Lower Limb Fractures — MCQs

10 questions

A 32-year-old marathon runner presents with persistent pain over the dorsum of the foot on weight-bearing. The most probable diagnosis is:

Lauge - Hansen classification belongs to:-

All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

Which of the following patients with a fracture should be your first priority to call the orthopedic postgraduate and inform?

Which of the following does not cause deep venous thrombosis (DVT)?

All are predisposing factors of Deep Vein thrombosis, EXCEPT :

What percentage of total body surface area is affected in an adult with burns involving both lower limbs and genitalia?

Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

Q10

The best position to palpate the minimal enlargement of spleen is :

Lower Limb Fractures Indian Medical PG Practice Questions and MCQs

Question 1: A 32-year-old marathon runner presents with persistent pain over the dorsum of the foot on weight-bearing. The most probable diagnosis is:

A. Morton's Neuroma
B. Plantar fasciitis
C. March fracture (Correct Answer)
D. Anterior talofibular ligament sprain

Explanation: ***March fracture*** - This is a type of **stress fracture** in the metatarsal bones, common in athletes, particularly runners, due to **repetitive microtrauma** from weight-bearing activities. - The presented symptoms of persistent pain over the **dorsum of the foot** with weight-bearing are classic for a stress fracture in a marathon runner. *Morton's Neuroma* - Characterized by pain and numbness between the third and fourth toes due to **nerve compression**, often described as feeling like a pebble in the shoe. - Pain usually presents in the **forefoot** and is exacerbated by tight shoes, not typically generalized dorsum pain on weight-bearing. *Plantar fasciitis* - Causes heel pain, especially with the **first steps in the morning** or after periods of rest, due to inflammation of the plantar fascia. - The pain is primarily located at the **bottom of the heel**, not the dorsum of the foot. *Anterior talofibular ligament sprain* - Typically results from an **inversion ankle injury**, causing pain and swelling over the **lateral aspect of the ankle**. - This type of injury usually presents with acute pain after a specific event and localized tenderness, different from the diffuse dorsum pain described.

Question 2: Lauge - Hansen classification belongs to:-

A. Ankle fracture (Correct Answer)
B. Femur fracture
C. Shoulder fracture
D. Elbow fracture

Explanation: ***Ankle fracture*** - The **Lauge-Hansen classification system** is specifically used to categorize **ankle fractures** based on the position of the foot at the time of injury and the deforming force. - This system describes the mechanism of injury (e.g., supination-adduction, pronation-abduction) and the resulting fracture patterns of the **distal fibula, medial malleolus, and posterior malleolus**. *Femur fracture* - **Femur fractures** are typically classified by other systems, such as the **AO/OTA classification** for long bone fractures or specific patterns like **intertrochanteric** or **subtrochanteric fractures**. - The Lauge-Hansen system is **not applicable** to injuries of the femur. *Shoulder fracture* - **Shoulder fractures** (e.g., proximal humerus fractures) are commonly classified using systems like the **Neer classification**, which describes the number of displaced parts. - The Lauge-Hansen system is **not used** for classifying shoulder injuries. *Elbow fracture* - **Elbow fractures** involve the distal humerus, proximal ulna, or radial head and are classified by various systems depending on the specific bone involved (e.g., **Mason classification for radial head fractures**). - The Lauge-Hansen system is **irrelevant** to elbow an injuries.

Question 3: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:

A. Multiple trauma
B. Stable closed fracture (Correct Answer)
C. Compound fracture
D. Intra-articular fracture

Explanation: ***Stable closed fracture*** - A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing. - The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment. *Multiple trauma* - In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization. - This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients. *Compound fracture* - **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management. - ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing. *Intra-articular fracture* - **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function. - ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.

Question 4: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?

A. Anterior dislocation of hip
B. Central fracture dislocation
C. Posterior dislocation
D. Pipkin's type 4 fracture (Correct Answer)

Explanation: ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.

Question 5: Which of the following patients with a fracture should be your first priority to call the orthopedic postgraduate and inform?

A. Patient's finger is blackening (Correct Answer)
B. Patient can't extend his arm
C. A 10 cm abrasion
D. Intra articular fracture of Elbow Joint

Explanation: ***Patient's finger is blackening*** - **Blackening of a digit** indicates **tissue necrosis** due to severe vascular compromise, demanding immediate orthopedic intervention to prevent irreversible damage and potential amputation. - This symptom points to an **acute compartment syndrome** or a critical vascular injury, making it the highest priority. *Patient can't extend his arm* - Inability to extend the arm can signify **nerve injury** (e.g., radial nerve) or a **rotator cuff tear**, which, while serious, is generally not as immediately life-threatening as vascular compromise. - While requiring orthopedic attention, it typically allows for a slightly less urgent response compared to potential tissue death. *A 10 cm abrasion* - An **abrasion**, even if large (10 cm), is a **superficial skin injury** and does not directly indicate an orthopedic emergency. - It primarily requires wound care to prevent infection and is not a priority for immediate orthopedic consultation. *Intra articular fracture of Elbow Joint* - An **intra-articular fracture** of the elbow joint is a significant injury requiring orthopedic management to restore joint function and prevent future arthritis. - However, it is an **acute bony injury** not immediately threatening tissue viability or limb salvage in the same way as vascular compromise.

Question 6: Which of the following does not cause deep venous thrombosis (DVT)?

A. Lower limb trauma
B. Subungual hematoma (Correct Answer)
C. Hip & pelvic surgeries
D. Cushing's syndrome

Explanation: ***Subungual hematoma*** - A **subungual hematoma** is a collection of blood under the fingernail or toenail, usually caused by trauma. - It is a localized injury that **does not affect systemic coagulation** or venous blood flow, thus not increasing DVT risk. *Lower limb trauma* - **Trauma to the lower limb**, especially involving fractures or significant soft tissue damage, can lead to **venous stasis** due to immobility and direct vessel injury [1]. - This immobility and vessel damage activate the **coagulation cascade**, significantly increasing the risk of DVT [1]. *Cushing's syndrome* - **Cushing's syndrome** is characterized by **hypercortisolism**, which leads to a **hypercoagulable state**. - **Elevated cortisol levels** increase circulating procoagulant factors and decrease fibrinolytic activity, predisposing patients to DVT. *Hip & pelvic surgeries* - **Major surgeries**, particularly those involving the **hip and pelvis**, frequently cause **endothelial injury**, blood stasis, and activate the coagulation system [1]. - Patients undergoing these procedures are at a **very high risk for DVT** due to prolonged immobility and surgical trauma [1].

Question 7: All are predisposing factors of Deep Vein thrombosis, EXCEPT :

A. Lower limb trauma
B. Cushing's syndrome
C. Hip surgery
D. Subungual melanoma (Correct Answer)

Explanation: ***Subungual melanoma*** - This is a rare form of melanoma that develops under the nail, and while serious, it is **not a recognized predisposing factor for deep vein thrombosis (DVT)**. Its primary concerns are local invasion and metastasis. - Unlike conditions affecting blood clotting or endothelium, **subungual melanoma does not directly promote hypercoagulability, venous stasis, or endothelial damage** that contribute to DVT. *Lower limb trauma* - **Trauma to the lower limb** can cause **endothelial damage** to blood vessels and **venous stasis** due to immobility or swelling, both key components of **Virchow's triad** for DVT [1]. - **Fractures or severe soft tissue injuries** often necessitate immobilization and can lead to inflammation, further increasing the risk of clot formation [1]. *Cushing's syndrome* - **Cushing's syndrome** is associated with **hypercoagulability** due to increased levels of clotting factors, such as **factor VIII** and **fibrinogen**, and decreased fibrinolytic activity. - The **elevated cortisol levels** seen in Cushing's syndrome [2] can directly contribute to a prothrombotic state, significantly increasing DVT risk. *Hip surgery* - **Major orthopedic surgeries**, especially hip surgery [1], are well-known to cause significant **venous stasis** and **endothelial damage**. - **Post-operative immobility** and a generalized **inflammatory response** following surgery contribute to a high risk of DVT formation [1].

Question 8: What percentage of total body surface area is affected in an adult with burns involving both lower limbs and genitalia?

A. 18%
B. 19%
C. 36%
D. 37% (Correct Answer)

Explanation: ***37%*** - The **Rule of Nines** is used to estimate the percentage of **Total Body Surface Area (TBSA)** affected by burns in adults. - According to this rule, each lower limb accounts for **18%** of TBSA, and the genitalia/perineum accounts for **1%**. Therefore, both lower limbs (18% + 18%) + genitalia (1%) = **37%**. *18%* - This percentage represents only **one entire lower limb** or the entire anterior trunk in an adult according to the Rule of Nines. - It does not account for both lower limbs and the genitalia. *19%* - This would represent one lower limb (18%) plus the genitalia (1%), or an entire lower limb plus a small additional area. - It does not cover the **entirety of both lower limbs** and genitalia. *36%* - This percentage would typically refer to the **entire back** (18%) and the **entire chest/abdomen** (18%), or both lower limbs without the genitalia. - It specifically **excludes the 1% for the genitalia**, making it an underestimation for the scenario described.

Question 9: Contraindications for skin traction: a) Dermatitis b) Vascularly compromised status of limb c) Abrasions d) Hypopigmentation (vitiligo) e) Bony deformity

A. ab
B. abc (Correct Answer)
C. acd
D. bcd

Explanation: ***ab*** - All conditions listed under 'a' and 'b' (Dermatitis, Vascularly compromised status of limb, Abrasions) are **absolute contraindications** for skin traction as they directly compromise skin integrity or circulation. - Applying skin traction in these situations can lead to **skin breakdown**, infection, or further **ischemic damage**, worsening the patient's condition. *ab* - While **dermatitis**, **vascular compromise**, and **abrasions** are indeed contraindications, the option for 'abc' implies there might be other correct choices included, which is not the case for this option. - This option is incomplete as it misses 'c' (Abrasions) which is also a significant contraindication. *acd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication, which does not inherently prevent skin traction. - It also omits **vascularly compromised status of limb**, a critical contraindication, while including 'a', 'c', and 'd'. *bcd* - This option incorrectly includes **hypopigmentation (vitiligo)** as a contraindication for skin traction. - It also omits **dermatitis**, a key contraindication, while including 'b', 'c', and 'd'.

Question 10: The best position to palpate the minimal enlargement of spleen is :

A. Bimanual palpation in supine position
B. Palpation of left subcostal area in right lateral decubitus position
C. Supine with lower limbs extended (Correct Answer)
D. Palpation of left subcostal area in knee-elbow position

Explanation: ***Supine with lower limbs extended*** - This position allows for optimal relaxation of the abdominal muscles, making it easier to **palpate the spleen** as it descends during inspiration. - In a supine position, the examiner can effectively use techniques like the **hooking method** or palpation from the right side of the patient to detect minimal splenic enlargement. *Bimanual palpation in supine position* - While bimanual palpation is useful for organs like the kidneys, it is generally less effective for detecting minimal splenic enlargement compared to other specialized techniques. - The goal is to feel the spleen as it descends, which is better achieved with precise contact during inspiration rather than a bimanual 'capture'. *Palpation of left subcostal area in right lateral decubitus position* - The **right lateral decubitus position** (Lieper's or Opeczky's position) is indeed used to make a slightly enlarged spleen more prominent by shifting it anteriorly and inferiorly. - However, while helpful for a potentially palpable spleen, the combined supine position with relaxed abdominal muscles can be overall more sensitive for **minimal enlargement** when initially assessing. *Palpation of left subcostal area in knee-elbow position* - The knee-elbow position is primarily used for rectal or vaginal examinations and is not suitable for abdominal palpation, especially for organs like the spleen. - It would make abdominal muscle contraction more likely, hindering effective palpation of the left subcostal area.

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