Fracture Complications Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Fracture Complications. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Fracture Complications Indian Medical PG Question 1: Which of the following is NOT a complication of a neck femur fracture?
- A. Nonunion
- B. Osteoarthritis
- C. AVN
- D. Malunion (Correct Answer)
Fracture Complications Explanation: ***Malunion***
- **Malunion** is a rare complication of a femoral neck fracture because the fracture is inherently unstable and tends to result in **nonunion** rather than healing in an abnormal position.
- The **vascular compromise** and mechanical forces often lead to a failure to heal whatsoever, or to avascular necrosis.
*Nonunion*
- **Nonunion** is a common and severe complication of femoral neck fractures due to the **precarious blood supply** to the femoral head and the high mechanical stress across the fracture site.
- The lack of adequate blood flow and movement at the fracture site hinders the formation of a **bony callus**, leading to failure of the bone to heal.
*AVN*
- **Avascular necrosis (AVN)** of the femoral head is a major complication resulting from the disruption of the arterial blood supply to the femoral head during the fracture.
- The **retinacular arteries**, which supply most of the femoral head, are often damaged, leading to the death of bone cells and subsequent collapse of the femoral head.
*Osteoarthritis*
- **Post-traumatic osteoarthritis** can develop as a long-term complication, even if the fracture heals.
- The initial injury and any subsequent irregularities in the joint surface or alignment can lead to accelerated **cartilage degeneration**.
Fracture Complications Indian Medical PG Question 2: Nonunion is most common in fracture of the:
- A. Talus
- B. Neck femur (Correct Answer)
- C. Scapula
- D. None of the options
Fracture Complications Explanation: ***Neck femur***
- Fractures of the **femoral neck** are highly prone to **nonunion** due to the precarious and often-disrupted blood supply to the femoral head, particularly the **retinacular arteries**.
- The high biomechanical stress and difficulty in achieving stable fixation in this region further contribute to the increased risk of nonunion.
*Talus*
- While talar fractures, especially those of the **talar neck**, can have a high incidence of complications like **avascular necrosis** due to limited blood supply, nonunion is less common than in femoral neck fractures.
- The talus has a complex vascular network that, while vulnerable, often allows for healing.
*Scapula*
- **Scapular fractures** are generally uncommon and, when they occur, typically heal well without surgical intervention.
- Due to the surrounding musculature and rich vascular supply, nonunion of the scapula is extremely rare.
*None of the options*
- This option is incorrect because **nonunion is indeed a significant problem** in specific fractures, particularly those of the femoral neck, making it a viable answer.
Fracture Complications Indian Medical PG Question 3: Proximal humerus fracture which has maximum chances of avascular necrosis
- A. One part
- B. Two part
- C. Three part
- D. Four part (Correct Answer)
Fracture Complications Explanation: ***Four part fracture***
- A **four-part proximal humerus fracture** typically involves displacement of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft.
- This extensive displacement significantly disrupts the **blood supply** to the humeral head, specifically the **arcuate artery** and its branches, leading to a high risk of **avascular necrosis**.
*One part fracture*
- A **one-part fracture** indicates that the fracture fragments are minimally displaced (<1 cm or <45° angulation).
- The **blood supply** to the humeral head remains largely intact, resulting in a very low risk of avascular necrosis.
*Two part fracture*
- A **two-part fracture** involves displacement of one major fragment (e.g., surgical neck or tuberosity) from the humeral head.
- While there is some disruption, the overall risk of **avascular necrosis** is lower compared to more complex fractures.
*Three part fracture*
- A **three-part fracture** involves separate displacement of the humeral head and two tuberosities.
- This fracture pattern causes more significant disruption to the **vascularity** of the humeral head than two-part fractures but generally less than four-part fractures.
Fracture Complications Indian Medical PG Question 4: Which of the following findings appear late in compartment syndrome?
- A. Paralysis
- B. Pain on passive stretch
- C. Pulselessness (Correct Answer)
- D. Pallor
Fracture Complications Explanation: ***Pulselessness***
- **Pulselessness** is a very late and ominous sign in compartment syndrome, indicating severe arterial compromise that has progressed beyond simple venous and lymphatic outflow obstruction.
- Its presence suggests **irreversible tissue damage** has likely already occurred due to prolonged ischemia.
*Paralysis*
- **Paralysis** is a late sign, indicating significant nerve ischemia and damage due to sustained pressure within the compartment.
- While it's a serious finding, it typically appears before pulselessness, as nerves are sensitive to ischemia but arteries are more resistant to complete occlusion until very high pressures are reached.
*Pain on passive stretch*
- **Pain on passive stretch** is considered one of the earliest and most reliable clinical signs of early compartment syndrome.
- It results from the stretching of ischemic muscle fibers within the confined compartment.
*Pallor*
- **Pallor** (skin paleness) is also a relatively late sign, occurring when capillary perfusion is significantly reduced due to rising intracompartmental pressure.
- It usually manifests when the pressure is high enough to restrict blood flow but often precedes the complete absence of pulses.
Fracture Complications Indian Medical PG Question 5: What is to be addressed first in case of polytrauma -
- A. Circulation
- B. Neurology
- C. Blood Pressure
- D. Airway (Correct Answer)
Fracture Complications Explanation: ***Airway***
- Maintaining a **patent airway** is the absolute first priority in polytrauma management according to the **ATLS (Advanced Trauma Life Support)** protocol.
- Failure to secure an airway can lead to **hypoxia** and **brain damage** within minutes, regardless of other injuries.
*Circulation*
- While critical, addressing **circulation** (C in ABCDE) comes after establishing a secure airway and adequate breathing (A and B).
- Uncontrolled hemorrhage would be the focus of circulation management, but only after guaranteeing proper oxygenation.
*Neurology*
- Neurological assessment (D in ABCDE for Disability) follows the primary survey of airway, breathing, and circulation.
- Initial neurological evaluation focuses on **level of consciousness** using the **GCS (Glasgow Coma Scale)**.
*Blood Pressure*
- **Blood pressure** is an indicator of circulatory status but is not the first thing to be addressed.
- It falls under the "C" for circulation in the ATLS protocol, which is secondary to airway and breathing.
Fracture Complications Indian Medical PG Question 6: All of the following can be the complications of a malunited Colles fracture except:
- A. Rupture of flexor pollicis longus tendon (Correct Answer)
- B. Carpal instability
- C. Carpal tunnel syndrome
- D. Reflex sympathetic dystrophy (RSD)
Fracture Complications Explanation: ***Rupture of flexor pollicis longus tendon***
- Malunion of a Colles fracture typically involves dorsal displacement of the distal radius, which can lead to friction and rupture of the **extensor pollicis longus (EPL)** tendon due to irritation over the dorsal bony prominence.
- The **flexor pollicis longus (FPL)** tendon is on the palmar side of the wrist and is generally not at risk for rupture from a dorsally malunited Colles fracture.
*Carpal instability*
- **Malunion of a Colles fracture** can significantly alter the normal anatomy and mechanics of the radiocarpal joint, leading to **carpal instability**.
- Changes in radial inclination, volar tilt, and radial length can disrupt load bearing and ligamentous integrity, predisposing to carpal collapse or dissociation.
*Carpal tunnel syndrome*
- Malunion can lead to **decreased carpal tunnel volume** and angulation of the carpal bones, increasing pressure on the **median nerve**.
- This anatomical alteration can lead to symptoms of **carpal tunnel syndrome**, such as numbness, tingling, and pain in the median nerve distribution.
*Reflex sympathetic dystrophy (RSD)*
- Also known as **Complex Regional Pain Syndrome (CRPS) Type I**, RSD is a well-recognized complication following trauma or surgery to an extremity, including Colles fractures.
- It presents with pain, swelling, *trophic skin changes*, and vasomotor dysfunction, and can be severely incapacitating.
Fracture Complications Indian Medical PG Question 7: What is the primary reason for early stabilization of a femur shaft fracture?
- A. To prevent significant blood loss.
- B. To reduce pain and discomfort.
- C. To facilitate quicker healing.
- D. To prevent fat embolism syndrome and systemic complications (Correct Answer)
Fracture Complications Explanation: ***To prevent fat embolism syndrome and systemic complications***
- Early stabilization of femur shaft fractures significantly **reduces the incidence of fat embolism syndrome (FES)**. Fat emboli released from the bone marrow can travel to the lungs and brain, causing severe respiratory distress and neurological deficits.
- By stabilizing the fracture, the **release of fat globules is minimized**, thereby preventing FES and associated systemic complications such as acute respiratory distress syndrome (ARDS) and adult respiratory distress syndrome (ADRS).
*To prevent significant blood loss.*
- While femur fractures can cause significant blood loss, the primary reason for early stabilization is not solely to prevent it but to reduce complications. **Blood loss is a direct consequence**, but FES poses a greater immediate threat to life.
- Furthermore, **blood loss can often be managed initially by other means**, such as fluid resuscitation and direct pressure, while FES requires prompt reduction of fracture movement.
*To reduce pain and discomfort.*
- Reducing pain and discomfort is an important benefit of stabilization, but it is **not the primary life-saving reason** for early intervention. Analgesics and proper splinting can also address pain.
- The focus on early stabilization goes beyond symptomatic relief to actively prevent **potentially fatal systemic complications**.
*To facilitate quicker healing.*
- While stability is crucial for proper healing, **early stabilization primarily addresses acute, life-threatening complications** rather than long-term healing rates. Optimal healing depends on many factors, including blood supply and infection control, not solely on initial stabilization.
- **Quicker healing is a secondary benefit**; the immediate priority is to prevent acute morbidity and mortality associated with the fracture.
Fracture Complications Indian Medical PG Question 8: Least common complication of a fall from height is -
- A. Fracture fibula (Correct Answer)
- B. Fracture base of skull
- C. Fracture 12th thoracic vertebra
- D. Fracture calcaneum
Fracture Complications Explanation: ***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.
Fracture Complications Indian Medical PG Question 9: Scaphoid fracture, which area has the maximum chances of avascular necrosis?
- A. Proximal 1/3 (Correct Answer)
- B. Middle 1/3
- C. Distal 1/3
- D. Scaphoid Tubercle Fracture
Fracture Complications Explanation: ***Proximal 1/3***
- The **scaphoid** has a precarious blood supply, with arterial branches entering predominantly from its distal pole and flowing proximally.
- A fracture in the **proximal one-third** disrupts this retrograde blood flow to the most proximal portion of the bone, making it highly susceptible to **avascular necrosis** due to lack of nourishment.
*Middle 1/3*
- While fractures in this region (often called the **waist**) are the most common type of scaphoid fracture, they carry a **moderate risk of avascular necrosis** compared to the proximal pole.
- The more distal blood supply may still perfuse some parts of the middle segment, but healing is often prolonged.
*Distal 1/3*
- Fractures in the **distal one-third** of the scaphoid (distal pole) have an **excellent prognosis** and a very low risk of avascular necrosis.
- This is because the blood supply to the distal pole is robust and typically remains intact even after a fracture in this region.
*Scaphoid Tubercle Fracture*
- The **scaphoid tubercle** is a prominence on the palmar aspect of the distal scaphoid.
- Fractures here are considered stable, heal well due to good blood supply, and rarely lead to **avascular necrosis**.
Fracture Complications Indian Medical PG Question 10: Most common complication of mid shaft humerus fracture is ?
- A. Radial nerve palsy (Correct Answer)
- B. Median nerve palsy
- C. Nonunion
- D. Malunion
Fracture Complications Explanation: ***Radial nerve palsy***
- The **radial nerve** runs in close proximity to the **spiral groove** of the humerus, making it highly vulnerable to injury in mid-shaft fractures.
- This results in the characteristic **wrist drop** and loss of sensation over the dorsal aspect of the hand.
*Median nerve palsy*
- The **median nerve** is not typically affected by mid-shaft humeral fractures as it is located more medially and anteriorly.
- Injury to the median nerve is more common with supracondylar fractures of the humerus or carpal tunnel syndrome.
*Nonunion*
- While **nonunion** (failure of bone healing) occasionally occurs after mid-shaft humerus fractures, **radial nerve palsy** is a more immediate and frequent complication observed at the time of injury.
- Risks for nonunion include severe trauma, soft tissue interposition, and inadequate immobilization.
*Malunion*
- **Malunion** (healing in an unacceptable alignment) can occur, especially with conservative management, but like nonunion, it is a complication of the healing process rather than an acute injury presentation.
- Functional outcomes are generally good even with some degree of angulation in humeral shaft fractures.
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