Upper Limb Fractures — MCQs
Fracture shaft of humerus can cause damage to which of the following nerves?
In an extension type of supracondylar fracture, what is the usual direction of displacement?
Which of the following best describes a Monteggia fracture?
A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
Which of the following patients with a fracture should be your first priority to call the orthopedic postgraduate and inform?
A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
A patient fell off a bicycle and is now experiencing pain around the hip, shortening of the limb, and the hip is positioned in flexion, adduction, and internal rotation (IR). What is the most likely diagnosis?
All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
Pilon fracture is
A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?
Upper Limb Fractures Indian Medical PG Practice Questions and MCQs
Question 1: Fracture shaft of humerus can cause damage to which of the following nerves?
- A. Ulnar nerve
- B. Radial nerve (Correct Answer)
- C. Axillary nerve
- D. Median nerve
Explanation: ***Radial nerve*** - The **radial nerve** runs in the **spiral groove** along the posterior aspect of the humerus shaft, making it highly susceptible to injury during a fracture in this region. - Damage can lead to **wrist drop** and impaired sensation over the posterior forearm and hand. *Ulnar nerve* - The **ulnar nerve** primarily runs along the medial epicondyle of the humerus, making it more vulnerable to injuries around the **elbow joint**, not typically the humeral shaft. - Injury to the ulnar nerve results in a characteristic **"claw hand"** deformity and sensory loss over the medial aspect of the hand. *Axillary nerve* - The **axillary nerve** wraps around the surgical neck of the humerus and is most commonly injured with **shoulder dislocations** or fractures involving the surgical neck, not the shaft. - Damage to the axillary nerve causes weakness in **deltoid abduction** and sensory loss over the lateral shoulder (regimental badge area). *Median nerve* - The **median nerve** travels more anteriorly and medially in the arm and is generally protected from direct injury in a mid-shaft humeral fracture. - Injury to the median nerve can cause a **"ape hand" deformity** and sensory loss over the radial aspect of the palm.
Question 2: In an extension type of supracondylar fracture, what is the usual direction of displacement?
- A. Posterolateral (Correct Answer)
- B. Anteromedial
- C. Anterolateral
- D. Posteromedial
Explanation: ***Posterolateral*** - In an **extension type supracondylar fracture**, the distal fragment (forearm and hand) is typically displaced **posteriorly and laterally**. - This common displacement pattern is often caused by a **fall on an outstretched hand** with the elbow in extension, forcing the olecranon against the humerus. *Anteromedial* - This is an **uncommon displacement** in supracondylar fractures and is not characteristic of the extension type. - While displacement can have a medial or lateral component, the primary displacement in extension type is posterior. *Anterolateral* - Displacement in an anterior direction is typically seen in **flexion-type supracondylar fractures**, which are much rarer. - Even in flexion-type fractures, the lateral component of displacement is less common than medial. *Posteromedial* - While posterior displacement is characteristic of extension supracondylar fractures, a **posteromedial displacement** is encountered, but **posterolateral** is the *most common* pattern. - The varus force often involved in these injuries tends to promote lateral displacement of the distal fragment.
Question 3: Which of the following best describes a Monteggia fracture?
- A. Fracture of distal radius with dislocation of the distal ulna
- B. Fracture of distal third of ulna with dislocation of the radial head.
- C. Fracture of the proximal third of the ulna with dislocation of the radial head. (Correct Answer)
- D. Fracture of proximal one third of radius with dislocation of the distal ulna.
Explanation: ***Fracture of the proximal third of the ulna with dislocation of the radial head.*** - A Monteggia fracture is characterized by a fracture in the **proximal third of the ulna** accompanied by a **dislocation of the radial head**. - This injury typically results from a fall on an outstretched hand with hyperpronation, leading to disruption of the radiocapitellar joint. *Fracture of distal radius with dislocation of the distal ulna* - This describes a **Galeazzi fracture-dislocation**, where there is a fracture of the distal or mid-shaft of the radius with dislocation of the distal radioulnar joint. - Unlike a Monteggia fracture, the primary fracture involves the **radius**, not the ulna, and the dislocation is at the **distal ulna**, not the radial head. *Fracture of distal third of ulna with dislocation of the radial head.* - While it mentions dislocation of the radial head, the fracture site is incorrectly identified as the **distal third of the ulna**. - A Monteggia fracture specifically involves the **proximal third** of the ulna, which is crucial for its classification and clinical presentation. *Fracture of proximal one third of radius with dislocation of the distal ulna.* - This description involves a fracture of the **radius** and a dislocation of the **distal ulna**, which does not align with a Monteggia fracture. - A Monteggia fracture is defined by an **ulnar fracture** and a **radial head dislocation**.
Question 4: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is
- A. 1st metacarpal fracture
- B. Scaphoid fracture (Correct Answer)
- C. Trapezoid fracture
- D. Lower end of radius fracture
Explanation: ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.
Question 5: Which of the following patients with a fracture should be your first priority to call the orthopedic postgraduate and inform?
- A. Patient's finger is blackening (Correct Answer)
- B. Patient can't extend his arm
- C. A 10 cm abrasion
- D. Intra articular fracture of Elbow Joint
Explanation: ***Patient's finger is blackening*** - **Blackening of a digit** indicates **tissue necrosis** due to severe vascular compromise, demanding immediate orthopedic intervention to prevent irreversible damage and potential amputation. - This symptom points to an **acute compartment syndrome** or a critical vascular injury, making it the highest priority. *Patient can't extend his arm* - Inability to extend the arm can signify **nerve injury** (e.g., radial nerve) or a **rotator cuff tear**, which, while serious, is generally not as immediately life-threatening as vascular compromise. - While requiring orthopedic attention, it typically allows for a slightly less urgent response compared to potential tissue death. *A 10 cm abrasion* - An **abrasion**, even if large (10 cm), is a **superficial skin injury** and does not directly indicate an orthopedic emergency. - It primarily requires wound care to prevent infection and is not a priority for immediate orthopedic consultation. *Intra articular fracture of Elbow Joint* - An **intra-articular fracture** of the elbow joint is a significant injury requiring orthopedic management to restore joint function and prevent future arthritis. - However, it is an **acute bony injury** not immediately threatening tissue viability or limb salvage in the same way as vascular compromise.
Question 6: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
- A. Anterior dislocation of hip
- B. Central fracture dislocation
- C. Posterior dislocation
- D. Pipkin's type 4 fracture (Correct Answer)
Explanation: ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.
Question 7: A patient fell off a bicycle and is now experiencing pain around the hip, shortening of the limb, and the hip is positioned in flexion, adduction, and internal rotation (IR). What is the most likely diagnosis?
- A. Intertrochanteric fracture (IT fracture)
- B. Posterior dislocation (Correct Answer)
- C. Transcervical fracture
- D. Anterior dislocation
Explanation: ***Posterior dislocation*** - The classic presentation of a **posterior hip dislocation** following trauma is a limb that is shortened, and held in **flexion, adduction, and internal rotation**. - This is the most common type of hip dislocation and often results from high-energy trauma, such as a bicycle fall. *Intertrochanteric fracture (IT fracture)* - While IT fractures also cause **pain and limb shortening**, the affected limb is typically held in **external rotation**, not internal rotation. - These fractures involve the region between the greater and lesser trochanters and are more common in elderly individuals after a fall. *Transcervical fracture* - A transcervical fracture (femoral neck fracture) also results in **pain** and **shortening** of the limb, but the limb's characteristic position is one of **external rotation**, similar to an IT fracture. - This type of fracture is typically associated with older patients with osteoporosis. *Anterior dislocation* - An **anterior hip dislocation** would present with the limb in **flexion, abduction, and external rotation**, which is contrary to the clinical presentation described (adduction and internal rotation). - This is a much rarer type of hip dislocation compared to posterior dislocation.
Question 8: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Explanation: ***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**.
Question 9: Pilon fracture is
- A. Bimalleolar fracture
- B. Trimalleolar fracture
- C. Distal tibia Intraarticular fracture (Correct Answer)
- D. Proximal tibia fracture
Explanation: ***Distal tibia Intraarticular fracture*** - A **pilon fracture** specifically refers to an **intra-articular fracture of the distal tibia**, involving the weight-bearing surface of the **ankle joint**. - These fractures typically result from high-energy axial loading mechanisms, driving the talus into the plafond and causing extensive articular damage. *Bimalleolar fracture* - A **bimalleolar fracture** involves fractures of both the **medial malleolus** (distal tibia) and the **lateral malleolus** (distal fibula). - While it involves the ankle, it does not necessarily involve the **tibial plafond** articular surface in the same destructive manner as a pilon fracture. *Trimalleolar fracture* - A **trimalleolar fracture** includes fractures of the medial, lateral, and **posterior malleolus** (a portion of the distal tibia). - Like bimalleolar fractures, it primarily describes the involvement of the malleoli rather than the intra-articular surface load-bearing portion of the distal tibia. *Proximal tibia fracture* - This term refers to a fracture occurring in the **upper part of the tibia**, near the knee joint. - It does not involve the **distal end of the tibia** or the ankle joint, which is characteristic of a pilon fracture.
Question 10: A patient fell off a bicycle and now complains of pain around the hip, with shortening of the affected limb. The hip is held in a position of flexion, adduction, and internal rotation. What is the most likely diagnosis?
- A. Intertrochanteric fracture (IT fracture)
- B. Transcervical fracture
- C. Posterior dislocation (Correct Answer)
- D. Anterior dislocation
Explanation: **Posterior dislocation** - **Posterior hip dislocations** typically occur after high-energy trauma (e.g., falls from height, motor vehicle accidents) and present with the affected limb in a classic position of **flexion, adduction, and internal rotation**. - **Shortening of the limb** is also a hallmark sign, often due to the femoral head displacing posteriorly and superiorly. *Intertrochanteric fracture (IT fracture)* - **Intertrochanteric fractures** usually present with the affected limb in **external rotation** and shortening, which is contrary to the internal rotation described in the case. - While pain is present, the specific rotational deformity helps differentiate it from a hip dislocation. *Transcervical fracture* - **Transcervical fractures** (femoral neck fractures) also typically present with the leg in **external rotation** and shortening. - These fractures are common in older adults and often associated with less severe trauma or falls. *Anterior dislocation* - **Anterior hip dislocations** are less common and typically present with the affected limb in a position of **flexion, abduction, and external rotation**. - This presentation is directly opposite to the adduction and internal rotation described in the question.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free