Trauma Practice Questions

Q: In Volkmann's contracture, which artery is injured?

Brachial artery. **Explanation:** **Volkmann’s Ischemic Contracture (VIC)** is the permanent flexion deformity of the wrist and fingers resulting from untreated **Compartment Syndrome**, most commonly following a **Supracondylar fracture of the humerus** in children. The **Brachial artery** is the primary vessel involved. It can be injured via direct laceration by the proximal bone fragment, kinking, or, most frequently, by intense vasospasm triggered by the injury. This arterial compromise leads to ischemia of the muscles in the deep flexor compartment of the forearm (specifically the *Flexor Digitorum Profundus* and *Flexor Pollicis Longus*). If ischemia persists for more than 6–8 hours, muscle necrosis occurs, followed by fibrosis and shortening, leading to the characteristic "claw-like" deformity. **Analysis of Incorrect Options:** * **Radial and Ulnar Arteries:** These are terminal branches of the brachial artery. While they may be affected by increased compartmental pressure in the forearm, the primary inciting event in the classic Supracondylar fracture scenario is proximal to their bifurcation, involving the Brachial artery. * **Subclavian Artery:** This artery is located much more proximally (near the clavicle and first rib). Injuries here would cause global limb ischemia rather than the localized forearm compartment syndrome seen in VIC. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Severe pain on passive extension of fingers. * **Most Sensitive Sign:** Pain out of proportion to the injury. * **Nerve Involved:** The **Median nerve** is the most commonly affected nerve in the forearm compartment. * **Infarct Shape:** The necrotic area typically takes an **ellipsoid shape** (Volkmann’s Ischemic Ellipsoid) at the level of the mid-forearm. * **Treatment:** Immediate removal of tight bandages/casts; if no improvement, urgent **Fasciotomy** is required.

Q: Which of the following statements regarding fracture of the clavicle is true?

The most common complication is malunion.. **Explanation:** **1. Why Option A is Correct:** Malunion is the most common complication of clavicle fractures. Because the clavicle acts as a strut between the sternum and the acromion, the weight of the arm (pulling the lateral fragment down) and the pull of the sternocleidomastoid muscle (pulling the medial fragment up) often lead to healing with a slight overlap or angulation. While this rarely affects functional outcomes, it is the most frequent sequela. Note: Non-union is rare, and neurovascular injury is even rarer due to the protection provided by the subclavius muscle. **2. Why Other Options are Incorrect:** * **Option B:** The most common site of fracture is the junction of the **medial two-thirds and the lateral one-third**. This is the weakest point of the bone where the curvature changes and the cross-section transitions from cylindrical to flattened. * **Option C:** The most common mechanism of injury is a **fall on an outstretched hand (FOOSH)** or a direct blow to the shoulder. A fall on the elbow is less common. * **Option D:** Clavicle fractures are typically **undisplaced or simple** (greenstick in children). Comminuted fractures are less common and usually occur only in high-energy trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Most common bone to fracture** in the human body and during birth (obstetric injury). * **First bone to ossify** in the fetus (5th–6th week) and the only long bone to ossify in **membrane** (except the ends). * **Management:** Most are treated conservatively with a **Figure-of-eight bandage** or a triangular sling. Surgery (ORIF) is reserved for skin tenting, neurovascular compromise, or extreme shortening (>2cm). * **Subclavius muscle** acts as a cushion, protecting the underlying subclavian vessels and brachial plexus from bone fragments.

Q: Gun stock deformity is seen in?

Supracondylar fracture humerus. **Explanation:** **Gun stock deformity** (also known as **Cubitus Varus**) is the most common late complication of a **Supracondylar fracture of the humerus**, particularly when the fracture is displaced or inadequately reduced. ### Why Supracondylar Fracture is Correct: The deformity occurs due to the **malunion** of the distal humerus fragment. Specifically, it results from a combination of **medial tilt, medial rotation, and posterior displacement** of the distal fragment. This leads to a decrease in the normal carrying angle of the elbow (which is usually 5-15° of valgus), causing the forearm to deviate toward the midline, resembling the stock of a gun. While it is primarily a cosmetic deformity, it rarely affects the functional range of motion. ### Why Other Options are Incorrect: * **Lateral Condylar Fracture:** This injury is more commonly associated with **Cubitus Valgus** (an increase in the carrying angle) due to non-union or growth arrest of the lateral physis. Cubitus valgus can lead to a "Tardy Ulnar Nerve Palsy." * **Medial Condylar Fracture:** While rare, these are more likely to cause cubitus varus if there is a growth arrest, but they are not the classic or most frequent cause associated with the term "Gun stock deformity" in clinical exams. ### High-Yield Clinical Pearls for NEET-PG: * **Most common complication:** Stiffness (overall); **Most common deformity:** Cubitus Varus. * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Nerve most commonly involved:** Median nerve (specifically the Anterior Interosseous Nerve - AIN) in extension-type fractures; however, the Radial nerve is also frequently cited. * **Treatment of choice for Cubitus Varus:** French Osteotomy (Modified step-cut osteotomy).

Q: Complications of elbow dislocation are all EXCEPT:

Volkmann's ischemic contracture. **Explanation:** The question asks for the complication that is **NOT** typically associated with elbow dislocation. While elbow dislocations are serious injuries, **Volkmann’s Ischemic Contracture (VIC)** is classically a late sequela of **Supracondylar fractures of the humerus** (due to brachial artery injury or compartment syndrome), rather than simple elbow dislocations. **Why Option D is the correct answer:** Volkmann’s Ischemic Contracture is the end-stage result of untreated compartment syndrome. While vascular compromise can occur in dislocations, the mechanical obstruction or arterial spasm required to produce the full-blown ischemic contracture is overwhelmingly linked to pediatric supracondylar fractures. In the context of "all except" questions in NEET-PG, VIC is the "most distal" or least common primary complication compared to the others listed. **Analysis of Incorrect Options:** * **Vascular Injury (A):** The **Brachial artery** is at high risk during posterior dislocations as it gets stretched over the displaced distal humerus. * **Median Nerve Injury (B):** Along with the Ulnar nerve, the Median nerve is frequently tethered or compressed during the displacement of the radius and ulna. * **Myositis Ossificans (C):** This is a **very common** complication of elbow trauma. It is often exacerbated by forceful passive stretching or massage following the reduction of a dislocation. **Clinical Pearls for NEET-PG:** * **Most common type:** Posterior/Posterolateral dislocation is the most frequent. * **Terrible Triad of Elbow:** Elbow dislocation + Coronoid fracture + Radial head fracture. * **Management:** Emergency closed reduction under sedation followed by brief immobilization (not exceeding 3 weeks to avoid stiffness). * **Rule of Thumb:** If a question asks for the most common complication of elbow dislocation, the answer is **Stiffness** (decreased range of motion).

Q: A 62-year-old woman presents with a 3-month history of progressive right shoulder pain, limiting her ability to lift her arm for daily activities. She denies neurological symptoms. Physical examination reveals weakness in abduction and external rotation with a normal passive range of motion. She cannot maintain 90 degrees of abduction. There is no motor deficit in the forearm or hand, and pulses and sensation are normal. Which of the following muscles constitute the injured structure?

Supraspinatus, infraspinatus, teres minor, subscapularis. **Explanation:** The clinical presentation describes a classic case of a **Rotator Cuff Tear**. The patient exhibits the "Drop Arm Sign" (inability to maintain 90 degrees of abduction) and weakness in external rotation, while maintaining a normal passive range of motion. This dissociation between active and passive movement is hallmark for a tendon/muscle tear rather than adhesive capsulitis (where both are restricted). The **Rotator Cuff** is a functional unit of four muscles that stabilize the glenohumeral joint. The correct anatomical components are: 1. **Supraspinatus:** Initiates abduction (0-15°). 2. **Infraspinatus:** Primary external rotator. 3. **Teres Minor:** External rotator and adductor. 4. **Subscapularis:** Primary internal rotator. **Analysis of Options:** * **Option D (Correct):** Correctly identifies the four SITS muscles (Supraspinatus, Infraspinatus, Teres minor, Subscapularis). * **Options A & B:** Incorrect because they include the **Teres Major**. While the Teres Major helps in adduction and internal rotation, it is *not* part of the rotator cuff. * **Options A & C:** Incorrect because they include the **Deltoid**. The deltoid is the primary abductor of the arm (after 15°) but is a superficial muscle, not part of the stabilizing rotator cuff. **High-Yield NEET-PG Pearls:** * **Most common muscle injured:** Supraspinatus (due to its location under the acromion). * **Investigation of Choice:** MRI is the gold standard for diagnosing rotator cuff tears. * **Clinical Tests:** Jobe’s Test (Empty Can) for Supraspinatus; Hornblower’s Sign for Teres Minor; Lift-off/Gerber’s test for Subscapularis. * **Nerve Supply:** Suprascapular nerve (Supra/Infraspinatus), Axillary nerve (Teres minor), Upper and Lower Subscapular nerves (Subscapularis).

Q: Which of the following best describes the patient's wrist fracture?

Colles fracture. ***Colles fracture*** - Affects the **distal radius** with **dorsal displacement** and **dorsal angulation**, creating the characteristic **"dinner fork" deformity** on clinical examination. - Most commonly occurs from a **fall on outstretched hand (FOOSH)** mechanism, particularly in elderly patients with **osteoporosis**. *Bennett's fracture* - This is a fracture-dislocation at the **base of the first metacarpal** (thumb), not involving the wrist or radius. - Requires **surgical fixation** due to instability at the **carpometacarpal joint** of the thumb. *Jones fracture* - Occurs at the **5th metatarsal** in the **foot**, specifically at the **metaphyseal-diaphyseal junction**. - Has poor healing potential due to **watershed blood supply** and often requires **surgical intervention**. *Salter-Harris fracture* - This classification applies to **growth plate injuries** in **pediatric patients** with open physes. - Would not be applicable to typical wrist fractures in adults where **growth plates are closed**.

Q: What is the typical position of the distal fragment in a fracture of the upper third of the femur shaft?

Adducted. In a fracture of the **upper third of the femur shaft**, the displacement of fragments is determined by the powerful muscle groups attached to them. **1. Why Adducted is Correct:** The position of the **distal fragment** is primarily influenced by the **Adductor group of muscles** (Adductor longus, brevis, and magnus). These muscles originate from the pelvis and insert along the linea aspera of the femoral shaft. When the bone is fractured in the upper third, these muscles pull the distal fragment medially, resulting in **Adduction**. **2. Analysis of Other Options:** * **Abducted:** This describes the **proximal fragment**. The proximal fragment is abducted by the Gluteus medius and minimus, and flexed by the Iliopsoas. * **Posteriorly displaced:** While the distal fragment may have some posterior tilt due to the pull of the gastrocnemius (more common in supracondylar fractures), the primary characteristic displacement in upper-third fractures is medial/adduction. * **Anteriorly displaced:** The proximal fragment is the one that appears anteriorly displaced (flexed) due to the Iliopsoas muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Proximal Fragment Position:** Flexed (Iliopsoas), Abducted (Glutei), and Externally Rotated (Short rotators). * **Distal Fragment Position:** Adducted (Adductors) and pulled proximally (Shortening due to Hamstrings and Quadriceps). * **Winquist-Hansen Classification:** Used to grade the comminution of femoral shaft fractures. * **Management:** The gold standard treatment for adult femoral shaft fractures is **Intramedullary (IM) Nailing** (antegrade or retrograde).

Question 1

Which of the following is true about Colles' fracture?

Accepted Answer

Extra-articular fracture of the distal radius with dorsal displacement

Answer

Intra-articular fracture of the distal radius with palmar displacement

Answer

Intra-articular fracture of the distal radius with dorsal displacement

Answer

Extra-articular fracture of the distal radius with palmar displacement

Question 2

In Volkmann's contracture, which artery is injured?

Accepted Answer

Brachial artery

Answer

Radial artery

Answer

Ulnar artery

Answer

Subclavian artery

Question 3

Which of the following statements regarding fracture of the clavicle is true?

Accepted Answer

The most common complication is malunion.

Answer

It occurs at the junction of the medial third and lateral two-thirds.

Answer

It usually occurs due to a fall on the elbow.

Answer

Comminuted fracture is common.

Question 4

Gun stock deformity is seen in?

Accepted Answer

Supracondylar fracture humerus

Answer

Lateral condylar fracture of humerus

Answer

Medial condylar fracture of humerus

Answer

All of the above

Question 5

Complications of elbow dislocation are all EXCEPT:

Accepted Answer

Volkmann's ischemic contracture

Answer

Vascular injury

Answer

Median nerve injury

Answer

Myositis ossificans

Question 6

What is the primary action of an intramedullary 'K' nail?

Accepted Answer

Three-point fixation

Answer

Two-point fixation

Answer

Compression

Answer

Weight concentration

Question 7

An 8-year-old boy falls on a flexed left elbow and suffers a closed, fully displaced flexion type supracondylar fracture. He complains of finger numbness, but will not allow examination of his arm. Which of the following is most likely injured in this fracture?

Accepted Answer

Ulnar nerve

Answer

Anterior interosseous nerve

Answer

Radial nerve

Answer

Radial artery

Question 8

A 62-year-old woman presents with a 3-month history of progressive right shoulder pain, limiting her ability to lift her arm for daily activities. She denies neurological symptoms. Physical examination reveals weakness in abduction and external rotation with a normal passive range of motion. She cannot maintain 90 degrees of abduction. There is no motor deficit in the forearm or hand, and pulses and sensation are normal. Which of the following muscles constitute the injured structure?

Accepted Answer

Supraspinatus, infraspinatus, teres minor, subscapularis

Answer

Supraspinatus, infraspinatus, teres major, deltoid

Answer

Supraspinatus, infraspinatus, teres major, subscapularis

Answer

Supraspinatus, infraspinatus, teres minor, deltoid

Question 9

Which of the following best describes the patient's wrist fracture?

Accepted Answer

Colles fracture

Answer

Bennett's fracture

Answer

Jones fracture

Answer

Salter-Harris fracture

Question 10

What is the typical position of the distal fragment in a fracture of the upper third of the femur shaft?

Accepted Answer

Adducted

Answer

Abducted

Answer

Posteriorly displaced

Answer

Anteriorly displaced

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?