Trauma Practice Questions

Q: What is the treatment of choice for a 65-year-old male with a fracture of the neck of the femur sustained 6 weeks ago?

Hemiarthroplasty. ### Explanation The treatment of choice for a fracture of the neck of the femur depends primarily on the **age of the patient** and the **duration since the injury**. **Why Hemiarthroplasty is Correct:** In an elderly patient (65 years old) with a "neglected" or old fracture (6 weeks duration), the risk of **Avascular Necrosis (AVN)** and **Non-union** is extremely high due to the precarious retrograde blood supply of the femoral head. At 6 weeks, the fracture site is unlikely to heal with internal fixation. Therefore, replacing the femoral head (Hemiarthroplasty) is the standard of care. It allows for immediate weight-bearing and avoids the complications of a second surgery if fixation fails. **Analysis of Incorrect Options:** * **A. SP (Smith-Petersen) Nailing:** This is an obsolete method of internal fixation. Even modern fixation (like Cannulated Cancellous Screws) is generally avoided in elderly patients with old fractures because the biological potential for healing is lost after 3 weeks. * **B. McMurray’s Osteotomy:** This is a displacement osteotomy used historically to convert shearing forces into compressive forces to promote healing in non-union. However, it is rarely performed today and is not the first choice in an elderly patient who requires early mobilization. **High-Yield Clinical Pearls for NEET-PG:** 1. **The "3-Week" Rule:** Neck of femur fractures are considered "neglected" if they are >3 weeks old. 2. **Age-Based Management:** * ** 60 years:** Replacement (Hemiarthroplasty if sedentary; Total Hip Arthroplasty if active/pre-existing arthritis). 3. **Garden Classification:** Used to grade displacement; Garden III and IV have the highest risk of AVN. 4. **Pauwels Classification:** Based on the angle of the fracture line; higher angles indicate greater instability.

Q: Spur sign is/are seen in which of the following conditions?

Acetabulum fracture of pelvis. ### Explanation The **Spur Sign** is a pathognomonic radiological feature of **Both Column Acetabular Fractures**. **1. Why Acetabulum fracture is correct:** In a "both column" fracture, the articular surface is completely detached from the stable posterior ilium (the axial skeleton). On an Obturator Oblique view (Judet view), the **Spur Sign** represents the lowermost part of the intact posterior ilium that remains attached to the sacroiliac joint. Because the acetabular roof has displaced medially and posteriorly, this intact piece of bone "juts out" like a spur. Its presence confirms that no part of the articular surface remains attached to the sciatic buttress. **2. Why other options are incorrect:** * **Supracondylar fracture of humerus:** This is associated with the "Fat Pad sign" (Sail sign) or "Gartland classification," but not a spur sign. * **Radial head fracture:** Common signs include the "Fat Pad sign" due to joint effusion and the "Mason classification." * **Talus fracture:** These are associated with "Hawkins’ Sign" (subchondral lucency indicating intact vascularity), which is a crucial prognostic factor for avascular necrosis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Judet Views:** Essential for acetabular fractures. *Iliac Oblique* shows the posterior column and anterior wall; *Obturator Oblique* shows the anterior column and posterior wall (and the Spur Sign). * **Letournel Classification:** The gold standard for acetabular fractures (divided into 5 simple and 5 associated patterns). * **Both Column Fracture:** The only acetabular fracture where the "Spur Sign" is visualized. * **Floating Acetabulum:** Another term used for both column fractures because the joint is completely disconnected from the ilium.

Q: What is the most serious complication of a fracture of a long bone?

Fat embolism. ### Explanation **Correct Option: A. Fat Embolism** Fat Embolism Syndrome (FES) is considered the most serious and life-threatening systemic complication specifically associated with long bone fractures (especially the femur and tibia). When a long bone breaks, fat globules from the bone marrow are released into the systemic circulation. These globules can cause mechanical obstruction and trigger a biochemical inflammatory response (via free fatty acids), leading to acute respiratory distress, neurological dysfunction, and petechial rashes. Its rapid onset (24–72 hours) and high mortality rate make it the most dreaded acute complication. **Why other options are incorrect:** * **B. Pulmonary Embolism (PE):** While life-threatening, PE is usually a secondary complication of DVT and occurs later in the recovery phase (often after a week of immobilization). In the context of the *fracture event itself*, fat embolism is the more direct and classic "serious" complication. * **C. Deep Vein Thrombosis (DVT):** DVT is a common complication due to stasis and immobilization, but it is not as acutely fatal as a massive fat embolism. * **D. Associated Joint Injuries:** These are common and can lead to long-term morbidity (like stiffness or arthritis), but they are rarely life-threatening. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosing FES. Major criteria include **respiratory insufficiency**, **cerebral involvement** (confusion/coma), and **petechial rash** (typically over the chest, axilla, and conjunctiva). * **Snowstorm Appearance:** The classic finding on a chest X-ray in a patient with FES. * **Prevention:** Early internal fixation and stabilization of the fracture is the most effective way to prevent FES. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Corticosteroids are controversial but sometimes mentioned.

Q: Aseptic necrosis is common in which of the following bones?

Scaphoid. **Explanation:** The correct answer is **Scaphoid**. The primary reason for the high incidence of aseptic necrosis (Avascular Necrosis - AVN) in the scaphoid is its **retrograde blood supply**. Approximately 70-80% of the scaphoid's blood supply enters through the dorsal ridge and distal pole via the radial artery. Consequently, a fracture through the waist or proximal pole interrupts the blood flow to the proximal fragment, leaving it ischemic. Since the scaphoid is largely covered by articular cartilage, it has limited areas for vascular entry, further predisposing it to AVN and non-union. **Analysis of Incorrect Options:** * **B. Calcaneum:** This is a large, cancellous bone with a robust, multi-directional blood supply. Fractures here typically heal well, though they may lead to subtalar arthritis. * **C. Cuboid:** Like most tarsal bones, it has a rich vascular network and is rarely subject to isolated ischemic necrosis. * **D. Trapezium:** While located in the carpus, it does not share the precarious retrograde vascular anatomy of the scaphoid and thus has a low risk of AVN. **High-Yield Clinical Pearls for NEET-PG:** * **Common Sites for AVN:** Remember the mnemonic **"S-F-A-T"** (Scaphoid, Femur head, Astragalus/Talus, Tally/Capitate). * **Talus:** Similar to the scaphoid, the talus has a retrograde blood supply (entering through the neck), making the body prone to AVN after neck fractures (**Hawkins’ Sign** on X-ray indicates a good prognosis/revascularization). * **Preiser’s Disease:** This refers to idiopathic AVN of the scaphoid (without a preceding fracture). * **Kienbock’s Disease:** AVN of the **Lunate** bone. * **Kohler’s Disease:** AVN of the **Navicular** bone in children.

Q: A 68-year-old female presents with a posterior displacement of the left distal wrist and hand after a fall. Radiographic examination reveals an oblique fracture of the radius. Which of the following is the most likely fracture involved in this case?

Colles' fracture. ### Explanation **Correct Option: A. Colles' fracture** A **Colles' fracture** is a distal radius fracture (usually within 2.5 cm of the wrist joint) characterized by **dorsal (posterior) displacement** and angulation of the distal fragment. It typically occurs in elderly, osteoporotic women following a fall on an outstretched hand (FOOSH). The classic clinical appearance is the **"Dinner Fork Deformity."** In this case, the patient’s age, mechanism of injury, and posterior displacement of the distal wrist are pathognomonic for Colles' fracture. **Why the other options are incorrect:** * **B. Scaphoid fracture:** This is the most common carpal bone fracture. It presents with tenderness in the **anatomical snuffbox**, not a gross posterior displacement of the distal radius. * **C. Bennett's fracture:** This is an intra-articular fracture-subluxation at the **base of the first metacarpal** (thumb). It does not involve the distal radius or cause a dinner fork deformity. * **D. Volkmann's ischemic contracture (VIC):** This is a **sequela (complication)** of untreated compartment syndrome, often following supracondylar fractures of the humerus. It is a permanent flexion deformity of the wrist and fingers due to muscle ischemia, not an acute fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Smith’s Fracture:** Often called a "Reverse Colles," it involves **ventral (palmar)** displacement of the distal radius fragment. * **Barton’s Fracture:** An intra-articular oblique fracture of the distal radius with associated subluxation of the carpus. * **Chauffeur’s Fracture:** An intra-articular fracture of the **radial styloid process**. * **Eponymous Deformity:** Remember, Colles = Dinner Fork; Smith = Garden Spade.

Q: Which of the following factors favor fat embolism in a trauma patient?

Hypovolemic shock. **Explanation:** Fat Embolism Syndrome (FES) typically occurs following fractures of long bones (like the femur) or the pelvis. The pathophysiology involves the release of fat globules from the bone marrow into the systemic circulation. **Why Hypovolemic Shock is the correct answer:** Hypovolemic shock is a major predisposing factor for fat embolism. In a state of shock, there is **decreased systemic blood flow and stasis** in the microcirculation. This sluggish flow allows fat globules to coalesce and obstruct small capillaries more easily. Furthermore, shock triggers a systemic inflammatory response that increases the permeability of the lung capillaries, exacerbating the damage caused by the biochemical breakdown of fat into free fatty acids (the "Chemical Theory" of FES). **Analysis of Incorrect Options:** * **A. Diabetes Mellitus:** While DM affects bone healing and vascular health, it is not a direct predisposing factor for the mechanical release or systemic manifestation of fat emboli. * **B. Mobility of joint:** While movement of the *fracture site* (not the joint specifically) can theoretically increase marrow pressure, the gold standard for preventing FES is **early stabilization/fixation** of the fracture. Joint mobility itself is not a recognized risk factor. * **C. Respiratory failure:** This is a **consequence** (clinical feature) of fat embolism, not a factor that favors its occurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major signs include **Petechial rash** (vest distribution/axilla), respiratory insufficiency, and cerebral involvement (confusion). * **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse pulmonary infiltrates). * **Management:** Primarily supportive (Oxygenation/Ventilation). Early splintage and operative fixation of fractures are the most effective preventive measures.

Q: Bohler's angle is reduced in which of the following fractures?

Fracture Calcaneus. **Explanation:** **Bohler’s Angle** (also known as the Tuber-joint angle) is a crucial radiographic measurement used to assess the integrity of the **calcaneus**. It is formed by drawing two lines on a lateral foot X-ray: 1. From the highest point of the anterior process to the highest point of the posterior facet. 2. From the highest point of the posterior facet to the highest point of the calcaneal tuberosity. The **normal range is 20° to 40°**. In a **calcaneal fracture** (typically caused by an axial load, such as falling from a height), the calcaneal body is compressed or flattened, causing the angle to **decrease or even become negative**. **Analysis of Incorrect Options:** * **Supracondylar fracture of humerus:** Assessed using the *Baumann angle* or the *Anterior Humeral Line*. * **Fracture neck of femur:** Evaluated using *Garden’s classification* or *Pauwels' classification*; Bohler’s angle has no anatomical relevance here. * **Colles fracture:** This is a distal radius fracture. Radiographic assessment focuses on *radial inclination, radial height,* and *palmar tilt*. **High-Yield Clinical Pearls for NEET-PG:** * **Gissane’s Angle (Crucial Angle):** Also used for calcaneal fractures; it is the angle between the downward slope of the thalami regalis and the upward slope of the anterior process (Normal: 120°–145°). In fractures, this angle **increases**. * **Don Juan Syndrome:** Calcaneal fractures are often associated with compression fractures of the **lumbar spine** (L1-L2) due to the same axial loading mechanism. Always screen the spine in these patients. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot, pathognomonic for calcaneal fracture.

Question 1

Prosthetic replacement of the femoral head is usually indicated for which of the following?

Accepted Answer

Untreated femoral neck fracture in a patient over 65 years

Answer

Fresh intracapsular fracture of the head of the femur in elderly patients

Answer

Fresh intracapsular fracture of the femoral neck in a young adult

Answer

Unreduced posterior dislocation of the hip

Question 2

What is the treatment of choice for a 65-year-old male with a fracture of the neck of the femur sustained 6 weeks ago?

Accepted Answer

Hemiarthroplasty

Answer

SP nailing

Answer

Mc Murray's osteotomy

Answer

None of the above

Question 3

Spur sign is/are seen in which of the following conditions?

Accepted Answer

Acetabulum fracture of pelvis

Answer

Supracondylar fracture of humerus

Answer

Radial head fracture

Answer

Talus fracture

Question 4

What is the most serious complication of a fracture of a long bone?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Deep vein thrombosis

Answer

Associated joint injuries

Question 5

Aseptic necrosis is common in which of the following bones?

Accepted Answer

Scaphoid

Answer

Calcaneum

Answer

Cuboid

Answer

Trapezium

Question 6

A 45-year-old driver involved in a motor vehicle collision sustains a posterior dislocation of the left hip. What is the most likely concomitant injury?

Accepted Answer

Left knee anterior cruciate ligament tear

Answer

Right knee meniscus tear

Answer

Subdural hematoma

Answer

Lumbar burst fracture

Question 7

A 68-year-old female presents with a posterior displacement of the left distal wrist and hand after a fall. Radiographic examination reveals an oblique fracture of the radius. Which of the following is the most likely fracture involved in this case?

Accepted Answer

Colles' fracture

Answer

Scaphoid fracture

Answer

Bennett's fracture

Answer

Volkmann's ischemic contracture

Question 8

Which of the following factors favor fat embolism in a trauma patient?

Accepted Answer

Hypovolemic shock

Answer

Diabetes Mellitus

Answer

Mobility of joint

Answer

Respiratory failure

Question 9

A patient with a history of road traffic accident (RTA) presents to the emergency department with an open injury classified as Gustilo-Anderson type III B. What does this classification indicate?

Accepted Answer

Limb wound greater than 10 cm with extensive soft tissue damage and periosteal stripping

Answer

Limb wound greater than 10 cm with extensive laceration

Answer

Limb wound less than 1 cm

Answer

Wound between 1 and 10 cm in length, without extensive soft tissue damage, flaps, or avulsion

Question 10

Bohler's angle is reduced in which of the following fractures?

Accepted Answer

Fracture Calcaneus

Answer

Supracondylar fracture of humerus

Answer

Fracture neck of femur

Answer

Colles fracture

Trauma — MCQs

Trauma — MCQs

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