Trauma Practice Questions

Q: A 55-year-old female with osteoporosis sustains a Colles fracture. What is the most important factor to assess before surgical intervention?

Fracture alignment. ***Fracture alignment*** - Maintaining **proper anatomical alignment** is critical for restoring normal function of the wrist and preventing long-term complications such as malunion or nonunion. - While patient age and activity level can influence the acceptable degree of displacement, a **significant displacement** typically necessitates surgical intervention to achieve optimal alignment. *Bone density* - While relevant for understanding the patient's underlying osteoporosis, bone density itself does not determine the immediate need for surgical intervention for an acute fracture. - **Osteoporosis management** is crucial for long-term health, but the immediate surgical decision for a Colles fracture focuses on the fracture morphology. *Vitamin D levels* - **Vitamin D levels** are important for bone health and healing in general, especially in osteoporotic patients, but they are not the primary determinant for the necessity or timing of surgical intervention for a Colles fracture. - Addressing low Vitamin D is part of overall **osteoporosis management**, not the immediate surgical decision-making for fracture reduction. *Functional status of the hand* - The **functional status** of the hand is the ultimate outcome goal of any treatment, but *before* surgery, the acute injury itself will severely limit function, making it an unreliable immediate assessment point for surgical indication. - While relevant for establishing baselines and post-operative goals, pre-operative functional status of the injured hand often reflects the trauma rather than dictating the need for surgical alignment.

Q: Which of the following is the best initial imaging study for evaluating a suspected fracture?

X-ray. ***X-ray*** - X-rays are generally the **first-line imaging study** for suspected fractures due to their widespread availability, low cost, and ability to clearly visualize bone structures. - They effectively show **bone alignment**, fracture patterns, and presence of **displacement**. *CT scan* - While excellent for detailed bony anatomy, **CT scans** expose patients to higher doses of **radiation** and are typically reserved for complex fractures or when standard X-rays are inconclusive. - They provide **cross-sectional views** and are useful for evaluating intra-articular fractures or bone fragments. *MRI* - **MRI** is superior for visualizing **soft tissues** like tendons, ligaments, and cartilage, and detecting occult fractures not seen on X-ray. - It is not the initial imaging choice for suspected fractures because it is **more expensive**, time-consuming, and less readily available than X-rays. *Ultrasound* - **Ultrasound** is useful for evaluating certain soft tissue injuries and can detect **ligamentous tears** or effusions. - However, its ability to clearly visualize and definitively diagnose most bone fractures is **limited**, especially deep or complex ones.

Q: Which clinical test is used to assess the integrity of the radial nerve following a mid-shaft humerus fracture?

Wrist drop test. ***Wrist drop test*** - The **radial nerve** innervates the muscles responsible for **wrist extension** and **finger extension**. - Damage to the radial nerve (e.g., from a mid-shaft humeral fracture) can result in an inability to extend the wrist and fingers, known as **wrist drop**. *Tinel's sign* - This test assesses for **nerve irritation or compression** by percussing over the nerve, often used for **carpal tunnel syndrome** or **cubital tunnel syndrome**. - It checks for tingling or pain, not functional integrity of the radial nerve. *Phalen's maneuver* - This test is used to diagnose **carpal tunnel syndrome**, which involves compression of the **median nerve**. - It involves holding the wrists in maximal flexion to provoke symptoms, unrelated to radial nerve integrity. *Froment's sign* - This test assesses the integrity of the **ulnar nerve**, specifically the **adductor pollicis muscle**. - It involves asking the patient to hold a piece of paper between their thumb and index finger.

Q: A 28-year-old male presents with a crush injury to the leg. His leg is swollen, and he experiences severe pain with passive stretching of the toes. What is the next best step in management?

Immediate fasciotomy. ***Immediate fasciotomy*** - The combination of a **crush injury**, **swollen leg**, and **severe pain with passive stretching of the toes** is highly indicative of **acute compartment syndrome**, which requires immediate surgical intervention to prevent irreversible tissue damage. - A fasciotomy rapidly relieves pressure within the muscle compartments, restoring blood flow and saving threatened muscle and nerve tissue. *MRI of the leg* - While an MRI can provide detailed images of soft tissues, it is a time-consuming diagnostic tool that would delay critical treatment for acute compartment syndrome. - The clinical presentation is sufficiently clear to proceed directly to surgical management. *Elevation of the limb* - In suspected **acute compartment syndrome**, the limb should be kept at **heart level** to optimize perfusion pressure. - Elevating the limb above heart level can reduce arterial inflow and potentially worsen ischemia, while keeping it dependent can increase venous pressure and compartment pressure. - This is not a definitive treatment and delays the necessary surgical intervention. *Administer IV antibiotics* - Although crush injuries carry a risk of infection, antibiotics are not the primary or immediate treatment for the life-threatening condition of **acute compartment syndrome**. - Delaying surgical decompression to administer antibiotics would result in irreversible muscle and nerve damage.

Q: What is the most common complication of a posterior shoulder dislocation?

Reverse Hill-Sachs lesion. ***Reverse Hill-Sachs lesion*** - A **reverse Hill-Sachs lesion** (also known as a **McLaughlin lesion**) is an impaction fracture on the anterior aspect of the humeral head, occurring when the humeral head strikes the posterior glenoid rim during a posterior dislocation. - It is the most common bony complication of a posterior shoulder dislocation due to the direct impact of the humeral head against the glenoid. *Bankart lesion* - A **Bankart lesion** is an injury to the anterior inferior glenoid labrum, often with an associated bony fragment, and is characteristic of **anterior shoulder dislocations**. - It results from the humeral head being forced anteriorly, tearing the labrum and capsule from the anterior glenoid, which is not the mechanism in posterior dislocations. *Rotator cuff tear* - While rotator cuff tears can occur with any shoulder dislocation, they are more commonly associated with **anterior dislocations**, especially in older patients. - They are also often seen with chronic instability or significant trauma, but a specific lesion like a reverse Hill-Sachs is more pathognomonic for a posterior dislocation. *Fracture of the scapula* - A **scapular fracture** is relatively uncommon with isolated shoulder dislocations and typically requires a significant, direct high-energy trauma. - Such fractures are less directly caused by the dislocation mechanism itself, compared to the impaction injury that creates a reverse Hill-Sachs lesion.

Q: A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Posterior displacement of the distal radius. ***Posterior displacement of the distal radius*** - The "dinner fork" deformity, or **Colles' fracture**, is characterized by **dorsal (posterior) displacement and angulation** of the distal fragment of the radius. - This posterior displacement, combined with supination and impaction, gives the wrist its characteristic shape resembling a dinner fork. *Anterior displacement of the distal radius* - This describes a **Smith's fracture (or reverse Colles' fracture)**, where the distal fragment of the radius is displaced volarly (anteriorly). - While also a common distal radial fracture, it presents with a different deformity than the "dinner fork." *Lateral angulation of the distal radius* - Angulation away from the midline (laterally or radially) can occur in various distal radius fractures but is **not the primary defining feature** of the classic "dinner fork" deformity. - The most prominent and characteristic deformity is the dorsal displacement, which contributes to the "dinner fork" appearance. *Medial angulation of the distal radius* - This refers to angulation towards the midline (medially or ulnarly) and is **less common as a primary component** of the classic Colles' fracture "dinner fork" deformity. - While some degree of angulation can be present, the distinctive shape of the "dinner fork" is mainly due to dorsal displacement and angulation.

Q: Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Distal radius. ***Distal radius*** - A fracture of the **distal radius** is the most common fracture of the upper extremity, typically occurring when a person falls on an **outstretched hand (FOOSH)**. - The force transmitted through the hand and wrist often causes the bone to break just above the wrist joint, resulting in what is commonly known as a **Colles fracture** if the fragment is displaced dorsally. *Scaphoid* - While a **scaphoid fracture** can occur with a FOOSH injury, it is less common than a distal radius fracture. - Scaphoid fractures are often challenging to diagnose immediately and require specific clinical suspicion due to potential complications like **avascular necrosis**. *Lunate* - The **lunate bone** is one of the carpal bones and is rarely fractured in isolation, particularly from a FOOSH injury. - More commonly, it is involved in dislocations or other severe carpal injuries, rather than a simple fracture. *Capitate* - The **capitate** is the largest carpal bone but is well-protected by surrounding bones, making isolated fractures from a FOOSH injury uncommon. - Fractures of the capitate typically occur in high-energy trauma and are often associated with other carpal injuries.

Q: What condition is associated with the absence of femoral artery pulsation in the affected limb?

Posterior dislocation of the hip. ***Posterior dislocation of the hip*** - A **posterior hip dislocation** can compress or injure the **femoral artery** due to the displacement of the femoral head posteriorly, leading to a diminished or absent pulse. - This is a **medical emergency** as vascular compromise can lead to **ischemia and necrosis** of the affected limb. *Fracture of the neck of femur* - While a **femoral neck fracture** can cause significant pain and may sometimes be associated with a compromised blood supply to the femoral head, it typically does not directly compress or injure the **femoral artery** itself. - The main vascular concern with femoral neck fractures is often the **avascular necrosis** of the femoral head due to disruption of its nutrient arteries. *Legg-Calvé-Perthes disease* - This condition involves **avascular necrosis of the femoral head** in children, primarily affecting the blood supply to the epiphysis, not the main femoral artery. - Though it affects hip vascularity, it does not typically manifest with an **absent femoral pulse**. *None of the options* - This option is incorrect because a **posterior dislocation of the hip** is a recognized cause of compromised femoral artery pulsation.

Q: Most common complication of fracture of tibia

Delayed union. ***Delayed union*** - The **tibia** has a relatively **poor blood supply** compared to other long bones, especially in its distal third, making it prone to delayed healing. - Delayed union is defined as a fracture that takes **longer than expected** to heal, but still has the potential to unite. *Infection* - While possible, especially with **open fractures**, infection is not the most common complication of all tibia fractures. - Infections can lead to **osteomyelitis**, but this specific complication is less frequent than delayed union. *Compartment syndrome* - This is a **serious complication** resulting from increased pressure within a closed fascial compartment, often of the lower leg. - While it is a significant risk with tibia fractures and requires immediate attention, it is **not the most common** complication overall. *Vascular injury* - Significant **vascular injury** is a rare but severe complication, particularly with high-energy trauma or displaced fractures. - Such injuries can lead to limb ischemia and require urgent surgical intervention, but occur **less frequently** than delayed union.

Question 1

A 55-year-old female with osteoporosis sustains a Colles fracture. What is the most important factor to assess before surgical intervention?

Accepted Answer

Fracture alignment

Answer

Bone density

Answer

Vitamin D levels

Answer

Functional status of the hand

Question 2

Which of the following is the best initial imaging study for evaluating a suspected fracture?

Accepted Answer

X-ray

Answer

CT scan

Answer

MRI

Answer

Ultrasound

Question 3

Which clinical test is used to assess the integrity of the radial nerve following a mid-shaft humerus fracture?

Accepted Answer

Wrist drop test

Answer

Tinel's sign

Answer

Phalen's maneuver

Answer

Froment's sign

Question 4

A 28-year-old male presents with a crush injury to the leg. His leg is swollen, and he experiences severe pain with passive stretching of the toes. What is the next best step in management?

Accepted Answer

Immediate fasciotomy

Answer

MRI of the leg

Answer

Elevation of the limb

Answer

Administer IV antibiotics

Question 5

What is the most common complication of a posterior shoulder dislocation?

Accepted Answer

Reverse Hill-Sachs lesion

Answer

Bankart lesion

Answer

Rotator cuff tear

Answer

Fracture of the scapula

Question 6

A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Accepted Answer

Posterior displacement of the distal radius

Answer

Anterior displacement of the distal radius

Answer

Lateral angulation of the distal radius

Answer

Medial angulation of the distal radius

Question 7

What factors should be considered when deciding between limb salvage surgery and amputation for a patient with a severe traumatic injury to the lower extremity?

Accepted Answer

Extent of tissue damage, potential for functional recovery, and patient's lifestyle considerations.

Answer

Surgeon's skill level as the primary factor.

Answer

Cosmetic appearance alone.

Answer

Patient's immediate decision during trauma.

Question 8

Identify the bone numbered in the X-ray that most commonly fractures when a person falls on outstretched hands.

Accepted Answer

Distal radius

Answer

Scaphoid

Answer

Lunate

Answer

Capitate

Question 9

What condition is associated with the absence of femoral artery pulsation in the affected limb?

Accepted Answer

Posterior dislocation of the hip

Answer

Fracture of the neck of femur

Answer

Legg-Calvé-Perthes disease

Answer

None of the options

Question 10

Most common complication of fracture of tibia

Accepted Answer

Delayed union

Answer

Infection

Answer

Compartment syndrome

Answer

Vascular injury

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?