Trauma Practice Questions

Q: Which of the following is NOT a symptom of Sudeck's dystrophy?

Increased bone density. **Explanation:** Sudeck’s atrophy (also known as **Complex Regional Pain Syndrome Type 1**) is a chronic pain condition that typically follows a minor injury or fracture, most commonly involving the distal radius (Colles' fracture). **Why "Increased bone density" is the correct answer:** The hallmark radiographic feature of Sudeck’s dystrophy is **patchy osteoporosis** (decreased bone density) or "ground-glass" appearance of the bones due to rapid bone resorption. This occurs because of localized sympathetic overactivity leading to increased vascularity and subsequent demineralization. Therefore, increased bone density is the opposite of what is observed in this condition. **Analysis of other options:** * **Pain (A):** This is the most prominent symptom. It is typically "burning" in nature and out of proportion to the severity of the initial injury. * **Sweating (C):** Autonomic dysfunction is a core feature. Patients often experience sudomotor changes, leading to excessive sweating (hyperhidrosis) or dryness in the affected limb. * **Stiffness (D):** Due to pain and trophic changes in the soft tissues, joints in the affected area become stiff, often leading to a "frozen" hand or foot. **High-Yield Clinical Pearls for NEET-PG:** * **Common Site:** Hand (following Colles' fracture) or Foot. * **Clinical Stages:** 1. Acute (Hyperemic), 2. Dystrophic (Ischemic), 3. Atrophic. * **X-ray finding:** Patchy/Sudden decalcification of the carpal/tarsal bones. * **Triple Phase Bone Scan:** The most sensitive investigation (shows increased uptake). * **Treatment:** Early mobilization (best prevention), sympathetic blocks, and Vitamin C (prophylactic).

Q: Gamma nail is used in the treatment of which of the following?

Intertrochanteric femur fracture. **Explanation:** The **Gamma nail** is a second-generation **intramedullary (IM) interlocking nail** specifically designed for the management of **Intertrochanteric (IT) femur fractures**. It consists of a short intramedullary nail inserted through the greater trochanter, a large-diameter lag screw that passes through the nail into the femoral head, and a distal locking bolt. **Why it is the correct choice:** The Gamma nail functions as a **load-sharing device**. Unlike the Dynamic Hip Screw (DHS), which is an extramedullary device, the Gamma nail is positioned closer to the mechanical axis of the femur. This reduces the lever arm and the bending moment on the implant, making it biomechanically superior for **unstable IT fractures** (e.g., fractures with loss of posteromedial support or reverse oblique patterns). **Analysis of Incorrect Options:** * **Fracture neck of femur:** These are typically treated with Multiple Cannulated Cancellous Screws (for young patients) or Hemi/Total Hip Arthroplasty (for elderly patients). * **Ankle arthrodesis:** This procedure involves fusing the talocrural joint using compression screws or specialized retrograde hindfoot nails (e.g., TTC nails), not Gamma nails. * **Hip arthrodesis:** This is a salvage procedure for a painful, destroyed hip joint, usually performed using specialized plates (e.g., Cobra plate) or long reconstruction nails, but not a standard Gamma nail. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** While DHS remains the gold standard for *stable* IT fractures, the Gamma nail/Cephalomedullary nail is preferred for *unstable* and *reverse oblique* fractures. * **Entry Point:** The entry point for a Gamma nail is the tip of the **Greater Trochanter**. * **Complication:** A classic complication associated with early Gamma nails was a fracture at the tip of the nail (distal femur fracture), though newer designs have reduced this risk.

Q: What deformity is typically seen in a posterior elbow dislocation?

Flexion. In a **posterior elbow dislocation**, which is the most common type of elbow dislocation, the radius and ulna are displaced posteriorly and superiorly relative to the distal humerus. ### **Explanation of the Correct Answer** **A. Flexion:** Following the injury, the elbow is typically held in a position of **semi-flexion (approximately 45° to 90°)**. This occurs because the triceps tendon is stretched over the displaced olecranon, acting as a tether, while the brachialis and biceps muscles undergo protective spasms. This position minimizes intra-articular pressure and tension on the surrounding soft tissues. ### **Explanation of Incorrect Options** * **B. Extension:** The elbow cannot be extended due to the mechanical locking of the olecranon against the posterior humerus and the intense pain/spasm of the flexor muscles. * **C & D. Medial/Lateral Deviation:** While minor side-to-side displacement may occur depending on the direction of the force, these are not the characteristic "deformity" positions. The primary clinical presentation is defined by the sagittal plane (flexion). ### **NEET-PG High-Yield Pearls** * **Mechanism of Injury:** Most commonly a fall on an outstretched hand (FOOSH) with the elbow in extension and abduction. * **Clinical Sign:** The **Three-Point Relationship** (the triangle formed by the olecranon and the two epicondyles) is **disturbed** in dislocation, whereas it remains intact in supracondylar fractures. * **Associated Injury:** Always check for **Brachial Artery** and **Median/Ulnar nerve** injuries. * **Radiology:** The "fat pad sign" may be seen, but the diagnosis is confirmed by the posterior displacement of the olecranon on a lateral X-ray. * **Management:** Emergency closed reduction followed by brief immobilization in flexion.

Q: What is a straddle fracture?

Pelvic fracture. **Explanation:** A **Straddle Fracture** is a specific type of unstable pelvic fracture characterized by **bilateral fractures of the superior and inferior pubic rami**. It is typically caused by a direct blow to the midline of the symphysis pubis, such as falling onto a hard object (e.g., a manhole cover or a bicycle frame). **Why the correct answer is right:** * **Pelvic Fracture:** The term "straddle" refers to the mechanism of injury involving the perineum. This injury results in a "floating" anterior segment of the pelvis. It is clinically significant because it is associated with a high incidence (up to 20%) of **genitourinary injuries**, particularly ruptures of the posterior urethra or bladder. **Why the incorrect options are wrong:** * **A. Fracture of the skull:** Skull fractures are classified by location (vault, base) or type (depressed, linear), but "straddle" is not a term used in neurotrauma. * **B. Fracture of C5 vertebra:** Cervical fractures have specific names like Jefferson (C1) or Hangman’s (C2). C5 is a common site for burst fractures, but not straddle fractures. * **C. Multiple rib fractures:** This describes a **Flail Chest** (if 3 or more ribs are broken in 2 or more places), which causes paradoxical respiration. **High-Yield Clinical Pearls for NEET-PG:** * **Malgaigne Fracture:** The most common vertical shear pelvic fracture (ipsilateral rami fracture + sacroiliac joint disruption). * **Duverney Fracture:** Isolated fracture of the iliac wing (stable). * **Open Book Injury:** Disruption of the pubic symphysis with injury to the sacroiliac ligaments. * **Investigation of Choice:** AP view X-ray is the initial screening tool, but **CT Scan** is the gold standard for defining pelvic ring stability. * **Management:** In hemodynamically unstable pelvic fractures, the first step is **Pelvic Binding** to reduce pelvic volume and tamponade bleeding.

Q: Which of the following statements is NOT true regarding anterior dislocation of the hip?

Associated with shortening of the limb.. **Explanation:** In hip dislocations, the clinical presentation is determined by the final position of the femoral head relative to the acetabulum. In **Anterior Dislocation of the Hip**, the femoral head is displaced anteriorly and usually inferiorly (obturator type) or superiorly (pubic type). **1. Why Option D is the Correct Answer (The "False" Statement):** In anterior dislocations, the femoral head is displaced away from the acetabulum in a manner that typically results in **lengthening** of the limb, not shortening. Shortening is a hallmark feature of **posterior** hip dislocations. Therefore, the statement "Associated with shortening of the limb" is incorrect regarding anterior dislocation. **2. Analysis of Other Options:** * **Option A (Femoral nerve injury):** In anterior dislocations, the femoral head moves forward, putting direct pressure on the **femoral nerve** and vessels. (In contrast, the sciatic nerve is at risk in posterior dislocations). * **Option B (Lateral rotation):** The displacement of the head anterior to the axis of the femur causes the limb to assume a position of **external (lateral) rotation** and abduction. * **Option C (Lengthening):** As the head is displaced inferiorly and anteriorly, the effective length of the limb increases. **Clinical Pearls for NEET-PG:** | Feature | Posterior Dislocation (Most Common) | Anterior Dislocation | | :--- | :--- | :--- | | **Attitude** | Flexion, Adduction, **Internal Rotation** | Flexion, Abduction, **External Rotation** | | **Limb Length** | **Shortening** | **Lengthening** | | **Nerve Injury** | Sciatic Nerve | Femoral Nerve | | **Mechanism** | Dashboard injury | Forced abduction/extension | * **Mnemonic for Posterior Dislocation:** **S**hortened, **A**dducted, **I**nternally rotated (**SAI**). * **X-ray finding:** In anterior dislocation, the lesser trochanter is more visible due to external rotation.

Q: What is the most common direction of elbow dislocation?

Posterior. The elbow is the second most commonly dislocated large joint in adults (after the shoulder). **Posterior dislocation** is the most common type, occurring in approximately 80-90% of cases. **Why Posterior is Correct:** The mechanism of injury is typically a **fall on an outstretched hand (FOOSH)** with the elbow in slight flexion. In this position, the force is transmitted through the forearm, driving the olecranon process of the ulna posteriorly and superiorly relative to the distal humerus. The strong bony stability of the trochlear notch is overcome, often resulting in the rupture of the ulnar collateral ligament and the anterior capsule. **Analysis of Incorrect Options:** * **Anterior Dislocation:** Rare; it usually occurs due to a direct blow to the posterior aspect of the flexed elbow (e.g., a fall on the point of the olecranon), driving the ulna forward. * **Medial/Lateral Dislocation:** These are extremely uncommon and are usually associated with extensive soft tissue disruption or complex fracture-dislocations. **High-Yield Clinical Pearls for NEET-PG:** * **Classification:** Elbow dislocations are named based on the position of the **radius and ulna relative to the humerus**. * **The "Terrible Triad" of the Elbow:** Includes (1) Posterior elbow dislocation, (2) Coronoid process fracture, and (3) Radial head fracture. * **Nerve Injury:** The **Ulnar nerve** is the most commonly injured nerve in posterior dislocations, followed by the Median nerve. * **Vascular Complication:** Always check the radial pulse to rule out **Brachial artery** injury. * **Clinical Sign:** In a posterior dislocation, the normal isosceles triangle formed by the olecranon and the two epicondyles is lost.

Q: Which of the following fractures can cause cubitus varus deformity as a complication?

Supracondylar fracture of the humerus. **Explanation:** **Supracondylar fracture of the humerus** is the most common cause of **Cubitus Varus** (also known as "Gunstock deformity"). This deformity occurs primarily due to the **malunion** of the distal fragment, specifically when there is a failure to correct the **medial tilt, internal rotation, and posterior displacement**. While it is a cosmetic deformity rather than a functional one, it is a high-yield topic for NEET-PG. **Analysis of Options:** * **Option A (Lateral Condyle Fracture):** This fracture typically leads to **Cubitus Valgus** (increased carrying angle) due to non-union or growth arrest of the lateral epiphysis. Cubitus valgus is classically associated with **Tardy Ulnar Nerve Palsy**. * **Option C (Radial Head Fracture):** This involves the proximal radius and usually results in restricted forearm rotation (pronation/supination) or elbow stiffness, but does not typically alter the carrying angle of the humerus. * **Option D (Chronic Osteomyelitis):** While it can cause growth disturbances or bone destruction, it is not a primary or common cause of cubitus varus compared to the mechanical malunion of a supracondylar fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of Supracondylar Fracture:** Stiffness (overall); **Cubitus Varus** (most common deformity). * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Nerve Injuries:** The **Anterior Interosseous Nerve (AIN)** is the most common nerve injured in extension-type fractures; the Ulnar nerve is most common in flexion-type. * **Baumann’s Angle:** Used radiologically to assess the reduction and predict the risk of cubitus varus.

Question 1

Which of the following is NOT a symptom of Sudeck's dystrophy?

Accepted Answer

Increased bone density

Answer

Pain

Answer

Sweating

Answer

Stiffness

Question 2

Gamma nail is used in the treatment of which of the following?

Accepted Answer

Intertrochanteric femur fracture

Answer

Fracture neck of femur

Answer

Ankle arthrodesis

Answer

Hip arthrodesis

Question 3

What deformity is typically seen in a posterior elbow dislocation?

Accepted Answer

Flexion

Answer

Extension

Answer

Medial deviation

Answer

Lateral deviation

Question 4

What is a straddle fracture?

Accepted Answer

Pelvic fracture

Answer

Fracture of the skull

Answer

Fracture of the C5 vertebra

Answer

Multiple rib fractures on both sides of the midline

Question 5

Which of the following statements is NOT true regarding anterior dislocation of the hip?

Accepted Answer

Associated with shortening of the limb.

Answer

Femoral nerve is more commonly injured.

Answer

The limb is rotated laterally.

Answer

Associated with lengthening of the limb.

Question 6

What is the most common direction of elbow dislocation?

Accepted Answer

Posterior

Answer

Answer

Equal frequency of anterior and posterior

Answer

Medial

Question 7

Which of the following fractures can cause cubitus varus deformity as a complication?

Accepted Answer

Supracondylar fracture of the humerus

Answer

Fracture of the lateral condyle of the humerus

Answer

Fracture of the radial head

Answer

Chronic osteomyelitis

Question 8

All of the following are types of avascular nonunion of fracture except?

Accepted Answer

Oligotrophic nonunion

Answer

Torsion wedge nonunion

Answer

Comminuted nonunion

Answer

Defect nonunion

Question 9

A 32-year-old biker sustained an injury over his left hip joint. X-ray revealed a posterior dislocation of the right hip joint. What is the clinical attitude of the affected lower limb?

Accepted Answer

Internal rotation, flexion, and adduction

Answer

External rotation, extension, and abduction

Answer

Internal rotation, extension, and abduction

Answer

External rotation, flexion, and abduction

Question 10

What is the treatment of choice in a fracture neck of femur in a 40-year-old male presenting after 2 days?

Accepted Answer

Closed reduction and internal fixation by cancellous screws

Answer

Hemiarthroplasty

Answer

Closed reduction and internal fixation by Austin Moore pins

Answer

Plaster and rest

Trauma — MCQs

Trauma — MCQs

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