Ankle Fractures Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Ankle Fractures. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Ankle Fractures Indian Medical PG Question 1: An RTA patient presented to the emergency department with severe pain in the ankle. An X-ray was performed, given below. What is the best next step in management?
- A. Neurovascular Assessment and Closed reduction with slab application (Correct Answer)
- B. Neurovascular Assessment and Closed reduction with cast application
- C. Neurovascular Assessment and Immediate surgery
- D. Neurovascular Assessment and Immediate open reduction
Ankle Fractures Explanation: ***Neurovascular Assessment and Closed reduction with slab application***
- The X-ray shows an **ankle dislocation without an obvious fracture**, making **closed reduction** the appropriate initial treatment.
- A **slab (splint)** is preferred over a full cast initially for acute injuries to accommodate for swelling, reducing the risk of compartment syndrome, and allowing for serial neurovascular checks.
*Neurovascular Assessment and Closed reduction with cast application*
- While closed reduction is correct, applying a **full cast** immediately after an acute injury carries a risk of **compartment syndrome** due to potential swelling that cannot be accommodated by a rigid cast.
- A cast would typically be applied after the initial swelling has subsided, usually a few days to a week after initial reduction and splinting.
*Neurovascular Assessment and Immediate surgery*
- **Immediate surgery** is generally reserved for **open fractures/dislocations**, dislocations that cannot be reduced closed (irreducible dislocations), or those with significant associated fractures that require surgical fixation to stabilize the joint.
- In this case, the dislocation appears to be isolated and amenable to closed reduction, making surgery not the immediate next step.
*Neurovascular Assessment and Immediate open reduction*
- **Open reduction** is performed when closed reduction fails or is contraindicated, for example, due to soft tissue interposition or highly unstable fracture patterns.
- Since closed reduction has not yet been attempted, immediate open reduction is premature and unnecessary for an apparently simple dislocation.
Ankle Fractures Indian Medical PG Question 2: A ballet dancer presents with chronic anterolateral ankle pain. Most likely diagnosis?
- A. Lateral Ankle Sprain (Correct Answer)
- B. Calcaneal Stress Fracture
- C. Tibialis Posterior Tendinitis
- D. Anterior Ankle Impingement Syndrome
Ankle Fractures Explanation: **Lateral Ankle Sprain**
- **Chronic anterolateral ankle pain** in a ballet dancer is highly suggestive of a **lateral ankle sprain**, often due to repetitive strain and instability.
- Sprains commonly involve the **anterior talofibular ligament (ATFL)** and **calcaneofibular ligament (CFL)**, leading to persistent discomfort and potential functional deficits.
*Calcaneal Stress Fracture*
- A **calcaneal stress fracture** typically presents with **heel pain** that is worse with weight-bearing activities, rather than primarily anterolateral pain.
- While common in athletes, the pain location is less consistent with the description in the question.
*Tibialis Posterior Tendinitis*
- **Tibialis posterior tendinitis** causes pain and tenderness along the **medial arch** and posterior aspect of the ankle, often associated with a **flatfoot deformity**.
- The pain location described (anterolateral) does not align with the typical presentation of this condition.
*Anterior Ankle Impingement Syndrome*
- **Anterior ankle impingement syndrome** results from compression of soft tissues or bony spurs at the **anterior ankle joint**, typically causing pain with **dorsiflexion**.
- While possible in a dancer, the presentation as chronic anterolateral pain without specific mention of dorsiflexion-related pain makes a lateral ankle sprain a more probable initial diagnosis.
Ankle Fractures Indian Medical PG Question 3: The operative procedure known as "microfracture" is done for the
- A. Delayed union of femur
- B. Osteochondral defect of femur (Correct Answer)
- C. Non union of tibia
- D. Loose bodies of ankle joint
Ankle Fractures Explanation: ***Osteochondral defect of femur***
- **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**.
- It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue.
*Delayed union of femur*
- **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery.
- Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture.
*Non union of tibia*
- **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**.
- This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses.
*Loose bodies of ankle joint*
- **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage.
- This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.
Ankle Fractures Indian Medical PG Question 4: Immediate treatment of compound fracture of tibia includes:
- A. Antibiotics and debridement only
- B. Debridement and splinting only
- C. Antibiotics, debridement, and splinting (Correct Answer)
- D. Debridement, splinting, and blood transfusion
Ankle Fractures Explanation: ***Antibiotics, debridement, and splinting***
- **Antibiotics** are crucial to prevent infection in **compound (open) fractures** due to communication with the external environment.
- **Debridement** removes contaminated and devitalized tissue, while **splinting** stabilizes the fracture and minimizes further soft tissue damage.
*Antibiotics and debridement only*
- While antibiotics and debridement are essential, **splinting** is also critical for immobilizing the fracture and preventing further injury.
- Without stabilization, the fracture site can move, causing additional soft tissue damage and increasing the risk of infection and delayed healing.
*Debridement and splinting only*
- This option overlooks the critical need for **antibiotics** in compound fractures, which are at high risk of infection due to the exposure of bone and tissue to bacteria.
- Infection can lead to serious complications such as **osteomyelitis**, significantly impacting recovery and patient outcomes.
*Debridement, splinting, and blood transfusion*
- While debridement and splinting are correct, a **blood transfusion** is generally not an immediate routine treatment for all compound tibial fractures unless there is significant hemorrhage leading to hypovolemic shock.
- The primary immediate concerns are infection prevention and stabilization, not typically massive blood loss requiring transfusion in every case.
Ankle Fractures Indian Medical PG Question 5: Commonest ligament injured in ankle injury ?
- A. Anterior talofibular ligament (Correct Answer)
- B. Calcaneofibular ligament
- C. Posterior talofibular ligament
- D. Spring ligament
Ankle Fractures Explanation: ***Anterior talofibular ligament***
- The **anterior talofibular ligament (ATFL)** is the **most frequently injured ligament** in ankle sprains because it is the weakest and most commonly stretched during **inversion injuries**.
- Its position makes it vulnerable during movements where the foot rolls inward, a common mechanism for ankle sprains.
*Calcaneofibular ligament*
- The **calcaneofibular ligament (CFL)** is stronger than the ATFL and is typically injured with more severe inversion forces, often in conjunction with ATFL rupture.
- While it plays a crucial role in ankle stability, it is not the *most* commonly injured ligament.
*Posterior talofibular ligament*
- The **posterior talofibular ligament (PTFL)** is the strongest of the lateral ankle ligaments and is rarely injured in isolated ankle sprains.
- Its injury usually signifies a **severe ankle sprain** with significant talar displacement or dislocation.
*Spring ligament*
- The **spring ligament**, also known as the **plantar calcaneonavicular ligament**, is located on the medial side of the foot and supports the medial longitudinal arch.
- It is not directly involved in typical ankle sprains, which primarily affect the lateral collateral ligaments.
Ankle Fractures Indian Medical PG Question 6: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Ankle Fractures Explanation: ***Stable closed fracture***
- A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing.
- The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment.
*Multiple trauma*
- In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization.
- This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients.
*Compound fracture*
- **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management.
- ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing.
*Intra-articular fracture*
- **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function.
- ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.
Ankle Fractures Indian Medical PG Question 7: The rephrased question is:What is the most common complication of a fractured talus?
- A. Avascular necrosis (AVN) (Correct Answer)
- B. Osteoarthritis of the subtalar joint
- C. Nonunion of the talus
- D. Osteoarthritis of the ankle joint
Ankle Fractures Explanation: ***Avascular necrosis (AVN)***
- The talus has a **precarious blood supply**, with arterial branches entering at multiple points but often centrally, making it vulnerable to **ischemia** after fracture.
- Fractures, especially neck fractures, can disrupt these delicate vessels, leading to **osteonecrosis** and collapse of the bone.
*Nonunion of the talus*
- While possible, talar nonunion is **less common** than AVN due to the talus's dense cortical bone and limited muscle attachments.
- Nonunion is more frequently seen with fractures of other bones, such as the **scaphoid**.
*Osteoarthritis of the subtalar joint*
- **Subtalar osteoarthritis** can occur post-talar fracture, often as a **secondary complication** of disrupted articular surfaces or AVN.
- However, the **initial and most common direct complication** stemming from the blood supply disruption is AVN.
*Osteoarthritis of the ankle joint*
- **Ankle osteoarthritis** can also develop after certain talar fractures, particularly those involving the talar dome or leading to incongruity of the ankle joint.
- Similar to subtalar arthritis, it is often a **later or secondary sequela**, rather than the immediate and most frequent direct complication like AVN.
Ankle Fractures Indian Medical PG Question 8: A 10-year-old obese boy was referred to the emergency department with a history of hip pain. He was observed to be limping and complained of severe pain. Which of the following investigations is least appropriate for this condition?
- A. MRI of the hip
- B. CT scan of hip
- C. USG of hip (Correct Answer)
- D. X-ray of the hip
Ankle Fractures Explanation: ***USG of hip***
- An **ultrasound (USG)** of the hip is generally not the primary imaging modality for diagnosing conditions like **slipped capital femoral epiphysis (SCFE)**, which is suggested by the patient's presentation.
- While USG can detect effusions or synovitis, it provides poor visualization of bony structures and the physeal plate, which are crucial for diagnosing SCFE.
*X-ray of the hip*
- **X-rays** (AP and frog-leg lateral views) are the **initial and most important imaging study** for diagnosing SCFE.
- They effectively visualize the **epiphyseal displacement** relative to the metaphysis and are sufficient for diagnosis in most cases.
*MRI of the hip*
- **MRI** is highly sensitive for detecting early or subtle SCFE, especially when X-rays are inconclusive.
- It can evaluate the **physeal edema**, chondral changes, and avascular necrosis, providing more detailed information than X-rays.
*CT scan of hip*
- A **CT scan** provides excellent bony detail and can precisely assess the **degree of physeal slip** and femoral head deformity.
- It may be used for surgical planning, especially in complex cases or when the slip is difficult to assess with X-rays.
Ankle Fractures Indian Medical PG Question 9: Comment on the diagnosis:
- A. Jones fracture (Correct Answer)
- B. March fracture
- C. Shepherd's fracture
- D. Cotton's fracture
Ankle Fractures Explanation: ***Jones fracture***
- The image indicates a fracture located at the **proximal metaphyseal-diaphyseal junction of the fifth metatarsal**, which is characteristic of a **Jones fracture**.
- This fracture involves the **base of the fifth metatarsal** and is often associated with a higher risk of nonunion due to limited blood supply.
*March fracture*
- A **March fracture** is a type of stress fracture, typically affecting the **shaft of the second, third, or fourth metatarsals**, often seen in military recruits or those who engage in prolonged walking or running.
- It results from repetitive stress rather than an acute injury, and its location is distinct from the proximal fifth metatarsal.
*Shepherd's fracture*
- A **Shepherd's fracture** refers to an avulsion fracture of the **posterolateral tubercle of the talus**, also known as an os trigonum fracture.
- This fracture is located in the ankle region, distinct from the metatarsals.
*Cotton's fracture*
- A **Cotton's fracture** is a trimalleolar fracture of the ankle, involving the **medial malleolus**, **lateral malleolus**, and the **posterior malleolus** of the tibia.
- This is a complex ankle injury, entirely unrelated to fractures of the metatarsals.
Ankle Fractures Indian Medical PG Question 10: Match List-I with List-II and select the correct answer using the code given below the Lists: (Refer to the image below for the lists)
- A. A→4 B→3 C→1 D→2
- B. A→3 B→2 C→4 D→1
- C. A→4 B→3 C→2 D→1 (Correct Answer)
- D. A→3 B→2 C→1 D→4
Ankle Fractures Explanation: ***A→4 B→3 C→2 D→1***
- **Atrial fibrillation** is characterized by **irregularly irregular rhythm** without distinct P waves, making the R-R interval highly variable. It is a supraventricular tachyarrhythmia, originating above the ventricles.
- **Ventricular tachycardia** typically presents with a **wide QRS complex** (>0.12 s) and a **rapid, regular heart rate**, as it originates from the ventricles.
- **Complete heart block** is characterized by complete dissociation between **P waves and QRS complexes**, meaning the atria and ventricles beat independently. This is reflected in an irregular P-P interval and a regular but slower R-R interval often due to an escape rhythm.
- **Ventricular fibrillation** is an ECG emergency characterized by chaotic, **irregular electrical activity** and an absence of discernible P waves, QRS complexes, or T waves, leading to cardiac arrest.
*A→4 B→3 C→1 D→2*
- This option correctly matches A (Atrial fibrillation) with 4 (Irregular R-R interval without P waves) and B (Ventricular tachycardia) with 3 (Wide QRS complexes and regular rapid rate). However, it incorrectly matches C (Complete heart block) with 1 (Chaotic rhythm) and D (Ventricular fibrillation) with 2 (Dissociation of P and QRS waves).
- **Complete heart block** involves **dissociation of P and QRS waves**, and **Ventricular fibrillation** is defined by a **chaotic rhythm**, not the other way around as suggested by C→1 and D→2.
*A→3 B→2 C→4 D→1*
- This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate), which describes ventricular tachycardia.
- It also incorrectly matches C (Complete heart block) with 4 (Irregular R-R interval without P waves) and D (Ventricular fibrillation) with 1 (Chaotic rhythm), instead of the correct associations.
*A→3 B→2 C→1 D→4*
- This option incorrectly matches A (Atrial fibrillation) with 3 (Wide QRS complexes and regular rapid rate) which is characteristic of ventricular tachycardia.
- It also incorrectly matches B (Ventricular tachycardia) with 2 (Dissociation of P and QRS waves), which is a characteristic of complete heart block, not ventricular tachycardia.
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