Traumatology 1 based on KMTC question and answers explain further respectively
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Traumatology 1 based on KMTC question and answers explain further respectively
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KMTC Traumatology 1 exam questions and answers fractures dislocations wounds shock
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I now have rich, authoritative content to compile a comprehensive KMTC Traumatology 1 explanation. Here is the full breakdown:
KMTC Traumatology 1 - Questions & Answers Explained
SECTION 1: FRACTURES
Q1. What is a fracture?
A: A fracture is a break in the continuity of a bone.
Further explanation:
A fracture occurs when a force applied to bone exceeds the bone's mechanical strength. It is not only limited to a complete break - it includes cracks, greenstick (incomplete) breaks, and stress fractures.
Q2. How are fractures classified?
A: Fractures are classified as open (compound) or closed (simple), and by pattern.
Further explanation:
By skin integrity:
| Type | Description |
|---|---|
| Closed (Simple) | Bone is broken but skin is intact |
| Open (Compound) | Bone communicates with the external environment through a wound - high risk of infection |
By fracture pattern:
| Pattern | Description |
|---|---|
| Transverse | Perpendicular to the long axis of the bone |
| Oblique | At an angle to the long axis |
| Spiral | Caused by twisting force; wraps around the bone |
| Comminuted | Bone broken into 3 or more fragments |
| Greenstick | Incomplete fracture; common in children (bone bends on one side) |
| Impacted | Bone fragments are driven into each other |
| Pathological | Fracture through diseased bone (e.g. tumour, osteoporosis) |
| Stress (Fatigue) | Overuse fracture; common in athletes and military recruits |
By displacement:
-
Undisplaced - fragments remain aligned
-
Displaced - fragments have shifted (angulated, rotated, shortened, or overriding)
-
Campbell's Operative Orthopaedics 15th Ed 2026
Q3. What are the clinical features (signs and symptoms) of a fracture?
A: Pain, swelling, deformity, loss of function, crepitus, abnormal mobility, bruising.
Further explanation - the "5 Ps" + extras:
| Sign/Symptom | Mechanism |
|---|---|
| Pain & tenderness | Periosteal nerve irritation and haematoma |
| Swelling | Haematoma and oedema at fracture site |
| Deformity | Displacement of fragments - shortening, angulation, rotation |
| Loss of function | Pain inhibits movement |
| Crepitus | Grating sensation from bone fragment movement |
| Abnormal mobility | Movement at a site that should be rigid |
| Bruising (ecchymosis) | Blood extravasating from the fracture haematoma |
| Neurovascular deficit | If vessels or nerves are injured (pulselessness, paraesthesia) |
Important for exams: Crepitus should never be elicited deliberately - it causes pain and can worsen injury.
Q4. What are the stages of fracture healing?
A: Haematoma formation → Soft callus → Hard callus → Remodelling.
Further explanation:
Fracture healing is a continuous, overlapping process in 4 stages:
1. Haematoma Formation & Inflammation (Days 1-5)
- Bleeding from ruptured blood vessels forms a fracture haematoma
- Inflammatory cells (neutrophils, macrophages) invade the area
- Growth factors released stimulate healing
2. Soft Callus (Fibrocartilaginous Callus) Formation (Days 5 - 3 weeks)
- Fibroblasts and chondroblasts produce fibrous tissue and cartilage
- The fracture becomes stable but not yet rigid
- Visible on X-ray as a "fluffy" callus around the fracture
3. Hard Callus (Bony Callus) Formation (Weeks 3-12)
- Osteoblasts replace cartilage with woven bone via endochondral ossification
- The fracture becomes rigid
- Visible as dense calcification on X-ray
4. Remodelling (Months to Years)
- Osteoclasts and osteoblasts work together to convert woven bone into mature lamellar bone
- The bone regains its original shape and strength
- Wolff's Law: bone remodels along lines of mechanical stress
Primary bone healing (direct union) can occur when fracture ends are directly apposed with absolute rigid fixation (e.g. after ORIF plating) - no callus forms in this case.
- Bailey and Love's Short Practice of Surgery 28th Ed, p. 48
Q5. What are the complications of fractures?
A: Early and late complications.
Further explanation:
Early (immediate/within days):
- Haemorrhage and shock (especially femoral, pelvic fractures)
- Neurovascular injury (nerve/artery damage)
- Infection (especially open fractures)
- Fat embolism (marrow fat enters circulation - within 24-72 hrs)
- Compartment syndrome (raised pressure within a fascial compartment - emergency!)
Late (weeks to months):
| Complication | Definition |
|---|---|
| Delayed union | Fracture not healed at expected time (>3-6 months) |
| Non-union | Fracture fails to heal completely |
| Malunion | Fracture heals in wrong position (deformity) |
| Avascular necrosis | Blood supply to bone fragment is disrupted (e.g. femoral head, scaphoid) |
| Joint stiffness | Prolonged immobilization |
| Osteomyelitis | Bone infection (especially after open fractures) |
| Post-traumatic osteoarthritis | Cartilage damage from intra-articular fractures |
Q6. What is the management of fractures?
A: The 3 Rs - Reduce, Retain (Hold), Rehabilitate.
Further explanation:
1. Reduction (Restore alignment)
- Closed reduction: Manual manipulation under anaesthesia
- Open reduction: Surgical exposure (for displaced or complex fractures)
2. Immobilization / Retention (Hold the reduction)
| Method | Examples |
|---|---|
| Plaster of Paris (POP) cast | Colles fracture, greenstick |
| Traction | Femoral shaft fractures |
| External fixation | Open fractures, unstable pelvic fractures |
| Internal fixation (ORIF) | Plates, screws, nails, wires |
3. Rehabilitation
- Early mobilization to prevent stiffness, DVT, and muscle wasting
- Physiotherapy essential
SECTION 2: DISLOCATIONS
Q7. What is a dislocation?
A: Complete loss of contact between the articular surfaces of a joint.
Further explanation:
- Dislocation: Complete displacement of joint surfaces - no contact between articular surfaces
- Subluxation: Partial displacement - some contact remains
- Fracture-dislocation: Dislocation associated with a fracture of the bones forming the joint
Common sites in trauma:
| Joint | Common Direction of Dislocation |
|---|---|
| Shoulder (glenohumeral) | Anterior (most common, ~95%) |
| Hip | Posterior (most common, from dashboard injury) |
| Elbow | Posterior |
| Patella | Lateral |
| Ankle | Associated with fractures |
Q8. What are the signs and symptoms of dislocation?
A: Severe pain, deformity, loss of movement, altered limb position.
Further explanation:
- Immediate, severe pain at the joint
- Deformity - the joint looks abnormal compared to the unaffected side
- Loss of normal movement - springy block to movement (unlike fracture)
- Swelling and bruising around the joint
- Neurovascular compromise - always assess distal pulses and sensation
Key exam point: A dislocated shoulder typically shows a "squared off" (flattened) deltoid with a hollow beneath the acromion.
Q9. How is dislocation managed?
A: Reduction (closed), immobilization, rehabilitation.
Further explanation:
- Closed reduction should be done as soon as possible under adequate analgesia or anaesthesia - to prevent pressure necrosis of articular cartilage and risk of avascular necrosis
- Post-reduction X-ray is mandatory to confirm position and rule out associated fracture
- Immobilization - brief period in a sling or splint
- Rehabilitation - early mobilization and strengthening exercises to prevent recurrence
Recurrent dislocation (especially shoulder) may require surgical stabilization (Bankart repair, Latarjet procedure).
SECTION 3: WOUNDS
Q10. What is a wound?
A: A wound is a disruption of the normal continuity of body tissues.
Further explanation:
Wounds can be classified by several systems. The most widely used is the CDC wound classification by contamination:
| Class | Name | Description |
|---|---|---|
| Class I | Clean | Uninfected operative wound; no inflammation; respiratory, alimentary, genital, or urinary tracts NOT entered |
| Class II | Clean-contaminated | Above tracts entered under controlled conditions; no significant spillage |
| Class III | Contaminated | Open, fresh, accidental wounds; gross GI spillage; acute non-purulent inflammation |
| Class IV | Dirty/Infected | Old traumatic wounds with devitalized tissue; existing clinical infection or perforated viscera |
- Bailey and Love's Short Practice of Surgery 28th Ed, p. 50
By aetiology:
- Incised (clean cut - knife, glass)
- Lacerated (ragged/torn - blunt force)
- Contused (crush/bruising - no skin break)
- Puncture/Penetrating (deep narrow tract - nail, knife)
- Abrasion/Graze (superficial - skin scraped)
- Avulsion (tissue torn away)
- Burn (thermal, chemical, electrical)
Q11. What are the types of wound healing?
A: Primary intention, secondary intention, tertiary (delayed primary) intention.
Further explanation:
| Type | Description | Example |
|---|---|---|
| Primary (1st) Intention | Wound edges approximated and closed soon after injury - sutures, staples, glue, tape. Minimal scarring, rapid healing. | Surgical incision, clean laceration sutured within 6-8 hours |
| Secondary (2nd) Intention | Wound left open to heal from base upward by granulation tissue and epithelialization. Produces a larger, more visible scar. | Infected wounds, pressure ulcers, large tissue loss |
| Tertiary / Delayed Primary (3rd) Intention | Wound initially left open (debrided, cleaned), then closed surgically after 4-5 days once infection is controlled. | Contaminated traumatic wounds |
- Bailey and Love's Short Practice of Surgery 28th Ed
Q12. What are the factors affecting wound healing?
A: Local and systemic factors.
Local factors:
- Infection (most common cause of delayed healing)
- Foreign body / dead tissue (slough, eschar)
- Blood supply (ischaemia delays healing)
- Wound size and depth
- Movement / repeated trauma
- Radiation
Systemic factors:
- Malnutrition (especially Vitamin C, zinc deficiency)
- Diabetes mellitus (impaired neutrophil function + microangiopathy)
- Anaemia
- Immunosuppression (steroids, chemotherapy)
- Old age
- Jaundice / uraemia
- Smoking (reduces tissue oxygenation)
Q13. What are abnormal scar types?
A: Hypertrophic scars and keloid scars.
Further explanation:
| Feature | Hypertrophic Scar | Keloid Scar |
|---|---|---|
| Extent | Stays within wound boundaries | Extends beyond wound margins |
| Onset | Within weeks of injury | Months after injury |
| Skin types | Any skin type | More common in darker skin types |
| Spontaneous regression | May regress over time | Rarely regresses |
| Sites affected | Any wound site | Face, earlobes, deltoid, presternal region |
| Treatment | Silicone, compression, steroids, excision | Excision + adjuvant radiotherapy; may recur |
- Bailey and Love's Short Practice of Surgery 28th Ed, p. 48
SECTION 4: SHOCK
Q14. What is shock?
A: Shock is a state of acute circulatory failure resulting in inadequate tissue perfusion and oxygenation.
Further explanation:
The essential feature of hypovolemic shock (the most common type in trauma) is a reduction in intravascular volume that prevents the heart from pumping sufficient blood to vital organs.
Q15. What are the types of shock?
A: Hypovolemic, distributive (septic, neurogenic, anaphylactic), cardiogenic, obstructive.
| Type | Cause | Mechanism |
|---|---|---|
| Hypovolemic | Haemorrhage, burns, dehydration | Low circulating volume |
| Septic | Bacterial infection | Vasodilation + maldistribution of blood flow |
| Neurogenic | Spinal cord injury | Loss of sympathetic vasomotor tone |
| Anaphylactic | Allergic reaction | Massive vasodilation + increased capillary permeability |
| Cardiogenic | MI, cardiac tamponade | Heart pump failure |
| Obstructive | Tension pneumothorax, PE | Obstruction to blood flow |
Q16. What is the ATLS classification of haemorrhagic shock?
A: Four classes based on blood volume lost.
Blood volume is approximately 7% of ideal body weight (~4,900 mL in a 70 kg adult)
| Class | Blood Loss | Signs & Features | Treatment |
|---|---|---|---|
| Class I | Up to 15% (<750 mL) | No measurable change; normal HR, BP, RR | Crystalloid fluids; no transfusion usually needed |
| Class II | 15-30% (800-1,500 mL) | Tachycardia, tachypnoea; narrowed pulse pressure; anxiety; urine output 20-30 mL/hr; BP slightly low | Crystalloids; may need transfusion |
| Class III | 30-40% (up to 2,000 mL) | Marked tachycardia, tachypnoea; hypotension; confusion/combativeness; cold clammy skin; delayed capillary refill | Crystalloids + blood transfusion |
| Class IV | >40% (>2,000 mL) | Marked tachycardia; severely depressed BP; cold pale skin; negligible urine output; depressed consciousness | Immediate transfusion + surgery/angioembolization |
- Mulholland and Greenfield's Surgery: Scientific Principles and Practice 7e
Q17. What are the signs and symptoms of shock?
A: Tachycardia, hypotension, tachypnoea, pallor, cold clammy skin, altered consciousness, oliguria.
Pathophysiology:
- Low blood volume → reduced venous return → reduced cardiac output
- Compensatory catecholamine release → tachycardia, vasoconstriction (cold skin, pallor)
- Decreased renal perfusion → oliguria (urine <0.5 mL/kg/hr is a red flag)
- Anaerobic metabolism → lactic acidosis
Q18. What is the management of hypovolemic/haemorrhagic shock?
A: Control the bleeding, restore circulating volume, support vital organs - the "ABCDE" approach.
Step-by-step:
- Airway - secure and maintain patent airway with C-spine control
- Breathing - high-flow oxygen (15L/min via non-rebreather mask)
- Circulation:
- Control external bleeding (direct pressure, tourniquet)
- Establish 2 large-bore IV cannulae (14-16G)
- Warm IV fluids (crystalloids - Normal Saline or Ringer's Lactate) 1-2 litres as initial bolus
- Blood transfusion for Class III/IV
- Monitor HR, BP, urine output, GCS
- Disability - assess neurological status (AVPU or GCS)
- Exposure - expose patient fully to identify all injuries, prevent hypothermia
Golden hour concept - definitive treatment of haemorrhagic shock must occur within the first hour to prevent irreversible organ failure.
SUMMARY TABLE - Key KMTC Traumatology 1 Points
| Topic | Key Point |
|---|---|
| Fracture | Break in bone continuity; classified as open vs. closed, by pattern |
| Fracture healing | Haematoma → Soft callus → Hard callus → Remodelling |
| Fracture complications | Compartment syndrome, fat embolism, non-union, malunion, AVN |
| Dislocation | Complete loss of joint surface contact; shoulder (anterior) and hip (posterior) most common |
| Wound classification | Clean, Clean-contaminated, Contaminated, Dirty |
| Wound healing | Primary (sutured), Secondary (open), Tertiary (delayed closure) |
| Abnormal scars | Hypertrophic (within wound), Keloid (beyond wound - darker skin, earlobes) |
| Shock types | Hypovolemic (trauma), Septic, Neurogenic, Anaphylactic, Cardiogenic |
| ATLS shock classes | I (<15%), II (15-30%), III (30-40%), IV (>40%) blood loss |
| Shock management | ABCDE: control bleeding, oxygen, IV fluids, blood transfusion |
These explanations cover the core content of KMTC Traumatology 1 across all four domains. When you paste your specific Q&A questions, I can tailor each explanation precisely to the wording and expected depth of your exam.
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