Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1021: A clinician is assessing a patient for damage to the axillary nerve following a shoulder dislocation. Which clinical test should be performed to evaluate the integrity of this nerve?

A. Elbow flexion test
B. Shoulder abduction test (Correct Answer)
C. Wrist extension test
D. Finger adduction test

Explanation: ***Shoulder abduction test*** - The **axillary nerve** innervates the **deltoid muscle**, which is the primary muscle responsible for **shoulder abduction**. - Testing the patient's ability to abduct their shoulder against resistance directly assesses the motor function of the axillary nerve. *Elbow flexion test* - This test primarily evaluates the function of the **musculocutaneous nerve**, which innervates the **biceps brachii** and **brachialis muscles**. - It is not directly relevant to assessing the integrity of the axillary nerve. *Wrist extension test* - This test primarily assesses the function of the **radial nerve**, which innervates the extensors of the wrist and fingers. - Damage to the axillary nerve would not typically affect wrist extension. *Finger adduction test* - This test primarily evaluates the function of the **ulnar nerve**, which innervates the intrinsic muscles of the hand responsible for finger adduction. - This test is unrelated to the axillary nerve's distribution or function.

Question 1022: Which clinical test is used to assess the integrity of the radial nerve following a mid-shaft humerus fracture?

A. Wrist drop test (Correct Answer)
B. Tinel's sign
C. Phalen's maneuver
D. Froment's sign

Explanation: ***Wrist drop test*** - The **radial nerve** innervates the muscles responsible for **wrist extension** and **finger extension**. - Damage to the radial nerve (e.g., from a mid-shaft humeral fracture) can result in an inability to extend the wrist and fingers, known as **wrist drop**. *Tinel's sign* - This test assesses for **nerve irritation or compression** by percussing over the nerve, often used for **carpal tunnel syndrome** or **cubital tunnel syndrome**. - It checks for tingling or pain, not functional integrity of the radial nerve. *Phalen's maneuver* - This test is used to diagnose **carpal tunnel syndrome**, which involves compression of the **median nerve**. - It involves holding the wrists in maximal flexion to provoke symptoms, unrelated to radial nerve integrity. *Froment's sign* - This test assesses the integrity of the **ulnar nerve**, specifically the **adductor pollicis muscle**. - It involves asking the patient to hold a piece of paper between their thumb and index finger.

Question 1023: Which technique involves realigning bone fragments through external manipulation without surgical intervention?

A. Open reduction
B. External fixation
C. Internal fixation
D. Closed reduction (Correct Answer)

Explanation: ***Closed reduction*** - This technique involves **realigning fractured bone fragments** through **external manipulation** of the limb, without the need for an incision or direct visualization of the bone. - It is typically performed under **anesthesia** to relax muscles and minimize pain, allowing the surgeon to maneuver the bone ends into proper alignment. *Open reduction* - This method requires a **surgical incision** to directly visualize the fractured bone fragments and reduce them by hand or with surgical instruments. - It is generally reserved for fractures that cannot be adequately reduced by closed methods, or for those requiring **internal fixation**. *External fixation* - This technique uses **pins or wires inserted into the bone** through the skin, which are then connected to an external frame to stabilize the fracture. - While it involves external apparatus, its primary purpose is **stabilization**, not the initial realignment of bone fragments through manipulation. *Internal fixation* - This involves the surgical implantation of **plates, screws, rods, or wires** directly onto or within the bone fragments to stabilize them after reduction. - It is a method of **stabilizing** the fracture after reduction, which can be achieved through either open or closed techniques, rather than a reduction technique itself.

Question 1024: What is the most common complication of a posterior shoulder dislocation?

A. Bankart lesion
B. Rotator cuff tear
C. Fracture of the scapula
D. Reverse Hill-Sachs lesion (Correct Answer)

Explanation: ***Reverse Hill-Sachs lesion*** - A **reverse Hill-Sachs lesion** (also known as a **McLaughlin lesion**) is an impaction fracture on the anterior aspect of the humeral head, occurring when the humeral head strikes the posterior glenoid rim during a posterior dislocation. - It is the most common bony complication of a posterior shoulder dislocation due to the direct impact of the humeral head against the glenoid. *Bankart lesion* - A **Bankart lesion** is an injury to the anterior inferior glenoid labrum, often with an associated bony fragment, and is characteristic of **anterior shoulder dislocations**. - It results from the humeral head being forced anteriorly, tearing the labrum and capsule from the anterior glenoid, which is not the mechanism in posterior dislocations. *Rotator cuff tear* - While rotator cuff tears can occur with any shoulder dislocation, they are more commonly associated with **anterior dislocations**, especially in older patients. - They are also often seen with chronic instability or significant trauma, but a specific lesion like a reverse Hill-Sachs is more pathognomonic for a posterior dislocation. *Fracture of the scapula* - A **scapular fracture** is relatively uncommon with isolated shoulder dislocations and typically requires a significant, direct high-energy trauma. - Such fractures are less directly caused by the dislocation mechanism itself, compared to the impaction injury that creates a reverse Hill-Sachs lesion.

Question 1025: In a pelvic fracture, which nerve is most at risk of injury due to its location within the pelvis?

A. Sciatic nerve (Correct Answer)
B. Femoral nerve
C. Obturator nerve
D. Pudendal nerve

Explanation: ***Sciatic nerve*** - The **sciatic nerve** is formed by nerve roots from L4-S3 and exits the pelvis through the **greater sciatic foramen**, making it vulnerable to injury from pelvic fractures, especially those involving the **posterior pelvis** or **sacrum**. - Its large size and proximity to various pelvic structures increase the likelihood of compression or direct trauma during significant pelvic trauma. *Femoral nerve* - The **femoral nerve** originates from L2-L4 and courses through the **psoas major muscle** and then under the inguinal ligament, making it less directly exposed to typical sites of fracture in the deep pelvis. - While it can be injured in high-energy trauma, it is not typically the most vulnerable compared to the sciatic nerve in general pelvic fractures. *Obturator nerve* - The **obturator nerve** (L2-L4) passes through the **obturator canal** to supply the medial thigh muscles, which provides some protection from direct impact compared to nerves within the open pelvic cavity. - Injuries to the obturator nerve are usually associated with specific types of fractures involving the superior pubic rami or anterior pelvic region, rather than being the most commonly injured in all pelvic fractures. *Pudendal nerve* - The **pudendal nerve** (S2-S4) exits the pelvis through the greater sciatic foramen, hooks around the ischial spine, and re-enters through the lesser sciatic foramen to supply the perineum. - While it is located within the pelvis, its deep and somewhat protected course reduces its likelihood of direct trauma from typical pelvic fractures, compared to the more exposed sciatic nerve near major fracture lines.

Question 1026: Palpable femur head on per rectal exam is a feature of which of the following conditions?

A. Posterior hip dislocation (Correct Answer)
B. Anterior hip dislocation
C. Central hip dislocation
D. Inferior hip dislocation

Explanation: ***Posterior hip dislocation*** - In **posterior hip dislocation**, the femoral head is displaced posteriorly, often coming to rest on the **ischium**. - This posterior displacement can make the **femoral head palpable** through the rectum, particularly in thin individuals. *Anterior hip dislocation* - Involves the femoral head displacing **anteriorly**, usually into the **obturator foramen** or onto the **pubis**. - The femoral head would be palpable in the **groin region**, not rectally. *Central hip dislocation* - Occurs when the femoral head is driven **centrally** through the **acetabulum** into the pelvis. - While it involves intrapelvic displacement, the femoral head is typically covered by pelvic bone and not directly palpable per rectally. *Inferior hip dislocation* - This is a rare form of dislocation where the femoral head is forced **inferiorly** from the acetabulum. - The femoral head would typically be palpable in the **perineal region**, not through the rectum.

Question 1027: Which of the following statements about Galeazzi fracture dislocation is incorrect?

A. Results from fall on outstretched hand
B. Fracture of distal third of radius and dislocation of DRUJ
C. Radius is angulated laterally and posteriorly
D. Ulna dislocates dorsally at DRUJ (Correct Answer)

Explanation: ***Ulna dislocates dorsally at DRUJ*** - This statement is incorrect because in a **Galeazzi fracture-dislocation**, the **ulna typically dislocates volarly (anteriorly)** relative to the radius at the **distal radio-ulnar joint (DRUJ)**. - The DRUJ dislocation is usually in a volar direction due to the force of injury. *Fracture of distal third of radius and dislocation of DRUJ* - This is a hallmark of a **Galeazzi fracture-dislocation**, explicitly defining the two main components of the injury. - The **distal third of the radius** is the most common site of fracture, coupled with the disruption of the DRUJ. *Radius is angulated laterally and posteriorly* - This describes the typical displacement pattern of the **radial fracture fragment** in a Galeazzi injury. - The angulation often results from the forces acting on the forearm during the injury, with the pronator quadratus pulling the distal fragment volarly and an abduction force causing lateral angulation. *Results from fall on outstretched hand* - This is the most common mechanism of injury for a **Galeazzi fracture-dislocation**, similar to many other forearm and wrist fractures. - The axial load and pronation forces generated during a fall on an **outstretched hand** contribute to the characteristic fracture and dislocation.

Question 1028: Dunlop traction is a type of traction used in the management of?

A. Fracture of the humerus (Correct Answer)
B. Fracture of the radius
C. Fracture of the femur
D. Fracture of the tibia

Explanation: ***Fracture of the humerus*** - **Dunlop traction** is specifically designed for the management of **supracondylar fractures** of the humerus in children. - It involves traction applied to the arm, often in conjunction with skin or skeletal traction to maintain reduction and alignment. *Fracture of the radius* - Fractures of the radius, particularly distal radius fractures, are typically managed with **closed reduction and casting** or **surgical fixation**, not Dunlop traction. - Traction methods for forearm fractures are less common and usually involve specialized techniques for specific fracture patterns. *Fracture of the femur* - Femur fractures, especially in children, are commonly managed with **Bryant's traction** or **femoral skeletal traction** in younger children, or surgical intervention. - Dunlop traction is not suitable due to the significant muscle mass and bone size of the femur requiring stronger, more robust traction. *Fracture of the tibia* - Tibia fractures are generally managed with **casting**, **external fixation**, or **intramedullary nailing**. - While traction can be used initially for severely displaced or open tibial fractures, it typically involves **skeletal traction** rather than Dunlop traction.

Question 1029: Chauffeur fracture is -

A. Intra-articular fracture of the radial styloid process (Correct Answer)
B. Intra-articular fracture of the base of the 1st metacarpal
C. Extra-articular fracture of the base of the 1st metacarpal
D. Extra-articular fracture of the styloid process

Explanation: ***Intra-articular fracture of the radial styloid process*** - A **chauffeur fracture**, also known as a **Hutchinson fracture**, is an **intra-articular fracture** of the distal radius involving the radial styloid process. - This fracture often results from a **direct impact** or **compressive force** on the wrist, historically seen in individuals cranking early automobiles. *Intra-articular fracture of the base of the 1st metacarpal* - This description refers to a **Bennett's fracture**, which is a **two-part intra-articular fracture** of the base of the first metacarpal. - It is typically caused by **axial force** directed along the metacarpal, often from a punch, rather than a wrist-level injury. *Extra-articular fracture of the base of the 1st metacarpal* - An **extra-articular fracture** of the base of the 1st metacarpal is known as a **Rolando fracture** if comminuted, or a simpler extra-articular fracture. - These fractures do not involve the joint surface, distinguishing them from intra-articular fractures. *Extra-articular fracture of the styloid process* - While it involves the styloid process, an **extra-articular fracture of the styloid process** would imply a fracture not extending into the joint space. - A Chauffeur's fracture specifically involves the **articular surface** of the radial styloid, making this option incorrect.

Question 1030: What condition is associated with the absence of femoral artery pulsation in the affected limb?

A. Fracture of the neck of femur
B. Legg-Calvé-Perthes disease
C. Posterior dislocation of the hip (Correct Answer)
D. None of the options

Explanation: ***Posterior dislocation of the hip*** - A **posterior hip dislocation** can compress or injure the **femoral artery** due to the displacement of the femoral head posteriorly, leading to a diminished or absent pulse. - This is a **medical emergency** as vascular compromise can lead to **ischemia and necrosis** of the affected limb. *Fracture of the neck of femur* - While a **femoral neck fracture** can cause significant pain and may sometimes be associated with a compromised blood supply to the femoral head, it typically does not directly compress or injure the **femoral artery** itself. - The main vascular concern with femoral neck fractures is often the **avascular necrosis** of the femoral head due to disruption of its nutrient arteries. *Legg-Calvé-Perthes disease* - This condition involves **avascular necrosis of the femoral head** in children, primarily affecting the blood supply to the epiphysis, not the main femoral artery. - Though it affects hip vascularity, it does not typically manifest with an **absent femoral pulse**. *None of the options* - This option is incorrect because a **posterior dislocation of the hip** is a recognized cause of compromised femoral artery pulsation.

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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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