Upper Limb Trauma (Clavicle, Shoulder, Elbow, Forearm, Hand) MCQs

Orthopedics · 69 free questions with answers & explanations.

1. A 10-year-old boy falls on an outstretched hand. X-ray shows a fracture of the distal humerus with anterior displacement of the distal fragment. The nerve most commonly injured in this fracture is:
2. A 22-year-old motorcyclist has a fracture of the shaft of the humerus at the junction of the middle and lower thirds. Which nerve is most commonly injured at this site and what functional deficit would be expected?
3. A 35-year-old man presents with pain and tenderness over the anatomical snuffbox after a fall on his outstretched hand. X-ray is reported as normal. The most appropriate next step is:
4. A 60-year-old woman falls on an outstretched hand. She has a dinner-fork deformity of the wrist. X-ray shows dorsal displacement and tilt of the distal radial fragment with impaction. This fracture is called:
5. A 14-year-old boy sustains a fracture of the lateral condyle of the humerus. If this fracture is not recognised and treated, the most feared late complication is:
6. A 60-year-old woman falls on her outstretched hand. X-ray shows a Neer Type IV proximal humerus fracture (4-part fracture with head impacted). The preferred definitive treatment in this patient is:
7. During ORIF of a lateral condyle fracture of the humerus in a child, which structure must be carefully protected to prevent a cubitus valgus deformity and tardy ulnar nerve palsy?
8. A 25-year-old rugby player is tackled and sustains anterior shoulder dislocation. Which of the following is the most common pathological lesion underlying recurrent anterior instability?
9. A 30-year-old falls on a dorsally flexed wrist. X-ray shows a scaphoid fracture at the waist. MRI confirms no displacement and normal vascularity of the proximal pole. What is the most appropriate initial management?
10. In a Galeazzi fracture-dislocation, which bone is fractured and which joint is disrupted?
11. A 35-year-old woman falls on an outstretched hand. X-ray shows a Colles' fracture. The deformity that gives the characteristic 'dinner fork' appearance is:
12. In the Neer classification of proximal humeral fractures, a 4-part fracture with displacement of the head fragment is best treated by:
13. A 10-year-old boy sustains a Gartland Type III supracondylar fracture of the humerus with a pulseless but well-perfused hand (pink hand). The MOST appropriate next step is:
14. A Monteggia fracture (Bado Type I) in an adult involves:
15. Bennett's fracture is an intra-articular fracture at the base of the first metacarpal. The deforming force that causes proximal displacement and abduction of the metacarpal shaft is:
16. A 28-year-old cricketer falls on an outstretched hand and sustains a proximal humerus fracture. X-ray shows displacement of both the greater tuberosity (>5 mm) and the surgical neck with 45° angulation, but the articular segment retains blood supply. According to the Neer classification, this is a:
17. A child aged 7 years presents with a supracondylar humerus fracture. The anterior humeral line (AHL) on lateral X-ray passes through the posterior third of the capitellum. The Baumann angle on AP is 55°. According to Gartland classification, this fracture is:
18. A 40-year-old woman sustains a Monteggia fracture-dislocation. X-ray shows a fracture of the proximal third of the ulna with anterior bowing and anterior dislocation of the radial head. According to the Bado classification, this is:
19. Which of the following is the most appropriate initial management for a closed displaced both-bone forearm fracture in a 10-year-old child with >15° angulation?
20. In distal radius fractures, Fernandez classification Type III specifically refers to:
21. A 28-year-old cricketer sustains a posterior dislocation of the shoulder while bowling. Clinically, the arm is held in internal rotation and adduction; the anterior shoulder appears flat. Which radiographic view BEST demonstrates the posterior dislocation that may be missed on standard AP view?
22. A 6-year-old child falls on an outstretched hand and sustains a Gartland type III supracondylar fracture of the humerus. The radial pulse is absent but the hand is warm, well-perfused, and pink. Which is the MOST appropriate immediate management?
23. A 25-year-old falls from a bicycle and sustains an isolated fracture of the radial shaft (Monteggia variant). The ulnar bow is intact. X-ray shows a fracture at the junction of middle and distal thirds of the radius with dorsal angulation. There is no associated ulnar fracture. What is the CORRECT eponymous description and management?
24. In Neer's classification of proximal humerus fractures, a '3-part fracture' involves displacement (>1 cm or >45°) of which specific anatomical parts?
25. A 55-year-old woman with osteoporotic bone sustains a comminuted intra-articular distal radius fracture (AO type C3). Which implant provides the most stable fixation and allows early wrist mobilisation in this scenario?
26. A 30-year-old falls directly on the outstretched hand. X-ray shows a perilunate dislocation without fracture. According to Mayfield's progressive perilunar instability pattern, this injury corresponds to which stage?
27. In the Neer classification of proximal humerus fractures, a 'part' is defined as a segment displaced by at least which degree of angulation AND separation?
28. A 28-year-old motorcyclist sustains a Grade IIIB open both-bones forearm fracture. After debridement and wound management, the preferred definitive fixation is:
29. A 14-year-old boy has a displaced lateral condyle fracture of the humerus with >2 mm displacement confirmed on CT. The Milch classification for this fracture determines the operative approach. A Milch Type II fracture is unstable because the fracture line passes through:
30. A 28-year-old rugby player is brought to the emergency with an anterior shoulder dislocation. The Hill-Sachs lesion is best described as:
31. A 45-year-old falls on an outstretched hand and sustains a Neer Type II fracture-dislocation of the proximal humerus. Which combination of features defines this pattern?
32. A 7-year-old child sustains a supracondylar humerus fracture (Gartland Type III). Which nerve is MOST commonly injured in this fracture pattern?
33. A 32-year-old with a Monteggia fracture-dislocation has a proximal ulna fracture with dislocation of the radial head. According to Bado's classification, a Type I pattern involves:
34. In a distal radius fracture with dorsal tilt >20°, radial shortening >5 mm, and articular step-off >2 mm, which implant provides the BEST biomechanical advantage?
35. A 28-year-old falls on an outstretched hand. X-ray shows a Galeazzi fracture-dislocation. Which combination correctly describes this injury?
36. A 55-year-old sustains a proximal humerus fracture. Neer classification divides the proximal humerus into four segments. Which part must be displaced >1 cm or angulated >45° to be counted as a 'part'?
37. A 6-year-old boy falls off a swing. Lateral X-ray shows a posterior fat pad sign with no visible fracture line. What is the most likely injury and appropriate management?
38. In Monteggia fracture-dislocation, the BADO classification Type I involves anterior dislocation of the radial head with which pattern of ulna fracture?
39. A 40-year-old falls on an abducted arm. She cannot initiate abduction but can complete it when passively brought past 15°. She has a positive drop arm sign. MRI confirms a complete supraspinatus tear with 3 cm retraction. What is the preferred management?
40. A 35-year-old man presents with recurrent anterior shoulder dislocations (4 episodes in 2 years). MRI arthrogram shows a Bankart lesion (anterior labral tear) and a Hill-Sachs lesion engaging with the glenoid rim in external rotation (engaging Hill-Sachs). The bone loss of the glenoid is estimated at 20% on CT. Which surgical procedure is most appropriate for this patient?
41. In a posterior Monteggia fracture-dislocation (Bado Type II), the radial head dislocates in which direction, and the associated fracture pattern is:
42. Following anterior dislocation of the shoulder, an axillary nerve injury occurs. The area of sensory loss that is most specific for axillary nerve injury is:
43. In a distal radius fracture with dorsal comminution, the radiographic criterion that most strongly indicates the need for surgical fixation is:
44. A 25-year-old cricketer sustains a posterior shoulder dislocation during a seizure. On examination, the arm is held in internal rotation and adduction. X-ray shows a 'light bulb' sign. Which additional radiological finding confirms posterior dislocation on a standard AP view?
45. A 5-year-old child presents with an elbow injury. Radiographs show an avulsion of the medial epicondyle. The fragment is trapped within the elbow joint. Which important associated injury must be excluded?
46. A 30-year-old falls on an outstretched hand. X-ray shows a fracture of the proximal one-third of the ulna with anterior dislocation of the radial head. The diagnosis is:
47. A 45-year-old man falls on his outstretched hand and sustains a displaced proximal humeral fracture. The Neer classification divides the proximal humerus into 4 parts. A 4-part fracture in an elderly patient is best treated by:
48. A 22-year-old cricket bowler presents with elbow pain and a palpable bony fragment medially. X-ray shows a medial epicondyle avulsion. Which nerve is at highest risk from this injury?
49. The Galeazzi fracture-dislocation consists of:
50. A 30-year-old rugby player sustains a grade V acromioclavicular joint dislocation (Rockwood classification). Radiograph shows complete separation with inferior displacement of the acromion ('reversed piano key'). The surgical procedure that reconstructs the coracoclavicular ligament using a tendon graft or synthetic tape is:
51. A 60-year-old woman sustains a comminuted distal radius fracture. Post-reduction X-ray shows radial inclination of 10°, volar tilt of -10° (dorsal angulation), and radial shortening of 6 mm. These measurements indicate an acceptable reduction?
52. A 5-year-old boy falls on his outstretched hand and presents with a supracondylar fracture of the humerus. The anterior humeral line on lateral X-ray passes through the anterior third of the capitellum. Extension type Gartland grade II fracture is diagnosed. The treatment of choice is:
53. A patient develops 'Galeazzi fracture dislocation' with a distal radial shaft fracture and distal radioulnar joint (DRUJ) disruption. The radiographic indicator of DRUJ instability on AP X-ray is:
54. A 40-year-old woman sustains a posterior shoulder dislocation after an epileptic seizure. She presents 3 weeks later with restricted shoulder internal rotation. Radiograph shows a 'trough line' sign and 'rim sign'. The posterior dislocation involves an impaction defect of the anterior humeral head. When the Hill-Sachs equivalent (reverse Hill-Sachs) involves >40% of the humeral head articular surface, the most appropriate treatment is:
55. A 6-year-old child presents with a completely displaced supracondylar humerus fracture (Gartland Type III) with absent radial pulse but warm pink hand and cap refill < 2 seconds (the 'pink pulseless hand'). The MOST appropriate management is:
56. A 5-year-old child falls on an outstretched hand and develops swelling around the elbow. Radiograph shows a completely displaced supracondylar fracture (Gartland Type III) with the anterior humeral line (AHL) passing anterior to the capitellum. The immediate treatment priority is:
57. A 30-year-old presents 6 weeks after a Monteggia fracture that was treated conservatively in a cast. Radiograph now shows a healed ulnar fracture with persistent radial head dislocation. The most appropriate management is:
58. A 45-year-old presents with recurrent anterior shoulder dislocation. Radiograph reveals a Hill-Sachs lesion occupying 25% of the humeral head and a glenoid bone loss of 30% (inverted pear glenoid). The Instability Severity Index Score (ISIS) is 8. The most appropriate surgical treatment is:
59. In elbow trauma, a Monteggia fracture-dislocation is defined as a fracture of the proximal ulna with dislocation of the radial head. The Bado classification Type I, which accounts for the majority of cases, involves:
60. A 70-year-old woman sustains a displaced three-part proximal humeral fracture (greater tuberosity + surgical neck). She is cognitively intact, lives alone, and is fully independent. The treatment option that offers superior functional outcomes with lower rates of reoperation compared to hemiarthroplasty in elderly patients with complex proximal humeral fractures is:
61. A 28-year-old rugby player sustains a posterior dislocation of the elbow. After closed reduction, examination reveals instability in the lateral pivot-shift test. The primary soft tissue restraint injured in posterior elbow dislocation that must be reconstructed for persistent instability is:
62. A child with a completely displaced (Gartland type III) supracondylar fracture of the humerus has a pink hand without palpable radial pulse. After closed reduction and percutaneous pinning, the hand remains pink. The most appropriate next step regarding the pulseless state is:
63. A 7-year-old boy falls on an outstretched hand. X-ray shows a supracondylar humerus fracture with posterior displacement of the distal fragment, with the anterior humeral line not intersecting the capitellum. The radial pulse is absent and the hand is pale. Gartland classification is Type III. Immediate management is:
64. A 55-year-old man presents with inability to actively pronate the forearm and weakness of wrist and finger flexors with preserved intrinsic hand muscles, 4 months after a distal biceps tendon repair surgery. Nerve conduction shows absent compound muscle action potential from the anterior interosseous nerve territory. The most likely nerve injury is:
65. A 7-year-old boy falls on an outstretched hand. X-ray shows a fracture at the lateral condyle of the humerus with the fragment displaced by 4 mm. The fracture line extends into the articular surface. What is the most appropriate management?
66. A 35-year-old motorcyclist sustains a fracture of the surgical neck of the humerus. On examination, the deltoid muscle is paralysed and there is a small patch of numbness over the regimental badge area of the upper arm. Which nerve is most likely injured?
67. A 28-year-old woman presents after a fall on an outstretched hand. X-ray reveals a Colles fracture. The classical deformity on clinical examination is best described as:
68. A 45-year-old man falls from a height and sustains a fracture of the shaft of the humerus at the junction of the middle and lower thirds. He is unable to extend the wrist and fingers and has numbness in the dorsal web space between the thumb and index finger. Which nerve is damaged, and at what site does it bear this vulnerability?
69. A 10-year-old boy falls on an outstretched hand and is brought with a painful, swollen elbow. X-ray shows anterior displacement of the distal humerus with the anterior humeral line passing anterior to the capitellum. There is a posterior fat pad sign. What is the most likely diagnosis?