Trauma Practice Questions

Q: The most common complication of intracapsular fracture neck of femur is

Non-Union. ***Non-Union*** - **Intracapsular fractures** of the femoral neck often disrupt the blood supply to the femoral head, increasing the risk of **avascular necrosis** and impaired healing. - Due to the limited blood supply and mechanical forces, the bone fragments may fail to unite, leading to **non-union**. *Mal union* - **Malunion** implies that the fracture has healed but in an anatomically incorrect or deformed position. - While it can occur, **non-union** is a more prevalent and severe complication in intracapsular femoral neck fractures due to the specific anatomical challenges. *Osteoarthritis* - **Osteoarthritis** can develop as a long-term complication if the fracture heals with altered joint mechanics or secondary to avascular necrosis. - However, it is a delayed consequence, whereas **non-union** is an early and direct failure of the healing process. *Shortening* - **Shortening** of the limb can occur due to fracture displacement or subsequent collapse, especially if the fracture is unstable or undergoes malunion. - It is a symptom or consequence that can be associated with failed healing or non-union, but **non-union** itself is the primary failure of bone repair.

Q: Treatment of choice in Acute myositis ossificans is:

Immobilization of the affected area. ***Immobilization of the affected area*** - Initial treatment for **acute myositis ossificans** focuses on conservative measures, primarily **rest and immobilization**. - This helps to **reduce inflammation**, prevent further injury, and minimize the risk of ossification progression. *Early mobilization and active exercises* - **Early mobilization** and aggressive exercises can **aggravate the condition** and promote further heterotopic ossification during the acute inflammatory phase. - While physical therapy is important later, it must be introduced cautiously and gently **after the acute phase** has subsided. *Immediate surgical excision of ossified tissue* - **Surgical excision** during the acute phase is **contraindicated** due to a high risk of **recurrence** and increased bleeding. - Surgery is typically reserved for **mature, symptomatic lesions** causing functional impairment, and is usually performed at least 6 to 12 months after onset. *High-dose corticosteroids and NSAIDs* - While **NSAIDs** might be used to manage pain and inflammation in some cases, **high-dose corticosteroids** are generally not the primary treatment of choice for acute myositis ossificans. - The effectiveness of corticosteroids in preventing or treating myositis ossificans is **not well-established**, and prolonged use carries significant side effects.

Q: Which of the following statements about Galeazzi fracture dislocation is incorrect?

Ulna dislocates dorsally at DRUJ. ***Ulna dislocates dorsally at DRUJ*** - This statement is incorrect because in a **Galeazzi fracture-dislocation**, the **ulna typically dislocates volarly (anteriorly)** relative to the radius at the **distal radio-ulnar joint (DRUJ)**. - The DRUJ dislocation is usually in a volar direction due to the force of injury. *Fracture of distal third of radius and dislocation of DRUJ* - This is a hallmark of a **Galeazzi fracture-dislocation**, explicitly defining the two main components of the injury. - The **distal third of the radius** is the most common site of fracture, coupled with the disruption of the DRUJ. *Radius is angulated laterally and posteriorly* - This describes the typical displacement pattern of the **radial fracture fragment** in a Galeazzi injury. - The angulation often results from the forces acting on the forearm during the injury, with the pronator quadratus pulling the distal fragment volarly and an abduction force causing lateral angulation. *Results from fall on outstretched hand* - This is the most common mechanism of injury for a **Galeazzi fracture-dislocation**, similar to many other forearm and wrist fractures. - The axial load and pronation forces generated during a fall on an **outstretched hand** contribute to the characteristic fracture and dislocation.

Q: Dunlop traction is a type of traction used in the management of?

Fracture of the humerus. ***Fracture of the humerus*** - **Dunlop traction** is specifically designed for the management of **supracondylar fractures** of the humerus in children. - It involves traction applied to the arm, often in conjunction with skin or skeletal traction to maintain reduction and alignment. *Fracture of the radius* - Fractures of the radius, particularly distal radius fractures, are typically managed with **closed reduction and casting** or **surgical fixation**, not Dunlop traction. - Traction methods for forearm fractures are less common and usually involve specialized techniques for specific fracture patterns. *Fracture of the femur* - Femur fractures, especially in children, are commonly managed with **Bryant's traction** or **femoral skeletal traction** in younger children, or surgical intervention. - Dunlop traction is not suitable due to the significant muscle mass and bone size of the femur requiring stronger, more robust traction. *Fracture of the tibia* - Tibia fractures are generally managed with **casting**, **external fixation**, or **intramedullary nailing**. - While traction can be used initially for severely displaced or open tibial fractures, it typically involves **skeletal traction** rather than Dunlop traction.

Q: Chauffeur fracture is -

Intra-articular fracture of the radial styloid process. ***Intra-articular fracture of the radial styloid process*** - A **chauffeur fracture**, also known as a **Hutchinson fracture**, is an **intra-articular fracture** of the distal radius involving the radial styloid process. - This fracture often results from a **direct impact** or **compressive force** on the wrist, historically seen in individuals cranking early automobiles. *Intra-articular fracture of the base of the 1st metacarpal* - This description refers to a **Bennett's fracture**, which is a **two-part intra-articular fracture** of the base of the first metacarpal. - It is typically caused by **axial force** directed along the metacarpal, often from a punch, rather than a wrist-level injury. *Extra-articular fracture of the base of the 1st metacarpal* - An **extra-articular fracture** of the base of the 1st metacarpal is known as a **Rolando fracture** if comminuted, or a simpler extra-articular fracture. - These fractures do not involve the joint surface, distinguishing them from intra-articular fractures. *Extra-articular fracture of the styloid process* - While it involves the styloid process, an **extra-articular fracture of the styloid process** would imply a fracture not extending into the joint space. - A Chauffeur's fracture specifically involves the **articular surface** of the radial styloid, making this option incorrect.

Q: Management of displaced non comminuted intercondylar humerus fracture is?

Open reduction and internal fixation. ***Open reduction and internal fixation*** - **Displaced intra-articular fractures** of the humeral condyles, even if non-comminuted, require **anatomic reduction** and **stable fixation** to restore joint congruity and function. - ORIF allows direct visualization for accurate reduction and provides excellent stability, crucial for early range of motion and preventing long-term complications like **post-traumatic arthritis**. *Above elbow plaster cast application* - This method is typically reserved for **stable, non-displaced fractures** or as a temporary measure. - It would not achieve or maintain adequate reduction for a **displaced intra-articular fracture**, potentially leading to malunion, stiffness, and pain. *Olecranon pin traction method* - Traction methods are generally less precise for achieving **anatomic reduction** of complex articular fractures compared to ORIF. - While it can be used for some complex elbow fractures, its role in **displaced non-comminuted intercondylar fractures** is limited due to the need for precise articular alignment. *External fixation method* - External fixation is often used for **open fractures**, **severely comminuted fractures**, or when internal fixation is not feasible due to soft tissue compromise. - While it provides stability, it does not allow for the same level of **anatomic reduction** of the articular surface as ORIF for a displaced intercondylar fracture and can limit early motion.

Q: Cubitus valgus develops as a complication of which type of fracture?

Supracondylar fracture of humerus. ***Supracondylar fracture of humerus*** - **Cubitus valgus** is a common late complication of a **supracondylar fracture of the humerus**, especially if not properly reduced or fixed. - This deformity results from growth disturbance, malunion, or physeal damage at the **distal humerus**, leading to an increased carrying angle of the elbow. *Smith's fracture* - A **Smith's fracture** is a fracture of the **distal radius** with volar displacement of the distal fragment. - This fracture primarily affects the wrist and does not lead to cubitus valgus deformity, which is an elbow pathology. *Malgaigne fracture* - A **Malgaigne fracture** is an unstable pelvic fracture involving vertical shear forces affecting both anterior and posterior pelvic rings. - This fracture is located in the pelvis and has no anatomical or biomechanical connection to the elbow joint or the development of cubitus valgus. *Saddle fracture* - The term **saddle fracture** is not a standard or recognized orthopedic classification for a specific bone fracture. - This term does not correspond to a known fracture pattern that would lead to cubitus valgus.

Q: The Kocher maneuver is primarily indicated for which of the following conditions?

Shoulder reduction. ***Shoulder reduction*** - The **Kocher maneuver** is a classic technique used to reduce an anterior shoulder dislocation. - It involves a specific sequence of **external rotation, adduction, and internal rotation** of the arm. *Elbow reduction* - Elbow dislocations are typically reduced using **traction-countertraction** techniques, not the Kocher maneuver. - These methods focus on overcoming muscle spasm and restoring the alignment of the **ulna and radius** with the humerus. *Ankle dislocation* - Ankle dislocations usually require **traction and direct manipulation** to realign the talus within the ankle mortise. - These reductions often address associated fractures or ligamentous injuries of the **tibiotalar joint**. *Knee dislocation* - Knee dislocations are serious injuries involving complete disruption of the **tibiofemoral joint**, and their reduction primarily involves **gentle longitudinal traction** and direct manipulation. - Prompt reduction is crucial due to the high risk of **neurovascular compromise**.

Q: Palpable femur head on per rectal exam is a feature of which of the following conditions?

Posterior hip dislocation. ***Posterior hip dislocation*** - In **posterior hip dislocation**, the femoral head is displaced posteriorly, often coming to rest on the **ischium**. - This posterior displacement can make the **femoral head palpable** through the rectum, particularly in thin individuals. *Anterior hip dislocation* - Involves the femoral head displacing **anteriorly**, usually into the **obturator foramen** or onto the **pubis**. - The femoral head would be palpable in the **groin region**, not rectally. *Central hip dislocation* - Occurs when the femoral head is driven **centrally** through the **acetabulum** into the pelvis. - While it involves intrapelvic displacement, the femoral head is typically covered by pelvic bone and not directly palpable per rectally. *Inferior hip dislocation* - This is a rare form of dislocation where the femoral head is forced **inferiorly** from the acetabulum. - The femoral head would typically be palpable in the **perineal region**, not through the rectum.

Q: What is the treatment for patient with hypertrophic nonunion with deformity at fracture site?

Fixation with bone grafting. ***Fixation with bone grafting*** - In a **hypertrophic nonunion**, there is biological activity and callus formation, indicating that the problem is primarily mechanical instability, which requires **fixation**. - Since a **deformity** is present, **bone grafting** may also be necessary to correct the alignment and fill any bone defects, thus providing additional structural support and osteogenic potential. *No treatment required* - A **hypertrophic nonunion** with **deformity** indicates a persistent problem that will not resolve spontaneously and requires intervention due to instability and malalignment. - Doing nothing would lead to continued pain, functional impairment, and potential long-term complications from the uncorrected deformity. *Fixation with possible bone grafting* - While fixation is crucial for hypertrophic nonunions, the presence of a **deformity** strongly suggests that bone grafting will likely be necessary, rather than just "possible," to address the morphological defect and promote union. - This option understates the probable need for grafting when a deformity is a key feature of the nonunion. *Bone grafting only* - **Bone grafting** alone does not address the fundamental issue of **mechanical instability** in a hypertrophic nonunion, which is characterized by adequate biological response but insufficient stability for healing. - Without stable **fixation**, the grafted bone would likely fail to incorporate, and the nonunion would persist or worsen.

Question 1

The most common complication of intracapsular fracture neck of femur is

Accepted Answer

Non-Union

Answer

Mal union

Answer

Osteoarthritis

Answer

Shortening

Question 2

Treatment of choice in Acute myositis ossificans is:

Accepted Answer

Immobilization of the affected area

Answer

Early mobilization and active exercises

Answer

Immediate surgical excision of ossified tissue

Answer

High-dose corticosteroids and NSAIDs

Question 3

Which of the following statements about Galeazzi fracture dislocation is incorrect?

Accepted Answer

Ulna dislocates dorsally at DRUJ

Answer

Results from fall on outstretched hand

Answer

Fracture of distal third of radius and dislocation of DRUJ

Answer

Radius is angulated laterally and posteriorly

Question 4

Dunlop traction is a type of traction used in the management of?

Accepted Answer

Fracture of the humerus

Answer

Fracture of the radius

Answer

Fracture of the femur

Answer

Fracture of the tibia

Question 5

Chauffeur fracture is -

Accepted Answer

Intra-articular fracture of the radial styloid process

Answer

Intra-articular fracture of the base of the 1st metacarpal

Answer

Extra-articular fracture of the base of the 1st metacarpal

Answer

Extra-articular fracture of the styloid process

Question 6

Management of displaced non comminuted intercondylar humerus fracture is?

Accepted Answer

Open reduction and internal fixation

Answer

Above elbow plaster cast application

Answer

Olecranon pin traction method

Answer

External fixation method

Question 7

Cubitus valgus develops as a complication of which type of fracture?

Accepted Answer

Supracondylar fracture of humerus

Answer

Smiths fracture

Answer

Malgaigne fracture

Answer

Saddle fracture

Question 8

The Kocher maneuver is primarily indicated for which of the following conditions?

Accepted Answer

Shoulder reduction

Answer

Elbow reduction

Answer

Ankle dislocation

Answer

Knee dislocation

Question 9

Palpable femur head on per rectal exam is a feature of which of the following conditions?

Accepted Answer

Posterior hip dislocation

Answer

Anterior hip dislocation

Answer

Central hip dislocation

Answer

Inferior hip dislocation

Question 10

What is the treatment for patient with hypertrophic nonunion with deformity at fracture site?

Accepted Answer

Fixation with bone grafting

Answer

No treatment required

Answer

Bone grafting only

Answer

Fixation with possible bone grafting

Trauma — MCQs

Trauma — MCQs

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