Trauma Practice Questions

Q: What is the absolute pressure threshold for surgical intervention in compartment syndrome?

30 mm Hg. ***30 mm Hg*** - A definitive **absolute compartment pressure** of **30 mmHg** or more is a clear indication for **surgical fasciotomy** to relieve pressure and prevent irreversible tissue damage. - This threshold directly reflects the pressure at which capillary perfusion becomes significantly compromised, leading to **ischemia** and potential **necrosis**. - This is the classical **absolute pressure criterion** widely taught for compartment syndrome management. *15 mm Hg* - A pressure of **15 mmHg** is generally considered within the normal range for tissue compartments and does not warrant surgical intervention. - This value is well below the threshold for microcirculatory compromise and typically indicates no immediate danger of **compartment syndrome**. *20 mm Hg* - While elevated above normal, **20 mmHg** is usually not sufficiently high on its own to mandate immediate surgical fasciotomy. - Clinical signs and symptoms, along with trending pressures, would be more critical at this level to determine the need for intervention. *40 mm Hg* - While fasciotomy is certainly indicated at **40 mmHg**, this is not the **threshold** value—it is already significantly above the critical point. - The question asks for the **absolute pressure threshold**, which is the minimum value at which intervention becomes mandatory, not a value well beyond it.

Q: Patient comes with crush injury to upper limb, doctor is concerned about gangrene and sepsis. What scoring system can help decide between amputation and limb salvage?

MESS. ***MESS*** - The **Mangled Extremity Severity Score (MESS)** is a widely used scoring system to assess the severity of limb injuries and predict the need for **amputation**. - It considers factors like **skeletal/soft tissue injury**, **limb ischemia**, **shock**, and **age** to guide management decisions. *Glasgow Coma Scale* - The **Glasgow Coma Scale (GCS)** is used to assess a patient's level of **consciousness** following a traumatic brain injury or other neurological insults. - It has no relevance in evaluating the severity of a **crush injury** to a limb or guiding decisions between amputation and limb salvage. *Gustilo Anderson classification* - The **Gustilo-Anderson classification** is used to categorize **open fractures** based on the extent of soft tissue damage, wound size, and contamination. - While it helps in assessing the **severity of an open fracture** and guiding initial treatment, it does not provide a comprehensive assessment for limb salvage versus amputation decision-making as MESS does. *ASIA guidelines* - The **ASIA (American Spinal Injury Association) Impairment Scale** is used to classify the severity of **spinal cord injuries**. - It evaluates sensory and motor function to determine the level and completeness of a spinal cord injury, which is unrelated to the assessment of a **crush injury** for limb salvage.

Q: Most common complication of mid shaft humerus fracture is ?

Radial nerve palsy. ***Radial nerve palsy*** - The **radial nerve** runs in close proximity to the **spiral groove** of the humerus, making it highly vulnerable to injury in mid-shaft fractures. - This results in the characteristic **wrist drop** and loss of sensation over the dorsal aspect of the hand. *Median nerve palsy* - The **median nerve** is not typically affected by mid-shaft humeral fractures as it is located more medially and anteriorly. - Injury to the median nerve is more common with supracondylar fractures of the humerus or carpal tunnel syndrome. *Nonunion* - While **nonunion** (failure of bone healing) occasionally occurs after mid-shaft humerus fractures, **radial nerve palsy** is a more immediate and frequent complication observed at the time of injury. - Risks for nonunion include severe trauma, soft tissue interposition, and inadequate immobilization. *Malunion* - **Malunion** (healing in an unacceptable alignment) can occur, especially with conservative management, but like nonunion, it is a complication of the healing process rather than an acute injury presentation. - Functional outcomes are generally good even with some degree of angulation in humeral shaft fractures.

Q: Functional cast bracing not used in fracture of ?

Thoracolumbar spine fracture. ***Thoracolumbar spine fracture*** - **Functional cast bracing** is unsuitable for **thoracolumbar spine fractures** because it cannot adequately immobilize this segment of the spine due to the complex anatomy and motion involved. - These fractures often require rigid external immobilization or **surgical stabilization** to prevent neurological compromise and ensure proper healing. *Humerus fracture* - **Functional bracing** for **humerus fractures** allows for limited, controlled motion at the shoulder and elbow joints while supporting the fracture site. - This approach helps to prevent joint stiffness and promote **early rehabilitation**, which is beneficial for humeral healing. *Tibia fracture* - **Functional cast bracing** is often used for **tibia shaft fractures** to allow weight-bearing and controlled ankle and knee motion. - This helps to stimulate bone healing (Wolff's Law) and maintain muscle strength while providing adequate **fracture stability**. *Ulna fracture* - Depending on the specific type and location, **functional bracing** for **ulna fractures** can permit some wrist and elbow movement while stabilizing the fracture. - This method helps to preserve **range of motion** and facilitate earlier return to normal activities.

Q: Garden's classification used for which fracture?

Neck of femur. ***Neck of femur*** - **Garden's classification** is a widely used system to categorize **femoral neck fractures** based on displacement. - This classification helps guide treatment decisions, as different grades of displacement have varying prognoses for **avascular necrosis** and **non-union**. *Fracture of the surgical neck of the humerus* - Fractures of the surgical neck of the humerus are typically classified using the **Neer classification system**. - The Neer classification is based on the number of displaced parts, such as the **humeral head**, **greater tuberosity**, **lesser tuberosity**, and **humeral shaft**. *Fracture of the shaft of the humerus* - Fractures of the humeral shaft are generally classified by their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., spiral, transverse, oblique, comminuted), and the presence of **open vs. closed injuries**. - There is no specific, widely recognized classification system comparable to Garden's used exclusively for these fractures. *Fracture of the shaft of the femur* - Fractures of the femoral shaft are commonly classified based on their **location** (e.g., proximal, middle, distal third), **morphology** (e.g., transverse, oblique, spiral, comminuted), and the presence of **segmental or open fractures**. - The **Winquist and Hansen classification** is sometimes used for comminuted femoral shaft fractures, but Garden's classification is not applicable here.

Q: Which of the following factors does NOT indicate an unstable pelvis?

Avulsion fractures of the L5 transverse process. ***Avulsion fractures of the L5 transverse process*** - While significant, avulsion fractures of the **L5 transverse process** are generally considered indicative of a **high-energy trauma** and potential for associated injuries, but they do not directly represent **pelvic instability** in the same way as disruptions to the pelvic ring itself. - These fractures point to powerful shearing forces but don't disrupt the **structural integrity** of the pelvic ring that dictates its stability. *Posterior sacroiliac complex displacement by > 1 cm* - This degree of displacement signifies a substantial injury to the **strong posterior ligamentous structures** of the sacroiliac joint. - Such displacement indicates a highly unstable pelvic ring, often associated with significant hemorrhage and requiring surgical stabilization. *Avulsion fracture of sacral or ischial end of the sacrospinous ligament* - An avulsion fracture at either the sacral or ischial attachment of the **sacrospinous ligament** suggests a severe disruption of the posterior pelvic ring. - The **sacrospinous ligament** is a key stabilizer of the pelvis, and injury to it indicates pelvic instability due to the loss of its anchoring function between the sacrum and ischium. *Isolated disruption of pubic symphysis with pubic diastasis of 2 cm.* - A **pubic diastasis of 2 cm** signifies a significant opening of the pubic symphysis, which is a critical anterior component of the pelvic ring. - This indicates **anterior pelvic instability**, even in the absence of posterior injuries, as the normal interlocking mechanism of the symphysis is compromised.

Q: Thomas splint is used for immobilizing fractures of ?

Femur. ***Femur*** - The **Thomas splint** is primarily designed for the temporary immobilization and traction of **femoral shaft fractures**. - Its design allows for effective stabilization and helps reduce muscle spasms and pain associated with these types of fractures. *Tibia* - While it can be used in some lower limb injuries, the Thomas splint is not the primary or most effective device for isolated **tibial fractures**. - Other splints, such as a **long leg posterior splint** or an air splint, are typically preferred for tibial immobilization. *Radius* - The **radius** is a bone in the forearm, and its fractures are typically managed with a variety of **short arm casts** or splints. - The Thomas splint is specifically designed for the much longer and larger **femur** and would be completely unsuitable for a forearm injury. *Ulna* - Similar to the radius, the **ulna** is a forearm bone, and its fractures require immobilization techniques appropriate for the upper limb. - The **Thomas splint's bulk** and mechanism are inappropriate for the immobilization of forearm bones.

Q: 12 yr old Child admitted to ICU with blunt trauma and femur fracture- Pao2 60% despite 100%o2 and rebreather mask, CXR shows lung fields clear but the patient remains confused. What is most likely the diagnosis?

Fat embolism syndrome.. ***Fat embolism syndrome*** - A **femur fracture** is a classic risk factor for fat embolism syndrome, which causes hypoxemia, neurological dysfunction (confusion), and a normal chest X-ray in its early stages [1]. - The severe **hypoxemia (PaO2 60% despite 100% O2)** that is unresponsive to oxygen therapy is characteristic, along with the patient's altered mental status [1]. *Hypovolaemic shock* - While blunt trauma and a femur fracture can lead to hypovolemic shock, the primary symptoms would be **hypotension** and **tachycardia**, not profound hypoxemia with clear lung fields. - Hypovolemic shock typically causes **generalized tissue hypoperfusion**, not selective neurological symptoms and respiratory failure in the context of a normal chest X-ray. *Pulmonary embolism* - A pulmonary embolism can cause hypoxemia and confusion, but it is less likely immediately after blunt trauma unless there's a predisposing condition, and a **clear chest X-ray** makes it less probable compared to fat embolism syndrome. - Furthermore, the sudden and severe presentation of hypoxemia and neurological changes following a long bone fracture is more characteristic of fat embolism syndrome. *Pulmonary contusion* - Pulmonary contusion would likely be visible on a **chest X-ray** as infiltrates or consolidation and would typically present with symptoms of direct lung injury, such as cough or hemoptysis, which are not mentioned. - While it can cause hypoxemia, a **clear chest X-ray** makes pulmonary contusion an unlikely diagnosis in this scenario.

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

Distal radius. ***Distal radius*** - The **distal radius** is the bone most frequently fractured when a person falls on an **outstretched hand**. This is commonly known as a **Colles fracture** if the fragment is displaced dorsally. - The force of impact is transmitted directly to the distal end of the radius, making it susceptible to fracture, especially in cases of **osteoporosis**. *Scaphoid* - The **scaphoid** bone is also commonly fractured with a fall on an outstretched hand, but it is less frequent than the distal radius. - A scaphoid fracture is concerning due to its **precarious blood supply**, which can lead to **avascular necrosis** and non-union. *Lunate* - The **lunate** bone is centrally located in the wrist and is less commonly fractured but can be dislocated or injured in high-impact trauma. - Injuries to the lunate are often associated with **perilunate dislocations**, which are severe wrist injuries. *Capitate* - The **capitate** is the largest carpal bone, located in the center of the wrist, and is rarely fractured in isolation from a fall on an outstretched hand. - Fractures of the capitate are often associated with more extensive carpal injuries due to its robust nature and central, protected position.

Question 1

What is the absolute pressure threshold for surgical intervention in compartment syndrome?

Accepted Answer

30 mm Hg

Answer

15 mm Hg

Answer

20 mm Hg

Answer

40 mm Hg

Question 2

Patient comes with crush injury to upper limb, doctor is concerned about gangrene and sepsis. What scoring system can help decide between amputation and limb salvage?

Accepted Answer

MESS

Answer

Glasgow Coma Scale

Answer

Gustilo Anderson classification

Answer

ASIA guidelines

Question 3

Most common complication of mid shaft humerus fracture is ?

Accepted Answer

Radial nerve palsy

Answer

Median nerve palsy

Answer

Nonunion

Answer

Malunion

Question 4

Functional cast bracing not used in fracture of ?

Accepted Answer

Thoracolumbar spine fracture

Answer

Humerus fracture

Answer

Tibia fracture

Answer

Ulna fracture

Question 5

Garden's classification used for which fracture?

Accepted Answer

Neck of femur

Answer

Fracture of the surgical neck of the humerus

Answer

Fracture of the shaft of the humerus

Answer

Fracture of the shaft of the femur

Question 6

Which of the following factors does NOT indicate an unstable pelvis?

Accepted Answer

Avulsion fractures of the L5 transverse process

Answer

Posterior sacroiliac complex displacement by > 1 cm

Answer

Avulsion fracture of sacral or ischial end of the sacrospinous ligament

Answer

Isolated disruption of pubic symphysis with pubic diastasis of 2 cm.

Question 7

Thomas splint is used for immobilizing fractures of ?

Accepted Answer

Femur

Answer

Tibia

Answer

Radius

Answer

Ulna

Question 8

12 yr old Child admitted to ICU with blunt trauma and femur fracture- Pao2 60% despite 100%o2 and rebreather mask, CXR shows lung fields clear but the patient remains confused. What is most likely the diagnosis?

Accepted Answer

Fat embolism syndrome.

Answer

Hypovolaemic shock.

Answer

Pulmonary embolism.

Answer

Pulmonary contusion.

Question 9

An RTA patient presented to the emergency department with severe pain in the ankle. An X-ray was performed, given below. What is the best next step in management?

Accepted Answer

Neurovascular Assessment and Closed reduction with slab application

Answer

Neurovascular Assessment and Closed reduction with cast application

Answer

Neurovascular Assessment and Immediate surgery

Answer

Neurovascular Assessment and Immediate open reduction

Question 10

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

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?