Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1091: The treatment of choice for fracture of radius and ulna in an adult is:

A. Plaster for 4 weeks
B. Closed reduction and calipers
C. Kuntscher nails
D. Only plates (Correct Answer)

Explanation: ***Only plates*** - **Open reduction and internal fixation (ORIF)** with plates and screws is the preferred treatment for diaphyseal fractures of both the radius and ulna in adults, as it provides **stable fixation** and allows for early mobilization. - This method helps restore normal forearm anatomy and function, crucial for maintaining **pronation and supination**. *Plaster for 4 weeks* - **Conservative management** with plaster casting for fractures of both radius and ulna in adults often leads to **malunion**, nonunion, or loss of forearm rotation. - It is generally reserved for **undisplaced fractures** or in situations where surgery is contraindicated. *Closed reduction and calipers* - **Closed reduction** can be attempted for some forearm fractures, but maintaining reduction with external devices like calipers is challenging due to the dynamic forces of the forearm muscles. - This method has a higher risk of **redisplacement** and suboptimal anatomical alignment, leading to functional limitations. *Kuntscher nails* - **Kuntscher nails** (intramedullary nails) are more commonly used for long bone fractures like the femur or tibia. - While intramedullary nailing can be used for forearm fractures, **plating** is generally favored for diaphyseal radius and ulna fractures due to better control of **rotational alignment** and restoration of the interosseous space.

Question 1092: Which fracture is characterized by a 'dinner fork' deformity?

A. Lateral condyle fracture (elbow injury)
B. Supracondylar fracture (humerus injury)
C. Colle's fracture (distal radius fracture with dorsal angulation). (Correct Answer)
D. March fracture (metatarsal stress fracture)

Explanation: ***Colle's fracture (distal radius fracture with dorsal angulation)*** - A **Colle's fracture** is a fracture of the distal radius that results in **dorsal displacement** and angulation of the distal fragment. - This dorsal displacement creates a characteristic appearance on clinical examination resembling a **"dinner fork" deformity**. *Lateral condyle fracture (elbow injury)* - A **lateral condyle fracture** involves the lateral portion of the distal humerus, typically occurring in children. - It usually presents with pain and swelling around the elbow but does not produce a "dinner fork" deformity. *Supracondylar fracture (humerus injury)* - A **supracondylar fracture** involves the humerus just above the elbow joint and is also common in children. - It can lead to severe swelling and potential neurovascular compromise, but not the specific "dinner fork" deformity. *March fracture (metatarsal stress fracture)* - A **March fracture** is a **stress fracture** of the metatarsal bones, commonly seen in individuals who engage in repetitive high-impact activities. - It presents with foot pain, especially during weight-bearing, and is not associated with any external deformity like a "dinner fork."

Question 1093: Sciatic nerve palsy may occur in which injury?

A. Posterior dislocation of hip joint (Correct Answer)
B. Fracture neck of femur
C. Trochanteric fracture
D. Anterior dislocation of hip

Explanation: ***Posterior dislocation of hip joint*** - This injury commonly results from **high-energy trauma**, such as a dashboard injury, forcing the femoral head posteriorly out of the acetabulum. - The **sciatic nerve** runs in close proximity to the posterior aspect of the hip joint and can be stretched or compressed during such a dislocation, leading to palsy. *Fracture neck of femur* - This fracture typically involves the **femoral neck** and is more associated with complications like avascular necrosis due to disruption of blood supply. - While it can involve nerve injury, **sciatic nerve palsy** is not a common or direct complication of this specific fracture type. *Trochanteric fracture* - This fracture involves the **greater or lesser trochanter** of the femur, often due to a fall in elderly individuals. - Nerve injury is rare with this type of fracture, and the sciatic nerve is generally not vulnerable in this location. *Anterior dislocation of hip* - This is a less common type of hip dislocation where the femoral head displaces **anteriorly**. - While other neurovascular structures might be at risk, the **femoral nerve** or vessels are more likely to be involved, not the sciatic nerve, which is located posteriorly.

Question 1094: Which of the following is NOT a complication of a neck femur fracture?

A. Nonunion
B. Osteoarthritis
C. AVN
D. Malunion (Correct Answer)

Explanation: ***Malunion*** - **Malunion** is a rare complication of a femoral neck fracture because the fracture is inherently unstable and tends to result in **nonunion** rather than healing in an abnormal position. - The **vascular compromise** and mechanical forces often lead to a failure to heal whatsoever, or to avascular necrosis. *Nonunion* - **Nonunion** is a common and severe complication of femoral neck fractures due to the **precarious blood supply** to the femoral head and the high mechanical stress across the fracture site. - The lack of adequate blood flow and movement at the fracture site hinders the formation of a **bony callus**, leading to failure of the bone to heal. *AVN* - **Avascular necrosis (AVN)** of the femoral head is a major complication resulting from the disruption of the arterial blood supply to the femoral head during the fracture. - The **retinacular arteries**, which supply most of the femoral head, are often damaged, leading to the death of bone cells and subsequent collapse of the femoral head. *Osteoarthritis* - **Post-traumatic osteoarthritis** can develop as a long-term complication, even if the fracture heals. - The initial injury and any subsequent irregularities in the joint surface or alignment can lead to accelerated **cartilage degeneration**.

Question 1095: The rephrased question is:What is the most common complication of a fractured talus?

A. Avascular necrosis (AVN) (Correct Answer)
B. Osteoarthritis of the subtalar joint
C. Nonunion of the talus
D. Osteoarthritis of the ankle joint

Explanation: ***Avascular necrosis (AVN)*** - The talus has a **precarious blood supply**, with arterial branches entering at multiple points but often centrally, making it vulnerable to **ischemia** after fracture. - Fractures, especially neck fractures, can disrupt these delicate vessels, leading to **osteonecrosis** and collapse of the bone. *Nonunion of the talus* - While possible, talar nonunion is **less common** than AVN due to the talus's dense cortical bone and limited muscle attachments. - Nonunion is more frequently seen with fractures of other bones, such as the **scaphoid**. *Osteoarthritis of the subtalar joint* - **Subtalar osteoarthritis** can occur post-talar fracture, often as a **secondary complication** of disrupted articular surfaces or AVN. - However, the **initial and most common direct complication** stemming from the blood supply disruption is AVN. *Osteoarthritis of the ankle joint* - **Ankle osteoarthritis** can also develop after certain talar fractures, particularly those involving the talar dome or leading to incongruity of the ankle joint. - Similar to subtalar arthritis, it is often a **later or secondary sequela**, rather than the immediate and most frequent direct complication like AVN.

Question 1096: Tardy ulnar nerve palsy is most commonly associated with which of the following fractures of the humerus?

A. Supracondylar condyle of the humerus
B. Fracture shaft of the humerus
C. Lateral condyle of the humerus
D. Medial condyle of the humerus (Correct Answer)

Explanation: ***Medial condyle of the humerus*** - Fractures involving the **medial condyle** or **epicondyle** can directly injure the **ulnar nerve** as it passes through the cubital tunnel. - Malunion or delayed healing of these fractures can lead to chronic irritation or compression, resulting in **tardy ulnar nerve palsy**. *Lateral condyle of the humerus* - Fractures of the **lateral condyle** are less directly associated with ulnar nerve injury because the nerve is located on the medial side of the elbow. - While all elbow fractures carry some risk of nerve injury, the proximity of the ulnar nerve to the medial structures makes medial condyle fractures more relevant. *Supracondylar condyle of the humerus* - **Supracondylar fractures** are more commonly associated with injury to the **brachial artery** and the **median nerve** (Volkmann's contracture). - Although any severe elbow trauma can cause nerve damage, primary ulnar nerve involvement is less typical with supracondylar fractures compared to medial condyle fractures. *Fracture shaft of the humerus* - Fractures of the **humeral shaft** are most commonly associated with injury to the **radial nerve** due to its close proximity to the mid-shaft of the humerus. - The ulnar nerve courses more distally and medially, making shaft fractures an infrequent cause of direct ulnar nerve palsy.

Question 1097: A 60-year-old man who fell in the bathroom and is unable to stand on his right buttock region due to ecchymosis, with external rotation of the leg and the lateral border of the foot touching the bed. The most probable diagnosis is:

A. Extra capsular fracture neck of femur (Correct Answer)
B. Anterior dislocation of hip
C. Intra capsular fracture neck of femur
D. Posterior dislocation of hip

Explanation: **Extra capsular fracture neck of femur** - The classic presentation of an **extra capsular fracture of the neck of femur** includes a fall, **ecchymosis** in the buttock region, and the affected leg displaying **external rotation** and shortening. - This type of fracture often involves the **intertrochanteric region**, leading to significant soft tissue damage and the observed clinical signs. *Anterior dislocation of hip* - This typically presents with the hip in **flexion, abduction, and external rotation**, but the limb is usually **lengthened**, not shortened. - While there is external rotation, the characteristic **shortening of the leg** and inability to bear weight on the buttock are less typical. *Intra capsular fracture neck of femur* - This fracture often presents with a less pronounced deformity, and the leg may show **mild external rotation** or be in a neutral position. - **Ecchymosis** may be delayed or less significant compared to extracapsular fractures because the fracture is contained within the joint capsule. *Posterior dislocation of hip* - This type of dislocation is characterized by the hip being in **flexion, adduction, and internal rotation**. - The presented symptoms of **external rotation** and the foot touching the bed laterally are inconsistent with a posterior dislocation.

Question 1098: In a typical nasal bone fracture from lateral trauma, the fracture line is usually

A. Oblique
B. Comminuted
C. Vertical
D. Horizontal (Correct Answer)

Explanation: ***Horizontal*** - Lateral trauma to the nasal bones typically causes a **horizontal fracture line** along the nasal bridge, often involving the nasal septum. - This is due to the force being applied from the side, pushing the nasal bones inwards and leading to a fracture that runs **perpendicular to the long axis** of the nasal bones. *Oblique* - An oblique fracture line would involve a force applied at an **angle** to the nasal bones, which is less common in typical lateral trauma scenarios. - While possible, it is not the most common or typical fracture pattern for this specific mechanism of injury. *Comminuted* - A comminuted fracture involves **multiple fragments** or more severe crushing, which usually results from a higher-energy impact or a direct frontal blow, not a typical lateral trauma. - While comminution can occur with any fracture, it is not the **primary characteristic** of a typical lateral nasal bone fracture. *Vertical* - A vertical fracture line would suggest a force applied more directly from **above or below**, along the long axis of the nasal bones, which is inconsistent with lateral trauma. - Such a fracture pattern is less common in isolated nasal bone injuries and rare following a lateral impact.

Question 1099: Which of the following statements about Hangman's fracture is correct?

A. Odontoid fractures are more common than Hangman's fractures.
B. Surgical treatment is rarely necessary.
C. High post-admission mortality is uncommon.
D. Most cases heal well without surgery. (Correct Answer)

Explanation: **Most cases heal well without surgery.** * A **Hangman's fracture** is a fracture of both pedicles of the **axis (C2)** vertebra, typically caused by hyperextension and distraction. * Despite being a severe injury, most stable Hangman's fractures (Type I and some Type II) can be managed non-surgically with **halo immobilization** and achieve good healing outcomes. *Odontoid fractures are more common than Hangman's fractures.* * **Odontoid fractures** (fractures of the dens of C2) are actually more common than Hangman's fractures. * Odontoid fractures constitute about **10-15% of all cervical spine fractures**, whereas Hangman's fractures are less frequent. *Surgical treatment is rarely necessary.* * While many stable Hangman's fractures heal non-surgically, **surgical treatment is often necessary** for unstable fractures, such as most Type IIA and Type III fractures, or failed non-operative management. * Unstable fractures involve significant **displacement**, angular deformity, or compromise of the spinal canal, warranting surgical stabilization. *High post-admission mortality is uncommon.* * Hangman's fractures, especially unstable types, can be associated with significant **spinal cord injury** and instability. * Therefore, a **high post-admission mortality** can occur, particularly in severe cases or those with associated injuries, making this statement incorrect.

Question 1100: A patient presents with a compound fracture of the tibia, with a 1-cm opening in the skin. Which grade does it belong to?

A. Grade IIIA
B. Grade IIIB
C. Grade I
D. Grade II (Correct Answer)

Explanation: ***Grade II*** - A **Grade II open fracture** is defined by a skin wound between **1 cm and 10 cm** in length, often accompanied by moderate crush injury and minimal to moderate soft tissue damage. - The presence of a **1-cm skin opening** with a compound fracture places it within this category, distinguishing it from smaller (Grade I) or larger/more complex (Grade III) wounds. *Grade I* - A **Grade I open fracture** involves a clean skin wound of **less than 1 cm** and typically has minimal soft tissue damage. - The stated wound size of **1 cm** exceeds the strict definition for Grade I, which requires the wound to be *under* 1 cm. *Grade IIIA* - **Grade IIIA open fractures** are characterized by extensive soft tissue damage, **adequate bone coverage**, and wound sizes *greater than 10 cm*. - Although the wound is *compound*, its small size (1 cm) does not fit the criteria for *extensive* soft tissue damage or a wound larger than 10 cm, which are hallmarks of Grade IIIA. *Grade IIIB* - **Grade IIIB open fractures** involve severe soft tissue loss with **periosteal stripping** and **bone exposure**, even after debridement. - These fractures require **soft tissue reconstruction** for wound closure, which is a much more severe injury than described by a 1-cm skin opening.

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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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