Trauma Practice Questions

Q: Most common nerve injured in fracture of medial epicondyle of humerus is:

Ulnar nerve. ***Ulnar nerve*** - The **ulnar nerve** runs directly behind the **medial epicondyle** of the humerus in a groove called the **cubital tunnel**, making it highly vulnerable to injury during fractures of this bony prominence. - Injury to the ulnar nerve at this location can cause symptoms like **numbness and tingling** in the **little finger and half of the ring finger**, **weakness in certain hand muscles**, and eventually a **"claw hand" deformity**. *Radial nerve* - The **radial nerve** courses along the posterior aspect of the humerus in the **spiral groove** and is more commonly injured with **mid-shaft humeral fractures**. - Injury typically results in **wrist drop** and **sensory loss over the dorsum of the hand**. *Median nerve* - The **median nerve** travels more anteriorly in the arm and forearm and is most commonly injured with **supracondylar fractures of the humerus** or **carpal tunnel syndrome** at the wrist. - Damage leads to **ape hand deformity** and sensory deficits over the **thumb, index, middle, and radial half of the ring finger**. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles and provides sensation to the lateral forearm; it is **less commonly injured in elbow fractures**. - Injury would primarily affect **elbow flexion** and **sensation over the lateral forearm**, which is not the typical presentation for medial epicondyle fractures.

Q: What is the generally recommended maximum weight for skeletal traction in adult patients?

15 kg. ***15 kg*** - While the specific weight can vary based on the bone and patient, 10-15 kg is generally the **maximum recommended weight for skeletal traction** in adults to avoid complications. - Applying too much weight risks **damage to the bone, soft tissues, and nerves**, as well as potential pin site infections and neurovascular compromise. *5 kg* - This weight is typically more appropriate for **skin traction**, where the pulling force is applied externally to the skin, limiting the amount of weight that can be safely used without causing skin damage. - In skeletal traction, 5 kg is often used for **initial alignment or very tenuous fractures**, but it is generally insufficient for significant reduction or long-term stabilization. *10 kg* - 10 kg is a common starting point or moderate weight used in skeletal traction, particularly for **femur or tibia fractures**. - While often effective, it is not consistently the maximum safe weight, as some situations may allow or require slightly more weight up to 15 kg for optimal reduction. *20 kg* - Applying 20 kg of weight in skeletal traction is generally considered **excessive and dangerous** in most adult applications. - This high amount of weight significantly increases the risk of **pin loosening, osteomyelitis, neurovascular injury, and avascular necrosis**, especially in areas like the cervical spine or tibia.

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Open femoral fracture. ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.

Q: Which of the following fractures is least likely associated with vascular injury?

Fracture shaft of humerus. ***Fracture shaft of humerus*** - While any fracture can theoretically cause vascular injury, **mid-shaft humeral fractures** are less commonly associated with significant **vascular compromise** compared to those around major joints or near critical neurovascular bundles. - The **brachial artery** and its branches are often sufficiently mobile and protected by surrounding musculature in the mid-shaft region, reducing the incidence of direct laceration or entrapment. *Fracture supracondylar femur* - **Supracondylar femur fractures** are in close proximity to the **femoral artery** and its branches in the popliteal fossa. - Displacement of these fractures can easily **lacerate or compress** these vital vessels, leading to high rates of vascular injury. *Fracture supracondylar humerus* - **Supracondylar humerus fractures** in children are notoriously associated with **brachial artery injury** due to the artery's close proximity and fixated position over the joint. - The acute angulation and displacement often seen in these fractures put the artery at significant risk of **kinking, compression, or transection**. *Fracture shaft of femur* - **Femoral shaft fractures** can be associated with significant vascular injury, particularly from **large displaced fragments** or high-energy trauma. - The **superficial femoral artery** and its perforating branches can be torn, leading to substantial hemorrhage or arterial compromise.

Q: Which of the following is NOT a complication of elbow dislocation?

Radial nerve injury. ***Radial nerve injury*** - The **radial nerve** is rarely injured in an elbow dislocation due to its anatomical course, which is less exposed to the shearing forces involved in this type of injury. - While other nerves like the ulnar and median nerves are more susceptible, significant stretching or compression of the radial nerve is **uncommon** in typical elbow dislocations. *Vascular injury* - The **brachial artery** runs in close proximity to the elbow joint and can be torn or compressed during a dislocation, leading to **ischemia** if not promptly recognized and treated. - This complication can result in **Volkmann's ischemic contracture** if perfusion is not restored. *Median nerve injury* - The **median nerve** passes anterior to the elbow joint and is vulnerable to injury from stretching or direct compression during dislocation. - Injury can manifest as **sensory deficits** in the distribution of the median nerve and **weakness** of forearm pronation and thumb flexion/opposition. *Myositis ossificans* - This is a common chronic complication of elbow dislocations, particularly in cases of **delayed reduction** or aggressive physical therapy. - It involves the **abnormal ossification** of soft tissues around the joint, commonly in the brachialis muscle, leading to **pain and restricted range of motion**.

Q: Most commonly recommended cast position for proximal forearm fractures is ?

Supinated position. ***Supinated position*** - The **supinated position** is generally recommended for proximal forearm fractures because the **biceps brachii** and **supinator muscles**, which are often attached to the proximal fracture segment, cause **supination** when they contract. - Placing the forearm in supination **aligns the distal fracture fragment** with the proximal fragment, promoting better reduction and healing. *Pronated flexion* - **Pronation** would cause the distal fragment to rotate away from the proximal fragment, leading to **malunion** or nonunion. - While some fractures might benefit from a degree of flexion, **pronated flexion** specifically is not the primary position for proximal forearm alignment. *Neutral position* - A **neutral position** might not adequately account for the rotational forces exerted by the biceps and supinator on the proximal fragment, potentially leading to **rotational displacement**. - It does not offer the same alignment benefits as full supination for most proximal forearm fractures. *Position does not matter* - The **cast position is crucial** for forearm fractures, especially proximal ones, as the muscles attached to the forearm bones exert significant rotational forces. - An **incorrect cast position** can lead to rotational deformities, **malunion**, and functional impairment of the forearm.

Q: Garden spade deformity is seen in ?

Smith's fracture. ***Smith's fracture*** - This fracture involves **volar displacement** of the distal radial fragment, causing the characteristic **garden spade deformity** or **reverse Colles' fracture**. - It typically results from a fall onto a **flexed wrist** or a direct blow to the back of the wrist. *Colle’s fracture* - This fracture is characterized by **dorsal displacement** of the distal radial fragment, leading to a **dinner fork deformity**. - It usually occurs from a fall onto an **extended wrist**. *Bennett’s fracture* - This is an **intra-articular fracture** of the base of the **first metacarpal bone**, involving the carpometacarpal joint. - It is often caused by axial loading on a partially flexed thumb. *Barton’s fracture* - This is an **intra-articular fracture** of the distal radius involving either the **dorsal or volar rim**. - It is essentially a **shear fracture** with associated carpal displacement.

Question 1

Most common nerve injured in fracture of medial epicondyle of humerus is:

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 2

What is the generally recommended maximum weight for skeletal traction in adult patients?

Accepted Answer

15 kg

Answer

5 kg

Answer

10 kg

Answer

20 kg

Question 3

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Open femoral fracture

Answer

Closed tibial fracture

Answer

Open humeral fracture

Answer

Closed humeral fracture

Question 4

Which of the following fractures is least likely associated with vascular injury?

Accepted Answer

Fracture shaft of humerus

Answer

Fracture supracondylar femur

Answer

Fracture supracondylar humerus

Answer

Fracture shaft of femur

Question 5

Which of the following is NOT a complication of elbow dislocation?

Accepted Answer

Radial nerve injury

Answer

Vascular injury

Answer

Median nerve injury

Answer

Myositis ossificans

Question 6

Most commonly recommended cast position for proximal forearm fractures is ?

Accepted Answer

Supinated position

Answer

Pronated flexion

Answer

Neutral position

Answer

Position does not matter

Question 7

Which of the following statements is true regarding the proximal fragment in a supratrochanteric fracture?

Accepted Answer

The proximal fragment exhibits flexion, abduction, and external rotation.

Answer

The proximal fragment is flexed.

Answer

The proximal fragment is abducted.

Answer

The proximal fragment is externally rotated.

Question 8

Garden spade deformity is seen in ?

Accepted Answer

Smith's fracture

Answer

Colle’s fracture

Answer

Bennett’s fracture

Answer

Barton’s fracture

Question 9

What is the Essex-Lopresti lesion in the upper limb?

Accepted Answer

Comminuted radial head fracture with interosseous membrane disruption and DRUJ instability

Answer

Isolated radial head fracture without soft tissue involvement

Answer

Radial shaft

Answer

Radial shaft and radio-ulnar joint fracture

Question 10

What is the characteristic feature of Barton's fracture?

Accepted Answer

Intra-articular fracture of the distal end radius with carpal bone subluxation and joint involvement

Answer

Extra-articular fracture of the distal end radius

Answer

Intra-articular fracture of the distal end radius without carpal bone subluxation

Answer

Intra-articular fracture of the distal end radius with carpal bone subluxation

Trauma — MCQs

Trauma — MCQs

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