Trauma Practice Questions

Q: High-stepping gait is characteristic of which condition?

Common peroneal nerve palsy. ### Explanation **Correct Answer: B. Common Peroneal Nerve Palsy** The **Common Peroneal Nerve (CPN)**, specifically its deep branch, innervates the muscles of the anterior compartment of the leg (Tibialis anterior, Extensor digitorum longus, and Extensor hallucis longus). These muscles are responsible for **dorsiflexion** of the foot and extension of the toes. In CPN palsy, the loss of dorsiflexion leads to **Foot Drop**. To prevent the toes from dragging on the ground during the swing phase of walking, the patient compensates by excessively flexing the hip and knee, lifting the foot high off the ground. This results in the characteristic **High-stepping gait**. **Analysis of Incorrect Options:** * **A. CTEV:** Characterized by a "Cave" (Cavus, Adductus, Varus, Equinus) deformity. The gait is typically a "stumbling" gait or walking on the outer border of the foot, not high-stepping. * **C. Poliomyelitis:** While it can cause various paralytic deformities (including foot drop), it typically presents with a **Hand-knee gait** (due to quadriceps weakness) or a **Trendelenburg gait** (due to gluteal weakness). * **D. Cerebral Palsy:** Most commonly presents with a **Scissor gait** (due to adductor spasticity) or a **Crouch gait**. **Clinical Pearls for NEET-PG:** * **Most common site of injury:** The CPN is the most frequently injured nerve in the lower limb because it winds superficially around the **neck of the fibula**. * **Sensory Loss:** Occurs over the lateral aspect of the leg and the dorsum of the foot (sparing the web space between the 1st and 2nd toes if only the superficial branch is involved). * **Trendelenburg Gait:** Seen in Superior Gluteal Nerve injury (weakness of Gluteus Medius/Minimus). * **Waddling Gait:** Seen in bilateral developmental dysplasia of the hip (DDH) or muscular dystrophy.

Q: For which of the following conditions is a TT splint NOT indicated?

Infective arthritis of the knee. **Explanation:** The **Thomas Splint (TT Splint)** is a traction splint primarily designed to provide immobilization and maintain longitudinal traction for injuries involving the femur and the knee joint. **Why Infective Arthritis is the Correct Answer:** In **Infective (Septic) Arthritis** of the knee, the primary goal of splintage is absolute rest and immobilization to prevent joint destruction, but **traction is not indicated**. Instead, these patients are typically managed with a **Bohler-Braun splint** or a simple posterior slab/plaster. A Thomas splint is cumbersome for the frequent clinical monitoring and joint aspirations required in septic cases. Furthermore, the pressure from the ring of the Thomas splint can cause discomfort and skin breakdown in patients who are already systemically ill. **Analysis of Incorrect Options:** * **Injuries around the knee joint & Knee dislocation:** The Thomas splint is excellent for stabilizing the knee joint, preventing further neurovascular damage, and maintaining alignment during transport or definitive healing. * **Fracture of the femur:** This is the **classic indication** for a Thomas splint. It provides the necessary traction to overcome the powerful pull of the thigh muscles, preventing shortening and reducing pain by stabilizing the fracture fragments. **NEET-PG High-Yield Pearls:** * **Measurement:** The Thomas splint ring size is "1.5 inches (or 4 cm) more than the circumference of the thigh at the groin." The length is "6 inches (15 cm) beyond the heel." * **Modifications:** The **Keller-Blake splint** is a modification of the Thomas splint with a half-ring, making it easier to apply in emergencies. * **Fixed vs. Sliding Traction:** Thomas splint can be used for both fixed traction (tied to the end of the splint) and sliding traction (using weights and pulleys).

Q: Long compression is used for which fracture?

Calcaneum. **Explanation:** **Long Compression** (also known as the **Essex-Lopresti method**) is a specific technique used for the reduction and fixation of **Calcaneum fractures**, particularly those involving the joint surface (intra-articular). The calcaneum is composed primarily of cancellous bone with a thin cortical shell. When it fractures, it often undergoes significant compression and loss of height (measured by **Bohler’s angle**). The "Long Compression" technique involves using a heavy-duty pin (Schanz screw or Gissane spike) inserted through the posterior aspect of the tuberosity into the displaced fragment. This allows the surgeon to apply longitudinal traction and leverage to restore the height and alignment of the bone before securing it. **Analysis of Incorrect Options:** * **Talus:** Fractures of the talus (e.g., Aviator’s fracture) are typically treated with ORIF using lag screws to achieve interfragmentary compression, but the specific "Long Compression" maneuver is not a standard term for this bone. * **Fibula:** Most fibular fractures are treated with plate fixation (e.g., lateral malleolus) or are managed conservatively if they are non-weight-bearing. * **Femur:** Femoral fractures usually require intramedullary nailing or heavy plating. While compression is used in plating, the specific clinical term "Long Compression" is not associated with femoral trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Bohler’s Angle:** Normal is 25°–40°. A decrease indicates a calcaneal burst fracture. * **Angle of Gissane:** Normal is 120°–145°. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot; pathognomonic for calcaneal fracture. * **Associated Injuries:** Always check the **Lumbar Spine (L1)** in calcaneal fractures (Don Juan Syndrome/Lover’s Fracture) due to axial loading.

Q: In a posteriorly dislocated elbow, which nerve is most commonly involved?

Ulnar nerve. **Explanation:** In a **posterior dislocation of the elbow** (the most common type), the radius and ulna are displaced posteriorly and often laterally relative to the distal humerus. The **ulnar nerve** is the most commonly injured nerve because of its vulnerable anatomical position in the fibro-osseous tunnel (cubital tunnel) behind the medial epicondyle. During posterior displacement, the nerve is subjected to significant traction or direct compression as the joint capsule and medial collateral ligaments are disrupted. **Analysis of Options:** * **Ulnar Nerve (Correct):** Its proximity to the medial joint complex makes it highly susceptible to traction injuries during the deformity. * **Median Nerve:** This is the second most commonly injured nerve. It is typically affected in **posterolateral** dislocations or when there is an associated "entrapment" within the joint or a concomitant brachial artery injury. * **Radial Nerve:** Injury is rare in simple elbow dislocations. It is more commonly associated with fractures of the humeral shaft (Holstein-Lewis fracture) or radial head. * **Musculocutaneous Nerve:** This nerve is well-protected by the overlying musculature and is rarely involved in elbow trauma. **NEET-PG High-Yield Pearls:** * **Most common direction:** Posterolateral. * **Most common complication:** Stiffness (Loss of terminal extension). * **Terrible Triad of the Elbow:** Elbow dislocation + Coronoid fracture + Radial head fracture. * **Clinical Sign:** The "Three-point relationship" (between the olecranon and the two epicondyles) is lost in dislocation but maintained in supracondylar fractures of the humerus. * **Vascular Injury:** The **Brachial artery** is the most common vessel injured, especially in open dislocations or severe anterior displacement of the humerus.

Q: Which of the following statements is not true about Myositis ossificans?

It is associated with muscle tendon rupture.. **Explanation:** **Myositis Ossificans (MO)** is a condition characterized by heterotopic ossification (bone formation) within soft tissues, most commonly muscles. **Why Option A is the Correct Answer (The "Not True" Statement):** Myositis ossificans is typically associated with **muscle contusions** or **blunt trauma** that leads to an intramuscular hematoma, rather than a complete muscle tendon rupture. While trauma is the trigger, the pathology involves the ossification of the hematoma within the muscle belly itself, not the tendon. **Analysis of Other Options:** * **Option B:** The pathophysiology involves an inflammatory response following trauma. Primitive mesenchymal cells in the connective tissue differentiate into osteoblasts, leading to the deposition of **hydroxyapatite crystals** (the inorganic component of bone) within the soft tissue. * **Option C:** It is a well-known complication of **Supracondylar fractures of the humerus**, especially if there is repeated forceful manipulation or passive stretching of the elbow joint post-injury. The Brachialis muscle is most frequently involved. * **Option D:** The process begins with a **musculo-periosteal haematoma**. If this hematoma is not absorbed, it undergoes organization and subsequent ossification, transforming into a mass of lamellar bone. **NEET-PG High-Yield Pearls:** * **Most common site:** Brachialis (Elbow) and Quadriceps (Thigh). * **Radiological Sign:** **"Zonal Phenomenon"** – Mature lamellar bone is found at the periphery, while the center remains immature (unlike osteosarcoma, which is more dense centrally). * **Management:** Rest and immobilization in the acute phase. **Passive stretching is strictly contraindicated** as it worsens the condition. * **Surgery:** Excision is only considered after the bone has "matured" (usually 6–12 months), indicated by a cold bone scan and well-defined margins on X-ray.

Q: What is the most common complication following an intertrochanteric fracture of the femur?

Malunion. ### Explanation **Correct Answer: B. Malunion** Intertrochanteric (IT) fractures occur in the extracapsular region of the proximal femur, which is characterized by a rich blood supply and a large surface area of cancellous bone. Because of this robust vascularity, these fractures almost always heal (low rate of non-union). However, the region is subject to significant biomechanical stresses and powerful muscle pulls (iliopsoas, abductors, and gluteals). This often leads to a **coxa vara** deformity (decreased neck-shaft angle), resulting in **malunion**. This is the most frequent complication, especially in unstable fracture patterns or when internal fixation fails to maintain anatomical alignment. **Why other options are incorrect:** * **A. Avascular Necrosis (AVN):** This is a classic complication of **intracapsular** neck of femur fractures, where the retrograde blood supply (medial circumflex femoral artery) is disrupted. Since IT fractures are extracapsular, the blood supply to the head remains intact. * **C. Rupture of the Iliopsoas tendon:** While the iliopsoas attaches to the lesser trochanter (which is often avulsed in IT fractures), a complete tendon rupture is rare. The clinical focus is on the bony avulsion rather than tendon integrity. * **D. Distal gangrene:** This would imply major arterial injury (e.g., femoral artery). While vascular injury can occur in high-energy femoral shaft trauma, it is extremely rare in isolated IT fractures. **NEET-PG High-Yield Pearls:** * **Neck of Femur (Intracapsular) Fractures:** Most common complication is **Non-union**, followed by **AVN**. * **Intertrochanteric (Extracapsular) Fractures:** Most common complication is **Malunion (Coxa Vara)**. * **Treatment of Choice:** For stable IT fractures, the **Dynamic Hip Screw (DHS)** is preferred; for unstable/reverse oblique patterns, the **Proximal Femoral Nail (PFN)** is the gold standard.

Q: Which bone is most commonly fractured in a fall on an outstretched hand?

Lower End Radius (Colles fracture). **Explanation:** The **Lower End of the Radius** is the most common site of fracture following a **Fall On an Outstretched Hand (FOOSH)**. When a person falls forward, the natural reflex is to extend the hand to break the fall. This results in the body's weight being transmitted through the carpal bones (specifically the scaphoid and lunate) directly into the distal articular surface of the radius. In adults, especially post-menopausal women with decreased bone density, this force typically results in a **Colles' fracture**—a transverse fracture of the distal radius with dorsal displacement and angulation (the "Dinner Fork" deformity). **Analysis of Incorrect Options:** * **Lower End Ulna:** While the ulnar styloid is often fractured concurrently with the radius, the radius bears approximately 80% of the axial load at the wrist, making it the primary site of injury. * **5th Metacarpal:** A fracture of the 5th metacarpal neck is known as a **Boxer’s fracture**, typically caused by a direct blow with a clenched fist against a hard object, not a FOOSH. * **Capitate:** Although it is the largest carpal bone, it is centrally located and well-protected. The most commonly fractured carpal bone in a FOOSH is the **Scaphoid**, not the capitate. **High-Yield Clinical Pearls for NEET-PG:** * **Colles' Fracture:** Distal fragment is displaced **Dorsally** (Dinner fork deformity). * **Smith’s Fracture:** Also known as a "Reverse Colles," caused by a fall on a **flexed** wrist; the distal fragment is displaced **Ventrally** (Garden spade deformity). * **Barton’s Fracture:** An intra-articular fracture-dislocation of the distal radius. * **Most common complication of Colles' fracture:** Stiffness of the fingers and wrist; the most common nerve involved is the **Median Nerve**.

Q: What is the mechanism of injury in a lateral condylar fracture of the proximal tibia?

Strain of a valgus knee with axial loading. **Explanation:** The proximal tibia (tibial plateau) is a critical weight-bearing surface. Fractures here, specifically of the **lateral condyle**, are most commonly caused by a combination of **valgus stress (abduction) and axial loading**. 1. **Mechanism of Correct Answer:** When a valgus force is applied to the knee (often from a lateral blow, such as a "bumper injury" in a pedestrian), the lateral femoral condyle is driven into the lateral tibial plateau. Because the lateral plateau is convex and relatively weaker than the medial side, the axial load causes the femoral condyle to act like a "wedge," resulting in a split, depression, or a combination of both (Schatzker Types I-III). 2. **Analysis of Incorrect Options:** * **Strain of a valgus knee (A):** While valgus stress is necessary, simple strain without **axial loading** usually results in a Medial Collateral Ligament (MCL) tear rather than a bony fracture. * **Strain of a varus knee (B):** Varus stress (adduction) targets the **medial condyle**. Medial plateau fractures are less common and usually signify higher energy trauma. * **Rotational injury (D):** Rotational forces are typically associated with ligamentous injuries (like ACL tears) or meniscal injuries, rather than isolated tibial plateau fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Schatzker Classification:** The most widely used system. Type II (Split-depression) is the most common. * **Associated Injuries:** Lateral plateau fractures are frequently associated with **MCL injuries** and **lateral meniscal tears**. * **Nerve Involvement:** High-energy fractures or those involving the proximal fibula may damage the **Common Peroneal Nerve**, leading to foot drop. * **Compartment Syndrome:** Always monitor for this surgical emergency in high-energy tibial plateau fractures.

Question 1

Which of the following is NOT a major criterion for Gurd?

Accepted Answer

Thrombocytopenia

Answer

Subconjunctival petechiae

Answer

PaO2 <60mmHg

Answer

Pulmonary edema

Question 2

High-stepping gait is characteristic of which condition?

Accepted Answer

Common peroneal nerve palsy

Answer

Congenital talipes equinovarus (CTEV)

Answer

Poliomyelitis

Answer

Cerebral palsy

Question 3

For which of the following conditions is a TT splint NOT indicated?

Accepted Answer

Infective arthritis of the knee

Answer

Injuries around the knee joint

Answer

Knee dislocation

Answer

Fracture of the femur

Question 4

Long compression is used for which fracture?

Accepted Answer

Calcaneum

Answer

Talus

Answer

Fibula

Answer

Femur

Question 5

In a posteriorly dislocated elbow, which nerve is most commonly involved?

Accepted Answer

Ulnar nerve

Answer

Median nerve

Answer

Radial nerve

Answer

Musculocutaneous nerve

Question 6

Which of the following statements is not true about Myositis ossificans?

Accepted Answer

It is associated with muscle tendon rupture.

Answer

There is inflammation around the ruptured muscle with deposition of hydroxyapatite crystals.

Answer

It is common in supracondylar fracture.

Answer

It involves ossification of a musculo-periosteal haematoma.

Question 7

What is the most common complication following an intertrochanteric fracture of the femur?

Accepted Answer

Malunion

Answer

Avascular necrosis of the femoral head

Answer

Rupture of the Iliopsoas tendon

Answer

Distal gangrene

Question 8

Which bone is most commonly fractured in a fall on an outstretched hand?

Accepted Answer

Lower End Radius (Colles fracture)

Answer

Lower End Ulna

Answer

5th Metacarpal

Answer

Capitate

Question 9

What is the mechanism of injury in a lateral condylar fracture of the proximal tibia?

Accepted Answer

Strain of a valgus knee with axial loading

Answer

Strain of a valgus knee

Answer

Strain of a varus knee

Answer

Rotational injury

Question 10

A 30-year-old male underwent excision of the right radial head. Postoperatively, the patient developed an inability to extend the fingers and thumb of the right hand. He had no sensory deficit. Which of the following is the most likely cause?

Accepted Answer

Injury to the posterior interosseous nerve

Answer

Iatrogenic injury to the common extensor origin

Answer

Injury to the anterior interosseous nerve

Answer

High radial nerve palsy

Trauma — MCQs

Trauma — MCQs

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