Trauma Practice Questions

Q: Fracture of the scaphoid bone is most commonly seen in which patient population?

Young active adult. **Explanation:** The **scaphoid** is the most commonly fractured carpal bone (approx. 60–70%). The mechanism of injury is typically a **fall on an outstretched hand (FOOSH)** with the wrist in dorsiflexion and radial deviation. **1. Why "Young Active Adult" is correct:** This population is most frequently involved in high-energy activities, sports, and motor vehicle accidents. In young adults, the bone density is high, but the force of impact is sufficient to snap the scaphoid across its waist. In contrast, similar trauma in other age groups often results in different fracture patterns due to varying bone strengths. **2. Why the other options are incorrect:** * **Elderly (Male/Postmenopausal Female):** In the elderly, the distal radius is relatively weaker due to osteoporosis. Therefore, a FOOSH more commonly results in a **Colles' fracture** rather than a scaphoid fracture. * **Children:** The scaphoid is largely cartilaginous in young children and does not ossify completely until mid-adolescence. Consequently, a FOOSH in children typically results in a **greenstick fracture of the distal radius** or a supracondylar fracture of the humerus. **Clinical Pearls for NEET-PG:** * **Most common site:** The **waist** of the scaphoid (70%). * **Blood Supply:** Supplied by the radial artery (retrograde flow). This makes the **proximal pole** highly susceptible to **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox**. * **Radiology:** If initial X-rays are negative but clinical suspicion is high, repeat X-rays in 10–14 days or perform an MRI (most sensitive). * **Management:** Undisplaced fractures are treated with a **Scaphoid cast** (Glass-holding position).

Q: Which of the following is NOT a principle in the treatment of compound fractures?

Immediate wound closure. **Explanation:** The primary goal in managing compound (open) fractures is to prevent **osteomyelitis** and promote soft tissue healing. **Why "Immediate Wound Closure" is the correct answer:** In compound fractures, the wound is considered contaminated by definition. **Immediate primary closure** is strictly contraindicated because it traps bacteria and debris inside the wound, creating an anaerobic environment that significantly increases the risk of gas gangrene and severe infection. Instead, these wounds are typically managed by **delayed primary closure** or healing by secondary intention once the wound is clinically clean. **Analysis of Incorrect Options:** * **Wound Debridement:** This is the "gold standard" and most critical step. It involves removing all devitalized tissue and foreign bodies to convert a contaminated wound into a clean one. * **Tendon Repair:** While not always the first priority, primary or delayed repair of tendons is a standard principle of reconstructive management once the infection risk is mitigated. * **Aggressive Antibiotic Therapy:** Early administration of intravenous antibiotics (usually a cephalosporin, adding an aminoglycoside for Gustilo-Anderson Type II/III) is mandatory to reduce infection rates. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Period:** Debridement should ideally be performed within **6 hours** of injury. * **Gustilo-Anderson Classification:** This is the most common system used to grade open fractures (Type I to III). * **The "Three Is":** The pillars of management are **I**rrigation (lavage), **I**ncision (debridement), and **I**nternal/External fixation. * **Rule of Thumb:** Never close an open fracture wound primarily if there is any doubt regarding tissue viability or contamination.

Q: A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?

Stiffness of the wrist joint. ### Explanation **1. Why Option A is Correct:** Stiffness of the wrist and fingers is the **most common late complication** of a Colles fracture. It typically results from prolonged immobilization in a Plaster of Paris (POP) cast, lack of physiotherapy, or persistent post-traumatic edema. In elderly patients or children, failure to perform active finger exercises during the casting period leads to adhesions in the tendon sheaths and joint capsules, resulting in significant functional impairment. **2. Why the Other Options are Incorrect:** * **Option B (Ulnar Nerve Palsy):** This is rarely associated with Colles fractures. Ulnar nerve injury is more commonly seen in fractures of the medial epicondyle of the humerus or distal ulnar shaft fractures. * **Option C (Median Nerve Palsy):** While the median nerve can be involved, it is typically an **early/acute complication** (due to direct trauma or carpal tunnel compression from edema) rather than a late complication. If it occurs late, it is usually due to secondary Carpal Tunnel Syndrome, but stiffness remains the more universally recognized and frequent late sequela. **3. Clinical Pearls for NEET-PG:** * **Eponymous Deformity:** Colles fracture presents with a "Dinner Fork Deformity" (dorsal displacement). * **Rupture of Extensor Pollicis Longus (EPL):** This is a classic, high-yield **late complication** caused by ischemia or attrition of the tendon at Lister’s tubercle. * **Sudeck’s Osteodystrophy (CRPS):** Another important late complication characterized by pain, swelling, and "patchy osteoporosis" on X-ray. * **Malunion:** Leads to a permanent dinner fork deformity but often remains functionally acceptable in the elderly.

Q: Pipkin classification is used for which type of fracture?

Femoral head fracture. **Explanation:** The **Pipkin Classification** is the standard system used to categorize **Femoral Head Fractures**, which typically occur as a result of high-energy trauma (like dashboard injuries) often associated with posterior hip dislocations. **1. Why the Correct Answer is Right:** The classification is based on the location of the fracture line relative to the **fovea capitis** and the presence of associated injuries to the acetabular rim or femoral neck. * **Type I:** Fracture inferior to the fovea capitis (small fragment). * **Type II:** Fracture superior to the fovea capitis (large fragment). * **Type III:** Type I or II fracture associated with a **femoral neck fracture** (high risk of AVN). * **Type IV:** Type I or II fracture associated with an **acetabular rim fracture**. **2. Why Incorrect Options are Wrong:** * **Acetabular Fractures:** These are most commonly classified using the **Judet-Letournel Classification** (based on columns and walls). * **Pelvis Ring Fractures:** These use the **Tile Classification** (based on stability) or the **Young-Burgess Classification** (based on mechanism of injury like APC or LC). * **Femoral Shaft Fractures:** These are typically classified using the **Winquist-Hansen Classification** (based on the degree of comminution). **Clinical Pearls for NEET-PG:** * **Mechanism:** Most femoral head fractures occur during **posterior hip dislocation**. * **Prognosis:** Pipkin Type III has the worst prognosis due to the high risk of **Avascular Necrosis (AVN)**. * **Management:** Type I and II are often treated with ORIF if displaced; Type III and IV usually require surgical intervention and carry a high risk of secondary osteoarthritis.

Q: An injury to the shown area can lead to fracture of which bone?

Scaphoid. ***Scaphoid*** - The **anatomical snuffbox** is the most vulnerable area for scaphoid fractures, typically occurring after a **fall on outstretched hand (FOOSH)** injury. - **Tenderness in the anatomical snuffbox** and pain with **radial deviation** of the wrist are classic clinical findings of scaphoid fracture. *Lunate* - Lunate fractures are much **rarer** and typically occur with **high-energy trauma** or **perilunate dislocations**. - The lunate is **not directly palpable** in the anatomical snuffbox area, making it less susceptible to injury from this mechanism. *Hamate* - Hamate fractures commonly occur from **direct trauma** to the **hypothenar eminence** or **hook of hamate**. - The hamate is located on the **ulnar side** of the wrist and is not anatomically related to the snuffbox area. *Trapezium* - Trapezium fractures are typically associated with **Bennett's fracture** involving the **first metacarpal base**. - Located at the **base of the thumb**, the trapezium is not directly involved in anatomical snuffbox injuries.

Q: Non-union is a complication of which of the following fractures?

Scaphoid fracture. ### **Explanation** The correct answer is **A. Scaphoid fracture**. **1. Why Scaphoid Fracture is the Correct Answer:** Non-union is a notorious complication of scaphoid fractures primarily due to its **precarious blood supply**. The scaphoid receives its blood supply in a **retrograde fashion** (from distal to proximal) via the dorsal carpal branch of the radial artery. A fracture across the waist or proximal pole can easily interrupt this supply, leading to ischemia of the proximal fragment. This results in a high incidence of **Avascular Necrosis (AVN)** and subsequent **non-union**. **2. Why the Other Options are Incorrect:** * **B. Colles' Fracture:** This occurs at the distal radius, which has a rich blood supply and cancellous bone. It typically heals well; the most common complication is **Mal-union** (dinner fork deformity), not non-union. * **C. Intertrochanteric Fracture:** This region is extracapsular and consists of highly vascular cancellous bone. These fractures heal readily; the primary complication is **Mal-union** (coxa vara). In contrast, *Neck of Femur* fractures (intracapsular) are prone to non-union. * **D. Supracondylar Fracture (Humerus):** This is common in children. The most frequent complications are **Mal-union** (Cubitus varus/Gunstock deformity) and vascular injury (Volkmann’s Ischemic Contracture). Non-union is extremely rare here. **3. High-Yield Clinical Pearls for NEET-PG:** * **Common sites for Non-union:** Scaphoid (waist), Neck of Femur, Talus (neck), and Lower 1/3rd of Tibia. * **Scaphoid Fact:** The most common site of fracture is the **waist (70%)**. The more proximal the fracture, the higher the risk of AVN and non-union. * **Radiology:** If a scaphoid fracture is clinically suspected (tenderness in the anatomical snuffbox) but X-rays are negative, the wrist should be immobilized and re-imaged after **10–14 days**.

Q: All of the following statements about dislocation of the shoulder are true, except?

The commonest position for the head of the humerus to move into is the subglenoid.. **Explanation:** **1. Why Option B is the Correct Answer (The False Statement):** While the shoulder is the most commonly dislocated joint in the body, the most frequent anatomical position for the humeral head in an anterior dislocation is **Subcoracoid**, not subglenoid. In anterior dislocations (which account for >95% of cases), the head usually settles beneath the coracoid process. Subglenoid is the second most common position. **2. Analysis of Other Options:** * **Option A:** The classic mechanism of injury is a fall on an outstretched hand with the arm in **abduction, extension, and external rotation**. This forces the humeral head against the weak anterior capsule. * **Option C:** The **Axillary nerve** (C5-C6) is the most commonly injured nerve in shoulder dislocations due to its proximity to the surgical neck of the humerus. Clinically, this presents as "regimental badge" anesthesia over the lateral deltoid. * **Option D:** While many maneuvers exist (e.g., Hippocratic, Kocher’s, Stimson), the safest and easiest way to reduce a dislocation is using gentle traction/pressure under **General Anesthesia (GA)** with muscle relaxation. This overcomes muscle spasms (especially the subscapularis) and minimizes the risk of iatrogenic fractures. **3. NEET-PG High-Yield Pearls:** * **Most common type:** Anterior (Subcoracoid). * **Posterior Dislocation:** Associated with **seizures or electric shocks**. Look for the "Light bulb sign" on X-ray. * **Hill-Sachs Lesion:** Compression fracture of the posterosuperolateral humeral head. * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Luxatio Erecta:** A rare inferior dislocation where the arm is held fixed in an overhead position.

Q: A 45-year-old female has a history of a slip in the bathroom, complaining of right hip pain and tenderness in Scarpa's triangle. The X-ray is normal. What is the next investigation?

MRI. ### Explanation **1. Why MRI is the Correct Choice:** The clinical presentation (slip in a bathroom, hip pain, and tenderness in Scarpa’s triangle) is highly suspicious of a **fracture of the neck of the femur**. In elderly or osteoporotic patients, these fractures can be **occult** (not visible on initial X-rays). **MRI is the gold standard** and the investigation of choice for occult hip fractures. It has a sensitivity and specificity of nearly 100%. It can detect bone marrow edema within 24 hours of injury, which indicates a fracture even when the cortical lines appear intact on a radiograph. **2. Why Other Options are Incorrect:** * **USG-guided aspiration:** This is primarily used to diagnose septic arthritis or to relieve a tense joint effusion. It has no role in diagnosing an occult fracture. * **CT Scan:** While CT is excellent for evaluating complex fracture patterns and cortical detail, it is less sensitive than MRI for detecting early trabecular microfractures or bone marrow edema. It is usually the second-line choice if MRI is contraindicated. * **Bone Scan (Technetium-99m):** Historically used for occult fractures, but it may take 48–72 hours to become positive in the elderly (delayed osteoblastic activity). It is less specific and has been largely replaced by MRI. **3. Clinical Pearls for NEET-PG:** * **Tenderness in Scarpa’s Triangle:** A classic clinical sign of a hip fracture or hip joint pathology. * **Occult Fracture Definition:** A fracture that is clinically suspected but not visible on initial plain radiographs. * **Management Rule:** If a patient has a high clinical suspicion of a hip fracture but normal X-rays, they **must not** be discharged. They require an MRI to rule out the fracture. * **MRI Contraindication:** If the patient has a pacemaker or metallic implants, a **CT scan** becomes the next best investigation.

Question 1

Fracture of the scaphoid bone is most commonly seen in which patient population?

Accepted Answer

Young active adult

Answer

Elderly male

Answer

Elderly postmenopausal female

Answer

Children

Question 2

Which of the following is NOT a principle in the treatment of compound fractures?

Accepted Answer

Immediate wound closure

Answer

Wound debridement

Answer

Tendon repair

Answer

Aggressive antibiotic therapy

Question 3

A 75-year-old woman presents with a history of tripping and falling in the bathroom, and is unable to walk or bear weight on her left hip. On examination, her left lower limb was noted to be in an externally rotated position, the hip was tender, and active straight leg raising was not possible. What is the most likely diagnosis?

Accepted Answer

Fracture neck of femur

Answer

Osteoarthritis hip

Answer

Dislocation of hip joint

Answer

Acetabular fracture

Question 4

A 37-year-old male is brought to the emergency room after a road traffic accident. On examination, the capillary refilling time is delayed in the left lower limb. Which of the following is NOT an indication for amputation in this patient?

Accepted Answer

Transcutaneous Oxygen Tension - 40mmHg

Answer

Severe Peripheral Vascular disease

Answer

Ankle-Brachial Index < 0.45

Answer

Fulminant Gas Gangrene

Question 5

A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?

Accepted Answer

Stiffness of the wrist joint

Answer

Ulnar nerve palsy

Answer

Median nerve palsy

Answer

None of the above

Question 6

Pipkin classification is used for which type of fracture?

Accepted Answer

Femoral head fracture

Answer

Acetabular fractures

Answer

Pelvis ring fracture

Answer

Femoral shaft fracture

Question 7

An injury to the shown area can lead to fracture of which bone?

Accepted Answer

Scaphoid

Answer

Lunate

Answer

Hamate

Answer

Trapezium

Question 8

Non-union is a complication of which of the following fractures?

Accepted Answer

Scaphoid fracture

Answer

Colles' fracture

Answer

Intertrochanteric fracture of the hip

Answer

Supracondylar fracture of the humerus

Question 9

All of the following statements about dislocation of the shoulder are true, except?

Accepted Answer

The commonest position for the head of the humerus to move into is the subglenoid.

Answer

The injury is produced by a fall with the arm fully abducted.

Answer

The axillary nerve is likely to be injured.

Answer

The easiest way to reduce it is by simple pressure with the patient under general anesthesia with muscle relaxation.

Question 10

A 45-year-old female has a history of a slip in the bathroom, complaining of right hip pain and tenderness in Scarpa's triangle. The X-ray is normal. What is the next investigation?

Accepted Answer

MRI

Answer

USG-guided aspiration

Answer

CT scan

Answer

Bone scan

Trauma — MCQs

Trauma — MCQs

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