Trauma Practice Questions

Q: A 36-year-old man presents with an ankle injury sustained during a soccer match. What urgent intervention is required?

Applying a splint to stabilize the injury. ***Applying a splint to stabilize the injury*** - **Splinting** is a crucial urgent intervention for an ankle injury to **immobilize** the affected joint, reducing pain and preventing further damage to soft tissues or bone fragments. - It provides temporary stability until a definitive diagnosis and treatment plan can be established. *Performing a CT scan to assess the injury* - A **CT scan** is a diagnostic tool used to visualize complex fractures or soft tissue injuries in detail, but it is not an urgent intervention for initial management. - While important for diagnosis, it should typically follow initial stabilization and clinical assessment. *Immediate reduction of the dislocation* - **Reduction** is an urgent intervention for **dislocations**, but the question describes an "ankle injury," which could be a sprain, fracture, or dislocation. **Reduction** is only appropriate if a **dislocation** is confirmed. - Attempting to reduce a potential fracture without imaging can cause further trauma or pain. *Manipulation to restore alignment* - **Manipulation to restore alignment** is typically reserved for **dislocations** or certain types of **fractures** after proper imaging has been performed to understand the extent and type of injury. - Similar to reduction, it is not the universal first urgent intervention for an undiagnosed ankle injury.

Q: Displaced transverse patella; what is the treatment?

Tension band wiring. ***Tension band wiring*** - This is the standard treatment for **displaced patellar fractures**, especially transverse ones, as it converts distractive forces into compressive ones, promoting healing. - It involves using K-wires and a cerclage wire to achieve **stable fixation** and allow for early range of motion. *POP cast* - A **Plaster of Paris (POP) cast** is typically used for non-displaced or minimally displaced fractures that do not require surgical stabilization. - It would not provide adequate stability for a **displaced transverse patella fracture**, which is prone to further displacement due to quadriceps pull. *Non-operative* - **Non-operative treatment** is reserved for **non-displaced** or minimally displaced patellar fractures where the extensor mechanism remains intact. - A **displaced transverse patella fracture** disrupts the extensor mechanism, making non-operative treatment unsuitable as it would lead to poor functional outcomes and a high risk of nonunion. *Patellectomy* - **Patellectomy** (partial or total removal of the patella) is considered for severely comminuted fractures where reconstruction is not possible or for chronic symptomatic nonunion. - It is generally avoided as a primary treatment for displaced transverse fractures due to the importance of the patella in **knee extension mechanics** and the risk of quadriceps weakness.

Q: In fracture of the olecranon, excision of the proximal fragment is indicated in all of the following situations, EXCEPT:

Fracture extending to coronoid process. ***Fracture extending to coronoid process*** - Excision of the proximal fragment of the olecranon is generally contraindicated when the fracture extends to the **coronoid process** because it can compromise the stability and articulation of the elbow joint. - This type of fracture often requires more extensive reconstructive procedures to restore joint integrity. *Old ununited fractures* - For **old ununited olecranon fractures**, excision of the proximal fragment can be a viable option, especially if the fragment is small and does not contribute significantly to joint stability after non-union. - This approach aims to reduce pain and improve function by removing the source of irritation. *Elderly patient* - In **elderly patients**, excision of the fractured olecranon fragment is often favored, particularly if the fragment is small or the patient has low functional demands. - This approach offers a simpler solution compared to complex internal fixation, reducing surgical time and risks of prolonged immobility and complications. *Comminuted fracture* - For **comminuted olecranon fractures**, especially if the fragments are too small or numerous to be effectively fixed, excision of the proximal fragment is a reasonable option. - This can help restore functional range of motion and reduce pain when reconstruction is not feasible.

Q: Initially, compression osteosynthesis was used for:

Non union. ***Non union*** - Compression osteosynthesis was developed to address **non-union** of fractures by providing mechanical stability and promoting bone healing through direct contact and compression at the fracture site. - The compression stimulates an osteogenic response, improving the chances of union even in cases where previous attempts at healing failed. *Malunion* - **Malunion** refers to a fracture that has healed in an incorrect anatomical position. Compression osteosynthesis is primarily for promoting healing contact, not for realigning already united but malpositioned bone fragments. - Correcting a malunion usually requires an osteotomy to re-break the bone and then fix it in the proper alignment, which may or may not involve compression. *Correct alignment of bone* - While maintaining **correct alignment** is crucial in fracture management, compression osteosynthesis is a technique applied *after* initial alignment has been achieved. It serves to stabilize the aligned fragments and promote healing, rather than being the primary method for initial alignment itself. - Techniques like traction or manipulation are typically used for initial alignment before fixation with compression. *Improper alignment of bone* - **Improper alignment** of bone refers to a fracture where the bone fragments are not in their anatomical position. Compression osteosynthesis is not designed to correct improper alignment; instead, alignment must be corrected *before* compression is applied. - Applying compression to improperly aligned fragments would stabilize the malalignment, hindering proper healing and function.

Q: Least common complication of a fall from height is -

Fracture fibula. ***Fracture fibula*** - A fibula fracture is the **least common** with a fall from height because the force is typically axial, impacting the lower limbs. - The fibula is a **non-weight-bearing bone**, making it less susceptible to direct axial compression trauma from a fall. *Fracture base of skull* - **Basilar skull fractures** can occur from significant head trauma in a fall, especially when the head strikes a surface. - While not as common as extremity fractures, they are a serious and known complication of falls from height. *Fracture 12th thoracic vertebra* - **Vertebral compression fractures**, particularly in the thoracolumbar region (like T12), are common due to axial loading upon landing on the buttocks or feet. - This is a frequent injury in falls from height due to the **compressive forces** transmitted through the spine. *Fracture calcaneum* - **Heel bone fractures** (calcaneum) are very common in falls from height, as direct impact often occurs on the feet. - The calcaneus bears the initial and substantial impact, making it highly vulnerable to **crush injuries** in such falls.

Q: Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?

Tongue-type fracture. ***Tongue-type fracture*** - This fracture pattern involves a **vertical fracture line** extending posteriorly through the body of the calcaneus, creating a "tongue"-shaped fragment that includes the posterior facet. - The superior portion of this fragment is **displaced superiorly**, leading to a characteristic increase in **Gissane's angle**. *Joint depression-type fracture* - This fracture involves the **depression of the articular surface** of the posterior facet into the body of the calcaneus. - In this type, the **Gissane's angle** is typically **decreased**, not increased, due to the collapse of the articular surface. *Extra-articular fracture* - An **extra-articular fracture** does not involve the articular surfaces of the calcaneus, meaning the **Gissane's angle** (which describes the relationship of the articular surfaces) is generally **preserved** or minimally affected. - These fractures occur outside the subtalar joint and are classified differently than intra-articular types. *Avulsion fracture* - An **avulsion fracture** typically occurs when a ligament or tendon pulls a piece of bone away from the main bone mass, often at muscle insertions like the Achilles tendon. - While it can occur in the calcaneus, it does not involve the characteristic displacement of the posterior facet that would lead to an **increased Gissane's angle** in the way a tongue-type fracture does.

Q: Which maneuver is used in the reduction of shoulder dislocation?

Kocher's manoeuvre. ***Kocher's manoeuvre*** - **Kocher's manoeuvre** is a classic technique used for the **reduction of anterior shoulder dislocations**, involving external rotation, adduction, and internal rotation. - This method aims to safely guide the humeral head back into the glenoid fossa with a series of controlled movements. *Allis manoeuvre* - The **Allis manoeuvre** is primarily used for the **reduction of posterior hip dislocations**, involving hip flexion, adduction, and internal rotation with axial traction. - It is not indicated for shoulder dislocations. *Sultanpur technique* - The "Sultanpur technique" is **not a recognized medical term** or maneuver for reducing dislocations. - This option appears to be a distractor. *Intramedullary nail* - An **intramedullary nail** is a surgical device used for **fixing long bone fractures**, such as those in the femur or tibia. - It is an orthopedic implant and not a reduction maneuver for dislocations.

Q: Most common nerve to be damaged in dislocation of the shoulder is:

Axillary nerve. ***Axillary nerve*** - The **axillary nerve** is the most commonly injured nerve in **shoulder dislocations** due to its anatomical course around the surgical neck of the humerus. - Damage to the axillary nerve can lead to weakness in **deltoid abduction** and sensory loss over the **regimental badge area**. *Radial nerve* - The **radial nerve** is more commonly injured in mid-shaft humeral fractures or prolonged compression, not typically shoulder dislocations. - Injury to the radial nerve primarily affects **wrist extension** and sensation in the dorsal hand. *Median nerve* - The **median nerve** is less frequently injured in isolated shoulder dislocations and is more often associated with injuries closer to the elbow or wrist. - Damage to the median nerve causes deficits in **thumb opposition** and sensation over the palmar aspect of the first three and a half digits. *Musculocutaneous nerve* - The **musculocutaneous nerve** is relatively protected in shoulder dislocations, as it pierces the coracobrachialis muscle. - Injury to this nerve would primarily impair **forearm flexion** and sensation over the lateral forearm.

Q: Hill-Sach's lesion is seen in:

Recurrent dislocation of shoulder. ***Recurrent dislocation of shoulder*** - A **Hill-Sach's lesion** is a **compression fracture** of the posterolateral part of the humeral head, occurring as the humeral head impacts the anterior rim of the glenoid during **anterior shoulder dislocation**. - It is particularly associated with **recurrent anterior shoulder dislocations** due to repeated impaction. *Anterior dislocation of hip* - This condition involves the femoral head moving anteriorly out of the acetabulum and is not associated with a Hill-Sach's lesion. - While it causes significant pain and immobility, the specific bone lesion known as Hill-Sach's involves the humerus, not the femur. *Posterior dislocation of hip* - A posterior hip dislocation involves the femoral head moving posteriorly out of the acetabulum and is not linked to a Hill-Sach's lesion. - This type of injury is often seen in high-impact trauma, such as car accidents, and can be associated with acetabular fractures or sciatic nerve injury. *Posterior dislocation of shoulder* - This involves the humeral head dislocating posteriorly relative to the glenoid, and while bone lesions can occur, they are typically **reverse Hill-Sach's lesions** (on the anterior aspect of the humeral head) or **bony Bankart lesions** of the posterior glenoid. - A standard Hill-Sach's lesion specifically refers to the posterolateral humeral head defect seen in **anterior dislocations**.

Question 1

A 36-year-old man presents with an ankle injury sustained during a soccer match. What urgent intervention is required?

Accepted Answer

Applying a splint to stabilize the injury

Answer

Performing a CT scan to assess the injury

Answer

Manipulation to restore alignment

Answer

Immediate reduction of the dislocation

Question 2

Displaced transverse patella; what is the treatment?

Accepted Answer

Tension band wiring

Answer

POP cast

Answer

Non operative

Answer

Patellectomy

Question 3

In fracture of the olecranon, excision of the proximal fragment is indicated in all of the following situations, EXCEPT:

Accepted Answer

Fracture extending to coronoid process

Answer

Elderly patient

Answer

Old ununited fractures

Answer

Comminuted fracture

Question 4

Initially, compression osteosynthesis was used for:

Accepted Answer

Non union

Answer

Malunion

Answer

Correct alignment of bone

Answer

Improper alignment of bone

Question 5

Least common complication of a fall from height is -

Accepted Answer

Fracture fibula

Answer

Fracture base of skull

Answer

Fracture 12th thoracic vertebra

Answer

Fracture calcaneum

Question 6

Which type of intra-articular fracture of the calcaneum is characterized by an increased Gissane's angle?

Accepted Answer

Tongue-type fracture

Answer

Extra-articular fracture

Answer

Joint depression-type fracture

Answer

Avulsion fracture

Question 7

Which of the following statements is true regarding Colles' fracture?

Accepted Answer

Extra-articular fracture of distal radius with dorsal displacement

Answer

Intra-articular fracture of distal radius with palmar displacement

Answer

Intra-articular fracture of distal radius with dorsal displacement

Answer

Extra-articular fracture of distal radius with palmar displacement

Question 8

Which maneuver is used in the reduction of shoulder dislocation?

Accepted Answer

Kocher's manoeuvre

Answer

Allis manoeuvre

Answer

Sultanpur technique

Answer

Intramedullary nail

Question 9

Most common nerve to be damaged in dislocation of the shoulder is:

Accepted Answer

Axillary nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 10

Hill-Sach's lesion is seen in:

Accepted Answer

Recurrent dislocation of shoulder

Answer

Anterior dislocation of hip

Answer

Posterior dislocation of hip

Answer

Posterior dislocation of shoulder

Trauma — MCQs

Trauma — MCQs

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