Trauma Practice Questions

Q: Which of the following is not a complication of Colles fracture?

Wrist drop. **Explanation:** **Colles fracture** is a distal radius fracture occurring at the cortico-cancellous junction, typically resulting from a fall on an outstretched hand (FOOSH). **Why Wrist Drop is the Correct Answer:** Wrist drop is caused by an injury to the **Radial Nerve** (specifically the mid-shaft humerus fracture or compression in the spiral groove). In a Colles fracture, the radial nerve is not anatomically vulnerable. While nerve injuries can occur in Colles fractures, the most commonly affected nerve is the **Median Nerve** due to its proximity to the carpal tunnel, leading to acute carpal tunnel syndrome, not wrist drop. **Analysis of Incorrect Options:** * **Stiffness of the wrist (A):** This is the **most common complication** of Colles fracture, often resulting from prolonged immobilization or inadequate rehabilitation. * **Stiffness of the shoulder (B):** Also known as "Frozen Shoulder" or "Shoulder-Hand Syndrome." Patients often keep the arm immobilized against the chest to support the cast, leading to secondary adhesive capsulitis. * **Carpal tunnel syndrome (C):** The displaced fracture fragments or subsequent edema can increase pressure within the carpal tunnel, compressing the Median nerve. **High-Yield Clinical Pearls for NEET-PG:** * **Malunion:** The most common late complication, resulting in a "Dinner Fork Deformity." * **Sudeck’s Osteodystrophy (CRPS):** Characterized by pain, swelling, and trophic skin changes. * **EPL Rupture:** Delayed rupture of the **Extensor Pollicis Longus** tendon (usually 4–8 weeks post-injury) occurs due to ischemia or attrition at Lister’s tubercle. * **Deformities:** Remember the "P-D-S" displacement: **P**osterior tilt, **D**orsal displacement, and **S**upination (along with lateral tilt and impaction).

Q: What is the most common type of anterior shoulder dislocation?

Subcoracoid. **Explanation:** **1. Why Subcoracoid is Correct:** Anterior shoulder dislocations account for approximately 95% of all shoulder dislocations. Among the subtypes of anterior dislocation, the **Subcoracoid** variety is the most common. In this type, the humeral head is displaced anteriorly and comes to rest inferior to the coracoid process. This occurs because the mechanism of injury—typically a combination of abduction, extension, and external rotation—forces the humeral head through the weakest part of the capsule (the interval between the superior and middle glenohumeral ligaments). **2. Analysis of Incorrect Options:** * **Subglenoid (A):** This is the second most common type of anterior dislocation. Here, the humeral head rests inferior to the glenoid fossa. It is often associated with greater tuberosity fractures. * **Posterior (C):** This is a different category of dislocation altogether (accounting for only 2-5% of cases). It is classically associated with seizures or electric shocks. * **Complete (D):** This is a general descriptive term for a total loss of contact between joint surfaces, not a specific anatomical subtype of anterior dislocation. **3. NEET-PG High-Yield Pearls:** * **Most common nerve injured:** Axillary nerve (tested via sensation over the "regimental badge" area). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (occurs during dislocation). * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum (most common cause of recurrence). * **Kocher’s Method:** A classic (though now less preferred due to complication risks) reduction technique involving Traction, External Rotation, Adduction, and Internal Rotation. * **Dugas Test:** Positive if the patient is unable to touch the opposite shoulder with the hand of the injured side.

Q: Tardy ulnar nerve palsy is typically seen after which type of injury?

Malunited lateral condylar fracture of the humerus. **Explanation:** **Tardy Ulnar Nerve Palsy** is a delayed-onset ulnar neuropathy that occurs years after an elbow injury. The most common cause is a **malunited lateral condylar fracture of the humerus**. **Why Option B is correct:** A malunion or non-union of the lateral condyle leads to a **Cubitus Valgus** deformity (increased carrying angle). This deformity causes the ulnar nerve to take a longer, stretched path around the medial epicondyle. Over time, the chronic stretching and friction during elbow movements lead to progressive nerve ischemia and fibrosis, resulting in "tardy" (late) palsy. **Why other options are incorrect:** * **Option A:** Malunited supracondylar fractures typically result in **Cubitus Varus** (Gunstock deformity). This deformity does not stretch the ulnar nerve; in rare cases, it may cause ulnar nerve shifting, but it is not the classic cause of tardy palsy. * **Option C:** Medial condylar fractures are rare. While they are closer to the nerve, they do not typically produce the specific valgus deformity required for chronic stretching of the nerve. * **Option D:** Forearm fractures do not alter the anatomy of the cubital tunnel or the carrying angle of the elbow. **High-Yield Clinical Pearls for NEET-PG:** * **Latent Period:** The palsy typically appears **10–20 years** after the initial injury. * **Clinical Features:** Clawing of the ring and little fingers, wasting of interossei, and sensory loss over the ulnar 1.5 fingers. * **Treatment of Choice:** **Anterior transposition of the ulnar nerve** (moving the nerve to the front of the medial epicondyle to relieve tension). * **Most common cause of Cubitus Valgus:** Non-union of the lateral condyle. * **Most common cause of Cubitus Varus:** Malunited supracondylar fracture.

Q: Which of the following is a complication of a talar fracture?

Avascular necrosis. **Explanation:** The **talus** is unique because approximately 60% of its surface is covered by articular cartilage, and it has no muscular or tendinous attachments. Its blood supply is **retrograde**, primarily entering through the neck via the artery of the tarsal canal (a branch of the posterior tibial artery). **Avascular Necrosis (AVN)** is the most dreaded and characteristic complication of talar neck fractures. When a fracture occurs, this tenuous retrograde blood supply is easily disrupted. The risk of AVN increases with the severity of displacement, as classified by the **Hawkins Classification**: * Type I (Undisplaced): 0–15% risk * Type II (Subluxation of subtalar joint): 20–50% risk * Type III (Subluxation of subtalar and ankle joints): 85–100% risk **Why other options are incorrect:** * **Non-union:** While it can occur, the talus has a relatively good healing capacity if the blood supply is preserved; AVN is far more frequent than non-union. * **Osteoarthritis (Ankle/Subtalar):** These are common *late* sequelae due to the intra-articular nature of the injury, but AVN is the "classic" and most high-yield complication associated specifically with the talus's unique vascular anatomy. **High-Yield Clinical Pearls for NEET-PG:** 1. **Hawkins Sign:** A subchondral radiolucent line seen on an X-ray at 6–8 weeks post-injury. It indicates intact vascularity (active bone resorption) and is a **positive prognostic sign** (rules out AVN). 2. **Most common site of fracture:** Talar neck. 3. **Snowboarder’s Fracture:** Fracture of the lateral process of the talus. 4. **Aviator’s Astragalus:** Historical term for talar fractures caused by high-energy dorsiflexion.

Q: A 60-year-old female presents after a fall in the bathroom, unable to stand. On examination, her right leg is in external rotation, with limited movement and tenderness in Scarpa's triangle. There is no history of fever. X-ray shows no fracture line. What is the next step in management?

MRI. **Explanation:** The clinical presentation of an elderly female with a fall, inability to bear weight, and a limb in **external rotation** with tenderness in **Scarpa’s triangle** is highly suspicious of a **fracture of the neck of the femur**, even if the initial X-ray is negative. **1. Why MRI is the Correct Choice:** In approximately 2–10% of hip fractures, the initial plain radiograph is negative or occult. In an elderly patient with a high clinical suspicion of a fracture (inability to walk, external rotation), **MRI is the gold standard** and the investigation of choice. It can detect bone marrow edema and occult fractures within 24 hours of injury with nearly 100% sensitivity. If MRI is contraindicated, a CT scan or Bone Scan (after 48–72 hours) may be considered. **2. Why Other Options are Incorrect:** * **Option B:** Bed rest and repeat X-ray is outdated. Delaying diagnosis in the elderly increases the risk of complications like DVT, pulmonary embolism, and pressure sores. * **Option C:** Joint aspiration is used to rule out septic arthritis. The absence of fever and the history of trauma make an occult fracture much more likely than infection. * **Option D:** Mobilizing a patient with a potential hip fracture without stabilization can lead to displacement of the fracture, damage to the blood supply (increasing the risk of AVN), and severe pain. **Clinical Pearls for NEET-PG:** * **Occult Fracture:** A fracture that is not visible on initial radiographs but is clinically suspected. * **Scarpa’s Triangle Tenderness:** A classic sign of intracapsular hip fractures. * **Garden’s Classification:** Used for femoral neck fractures; Stage I and II are undisplaced, while III and IV are displaced. * **Management Rule:** In elderly patients with hip pain post-trauma and negative X-rays, **always** assume a fracture until proven otherwise by MRI.

Q: What is the earliest sign of compartment syndrome of the leg?

Pain on passive stretch. **Explanation:** Compartment syndrome occurs when increased interstitial pressure within a closed osteofascial space compromises local perfusion. **Why "Pain on passive stretch" is the correct answer:** Pain is the most sensitive and earliest clinical indicator of compartment syndrome. Specifically, **pain out of proportion to the injury** and **pain on passive stretching** of the muscles within the affected compartment are the hallmark early signs. This occurs because stretching ischemic muscle fibers triggers an immediate nociceptive response before nerve conduction is lost or arterial flow is completely halted. **Analysis of Incorrect Options:** * **A. Tingling or numbness (Paresthesia):** This indicates nerve ischemia. While an important sign, it typically develops *after* the initial onset of ischemic pain. * **B. Skin mottling:** This is a late sign indicating significant vascular compromise and impending tissue necrosis. * **C. Pulselessness:** This is a **very late and ominous sign**. Because compartment pressure rarely exceeds systolic arterial pressure, distal pulses often remain palpable even when the tissue within the compartment is dying. Relying on pulselessness for diagnosis often leads to missed opportunities for limb salvage. **High-Yield Clinical Pearls for NEET-PG:** * **The 6 P’s:** Pain (earliest), Pallor, Paresthesia, Paralysis, Pulselessness (latest), and Poikilothermia. * **Diagnosis:** Primarily clinical. However, if uncertain, intra-compartmental pressure can be measured (e.g., Stryker device). * **Critical Pressure:** A **Delta pressure (Diastolic BP – Compartment Pressure) < 30 mmHg** is an absolute indication for fasciotomy. * **Most common site:** Deep posterior and anterior compartments of the leg (often following tibial fractures). * **Management:** Immediate emergency fasciotomy. Do not elevate the limb, as this reduces arterial inflow.

Q: Which among the following patients with a fracture requires the 1st priority to be informed to a senior?

Patient's finger is blackening. ### Explanation The correct answer is **A. Patient's finger is blackening**. **1. Why Option A is the Priority:** A blackening finger in the context of a fracture is a clinical sign of **impending gangrene** or severe **vascular compromise**. This is a surgical emergency. It indicates that the blood supply to the distal extremity is severely restricted, likely due to arterial injury, tight casting, or advanced **Compartment Syndrome**. If not addressed immediately (via vascular repair or fasciotomy), it leads to irreversible tissue necrosis and permanent loss of the limb. In triage, "Life over Limb, Limb over Function" is the rule; vascular compromise represents a threat to the limb. **2. Analysis of Incorrect Options:** * **B. Patient cannot extend his arm:** This suggests a nerve injury (e.g., Radial nerve palsy) or mechanical block. While serious, nerve injuries are rarely immediate emergencies compared to vascular compromise. * **C. A 10 cm abrasion:** This is a superficial soft tissue injury. While it requires cleaning and dressing to prevent infection, it is not limb-threatening. * **D. Intra-articular fracture:** These require anatomical reduction and surgery to prevent long-term secondary osteoarthritis, but they do not require the same "minutes-to-hours" urgency as a pulseless or blackening limb. **3. Clinical Pearls for NEET-PG:** * **The 5 P’s of Compartment Syndrome/Ischemia:** Pain (out of proportion), Pallor, Paresthesia, Pulselessness, and Paralysis. * **Earliest Sign:** Pain on passive stretching of muscles. * **Late Sign:** Pulselessness and blackening (indicates necrosis). * **Golden Hour:** Vascular repairs should ideally be performed within **6 hours** to prevent irreversible ischemic contracture (Volkmann’s Ischemic Contracture).

Q: Fat embolism syndrome is characterized by which of the following?

All of the above. **Explanation:** Fat Embolism Syndrome (FES) is a systemic inflammatory response to fat globules released into the circulation, typically following fractures of long bones (e.g., femur, tibia) or pelvic fractures. The diagnosis is primarily clinical, based on **Gurd’s Criteria**. 1. **Hypoxemia (B):** This is the most common early sign and a Major Criterion. Fat globules and free fatty acids cause direct endothelial damage in the pulmonary capillaries, leading to acute respiratory distress and impaired gas exchange. 2. **Tachycardia (A):** This is a Minor Criterion. It occurs as a compensatory response to hypoxia and systemic inflammatory response syndrome (SIRS). 3. **Fat globules in urine (C):** This is also a Minor Criterion (Lipuria). As fat enters the systemic circulation, it can be filtered by the kidneys and detected in the urine. Since all three features are recognized components of the clinical presentation and Gurd’s criteria, **Option D (All of the above)** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Dyspnea (Respiratory distress), Mental confusion (Cerebral involvement), and Petechial rashes (typically over the chest, axilla, and conjunctiva). * **Gurd’s Major Criteria:** Axillary/Subconjunctival petechiae, Hypoxemia ($PaO_2 < 60$ mmHg), CNS depression, and Pulmonary edema. * **Snowstorm Appearance:** The characteristic finding on a Chest X-ray (diffuse bilateral infiltrates). * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early stabilization and internal fixation of fractures are the best preventive measures. * **Free Fatty Acids:** These are the primary chemical mediators responsible for the lung parenchymal damage.

Question 1

Which of the following is not a complication of Colles fracture?

Accepted Answer

Wrist drop

Answer

Stiffness of the wrist

Answer

Stiffness of the shoulder

Answer

Carpal tunnel syndrome

Question 2

What is the most common type of anterior shoulder dislocation?

Accepted Answer

Subcoracoid

Answer

Subglenoid

Answer

Posterior

Answer

Complete

Question 3

Tardy ulnar nerve palsy is typically seen after which type of injury?

Accepted Answer

Malunited lateral condylar fracture of the humerus

Answer

Malunited fracture of the humerus above the condyles

Answer

Malunited medial condylar fracture of the humerus

Answer

Fracture of both bones of the forearm

Question 4

Which of the following is a complication of a talar fracture?

Accepted Answer

Avascular necrosis

Answer

Non-union

Answer

Osteoarthritis of ankle joint

Answer

Osteoarthritis of subtalar joint

Question 5

A 60-year-old female presents after a fall in the bathroom, unable to stand. On examination, her right leg is in external rotation, with limited movement and tenderness in Scarpa's triangle. There is no history of fever. X-ray shows no fracture line. What is the next step in management?

Accepted Answer

MRI

Answer

Strict bed rest for 10 days and repeat X-ray

Answer

Joint aspiration

Answer

Start proper analgesia and begin mobilization to prevent stiffness

Question 6

What is the earliest sign of compartment syndrome of the leg?

Accepted Answer

Pain on passive stretch

Answer

Tingling or numbness

Answer

Skin mottling

Answer

Pulselessness

Question 7

Which among the following patients with a fracture requires the 1st priority to be informed to a senior?

Accepted Answer

Patient's finger is blackening

Answer

Patient cannot extend his arm

Answer

A 10 cm abrasion

Answer

Intra-articular fracture of the elbow joint

Question 8

Fat embolism syndrome is characterized by which of the following?

Accepted Answer

All of the above

Answer

Tachycardia

Answer

Hypoxemia

Answer

Fat globules in urine

Question 9

Nonunion is a very common complication of intracapsular fractures of the neck of femur. Which of the following is not a very important cause for the same?

Accepted Answer

Stress at fracture site due to muscle spasm

Answer

Inadequate immobilization

Answer

Inadequate blood supply

Answer

Inhibitory effect of synovial fluid

Question 10

All of the following are indications for open reduction and internal fixation of fractures except?

Accepted Answer

Compound fracture

Answer

Unsatisfactory closed reduction

Answer

Multiple trauma

Answer

Intra-articular fracture

Trauma — MCQs

Trauma — MCQs

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