Trauma Practice Questions

Q: Which of the following is NOT a feature of fat embolism?

Hypotension. **Explanation:** Fat Embolism Syndrome (FES) typically follows fractures of long bones (like the femur) or pelvic fractures. The pathophysiology involves the release of fat globules from the bone marrow into the systemic circulation, leading to mechanical obstruction and a secondary inflammatory response. **Why Hypotension is the correct answer:** Fat Embolism is characterized by a classic triad of **Respiratory distress, Neurological symptoms, and Petechial rashes.** While FES affects the pulmonary vasculature, it typically presents with **normotension or hypertension** (due to sympathetic overactivity). Hypotension is not a standard feature of FES; its presence should instead raise suspicion for **hypovolemic shock** (due to blood loss from the fracture itself) or a massive pulmonary embolism. **Analysis of Incorrect Options:** * **Tachycardia & Tachypnoea:** These are the earliest and most common signs. They occur as a compensatory response to pulmonary micro-vascular obstruction and the resulting hypoxia (V/Q mismatch). * **Petechial Rashes:** This is a pathognomonic sign, usually appearing 24–72 hours after injury. They are typically found in a "vest-like" distribution (chest, axilla, neck, and conjunctiva) due to fat globules obstructing dermal capillaries. **High-Yield Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include axillary/subconjunctival petechiae, hypoxemia ($PaO_2 < 60$ mmHg), and CNS depression. * **Snowstorm Appearance:** The characteristic finding on a Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early stabilization and internal fixation of fractures are the best preventive measures. * **Free Fatty Acids:** The biochemical theory suggests that lipase breaks down neutral fat into toxic free fatty acids, causing endothelial damage (ARDS).

Q: The Gustilo-Anderson classification is used for which type of fracture?

Compound fractures. **Explanation:** The **Gustilo-Anderson classification** is the most widely used system for grading **open (compound) fractures**. It is designed to assess the severity of soft tissue injury, the degree of contamination, and the energy of the mechanism, which helps in predicting the risk of infection and guiding surgical management. * **Type I:** Clean wound 10 cm or high-energy trauma (includes segmental fractures, farm injuries, or vascular injuries). * **IIIA:** Adequate soft tissue coverage of the bone. * **IIIB:** Extensive soft tissue loss; requires a flap for coverage. * **IIIC:** Associated with arterial injury requiring repair. **Analysis of Incorrect Options:** * **B. Closed fractures:** These are classified using systems like the **Tscherne classification**, which focuses on internal soft tissue edema and compartment pressure. * **C. Distal end radius fractures:** These are specifically classified using the **Frykman** or **Fernandez** systems. * **D. Femur head fractures:** These are classified using the **Pipkin classification**. **Clinical Pearls for NEET-PG:** * **Antibiotic Choice:** Type I/II usually require 1st generation cephalosporins; Type III requires the addition of an aminoglycoside. * **Golden Period:** Debridement should ideally occur within 6–8 hours to minimize infection risk. * **High-Yield Fact:** Any open fracture sustained in a **farm/soil environment** is automatically classified as **Type IIIA** regardless of wound size due to high contamination.

Q: Which of the following is the characteristic posture in a posterior dislocation of the hip joint?

Posterior dislocation of hip joint. ### Explanation **Posterior Dislocation of the Hip Joint** is the most common type of hip dislocation (accounting for ~90% of cases), typically resulting from high-energy trauma like a "dashboard injury." #### 1. Why the Correct Answer is Right The characteristic clinical posture of a posterior hip dislocation is **Flexion, Adduction, and Internal Rotation (FADIR)**. * **Mechanism:** When the femoral head is forced posteriorly out of the acetabulum, the tension of the iliofemoral ligament and the surrounding musculature pulls the limb into this specific position. The affected limb also appears **shortened**. #### 2. Analysis of Incorrect Options * **Anterior Dislocation of Hip Joint:** This presents with the opposite deformity: **Flexion, Abduction, and External Rotation (FABER)**. The limb is held away from the midline, unlike the "crossed-leg" appearance of posterior dislocation. * **Fracture of the Femoral Neck/Shaft:** These fractures typically present with **Shortening and External Rotation**. In a neck of femur fracture, the psoas muscle pulls the distal fragment into external rotation, which is a key clinical differentiator from posterior dislocation. #### 3. Clinical Pearls for NEET-PG * **Most Common Nerve Injury:** The **Sciatic Nerve** (specifically the common peroneal component) is at risk in posterior dislocations. * **Radiology:** On an AP X-ray, the femoral head appears smaller than the contralateral side in posterior dislocation (due to being further from the film) and larger in anterior dislocation. * **Emergency:** Hip dislocation is an orthopedic emergency. Reduction must be performed within **6 hours** to minimize the risk of **Avascular Necrosis (AVN)** of the femoral head. * **Reduction Maneuvers:** Bigelow’s, Stimson’s, and Allis’ maneuvers are commonly used for reduction.

Q: Cubitus varus deformity results from which of the following?

Malunited supracondylar fracture of the humerus. **Explanation:** **Cubitus Varus (Gunstock Deformity)** is the most common late complication of a **Supracondylar Fracture of the Humerus**, particularly when managed conservatively. 1. **Why Option A is Correct:** The deformity results from **malunion** of the distal fragment, specifically due to **coronal tilt (medial tilt)**, internal rotation, and posterior displacement. While the fracture is extra-articular and does not usually affect longitudinal growth, the mechanical malalignment leads to a decrease in the carrying angle, resulting in the characteristic "Gunstock" appearance. 2. **Why Other Options are Incorrect:** * **Option B (Lateral Condyle Fracture):** Malunion or non-union here typically leads to **Cubitus Valgus** (increased carrying angle) because the lateral growth plate is affected, causing a growth arrest on the lateral side while the medial side continues to grow. This can lead to late-onset Ulnar Nerve Palsy (Tardy Ulnar Nerve Palsy). * **Option C & D:** Fracture-dislocations and capitellum fractures are more likely to result in **stiffness (myositis ossificans)** or loss of range of motion rather than a specific angular varus deformity. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Cubitus Varus:** Malunion (not growth arrest). * **Treatment of choice:** French Osteotomy (Lateral closing wedge osteotomy). * **Supracondylar Fracture Complications:** * *Immediate:* Vascular injury (Brachial artery). * *Early:* Volkmann’s Ischemic Contracture (VIC). * *Late:* Cubitus Varus (most common). * **Nerve Injury:** Most common is the **Median nerve** (specifically AIN), though posterolateral displacement can injure the Radial nerve.

Q: What is Barton's fracture?

Fracture of the distal radius. **Explanation:** **Barton’s fracture** is defined as an intra-articular fracture of the **distal radius** with associated subluxation or dislocation of the radiocarpal joint. It involves a fracture of the dorsal or volar rim of the distal radius, with the carpus following the fractured fragment. 1. **Why Option B is correct:** The distal radius is the anatomical site for Barton’s fracture. Unlike Colles' or Smith's fractures (which are extra-articular), Barton’s is specifically **intra-articular**, involving the articular surface of the radiocarpal joint. 2. **Why other options are incorrect:** * **Option A:** Fractures of the proximal radius include radial head or neck fractures (often associated with Essex-Lopresti injury). * **Option C:** Isolated ulnar fractures include the "Nightstick fracture" or Monteggia fracture-dislocations. * **Option D:** Humerus fractures are categorized by location (proximal, shaft, or supracondylar) and are anatomically distinct from wrist injuries. **High-Yield Clinical Pearls for NEET-PG:** * **Types:** It can be **Dorsal Barton’s** (more common) or **Volar Barton’s** (Reverse Barton’s). * **Mechanism:** Usually caused by a fall on an outstretched hand (FOOSH) or high-velocity trauma. * **Management:** Because it is intra-articular and inherently unstable, it often requires **Open Reduction and Internal Fixation (ORIF)** with a Buttress plate. * **Differential Diagnosis:** Do not confuse it with **Colles' fracture** (extra-articular, dorsal displacement) or **Smith's fracture** (extra-articular, volar displacement).

Q: In head injury, which structure is typically repaired first?

Bone. ### Explanation In the management of musculoskeletal trauma, the sequence of repair follows a fundamental surgical principle: **"Life before limb, and stability before mobility."** **1. Why Bone is the Correct Answer:** The primary goal in orthopedic trauma is to provide a stable framework. Bone is the structural foundation of the limb. Rigid internal fixation of the **bone** must be performed first because: * It provides a stable "scaffold" for the repair of soft tissues. * It prevents further damage to neurovascular structures caused by mobile bone fragments. * It allows for the correct anatomical tensioning of tendons and muscles during their subsequent repair. **2. Why Other Options are Incorrect:** * **Tendon and Muscle (Options B & C):** These are "soft" structures. If repaired before the bone, any subsequent manipulation of the fracture to achieve alignment would likely rupture the fresh sutures in the muscle or tendon. * **Nerve (Option D):** Nerves are delicate and require a tension-free environment to heal. Repairing a nerve before stabilizing the bone risks stretching or tearing the anastomosis during fracture reduction. **3. Clinical Pearls for NEET-PG:** * **The Standard Sequence of Repair:** Bone → Tendon → Nerve → Vessel (Note: If the limb is ischemic, the **Vessel** repair takes priority, often using a temporary vascular shunt to restore perfusion while the bone is stabilized). * **Debridement:** In open fractures, thorough debridement is always the absolute first step before any repair. * **Rule of Thumb:** Fix the "hard" (bone) before the "soft" (nerves/tendons).

Q: An 80-year-old female, after a fall, developed an inability to walk with an external rotation deformity. On examination, Straight Leg Raise (SLR) is not possible, and there is broadening of the greater trochanter with the lateral border of the foot touching the bed. What is the most probable diagnosis?

Intertrochanteric femur fracture. **Explanation:** The clinical presentation of an elderly patient with a fall, inability to walk, and a prominent **external rotation deformity** is classic for a proximal femur fracture. **Why Intertrochanteric (IT) Fracture is correct:** The key clinical differentiator here is the degree of external rotation. In **Intertrochanteric fractures**, the fracture is extracapsular. The distal fragment is pulled by the powerful external rotators (iliopsoas and short rotators) without the restraint of the hip capsule, leading to a **marked external rotation (80-90°)** where the lateral border of the foot touches the bed. Additionally, since the fracture is outside the capsule, significant swelling and **broadening of the greater trochanter** are observed due to hematoma formation. **Why other options are incorrect:** * **Neck of femur fracture:** These are intracapsular. The intact capsule limits the displacement; therefore, the external rotation is typically **mild (30-45°)**. Broadening of the trochanter is usually absent. * **Subtrochanteric fracture:** While these present with significant deformity, the proximal fragment is usually flexed, abducted, and externally rotated, but the "foot touching the bed" and "broadening of the trochanter" are more characteristic of IT fractures. * **Greater trochanteric fracture:** These are usually isolated avulsion injuries. Patients can often still bear some weight, and there is no significant limb shortening or gross external rotation deformity. **NEET-PG High-Yield Pearls:** * **External Rotation:** Mild (30-45°) = Neck of Femur; Severe (80-90°) = Intertrochanteric. * **Ecchymosis:** More common in IT fractures (extracapsular) than neck fractures (intracapsular). * **Shortening:** More pronounced in IT fractures. * **Treatment Gold Standard:** IT fractures are typically managed with a **Dynamic Hip Screw (DHS)** or **Cephalomedullary nail (PFN)**.

Q: What is the best treatment for a femoral neck fracture sustained three weeks ago in a young adult?

Reduction of fracture and multiple pin or screw fixation. **Explanation:** In young adults, the primary goal of treating a femoral neck fracture is **preservation of the natural femoral head**, regardless of the delay in presentation (within a reasonable window like 3 weeks). **1. Why Option D is correct:** The femoral head in young patients has high osteogenic potential and superior functional outcomes if salvaged. Even in "neglected" fractures (typically defined as >3 weeks), the first-line management remains **Anatomical Reduction and Internal Fixation (ARIF)** using Multiple Cannulated Cancellous Screws or a Dynamic Hip Screw (DHS). While the risk of Avascular Necrosis (AVN) and non-union increases with time, every effort is made to avoid arthroplasty in young patients due to the limited lifespan of prostheses. **2. Why other options are incorrect:** * **Options A & C:** Total Hip Replacement (THR) and Hemiarthroplasty (Prosthetic replacement) are the treatments of choice for **elderly patients**. In young adults, these are considered "salvage procedures" only after fixation has failed, as they lead to multiple revisions over the patient's lifetime. * **Option B:** While osteotomies (like McMurray’s or Schanz) are used to treat established **non-union** by converting shear forces into compressive forces, they are generally secondary considerations if primary fixation is still feasible. **Clinical Pearls for NEET-PG:** * **Pauwels’ Classification:** Based on the angle of the fracture line; higher angles (Type III) are more unstable and have higher non-union rates. * **Garden’s Classification:** Based on displacement; Type III and IV have the highest risk of AVN. * **Blood Supply:** The **Medial Circumflex Femoral Artery** is the most important source of blood to the femoral head. * **Urgency:** Femoral neck fractures in the young are considered **orthopaedic emergencies** to minimize the risk of AVN.

Question 1

Which of the following is NOT a feature of fat embolism?

Accepted Answer

Hypotension

Answer

Tachycardia

Answer

Petechial Rashes

Answer

Tachypnoea

Question 2

The Gustilo-Anderson classification is used for which type of fracture?

Accepted Answer

Compound fractures

Answer

Closed fractures

Answer

Distal end radius fractures

Answer

Femur head fractures

Question 3

Which of the following is the characteristic posture in a posterior dislocation of the hip joint?

Accepted Answer

Posterior dislocation of hip joint

Answer

Anterior dislocation of hip joint

Answer

Fracture of the femoral head

Answer

Fracture of the shaft of the femur

Question 4

Cubitus varus deformity results from which of the following?

Accepted Answer

Malunited supracondylar fracture of the humerus

Answer

Malunited lateral condyle fracture of the humerus

Answer

Fracture dislocation of the elbow joint

Answer

Malunited capitellum fracture

Question 5

What is Barton's fracture?

Accepted Answer

Fracture of the distal radius

Answer

Fracture of the proximal radius

Answer

Fracture of the ulna

Answer

Fracture of the humerus

Question 6

In head injury, which structure is typically repaired first?

Accepted Answer

Bone

Answer

Tendon

Answer

Muscle

Answer

Nerve

Question 7

An 80-year-old female, after a fall, developed an inability to walk with an external rotation deformity. On examination, Straight Leg Raise (SLR) is not possible, and there is broadening of the greater trochanter with the lateral border of the foot touching the bed. What is the most probable diagnosis?

Accepted Answer

Intertrochanteric femur fracture

Answer

Neck of femur fracture

Answer

Subtrochanteric femur fracture

Answer

Greater trochanteric fracture

Question 8

Which of the following statements is incorrect regarding Monteggia fracture-dislocation?

Accepted Answer

The ulna typically angulates posteriorly in the extension type.

Answer

Fracture of the proximal third of the ulna with associated dislocation of the radial head.

Answer

The extension type is the more common variant.

Answer

Malunion is a common complication in conservatively managed patients.

Question 9

What is the best treatment for a femoral neck fracture sustained three weeks ago in a young adult?

Accepted Answer

Reduction of fracture and multiple pin or screw fixation

Answer

Total hip replacement

Answer

Reduction of fracture and femoral osteotomy with head

Answer

Prosthetic replacement of femoral head

Question 10

If the head of the radius is removed, what deformity will result?

Accepted Answer

Valgus deformity

Answer

Lengthening of limb

Answer

Varus deformity

Answer

No deformity

Trauma — MCQs

Trauma — MCQs

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