Trauma Practice Questions

Q: A 32-year-old male with a history of seizures presents with pain in the left shoulder region. The left upper limb is addicted and internally rotated. What is the diagnosis?

Posterior dislocation of shoulder. ### Explanation **Correct Option: B. Posterior Dislocation of Shoulder** The diagnosis is based on the classic clinical presentation and history. Posterior shoulder dislocations are rare (2-5% of all dislocations) and are classically associated with **seizures** or **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 pathognomonic **loss of external rotation**. On examination, there is often a palpable fullness in the posterior shoulder and a flattened anterior profile (loss of deltoid contour). **Analysis of Incorrect Options:** * **A. Anterior Dislocation:** This is the most common type. The limb is typically held in **abduction and external rotation**. It is usually caused by trauma (fall on an outstretched hand), not seizures. * **C. Inferior Dislocation (Luxatio Erecta):** A rare condition where the arm is held fixed in **full abduction** (pointing upwards) over the head. * **D. Impingement Syndrome:** A chronic overuse condition involving the rotator cuff; it does not present with an acute deformity or a fixed rotational deformity following a seizure. **High-Yield Clinical Pearls for NEET-PG:** * **Radiology:** Look for the **"Light Bulb Sign"** on AP view (the internally rotated humerus looks symmetrical like a bulb) and the **"Empty Glenoid Sign."** * **Best View:** The **Axillary view** is the gold standard to confirm posterior displacement. * **Associated Lesion:** **Reverse Hill-Sachs lesion** (impaction fracture of the anterior humeral head). * **Treatment:** Closed reduction (Modified Hippocratic method) followed by immobilization in **external rotation** (unlike anterior dislocation).

Q: Recurrent dislocation of the shoulder is most commonly associated with which type?

Anterior dislocation. **Explanation:** **1. Why Anterior Dislocation is Correct:** Anterior dislocation is the most common type of shoulder dislocation, accounting for approximately **95-97%** of all cases. Recurrence is a hallmark of anterior instability because the initial traumatic event often causes structural damage to the glenohumeral joint. The most significant factor is the **Bankart lesion** (avulsion of the anterior-inferior labrum), which fails to heal anatomically, leading to a permanent loss of the "chock-block" effect. Additionally, the presence of a **Hill-Sachs lesion** (compression fracture of the posterosuperior humeral head) further reduces joint stability, making recurrent episodes highly likely, especially in younger patients (age <20 years has a recurrence rate of up to 90%). **2. Why Other Options are Incorrect:** * **Posterior Dislocation:** These are rare (2-5%) and typically associated with seizures or electric shocks. While they can become chronic or "missed," they do not have the same high incidence of spontaneous recurrence as anterior dislocations. * **Inferior Dislocation (Luxatio Erecta):** This is the rarest form, characterized by the arm being locked in an overhead position. It is usually a high-energy trauma event associated with significant neurovascular injury rather than chronic recurrence. **3. Clinical Pearls for NEET-PG:** * **Most common cause of recurrence:** Patient age at the time of the first dislocation (younger = higher risk). * **Bankart Lesion:** Most common pathological finding in recurrent anterior dislocation. * **Putti-Platt/Magnuson-Stack:** Historical surgeries for recurrence (now largely replaced by Bankart repair). * **Latarjet Procedure:** Indicated when there is significant glenoid bone loss (>20-25%). * **Nerve Injury:** The **Axillary nerve** is the most commonly injured nerve in anterior dislocations (tested by sensation over the "Regimental Badge" area).

Q: What is the most common type of hip dislocation?

Posterior. **Explanation:** **1. Why Posterior Dislocation is Correct:** Posterior hip dislocation is the most common type, accounting for approximately **85-90%** of all traumatic hip dislocations. The underlying mechanism is typically a high-energy trauma, such as a "dashboard injury" in a motor vehicle accident. When the hip is flexed and adducted, a force applied to the knee drives the femoral head backward, rupturing the posterior capsule and dislodging it from the acetabulum. **2. Analysis of Incorrect Options:** * **Anterior Dislocation (Option B):** Much less common (approx. 10-15%). It occurs when the hip is in extreme extension, abduction, and external rotation (e.g., a fall from a height). * **Central Dislocation (Option C):** This is technically a fracture-dislocation where the femoral head is driven medially through a fractured acetabular floor into the pelvis. It is considered an acetabular fracture rather than a simple ligamentous dislocation. **3. High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** * **Posterior:** Limb is **Shortened, Adducted, and Internally Rotated** (Mnemonic: "S-A-I-R"). * **Anterior:** Limb is **Abducted and Externally Rotated**. * **Associated Nerve Injury:** The **Sciatic nerve** (specifically the peroneal division) is most commonly injured in posterior dislocations. * **Vascular Complication:** **Avascular Necrosis (AVN)** of the femoral head is the most serious late complication; the risk increases if reduction is delayed beyond 6 hours. * **X-ray Sign:** In posterior dislocation, the femoral head appears smaller than the contralateral side on AP view (due to being closer to the film). * **Management:** Emergency closed reduction (e.g., Allis or Bigelow maneuver) under sedation.

Q: Which of the following is referred to as Luxatio erecta?

Inferior dislocation of shoulder. **Explanation:** **Luxatio Erecta** is the medical term for **Inferior Dislocation of the Shoulder**. It is the rarest form of shoulder dislocation (accounting for <1%) and occurs when a hyperabduction force is applied to the arm, levering the humeral head against the acromion and displacing it inferiorly out of the glenoid cavity. * **Why Option B is correct:** In this condition, the humeral head is displaced inferior to the glenoid. Clinically, the patient presents in a classic "salute" posture: the arm is locked in fixed abduction, with the forearm resting on or behind the head. * **Why Option A is incorrect:** A tear of the glenoid labrum (e.g., Bankart lesion) is a common consequence of shoulder dislocation but is not a type of dislocation itself. * **Why Option C is incorrect:** Anterior dislocation is the most common type of shoulder dislocation (95%). It presents with the arm held in slight abduction and external rotation, not the vertical "erect" position seen in Luxatio erecta. * **Why Option D is incorrect:** A defect in the posterosuperior humeral head is known as a **Hill-Sachs lesion**, which is a secondary bony injury resulting from anterior instability. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Forceful hyperabduction. * **Clinical Sign:** Arm is locked in fixed abduction (110°–160°). * **Complications:** This type has the highest incidence of **axillary nerve** and **axillary artery** injury among all shoulder dislocations. * **Radiology:** The humeral shaft is parallel to the spine of the scapula on an X-ray.

Q: What is the best treatment for a trochanteric fracture of the femur?

Dynamic hip screw. **Explanation:** Trochanteric (intertrochanteric) fractures are extracapsular fractures that occur in a highly vascular area. The primary goal of treatment is early mobilization to prevent complications of prolonged recumbency (like DVT or pneumonia). **1. Why Dynamic Hip Screw (DHS) is the Correct Answer:** The **Dynamic Hip Screw (DHS)** is the gold standard for stable intertrochanteric fractures. The underlying medical concept is the **"sliding principle."** The DHS allows the femoral head fragment to collapse and slide along the barrel of the plate during weight-bearing. This controlled compression at the fracture site promotes secondary bone healing and increases stability. **2. Why the Other Options are Incorrect:** * **Inlay plates:** These are not used for trochanteric fractures as they do not provide the necessary dynamic compression or angular stability required to withstand the biomechanical stresses of the proximal femur. * **Plaster in abduction / Internal rotation:** Conservative management with hip spica or traction was used historically but is now obsolete. It leads to high rates of malunion (coxa vara) and life-threatening complications due to prolonged immobilization in elderly patients. **Clinical Pearls for NEET-PG:** * **Classification:** Boyd and Griffin or Evans classification is commonly used for these fractures. * **Stable vs. Unstable:** For **stable** fractures, DHS is preferred. For **unstable** fractures (e.g., reverse oblique type or loss of posteromedial cortex), a **Proximal Femoral Nail (PFN)** is the treatment of choice because it is an intramedullary device with a shorter lever arm. * **Complication:** The most common deformity following a poorly treated trochanteric fracture is **Coxa Vara** (decreased neck-shaft angle) leading to a short-limbed gait.

Q: Which complication may arise after a supracondylar fracture?

All of the above. **Explanation:** Supracondylar fractures of the humerus (specifically the extension type, which accounts for 95% of cases) are among the most common pediatric fractures and are notorious for both immediate neurovascular and late structural complications. 1. **Nerve Injury (Option A):** The displaced proximal fragment can stretch or contuse adjacent nerves. The **Median nerve** (specifically the Anterior Interosseous Nerve branch) is the most commonly injured in extension-type fractures. The Radial nerve is the second most common, while the Ulnar nerve is typically injured in flexion-type fractures or during surgical pinning. 2. **Vascular Injury (Option B):** The **Brachial artery** lies in close proximity to the sharp edge of the proximal bone fragment. Injury or spasm can lead to pulselessness and, if untreated, **Volkmann’s Ischemic Contracture (VIC)**. 3. **Deformity (Option C):** **Cubitus varus** (Gunstock deformity) is the most common late complication. It usually results from malunion (inadequate reduction of medial tilt or rotation) rather than physeal arrest. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Anterior Interosseous Nerve (AIN) – test by asking the patient to make an "OK" sign. * **Most common deformity:** Cubitus varus (primarily a cosmetic issue, rarely affects function). * **Gartland Classification:** Used to grade displacement (Type I: Undisplaced; Type II: Angulated but posterior cortex intact; Type III: Completely displaced). * **Urgency:** A "pink pulseless hand" is a surgical emergency requiring immediate reduction.

Q: Which of the following is NOT true about a Colles fracture?

Characterized by a garden spade deformity. **Explanation:** A **Colles fracture** is a distal radius fracture occurring approximately 2.5 cm proximal to the wrist joint. The hallmark clinical presentation is a **"Dinner Fork Deformity,"** not a garden spade deformity. 1. **Why Option D is the Correct Answer (False Statement):** The **Garden Spade Deformity** is characteristic of a **Smith’s fracture** (also known as a Reverse Colles). In a Smith’s fracture, the distal fragment is displaced volarly (ventrally). In contrast, a Colles fracture causes dorsal displacement, resembling the curve of a dinner fork. 2. **Analysis of Other Options:** * **Option A (True):** It is most common in elderly post-menopausal women due to osteoporosis. It typically results from a fall on an outstretched hand (FOOSH). * **Option B (True):** The classic displacement pattern in Colles includes **dorsal** displacement, dorsal tilt, lateral displacement, lateral tilt, impaction, and supination. * **Option C (True/Contextual):** While the fracture line is extra-articular (proximal to the joint), it is clinically categorized as a fracture "at the wrist" or involving the distal radial metaphysis. **High-Yield Clinical Pearls for NEET-PG:** * **Deformity Mnemonic:** **C**olles = **D**inner Fork (CD); **S**mith = **G**arden Spade (SG). * **Most common complication:** Stiffness of fingers and shoulder (Frozen shoulder). * **Most common nerve involved:** Median nerve (Carpal Tunnel Syndrome). * **Late complication:** Rupture of the **Extensor Pollicis Longus (EPL)** tendon due to ischemia or attrition at Lister’s tubercle. * **Treatment:** Most are managed by closed reduction and a "Colles cast" (below-elbow cast with the wrist in slight flexion and ulnar deviation).

Q: Which of the following fractures is known for malunion?

Supracondylar Humerus. ### Explanation **Correct Answer: B. Supracondylar Humerus** The **Supracondylar fracture of the humerus** is notorious for **malunion**, specifically resulting in a **Cubitus Varus deformity** (also known as "Gunstock deformity"). This occurs due to the failure to correct the rotational or coronal tilt of the distal fragment during reduction. Unlike many other fractures, the supracondylar region has a high remodeling potential in children for sagittal plane deformities (extension/flexion), but it has **zero remodeling potential** for rotational or varus/valgus malalignment. Therefore, any residual varus tilt persists and leads to a permanent cosmetic deformity. **Why the other options are incorrect:** * **A. Femur Neck:** This fracture is primarily known for **Non-union** and **Avascular Necrosis (AVN)**. This is due to the precarious retrograde blood supply and the lack of a periosteal layer (intracapsular), which prevents callus formation. * **C. Scaphoid:** Similar to the femoral neck, the scaphoid is prone to **Non-union** and **AVN** (specifically of the proximal pole) because of its tenuous distal-to-proximal blood supply. * **D. Lateral Condyle of Humerus:** This is a "fracture of necessity" (requires ORIF). It is famous for **Non-union** (due to the pull of extensor muscles and synovial fluid interference), which subsequently leads to **Cubitus Valgus** and **Tardy Ulnar Nerve Palsy**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of Supracondylar Fracture:** Malunion (Cubitus Varus). * **Most serious complication:** Volkmann’s Ischemic Contracture (VIC) due to brachial artery injury or compartment syndrome. * **Baumann’s Angle:** Used radiologically to assess the adequacy of reduction and predict future varus deformity. * **Reverse Gunstock Deformity:** Refers to Cubitus Valgus, typically seen following lateral condyle non-union.

Question 1

A 32-year-old male with a history of seizures presents with pain in the left shoulder region. The left upper limb is addicted and internally rotated. What is the diagnosis?

Accepted Answer

Posterior dislocation of shoulder

Answer

Anterior dislocation of shoulder

Answer

Inferior dislocation of shoulder

Answer

Impingement syndrome

Question 2

Recurrent dislocation of the shoulder is most commonly associated with which type?

Accepted Answer

Anterior dislocation

Answer

Posterior dislocation

Answer

Inferior dislocation

Answer

All of the above

Question 3

What is the most common type of hip dislocation?

Accepted Answer

Posterior

Answer

Answer

Central

Answer

None of the above

Question 4

Which of the following is referred to as Luxatio erecta?

Accepted Answer

Inferior dislocation of shoulder

Answer

Tear of the glenoid labrum

Answer

Anterior dislocation of shoulder

Answer

Defect in the humeral head

Question 5

What is the best treatment for a trochanteric fracture of the femur?

Accepted Answer

Dynamic hip screw

Answer

Inlay plates

Answer

Plaster in abduction

Answer

Plaster in abduction and internal rotation

Question 6

Which complication may arise after a supracondylar fracture?

Accepted Answer

All of the above

Answer

Median nerve injury

Answer

Damage to brachial artery

Answer

Cubitus varus

Question 7

Which of the following is NOT true about a Colles fracture?

Accepted Answer

Characterized by a garden spade deformity

Answer

Common in old age

Answer

Results in dorsal displacement of the distal fragment

Answer

Occurs at the radio-carpal joint

Question 8

Which of the following fractures is known for malunion?

Accepted Answer

Supracondylar Humerus

Answer

Femur neck

Answer

Scaphoid

Answer

Lateral condyle of humerus

Question 9

Which of the following methods is an example of rigid fixation?

Accepted Answer

Lag screw fixation

Answer

Miniplate osteosynthesis

Answer

Transosseous wiring

Answer

None of the above

Question 10

What is the immediate treatment of an unstable tibial plateau fracture?

Accepted Answer

Internal fixation with plate and screw

Answer

Internal fixation with nail

Answer

External fixator

Answer

Complete bed rest

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?