Trauma Practice Questions

Q: Avascular necrosis of the hip may occur following which of the following fractures?

Transcervical fracture of the neck of femur. ### Explanation **Correct Answer: C. Transcervical fracture of the neck of femur** **Why it is correct:** The blood supply to the femoral head is predominantly retrograde, provided by the **medial circumflex femoral artery** via its retinacular branches. These vessels run along the surface of the femoral neck. An intracapsular fracture, such as a **transcervical fracture**, disrupts these vessels and the intraosseous blood flow. Furthermore, the fracture causes an intracapsular hematoma, increasing pressure (tamponade effect) which further compromises capillary flow, leading to a high incidence of **Avascular Necrosis (AVN)**. **Why the other options are incorrect:** * **A & B (Intertrochanteric and Subtrochanteric fractures):** These are **extracapsular** fractures. The blood supply to the femoral head remains intact because the fracture line is distal to the attachment of the hip capsule and the entry point of the retinacular vessels. These areas are highly vascular (cancellous bone), so they rarely result in AVN but are more prone to malunion. * **D (Fracture of the posterior lip of the acetabulum):** While this can be associated with posterior hip dislocation (which *can* cause AVN), the fracture of the acetabulum itself does not directly compromise the blood supply to the femoral head. **High-Yield Clinical Pearls for NEET-PG:** * **Garden’s Classification:** Used for neck of femur fractures; Stages III and IV have the highest risk of AVN. * **Most important artery:** Medial circumflex femoral artery (specifically the posterosuperior retinacular branch). * **Pauwels’ Classification:** Based on the angle of the fracture line; higher angles (vertical fractures) have higher shear forces and higher risks of non-union/AVN. * **Management Rule:** In elderly patients with displaced transcervical fractures, **Arthroplasty** is preferred over internal fixation due to the high risk of AVN.

Q: What is the first priority in managing a patient with a fractured femur from an acute accident?

Secure airway and treat shock. In trauma management, the primary goal is to address life-threatening conditions before limb-threatening ones. This follows the **ATLS (Advanced Trauma Life Support)** protocol, which prioritizes the **ABCDE** approach (Airway, Breathing, Circulation, Disability, Exposure). **1. Why "Secure airway and treat shock" is correct:** A fractured femur is a major orthopedic injury often associated with high-energy trauma. It can lead to significant internal hemorrhage (up to 1.5 liters of blood loss into the thigh), resulting in **hypovolemic shock**. According to ATLS guidelines, stabilizing the airway and managing circulation (shock) takes precedence over the fracture itself to ensure patient survival. **2. Why the other options are incorrect:** * **B. Splint the fracture:** While splinting is crucial to reduce pain and prevent further fat embolism or vascular injury, it is part of the "Secondary Survey" or the end of the "Circulation" phase. It must not delay life-saving resuscitation. * **C. Perform a physical examination:** A detailed head-to-toe physical examination is part of the Secondary Survey, which is only performed once the patient is hemodynamically stable. * **D. Obtain X-rays:** Imaging is a diagnostic tool used after the initial stabilization. "Treat first what kills first" is the rule; an X-ray should never precede resuscitation in an acute setting. **Clinical Pearls for NEET-PG:** * **Blood loss in fractures:** Femur (1–1.5L), Pelvis (2L+), Tibia (0.5L), Humerus (0.5L). * **Thomas Splint:** The classic traction splint used for mid-shaft femur fractures to stabilize the bone and tamponade internal bleeding. * **Fat Embolism Syndrome:** A high-yield complication of long bone fractures, characterized by the triad of dyspnea, confusion, and petechial rashes.

Question 1

A patient presents with painful Myositis Ossificans around the elbow. What is the preferred treatment option in this case?

Accepted Answer

Immobilization

Answer

Active mobilization

Answer

Passive mobilization

Answer

Infra-Red Therapy

Question 2

Volkmann's ischemic contracture is commonly caused by which of the following?

Accepted Answer

Both a tight plaster cast and a tight splint

Answer

A tight plaster cast

Answer

A tight splint

Answer

Neither a tight plaster cast nor a tight splint

Question 3

What is the classically described position of the hand during the application of a POP cast for a scaphoid fracture?

Accepted Answer

Tumbler holding position

Answer

Boat shaped position

Answer

Clenched fist position

Answer

Boxing position

Question 4

A 28-year-old man sustains a right tibial and fibular midshaft fracture into multiple bone fragments after an all-terrain vehicle accident. On physical examination, there is intense pain on palpation over the right shin, with no shortening of the limb and intact overlying skin. Which of the following terms best describes these fractures?

Accepted Answer

Comminuted

Answer

Compound

Answer

Displaced

Answer

Incomplete

Question 5

Which of the following is not an indication for secondary nerve repair?

Accepted Answer

Division of nerve by sharp object

Answer

Syndrome of irritation

Answer

Delayed presentation of nerve injury

Answer

Syndrome of incomplete interruption

Question 6

Which of the following is NOT true about intracapsular neck fracture?

Accepted Answer

Severe pain around the hip

Answer

Less than 1 inch shortening

Answer

Less than 45 degrees of external rotation

Answer

Trivial trauma can cause fracture

Question 7

An elderly lady presents with a history of a fall in the washroom and pain in the gluteal region. Her limb is noted to be in lateral rotation. An X-ray of the pelvis is normal, but the pain persists even after 24 hours. What is the next step?

Accepted Answer

MRI within 24 hours

Answer

Closed reduction under general anesthesia

Answer

The patient is discharged home with analgesics, as a fracture has been ruled out.

Answer

Bone scan within the next 72 hours

Question 8

Avascular necrosis of the hip may occur following which of the following fractures?

Accepted Answer

Transcervical fracture of the neck of femur

Answer

Intertrochanteric fracture of the hip

Answer

Subtrochanteric fracture

Answer

Fracture of the posterior lip of the acetabulum

Question 9

Anterior dislocation of the shoulder is most commonly complicated by which of the following?

Accepted Answer

Circumflex nerve injury

Answer

Axillary artery injury

Answer

Recurrent dislocation

Answer

Axillary nerve injury

Question 10

What is the first priority in managing a patient with a fractured femur from an acute accident?

Accepted Answer

Secure airway and treat shock

Answer

Splint the fracture

Answer

Perform a physical examination

Answer

Obtain X-rays

Trauma — MCQs

Trauma — MCQs

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