NEET-PG 2012 — Orthopaedics

Q: One of the common fractures that occur during boxing by hitting with a closed fist is:

Bennett's fracture dislocation. ***Bennett's fracture dislocation*** - This is an **intra-articular fracture** of the base of the **first metacarpal**, extending into the carpometacarpal (CMC) joint. - It is frequently caused by axial compression with the thumb in a flexed and adducted position, a common injury mechanism in **punching a hard object** during boxing. *Monteggia fracture dislocation* - This injury involves a fracture of the **proximal ulna** coupled with an **anterior dislocation of the radial head**. - It is typically caused by a direct blow to the forearm or a fall on an outstretched hand with a hyperpronated forearm, not a direct punch. *Galeazzi fracture dislocation* - This involves a fracture of the **distal radius** with an associated **dislocation of the distal radioulnar joint (DRUJ)**. - It results from a fall on an outstretched hand with a hyperpronated forearm, which is not consistent with a boxing injury. *Smith's fracture* - Also known as a **reverse Colles' fracture**, this is a fracture of the **distal radius** with **volar displacement of the distal fragment**. - It typically results from a fall on a flexed wrist or a direct blow to the back of the wrist, not a punching injury. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which of the following conditions can cause locking of the knee joint?

Loose body in knee joint. ***Loose body in knee joint*** - A **loose body** (e.g., a fragment of cartilage or bone) can get trapped between the articular surfaces of the knee joint, mechanically obstructing its movement and causing sudden, painful **locking**. - This mechanical impingement prevents full extension or flexion of the knee until the loose body shifts, leading to episodic locking symptoms. *Osgood Schlatter* - This condition involves inflammation and potential avulsion of the **tibial tuberosity** where the patellar tendon inserts. - It primarily causes pain and swelling below the kneecap, especially during physical activity, but does not typically result in true mechanical locking of the joint. *Tuberculosis of knee* - **Tuberculosis of the knee joint** is an infectious arthritis that causes chronic pain, swelling, and gradual destruction of articular cartilage and bone. - While it can lead to pain and limited range of motion, it usually does not present with the sudden, intermittent mechanical locking characteristic of a loose body. *a and b both* - Neither **Osgood Schlatter** nor **Tuberculosis of the knee** typically cause the characteristic mechanical locking sensation described for a loose body in the joint. - Each of these conditions has distinct pathophysiological mechanisms and clinical presentations that do not involve a physical obstruction causing locking. [Practice more Orthopaedics PYQs on OnCourse]

Q: Treatment of choice for displaced fracture neck femur in a 40 years old female

Multiple screw fixation. ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario. [Practice more Orthopaedics PYQs on OnCourse]

Q: Cloacae are openings found in which of the following?

Involucrum. ***Involucrum*** - **Cloacae** are openings or sinuses that develop in the **involucrum**, which is the new bone formation that surrounds a segment of necrotic bone (sequestrum) during osteomyelitis. - These openings act as channels for the discharge of **pus** and inflammatory debris from the infected bone to the external environment. *Sequestrum* - A **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from the surrounding healthy bone due to osteomyelitis. - While central to the pathology, the cloacae are openings *through the involucrum* that encases the sequestrum, not in the sequestrum itself. *Normal bone* - **Normal bone** does not contain cloacae; these structures are a pathological feature indicative of chronic osteomyelitis. - Healthy bone remodels and resorbs normally, without the formation of channels for pus drainage. *Myositis* - **Myositis** is an inflammation of the **muscles**, not bone, and does not involve the formation of cloacae. - While it can be caused by infection, the pathological changes are localized to muscle tissue. [Practice more Orthopaedics PYQs on OnCourse]

Q: Which of the following statements is true regarding supracondylar fractures of the humerus?

Extension type most common. **Extension type most common** - **Extension-type supracondylar fractures** account for the vast majority (about 95%) of all supracondylar humerus fractures. - This type typically results from a fall on an **outstretched hand** with the elbow in extension, forcing the distal fragment posteriorly. *More common in adults* - **Supracondylar fractures of the humerus** are predominantly observed in children, especially between 5 and 10 years of age. - They are the **most common elbow fracture in children**, making this statement incorrect. *Flexion type is less common than extension type* - While flexion-type fractures do occur, they are significantly less common, representing only about 5% of all supracondylar fractures. - This type typically results from a direct blow to the posterior aspect of the elbow, with the distal fragment displaced anteriorly. *Both types are equally common* - As established, extension-type fractures are far more prevalent than flexion-type fractures, making them not equally common. - The significant disparity in incidence confirms that this statement is incorrect. [Practice more Orthopaedics PYQs on OnCourse]

31 Previous Year Questions with Answers & Explanations

Questions

One of the common fractures that occur during boxing by hitting with a closed fist is:

Which of the following conditions can cause locking of the knee joint?

Treatment of choice for displaced fracture neck femur in a 40 years old female

Cloacae are openings found in which of the following?

Which of the following statements is true regarding supracondylar fractures of the humerus?

Which of the following describes grade 2 fracture neck femur?

Anterolateral decompression is primarily indicated for

Which of the following bone tumors characteristically presents with nocturnal pain relieved by NSAIDs and shows a radiolucent nidus surrounded by sclerotic bone?

What type of cast is primarily associated with the development of Cast syndrome?

Q10

Green stick fracture is

NEET-PG 2012 - Orthopaedics NEET-PG Practice Questions and MCQs

Question 1: One of the common fractures that occur during boxing by hitting with a closed fist is:

A. Monteggia fracture dislocation
B. Galeazzi fracture dislocation
C. Bennett's fracture dislocation (Correct Answer)
D. Smith's fracture

Explanation: ***Bennett's fracture dislocation*** - This is an **intra-articular fracture** of the base of the **first metacarpal**, extending into the carpometacarpal (CMC) joint. - It is frequently caused by axial compression with the thumb in a flexed and adducted position, a common injury mechanism in **punching a hard object** during boxing. *Monteggia fracture dislocation* - This injury involves a fracture of the **proximal ulna** coupled with an **anterior dislocation of the radial head**. - It is typically caused by a direct blow to the forearm or a fall on an outstretched hand with a hyperpronated forearm, not a direct punch. *Galeazzi fracture dislocation* - This involves a fracture of the **distal radius** with an associated **dislocation of the distal radioulnar joint (DRUJ)**. - It results from a fall on an outstretched hand with a hyperpronated forearm, which is not consistent with a boxing injury. *Smith's fracture* - Also known as a **reverse Colles' fracture**, this is a fracture of the **distal radius** with **volar displacement of the distal fragment**. - It typically results from a fall on a flexed wrist or a direct blow to the back of the wrist, not a punching injury.

Question 2: Which of the following conditions can cause locking of the knee joint?

A. Osgood Schlatter
B. Tuberculosis of knee
C. a and b both
D. Loose body in knee joint (Correct Answer)

Explanation: ***Loose body in knee joint*** - A **loose body** (e.g., a fragment of cartilage or bone) can get trapped between the articular surfaces of the knee joint, mechanically obstructing its movement and causing sudden, painful **locking**. - This mechanical impingement prevents full extension or flexion of the knee until the loose body shifts, leading to episodic locking symptoms. *Osgood Schlatter* - This condition involves inflammation and potential avulsion of the **tibial tuberosity** where the patellar tendon inserts. - It primarily causes pain and swelling below the kneecap, especially during physical activity, but does not typically result in true mechanical locking of the joint. *Tuberculosis of knee* - **Tuberculosis of the knee joint** is an infectious arthritis that causes chronic pain, swelling, and gradual destruction of articular cartilage and bone. - While it can lead to pain and limited range of motion, it usually does not present with the sudden, intermittent mechanical locking characteristic of a loose body. *a and b both* - Neither **Osgood Schlatter** nor **Tuberculosis of the knee** typically cause the characteristic mechanical locking sensation described for a loose body in the joint. - Each of these conditions has distinct pathophysiological mechanisms and clinical presentations that do not involve a physical obstruction causing locking.

Question 3: Treatment of choice for displaced fracture neck femur in a 40 years old female

A. None of the options
B. Bipolar hemiarthroplasty
C. Multiple screw fixation (Correct Answer)
D. THR

Explanation: ***Multiple screw fixation*** - For a **displaced femoral neck fracture** in a younger patient (40 years old), **internal fixation** with multiple screws is generally the preferred treatment to preserve the native **femoral head**. - This approach aims to achieve **anatomical reduction** and stable fixation, allowing for bone healing and a better long-term functional outcome in active individuals. *Bipolar hemiarthroplasty* - This procedure is typically reserved for older, less active patients with **displaced femoral neck fractures**, particularly those with pre-existing conditions that might limit their longevity or activity level. - While it replaces the femoral head, it does not preserve the native joint, which is a less desirable outcome in a 40-year-old. *THR* - **Total hip replacement** is usually considered for older patients, or younger patients with **pre-existing arthritis** or failed internal fixation, due to concerns about the prosthesis's longevity and potential future revisions. - In a 40-year-old, the goal is typically to preserve the native joint if possible, unless there are other complicating factors. *None of the options* - Internal fixation with multiple screws is a well-established and appropriate treatment for a displaced femoral neck fracture in a 40-year-old patient. - Therefore, one of the provided options is indeed the correct treatment choice for this specific scenario.

Question 4: Cloacae are openings found in which of the following?

A. Sequestrum
B. Involucrum (Correct Answer)
C. Normal bone
D. Myositis

Explanation: ***Involucrum*** - **Cloacae** are openings or sinuses that develop in the **involucrum**, which is the new bone formation that surrounds a segment of necrotic bone (sequestrum) during osteomyelitis. - These openings act as channels for the discharge of **pus** and inflammatory debris from the infected bone to the external environment. *Sequestrum* - A **sequestrum** is a piece of **necrotic (dead) bone** that has become separated from the surrounding healthy bone due to osteomyelitis. - While central to the pathology, the cloacae are openings *through the involucrum* that encases the sequestrum, not in the sequestrum itself. *Normal bone* - **Normal bone** does not contain cloacae; these structures are a pathological feature indicative of chronic osteomyelitis. - Healthy bone remodels and resorbs normally, without the formation of channels for pus drainage. *Myositis* - **Myositis** is an inflammation of the **muscles**, not bone, and does not involve the formation of cloacae. - While it can be caused by infection, the pathological changes are localized to muscle tissue.

Question 5: Which of the following statements is true regarding supracondylar fractures of the humerus?

A. Extension type most common (Correct Answer)
B. Flexion type is less common than extension type
C. Both types are equally common
D. More common in adults

Explanation: **Extension type most common** - **Extension-type supracondylar fractures** account for the vast majority (about 95%) of all supracondylar humerus fractures. - This type typically results from a fall on an **outstretched hand** with the elbow in extension, forcing the distal fragment posteriorly. *More common in adults* - **Supracondylar fractures of the humerus** are predominantly observed in children, especially between 5 and 10 years of age. - They are the **most common elbow fracture in children**, making this statement incorrect. *Flexion type is less common than extension type* - While flexion-type fractures do occur, they are significantly less common, representing only about 5% of all supracondylar fractures. - This type typically results from a direct blow to the posterior aspect of the elbow, with the distal fragment displaced anteriorly. *Both types are equally common* - As established, extension-type fractures are far more prevalent than flexion-type fractures, making them not equally common. - The significant disparity in incidence confirms that this statement is incorrect.

Question 6: Which of the following describes grade 2 fracture neck femur?

A. Incomplete fracture, medial trabeculae intact
B. Complete fracture with undisplaced neck (Correct Answer)
C. Complete fracture with ischemic head
D. Moderate displacement of neck, vascularity damaged

Explanation: ***Complete fracture with undisplaced neck*** - A **Garden Type II fracture** of the femoral neck is characterized by a **complete fracture line** through the femoral neck. - Despite the complete fracture, the **femoral head remains undisplaced** and in its anatomical position, indicating an intact or minimally disrupted posteromedial soft-tissue hinge. *Incomplete fracture, medial trabeculae intact* - This description corresponds to a **Garden Type I fracture**, which is an **incomplete fracture** of the femoral neck, usually impacted in valgus. - In such cases, the medial trabeculae are often intact, or show buckling on the lateral side, indicating a stable fracture. *Complete fracture with ischemic head* - The presence of an **ischemic head** is a complication that can occur with any displaced femoral neck fracture (Garden Type III or IV), but it's not a primary defining characteristic of a specific Garden grade. - **Avascular necrosis (AVN)** of the femoral head is a risk, especially with displacement, due to disruption of the blood supply. *Moderate displacement of neck, vascularity damaged* - This description is more consistent with a **Garden Type III fracture**, where there is a **complete fracture with moderate displacement** of the femoral head, usually with some varus angulation. - Such displacement significantly increases the risk of **vascular injury** to the femoral head, predisposing to avascular necrosis.

Question 7: Anterolateral decompression is primarily indicated for

A. Spinal tuberculosis (Pott's disease) (Correct Answer)
B. Lumbar disc herniation
C. Ankylosing spondylitis
D. Spinal metastasis

Explanation: ***Spinal tuberculosis (Pott's disease)*** - **Anterolateral decompression** is crucial for **Pott's disease** to remove infected bone and pus, relieve pressure on the spinal cord, and facilitate fusion. - This approach allows direct access to the anterior spinal column, which is commonly affected by the destructive process of **tuberculosis**. *Spinal metastasis* - While spinal metastasis can cause compression, **anterolateral decompression** is less common as a primary approach; often, surgical treatment involves posterior decompression, stabilization, and adjuvant therapies like radiation. - The goal is often **pain management** and neurological preservation in the context of advanced disease. *Lumbar disc herniation* - **Lumbar disc herniation** is typically addressed by posterior approaches like **microdiscectomy** or laminectomy, which directly access the posterior aspect of the disc. - **Anterolateral decompression** is generally not indicated as the primary treatment for standard disc herniations. *Ankylosing spondylitis* - Surgical intervention in **ankylosing spondylitis** is usually reserved for severe kyphosis or spinal fractures, employing osteotomies and stabilization techniques, often through posterior approaches. - **Anterolateral decompression** is not a standard procedure for the typical manifestations or complications of **ankylosing spondylitis**.

Question 8: Which of the following bone tumors characteristically presents with nocturnal pain relieved by NSAIDs and shows a radiolucent nidus surrounded by sclerotic bone?

A. Osteoid osteoma (Correct Answer)
B. Chondrosarcoma
C. Enchondroma
D. None of the options

Explanation: ***Osteoid osteoma*** - This benign bone tumor is characterized by **nocturnal pain** that is typically **relieved by NSAIDs**, a highly distinctive clinical feature due to prostaglandin production within the nidus. - Radiographically, it presents as a small **radiolucent nidus** (less than 1.5 cm) surrounded by a significant margin of **sclerotic bone**. *Chondrosarcoma* - This is a **malignant cartilage-forming tumor** that usually presents with a dull, aching pain that is often **not relieved by NSAIDs** and may worsen over time. - Radiographically, it appears as a **large, destructive lesion with calcifications**, not a small nidus with surrounding sclerosis. *Enchondroma* - An enchondroma is a **benign cartilaginous tumor** that is typically found in the medullary cavity of long bones, often in the small bones of the hands and feet. - It is usually **asymptomatic** and discovered incidentally, and on imaging, it appears as a **well-circumscribed lytic lesion** without the prominent sclerotic rim or specific nocturnal pain pattern seen in osteoid osteoma. *None of the options* - This option is incorrect because **osteoid osteoma** perfectly matches the clinical and radiographic description provided in the question.

Question 9: What type of cast is primarily associated with the development of Cast syndrome?

A. Full arm cast
B. Short arm cast
C. Hip spica cast (Correct Answer)
D. Above knee cast

Explanation: ***Hip spica cast*** - A **hip spica cast** encases the trunk and one or both legs, increasing intra-abdominal pressure due to its extensive coverage. - This pressure can compress the **superior mesenteric artery** against the **duodenum**, leading to Cast syndrome (also known as superior mesenteric artery syndrome). *Full arm cast* - A full arm cast does not cover the abdomen and therefore does not exert pressure on the **superior mesenteric artery** or duodenum. - It is associated with complications like compartment syndrome or nerve impingement in the upper extremity, but not Cast syndrome. *Short arm cast* - Similar to a full arm cast, a short arm cast is limited to the forearm and hand and poses no risk for **abdominal compression**. - Complications are localized to the distal upper limb, such as carpal tunnel syndrome or skin breakdown. *Above knee cast* - An above knee cast covers the lower leg and thigh but does not extend to the abdomen. - It does not contribute to the increased intra-abdominal pressure necessary for the development of **superior mesenteric artery syndrome**.

Question 10: Green stick fracture is

A. Fracture in adults
B. Complete fracture
C. Fracture spine
D. Incomplete fracture (Correct Answer)

Explanation: ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.