During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
The Salter Harris classification is used for classifying which type of injuries?
In which condition is the Milwaukee Brace primarily used?
Vertebra Plana is associated with all of the following conditions except -
Lift off test is done to assess the function of:
The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -
In which condition is the Hamilton Ruler test sign positive?
Which of the following statements is true regarding a Monteggia fracture?
Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?
NEET-PG 2015 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 11: During performing a total hip replacement, the surgeon found destruction of the articular cartilage and multiple wedge-shaped subchondral depressions. What is this called?
- A. Osteolysis
- B. Osteomyelitis
- C. Osteonecrosis (Correct Answer)
- D. Osteogenesis
Explanation: ***Osteonecrosis*** - **Osteonecrosis**, also known as **avascular necrosis**, is characterized by the death of bone tissue due to a lack of blood supply, which leads to the collapse of the subchondral bone and articular cartilage destruction. - The description of **wedge-shaped subchondral depressions** and **articular cartilage destruction** is highly indicative of osteonecrosis, especially in the context of advanced hip joint pathology requiring total hip replacement. *Osteolysis* - **Osteolysis** refers to the active resorption of bone, often seen around implants in prosthetic joints due to wear particles, leading to bone loss. - While it involves bone destruction, it typically presents as diffuse bone loss rather than specific wedge-shaped subchondral depressions. *Osteomyelitis* - **Osteomyelitis** is an infection of the bone or bone marrow, often leading to bone destruction, but it is primarily characterized by inflammation and pus formation. - The presented scenario does not mention signs of infection (e.g., fever, pus, inflammation) but focuses purely on structural destruction consistent with vascular compromise. *Osteogenesis* - **Osteogenesis** is the process of bone formation or development. - This term describes the creation of bone tissue and is the opposite of bone destruction, making it an incorrect answer for a condition involving cartilage and bone deterioration.
Question 12: The Salter Harris classification is used for classifying which type of injuries?
- A. Soft tissue injuries in pediatric patients
- B. Long bone fractures without growth plate involvement
- C. Joint dislocations in pediatric orthopedics
- D. Fractures involving the physis in children (Correct Answer)
Explanation: ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.
Question 13: In which condition is the Milwaukee Brace primarily used?
- A. Spondylolisthesis
- B. Scheuermann's Disease
- C. Congenital Kyphosis
- D. Adolescent Idiopathic Scoliosis (Correct Answer)
Explanation: ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.
Question 14: Vertebra Plana is associated with all of the following conditions except -
- A. Leukemia
- B. Excessive use of systemic steroids
- C. Scheurmanns Disease (Correct Answer)
- D. Histiocytosis X
Explanation: ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.
Question 15: Lift off test is done to assess the function of:
- A. Supraspinatus muscle function
- B. Infraspinatus muscle function
- C. Subscapularis muscle function (Correct Answer)
- D. Teres Minor muscle function
Explanation: ***Subscapularis muscle function*** - The **Lift-off test**, or Gerber's Lift-off test, specifically assesses the integrity and strength of the **subscapularis muscle** by evaluating its internal rotation and extension strength. - A positive test occurs when the patient is unable to lift their hand off their back, indicating a **subscapularis tear or weakness**. *Supraspinatus muscle function* - The **supraspinatus muscle** is primarily tested with the **empty can test** or full can test, which assess its role in shoulder abduction. - These tests evaluate for **impingement** or **tears** of the supraspinatus tendon. *Infraspinatus muscle function* - The **infraspinatus muscle** is mainly responsible for external rotation and is assessed using tests like the **resisted external rotation test** with the arm at the side. - This test is used to detect **infraspinatus tears** or weakness. *Teres Minor muscle function* - The **teres minor muscle** also contributes to external rotation of the shoulder, often tested in conjunction with the infraspinatus. - Its function can be isolated by testing resisted **external rotation** in 90 degrees of abduction and external rotation.
Question 16: The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -
- A. Supracondylar Fracture of the humerus (Correct Answer)
- B. Monteggia Fracture dislocation
- C. Fracture of Proximal Radius
- D. Fracture lateral condyle of the humerus
Explanation: ***Supracondylar Fracture of the humerus*** - **Anterior humeral line** passes through the **anterior cortex of the humerus** and should intersect the middle third of the capitellum in a normal elbow. - In supracondylar fractures, particularly those with **posterior displacement**, this line is often displaced **anteriorly or posteriorly**, failing to intersect the capitellum correctly. Additionally, the **radiocapitellar alignment** refers to the relationship between the **radius head** and the **capitellum**. Fractures and displacements around the elbow joint, such as supracondylar fractures, can disrupt this alignment. *Fracture lateral condyle of the humerus* - While a fracture of the lateral condyle can affect the elbow joint, it primarily involves a part of the **articular surface** and not necessarily the overall alignment of the entire distal humerus relative to the capitellum in the same way a supracondylar fracture does. - The **lateral condyle** is a smaller segment, and its fracture may not significantly alter the anterior humeral line **unless there is significant displacement** that indirectly affects the alignment of the capitellum. *Monteggia Fracture dislocation* - A **Monteggia fracture** involves a fracture of the **ulna** with dislocation of the **radial head** at the elbow. - While radiocapitellar alignment is severely disrupted, the **anterior humeral line** itself, which assesses the distal humerus, is typically **unaffected** as the primary injury is in the forearm bones and the radial head. *Fracture of Proximal Radius* - A fracture of the proximal radius (e.g., **radial head or neck fracture**) primarily affects the **radial articular surface** and its alignment with the capitellum. - While **radiocapitellar alignment** would clearly be disturbed, the position of the **distal humerus** relative to the capitellum, which the anterior humeral line evaluates, usually remains intact.
Question 17: In which condition is the Hamilton Ruler test sign positive?
- A. Anterior dislocation of shoulder (Correct Answer)
- B. Posterior dislocation of shoulder
- C. Luxatio erecta
- D. Acromioclavicular joint dislocation
Explanation: ***Anterior dislocation of shoulder*** - The **Hamilton Ruler test** is positive when a straight edge, like a ruler, can be laid across the **lateral aspect of the deltoid prominence** from the acromion to the lateral epicondyle. - This is indicative of the **loss of the normal rounded contour of the shoulder**, which occurs due to the humeral head dislocating anteriorly. *Acromioclavicular joint dislocation* - This condition presents with a **"step-off" deformity** at the AC joint and pain directly over the joint, but the overall contour of the shoulder glenohumeral joint is preserved. - The deltoid prominence remains intact, making the Hamilton Ruler test negative. *Posterior dislocation of shoulder* - In posterior dislocation, the **humeral head moves posteriorly**, and the anterior contour of the shoulder might appear flattened, but the characteristic prominent anterior bulge seen in anterior dislocation is absent. - The Hamilton Ruler test specifically assesses for the loss of the lateral deltoid prominence, which is more typical of anterior displacement. *Luxatio erecta* - **Luxatio erecta** is an inferior dislocation of the shoulder where the arm is fixed in an **abducted and externally rotated position**, making it appear "erect". - While a severe type of shoulder dislocation, the specific anatomical changes that lead to a positive Hamilton Ruler test (loss of lateral deltoid prominence with the humeral head moving anteriorly and medially) are not typically present in this configuration.
Question 18: Which of the following statements is true regarding a Monteggia fracture?
- A. Upper ulnar fracture with dislocated radial head. (Correct Answer)
- B. Upper radial fracture with dislocated ulna.
- C. Lower radial fracture with dislocated ulna.
- D. Lower ulnar fracture with dislocated radius.
Explanation: ***Upper ulnar fracture with dislocated radial head.*** - A Monteggia fracture is classically defined as a fracture of the **proximal or middle third of the ulna** accompanied by an **anterior dislocation of the radial head**. - This injury pattern disrupts the alignment of the **forearm bones** and the **elbow joint**, requiring careful reduction and stabilization. *Upper radial fracture with dislocated ulna.* - This statement incorrectly identifies the fractured bone as the radius and the dislocated bone as the ulna. - The defining characteristic of a Monteggia fracture is the **ulnar fracture** and **radial head dislocation**. *Lower radial fracture with dislocated ulna.* - This describes a different type of injury, such as a **Galeazzi fracture**, which involves a **radial shaft fracture** with dislocation of the **distal radioulnar joint**. - It does not fit the criteria for a Monteggia fracture pattern. *Lower ulnar fracture with dislocated radius.* - This description is not consistent with a Monteggia fracture, which specifically involves the **proximal ulna** and **radial head dislocation**. - A lower ulnar fracture with distal radius dislocation is a distinct injury pattern.
Question 19: 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 20: Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?
- A. Basicervical fracture
- B. Trans cervical fracture
- C. Sub Capital fractures (Correct Answer)
- D. Intertrochanteric fractures
Explanation: ***Sub Capital fractures*** - These fractures occur at the anatomical **neck of the femur**, very close to the femoral head. - Due to their location, they disrupt the main blood supply to the femoral head, primarily from the **retinacular arteries**, leading to a high risk of **avascular necrosis**. *Trans cervical fracture* - This fracture occurs through the **midneck of the femur**, which is still within the intracapsular region. - While it has a significant risk of **ischemia**, the compromise is generally less severe than in subcapital fractures. *Intertrochanteric fractures* - These are **extracapsular fractures** occurring between the greater and lesser trochanters. - They tend to have an **excellent blood supply** and thus a low risk of avascular necrosis, but are associated with more significant blood loss and malunion issues. *Basicervical fracture* - This is an **intracapsular fracture** that occurs at the base of the femoral neck, near the junction with the trochanters. - Although intracapsular, its position is slightly more proximal than subcapital fractures, potentially leaving more of the **retinacular vessels** intact, resulting in a somewhat lower risk of avascular necrosis compared to subcapital fractures.