Fracture Healing Process — MCQs
Nonunion is most common in fracture of the:
The operative procedure known as "microfracture" is done for the
Which of the following statements about wound healing is false?
Which of the following bone defects offers the best chance for bone fill?
All of the following produce osteoblastic secondaries except:
The X-ray shows plating done for a fracture. How does this fracture heal?
Tension band wiring is indicated in fracture of which of the following ?
Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:
Rupture of extensor pollicis longus occurs four weeks after:
Position of wrist in cast of colle's fracture is:
Fracture Healing Process Indian Medical PG Practice Questions and MCQs
Question 1: Nonunion is most common in fracture of the:
- A. Talus
- B. Neck femur (Correct Answer)
- C. Scapula
- D. None of the options
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.
Question 2: The operative procedure known as "microfracture" is done for the
- A. Delayed union of femur
- B. Osteochondral defect of femur (Correct Answer)
- C. Non union of tibia
- D. Loose bodies of ankle joint
Explanation: ***Osteochondral defect of femur*** - **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**. - It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue. *Delayed union of femur* - **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery. - Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture. *Non union of tibia* - **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**. - This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses. *Loose bodies of ankle joint* - **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage. - This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.
Question 3: Which of the following statements about wound healing is false?
- A. Inhibited by diabetes mellitus (DM)
- B. Inhibited by foreign body
- C. Hematomas promote wound healing (Correct Answer)
- D. Inhibited by infection
Explanation: ***Hematomas promotes wound healing*** - Hematomas (localized collections of **blood outside blood vessels**) actually **inhibit wound healing** by acting as a medium for bacterial growth and increasing tissue tension. - This statement is **false** because hematomas interfere with proper tissue apposition and oxygen delivery, which are crucial for successful wound repair [3]. *Inhibited by diabetes mellitus (DM)* - **Diabetes mellitus** impairs various stages of wound healing due to **poor glycemic control**, leading to compromised immune function, neuropathy, and reduced blood flow [1]. - This often results in **delayed wound closure** and increased risk of infection [2]. *Inhibited by foreign body* - The presence of a **foreign body** in a wound can lead to a persistent inflammatory response, impeding tissue repair and increasing the likelihood of chronic infection. - This sustained inflammation prevents the orderly progression through the phases of wound healing, thus **inhibiting the process**. *Inhibited by infection* - **Infection** in a wound significantly delays healing by causing ongoing inflammation, tissue destruction, and increased metabolic demands [1]. - Bacteria compete for nutrients and produce toxins that harm host cells, preventing proper **granulation tissue formation** and **epithelialization**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 116-117. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 110-111. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 106-107.
Question 4: Which of the following bone defects offers the best chance for bone fill?
- A. 3 Walled defect (Correct Answer)
- B. Hemisepta
- C. Osseous crater
- D. 2 Walled defect
Explanation: ***3 Walled defect*** - A **3-walled defect** provides the best prognosis for bone fill because it retains the most natural bone structure, enhancing the ability to contain bone graft material effectively. - The presence of three bony walls offers **excellent support and blood supply** for graft survival and successful bone regeneration. *Hemisepta* - A **hemisepta** refers to a one-walled defect, which offers very limited containment for graft materials. - It has a **poor prognosis** for bone fill due to insufficient support and rapid loss of grafting material. *Osseous crater* - An **osseous crater** is a two-walled defect where the buccal and lingual walls are present, but the interproximal walls are missing. - While better than a one-walled defect, it still presents challenges in graft containment and has a **less predictable outcome** compared to a 3-walled defect. *2 Walled defect* - A **2-walled defect** offers less containment and support for bone graft materials compared to a 3-walled defect. - The reduced number of walls means there is a **higher chance of graft material displacement** and a slower healing process.
Question 5: All of the following produce osteoblastic secondaries except:
- A. Carcinoma of Prostate
- B. Carcinoma of Breast
- C. Carcinoid tumors
- D. Multiple myeloma (Correct Answer)
Explanation: ***Multiple myeloma*** - Multiple myeloma is a **plasma cell malignancy** that typically causes **osteolytic (bone-destroying) lesions** due to the activation of osteoclasts and inhibition of osteoblasts, rather than osteoblastic (bone-forming) metastases [1]. - The bone lesions are often described as **punched-out lesions** on imaging [1]. *Carcinoma of Prostate* - **Prostate cancer** is well-known for producing **osteoblastic (sclerotic)** bone metastases, characterized by new bone formation [2]. - This is mediated by factors secreted by prostate cancer cells that stimulate osteoblasts [2]. *Carcinoma of Breast* - **Breast cancer** metastases to bone can be **mixed osteoblastic and osteolytic**, but frequently present with an osteoblastic component, especially in advanced stages. - The type of bone lesion can be influenced by various signaling pathways between cancer cells and bone cells. *Carcinoid tumors* - **Carcinoid tumors**, particularly those of gastrointestinal origin, can cause **osteoblastic bone metastases**, sometimes presenting as sclerotic lesions. - While less common than prostate or breast cancer, they are recognized for their potential to induce bone formation. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 501-502.
Question 6: The X-ray shows plating done for a fracture. How does this fracture heal?
- A. Primary healing (Correct Answer)
- B. Secondary healing
- C. Tertiary healing
- D. Distraction histiogenesis
Explanation: **Primary healing** - **Plating of a fracture** aims to achieve **absolute stability** at the fracture site, which facilitates primary bone healing. - In primary healing, there is **direct bone formation** across the fracture gap without the formation of a significant callus. *Secondary healing* - Secondary healing involves the formation of a **callus** (fibrous tissue, cartilage, and immature bone) to bridge the fracture gap. - This type of healing occurs in situations with **relative stability** and some micromotion at the fracture site, such as with casting or intramedullary nailing. *Tertiary healing* - **Tertiary healing** is not a recognized term in the context of fracture healing. - Bone healing typically involves either primary or secondary mechanisms depending on the stability achieved. *Distraction histiogenesis* - **Distraction histiogenesis** is the process by which new bone is formed between bone surfaces that are gradually pulled apart using an external fixator (**distraction osteogenesis**). - This is used in procedures like **limb lengthening** and is distinct from the direct healing of a fracture fixed with a plate.
Question 7: Tension band wiring is indicated in fracture of which of the following ?
- A. Fracture spine
- B. Fracture humerus
- C. Fracture tibia
- D. Olecranon (Correct Answer)
Explanation: ***Olecranon fracture*** - **Tension band wiring** is a widely used and effective technique for fixing olecranon fractures, converting tensile forces into compressive forces at the fracture site. - This method is suitable because the olecranon is subjected to significant **distracting forces** from the triceps muscle, and the tension band neutralizes these forces. *Fracture spine* - Spinal fractures generally require **fusion, laminectomy**, or other stabilization techniques depending on the fracture type and stability, not tension band wiring. - The biomechanics and forces acting on the spine are different, making tension band wiring inapplicable. *Fracture humerus* - Humerus fractures, depending on their location (proximal, shaft, distal), are typically managed with **plates and screws**, intramedullary nails, or external fixation. - Tension band wiring is not a primary method for most humeral fractures. *Fracture tibia* - Tibial fractures are commonly treated with **intramedullary nailing**, plates and screws, or external fixation, depending on the fracture pattern and soft tissue involvement. - Tension band wiring is not indicated for the long bone shaft fractures like tibia.
Question 8: Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:
- A. Fracture with metaphyseal comminution (Correct Answer)
- B. Segmental fracture
- C. Spiral fracture
- D. Oblique fracture
Explanation: ***Fracture with metaphyseal comminution*** - The **MIPPO technique** is particularly useful for achieving stability in fractures with **metaphyseal comminution** by bridging the comminuted zone with a plate applied percutaneously. - This approach minimizes soft tissue dissection, preserving **periosteal blood supply**, which is crucial for healing in these complex fractures. *Segmental fracture* - While MIPPO can be used, **segmental fractures** often require more direct reduction and stabilization of both fracture segments, which might be challenging with a purely percutaneous approach alone. - The primary concern in segmental fractures is often maintaining length and alignment across two distinct fracture lines. *Spiral fracture* - **Spiral fractures** are typically inherently stable after reduction and are often amenable to intramedullary nailing or less invasive plate fixation, as the fracture pattern allows for good interfragmentary compression. - The main advantage of MIPPO (minimizing soft tissue stripping around comminution) is less critical in these stable, non-comminuted patterns. *Oblique fracture* - Similar to spiral fractures, **oblique fractures** are often amenable to primary screw fixation or conventional plating techniques due to their stable nature after reduction and good contact between fracture fragments. - The specific advantages of MIPPO for comminuted fractures are less relevant for simple oblique patterns.
Question 9: Rupture of extensor pollicis longus occurs four weeks after:
- A. Smith's fracture
- B. Scaphoid fracture
- C. Colles' fracture (Correct Answer)
- D. Radial styloid fracture
Explanation: **Colles' fracture** - **Extensor pollicis longus (EPL)** rupture is a known complication of Colles' fracture, often occurring several weeks after the injury. - The tendon can be damaged due to **attrition over a bony spicule** from the distal radius fracture or due to **ischemia** in its compartment. *Smith's fracture* - A Smith's fracture involves **volar displacement** of the distal radius fragment, while EPL rupture is more commonly associated with dorsal displacement. - While complications can occur, EPL rupture is less characteristic of Smith's fracture compared to Colles' fracture. *Scaphoid fracture* - A scaphoid fracture primarily affects the **carpal bone** and can lead to complications like **non-union** or **avascular necrosis**. - Rupture of the EPL tendon is not a typical direct complication of a scaphoid fracture. *Radial styloid fracture* - A radial styloid fracture involves only the **lateral aspect of the distal radius**. - Although it's a wrist fracture, it is less commonly associated with EPL rupture than a complete Colles' fracture which involves a more extensive injury to the distal radius.
Question 10: Position of wrist in cast of colle's fracture is:
- A. Dorsal deviation & supination
- B. Palmar deviation & supination (Correct Answer)
- C. Dorsal deviation & pronation
- D. Palmar deviation & pronation
Explanation: ***Palmar deviation & supination*** - This position helps to **reduce the fracture** by counteracting the typical **dorsal displacement** and pronation forces seen in a Colles' fracture. - Maintaining **palmar flexion** (deviation) and **supination** positions the distal fragment correctly and prevents redisplacement during healing. *Dorsal deviation & supination* - **Dorsal deviation** would worsen the typical deformity of a Colles' fracture, which already involves dorsal displacement of the distal fragment. - While supination is generally desired, combined with dorsal deviation, it would not provide adequate reduction or stability. *Dorsal deviation & pronation* - This position would exacerbate both the **dorsal displacement** and **pronation deformity** commonly associated with a Colles' fracture. - Such a position would hinder fracture healing and likely lead to malunion. *Palmar deviation & pronation* - While **palmar deviation** (flexion) helps to reduce the dorsal displacement, **pronation** would counteract the desired supination, which is crucial for rotating the distal fragment back into its anatomical position. - Pronation could lead to malrotation of the distal radius.
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