Complications in Arthroscopy — MCQs
Complications of tubercular meningitis include all except
Which of the following is NOT a complication of elbow dislocation?
Which of the following injuries can be classified as Gustilo-Anderson Grade III injuries?
Which nerve is damaged in anterior dislocation of shoulder:
What is the most common complication of a felon?
The rephrased question is:What is the most common complication of a fractured talus?
A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
An athlete sustained an injury around the knee joint with suspected cartilage damage. Which of the following is the investigation of choice?
The joint cavity can be examined in detail with minimal surgical exposure by which procedure?
Triple deformity of the knee is present in which condition?
Complications in Arthroscopy Indian Medical PG Practice Questions and MCQs
Question 1: Complications of tubercular meningitis include all except
- A. Hydrocephalus
- B. Cerebral Artery Thrombosis
- C. Cortical venous thrombosis (Correct Answer)
- D. Cranial Nerve Palsy
Explanation: ***Cortical venous thrombosis*** - While TB meningitis can cause vascular complications, **isolated cortical venous thrombosis** is a rare and atypical complication. - The inflammatory exudate in TB meningitis typically affects arteries and basal cisterns, leading to problems like arteritis and communicating or obstructive hydrocephalus [1]. *Hydrocephalus* - This is a common complication due to the inflammatory exudate in the **basal cisterns**, which obstructs the flow of cerebrospinal fluid (CSF) [2]. - It can be either **communicating** (impaired absorption) or **non-communicating** (obstructive due to blockage) [2]. *Cerebral Artery Thrombosis* - The **inflammatory exudate** surrounding basal cisterns in TB meningitis can lead to vasculitis and thrombosis of nearby arteries, especially the large cerebral arteries. - This can result in **ischemic strokes** and focal neurological deficits [3]. *Cranial Nerve Palsy* - The inflamed meninges and exudate can directly compress or damage **cranial nerves** as they exit the brainstem and travel through the basal cisterns. - Cranial nerves III, IV, VI, VII, and VIII are particularly susceptible to this complication.
Question 2: Which of the following is NOT a complication of elbow dislocation?
- A. Vascular injury
- B. Median nerve injury
- C. Myositis ossificans
- D. Radial nerve injury (Correct Answer)
Explanation: ***Radial nerve injury*** - The **radial nerve** is rarely injured in an elbow dislocation due to its anatomical course, which is less exposed to the shearing forces involved in this type of injury. - While other nerves like the ulnar and median nerves are more susceptible, significant stretching or compression of the radial nerve is **uncommon** in typical elbow dislocations. *Vascular injury* - The **brachial artery** runs in close proximity to the elbow joint and can be torn or compressed during a dislocation, leading to **ischemia** if not promptly recognized and treated. - This complication can result in **Volkmann's ischemic contracture** if perfusion is not restored. *Median nerve injury* - The **median nerve** passes anterior to the elbow joint and is vulnerable to injury from stretching or direct compression during dislocation. - Injury can manifest as **sensory deficits** in the distribution of the median nerve and **weakness** of forearm pronation and thumb flexion/opposition. *Myositis ossificans* - This is a common chronic complication of elbow dislocations, particularly in cases of **delayed reduction** or aggressive physical therapy. - It involves the **abnormal ossification** of soft tissues around the joint, commonly in the brachialis muscle, leading to **pain and restricted range of motion**.
Question 3: Which of the following injuries can be classified as Gustilo-Anderson Grade III injuries?
- A. Open fracture with clean wounds less than 1 cm long
- B. Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions
- C. Compartment syndrome with an open fracture
- D. Open segmental fractures, open fractures with extensive soft tissue damage, or traumatic amputation. (Correct Answer)
Explanation: ***Open segmental fractures, open fractures with extensive soft tissue damage, or traumatic amputation.*** - Gustilo-Anderson **Grade III** injuries are characterized by **extensive soft tissue damage**, often with significant contamination and compromised vascularity. - This grade includes **segmental fractures**, traumatic amputations, or open fractures with **soil contamination** or a high-energy mechanism. *Open fracture with clean wounds less than 1 cm long* - This description corresponds to a **Gustilo-Anderson Grade I** injury, which involves a clean wound with minimal soft tissue damage. - The wound is typically less than 1 cm, and there is no significant muscle contusion or crushing. *Open fractures with a laceration more than 1 cm long usually up to 10 cms, without extensive soft tissue damage, flaps or avulsions* - This would be classified as a **Gustilo-Anderson Grade II** injury, characterized by a skin laceration greater than 1 cm but without significant soft tissue loss or extensive periosteal stripping. - The soft tissue damage is moderate, and the fracture pattern is usually simple. *Compartment syndrome with an open fracture* - While **compartment syndrome** is a serious complication often associated with high-energy open fractures, its presence alone does not define the Gustilo-Anderson classification grade. - The grading focuses on the extent of soft tissue injury, fracture pattern, and contamination at the time of injury, not secondary complications.
Question 4: Which nerve is damaged in anterior dislocation of shoulder:
- A. Median
- B. Axillary (Correct Answer)
- C. Musculocutaneous
- D. Radial
Explanation: **Axillary** - The **axillary nerve** wraps around the surgical neck of the humerus, which is vulnerable to injury during an **anterior shoulder dislocation**. - Damage to the axillary nerve can lead to **deltoid muscle weakness** (impaired shoulder abduction) and sensory loss over the **regimental badge area**. *Median* - The **median nerve** is typically not directly affected by an anterior shoulder dislocation. - It supplies most of the flexor muscles of the forearm and thenar eminence, and sensory innervation to the lateral palm and digits. *Musculocutaneous* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles, and provides sensory innervation to the lateral forearm. - It is less commonly injured in a shoulder dislocation compared to the axillary nerve. *Radial* - The **radial nerve** typically runs posterior to the humerus in the spiral groove and is more commonly injured in mid-shaft humeral fractures rather than shoulder dislocations. - Damage to the radial nerve manifests as **wrist drop** and sensory loss over the posterior forearm and hand.
Question 5: 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 6: 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
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.
Question 7: A sportsman presented to you after injury during practice exercise. You performed the test given in the image, and it came out as positive. What is the diagnosis?
- A. Anterior cruciate ligament tear (Correct Answer)
- B. Posterior cruciate ligament tear
- C. Medial meniscus tear
- D. Medial collateral ligament tear
Explanation: ***Anterior cruciate ligament tear*** - The image depicts the **Lachman test**, a highly sensitive and specific clinical test for **ACL integrity**. - A positive Lachman test, characterized by *increased anterior tibial translation* and a *soft or absent endpoint*, confirms an **ACL tear**. *Posterior cruciate ligament tear* - A PCL tear is identified by tests like the **posterior drawer test** or **posterior sag sign**, which show *posterior tibial translation*. - The test shown in the image specifically assesses **anterior stability**, not posterior. *Medial meniscus tear* - Medial meniscus tears are typically diagnosed with tests like **McMurray's test** or **Apley's grind test**, which involve *rotation* and *compression* of the knee. - While a crucial knee structure, the meniscus does not primarily contribute to **anterior-posterior stability** in the way the ACL does. *Medial collateral ligament tear* - An MCL tear is detected by applying a **valgus stress** to the knee at various degrees of flexion. - This tear presents with *medial joint line pain* and *instability to valgus stress*, which is not assessed by the depicted test.
Question 8: An athlete sustained an injury around the knee joint with suspected cartilage damage. Which of the following is the investigation of choice?
- A. X-ray
- B. Clinical examination
- C. Arthroscopy (Correct Answer)
- D. Arthrotomy
Explanation: **Explanation:** The investigation of choice for suspected intra-articular cartilage damage is **Arthroscopy**. It is considered the **"Gold Standard"** because it allows for direct visualization of the articular surfaces, menisci, and ligaments under magnification. Unlike imaging, it provides a dynamic assessment of the tissue's integrity and allows the surgeon to perform immediate therapeutic interventions (e.g., debridement or chondroplasty). **Analysis of Options:** * **X-ray (Option A):** X-rays are excellent for visualizing bony injuries or fractures but are poor at showing soft tissues like cartilage or menisci. They are usually the first-line screening tool but are not definitive for cartilage damage. * **Clinical Examination (Option B):** While essential for initial diagnosis (e.g., McMurray’s or Lachman tests), clinical exams are subjective and can be limited by pain, swelling, or muscle guarding in an acute athlete injury. * **Arthrotomy (Option D):** This involves a large surgical incision to open the joint. It is highly invasive and has been largely replaced by arthroscopy due to higher morbidity and longer recovery times. **Clinical Pearls for NEET-PG:** * **MRI vs. Arthroscopy:** While MRI is the investigation of choice for *non-invasive* screening of soft tissue injuries, **Arthroscopy** remains the overall "Gold Standard" for definitive diagnosis and treatment. * **Triad of O'Donoghue:** Often seen in athletes, involving injury to the ACL, MCL, and Medial Meniscus. * **Arthroscopy Media:** Normal saline or Ringer’s Lactate is used to distend the joint during the procedure. * **Common Portals:** The anterolateral portal is the most common primary portal used in knee arthroscopy.
Question 9: The joint cavity can be examined in detail with minimal surgical exposure by which procedure?
- A. Sialography
- B. Arthroscopy (Correct Answer)
- C. Biopsy
- D. Endoscopy
Explanation: **Explanation:** **Arthroscopy** is the correct answer because it is a minimally invasive surgical procedure used to visualize, diagnose, and treat problems inside a joint. It involves inserting a fiber-optic camera (arthroscope) through a small "portal" or stab incision. This allows for a detailed examination of the joint cavity (articular cartilage, ligaments, and synovium) with significantly less morbidity, faster recovery, and minimal surgical exposure compared to traditional open arthrotomy. **Analysis of Incorrect Options:** * **Sialography (A):** This is a radiographic examination of the salivary glands and ducts using a contrast medium. It is unrelated to joint pathology. * **Biopsy (C):** While a biopsy can be performed *during* an arthroscopy, the term refers to the removal of tissue for histological examination. It is a diagnostic technique, not a procedure designed for the comprehensive visualization of a joint cavity. * **Endoscopy (D):** This is a broad umbrella term for looking inside the body using an endoscope. While arthroscopy is technically a type of endoscopy, "Arthroscopy" is the specific and most appropriate clinical term for joint visualization. **High-Yield Clinical Pearls for NEET-PG:** * **Triangulation:** The fundamental skill in arthroscopy where the scope and the surgical instrument meet at a specific point within the joint to perform a task. * **Distension Media:** Normal saline or Ringer’s Lactate is used to expand the joint space for better visualization. * **Common Sites:** The **knee** is the most common joint examined via arthroscopy, followed by the shoulder and ankle. * **Complications:** Although rare, the most common complication of arthroscopy is **hemarthrosis** (bleeding into the joint).
Question 10: Triple deformity of the knee is present in which condition?
- A. Tuberculosis of the knee (Correct Answer)
- B. Pyogenic arthritis of the knee
- C. Osteoarthritis of the knee
- D. None of the above
Explanation: **Explanation:** The **Triple Deformity of the Knee** is a classic clinical feature of advanced **Tuberculosis (TB) of the knee joint**. It occurs due to the progressive destruction of the joint surfaces and the weakening of the cruciate and collateral ligaments, combined with the powerful pull of the hamstring muscles. The "Triple Deformity" consists of: 1. **Flexion:** Due to the spasm and contracture of the hamstrings. 2. **Posterior Subluxation of the Tibia:** The ACL and PCL are destroyed, allowing the tibia to slip backward on the femur. 3. **External Rotation of the Tibia:** The biceps femoris pulls the tibia laterally. **Why other options are incorrect:** * **Pyogenic Arthritis:** While it causes rapid joint destruction and flexion deformity due to pain, it typically presents as an acute emergency. It does not usually progress to the specific "triple" chronic malalignment seen in the indolent, long-standing course of TB. * **Osteoarthritis (OA):** OA typically presents with a **Varus (bow-leg)** deformity due to the collapse of the medial compartment. Posterior subluxation and significant external rotation are not characteristic features of OA. **Clinical Pearls for NEET-PG:** * **Stages of TB Knee:** Stage 1 (Synovitis), Stage 2 (Arthritis/Early destruction), Stage 3 (Erosion/Triple deformity), Stage 4 (Ankylosis - usually fibrous). * **Phemister’s Triad (Radiology):** Juxta-articular osteopenia, peripheral osseous erosions, and gradual narrowing of the joint space. * **Treatment:** TB of the knee is primarily managed with **AKT (Antitubercular Therapy)** and splinting. Surgery (Synovectomy or Arthrodesis) is reserved for specific indications.
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