A 33-year-old car passenger struck his knee on the dashboard in a head-on collision. His right lower limb is shortened, with the hip flexed, adducted and internally rotated. Before reduction, he cannot dorsiflex the right ankle or toes and has numbness over the dorsum of the foot. Which nerve is injured?

Sciatic nerve, peroneal division

Two patients have ulnar nerve injuries. A: a 25-year-old with a glass cut at the front of the wrist dividing only the ulnar nerve. B: a 28-year-old with a displaced medial epicondyle fracture and ulnar nerve injury at the elbow. Which finding best distinguishes the two?

Clawing of ring and little fingers is more marked in A

Little-finger sensation is lost in B but kept in A

Froment sign is positive in A but negative in B

Clawing of ring and little fingers is more marked in B

A 19-year-old college cricketer has dislocated his right shoulder anteriorly four times in two years, each time with less force, most recently while throwing. Between episodes the shoulder is pain-free, but he becomes apprehensive when the arm is abducted and externally rotated. Which lesion is the essential cause of his recurrence?

Bankart lesion of the anteroinferior labrum

Tear of the supraspinatus tendon

Hill-Sachs lesion of the humeral head

SLAP tear of the superior labrum

A 38-year-old tailor complains of clumsiness of the right hand and numbness of the little finger for a year. At age 8 he had a fracture around the elbow that was treated with a sling. Now the right elbow shows an increased carrying angle, there is wasting of the first dorsal interosseous, and Froment sign is positive. Which original fracture is most likely?

Lateral condyle of humerus with nonunion

Supracondylar humerus with malunion

Medial epicondyle with displacement

Dislocations and nerve injuries with fractures

22 NEET-PG practice questions on Dislocations and nerve injuries with fractures, part of Orthopaedics. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 33-year-old car passenger struck his knee on the dashboard in a head-on collision. His right lower limb is shortened, with the hip flexed, adducted and internally rotated. Before reduction, he cannot dorsiflex the right ankle or toes and has numbness over the dorsum of the foot. Which nerve is injured?
1. AFemoral nerve in the thigh
2. BSciatic nerve, tibial division
3. CObturator nerve in the pelvis
4. DSciatic nerve, peroneal division
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Answer: D · Sciatic nerve, peroneal division
A dashboard impact drives the femoral head backwards; a shortened limb held in flexion, adduction and internal rotation is a posterior dislocation of the hip. The sciatic nerve lies directly behind the joint and is stretched in about one in ten cases, and its peroneal division, being more tethered, is affected more often, causing foot drop. The dislocation is an emergency: reduce under anaesthesia within about 6 hours to lower the risk of avascular necrosis of the femoral head, and record nerve function before and after reduction.
- A: Femoral nerve injury weakens knee extension and fits anterior, not posterior, dislocation.
- B: Tibial division loss weakens plantar flexion and numbs the sole, not the dorsum.
- C: Obturator injury weakens adduction and is linked to anterior (obturator) dislocation.
Question 2 · Hard
Two patients have ulnar nerve injuries. A: a 25-year-old with a glass cut at the front of the wrist dividing only the ulnar nerve. B: a 28-year-old with a displaced medial epicondyle fracture and ulnar nerve injury at the elbow. Which finding best distinguishes the two?
1. ALittle-finger sensation is lost in B but kept in A
2. BClawing of ring and little fingers is more marked in A
3. CFroment sign is positive in A but negative in B
4. DClawing of ring and little fingers is more marked in B
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Answer: B · Clawing of ring and little fingers is more marked in A
This is the ulnar paradox. A lesion at the wrist paralyses the interossei and medial lumbricals but spares the ulnar half of flexor digitorum profundus, which then flexes the IP joints strongly and produces marked clawing. A lesion at the elbow also paralyses the ulnar part of FDP, so the fingers cannot flex at the DIP joints and clawing is less obvious, even though the injury is higher. Both lesions weaken adductor pollicis (positive Froment sign) and numb the little finger.
- A: Palmar digital sensation of the little finger is lost in both lesions.
- C: Adductor pollicis is ulnar-supplied in the hand, so Froment sign is positive in both.
- D: The paradox is the reverse: the higher lesion claws less, not more.
Question 3 · Medium
A 6-year-old boy fell from a swing on his outstretched hand. X-ray shows a displaced extension-type supracondylar fracture of the humerus with the distal fragment posterolateral. The radial pulse is present. When asked to make an 'OK' sign, he makes a flat pinch with the tip of the thumb and index finger extended; skin sensation of the hand is normal. Which nerve is injured?
1. AAnterior interosseous nerve
2. BSuperficial radial nerve
3. CUlnar nerve at the elbow
4. DPosterior interosseous nerve
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Answer: A · Anterior interosseous nerve
With posterolateral displacement of the distal fragment, the proximal fragment's spike moves anteromedially and can stretch the median nerve or its anterior interosseous branch. The AIN supplies flexor pollicis longus and the index part of flexor digitorum profundus and has no skin branch, so the child cannot flex the thumb IP and index DIP joints and makes a flat pinch, with normal sensation. Most such palsies are neurapraxias that recover after reduction.
- B: The superficial radial nerve is purely sensory, and sensation is normal.
- C: Ulnar injury affects intrinsic muscles and little-finger sensation.
- D: PIN palsy causes finger drop, not loss of tip flexion.
Question 4 · Medium
A 19-year-old college cricketer has dislocated his right shoulder anteriorly four times in two years, each time with less force, most recently while throwing. Between episodes the shoulder is pain-free, but he becomes apprehensive when the arm is abducted and externally rotated. Which lesion is the essential cause of his recurrence?
1. ATear of the supraspinatus tendon
2. BHill-Sachs lesion of the humeral head
3. CBankart lesion of the anteroinferior labrum
4. DSLAP tear of the superior labrum
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Answer: C · Bankart lesion of the anteroinferior labrum
Recurrent anterior dislocation follows a first dislocation in a young person in most cases. The essential lesion is the Bankart lesion: avulsion of the anteroinferior labrum and capsule from the glenoid rim, which removes the anterior buttress. A Hill-Sachs defect often coexists and contributes when large, but the labral detachment is the primary cause. The apprehension test is positive, and surgical repair of the labrum is the usual treatment.
- A: Supraspinatus tears follow dislocation mainly in older patients.
- B: A Hill-Sachs dent is a consequence that aids recurrence, not the essential cause.
- D: A SLAP tear involves the biceps anchor and causes pain, not recurrent dislocation.
Question 5 · Medium
A 38-year-old tailor complains of clumsiness of the right hand and numbness of the little finger for a year. At age 8 he had a fracture around the elbow that was treated with a sling. Now the right elbow shows an increased carrying angle, there is wasting of the first dorsal interosseous, and Froment sign is positive. Which original fracture is most likely?
1. ASupracondylar humerus with malunion
2. BOlecranon with fibrous union
3. CMedial epicondyle with displacement
4. DLateral condyle of humerus with nonunion
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Answer: D · Lateral condyle of humerus with nonunion
A lateral condyle fracture in childhood that goes into nonunion lets the lateral side of the elbow stop growing, producing a progressive cubitus valgus. The ulnar nerve behind the medial epicondyle is slowly stretched, and an ulnar palsy appears years later: tardy ulnar nerve palsy. Treatment is anterior transposition of the ulnar nerve. This is why displaced lateral condyle fractures in children are fixed accurately.
- A: Supracondylar malunion classically causes cubitus varus, not valgus.
- B: Olecranon fibrous union does not change the carrying angle.
- C: A medial epicondyle fracture can injure the ulnar nerve early, not with valgus years later.
Question 6 · Medium
A 32-year-old motorcyclist is struck on the outer side of the right knee by a car bumper. X-ray shows a fracture of the neck of the fibula. He cannot dorsiflex or evert the foot and walks with a high-stepping gait. Sensation is lost over the dorsum of the foot. Which nerve is injured?
1. ACommon peroneal nerve
2. BSural nerve
3. CDeep peroneal nerve alone
4. DTibial nerve
Answer and explanation in LearnFree account
Question 7 · Medium
A 45-year-old man is brought to casualty after a two-wheeler accident in which his right thigh was forced widely apart. The right lower limb is held flexed, abducted and externally rotated, and the femoral head is palpable in the groin. Which injury is most likely?
1. AAnterior dislocation of the hip
2. BIntertrochanteric fracture of the femur
3. CCentral fracture-dislocation of the hip
4. DPosterior dislocation of the hip
Answer and explanation in LearnFree account
Question 8 · Medium
A 27-year-old man woke with wrist drop after falling asleep drunk with his arm hanging over the back of a chair. Nerve conduction shows a conduction block across the spiral groove with normal conduction distal to it at 3 weeks. He recovers fully in 6 weeks. Which type of nerve injury did he have?
1. ANeurapraxia
2. BNeurotmesis
3. CAxonotmesis
4. DWallerian degeneration
Answer and explanation in LearnFree account
Question 9 · Medium
A 29-year-old man with epilepsy is seen in the medical ward the morning after a generalised tonic-clonic seizure. His left shoulder is painful and held adducted and internally rotated, and he cannot rotate it externally even passively. The AP radiograph was reported as normal, though the humeral head looks symmetrical and rounded. What should be done next?
1. AAxillary or scapular Y view of the shoulder
2. BNerve conduction study of the axillary nerve
3. CMRI to look for a rotator cuff tear
4. DReassurance with a sling for a soft-tissue strain
Answer and explanation in LearnFree account
Question 10 · Medium
A 30-year-old construction worker in Surat falls from a scaffold onto his outstretched hand. X-rays show a displaced fracture of the radial shaft at the junction of its middle and lower thirds, with an intact ulna, and the lower end of the ulna is prominent and unstable at the wrist. What is the treatment of choice?
1. ABelow-elbow cast for 6 weeks
2. BExcision of the lower end of the ulna
3. CClosed reduction and an above-elbow cast
4. DOpen reduction and plate fixation of the radius
Answer and explanation in LearnFree account
Question 11 · Hard
A 66-year-old woman had an anterior shoulder dislocation reduced in casualty after a fall at home. Two weeks later she still cannot lift the arm sideways and it drops when placed at 90 degrees of abduction. Sensation over the lateral upper arm is normal and the deltoid can be felt contracting when she tries to abduct. What is the most likely cause of her weakness?
1. AFrozen shoulder after immobilisation
2. BUnrecognised recurrent dislocation
3. CAxillary nerve injury from the dislocation
4. DRotator cuff tear from the dislocation
Answer and explanation in LearnFree account
Question 12 · Hard
A 22-year-old state-level volleyball player has had more than ten anterior dislocations of the right shoulder, now with minimal force, even in sleep. CT shows loss of about a quarter of the width of the anteroinferior glenoid (an 'inverted pear' glenoid) and a large Hill-Sachs lesion that engages in abduction and external rotation. What is the most appropriate surgery?
1. AAnterior capsular shift alone
2. BArthroscopic Bankart repair alone
3. CPhysiotherapy to strengthen the cuff
4. DCoracoid transfer to the glenoid (Latarjet)
Answer and explanation in LearnFree account
Question 13 · Easy
A 48-year-old housewife slips in her bathroom in Kochi and lands on her right arm, sustaining a closed spiral fracture of the middle third of the right humeral shaft. On examination she cannot extend her wrist or the metacarpophalangeal joints, and the skin over the first dorsal web space is numb. Which nerve is injured?
1. AMedian nerve
2. BPosterior interosseous nerve alone
3. CRadial nerve
4. DUlnar nerve
Answer and explanation in LearnFree account
Question 14 · Medium
A 30-year-old man had a closed fracture-dislocation with a complete radial nerve palsy. Consider these statements about axonotmesis, the grade suspected: 1. Wallerian degeneration occurs distal to the injury. 2. The endoneurial tubes remain in continuity. 3. Spontaneous regeneration proceeds at about 1 mm per day. 4. Surgical repair of the nerve is needed for recovery. Which statements are correct?
1. A1 and 4 only
2. B2 and 4 only
3. C3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 15 · Medium
A 42-year-old man has a closed transverse fracture of the middle third of the humerus after a fall. He had wrist drop on arrival, before any manipulation. The fracture is aligned in a functional brace. What is the best plan for the nerve?
1. ACock-up splint, physiotherapy and observation
2. BNerve conduction study before any treatment
3. CTendon transfer at the earliest opportunity
4. DUrgent exploration and repair of the nerve
Answer and explanation in LearnFree account
Question 16 · Easy
The Hill-Sachs lesion seen in recurrent anterior dislocation of the shoulder is:
1. AA compression defect of the anteromedial humeral head
2. BA compression defect of the posterolateral humeral head
3. CAn avulsion of the anteroinferior glenoid labrum
4. DA fracture of the greater tuberosity of the humerus
Answer and explanation in LearnFree account
Question 17 · Hard
A 34-year-old man is brought to casualty after a high-speed motorcycle crash with a grossly deformed left knee. X-ray shows a posterior dislocation of the tibia on the femur, which is reduced under sedation. After reduction the knee is grossly unstable, the dorsalis pedis pulse is palpable but weaker than on the right, and the ankle-brachial index on the left is 0.7. What is the next best step?
1. ACT angiography of the left lower limb
2. BSplint the knee and repeat the ABI after 24 hours
3. CImmediate ligament reconstruction of the knee
4. DMRI of the knee to assess the ligaments
Answer and explanation in LearnFree account
Question 18 · Easy
A 40-year-old man fell while climbing a coconut tree and grabbed a branch on the way down. He walks into casualty holding his right arm straight up above his head, with the elbow flexed and the forearm resting on top of his head; he cannot bring the arm down. What is the most likely diagnosis?
1. APosterior dislocation of the shoulder
2. BFracture of the surgical neck of humerus
3. CInferior dislocation of the shoulder
4. DAnterior subcoracoid dislocation
Answer and explanation in LearnFree account
Question 19 · Medium
A 12-year-old girl falls on her outstretched hand and has a painful, swollen elbow held in slight flexion. Before the X-ray, the doctor feels the tip of the olecranon and both epicondyles with the elbow bent to 90 degrees; the olecranon lies well behind the line of the epicondyles and the usual triangle is lost. What is the most likely diagnosis?
1. APulled elbow (radial head subluxation)
2. BExtension supracondylar fracture of humerus
3. CFracture of the lateral condyle of humerus
4. DPosterior dislocation of the elbow
Answer and explanation in LearnFree account
Question 20 · Medium
A 30-year-old man fell from a ladder on his dorsiflexed wrist. The wrist is swollen and he has tingling and numbness over the thumb, index and middle fingers that are getting worse. The lateral radiograph shows the lunate rotated forwards out of line with the radius and capitate. Which structure is being compressed?
1. AUlnar nerve in Guyon canal
2. BMedian nerve in the carpal tunnel
3. CSuperficial branch of radial nerve
4. DAnterior interosseous nerve
Answer and explanation in LearnFree account
Question 21 · Medium
Consider these pairs of fracture site and the nerve most at risk: 1. Surgical neck of humerus, axillary nerve. 2. Middle third of humeral shaft, radial nerve. 3. Medial epicondyle of humerus, median nerve. 4. Neck of fibula, common peroneal nerve. Which pairs are correct?
1. A1 and 3 only
2. B3 and 4 only
3. C1, 2 and 4 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 22 · Easy
A 24-year-old kabaddi player is brought to casualty after being pulled down by his outstretched arm. The right shoulder has lost its rounded contour, the humeral head is felt below the coracoid, and he holds the arm slightly abducted and externally rotated. Sensation is reduced over the lateral aspect of the upper arm. Which nerve is injured?
1. AMusculocutaneous nerve
2. BSuprascapular nerve
3. CAxillary nerve
4. DRadial nerve
Answer and explanation in LearnFree account

Dislocations and nerve injuries with fractures

Two patients have ulnar nerve injuries. A: a 25-year-old with a glass cut at the front of the wrist dividing only the ulnar nerve. B: a 28-year-old with a displaced medial epicondyle fracture and ulnar nerve injury at the elbow. Which finding best distinguishes the two?

A 32-year-old motorcyclist is struck on the outer side of the right knee by a car bumper. X-ray shows a fracture of the neck of the fibula. He cannot dorsiflex or evert the foot and walks with a high-stepping gait. Sensation is lost over the dorsum of the foot. Which nerve is injured?

A 45-year-old man is brought to casualty after a two-wheeler accident in which his right thigh was forced widely apart. The right lower limb is held flexed, abducted and externally rotated, and the femoral head is palpable in the groin. Which injury is most likely?

A 27-year-old man woke with wrist drop after falling asleep drunk with his arm hanging over the back of a chair. Nerve conduction shows a conduction block across the spiral groove with normal conduction distal to it at 3 weeks. He recovers fully in 6 weeks. Which type of nerve injury did he have?

A 42-year-old man has a closed transverse fracture of the middle third of the humerus after a fall. He had wrist drop on arrival, before any manipulation. The fracture is aligned in a functional brace. What is the best plan for the nerve?

The Hill-Sachs lesion seen in recurrent anterior dislocation of the shoulder is:

A 40-year-old man fell while climbing a coconut tree and grabbed a branch on the way down. He walks into casualty holding his right arm straight up above his head, with the elbow flexed and the forearm resting on top of his head; he cannot bring the arm down. What is the most likely diagnosis?

Consider these pairs of fracture site and the nerve most at risk: 1. Surgical neck of humerus, axillary nerve. 2. Middle third of humeral shaft, radial nerve. 3. Medial epicondyle of humerus, median nerve. 4. Neck of fibula, common peroneal nerve. Which pairs are correct?