simply "observation" without any immobilization like a sling is generally insufficient for a fracture. - It does not provide the initial support needed for fracture healing and pain management. *Arthroplasty* - **Arthroplasty** (joint replacement) is typically reserved for highly **displaced or comminuted fractures** where surgical fixation is not feasible, or in cases of **avascular necrosis**. - It is an **invasive procedure** with higher risks in an elderly patient and is not the first choice for a stable, impacted fracture. *Arm chest strapping* - **Arm chest strapping** is typically used for specific injuries like **rib fractures** or sternal contusions to immobilize the chest wall. - It is **not appropriate** for a humeral neck fracture, as it does not adequately immobilize the shoulder joint and could lead to complications like **shoulder stiffness**.

Q: A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured

Anterior cruciate ligament. ***Anterior cruciate ligament*** - A fracture of the **intercondylar eminence** typically involves the avulsion of the **tibial attachment** of the anterior cruciate ligament (ACL). - The ACL's fibers attach to the **tibial intercondylar area**, making it highly susceptible to injury with a fracture in this region. *Medial collateral ligament* - The **medial collateral ligament** (MCL) originates from the medial femoral epicondyle and attaches to the medial tibia, primarily resisting valgus forces. - While knee trauma can affect the MCL, a fracture of the intercondylar eminence specifically points to an injury involving a structure attached to that area. *Medial meniscus* - The **medial meniscus** is a C-shaped cartilage in the knee joint and can be injured by rotational forces or compression. - Its injury is not directly linked to an intercondylar eminence fracture, although severe trauma can injure multiple structures. *Lateral collateral ligament* - The **lateral collateral ligament** (LCL) originates from the lateral femoral epicondyle and attaches to the fibular head, resisting varus forces. - An injury to the LCL is less likely with an intercondylar eminence fracture, as the LCL does not attach to this specific tibial region.

Q: A patient on colles cast presents after two weeks with the inability to extend his thumb, the most likely reason is:

Rupture of extensor pollicis longus tendon. ***Rupture of extensor pollicis longus tendon*** - The **extensor pollicis longus (EPL)** tendon is vulnerable to rupture in a Colles' cast due to **ischemia** from pressure or **attritional rupture** over bony prominences following fracture healing. - This typically presents weeks after casting with an inability to **actively extend the thumb**. *Sudek's osteodystrophy* - Characterized by **pain, swelling, stiffness, and skin changes** (e.g., shiny, atrophic skin, excessive sweating) distal to the injury, often associated with a painful joint. - While it causes significant disability, it does not specifically present as an isolated inability to extend the thumb. *Carpal tunnel syndrome* - Involves compression of the **median nerve**, leading to **numbness, tingling, and weakness** in the thumb, index, middle, and radial half of the ring fingers. - It would typically cause weakness in **thumb abduction and opposition**, not primarily an inability to extend the thumb, and is often painful. *Compartment syndrome* - Presents with severe pain, paresthesias, pallor, pulselessness, and paralysis, indicating **compromised blood flow** and pressure buildup within a fascial compartment. - It is an **acute emergency** usually occurring soon after injury and does not manifest primarily as isolated thumb extensor weakness two weeks later.

Q: Which of the following statement(s) is/are true?

Dinner fork deformity is characteristic of Colles' fracture. **Dinner fork deformity is characteristic of Colles' fracture** - **Colles' fracture** involves a **dorsal displacement** and angulation of the distal radius, creating a characteristic **"dinner fork" or "bayonet" deformity** of the wrist. - This specific deformity is a classic clinical sign that aids in the diagnosis of a Colles' fracture, which is an **extra-articular fracture** of the distal radius with dorsal angulation. *Normally the radial styloid is 1/2 lower than the ulnar* - The **radial styloid** normally extends approximately **1-1.5 cm (or about 1/2 inch)** *distal* to the ulnar styloid, not lower than. - This difference in length is crucial for normal wrist kinematics, and its reversal can indicate conditions like **ulnar positive variance**. *All of the options* - This option is incorrect because the statement regarding the radial styloid being lower than the ulnar is **false**. - Since one of the options provided is factually incorrect, this choice cannot be true. *Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid* - While **oedema and tenderness in the anatomical snuffbox** are hallmark signs of a **scaphoid fracture**, this statement alone does not encompass all the truth presented in the options. - This specific physical finding is highly indicative of a scaphoid fracture, necessitating further imaging to confirm the diagnosis due to **poor vascular supply** to the scaphoid and risk of **avascular necrosis**.

Q: The position of arm in posterior dislocation of shoulder is:

In internal rotation. ***In internal rotation*** - A **posterior shoulder dislocation** classically presents with the arm held in **adduction and internal rotation**, making it difficult to externally rotate or abduct the arm. - This position occurs because the humeral head dislocates posteriorly, causing the powerful internal rotators (like the **subscapularis**) to pull the arm into this characteristic posture. *In adduction* - While the arm is typically held in **adduction** in a posterior dislocation, this option alone is incomplete as it does not include the critical component of **internal rotation**. - The combination of adduction and internal rotation is the hallmark finding, and simply 'in adduction' does not fully describe the classic presentation. *By the side* - The phrase **"by the side"** is too vague and does not adequately describe the specific rotational or adduction/abduction abnormalities seen in a posterior shoulder dislocation. - A dislocated shoulder, particularly posterior, will present with a visibly and functionally abnormal position, not simply "by the side." *In external rotation* - An arm held in **external rotation** is characteristic of an **anterior shoulder dislocation**, which is the most common type of shoulder dislocation. - In a posterior dislocation, the arm typically resists external rotation due to the locking of the humeral head posteriorly and the contraction of internal rotators.

Q: In extension injuries causing supracondylar fractures, the distal fragment is often displaced to

Posterior. ***Posterior*** - In **extension-type supracondylar fractures** (95% of cases), the mechanism of injury involves hyperextension at the elbow, causing the **distal fragment** to be displaced **posteriorly** due to the backward tilting forces. - This occurs from a fall on an outstretched hand with the elbow extended, where the hyperextension mechanism drives the distal fragment backward. *Anterior* - **Anterior displacement** of the distal fragment is characteristic of **flexion-type supracondylar fractures**, which are much less common (about 5% of cases). - These occur from a direct blow to the posterior elbow with the joint in flexion, not from extension injuries. *Lateral* - While displacement can have a lateral or medial component, pure **lateral displacement** is not the primary direction of the main distal fragment in typical extension-type supracondylar fractures. - The primary displacement is posterior in extension injuries, with secondary varus or valgus angulation potentially leading to lateral malalignment. *Medial* - Similar to lateral displacement, pure **medial displacement** alone is not the defining characteristic of extension-type supracondylar fractures. - Medial malalignment can occur in conjunction with the primary posterior displacement, especially when there is significant varus angulation.

Q: Classical sign of scaphoid fracture is?

Pain in snuffbox. ***Pain in snuffbox*** - Pain on palpation within the **anatomical snuffbox** is the most classic and reliable clinical sign of a scaphoid fracture. - This area is directly overlying the scaphoid bone and becomes exquisitely tender after an injury. *Pain with limited range of motion* - While a scaphoid fracture can cause pain and **limited range of motion** in the wrist, these signs are non-specific and can be present in many other wrist injuries. - They are not definitive enough to distinguish a scaphoid fracture from other pathologies. *Swelling of wrist* - **Swelling of the wrist** is a common finding after any acute injury or trauma to the area, including sprains or other fractures. - It is not specific to a scaphoid fracture and does not help in localizing the injury to this particular bone. *Scaphoid ring sign* - The **scaphoid ring sign** is an imaging finding seen on X-rays, specifically a posteroanterior view. - It indicates rotational subluxation of the scaphoid but is not a clinical sign directly observed during physical examination.

Q: What is the most common fracture resulting from a fall onto the feet?

Jones fracture. ***Jones fracture*** - A **Jones fracture** is a fracture of the base of the **fifth metatarsal**, which is commonly associated with an inversion injury or a fall onto the foot. - This fracture type is specifically located in a **watershed area** of blood supply, making it prone to **nonunion** and requiring careful management. *Calcaneal fracture* - A **calcaneal fracture** typically results from a **high-energy axial load** to the heel, such as a fall from a significant height landing on the feet. - While possible, it is not the most common fracture for a general fall onto the feet, as it requires considerable force directly to the heel. *Lisfranc fracture* - A **Lisfranc fracture** involves the **tarsometatarsal joints** and occurs due to significant force, often from a **crushing injury** or a rotational force when the foot is plantarflexed. - This fracture pattern involves displacement of the metatarsals from the tarsus and is less common than a Jones fracture from a simple fall onto the feet. *Ankle fracture* - An **ankle fracture** involves the distal tibia and/or fibula and usually results from **twisting injuries** or direct trauma to the ankle joint. - While falling can cause an ankle fracture, it typically involves a rotational component or impact directly to the ankle, rather than a direct fall onto the plantar surface of the foot most commonly leading to a Jones fracture.

Q: Surgical neck fracture leads to all EXCEPT

Teres major palsy. ***Teres major palsy*** - The **teres major** muscle is innervated by the **lower subscapular nerve** (C5-C7). - A surgical neck fracture of the humerus typically injures the **axillary nerve**, which does not innervate the teres major. *Deltoid muscle palsy* - The **axillary nerve**, which innervates the **deltoid muscle**, is commonly injured in a surgical neck fracture due to its proximity. - Injury to the axillary nerve would result in **deltoid muscle palsy**, leading to weakness in shoulder abduction and external rotation. *Weakness of abduction* - The **deltoid muscle** is the primary abductor of the arm after the initial 15 degrees, and it is innervated by the **axillary nerve**. - A surgical neck fracture carries a high risk of **axillary nerve injury**, compromising deltoid function and causing significant weakness in abduction. *Teres minor palsy* - The **teres minor muscle** is innervated by the **axillary nerve**, which is vulnerable in surgical neck fractures. - Palsy of the teres minor would impair **external rotation** of the shoulder.

Question 1

Management of Smith's fracture is

Accepted Answer

Above-elbow cast with forearm in pronation

Answer

Above-elbow cast with forearm in supination

Answer

Open reduction and fixation

Answer

Closed reduction with below-elbow cast

Question 2

Treatment of choice in a 65-year-old female with impacted fracture of the neck of the humerus is:

Accepted Answer

Triangular sling

Answer

Observation

Answer

Arthroplasty

Answer

Arm chest strapping

Question 3

A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured

Accepted Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Medial meniscus

Answer

Lateral collateral ligament

Question 4

A patient on colles cast presents after two weeks with the inability to extend his thumb, the most likely reason is:

Accepted Answer

Rupture of extensor pollicis longus tendon

Answer

Sudek's osteodystrophy

Answer

Carpal tunnel syndrome

Answer

Compartment syndrome

Question 5

Which of the following statement(s) is/are true?

Accepted Answer

Dinner fork deformity is characteristic of Colles' fracture

Answer

Normally the radial styloid is 1/2 lower than the ulnar

Answer

All of the options

Answer

Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid

Question 6

The position of arm in posterior dislocation of shoulder is:

Accepted Answer

In internal rotation

Answer

In adduction

Answer

By the side

Answer

In external rotation

Question 7

In extension injuries causing supracondylar fractures, the distal fragment is often displaced to

Accepted Answer

Posterior

Answer

Lateral

Answer

Medial

Answer

Question 8

Classical sign of scaphoid fracture is?

Accepted Answer

Pain in snuffbox

Answer

Pain with limited range of motion

Answer

Swelling of wrist

Answer

Scaphoid ring sign

Question 9

What is the most common fracture resulting from a fall onto the feet?

Accepted Answer

Jones fracture

Answer

Calcaneal fracture

Answer

Lisfranc fracture

Answer

Ankle fracture

Question 10

Surgical neck fracture leads to all EXCEPT

Accepted Answer

Teres major palsy

Answer

Deltoid muscle palsy

Answer

Weakness of abduction

Answer

Teres minor palsy

Trauma — MCQs

Trauma — MCQs

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