Trauma Practice Questions

Q: A 24-year-old male, known epileptic, presented following a seizure with pain in the right shoulder region. Examination revealed that the right upper limb was adducted and internally rotated, and movements could not be performed. Which of the following is the most likely diagnosis?

Posterior dislocation of shoulder. ### Explanation **Correct Option: A. Posterior dislocation of shoulder** **Reasoning:** Posterior shoulder dislocation is a classic "hidden" injury often associated with **seizures** or **high-voltage electric shocks**. During a seizure, the powerful internal rotators (Latissimus dorsi, Pectoralis major, and Subscapularis) overpower the weaker external rotators, forcing the humeral head posteriorly. The clinical hallmark is a limb fixed in **adduction and internal rotation**, with a total loss of external rotation. Radiologically, this may present as the "Light bulb sign" (due to internal rotation) or the "Rim sign." **Analysis of Incorrect Options:** * **B. Luxatio erecta:** This is an inferior dislocation where the arm is held **abducted** (pointing upwards) rather than adducted. It is rare and usually results from hyperabduction forces. * **C. Intrathoracic dislocation:** An extremely rare type of fracture-dislocation where the humeral head is driven between the ribs into the thoracic cavity; it presents with severe trauma, not typically simple seizures. * **D. Subglenoid dislocation:** This is a subtype of **Anterior dislocation** (the most common type). In anterior dislocations, the arm is typically held in **abduction and external rotation**, which is the opposite of this patient's presentation. **Clinical Pearls for NEET-PG:** * **Triple S:** **S**eizures, **S**hocks, and **S**capular fractures are highly associated with posterior dislocations. * **Most missed dislocation:** Posterior dislocations are missed in up to 50% of initial ER visits because the AP view can look deceptively normal. * **Imaging:** The **Axillary view** or **Scapular Y-view** is the gold standard to confirm the diagnosis. * **Trough Line Sign:** A vertical line on the humeral head caused by an impaction fracture (Reverse Hill-Sachs lesion).

Q: An oblique fracture of the olecranon, if displaced proximally, what is the treatment?

Tension band wiring. **Explanation:** The olecranon is an intra-articular structure and forms a key part of the elbow's extensor mechanism. When an olecranon fracture is displaced, it indicates that the **Triceps brachii** muscle has pulled the proximal fragment superiorly. **Why Tension Band Wiring (TBW) is the Correct Choice:** The gold standard for displaced, transverse, or short oblique fractures of the olecranon is **Tension Band Wiring**. This technique operates on the "conversion of forces" principle: it converts the distracting (pulling) force of the triceps muscle into a **compressive force** across the fracture site during elbow flexion. This promotes primary bone healing and allows for early range-of-motion exercises, preventing elbow stiffness. **Analysis of Incorrect Options:** * **A. Excision and resuturing:** This is only considered in elderly, low-demand patients with highly comminuted fractures where internal fixation is impossible. It is not the primary treatment for a standard oblique fracture. * **C. Elbow immobilization by cast:** This is reserved for undisplaced fractures. In displaced fractures, conservative management leads to non-union and loss of elbow extension. * **D. Open reduction and external fixation:** External fixation is rarely used for the olecranon; it is typically reserved for open fractures with severe soft tissue loss or active infection. **High-Yield Clinical Pearls for NEET-PG:** * **Indication for Plate Fixation:** If the fracture is highly comminuted, distal to the coronoid process, or an **oblique fracture extending distal to the midpoint of the trochlear notch**, a locking compression plate is preferred over TBW. * **Complication:** The most common complication of TBW is **symptomatic hardware** (prominent K-wires), often requiring secondary removal. * **Nerve Injury:** The **Ulnar nerve** is the most common nerve at risk during surgical approaches to the olecranon.

Q: Which of the following is NOT true about posterior dislocation of the hip?

Trendelenberg test is typically negative.. In posterior hip dislocation, the femoral head is displaced out of the acetabulum, leading to a loss of the fulcrum required for the hip abductors (Gluteus medius and minimus) to function. This results in a **positive Trendelenburg test**, making Option D the incorrect statement and thus the correct answer. ### Explanation of Options: * **Option A (Dashboard Injury):** This is the most common mechanism. A force applied to the knee while the hip and knee are flexed (as in a car crash) drives the femoral head posteriorly out of the acetabulum. * **Option B (Vascular Sign of Narath):** In posterior dislocations, the femoral head is no longer behind the femoral artery in the femoral triangle. Consequently, the femoral artery pulsations feel weak or "empty" because the bony support is missing. This is a classic clinical sign. * **Option C (Sciatic Nerve Injury):** The sciatic nerve runs immediately posterior to the acetabulum. It is injured in approximately 10–20% of cases, most commonly involving the peroneal division (leading to foot drop). ### High-Yield Clinical Pearls for NEET-PG: * **Clinical Presentation:** The limb is typically held in **Flexion, Adduction, and Internal Rotation** (Shortened). * **X-ray Finding:** The femoral head appears smaller than the contralateral side (Shenton’s line is broken). * **Management:** It is an orthopedic emergency. Reduction should be done within 6 hours to prevent **Avascular Necrosis (AVN)** of the femoral head. * **Commonest Type:** Posterior dislocation is the most common type of hip dislocation (approx. 90%).

Q: An incomplete tear of a ligament or a complex of ligaments around a joint is known as:

Sprain. ### Explanation **Correct Answer: C. Sprain** A **sprain** is defined as an injury to a **ligament** or a joint capsule, usually caused by a sudden stretch or twist beyond its normal range of motion. Pathologically, it represents an incomplete tear or stretching of the collagen fibers. Sprains are graded by severity: * **Grade I:** Microscopic tearing (stretch). * **Grade II:** Partial/Incomplete tear (the focus of this question). * **Grade III:** Complete rupture of the ligament. --- ### Why the other options are incorrect: * **A. Dislocation:** This refers to the **complete displacement** of the articular surfaces of the bones that form a joint, resulting in a total loss of contact between them. * **B. Subluxation:** This is a **partial or incomplete displacement** of the joint surfaces. Unlike a dislocation, some contact between the articular surfaces remains. * **C. Strain:** While often confused with a sprain, a strain specifically refers to an injury to a **muscle or a tendon** (the "T" in Strain for Tendon). It occurs due to overstretching or over-contraction of the musculotendinous unit. --- ### High-Yield Clinical Pearls for NEET-PG: 1. **Mnemonic:** Remember **S**prain = **S**upporting structure (Ligament); **S**train = **T**endon/Muscle. 2. **Most Common Site of Sprain:** The **Ankle**, specifically the **Anterior Talofibular Ligament (ATFL)** during an inversion injury. 3. **Management:** The standard initial treatment for sprains and strains is the **RICE** protocol (Rest, Ice, Compression, Elevation), though modern protocols now suggest **POLICE** (Protection, Optimal Loading, Ice, Compression, Elevation). 4. **Joint Stability:** A Grade III sprain (complete tear) often results in joint instability, whereas Grade I and II sprains typically maintain mechanical stability despite pain and swelling.

Q: Moneteggia fracture is a fracture of which part of the forearm?

Upper one-third of the ulna. ### Explanation **Monteggia fracture-dislocation** is a classic orthopedic injury defined as a **fracture of the proximal (upper) third of the ulna** associated with a **dislocation of the radial head** at the proximal radioulnar joint. #### Why the Correct Answer is Right: * **Option D (Upper one-third of the ulna):** By definition, the Monteggia lesion involves the shaft of the ulna, most commonly at the junction of the proximal and middle thirds. The force required to fracture the ulna in this mechanism often results in the secondary displacement of the radial head, making the ulnar fracture the primary bony component of this injury. #### Why Other Options are Wrong: * **Options A & B (Radius fractures):** Fractures of the radius shaft with associated distal radioulnar joint (DRUJ) dislocation are termed **Galeazzi fractures**. Monteggia specifically involves the ulna. * **Option C (Lower one-third of the ulna):** Fractures of the distal ulna are not part of the Monteggia complex. Isolated distal ulnar fractures are often called "Nightstick fractures" if caused by a direct blow. --- ### High-Yield Clinical Pearls for NEET-PG: 1. **Mnemonic (MUGR):** * **M**onteggia: **U**lna fracture (Proximal) + Radial head dislocation. * **G**aleazzi: **R**adius fracture (Distal) + Distal Radioulnar Joint (DRUJ) dislocation. 2. **Bado Classification:** Used to categorize Monteggia fractures based on the direction of radial head dislocation (Type I is Anterior, the most common). 3. **Nerve Injury:** The **Posterior Interosseous Nerve (PIN)**, a branch of the radial nerve, is the most commonly injured nerve in Monteggia fractures due to the radial head dislocation. 4. **Management:** In adults, these require **Open Reduction and Internal Fixation (ORIF)** with a plate and screws to ensure anatomical alignment and stability of the radioulnar joints.

Q: Which of the following is a late complication of fracture acetabulum of the hip?

Osteoarthritis. **Explanation:** Fractures of the acetabulum are intra-articular injuries that disrupt the weight-bearing surface of the hip joint. **1. Why Osteoarthritis is the Correct Answer:** Post-traumatic **Osteoarthritis (OA)** is the most common late complication of acetabular fractures. Even with anatomical reduction, the initial impact often causes chondrocyte death or subchondral damage. Any residual articular incongruity leads to abnormal stress distribution, accelerated cartilage wear, and secondary OA. This typically manifests years after the initial injury. **2. Why the Other Options are Incorrect:** * **Tardy sciatic nerve palsy:** While sciatic nerve injury is a common complication of acetabular fractures (occurring in up to 10-15% of cases), it is typically an **early/acute** complication occurring at the time of injury or during surgery. "Tardy" (delayed) palsy is characteristic of the ulnar nerve at the elbow, not the sciatic nerve at the hip. * **Recurrent dislocation:** This is a common complication of **traumatic hip dislocations** (especially if associated with a posterior wall fragment), but it is not a standard "late" complication of the acetabular fracture itself. Once the fracture heals, the joint usually remains stable unless there is significant bone loss. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common early complication:** Sciatic nerve injury (specifically the peroneal division). * **Most common late complication:** Post-traumatic Osteoarthritis. * **Avascular Necrosis (AVN):** Can occur if the fracture is associated with a hip dislocation that disrupts the femoral head's blood supply. * **Heterotopic Ossification:** A frequent complication following the surgical approach (especially the Kocher-Langenbeck approach); Prophylaxis with NSAIDs (Indomethacin) or low-dose radiation is often used. * **Judet Views:** The gold standard X-rays for diagnosis (Iliac oblique and Obturator oblique views).

Q: What is the treatment of choice for a non-united fracture of the shaft of the femur in an elderly patient?

Compression plating with bone grafting. **Explanation:** The management of a non-union in the femoral shaft requires addressing two fundamental requirements for bone healing: **mechanical stability** and **biological stimulation**. 1. **Why Option D is correct:** In an elderly patient, bone healing capacity is often diminished due to poor vascularity or osteoporosis. **Compression plating** (using a Dynamic Compression Plate) provides rigid internal fixation and compression at the fracture site, which eliminates motion. However, since it is a non-union, stability alone is often insufficient. **Bone grafting** (typically autologous cancellous graft) provides the necessary osteoconductive and osteoinductive properties to jump-start the biological healing process. The combination ensures both the "scaffold" and the "stability" needed for union. 2. **Why other options are incorrect:** * **Compression plating (A):** Provides stability but lacks the biological stimulus required to overcome an established non-union. * **Bone grafting (B):** Provides biology but lacks the mechanical stability required to hold the femur (a weight-bearing bone) in alignment. * **Nailing (C):** While intramedullary nailing is the gold standard for *fresh* femoral fractures, in the case of non-union (especially atrophic), nailing alone has a higher failure rate compared to the direct compression and grafting achieved via plating. **Clinical Pearls for NEET-PG:** * **Definition of Non-union:** A fracture that has no chance of healing without surgical intervention (typically after 6–9 months). * **Atrophic Non-union:** Characterized by "pencil-tip" bone ends and lack of callus; always requires bone grafting. * **Hypertrophic Non-union:** Characterized by "elephant foot" appearance; usually requires stability (plating/nailing) alone as biology is already active. * **Gold Standard Graft:** Autologous Iliac Crest Bone Graft (AICBG).

Q: In a fracture of the shaft of the humerus, which of the following complications requires immediate surgery?

Arterial occlusion. **Explanation:** In the management of humeral shaft fractures, **Arterial Occlusion (Option C)** is a surgical emergency. The brachial artery is the primary vessel at risk, especially in fractures of the distal third of the humerus. If blood flow is compromised, the limb faces an immediate risk of ischemia and subsequent **Volkmann’s Ischemic Contracture**. Therefore, immediate surgical exploration, vascular repair, and stabilization of the fracture are mandatory to restore perfusion. **Analysis of Other Options:** * **A. Compound Fracture:** While these require urgent debridement and stabilization (usually within 6–24 hours), they do not always necessitate "immediate" surgery in the same life-or-limb-threatening sense as a complete arterial block, provided the wound is cleaned and antibiotics are started. * **B. Nerve Injury:** The **Radial Nerve** is the most commonly injured nerve in humeral shaft fractures (especially Holstein-Lewis fractures). However, most are neuropraxias that resolve spontaneously. Surgery is only indicated if the nerve injury occurs *after* manipulation or in open injuries. * **C. Comminuted Fracture:** These are usually managed conservatively with a U-slab or functional bracing (Sarmiento brace). Surgery is only required if alignment cannot be maintained. **NEET-PG High-Yield Pearls:** * **Most common nerve injured:** Radial nerve (specifically in the spiral groove). * **Holstein-Lewis Fracture:** A spiral fracture of the distal 1/3rd of the humerus associated with radial nerve palsy. * **Primary treatment:** Most humeral shaft fractures (up to 90%) are managed **conservatively** with a hanging cast or functional brace. * **Absolute indications for surgery:** Vascular injury, "floating elbow" (simultaneous forearm fracture), and bilateral humeral fractures.

Question 1

A 24-year-old male, known epileptic, presented following a seizure with pain in the right shoulder region. Examination revealed that the right upper limb was adducted and internally rotated, and movements could not be performed. Which of the following is the most likely diagnosis?

Accepted Answer

Posterior dislocation of shoulder

Answer

Luxatio erecta

Answer

Intrathoracic dislocation of shoulder

Answer

Subglenoid dislocation of shoulder

Question 2

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

Question 3

An oblique fracture of the olecranon, if displaced proximally, what is the treatment?

Accepted Answer

Tension band wiring

Answer

Excision and resuturing

Answer

Elbow immobilization by cast

Answer

Open reduction and external fixation

Question 4

Which of the following is NOT true about posterior dislocation of the hip?

Accepted Answer

Trendelenberg test is typically negative.

Answer

Often associated with dashboard injuries.

Answer

A vascular sign of Narath may be observed.

Answer

Risk of sciatic nerve injury is present.

Question 5

A 24-year-old male, known epileptic, presented following a seizure with pain in the right shoulder region. Examination revealed that the right upper limb was adducted and internally rotated, and movements could not be performed. Which of the following is the most likely diagnosis?

Accepted Answer

Posterior dislocation of shoulder

Answer

Luxatio erecta

Answer

Intrathoracic dislocation of shoulder

Answer

Subglenoid dislocation of shoulder

Question 6

An incomplete tear of a ligament or a complex of ligaments around a joint is known as:

Accepted Answer

Sprain

Answer

Dislocation

Answer

Subluxation

Answer

Strain

Question 7

Moneteggia fracture is a fracture of which part of the forearm?

Accepted Answer

Upper one-third of the ulna

Answer

Lower one-third of the radius

Answer

Upper one-third of the radius

Answer

Lower one-third of the ulna

Question 8

Which of the following is a late complication of fracture acetabulum of the hip?

Accepted Answer

Osteoarthritis

Answer

Tardy sciatic nerve palsy

Answer

Recurrent dislocation

Answer

None of the above

Question 9

What is the treatment of choice for a non-united fracture of the shaft of the femur in an elderly patient?

Accepted Answer

Compression plating with bone grafting

Answer

Compression plating

Answer

Bone grafting

Answer

Nailing

Question 10

In a fracture of the shaft of the humerus, which of the following complications requires immediate surgery?

Accepted Answer

Arterial occlusion

Answer

Compound fracture

Answer

Nerve injury

Answer

Comminuted fracture

Trauma — MCQs

Trauma — MCQs

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