Trauma Practice Questions

Q: Which is the most commonly injured tarsal bone?

Calcaneus. **Explanation:** The **calcaneus** (heel bone) is the most commonly fractured tarsal bone, accounting for approximately **60% of all tarsal fractures** and about 2% of all fractures in the body. Its vulnerability is primarily due to its weight-bearing function and its position as the first point of contact during axial loading. **Why Calcaneus is correct:** Most calcaneal fractures occur due to high-energy axial loading, such as a **fall from a height** landing on the feet (often associated with "Don Juan Syndrome"). Because it consists of a thin cortical shell surrounding cancellous bone, it is highly susceptible to compression and comminution under sudden force. **Why other options are incorrect:** * **Talus:** It is the second most common tarsal bone to be fractured. It is protected within the ankle mortise and requires significant force to fracture, often leading to avascular necrosis (AVN) due to its unique retrograde blood supply. * **Navicular:** Fractures are relatively rare and usually occur as stress fractures in athletes or due to direct trauma/twisting. * **Cuneiform:** These are rarely injured in isolation because they are tightly bound by strong interosseous ligaments within the midfoot complex. **Clinical Pearls for NEET-PG:** * **Don Juan Syndrome (Lover’s Fracture):** Calcaneal fractures are frequently associated with concurrent **compression fractures of the lumbar spine** (L1-L2) and bilateral calcaneal injuries. Always screen the spine in these patients. * **Bohler’s Angle:** A decrease in this angle (normal = 25°–40°) on a lateral X-ray suggests a calcaneal compression fracture. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot is a pathognomonic physical finding for calcaneal fractures.

Q: The posterolateral lesion in the head of humerus in cases of recurrent anterior shoulder dislocation is:

Hill-Sachs lesion. ### Explanation **Correct Option: B. Hill-Sachs lesion** **Mechanism and Pathophysiology:** In **recurrent anterior shoulder dislocation**, the humeral head is displaced anteriorly and inferiorly. As it exits the glenoid labrum, the soft **posterolateral** aspect of the humeral head strikes against the hard **anteroinferior** rim of the glenoid. This compression results in a "bookshelf" deformity or an impaction fracture on the humeral head. This specific bony defect is known as the **Hill-Sachs lesion**. It is a hallmark of recurrent instability and increases the risk of future dislocations. **Analysis of Incorrect Options:** * **A. Bankart’s lesion:** This is an injury to the **anteroinferior glenoid labrum** (and sometimes the bony rim). While it also occurs in anterior dislocations, it involves the glenoid, not the humeral head. * **C. Reverse Hill-Sachs lesion:** This is an impaction fracture on the **anterior** aspect of the humeral head, occurring during **posterior** shoulder dislocations (often seen in seizures or electric shocks). * **D. Greater tuberosity avulsion fracture:** This typically occurs in older patients during an initial traumatic dislocation due to the pull of the rotator cuff muscles, but it is not the characteristic "posterolateral lesion" associated with recurrent instability. **High-Yield Clinical Pearls for NEET-PG:** * **Bankart’s Lesion:** Most common cause of shoulder instability; involves the 3 o'clock to 6 o'clock position (right shoulder). * **Imaging:** Hill-Sachs lesions are best visualized on the **Stryker Notch view** (X-ray) or MRI. * **Engaging Hill-Sachs:** A lesion is "engaging" if it drops over the glenoid rim during functional range of motion, necessitating surgical intervention (e.g., **Remplissage procedure**). * **ALPSA Lesion:** Anterior Labral Periosteal Sleeve Avulsion (a variant of Bankart’s).

Q: Which of the following statements regarding this diagnosis is true?

Recurrence is a common complication. ***Recurrence is a common complication*** - **Anterior shoulder dislocation** has a high recurrence rate, especially in **young adults under 30 years**, where recurrence can exceed 80-90%. - **Recurrent dislocations** occur due to damage to the **glenoid labrum** (Bankart lesion) and capsular structures during the initial injury. *Common in children and rare in adults* - Anterior shoulder dislocation is **most common in adults**, particularly in the **20-40 year age group**. - In children, shoulder dislocations are relatively **rare** due to the greater elasticity of their joint capsules and ligaments. *May be overlooked as clinically occult* - Anterior shoulder dislocation presents with **obvious clinical signs** including loss of normal shoulder contour and severe pain. - The **squared-off shoulder** appearance and inability to move the arm make this injury readily apparent, not occult. *Is not associated with other bony or cartilaginous injury* - Anterior shoulder dislocation is commonly associated with **Hill-Sachs lesion** (compression fracture of the humeral head). - Also frequently involves **Bankart lesion** (tear of the anterior glenoid labrum) and potential **greater tuberosity fractures**.

Q: What is the abnormality shown in this shoulder radiograph?

Posterior dislocation of the shoulder. ***Posterior dislocation of the shoulder*** - Classic radiographic signs include the **"light bulb" sign** (fixed internal rotation of humeral head) and **trough line** (reverse Hill-Sachs lesion). - Shows **empty glenoid fossa** and **widened joint space** on AP view, distinguishing it from anterior dislocation. *Anterior dislocation of the shoulder* - Would show the humeral head positioned **inferior and medial** to the glenoid fossa on AP radiograph. - Associated with **Hill-Sachs lesion** (compression fracture of posterolateral humoral head), not the trough line seen in posterior dislocation. *Chondrosarcoma* - Appears as a **destructive bone lesion** with **chondroid matrix calcification** and soft tissue mass. - Shows **cortical destruction** and **aggressive bone changes**, not joint displacement or dislocation. *Simple bone cyst* - Presents as a **well-defined, lytic lesion** in the metaphysis with **thin cortical margins**. - Typically occurs in **proximal humerus** of children/adolescents, appearing as a fluid-filled cavity without joint involvement.

Q: A student presents with a shoulder injury sustained while playing football. On comparing the symmetry of his two shoulders, a marked elevation of the distal end of the clavicle with respect to the acromion is noted on the injured side. X-ray examination reveals a grade III shoulder separation. Which ligament must be torn for this injury to have occurred?

Coracoclavicular. **Explanation:** The clinical presentation of a "marked elevation of the distal end of the clavicle" (Step-off deformity) following trauma is characteristic of an **Acromioclavicular (AC) joint dislocation**, commonly referred to as a "shoulder separation." **1. Why Coracoclavicular (CC) is correct:** The stability of the AC joint depends on two sets of ligaments: the **Acromioclavicular ligaments** (horizontal stability) and the **Coracoclavicular ligaments** (vertical stability). The CC ligament complex consists of the **Conoid** and **Trapezoid** ligaments. In a **Grade III injury**, both the AC and CC ligaments are completely ruptured. Because the CC ligaments normally anchor the clavicle down to the coracoid process, their tear allows the clavicle to be pulled superiorly by the trapezius muscle, resulting in the visible elevation noted in the question. **2. Why other options are incorrect:** * **Coracoacromial:** This ligament connects two parts of the same bone (scapula). It forms the coracoacromial arch but does not stabilize the clavicle. * **Costoclavicular:** This ligament anchors the medial (sternal) end of the clavicle to the first rib. It is not involved in distal shoulder separations. * **Superior glenohumeral:** This is a component of the shoulder joint capsule (glenohumeral joint) and provides stability against inferior translation of the humeral head, not the clavicle. **Clinical Pearls for NEET-PG:** * **Rockwood Classification:** Grade I (Sprain), Grade II (AC torn, CC intact), Grade III (Both AC and CC torn; 25-100% displacement). * **Piano Key Sign:** A classic physical exam finding where the elevated distal clavicle can be depressed but springs back up. * **Management:** Grade I-III are typically managed conservatively (sling/rehab), while Grade IV-VI usually require surgical intervention.

Q: What deformity is characterized by a decreased carrying angle?

Cubitus varus. The **carrying angle** is the physiological outward angulation of the forearm when the arm is in the anatomical position (extended and supinated). It normally measures approximately 5–15 degrees. **1. Why Cubitus Varus is correct:** * **Cubitus varus** (also known as "Gunstock deformity") is a condition where the forearm is deviated medially toward the midline. * This results in a **decrease** or reversal of the normal carrying angle. * It most commonly occurs as a late complication of a **supracondylar fracture of the humerus** due to malunion. **2. Analysis of Incorrect Options:** * **Cubitus valgus:** This is an **increase** in the carrying angle (forearm deviates further away from the midline). It is often a late complication of a fracture of the **lateral condyle of the humerus** and can lead to "Tardy Ulnar Nerve Palsy." * **Mannus varus/valgus:** These terms refer to deformities of the **hand/wrist** (Mannus = Hand), not the elbow. *Varus* indicates medial deviation and *valgus* indicates lateral deviation of the hand relative to the forearm. **3. High-Yield Clinical Pearls for NEET-PG:** * **Normal Carrying Angle:** Greater in females than in males due to wider pelvises. * **Supracondylar Fracture:** Most common cause of Cubitus Varus. * **Tardy Ulnar Nerve Palsy:** Classically associated with **Cubitus Valgus**, where the ulnar nerve is stretched over the medial epicondyle over time. * **Mnemonic:** "Val**G**us" = **G**oes out (away from midline); "Varus" = Inward (toward midline).

Q: Which of the following radiographic views is NOT important in the assessment of a scaphoid fracture?

Cone view. **Explanation:** The scaphoid is the most commonly fractured carpal bone, and its complex anatomy requires a specific "Scaphoid Series" for accurate diagnosis. **Why "Cone View" is the correct answer:** A **Cone view** is a specialized radiographic technique used to improve detail in a localized area (often used in dental imaging or for specific skull/sinus pathologies) by narrowing the X-ray beam. It is **not** a standard or recognized view for evaluating carpal fractures. In the context of the wrist, it provides no diagnostic advantage over standard orthopedic views. **Analysis of Incorrect Options:** * **Anteroposterior (AP):** A standard view to assess general carpal alignment and identify transverse fractures. * **Lateral:** Essential for evaluating the "spilled teacup" sign (lunate dislocation) and checking for dorsal/palmar displacement or angulation (humpback deformity) of the scaphoid. * **Oblique (usually 45°):** This view shifts the other carpal bones out of the way, providing a clearer profile of the scaphoid body. * **Note on the "Scaphoid View":** The most critical view (not listed above but often tested) is the **PA view with Ulnar Deviation**. This maneuvers the scaphoid out of its foreshortened position, placing it parallel to the film to better visualize the waist. **Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid receives its blood supply distally from the radial artery. Therefore, **proximal pole fractures** have the highest risk of **Avascular Necrosis (AVN)** and non-union. * **Clinical Sign:** Tenderness in the **Anatomical Snuffbox** is the most sensitive clinical finding. * **Management:** If X-rays are negative but clinical suspicion is high, the wrist should be immobilized in a **Thumb Spica cast** and re-imaged in 10–14 days. MRI is the gold standard for early detection.

Question 1

Which is the most commonly injured tarsal bone?

Accepted Answer

Calcaneus

Answer

Talus

Answer

Navicular

Answer

Cuneiform

Question 2

The posterolateral lesion in the head of humerus in cases of recurrent anterior shoulder dislocation is:

Accepted Answer

Hill-Sachs lesion

Answer

Banka's lesion

Answer

Reverse Hill-Sachs lesion

Answer

Greater tuberosity avulsion fracture

Question 3

Which of the following statements regarding this diagnosis is true?

Accepted Answer

Recurrence is a common complication

Answer

Common in children and rare in adults

Answer

May be overlooked as clinically occult

Answer

Is not associated with other bony or cartilaginous injury

Question 4

A 37-year-old female patient has a fracture of the clavicle. The junction of the inner and middle third of the bone exhibits overriding of the medial and lateral fragments. The arm is rotated medially, but it is not rotated laterally. Which of the following complications is most likely to occur secondary to the fractured clavicle?

Accepted Answer

Thrombosis of the subclavian vein, causing a pulmonary embolism

Answer

A fatal hemorrhage from the brachiocephalic vein

Answer

Thrombosis of the subclavian artery, causing an embolism in the ascending aorta

Answer

Damage to the upper trunk of the brachial plexus

Question 5

Which of the following is NOT a recognized feature of myositis ossificans?

Accepted Answer

The complication is less likely to occur in children.

Answer

It is a post-traumatic ossification.

Answer

It often follows posterior dislocation or supracondylar fracture of the elbow joint.

Answer

Diagnosis is made with certainty by skiagraphy.

Question 6

What is the abnormality shown in this shoulder radiograph?

Accepted Answer

Posterior dislocation of the shoulder

Answer

Anterior dislocation of the shoulder

Answer

Chondrosarcoma

Answer

Simple bone cyst

Question 7

A student presents with a shoulder injury sustained while playing football. On comparing the symmetry of his two shoulders, a marked elevation of the distal end of the clavicle with respect to the acromion is noted on the injured side. X-ray examination reveals a grade III shoulder separation. Which ligament must be torn for this injury to have occurred?

Accepted Answer

Coracoclavicular

Answer

Coracoacromial

Answer

Costoclavicular

Answer

Superior glenohumeral

Question 8

What is the most common dangerous complication of posterior dislocation of the knee?

Accepted Answer

Popliteal artery injury

Answer

Sciatic nerve injury

Answer

Ischemia of the lower leg compartment

Answer

Femoral artery injury

Question 9

What deformity is characterized by a decreased carrying angle?

Accepted Answer

Cubitus varus

Answer

Mannus varus

Answer

Cubitus valgus

Answer

Mannus valgus

Question 10

Which of the following radiographic views is NOT important in the assessment of a scaphoid fracture?

Accepted Answer

Cone view

Answer

Anteroposterior (AP)

Answer

Lateral

Answer

Oblique

Trauma — MCQs

Trauma — MCQs

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