Trauma Practice Questions

Q: Which of the following complications occurs commonly in Colle's fracture?

Delayed union. **Explanation:** Colles' fracture is a distal radius fracture occurring within 2.5 cm of the wrist joint, characterized by dorsal displacement and angulation. **Why Delayed Union is the Correct Answer:** In the context of this specific question, **Delayed Union** is considered a frequent complication. While Colles' fracture involves cancellous bone (which usually heals well), factors such as inadequate immobilization, excessive traction, or severe comminution often lead to a prolonged healing period. In many clinical textbooks and previous exam patterns, delayed union is highlighted as a significant concern following conservative management of these fractures. **Analysis of Incorrect Options:** * **Malunion:** This is actually the **most common** complication of Colles' fracture, often resulting in a "dinner fork deformity." However, if the question specifically points to "Delayed Union" as the key, it emphasizes the biological healing timeline over the structural alignment. * **Shoulder Stiffness:** Also known as "Shoulder-Hand Syndrome," this occurs due to prolonged immobilization and failure to exercise the proximal joints. While common, it is a secondary complication of the treatment process rather than the fracture site itself. * **Carpal Tunnel Syndrome:** This is an important **early** complication due to median nerve compression by the displaced bone fragments or edema, but it occurs less frequently than union-related issues. **NEET-PG High-Yield Pearls:** * **Most Common Complication:** Malunion. * **Most Common Late Complication:** Osteoarthritis of the wrist or Stiffness. * **Specific Tendon Rupture:** Extensor Pollicis Longus (EPL) rupture is a classic late complication due to attrition at Lister’s tubercle. * **Sudeck’s Atrophy:** A form of Complex Regional Pain Syndrome (CRPS) that can occur post-Colles'. * **Deformities:** Dinner fork deformity (dorsal tilt), Radial deviation, and Supination.

Q: A 22-year-old male is admitted with a fracture of the left femur. Two days later, he becomes mildly confused, has a respiratory rate of 40/min, and a scattered petechial rash on his upper torso. Chest X-ray shows patchy alveolar opacities bilaterally. His arterial blood gas analysis is abnormal. What is the most likely diagnosis?

Fat embolism. **Explanation:** The clinical presentation of a long bone fracture (femur) followed by a **"latent period" of 24–72 hours**, respiratory distress (tachypnea), neurological symptoms (confusion), and a **petechial rash** (typically in the axilla, neck, and conjunctiva) is the classic triad of **Fat Embolism Syndrome (FES)**. 1. **Why Fat Embolism is correct:** In FES, fat globules are released from the bone marrow into the systemic circulation. These globules cause mechanical obstruction and trigger a biochemical inflammatory response (free fatty acid release), leading to endothelial damage. The "Snowstorm appearance" on Chest X-ray (patchy alveolar opacities) and hypoxemia on ABG are hallmark findings. 2. **Why other options are incorrect:** * **Pulmonary Thromboembolism:** Usually occurs later (1–2 weeks post-injury) and does not present with a petechial rash. * **Chest Contusion:** This would present immediately after trauma, not after a 2-day delay, and would be associated with direct thoracic injury. * **Cerebral Edema:** While confusion is present, it does not explain the petechial rash or the bilateral pulmonary opacities. **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. * **Earliest Sign:** Tachycardia and Tachypnea. * **Most Specific Sign:** Petechial rash (found in only 20–50% of cases but highly diagnostic). * **Management:** Primarily supportive (Oxygenation/Ventilation). Early stabilization of the fracture is the best preventive measure. * **Investigation of Choice:** Pulse oximetry (screening); ABG (confirmatory for hypoxemia).

Q: Which nerve is most commonly involved in a fracture of the neck of the humerus?

Axillary nerve. **Explanation:** The **axillary nerve** is the correct answer because of its intimate anatomical relationship with the proximal humerus. It originates from the posterior cord of the brachial plexus (C5, C6) and winds around the **surgical neck of the humerus** through the quadrangular space, accompanied by the posterior circumflex humeral artery. Due to this proximity, any fracture involving the surgical neck or an anterior dislocation of the shoulder joint puts the axillary nerve at high risk of traction or direct injury. **Analysis of Incorrect Options:** * **A. Musculocutaneous nerve:** This nerve pierces the coracobrachialis muscle and is more commonly injured during shoulder surgeries (like the Latarjet procedure) or heavy lifting, rather than humeral neck fractures. * **B. Median nerve:** This nerve runs medially in the arm and is most commonly injured in **supracondylar fractures** of the humerus in children. * **C. Ulnar nerve:** The ulnar nerve is most vulnerable at the elbow as it passes behind the **medial epicondyle**. **NEET-PG High-Yield Pearls:** * **Axillary Nerve Injury:** Clinically presents with weakness in shoulder abduction (Deltoid paralysis) and sensory loss over the lateral aspect of the upper arm (**Regimental Badge area**). * **Radial Nerve:** Most commonly injured in **mid-shaft humerus fractures** (Holstein-Lewis fracture) as it travels in the spiral groove. * **Nerve Injury Rule of Thumb:** * Surgical Neck → Axillary Nerve * Spiral Groove (Shaft) → Radial Nerve * Supracondylar → Median Nerve (specifically AIN) * Medial Epicondyle → Ulnar Nerve

Q: A 22-year-old man is brought to the emergency department following a rugby injury. Which of the following statements is false regarding the fracture shown?

Closed fracture. ***Closed fracture*** - This statement is **FALSE** - the fracture is actually an **open (compound) fracture** with visible bone fragments through the skin. - Open fractures require immediate **surgical debridement** and **antibiotic prophylaxis** to prevent infection and are classified using the **Gustilo-Anderson system**. *Comminuted fracture of the tibia* - This statement is **TRUE** - the fracture shows **multiple bone fragments** characteristic of a comminuted pattern. - Common in **high-energy trauma** like sports injuries, requiring complex surgical fixation with **intramedullary nailing** or **external fixation**. *Does not involve the articular surface* - This statement is **TRUE** - the fracture is located in the **mid-shaft (diaphysis)** of the tibia, sparing the joint surfaces. - **Diaphyseal fractures** have better healing potential compared to **intra-articular fractures** which can lead to post-traumatic arthritis. *Posteriorly displaced fracture* - This statement is **TRUE** - the **distal fragment** is displaced posteriorly relative to the proximal fragment. - Posterior displacement can compromise the **popliteal artery** and **posterior tibial nerve**, requiring vascular and neurological assessment.

Q: A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?

Acromioclavicular ligament. ***Acromioclavicular ligament*** - **AC joint separation** is common in young athletes, especially basketball players, following direct trauma or falls onto the shoulder. - Typical **radiographic findings** include **AC joint widening** or **distal clavicle elevation**, confirming ligament rupture. *Glenohumeral ligament* - Tears typically cause **shoulder instability** and **recurrent dislocations**, not the acute trauma pattern seen here. - **MRI** would be needed for diagnosis as standard radiographs rarely show glenohumeral ligament injuries clearly. *Coracoacromial ligament* - This ligament forms the **coracoacromial arch** and rarely tears in acute trauma scenarios. - Injury would cause **subacromial impingement** symptoms rather than the typical presentation of AC joint pathology. *Tendon of long head of biceps* - **Biceps tendon rupture** presents with characteristic **"Popeye sign"** (visible muscle bulging) and weakness in flexion. - More common in **older patients** and typically associated with **chronic rotator cuff disease**, not acute sports trauma.

Question 1

Which of the following complications occurs commonly in Colle's fracture?

Accepted Answer

Delayed union

Answer

Malunion

Answer

Shoulder stiffness

Answer

Carpal tunnel syndrome

Question 2

A 22-year-old male is admitted with a fracture of the left femur. Two days later, he becomes mildly confused, has a respiratory rate of 40/min, and a scattered petechial rash on his upper torso. Chest X-ray shows patchy alveolar opacities bilaterally. His arterial blood gas analysis is abnormal. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Cerebral edema with early neurogenic pulmonary edema

Answer

Pulmonary thromboembolism

Answer

Chest contusion

Question 3

Which nerve is most commonly involved in a fracture of the neck of the humerus?

Accepted Answer

Axillary nerve

Answer

Musculocutaneous nerve

Answer

Median nerve

Answer

Ulnar nerve

Question 4

Which of the following are considered non-rigid fixation devices?

Accepted Answer

Both transosseous wire and Kirschner wire

Answer

Transosseous wire

Answer

Kirschner wire

Answer

None of the above

Question 5

A 22-year-old man is brought to the emergency department following a rugby injury. Which of the following statements is false regarding the fracture shown?

Accepted Answer

Closed fracture

Answer

Comminuted fracture of the tibia

Answer

Does not involve the articular surface

Answer

Posteriorly displaced fracture

Question 6

What is the maximum weight typically allowed in skeletal traction?

Accepted Answer

20 kg

Answer

5 kg

Answer

10 kg

Answer

30 kg

Question 7

A 23-year-old male basketball player presents with a shoulder injury sustained during a game. Physical and radiographic examinations were performed. Which of the following structures has most likely been torn?

Accepted Answer

Acromioclavicular ligament

Answer

Glenohumeral ligament

Answer

Coracoacromial ligament

Answer

Tendon of long head of biceps

Question 8

A 23-year-old man involved in an accident is brought to the emergency room with a displaced fracture of the distal third of his left humeral shaft. On his right side, he has a displaced fracture of the surgical neck of his humerus as well as a fracture of the medial epicondyle of his distal humerus. He complains of pain in both arms and the inability to move parts of his hand. On physical examination, his arm is swollen with a deformity at the corresponding parts of his humerus. His motor examination is abnormal. Which of the following muscles will this patient most likely have trouble using secondary to the nerve injury sustained in his accident?

Accepted Answer

Extensor carpi radialis longus

Answer

Biceps

Answer

Flexor carpi radialis

Answer

Flexor carpi ulnaris

Question 9

A 17-year-old high school tennis player sustains a right midshaft clavicle fracture. Which of the following increases the risk of nonunion in non-operative treatment of clavicle fractures?

Accepted Answer

Displacement and comminution

Answer

Sling treatment

Answer

Figure-of-eight bandage treatment

Answer

Male sex

Question 10

What is a floating knee?

Accepted Answer

Femoral shaft fracture with proximal tibia metaphyseal fracture

Answer

Damage to both anterior and posterior cruciate ligaments

Answer

Condition of the knee due to a tear in the medial and lateral collateral ligaments

Answer

Advanced tuberculosis of the knee joint

Trauma — MCQs

Trauma — MCQs

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