Trauma Practice Questions

Q: A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured

Anterior cruciate ligament. ***Anterior cruciate ligament*** - A fracture of the **intercondylar eminence** typically involves the avulsion of the **tibial attachment** of the anterior cruciate ligament (ACL). - The ACL's fibers attach to the **tibial intercondylar area**, making it highly susceptible to injury with a fracture in this region. *Medial collateral ligament* - The **medial collateral ligament** (MCL) originates from the medial femoral epicondyle and attaches to the medial tibia, primarily resisting valgus forces. - While knee trauma can affect the MCL, a fracture of the intercondylar eminence specifically points to an injury involving a structure attached to that area. *Medial meniscus* - The **medial meniscus** is a C-shaped cartilage in the knee joint and can be injured by rotational forces or compression. - Its injury is not directly linked to an intercondylar eminence fracture, although severe trauma can injure multiple structures. *Lateral collateral ligament* - The **lateral collateral ligament** (LCL) originates from the lateral femoral epicondyle and attaches to the fibular head, resisting varus forces. - An injury to the LCL is less likely with an intercondylar eminence fracture, as the LCL does not attach to this specific tibial region.

Q: A patient on colles cast presents after two weeks with the inability to extend his thumb, the most likely reason is:

Rupture of extensor pollicis longus tendon. ***Rupture of extensor pollicis longus tendon*** - The **extensor pollicis longus (EPL)** tendon is vulnerable to rupture in a Colles' cast due to **ischemia** from pressure or **attritional rupture** over bony prominences following fracture healing. - This typically presents weeks after casting with an inability to **actively extend the thumb**. *Sudek's osteodystrophy* - Characterized by **pain, swelling, stiffness, and skin changes** (e.g., shiny, atrophic skin, excessive sweating) distal to the injury, often associated with a painful joint. - While it causes significant disability, it does not specifically present as an isolated inability to extend the thumb. *Carpal tunnel syndrome* - Involves compression of the **median nerve**, leading to **numbness, tingling, and weakness** in the thumb, index, middle, and radial half of the ring fingers. - It would typically cause weakness in **thumb abduction and opposition**, not primarily an inability to extend the thumb, and is often painful. *Compartment syndrome* - Presents with severe pain, paresthesias, pallor, pulselessness, and paralysis, indicating **compromised blood flow** and pressure buildup within a fascial compartment. - It is an **acute emergency** usually occurring soon after injury and does not manifest primarily as isolated thumb extensor weakness two weeks later.

Q: Which of the following statement(s) is/are true?

Dinner fork deformity is characteristic of Colles' fracture. **Dinner fork deformity is characteristic of Colles' fracture** - **Colles' fracture** involves a **dorsal displacement** and angulation of the distal radius, creating a characteristic **"dinner fork" or "bayonet" deformity** of the wrist. - This specific deformity is a classic clinical sign that aids in the diagnosis of a Colles' fracture, which is an **extra-articular fracture** of the distal radius with dorsal angulation. *Normally the radial styloid is 1/2 lower than the ulnar* - The **radial styloid** normally extends approximately **1-1.5 cm (or about 1/2 inch)** *distal* to the ulnar styloid, not lower than. - This difference in length is crucial for normal wrist kinematics, and its reversal can indicate conditions like **ulnar positive variance**. *All of the options* - This option is incorrect because the statement regarding the radial styloid being lower than the ulnar is **false**. - Since one of the options provided is factually incorrect, this choice cannot be true. *Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid* - While **oedema and tenderness in the anatomical snuffbox** are hallmark signs of a **scaphoid fracture**, this statement alone does not encompass all the truth presented in the options. - This specific physical finding is highly indicative of a scaphoid fracture, necessitating further imaging to confirm the diagnosis due to **poor vascular supply** to the scaphoid and risk of **avascular necrosis**.

Q: The position of arm in posterior dislocation of shoulder is:

In internal rotation. ***In internal rotation*** - A **posterior shoulder dislocation** classically presents with the arm held in **adduction and internal rotation**, making it difficult to externally rotate or abduct the arm. - This position occurs because the humeral head dislocates posteriorly, causing the powerful internal rotators (like the **subscapularis**) to pull the arm into this characteristic posture. *In adduction* - While the arm is typically held in **adduction** in a posterior dislocation, this option alone is incomplete as it does not include the critical component of **internal rotation**. - The combination of adduction and internal rotation is the hallmark finding, and simply 'in adduction' does not fully describe the classic presentation. *By the side* - The phrase **"by the side"** is too vague and does not adequately describe the specific rotational or adduction/abduction abnormalities seen in a posterior shoulder dislocation. - A dislocated shoulder, particularly posterior, will present with a visibly and functionally abnormal position, not simply "by the side." *In external rotation* - An arm held in **external rotation** is characteristic of an **anterior shoulder dislocation**, which is the most common type of shoulder dislocation. - In a posterior dislocation, the arm typically resists external rotation due to the locking of the humeral head posteriorly and the contraction of internal rotators.

Q: Classical sign of scaphoid fracture is?

Pain in snuffbox. ***Pain in snuffbox*** - Pain on palpation within the **anatomical snuffbox** is the most classic and reliable clinical sign of a scaphoid fracture. - This area is directly overlying the scaphoid bone and becomes exquisitely tender after an injury. *Pain with limited range of motion* - While a scaphoid fracture can cause pain and **limited range of motion** in the wrist, these signs are non-specific and can be present in many other wrist injuries. - They are not definitive enough to distinguish a scaphoid fracture from other pathologies. *Swelling of wrist* - **Swelling of the wrist** is a common finding after any acute injury or trauma to the area, including sprains or other fractures. - It is not specific to a scaphoid fracture and does not help in localizing the injury to this particular bone. *Scaphoid ring sign* - The **scaphoid ring sign** is an imaging finding seen on X-rays, specifically a posteroanterior view. - It indicates rotational subluxation of the scaphoid but is not a clinical sign directly observed during physical examination.

Q: Fat embolism commonly occurs in: UP 04

Fracture of long bones. ***Fracture of long bones*** - **Fat embolism** most commonly occurs after **fractures of long bones**, especially the **femur** or **tibia**, due to the release of fat globules from the bone marrow. - These fat globules can then travel to the lungs and other organs, causing **respiratory distress**, neurological symptoms, and a petechial rash. *Psoriasis* - Psoriasis is a **chronic autoimmune skin condition** characterized by red, scaly patches, and is not associated with fat embolism. - Its pathophysiology involves abnormal keratinocyte proliferation and inflammation, not bone marrow injury. *Scurvy* - Scurvy is a disease caused by **vitamin C deficiency**, leading to problems with collagen synthesis, causing symptoms like gum bleeding, poor wound healing, and petechiae. - It has no direct association with the release of fat emboli or fractures. *Paget's disease* - Paget's disease of bone is a chronic disorder of **abnormal bone remodeling**, leading to enlarged and weakened bones. - While it can increase the risk of fractures, it is not a primary cause of fat embolism in itself; rather, a fracture in a Pagetic bone might lead to it.

Q: Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Fracture with metaphyseal comminution. ***Fracture with metaphyseal comminution*** - The **MIPPO technique** is particularly useful for achieving stability in fractures with **metaphyseal comminution** by bridging the comminuted zone with a plate applied percutaneously. - This approach minimizes soft tissue dissection, preserving **periosteal blood supply**, which is crucial for healing in these complex fractures. *Segmental fracture* - While MIPPO can be used, **segmental fractures** often require more direct reduction and stabilization of both fracture segments, which might be challenging with a purely percutaneous approach alone. - The primary concern in segmental fractures is often maintaining length and alignment across two distinct fracture lines. *Spiral fracture* - **Spiral fractures** are typically inherently stable after reduction and are often amenable to intramedullary nailing or less invasive plate fixation, as the fracture pattern allows for good interfragmentary compression. - The main advantage of MIPPO (minimizing soft tissue stripping around comminution) is less critical in these stable, non-comminuted patterns. *Oblique fracture* - Similar to spiral fractures, **oblique fractures** are often amenable to primary screw fixation or conventional plating techniques due to their stable nature after reduction and good contact between fracture fragments. - The specific advantages of MIPPO for comminuted fractures are less relevant for simple oblique patterns.

Q: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Navicular (scaphoid) fracture. ***Navicular (scaphoid) fracture*** - Tenderness in the **anatomical snuffbox** is a classic and highly indicative sign of a **scaphoid fracture**. - The scaphoid bone forms the floor of the anatomical snuffbox, and injury to this bone often results from a fall on an **outstretched hand**. *Monteggia's deformity* - This injury involves a fracture of the **proximal ulna** with an associated **dislocation of the radial head**. - It presents with pain and deformity in the forearm, not typically isolated tenderness in the anatomical snuffbox. *Greenstick fracture* - A greenstick fracture is an **incomplete fracture** where one side of the bone is broken and the other is bent, commonly seen in children. - It does not specifically manifest with tenderness in the anatomical snuffbox, as it can occur in various bones. *Spiral fracture* - A spiral fracture occurs when a bone is broken by a **twisting force**, creating a helical pattern. - While it can occur in various long bones, it is not specifically associated with tenderness in the anatomical snuffbox.

Q: Triangular relation of Elbow is maintained in

Supracondylar fracture. ***Supracondylar fracture*** - In a **supracondylar fracture** of the elbow, the relationship between the **medial epicondyle**, **lateral epicondyle**, and **olecranon** remains normal, forming an equilateral triangle in flexion. - This is because the fracture occurs at the **distal humerus**, above the epicondyles, preserving their anatomical relationship with the olecranon. *Fracture ulna* - A **fracture of the ulna** typically does not directly affect the epicondyles or olecranon's anatomical positions relative to each other. - The triangular relationship is formed by humeral and ulnar landmarks, and an ulnar shaft fracture would not disrupt this specific articulation. *Anterior dislocation of Elbow* - In an **anterior dislocation of the elbow**, the **olecranon** moves **anteriorly**, disrupting its normal alignment with the humeral epicondyles. - This displacement **abolishes the triangular relation** by altering the position of the olecranon relative to the palpable epicondyles. *Posterior dislocation of Elbow* - In a **posterior dislocation of the elbow**, the **olecranon** moves **posteriorly** and proximally, significantly disrupting the normal triangular relationship. - The olecranon will be located **posterior to the epicondyles**, and the three bony points will be displaced, thus losing their normal anatomical formation.

Q: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Scaphoid fracture. ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.

Question 1

A moving vehicle hits a pedestrian on his lateral aspect of the knee and causes a fracture. The fracture line is passing through the intercondylar eminence. Which of the following structures will most likely be injured

Accepted Answer

Anterior cruciate ligament

Answer

Medial collateral ligament

Answer

Medial meniscus

Answer

Lateral collateral ligament

Question 2

A patient on colles cast presents after two weeks with the inability to extend his thumb, the most likely reason is:

Accepted Answer

Rupture of extensor pollicis longus tendon

Answer

Sudek's osteodystrophy

Answer

Carpal tunnel syndrome

Answer

Compartment syndrome

Question 3

Which of the following statement(s) is/are true?

Accepted Answer

Dinner fork deformity is characteristic of Colles' fracture

Answer

Normally the radial styloid is 1/2 lower than the ulnar

Answer

All of the options

Answer

Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid

Question 4

The position of arm in posterior dislocation of shoulder is:

Accepted Answer

In internal rotation

Answer

In adduction

Answer

By the side

Answer

In external rotation

Question 5

Classical sign of scaphoid fracture is?

Accepted Answer

Pain in snuffbox

Answer

Pain with limited range of motion

Answer

Swelling of wrist

Answer

Scaphoid ring sign

Question 6

Fat embolism commonly occurs in: UP 04

Accepted Answer

Fracture of long bones

Answer

Psoriasis

Answer

Scurvy

Answer

Paget's disease

Question 7

Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Accepted Answer

Fracture with metaphyseal comminution

Answer

Segmental fracture

Answer

Spiral fracture

Answer

Oblique fracture

Question 8

Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Accepted Answer

Navicular (scaphoid) fracture

Answer

Monteggia's deformity

Answer

Greenstick fracture

Answer

Spiral fracture

Question 9

Triangular relation of Elbow is maintained in

Accepted Answer

Supracondylar fracture

Answer

Fracture ulna

Answer

Anterior dislocation of Elbow

Answer

Posterior dislocation of Elbow

Question 10

A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Accepted Answer

Scaphoid fracture

Answer

1st metacarpal fracture

Answer

Trapezoid fracture

Answer

Lower end of radius fracture

Trauma — MCQs

Trauma — MCQs

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