Trauma Practice Questions

Q: Treatment of myositis ossificans includes all except -

Vigorous passive massage. ***Vigorous passive massage*** - **Vigorous passive massage** is contraindicated in myositis ossificans as it can exacerbate the condition by causing further trauma and promoting heterotopic bone formation. - The goal of treatment is to prevent progression and reduce inflammation, not to aggressively manipulate the affected area. *Splinting elbow* - **Splinting the elbow** in a functional position is a common treatment to help prevent contractures and allow the heterotopic bone to mature. - This immobilization can reduce microtrauma and facilitate healing in the acute phase. *Indometacin* - **Indomethacin**, a non-steroidal anti-inflammatory drug (NSAID), is often used to prevent and treat myositis ossificans. - It works by inhibiting prostaglandin synthesis, which is believed to play a role in the formation of heterotopic bone. *Gentle active movements* - **Gentle active movements** are generally encouraged once the acute inflammatory phase has subsided and the lesion begins to mature. - These movements help maintain range of motion and prevent stiffness without causing excessive trauma that could worsen the condition.

Q: Which of the following is the appropriate treatment for atrophic non-union?

Stabilization and bone grafting. ***Stabilization and bone grafting*** - Atrophic non-union is characterized by a **lack of biological activity** and an **absence of callus formation**, requiring both **biological stimulation** (bone graft) and **mechanical stability** (stabilization). - Bone grafting provides **osteogenic cells**, **osteoconductive scaffold**, and **osteoinductive growth factors** to promote healing, while stabilization ensures the fracture fragments remain in apposition. *External fixation* - While providing stability, external fixation alone does not address the **biological deficiency** inherent in atrophic non-union. - It's mainly used for **open fractures**, **comminuted fractures**, or when internal fixation is not feasible, often as a temporary measure. *Application of cast* - A cast provides some immobilization but is generally insufficient for non-union, especially atrophic types, due to its **limited stability** and inability to compress the fracture site effectively. - It also does not contribute to the **biological stimulation** needed for healing in atrophic non-unions. *Internal fixation* - Internal fixation provides stability, but in atrophic non-union, the primary issue is a **lack of healing potential**, not just instability. - Without a concomitant **bone graft**, internal fixation alone is unlikely to achieve union in atrophic non-unions.

Q: Which is not true regarding compartment syndrome?

Intracompartmental pressure studies are required. ***Intracompartmental pressure studies are required*** - While **intracompartmental pressure studies** can confirm the diagnosis, the cardinal symptoms of compartment syndrome, such as severe pain disproportionate to injury, pain on passive stretch, and tense swelling, often make the diagnosis clinically. - The decision to perform a **fasciotomy** is primarily based on clinical findings and the severity of symptoms, with pressure measurements serving as supportive evidence, especially in equivocal cases or in uncooperative patients. *Common in soft-tissue crush injury* - **Crush injuries** frequently lead to muscle swelling and hemorrhage within a confined fascial compartment, significantly increasing the risk of compartment syndrome. - The extensive tissue damage and subsequent inflammatory response contribute to a rapid rise in **intracompartmental pressure**. *Pain on passive stretch of the muscles is characteristic* - **Severe pain with passive stretching** of the muscles within the affected compartment is a highly sensitive and often the earliest reliable sign of compartment syndrome. - This pain arises from **ischemia** and pressure on nerve endings as the muscle is stretched. *Common in a closed fracture* - **Closed fractures** are a very common cause of compartment syndrome, particularly in the tibia and forearm, due to bleeding and swelling within the rigid fascial compartment. - The intact skin prevents external decompression, causing **pressure buildup internally** that can compromise blood flow to muscles and nerves.

Q: All of the following are features of myositis ossificans except -

It matures from inside out. ***It matures from inside out*** - This statement is incorrect; **myositis ossificans** characteristically matures from the **outside in**, meaning the periphery ossifies first, creating a distinct radiologic appearance. - The mature bone is found at the periphery of the lesion, while the more immature, cellular components are centrally located. *Commonly occurs around the elbow* - Myositis ossificans is frequently observed around joints, with the **elbow** being one of the most common sites due to its vulnerability to trauma. - Other common locations include the **thigh** and **shoulder**. *Can be post traumatic or occur without trauma also* - While most commonly **post-traumatic**, myositis ossificans can also occur atraumatically, sometimes referred to as **myositis ossificans progressiva** or fibrodysplasia ossificans progressiva, a rare genetic disorder. - The traumatic form is often preceded by a significant contusion or muscle injury. *Massaging is a known associated factor* - **Aggressive massage** or manipulation following muscle trauma can exacerbate local tissue injury and enhance the conditions conducive to heterotopic ossification, including myositis ossificans. - This is why gentle management of muscle contusions is crucial to prevent its development.

Q: Maximum weight for skin traction -

4-5 kg. ***4-5 kg*** - The maximum effective and safe weight for **skin traction** in adults is generally considered to be 4.5-5 kg (approximately 10-11 lbs). - Exceeding this weight can cause **skin damage**, blistering, and neurovascular compromise due to excessive pressure and shearing forces. *1-2 kg* - While 1-2 kg may be used, it is often insufficient to achieve significant **reduction** or **stabilization of fractures** in adults, especially for limb traction. - This weight range might be appropriate for very **young children** or for very gentle, temporary traction. *15-20 kg* - This amount of weight is far too high for **skin traction** and would almost certainly lead to severe **skin breakdown**, pressure sores, and potentially neurovascular injury. - Weights in this range are typically reserved for **skeletal traction**, where the force is applied directly to the bone. *10-15 kg* - Similar to 15-20 kg, this weight range is too high for **skin traction** and carries a significant risk of **complications** such as skin necrosis, nerve damage, and vascular compromise. - It would be ineffective and harmful if not applied directly to the bone.

Q: Volkmann's ischaemic contracture due to external compression is commonly caused by

Tight plaster and tight splint. ***Tight plaster and tight splint*** - Both a **tight plaster cast** and a **tight splint** can cause Volkmann's ischaemic contracture by increasing pressure within the fascial compartments, leading to **compartment syndrome**. - This elevated pressure compromises **arterial inflow** and **venous outflow**, resulting in muscle and nerve ischaemia, which if prolonged, causes contracture. *Tight plaster* - While a **tight plaster** alone can contribute to Volkmann's ischaemic contracture, the combination with a **tight splint** is a more comprehensive answer for external compression. - A tight plaster applies circumferential pressure, which can restrict venous return and lead to swelling and increased intracompartmental pressure. *Supracondylar fractures* - **Supracondylar fractures** are a significant intrinsic cause of Volkmann's ischaemic contracture due to direct injury to the **brachial artery** or local swelling. - However, the question specifically asks for external compression causes, making a fracture an intrinsic rather than external factor. *Tight splint* - A **tight splint** can certainly cause Volkmann's ischaemic contracture by exerting external compression, leading to compromised blood flow. - However, when paired with a tight plaster, the risk of developing compartment syndrome leading to contracture is significantly higher due to compounded external pressure.

Q: All of the following can be the complications of a malunited Colles fracture except:

Rupture of flexor pollicis longus tendon. ***Rupture of flexor pollicis longus tendon*** - Malunion of a Colles fracture typically involves dorsal displacement of the distal radius, which can lead to friction and rupture of the **extensor pollicis longus (EPL)** tendon due to irritation over the dorsal bony prominence. - The **flexor pollicis longus (FPL)** tendon is on the palmar side of the wrist and is generally not at risk for rupture from a dorsally malunited Colles fracture. *Carpal instability* - **Malunion of a Colles fracture** can significantly alter the normal anatomy and mechanics of the radiocarpal joint, leading to **carpal instability**. - Changes in radial inclination, volar tilt, and radial length can disrupt load bearing and ligamentous integrity, predisposing to carpal collapse or dissociation. *Carpal tunnel syndrome* - Malunion can lead to **decreased carpal tunnel volume** and angulation of the carpal bones, increasing pressure on the **median nerve**. - This anatomical alteration can lead to symptoms of **carpal tunnel syndrome**, such as numbness, tingling, and pain in the median nerve distribution. *Reflex sympathetic dystrophy (RSD)* - Also known as **Complex Regional Pain Syndrome (CRPS) Type I**, RSD is a well-recognized complication following trauma or surgery to an extremity, including Colles fractures. - It presents with pain, swelling, *trophic skin changes*, and vasomotor dysfunction, and can be severely incapacitating.

Q: In major/unstable pelvic fractures with vascular injury, the amount of blood loss is around?

4-8 units. ***4-8 units*** - Unstable pelvic fractures with associated vascular injury are recognized sources of significant hemorrhage due to the rich vascular supply of the pelvis and the potential for **venous plexus disruption** and **arterial damage**. - This range represents a substantial blood loss that commonly requires **transfusion** and often aggressive hemostatic interventions. *2-4 units* - This amount of blood loss, while significant, is more typical of **isolated unstable pelvic fractures** without major vascular involvement. - While bleeding can be substantial, it often does not reach the higher threshold seen with direct vascular injuries. *1-4 units* - This range of blood loss is relatively less severe and might be seen in **stable or minimally displaced pelvic fractures**. - It does not accurately reflect the major hemorrhage expected in an **unstable pelvic fracture** complicated by vascular injury. *2-6 units* - This option presents an overlap with the more accurate range but still underestimates the potential severity of blood loss in a **major/unstable pelvic fracture** with established vascular injury. - The upper limit often falls short of the true extent of hemorrhage observed in such critical injuries.

Q: AVN of femoral head is most common in-

Intracapsular fracture neck of femur. ***Intracapsular fracture neck of femur*** - **Intracapsular fractures** disrupt the blood supply to the femoral head, particularly the **retinacular arteries**, leading to **avascular necrosis (AVN)**. - The femoral head receives most of its blood supply from within the capsule, making it highly susceptible to **ischemia** when these vessels are damaged. *Extracapsular fracture neck of femur* - These fractures occur **outside the joint capsule**, preserving the critical retinacular arterial blood supply to the femoral head. - While they can lead to other complications, **avascular necrosis** is rare because the blood flow to the femoral head is largely uninterrupted. *Fracture shaft humerus* - This type of fracture involves the **upper arm bone** and has no direct anatomical or vascular connection to the femoral head. - It does not interfere with the blood supply to the femoral head, and thus, **AVN of the femoral head** is not a complication. *Subtrochanteric fracture* - **Subtrochanteric fractures** occur in the proximal femur, but **below the trochanters** and outside the joint capsule. - Like extracapsular fractures, they typically do not compromise the **retinacular arteries** supplying the femoral head, making AVN an unlikely complication.

Question 1

Treatment of myositis ossificans includes all except -

Accepted Answer

Vigorous passive massage

Answer

Splinting elbow

Answer

Indometacin

Answer

Gentle active movements

Question 2

Which of the following is the appropriate treatment for atrophic non-union?

Accepted Answer

Stabilization and bone grafting

Answer

External fixation

Answer

Application of cast

Answer

Internal fixation

Question 3

Which is not true regarding compartment syndrome?

Accepted Answer

Intracompartmental pressure studies are required

Answer

Common in soft-tissue crush injury

Answer

Common in a closed fracture

Answer

Pain on passive stretch of the muscles is characteristic

Question 4

All of the following are features of myositis ossificans except -

Accepted Answer

It matures from inside out

Answer

Commonly occurs around the elbow

Answer

Can be post traumatic or occur without trauma also

Answer

Massaging is a known associated factor

Question 5

Maximum weight for skin traction -

Accepted Answer

4-5 kg

Answer

1-2 kg

Answer

15-20 kg

Answer

10-15 kg

Question 6

Volkmann's ischaemic contracture due to external compression is commonly caused by

Accepted Answer

Tight plaster and tight splint

Answer

Tight plaster

Answer

Supracondylar fractures

Answer

Tight splint

Question 7

Which of the following is false regarding clavicle?

Accepted Answer

Non-union is the commonest complication of clavicle fractures

Answer

First bone to ossify

Answer

Membranous ossification

Answer

Fracture can be treated with figure of 8 bandage

Question 8

All of the following can be the complications of a malunited Colles fracture except:

Accepted Answer

Rupture of flexor pollicis longus tendon

Answer

Carpal instability

Answer

Carpal tunnel syndrome

Answer

Reflex sympathetic dystrophy (RSD)

Question 9

In major/unstable pelvic fractures with vascular injury, the amount of blood loss is around?

Accepted Answer

4-8 units

Answer

2-4 units

Answer

1-4 units

Answer

2-6 units

Question 10

AVN of femoral head is most common in-

Accepted Answer

Intracapsular fracture neck of femur

Answer

Extracapsular fracture neck of femur

Answer

Fracture shaft humerus

Answer

Subtrochanteric fracture

Trauma — MCQs

Trauma — MCQs

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