Trauma Practice Questions

Q: A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?

Anterior inferior glenohumeral ligament. ***Anterior inferior glenohumeral ligament*** - This ligament is a primary static stabilizer against **anterior dislocation** of the shoulder; thus, it is frequently stretched or torn during such an event. - Damage to this ligament is often associated with a **Bankart lesion**, which is an injury to the anterior inferior labrum that can lead to recurrent dislocations. *Long head of biceps tendon* - While the **long head of the biceps tendon** can be injured in shoulder trauma, it is more commonly associated with chronic overuse or superior labral tears (**SLAP lesions**), rather than primary anterior dislocation. - Injuries to this tendon might occur as a secondary complication but are not the most likely primary soft tissue damage in an acute anterior dislocation. *Acromioclavicular ligament* - The **acromioclavicular ligament** stabilizes the **acromioclavicular (AC) joint**, which is distinct from the glenohumeral joint. - Injuries to this ligament typically result from direct trauma to the top of the shoulder, causing AC joint separation, not glenohumeral dislocation. *Supraspinatus tendon* - The **supraspinatus tendon** is part of the rotator cuff and is most commonly injured in impingement syndrome or rotator cuff tears, which can result from falls but are not the primary structure damaged in an **anterior glenohumeral dislocation**. - Its role is mainly in abduction of the arm, and while it can be involved in large tears associated with advanced age, it is not the initial or most common structure to fail in this specific injury. *Coracoclavicular ligament* - The **coracoclavicular ligament** is composed of the conoid and trapezoid ligaments, which are crucial for the stability of the **acromioclavicular (AC) joint**. - Injury to this ligament is indicative of a more severe AC joint separation (usually **type III or higher**) and is not the primary structure damaged in a glenohumeral dislocation.

Q: Most common complication of extra capsular fracture of neck of femur is:

Non union. ***Non union*** - **Non-union** is a common complication in extracapsular femoral neck fractures due to the **disrupted blood supply** and mechanical forces across the fracture site. - The **fracture fragments** may fail to heal properly, leading to persistent pain, instability, and functional impairment. *Malunion* - **Malunion** occurs when the fracture heals in an **unacceptable anatomical position**, causing deformity or altered biomechanics. - While it can be a complication, **non-union** is generally more prevalent and problematic in extracapsular femoral neck fractures. *Ischemic necrosis* - **Ischemic necrosis** (or avascular necrosis) is less common in extracapsular femoral neck fractures compared to intracapsular fractures. - This is because the **extracapsular location** often spares the crucial blood supply to the femoral head, which is frequently compromised in intracapsular injuries. *Pulmonary complications* - **Pulmonary complications** (e.g., pneumonia, pulmonary embolism) are significant risks in elderly patients with hip fractures due to prolonged immobility and surgery. - However, direct fracture-related complications like **non-union** are distinct and represent issues specifically with bone healing.

Q: Which nerve is commonly damaged in fracture of neck of fibula?

Common peroneal. ***Common peroneal*** - The **common peroneal nerve** (also known as the **common fibular nerve**) wraps superficially around the **neck of the fibula**, making it highly vulnerable to injury in fractures of this region. - Damage to this nerve typically results in **foot drop** and sensory loss over the dorsum of the foot and lateral leg, due to impaired dorsiflexion and eversion. *Tibial* - The **tibial nerve** lies in the posterior compartment of the leg and is generally well-protected, making it less susceptible to injury from a fibular neck fracture. - Injury to the tibial nerve would primarily affect plantarflexion of the foot and sensation to the sole. *Superficial peroneal* - The **superficial peroneal nerve** is a branch of the common peroneal nerve that descends along the lateral compartment of the leg. - While it originates from the common peroneal, a direct fracture of the fibular neck is more likely to injure the main common peroneal trunk rather than just this specific branch, leading to a broader deficit. *Deep peroneal* - The **deep peroneal nerve** is another branch of the common peroneal nerve that runs through the anterior compartment of the leg. - Similar to the superficial peroneal nerve, a fracture at the fibular neck is more likely to affect the main **common peroneal nerve** directly.

Q: A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Posterior dislocation. ***Posterior dislocation*** - An **electric shock** or **seizure** can cause strong muscle contractions, leading to a posterior shoulder dislocation. - Inability to perform **external rotation** and limited arm movement are classic signs of a posterior shoulder dislocation. *Clavicle fracture* - While a fall can cause a **clavicle fracture**, the primary symptoms would be pain over the clavicle and a visible deformity, not specifically limited external rotation or global arm immobility. - A clavicle fracture typically doesn't present with the specific inability to externally rotate the arm. *Luxation erecta* - **Luxatio erecta** is an inferior shoulder dislocation where the arm is held in an abducted and externally rotated position, pointing upwards, which is contrary to the described symptoms of inability to move the arm and external rotation. - It is a specific type of dislocation with a distinct presentation. *Anterior dislocation* - An **anterior dislocation** is the most common type of shoulder dislocation, but it usually presents with the arm held in slight abduction and external rotation, not an inability to externally rotate. - Typically results in a visible flattening of the deltoid contour and a prominent humeral head anteriorly.

Q: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Hemiahroplasty. ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.

Q: A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Axillary. ***Axillary*** - A fall forward onto the shoulder often results in an **anterior shoulder dislocation**, which commonly injures the **axillary nerve** due to its close proximity to the humeral head. - Injury to the axillary nerve would manifest as **deltoid muscle weakness** (impaired shoulder abduction) and **sensory loss over the lateral shoulder**. *Radial* - The radial nerve is more commonly injured in **midshaft humeral fractures** or compression injuries in the axilla (e.g., "crutch palsy"), not typically from a direct shoulder dislocation. - Radial nerve injury leads to **wrist drop** and difficulty extending the fingers and thumb. *Median* - The median nerve is generally protected in shoulder dislocations but can be affected by more severe trauma or **distal humeral fractures**, specifically around the elbow or wrist. - Injury to the median nerve affects **flexion of the wrist and fingers** and **thumb opposition**, along with sensory deficits in the first 3.5 digits. *Ulnar* - The ulnar nerve is most vulnerable at the **medial epicondyle of the humerus** (funny bone) or in compression injuries at the wrist (Guyon's canal). - Ulnar nerve injury results in **weakness of intrinsic hand muscles** (e.g., abducting/adducting fingers) and sensory loss to the little finger and half of the ring finger.

Q: In fracture of upper 1/3 of forearm, it is immobilized in:

Supination. ***Supination*** - In a fracture of the **proximal third of the forearm**, the **biceps brachii** and **supinator muscles**, which are still attached to the proximal fragment, will cause it to **supinate**. - To align the distal fragment with the proximal fragment and ensure proper healing, the forearm must be immobilized in **full supination**. *Pronation* - **Pronation** would cause malalignment of the fracture fragments, as the proximal fragment would remain supinated while the distal fragment is pronated. - This position is only used for fractures of the **distal third of the forearm** where the **pronator quadratus** and **pronator teres** dominate. *Any position* - Immobilizing in **any position** would risk **malunion** or nonunion due to the unopposed muscle forces acting on the proximal and distal fragments. - Correct anatomical alignment is crucial for restoring function and preventing long-term complications. *Mid prone* - The **mid-prone** position is typically used for fractures of the **middle third of the forearm**, where the pronator and supinator muscle forces are more balanced. - In a proximal third fracture, the stronger supinator muscles would still pull the proximal fragment into supination, causing misalignment in the mid-prone position.

Q: A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Fat embolism. ***Fat embolism*** - A **femur fracture** significantly increases the risk of **fat embolism**, where fat globules from the bone marrow enter the bloodstream and lodge in the pulmonary capillaries. - The classic triad of **fat embolism syndrome** includes respiratory distress, neurological symptoms, and a petechial rash, but respiratory symptoms (pulmonary infiltration and distress) are usually the first to appear. *Obstruction* - While an obstruction could cause respiratory distress, it typically wouldn't be associated with diffuse **pulmonary infiltrates** following a long bone fracture. - **Airway obstruction** would present with stridor or wheezing, and is usually localized rather than systemic. *Pulmonary embolism* - A **pulmonary embolism** (PE) can cause respiratory distress and infiltrates, but given the context of a recent femur fracture, fat embolism is a more specific and likely diagnosis. - PE is usually due to a **venous thromboembolism** and can be suspected in immobilized patients, but the question points more strongly to fat release. *Air embolism* - **Air embolism** usually results from iatrogenic causes (e.g., central line insertion, surgery) or trauma to large veins, allowing a significant amount of air into the circulation. - While it can cause respiratory distress, it doesn't typically cause the diffuse **pulmonary infiltrates** described, which are characteristic of fat embolism.

Q: Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Colles fracture. ***Colles fracture*** - This fracture commonly occurs in **post-menopausal women** due to **osteoporosis** and typically results from a fall onto an **outstretched hand**. - It involves a **distal radius fracture** with **dorsal displacement** and often radial angulation. *Smith fracture* - A Smith fracture involves a **distal radius fracture** with **volar displacement**, usually caused by a fall onto the back of the hand. - While it can occur in post-menopausal women, it is less common than a Colles fracture in such a scenario. *Monteggia's fracture* - This fracture involves a **fracture of the ulna** with **dislocation of the radial head**. - It usually results from a direct blow to the forearm or a fall with extreme pronation, which is less typical for a simple fall in a post-menopausal woman. *Galeazzi fracture* - A Galeazzi fracture involves a **fracture of the radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This injury is less common and typically results from a fall onto an outstretched hand with the forearm in pronation, and it is not the most common fracture in this demographic.

Q: Lauge - Hansen classification belongs to:-

Ankle fracture. ***Ankle fracture*** - The **Lauge-Hansen classification system** is specifically used to categorize **ankle fractures** based on the position of the foot at the time of injury and the deforming force. - This system describes the mechanism of injury (e.g., supination-adduction, pronation-abduction) and the resulting fracture patterns of the **distal fibula, medial malleolus, and posterior malleolus**. *Femur fracture* - **Femur fractures** are typically classified by other systems, such as the **AO/OTA classification** for long bone fractures or specific patterns like **intertrochanteric** or **subtrochanteric fractures**. - The Lauge-Hansen system is **not applicable** to injuries of the femur. *Shoulder fracture* - **Shoulder fractures** (e.g., proximal humerus fractures) are commonly classified using systems like the **Neer classification**, which describes the number of displaced parts. - The Lauge-Hansen system is **not used** for classifying shoulder injuries. *Elbow fracture* - **Elbow fractures** involve the distal humerus, proximal ulna, or radial head and are classified by various systems depending on the specific bone involved (e.g., **Mason classification for radial head fractures**). - The Lauge-Hansen system is **irrelevant** to elbow an injuries.

Question 1

A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?

Accepted Answer

Anterior inferior glenohumeral ligament

Answer

Long head of biceps tendon

Answer

Acromioclavicular ligament

Answer

Supraspinatus tendon

Answer

Coracoclavicular ligament

Question 2

Most common complication of extra capsular fracture of neck of femur is:

Accepted Answer

Non union

Answer

Malunion

Answer

Ischemic necrosis

Answer

Pulmonary complications

Question 3

Which nerve is commonly damaged in fracture of neck of fibula?

Accepted Answer

Common peroneal

Answer

Tibial

Answer

Superficial peroneal

Answer

Deep peroneal

Question 4

A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-

Accepted Answer

Posterior dislocation

Answer

Clavicle fracture

Answer

Luxation erecta

Answer

Anterior dislocation

Question 5

79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?

Accepted Answer

Hemiahroplasty

Answer

Hip spica

Answer

Nailing

Answer

Total Hip Replacement

Question 6

A boy was riding bicycle, he fell down forward and injury to his shoulder was seen, which nerve injury will be seen in the condition as given in X-ray?

Accepted Answer

Axillary

Answer

Radial

Answer

Median

Answer

Ulnar

Question 7

In fracture of upper 1/3 of forearm, it is immobilized in:

Accepted Answer

Supination

Answer

Pronation

Answer

Any position

Answer

Mid prone

Question 8

A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Obstruction

Answer

Pulmonary embolism

Answer

Air embolism

Question 9

Post-menopausal woman, fell down in washroom. What is the most common fracture she may suffer?

Accepted Answer

Colles fracture

Answer

Smith fracture

Answer

Monteggia's fracture

Answer

Galeazzi fracture

Question 10

Lauge - Hansen classification belongs to:-

Accepted Answer

Ankle fracture

Answer

Femur fracture

Answer

Shoulder fracture

Answer

Elbow fracture

Trauma — MCQs

Trauma — MCQs

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