Trauma Practice Questions

Q: Most common bone for which nailing is done

Tibia. ***Tibia*** - The **tibia** is the most common long bone for which **intramedullary nailing** (IM nailing) is performed, particularly for fractures of the **tibial shaft**. - Its subcutaneous location and strong cortical bone make it amenable to this type of internal fixation, promoting stability and healing. *Radius* - Fractures of the **radius**, especially distal radial fractures, are more commonly treated with **plate and screw fixation** or external fixation, rather than intramedullary nailing. - While IM nailing can be used for some radial shaft fractures, it is not the most common bone for this procedure. *Ulna* - Like the radius, the **ulna** is less frequently fixed with intramedullary nails; **plate and screw fixation** is generally preferred for ulnar shaft fractures. - Its triangular cross-section and the presence of the interosseous membrane complicate IM nailing in some cases. *Humerus* - While **humeral shaft fractures** can be treated with intramedullary nailing, especially in comminuted or pathological fractures, it is overall less common than tibial nailing. - The risk of shoulder and elbow stiffness, as well as radial nerve injury, are considerations with humeral nailing.

Q: Treatment of choice for displaced fracture neck femur in a 40 years old female

Multiple screw fixation. ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.

Q: Proximal humerus fracture which has maximum chances of avascular necrosis

Four part. ***Four part fracture*** - A **four-part proximal humerus fracture** typically involves displacement of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. - This extensive displacement significantly disrupts the **blood supply** to the humeral head, specifically the **arcuate artery** and its branches, leading to a high risk of **avascular necrosis**. *One part fracture* - A **one-part fracture** indicates that the fracture fragments are minimally displaced (<1 cm or <45° angulation). - The **blood supply** to the humeral head remains largely intact, resulting in a very low risk of avascular necrosis. *Two part fracture* - A **two-part fracture** involves displacement of one major fragment (e.g., surgical neck or tuberosity) from the humeral head. - While there is some disruption, the overall risk of **avascular necrosis** is lower compared to more complex fractures. *Three part fracture* - A **three-part fracture** involves separate displacement of the humeral head and two tuberosities. - This fracture pattern causes more significant disruption to the **vascularity** of the humeral head than two-part fractures but generally less than four-part fractures.

Q: In which of the following conditions is the Kocher-Langenbeck approach for emergency acetabular fixation contraindicated?

Morel - Lavallee lesion. ***Morel - Lavallee lesion*** - A Morel-Lavallee lesion is a **closed degloving injury** where the skin and subcutaneous tissue are avulsed from the underlying fascia, creating a potential space that fills with hematoma, fat, and lymphatic fluid. - The **Kocher-Langenbeck approach** involves significant soft tissue dissection, which increases the risk of **wound complications**, infection, and flap necrosis in an already compromised and devascularized soft tissue envelope found in a Morel-Lavallee lesion. *Open fracture* - An **open fracture** involves a break in the skin, exposing the fracture site, which significantly increases the risk of infection. - While it presents a challenge, an open fracture is generally a **stronger indication for urgent surgical stabilization** to prevent further contamination and promote healing, rather than a contraindication to a specific surgical approach if it's the most appropriate for the fracture pattern. *Progressive sciatic nerve injury* - **Progressive neurologic deficits**, including sciatic nerve injury, often necessitate urgent surgical intervention to decompress the nerve and prevent irreversible damage. - This symptom emphasizes the **urgency of surgical stabilization** and internal fixation for the acetabular fracture, making it an indication for rather than a contraindication to the Kocher-Langenbeck approach if it provides optimal access. *Recurrent dislocation despite closed reduction and traction* - **Instability** of the hip joint despite conservative measures indicates a need for surgical intervention to achieve stable reduction and fixation of the acetabular fracture. - This situation generally **supports the need for open reduction and internal fixation**, often via approaches like Kocher-Langenbeck, to restore joint congruity and stability, making it an indication, not a contraindication.

Q: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

Pipkin's type 4 fracture. ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.

Q: Which of the following is NOT a complication of a neck femur fracture?

Malunion. ***Malunion*** - **Malunion** is a rare complication of a femoral neck fracture because the fracture is inherently unstable and tends to result in **nonunion** rather than healing in an abnormal position. - The **vascular compromise** and mechanical forces often lead to a failure to heal whatsoever, or to avascular necrosis. *Nonunion* - **Nonunion** is a common and severe complication of femoral neck fractures due to the **precarious blood supply** to the femoral head and the high mechanical stress across the fracture site. - The lack of adequate blood flow and movement at the fracture site hinders the formation of a **bony callus**, leading to failure of the bone to heal. *AVN* - **Avascular necrosis (AVN)** of the femoral head is a major complication resulting from the disruption of the arterial blood supply to the femoral head during the fracture. - The **retinacular arteries**, which supply most of the femoral head, are often damaged, leading to the death of bone cells and subsequent collapse of the femoral head. *Osteoarthritis* - **Post-traumatic osteoarthritis** can develop as a long-term complication, even if the fracture heals. - The initial injury and any subsequent irregularities in the joint surface or alignment can lead to accelerated **cartilage degeneration**.

Q: Sciatic nerve palsy may occur in which injury?

Posterior dislocation of hip joint. ***Posterior dislocation of hip joint*** - This injury commonly results from **high-energy trauma**, such as a dashboard injury, forcing the femoral head posteriorly out of the acetabulum. - The **sciatic nerve** runs in close proximity to the posterior aspect of the hip joint and can be stretched or compressed during such a dislocation, leading to palsy. *Fracture neck of femur* - This fracture typically involves the **femoral neck** and is more associated with complications like avascular necrosis due to disruption of blood supply. - While it can involve nerve injury, **sciatic nerve palsy** is not a common or direct complication of this specific fracture type. *Trochanteric fracture* - This fracture involves the **greater or lesser trochanter** of the femur, often due to a fall in elderly individuals. - Nerve injury is rare with this type of fracture, and the sciatic nerve is generally not vulnerable in this location. *Anterior dislocation of hip* - This is a less common type of hip dislocation where the femoral head displaces **anteriorly**. - While other neurovascular structures might be at risk, the **femoral nerve** or vessels are more likely to be involved, not the sciatic nerve, which is located posteriorly.

Q: The treatment of choice for fracture of radius and ulna in an adult is:

Only plates. ***Only plates*** - **Open reduction and internal fixation (ORIF)** with plates and screws is the preferred treatment for diaphyseal fractures of both the radius and ulna in adults, as it provides **stable fixation** and allows for early mobilization. - This method helps restore normal forearm anatomy and function, crucial for maintaining **pronation and supination**. *Plaster for 4 weeks* - **Conservative management** with plaster casting for fractures of both radius and ulna in adults often leads to **malunion**, nonunion, or loss of forearm rotation. - It is generally reserved for **undisplaced fractures** or in situations where surgery is contraindicated. *Closed reduction and calipers* - **Closed reduction** can be attempted for some forearm fractures, but maintaining reduction with external devices like calipers is challenging due to the dynamic forces of the forearm muscles. - This method has a higher risk of **redisplacement** and suboptimal anatomical alignment, leading to functional limitations. *Kuntscher nails* - **Kuntscher nails** (intramedullary nails) are more commonly used for long bone fractures like the femur or tibia. - While intramedullary nailing can be used for forearm fractures, **plating** is generally favored for diaphyseal radius and ulna fractures due to better control of **rotational alignment** and restoration of the interosseous space.

Question 1

Volkmann's contracture: which artery is involved in this condition?

Accepted Answer

Brachial artery

Answer

Radial

Answer

Ulnar

Answer

Anterior interosseous artery

Question 2

Most common bone for which nailing is done

Accepted Answer

Tibia

Answer

Radius

Answer

Ulna

Answer

Humerus

Question 3

Treatment of choice for displaced fracture neck femur in a 40 years old female

Accepted Answer

Multiple screw fixation

Answer

None of the options

Answer

Bipolar hemiarthroplasty

Answer

THR

Question 4

Proximal humerus fracture which has maximum chances of avascular necrosis

Accepted Answer

Four part

Answer

One part

Answer

Two part

Answer

Three part

Question 5

Which of the following best describes a Monteggia fracture?

Accepted Answer

Fracture of the proximal third of the ulna with dislocation of the radial head.

Answer

Fracture of distal radius with dislocation of the distal ulna

Answer

Fracture of distal third of ulna with dislocation of the radial head.

Answer

Fracture of proximal one third of radius with dislocation of the distal ulna.

Question 6

In which of the following conditions is the Kocher-Langenbeck approach for emergency acetabular fixation contraindicated?

Accepted Answer

Morel - Lavallee lesion

Answer

Progressive sciatic nerve injury

Answer

Open fracture

Answer

Recurrent dislocation despite closed reduction and traction

Question 7

A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

Accepted Answer

Pipkin's type 4 fracture

Answer

Anterior dislocation of hip

Answer

Central fracture dislocation

Answer

Posterior dislocation

Question 8

Which of the following is NOT a complication of a neck femur fracture?

Accepted Answer

Malunion

Answer

Nonunion

Answer

Osteoarthritis

Answer

AVN

Question 9

Sciatic nerve palsy may occur in which injury?

Accepted Answer

Posterior dislocation of hip joint

Answer

Fracture neck of femur

Answer

Trochanteric fracture

Answer

Anterior dislocation of hip

Question 10

The treatment of choice for fracture of radius and ulna in an adult is:

Accepted Answer

Only plates

Answer

Plaster for 4 weeks

Answer

Closed reduction and calipers

Answer

Kuntscher nails

Trauma — MCQs

Trauma — MCQs

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