Which of the following is an orthopedic emergency?
What is the generally recommended maximum weight for skeletal traction in adult patients?
Windswept deformity is seen in which condition?
Most common site of osteochondritis dissecans?
Which condition can lead to the formation of loose bodies in the joint?
What is the purpose of the Insall-Salvati index?
Halopelvic traction is primarily used for correcting which specific spinal deformity?
Most common complication of intertrochanteric fracture femur is:
NEET-PG 2013 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 31: Which of the following is an orthopedic emergency?
- A. Intraarticular fracture
- B. Septic arthritis (Correct Answer)
- C. Fracture lateral condyle humerus
- D. Fracture neck femur
Explanation: ***Septic arthritis*** - This is an **orthopedic emergency** due to the rapid destruction of cartilage and bone if not treated promptly. - It requires urgent **surgical washout** and intravenous antibiotics to prevent irreversible joint damage and systemic infection. *Intraarticular fracture* - While requiring careful management to optimize joint function, an **intraarticular fracture** is typically not an immediate emergency unless there's associated neurovascular compromise or compartment syndrome. - Surgical intervention can often be planned within a certain timeframe (days) rather than hours. *Fracture lateral condyle humerus* - This fracture in children is significant due to potential for non-union or avascular necrosis, but it is not considered an immediate **life- or limb-threatening emergency**. - Management usually involves **reduction and fixation** but does not carry the same degree of urgency as active joint infection. *Fracture neck femur* - A fractured neck of femur requires surgical intervention to prevent complications like **avascular necrosis** and optimize mobility, particularly in elderly patients. - While serious, it primarily presents a risk of long-term disability and complications, not an immediate destructive process like septic arthritis.
Question 32: What is the generally recommended maximum weight for skeletal traction in adult patients?
- A. 5 kg
- B. 10 kg
- C. 20 kg
- D. 15 kg (Correct Answer)
Explanation: ***15 kg*** - While the specific weight can vary based on the bone and patient, 10-15 kg is generally the **maximum recommended weight for skeletal traction** in adults to avoid complications. - Applying too much weight risks **damage to the bone, soft tissues, and nerves**, as well as potential pin site infections and neurovascular compromise. *5 kg* - This weight is typically more appropriate for **skin traction**, where the pulling force is applied externally to the skin, limiting the amount of weight that can be safely used without causing skin damage. - In skeletal traction, 5 kg is often used for **initial alignment or very tenuous fractures**, but it is generally insufficient for significant reduction or long-term stabilization. *10 kg* - 10 kg is a common starting point or moderate weight used in skeletal traction, particularly for **femur or tibia fractures**. - While often effective, it is not consistently the maximum safe weight, as some situations may allow or require slightly more weight up to 15 kg for optimal reduction. *20 kg* - Applying 20 kg of weight in skeletal traction is generally considered **excessive and dangerous** in most adult applications. - This high amount of weight significantly increases the risk of **pin loosening, osteomyelitis, neurovascular injury, and avascular necrosis**, especially in areas like the cervical spine or tibia.
Question 33: Windswept deformity is seen in which condition?
- A. Hyperparathyroidism
- B. Scurvy
- C. Rheumatoid Arthritis
- D. Rickets (Correct Answer)
Explanation: ***Rickets*** - **Windswept deformity** is characterized by bilateral knee deformities where one knee is in **valgus** and the other is in **varus**. - This condition is caused by a deficiency in **vitamin D**, **calcium**, or **phosphate**, leading to improper bone mineralization and subsequent bone deformities. *Rheumatoid Arthritis* - Rheumatoid arthritis is a **chronic autoimmune inflammatory disease** primarily affecting the synovial joints. - While it can cause joint deformities, they typically involve symmetric joint swelling, pain, and stiffness, with characteristic deformities like **ulnar deviation** or **swan-neck deformities**, rather than windswept deformity. *Hyperparathyroidism* - Hyperparathyroidism leads to excessive production of **parathyroid hormone**, which causes increased bone resorption and elevated blood calcium levels. - It can result in bone fragility, **osteitis fibrosa cystica**, and kidney stones, but it does not cause specific windswept deformity. *Scurvy* - Scurvy results from a severe deficiency of **vitamin C**, which is essential for collagen synthesis. - It presents with symptoms like bleeding gums, poor wound healing, and perifollicular hemorrhages, but it does not typically cause windswept deformity of the knees.
Question 34: Most common site of osteochondritis dissecans?
- A. Lateral part of the medial femoral condyle (Correct Answer)
- B. Medial part of the medial femoral condyle
- C. Lateral part of the lateral femoral condyle
- D. Medial part of the lateral femoral condyle
Explanation: ***Lateral part of the medial femoral condyle*** - This is the **most common site** for osteochondritis dissecans in the knee, accounting for about 85% of cases. - The condition involves a localized area of **osteonecrosis and subchondral bone separation** from the epiphysis, typically afflicting this specific load-bearing region. *Medial part of the medial femoral condyle* - This location is **less common** for osteochondritis dissecans compared to the lateral aspect of the medial femoral condyle. - While osteochondral lesions can occur on any part of the condyle, the specific biomechanical stresses make the lateral part more susceptible. *Lateral part of the lateral femoral condyle* - Osteochondritis dissecans is **rarely found** in this location. - The lateral femoral condyle is generally less involved in osteochondritis dissecans of the knee. *Medial part of the lateral femoral condyle* - This site is also an **uncommon location** for osteochondritis dissecans. - The disease has a strong predilection for the medial femoral condyle, particularly its lateral aspect.
Question 35: Which condition can lead to the formation of loose bodies in the joint?
- A. Rheumatoid arthritis
- B. Ankylosing spondylitis
- C. Osteoarthritis (Correct Answer)
- D. Systemic lupus erythematosus
Explanation: ***Osteoarthritis*** - In **osteoarthritis**, the **degenerative process** of cartilage can lead to fragments breaking off and floating within the joint space, forming **loose bodies**. - These loose bodies, also known as **joint mice**, can cause mechanical symptoms like locking, clicking, or catching in the joint. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an **inflammatory autoimmune disease** primarily affecting the synovium. - While it can cause joint damage, it typically does not lead to the formation of cartilaginous or bony loose bodies. *Ankylosing spondylitis* - **Ankylosing spondylitis** is a **chronic inflammatory disease** primarily affecting the spine and sacroiliac joints. - Its hallmark is new bone formation and fusion of vertebrae, not the formation of loose bodies within the joint. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease that can affect multiple organs, including joints. - While it can cause **non-erosive arthritis**, it does not typically result in the formation of loose bodies.
Question 36: What is the purpose of the Insall-Salvati index?
- A. To measure ankle dorsiflexion range
- B. To assess patellar height and tendon length ratio (Correct Answer)
- C. To evaluate elbow joint stability
- D. To assess wrist bone alignment
Explanation: ***To assess patellar height and tendon length ratio*** - The **Insall-Salvati index** is a radiographic measurement used to determine **patellar height** by comparing the length of the patellar tendon to the greatest diagonal length of the patella. - It helps in diagnosing conditions like **patella alta** (high-riding patella) or **patella baja** (low-riding patella), which can contribute to knee pain and instability. *To evaluate elbow joint stability* - **Elbow joint stability** is typically assessed through clinical examination for ligamentous integrity (e.g., UCL, RCL) and sometimes dynamic imaging, not by the Insall-Salvati index. - The Insall-Salvati index is specific to the **knee joint** and **patellar position**. *To measure ankle dorsiflexion range* - **Ankle dorsiflexion range** is measured clinically using a goniometer or in 3D motion analysis, not with the Insall-Salvati index. - This index is a specialized measurement for the **patellofemoral joint**. *To assess wrist bone alignment* - **Wrist bone alignment** is evaluated using various radiographic measurements such as the scaphoid-lunate angle or carpal height ratio. - The Insall-Salvati index has no application in the assessment of the **wrist**.
Question 37: Halopelvic traction is primarily used for correcting which specific spinal deformity?
- A. Kyphosis (Correct Answer)
- B. Spondylolisthesis
- C. Scoliosis
- D. Spinal stenosis
Explanation: **Kyphosis** * **Halopelvic traction** is a technique specifically designed to apply sustained corrective forces to the spine, making it particularly effective in treating severe **kyphosis**, especially in young patients prior to surgical correction. * It aids in gradually stretching soft tissues and straightening the spinal curvature over time, often used in cases of congenital or severe developmental kyphosis. *Scoliosis* * While traction can be used in some spinal deformities, **scoliosis** (lateral curvature) is more commonly treated with **bracing** or **surgical fusion**, as halopelvic traction is less effective in correcting the rotational component. * Correction of scoliotic curves typically involves forces applied in multiple planes, which halopelvic traction is not ideally suited for. *Spondylolisthesis* * **Spondylolisthesis** involves the **slippage of one vertebra over another**, which is primarily managed through **stabilization** to prevent further slippage. * Halopelvic traction is not indicated as it could potentially exacerbate instability in the presence of vertebral slippage. *Spinal stenosis* * **Spinal stenosis** refers to the **narrowing of the spinal canal**, which compresses nerves and is usually treated with **decompressive surgery** or **conservative management** for pain relief. * Traction methods are generally not used for spinal stenosis as they do not address the underlying anatomical narrowing and may worsen symptoms.
Question 38: Most common complication of intertrochanteric fracture femur is:
- A. Malunion (Correct Answer)
- B. Nerve injury
- C. Osteoarthritis
- D. Non-union
Explanation: ***Malunion*** - **Malunion** is the most common complication of intertrochanteric fractures, particularly with unstable fracture patterns or inadequate reduction and fixation. - This typically results in leg length discrepancy, gait disturbance, and persistent pain due to abnormal alignment. *Nerve injury* - **Nerve injury** is a rare complication of intertrochanteric fractures, as the major nerves (e.g., sciatic, femoral) are not in close proximity to the fracture site. - While possible with severe trauma or surgical errors, it is not considered the most common complication. *Osteoarthritis* - **Osteoarthritis** can develop years after an intertrochanteric fracture due to altered biomechanics, but it is a long-term sequela, not an immediate or most common post-fracture complication. - Early complications like malunion or infection are more prevalent. *Non-union* - **Non-union** is relatively uncommon in intertrochanteric fractures because this area of the femur has an excellent blood supply, which promotes healing. - This complication is more frequently seen in femoral neck fractures due to their tenuous blood supply.