Trauma Practice Questions

Q: Which of the following is/are not included in the management of an intra-articular fracture?

None of the above. ### Explanation The primary goal in managing an **intra-articular fracture** is to achieve anatomical reduction and stable internal fixation to restore joint congruity and allow early range of motion. However, management strategies vary depending on the severity, joint involved, and patient factors. **Why "None of the above" is correct:** All three options (A, B, and C) are recognized components of managing intra-articular injuries under specific clinical circumstances. Therefore, none of them can be excluded from the potential management spectrum. * **Aspiration (Option C):** This is often the immediate step in managing a tense **haemarthrosis** (blood in the joint) associated with a fracture. It relieves pain, reduces pressure, and aids in diagnosis (e.g., seeing fat globules/lipohemarthrosis indicates an intra-articular fracture). * **Excision (Option B):** In certain joints where the fragment is small, comminuted, or non-essential for stability, excision is preferred. A classic example is the **excision of the radial head** in Mason Type III fractures or excision of a comminuted patella (pole excision). * **Arthrodesis (Option A):** While usually a salvage procedure, primary or delayed arthrodesis (joint fusion) is a management option for severely comminuted intra-articular fractures where reconstruction is impossible, particularly in the weight-bearing joints of the foot (e.g., **Calcaneal fractures** or Lisfranc injuries). ### High-Yield Clinical Pearls for NEET-PG: * **Lipohemarthrosis:** The presence of fat droplets in aspirated joint fluid is pathognomonic for an intra-articular fracture (fat escapes from the bone marrow). * **AO Principles:** The gold standard for intra-articular fractures is **Absolute Stability** (Anatomical reduction + Compression). * **Complications:** The most common long-term complication of an intra-articular fracture is **Secondary Osteoarthritis** due to joint surface irregularity.

Q: Which of the following statements regarding shoulder dislocation is true?

All of the above.. **Explanation:** The shoulder joint is the most commonly dislocated joint in the body due to the shallow glenoid cavity and its wide range of motion. * **Option A:** **Anterior dislocation** is the most frequent type, accounting for approximately **95-97%** of all shoulder dislocations. It typically occurs due to a fall on an outstretched hand with the arm in abduction and external rotation. * **Option B:** **Posterior dislocation** is rare (2-5%) and often associated with seizures or electric shocks. A hallmark clinical sign is **fixed internal (medial) rotation** and an inability to externally rotate the arm. On X-ray, this may present as the "Light Bulb sign." * **Option C:** **Kocher’s Maneuver** is a classic (though now less commonly used due to risk of humeral fractures) method for reducing anterior dislocations. It involves four steps: Traction, External rotation, Adduction, and Internal rotation (Mnemonic: **TEAM**). Since all three statements are clinically accurate, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Axillary nerve (tested via "Regimental Badge Sign" over the deltoid). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (seen in anterior dislocation). * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Luxatio Erecta:** A rare inferior dislocation where the arm is held vertically over the head. * **Preferred Reduction Technique:** Hippocratic or Milch maneuvers are often preferred over Kocher’s to minimize complications.

Q: Acute compartment syndrome is characterized by all of the following EXCEPT?

Decreased intracompartmental pressure. **Explanation:** Acute Compartment Syndrome (ACS) is a surgical emergency caused by increased pressure within a closed osteofascial compartment, leading to impaired local circulation and potential tissue necrosis. **Why "Decreased intracompartmental pressure" is the correct answer:** The fundamental pathophysiology of ACS is an **increase** in intracompartmental pressure (typically >30 mmHg or a Delta pressure <30 mmHg). This elevated pressure exceeds capillary perfusion pressure, leading to ischemia. Therefore, "decreased" pressure is the opposite of what occurs in this condition. **Analysis of other options (The 6 P’s of Ischemia):** * **Paresthesia:** Often the **earliest** neurological sign, indicating nerve ischemia within the compartment. * **Pallor:** Occurs as a result of compromised microvascular perfusion to the overlying skin and distal tissues. * **Pulselessness:** This is a **late and ominous sign**. It is important to note that in early ACS, distal pulses are usually **present** because the intracompartmental pressure rarely exceeds systolic arterial pressure. Its presence indicates advanced tissue death or associated arterial injury. **High-Yield Clinical Pearls for NEET-PG:** 1. **Earliest Clinical Sign:** Pain out of proportion to the injury and **Pain on passive stretching** of the involved muscles. 2. **Most Common Site:** Leg (Tibia fractures), followed by the forearm (Supracondylar fractures of the humerus). 3. **Diagnosis:** Primarily clinical; however, **Stryker’s monitor** is used for objective pressure measurement. 4. **Delta Pressure ($\Delta P$):** Diastolic BP minus Compartmental Pressure. If $\Delta P < 30$ mmHg, fasciotomy is indicated. 5. **Management:** Immediate **Emergency Fasciotomy** (leaving the wound open) to decompress the compartment.

Q: Which of the following statements regarding eponymous fractures is NOT TRUE?

Pott's fracture is a trimalleolar ankle fracture.. ### Explanation The correct answer is **D**. While Pott’s fracture is a general term used for various ankle fractures involving the malleoli, it is classically defined as a **bimalleolar fracture** (involving the lateral and medial malleoli). A **trimalleolar fracture** (involving the lateral, medial, and posterior malleolus of the tibia) is specifically known as a **Cotton’s fracture**. #### Analysis of Options: * **A. Monteggia Fracture:** This is correctly described as a fracture of the proximal 1/3rd of the ulna associated with dislocation of the proximal radio-ulnar joint (radial head). Remember the mnemonic **MUGR** (Monteggia-Ulna / Galeazzi-Radius). * **B. Galeazzi Fracture:** This is correctly described as a fracture of the distal 1/3rd of the radius with dislocation of the distal radio-ulnar joint (DRUJ). It is often called a "fracture of necessity" because it almost always requires ORIF in adults. * **C. Colles Fracture:** This is a classic extra-articular fracture of the distal radius at the cortico-cancellous junction (approx. 2cm proximal to the joint). It is characterized by **dorsal** displacement and tilt, producing the "dinner fork deformity." #### NEET-PG High-Yield Pearls: * **Reverse Monteggia:** Fracture of the proximal radius with dislocation of the proximal ulna. * **Smith’s Fracture:** Often called a "Reverse Colles," it involves **volar** (palmar) displacement/tilt of the distal radial fragment. * **Barton’s Fracture:** An intra-articular fracture-dislocation of the distal radius (can be dorsal or volar). * **Chauffeur’s Fracture:** An isolated fracture of the radial styloid process.

Q: A person with multiple injuries develops fever, restlessness, tachycardia, tachypnea, and periumbilical rash. What is the likely diagnosis?

Fat embolism. **Explanation:** The clinical presentation of **Fat Embolism Syndrome (FES)** typically follows a latent period of 24–72 hours after a long bone fracture (e.g., femur or tibia) or pelvic injury. The classic triad includes **respiratory distress** (tachypnea, hypoxia), **neurological symptoms** (restlessness, confusion), and a **petechial rash**. The rash, found in only 20–50% of cases but highly pathognomonic, typically appears on the chest, axilla, neck, and conjunctiva; a periumbilical distribution is also a recognized variant. **Why other options are incorrect:** * **Air Embolism:** Usually occurs following sudden decompression, venous catheterization, or surgery. It presents with a "mill-wheel murmur" and sudden cardiovascular collapse, not a petechial rash. * **Pulmonary Embolism (Thromboembolism):** Typically occurs 1–2 weeks post-injury due to DVT. While it causes tachycardia and tachypnea, it does not present with a petechial rash or immediate restlessness. * **Bacterial Pneumonitis:** Presents with productive cough, high-grade fever, and localized lung consolidation on X-ray, usually developing later in the clinical course. **High-Yield Clinical 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:** Classic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Free fat globules** may be seen in urine or sputum (though not highly sensitive). * **Management:** Primarily supportive (Oxygenation/Ventilation). Early stabilization and internal fixation of fractures are the best preventive measures.

Q: A rugby player fell onto his shoulder some weeks ago. He now presents with a painful lump about 4 cm in diameter on the top of his shoulder. What has he injured?

The acromioclavicular joint. ### Explanation **1. Why the Acromioclavicular (AC) Joint is Correct:** The clinical presentation describes a classic **Acromioclavicular Joint Dislocation** (often called a "shoulder separation"). A direct fall onto the point of the shoulder forces the acromion downward while the clavicle remains stabilized by the sternoclavicular joint. This results in the tearing of the AC ligaments and, in more severe cases, the coracoclavicular (CC) ligaments. The "painful lump" on top of the shoulder is the **lateral end of the clavicle**, which becomes prominent as it loses its attachment to the acromion. **2. Why the Other Options are Incorrect:** * **Common Extensor Origin:** This is located at the **lateral epicondyle of the humerus** (elbow). Injury here leads to "Tennis Elbow," not a shoulder lump. * **Head of the Humerus:** A fracture or dislocation of the humeral head would typically present with a "squared-off" shoulder appearance (in anterior dislocation) or pain deep within the glenohumeral joint, rather than a localized lump on the *top* of the shoulder. * **Sternoclavicular Joint:** This joint is located medially, where the clavicle meets the sternum. An injury here would cause a lump at the base of the neck/chest, not the top of the shoulder. **3. High-Yield Clinical Pearls for NEET-PG:** * **Step-off Deformity:** The visible gap or elevation of the clavicle in AC joint injuries is often referred to as a "step-off" deformity. * **Piano Key Sign:** A pathognomonic clinical test where pressing down on the elevated distal clavicle causes it to move down and spring back up, similar to a piano key. * **Ligamentous Support:** The AC joint is stabilized by the weak AC ligament (horizontal stability) and the strong **Coracoclavicular (CC) ligament** (vertical stability), which consists of the **conoid** and **trapezoid** parts. * **Mechanism of Injury:** Most common in contact sports like rugby or cycling accidents.

Question 1

A patient presents with a history of trauma and X-ray findings of a fracture of the proximal medial bone of the forearm with dislocation. Which muscles may become paralyzed?

Accepted Answer

Extensor pollicis longus

Answer

Flexor carpi ulnaris

Answer

Adductor pollicis

Answer

Opponens pollicis

Question 2

Traumatic glenohumeral instability with a Bankart lesion is treated by which of the following methods?

Accepted Answer

Surgery

Answer

Conservative methods

Answer

Rehabilitation

Answer

Observation followed by inferior capsule shift

Question 3

Which of the following is/are not included in the management of an intra-articular fracture?

Accepted Answer

None of the above

Answer

Arthrodesis

Answer

Excision

Answer

Aspiration

Question 4

Which of the following statements regarding shoulder dislocation is true?

Accepted Answer

All of the above.

Answer

Anterior dislocation is more common than posterior dislocation.

Answer

Fixed medial rotation is characteristic of posterior dislocation.

Answer

Kocher's maneuver is an effective reduction technique for anterior dislocation.

Question 5

What is the treatment of choice for a one-week-old fracture of the neck of the femur in a 65-year-old patient?

Accepted Answer

Closed reduction and internal fixation by cannulated cancellous screws

Answer

Hemi-replacement arthroplasty

Answer

Closed reduction and internal fixation by Austin Moore pins

Answer

Total hip replacement

Question 6

Acute compartment syndrome is characterized by all of the following EXCEPT?

Accepted Answer

Decreased intracompartmental pressure

Answer

Pulselessness

Answer

Paresthesia

Answer

Pallor

Question 7

Which of the following statements regarding eponymous fractures is NOT TRUE?

Accepted Answer

Pott's fracture is a trimalleolar ankle fracture.

Answer

Monteggia fracture is a fracture of the proximal third of the ulna with radial head dislocation.

Answer

Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radio-ulnar joint.

Answer

Colles fracture is a fracture at the cortico-cancellous junction of the distal end of the radius with dorsal tilt.

Question 8

A person with multiple injuries develops fever, restlessness, tachycardia, tachypnea, and periumbilical rash. What is the likely diagnosis?

Accepted Answer

Fat embolism

Answer

Air embolism

Answer

Pulmonary embolism

Answer

Bacterial pneumonitis

Question 9

A 26-year-old male sustained a mid-arm injury, resulting in wrist drop, finger drop, and loss of sensation on the dorsum of the hand. The patient can perform elbow extension. What is the most likely diagnosis?

Accepted Answer

High radial nerve injury

Answer

Very high radial nerve injury

Answer

Low radial nerve injury

Answer

Posterior interosseous nerve injury

Question 10

A rugby player fell onto his shoulder some weeks ago. He now presents with a painful lump about 4 cm in diameter on the top of his shoulder. What has he injured?

Accepted Answer

The acromioclavicular joint

Answer

Common extensor origin

Answer

The head of the humerus

Answer

The sternoclavicular joint

Trauma — MCQs

Trauma — MCQs

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