Revision Arthroplasty — MCQs

10 questions

Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

Most common complication of extra capsular fracture of neck of femur is:

A child presents with painful limp and restricted hip rotation. ESR and CRP are elevated. Initial plain radiograph is normal. What is the next best imaging study?

A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?

What is the most effective management strategy for hemarthrosis?

All of the following can be the complications of a malunited Colles fracture except:

What is the most common complication of a felon?

Severe disability in primary osteoarthritis of hip is best managed by -

The Henderson-Jones classification is used for:

Q10

False about fracture of vertebrae

Revision Arthroplasty Indian Medical PG Practice Questions and MCQs

Question 1: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -

A. Hemiarthroplasty (Correct Answer)
B. Closed reduction and fixation with three cancellous screws
C. Longitudinal skin traction for 6 weeks
D. Excision arthroplasty

Explanation: ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.

Question 2: Most common complication of extra capsular fracture of neck of femur is:

A. Malunion
B. Ischemic necrosis
C. Pulmonary complications
D. Non union (Correct Answer)

Explanation: ***Non union*** - **Non-union** is a common complication in extracapsular femoral neck fractures due to the **disrupted blood supply** and mechanical forces across the fracture site. - The **fracture fragments** may fail to heal properly, leading to persistent pain, instability, and functional impairment. *Malunion* - **Malunion** occurs when the fracture heals in an **unacceptable anatomical position**, causing deformity or altered biomechanics. - While it can be a complication, **non-union** is generally more prevalent and problematic in extracapsular femoral neck fractures. *Ischemic necrosis* - **Ischemic necrosis** (or avascular necrosis) is less common in extracapsular femoral neck fractures compared to intracapsular fractures. - This is because the **extracapsular location** often spares the crucial blood supply to the femoral head, which is frequently compromised in intracapsular injuries. *Pulmonary complications* - **Pulmonary complications** (e.g., pneumonia, pulmonary embolism) are significant risks in elderly patients with hip fractures due to prolonged immobility and surgery. - However, direct fracture-related complications like **non-union** are distinct and represent issues specifically with bone healing.

Question 3: A child presents with painful limp and restricted hip rotation. ESR and CRP are elevated. Initial plain radiograph is normal. What is the next best imaging study?

A. CT Scan
B. MRI with contrast (Correct Answer)
C. Bone Scan
D. Plain Radiograph

Explanation: ***MRI with contrast*** - An **MRI with contrast** is the most sensitive and specific imaging modality for detecting early changes in **osteomyelitis** or **septic arthritis**, which are serious conditions given the child's symptoms and elevated inflammatory markers. - It can visualize soft tissue and bone marrow edema, joint effusions, and abscesses, guiding immediate treatment. *CT Scan* - While useful for bony detail, a CT scan is **less sensitive than MRI** for detecting early bone marrow changes or soft tissue inflammation in the hip joint. - It also involves **radiation exposure**, which should be limited in children when other effective modalities are available. *Bone Scan* - A bone scan using **technetium-99m** is sensitive for detecting increased bone turnover, but it is **not specific for infection** and cannot differentiate between inflammatory processes, tumors, or fractures. - It provides less anatomical detail compared to MRI, making precise localization of an infection more challenging. *Plain Radiograph* - Plain radiographs are typically the **initial imaging study** for orthopedic complaints but are often **normal in early stages** of septic arthritis or osteomyelitis. - Significant radiographic changes, such as bone erosion or joint space widening, usually appear much later in the disease process.

Question 4: A 70-year-old woman with chronic osteoarthritis of the hip presents with worsening pain and limited mobility despite conservative management. What is the next appropriate step?

A. NSAIDs
B. Physical therapy
C. Intra-articular corticosteroid injections
D. Total hip replacement (Correct Answer)

Explanation: ***Total hip replacement*** - For **severe osteoarthritis (OA)** causing significant pain and **functional impairment** despite failed conservative management, **total hip replacement** is the most definitive and effective treatment. - This procedure alleviates pain and restores **mobility**, dramatically improving the patient's quality of life. *NSAIDs* - **NSAIDs** are typically part of **initial conservative management** for symptomatic relief in mild to moderate OA, but they have already failed in this patient. - Continued use in elderly patients carries risks of **gastrointestinal, renal, and cardiovascular side effects**, making it a less desirable long-term solution. *Physical therapy* - **Physical therapy** is a crucial component of conservative management to improve **strength, flexibility, and function**, but it often becomes insufficient in advanced OA. - Since this patient has worsening symptoms despite conservative measures, physical therapy alone is unlikely to provide adequate relief. *Intra-articular corticosteroid injections* - **Corticosteroid injections** can provide temporary pain relief by reducing inflammation but do not address the underlying **structural damage** of severe OA. - Their effectiveness diminishes over time, and repeated injections are discouraged due to potential cartilage damage.

Question 5: What is the most effective management strategy for hemarthrosis?

A. Immobilization with a P.O.P. cast
B. Application of a compression bandage
C. Needle aspiration to remove excess blood (Correct Answer)
D. All of the options

Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.

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)

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.

Question 7: What is the most common complication of a felon?

A. Osteomyelitis (Correct Answer)
B. Subungual hematoma
C. Infective arthritis
D. No complications

Explanation: ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.

Question 8: Severe disability in primary osteoarthritis of hip is best managed by -

A. Arthroplasty (Correct Answer)
B. Arthrodesis
C. Mc Murray's osteotomy
D. Intra-articular hydrocortisone and physiotherapy

Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.

Question 9: The Henderson-Jones classification is used for:

A. Diabetic foot
B. Prosthetic joint infection (Correct Answer)
C. Pressure ulcers
D. Burns

Explanation: ***Prosthetic joint infection*** - The **Henderson-Jones classification** is a system used to categorize **prosthetic joint infections (PJI)** based on their **timing** of onset, distinguishing between early, delayed, and late infections. - This classification aids in guiding **treatment strategies**, as the approach for PJI varies depending on when the infection develops after surgery. *Diabetic foot* - **Diabetic foot ulcers** are typically classified using systems like the **Wagner classification** or the **University of Texas Wound Classification System**, which focus on wound depth, presence of infection, and ischemia. - These classifications specifically address the unique pathology and progression of **foot complications** in diabetic patients. *Pressure ulcers* - **Pressure ulcers (bedsores)** are commonly classified using the **National Pressure Ulcer Advisory Panel (NPUAP)** staging system or the **International Pressure Ulcer Classification System**, which categorize ulcers by depth of tissue damage. - These systems are crucial for assessing severity, guiding treatment, and predicting outcomes for **skin and underlying tissue injury** caused by sustained pressure. *Burns* - **Burns** are traditionally classified by **depth** (e.g., first, second, third, and fourth-degree burns) and **total body surface area (TBSA)** affected, using tools like the Rule of Nines. - This classification helps determine the **severity** of the burn and guides initial management, fluid resuscitation, and surgical intervention.

Question 10: False about fracture of vertebrae

A. Fracture dislocation is common in flexion rotation injury
B. Chance fracture occurs due to flexion distraction injury
C. Wedge compression causes flexion injury
D. Anterior longitudinal ligament runs along the posterior surface of vertebral bodies (Correct Answer)

Explanation: ***Anterior longitudinal ligament runs along the posterior surface of vertebral bodies*** - The **anterior longitudinal ligament (ALL)** runs along the **anterior aspect** of the vertebral bodies, preventing hyperextension. - The **posterior longitudinal ligament (PLL)** runs along the posterior surface of the vertebral bodies, within the vertebral canal. *Fracture dislocation is common in flexion rotation injury* - **Flexion-rotation injuries** are highly unstable and frequently lead to **fracture-dislocations** of the vertebral column. - The combined forces cause significant disruption of both bony and ligamentous structures, increasing the likelihood of displacement. *Chance fracture occurs due to flexion distraction injury* - A **Chance fracture** (or seatbelt fracture) is caused by a **flexion-distraction injury**, typically seen in individuals wearing lap belts during deceleration. - This mechanism results in a horizontal splitting of the vertebral body and posterior elements. *Wedge compression causes flexion injury* - A **wedge compression fracture** is the most common type of vertebral fracture and results from a **flexion injury** (hyperflexion). - The anterior portion of the vertebral body collapses, creating a wedge shape, while the posterior column remains intact.

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