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MULTIPLE CHOICE QUESTIONS IN ORTHOPAEDICS AND TRAUMA
1. Which is the strongest lig!ent"
A Ilio#$e!orl lig!ent
% Ischio#$e!orl lig!ent
& P'(o#$e!orl lig!entD Trns)erse cet('lr lig!ent
E Lig!ent'! teres.
A Ilio-femoral ligament blends with anterior part of hip joint capsule
and is the strongest ligament at hip joint.
*. Which +rt o$ ,'-rice+s !'scle is !ost $re,'entl $i(rose- in +ost
in/ection ,'-rice+s contrct're"
A Rect's $e!oris% 0st's !e-ilis
& 0st's inter!e-i's
D 0st's lterlis
E All o$ (o)e.
D Vastus lateralis is most frequently affected probably because
injections are usually given in this area of thigh.
. R-ion'clei-e (one scnning is !ost 'se$'l in"
A A)sc'lr necrosis
% Mlignnc
& Rhe'!toi- rthritis
D Stress $rct'res
E Ac'te osteo!elitis.
adionucleide bone scanning is most useful in defining e!tent of
primary tumour" locating unsuspected metastasis and primary malignant
tumour. In all other conditions mentioned its use is more of academic interest
2. Co!!onest c'se o$ $il're o$ rthrogr+h is"
A E3tr#rtic'lr in/ection o$ contrst
% 4'((ling o$ ir in the /oint
& 5lse +ositi)e inter+rettion
D 5lse negti)e inter+rettion
E Allergic rection.
A #!tra-articular injection of contrast medium is the commonest
cause of failure of arthrography especially in smaller and deep situated joints.Allergic reaction to contrast medium is rare but when it happens e!amination
will have to be discontinued. $ther factors also ma%e this procedure futile.
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6. Melogr+h is necessr in $ollo7ing con-itions"
A S's+icion o$ n intrs+inl t'!o'r
% Con$licting clinicl $in-ings n- C.T. scn
& E)l'tion o$ +re)io'sl o+erte- s+ine
D All o$ (o)eE So!e o$ (o)e.
D Due to its complications and since it is an invasive technique"
myelography has been replaced by &' scan. (ow a days primary indications
of myelography are as mentioned in the question.
8. Arthrosco+e 7s in)ente- n- $irst 'se- ("
A T9gi
% Wtn(e& Dn-
D :c9son
E Ptel.
A )irst prototype of arthroscope was made and used by 'a%agi in *+*,.
odern day arthroscope was made by 'a%agi and atanabe. Dandy" /ac%son
and 0atcl are some of the leaders of arthroscopic surgery nowadays.
;. Wht is the g'i-eline to -elto+ectorl groo)e"
A A3illr )ein
% Ce+hlic )ein
& M'sc'lo#c'tneo's ner)e
D Me-in ner)e
E None o$ (o)e.
&ephalic vein lies in deitopedoral groove and serves as landmar% in
identification of plane between deltoid and pectaralis major during anterior
e!posure of shoulder.
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brea%age is not the problem with newer modern day instruments. $ther
complications mentioned can occur but are uncommon.
>. Which o$ the $ollo7ing is !ost serio's co!+liction o$ !elo#gr+h"
A Allergic rection
% He-che
& Trnsient ne'rologicl -e$icit
D Archnoi-itis
E Nec9 sti$$ness.
If performed in proper aseptic manner" fever is not the usual
complication while all others are the dangers of myelography. 'hesecomplications are fairly common with nonabsorbable" oily contrast mediums
rather than with newer water soluble contrast medium.
1?. Wht re contrin-ictions o$ rthrosco+"
A Prtil or co!+lete n9losis o$ /oint
% Ris9 o$ intro-'cing se+sis $ro! ner( s9in lesion
& M/or collterl lig!ento's n- c+s'lr -isr'+tions
D All o$ (o)e
E So!e o$ (o)e.
D Introduction of infection can create disaster. In an an%ylosed joint
instrument can not be manouvered. ajor collateral ligamentous and
capsular disruptions allow irrigating solution to e!travasate and ma%e
e!amination difficult or impossible.
11. Co!!onest c'se o$ ,'-rice+s contrct're is"A Congenitl
% Ische!ic !ositis
& 5ollo7ing $e!orl sh$t $rct're
D 5ollo7ing o+ertions on thigh
E Post in/ection $i(rosis.
# 0ost injection fibrosis usually occurs after repeated intramuscular
injections or saline infusions in an infant. 'his is the commonest cause in
India and other causes are less common.
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1*. Wht is the erliest in-iction o$ 0ol9!nn@s ische!i"
A Pin
% Pllor n- +oor c+illr $illing
& Presthesi in !e-in ner)e re
D Contrct're o$ $ingers
E ngrene o$ ti+s o$ $ingers.
A #arliest sign of vascular compromise is persistent pain which is
e!acerbated on passive e!tension of fingers. Action must be ta%en at this stage.
0allor" poor capillary filling" absent radial pulse and paraesthesia in median
nerve area are also early signs but may not be present in every case and one
should not wait for these signs. &ontracture and gangrne is a very late
phenomenon.
1. Which o$ the $ollo7ing is incorrect (o't -isloction o$ sternocl)ic'lr /oint"
A Anterior -isloction occ'rs -'e to in-irect in/'r n- is co!!on
t+e o$ -isloction
% Posterior -isloction is rre n- occ'rs -'e to -irect in/'r o)er
!e-il en- o$ cl)icle
& Sternocl)ic'lr -isloction is co!!on co!+re- to
cro!iocl)ic'lr -isloction
D Trche cn (e co!+resse- in +osterior -isloction
E Mni+'lti)e re-'ction is o$ten 'nst(le n- $i3tion 7ith 7ire
! (e re,'ire-.
1 Dislocation of sternoclavicular joint is much less frequent than
acromioclavicular joint dislocation. All other statements are true and briefly
describe the salient features of sterooclavicular
joint dislocation.
12. Which o$ the $ollo7ing is the erliest l(ortor $in-ing in
cse o$ $t e!(olis!"
A Increse- ser'! cholestrol% Increse- ser'! li+se
& Increse- ser'! $tt ci-s
D Li+'ri
E Increse- l9line +hos+htse.
D 0resence of fat dropiet in urine is the earliest laboratory finding in fat
embolism. 2ut it most be remembered that the diagnosis is mainly clinical and
one should not wait for any inves before instituting treatment.
16. 5irst tret!ent +riorit in +tient 7ith !'lti+le in/'ries is"
A Air7 !intennce
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% 4lee-ing control
& Circ'ltor )ol'!e restortion
D S+linting o$ $rct'res
E Re-'ction o$ -isloction.
3 3..1. 4Airway" bleeding and circulation5 are the priorities inmanagement of seriously injured patient in that order.
18. Which o$ the $ollo7ing $rct're -oes not 's'll nee- o+en
re-'ction n- internl $i3tion"
A Mi- sh$t $rct're o$ $e!'r
% Pthologicl $rct'res
& Trochnteric $rct're in el-erlD Dis+lce- intr#rtic'lr $rct'res
E Dis+lce- $rct're o$ (oth (ones o$ $orer! in -'lts.
A $ut of the fractures mentioned" femoral shaft fracture is least li%ely to
need operative treatment. In this fracture operation is done to get patient out
of traction early. All other fractures mentioned will almost always need open
reduction and internal fi!ation.
1;. Co!!onest c'se o$ $il're o$ internl $i3tion is"
A In$ection
% Corrosion
& Metl rection
D I!!'ne -e$icient +tient
E Stress $rct're o$ i!+lnt.
A ost common and seriot advantage of open reduction and mfpmal
fi!ation is infection which will ultimately lead to implant becoming loose andnon-union. Immune deficient patient does not behave differently as regards
fracture healing. &orrosion" metal reaction and stress fracture cf implant are
rare.
1
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E In$ection.
1 ithin first few hours after severe injuries death may occur due to
hypovolaemia from haemorrhage and within 6 days from fat embolism.
0ulmonary embolism usually occurs at about 6 wee%s from injury.
espiratory distress is a part of fat embolismsindrome.
1>. Internl $i3tion o$ $rct're is contrin-icte- in 7hich sit'tion"
A Acti)e in$ection
% When (one g+ is +resent
& In e+i+hsel in/'ries
D In co!+o'n- $rct're
E In +thologicl $rct'rB.
A Active infection is the only definite contiaind%a on of internal fi!ation7
and in this situation 89 e!ternal :;8ation is the
treatment of choice. In pathological fractures and in presence of bone gap
internal fi!ation is qmie oftea mandatory. &ompound fracture is a relative
contimnrlicarion.
*?. Most o$ten o+en re-'ction o$ $rct're is re,'ire- in"
A Close- $rct're 7ith ner)e in/'r
% Co!+o'n- $rct're
& 5rct're in chil-ren
D Unstis$ctor close- re-'ction
E Non 'nion.
D ?nsatisfactory closed reduction is the commonest reason for performing
open reduction. (e!t commonest reason for this is non-union. )ractures in
children rarely require open reduction. &ompound fractures and fractures
associated with nerve injury are also uncommon reasons.
*1. In $e7 -s ol- $rct're 7hich o$ the $ollo7ing -oes not occ'r"
A C+illr +roli$ertion
% Proli$ertion o$ osteogenic cells o)er en-oste'! n- (one en-s
& Locl +H is ci-
D Locl +H is l9line
E There is )er little rise in le)el o$ l9line +hos+htse t $rct're site.
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D ?pto a wee% after fracture local p@ remains acidic and only after
this period p@ becomes al%aline and level of al%aline phosphatase mar%edly
rises. All other statements are true.
**. 5rct're -isese cn (e +re)ente- ("A Plster i!!o(ilition o$ $rct're
% Cst (rce tret!ent o$ $rct're
& Internl $i3tion o$ $rct're
D E3ternl $i3tion o$ $rct're
E Phsiother+
# )racture disease in some measure always occurs and none of the
methods of treatment of fracture can prevent it. It can only be minimised by
regular physiotherapy to reduce oedema" improve muscle tone and maintainfunctional movements in joints which have not been immobili>ed.
*. Which o$ the $ollo7ing is co!!onest !teril 'se- to !9e
ortho+e-ic i!+lnt"
A Titni'!
% Stinless steel
& Polethlene UHMWPE
D Methl#!ethcrlte
E Cr(on.
ost implants are made of stainless steel as it is comparatively cheap
and can be easily cast into desired shape. 'itanium is e!pensive and difficult
to fashion into desired shape. &arbon and polyethylene implants are used only
for some specific uses and methylmethacrylate is not made up into an implant
as such.
*2. 4one gr$t 7or9s ( +ro)i-ing $ollo7ing !echnis!s. Which o$
these is !ost i!+ortnt.
A 4one in-'ction $ctor% Osteogenic cells
& Li)ing osteo(lsts
D Minerl sc$$ol- $or )sc'lr +roli$ertion
E 4ri-ging the (one g+.
D 0rovision of mineral scaffold into which newly forming vascular
channels can grow is the most useful function of bone graft and that is why
ban% bone" heterogenous bone and homografts succeed. 2one inducing factor"
osteogenic cells and living osteoblasts are supplied only by fresh autogenousgrafts.
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*6. Co!!onest co!+liction 7hile 'sing e3ternl $i3tor is"
A Pin trct in$ection
% Co!+rt!ent sn-ro!e
& Loosening o$ +ins
D 5i3tion o$ !'scles
E :oint sti$$ness.
A 0in tract infection is by far the commonest problem. In addition to
complications mentioned" neurovascular damage can occur while inserting the
pins and refracture can occur after removal of fi!ator.
*8. A +tient 7ho hs s'stine- o+en 7o'n- on leg is (lee-ing
+ro$'sel. 4e$ore +tient rri)es in hos+itl the s$est
!etho- to sto+ (lee-ing is"A Ele)tion o$ leg
% Locl +ress're on 7o'n- n- ele)tion o$ leg
& Ligtion o$ (lee-ing )essel
D Use o$ to'rni,'et
E Press're o)er $e!orl rter in groin.
% Locl +ress're on 7o'n- n- ele)tion o$ leg is the s$est n- !ost e$$ecti)e !etho- to
sto+ (lee-ing. To'rni,'et cn (e -ngero's i$ not +ro+erl 'se-. Ele)tion lone n- locl
+ress're on $e!orl rter is ine$$ecti)e.
*;. Which o$ the $ollo7ing is n (sol'te contrin-iction o$
o+en re-'ction"
A Acti)e in$ection
% S!ll sie- $rg!ent
& 0er so$t (one
D enerl !e-icl co!+lictions
E Se)ere scrring o$ -/cent so$t tiss'es.
A Acti)e in$ection is contrin-iction $or o+en re-'ction s this ! le- to $'rther
co!+lictions n- e)en !ore -i$$ic'lt in sl)ge. In other con-itions !entione- o+en re-'ction
cn +ro-'ce +ro(le! n- sho'l- not (e lightl 'n-ert9en.
*
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D Dr cooling 7ith ice is the (est 7 to +reser)e !+'tte- +rt s this c'ses lest
ltertion o$ tiss'e str'ct'res.
*>. Which o$ the $ollo7ing $rct're is slo7est to hel n- o$ten -e)elo+s
non#'nion"
A Intrc+s'lr $e!orl nec9 $rct're% Sc+hoi-
& Lo7er thir- o$ ti(i
D Pro3i!l h'!er's
E Distl $e!'r.
A Intrc+s'lr $e!orl nec9 $rct'res re slo7est to hel n- -e)elo+ non#'nion in higher
+ercentge o$ cses co!+re- to sc+hoi- n- -istl ti(il $rct'resF (oth o$ 7hich lso ten- to
hel slo7l -'e to -e$icient (loo- s'++l o$ one $rg!ent. Pro3i!l h'!er's n- -istl $e!orl
$rct'res -o not 's'll go to -ele- 'nion.
?. Co!!onest c'se o$ $il're o$ internl $i3tion o$ $rct're is"
A In$ection
% 5tig'e $rct're o$ i!+lnt
& Corrosion in i!+lnt
D Loosening o$ i!+lnt
E Metl rection.
A Infection following an open operation is the commonest cause of failure
following internal fi!ation. All other factors can also lead to complications but.
statistically they are not as important
1. Che!icll Plster o$ Pris is"
A Clci'! cr(onte
% Clci'! +hos+hte
& Clci'! s'l+hte
D Anh-ro's clci'! s'l+hteE He!ih-rte- clci'! s'l+hte.
E Po7-er o$ +lster o$ +ns che!icll is he!ih-rte- clci'! s'l+hte.
*. Which o$ the $ollo7ing is not seen in cse o$ $t e!(olis!"
A 5t glo('les in 'rine
% Le$t hert strin on EC
& Sno7 stor! ++ernce on chest G#R
D Nor!l cr(on -io3i-e tension in rteril (loo-
E Lo7 o3gen tension in rteril (loo-.
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#& will show right heart strain and not the left heart strain.
. Close- re-'ction 7ith +erc'tneo's #7ire $i3tion is (est
s'it(le $or"
A 4ennett $rct're% Lterl !lleol's $rct're
& Me-il !lleol's $rct're
D Lterl ti(il con-le $rct're
E Cl)icle $rct're.
D alunited fractures are the commonest cause of deformity in long bones
since the incidence of fracture is much higher than congenital" developmental"
metabolic" infective and neoplastic conditions.
2. In heling $rct're !o'nt o$ crtilge $or!tion
increse- ("
A Rigi- i!!o(ilition
% Mo)e!ent t $rct're site
& Necrosis o$ (one en-s
D Co!+ression +lting
E In$ection.
ore the movement at fracture site" more will be cartilage formation and
non union can occur. &ompression plating helps in conversion of cartilage into
bone and thereby fracture healing can occur in a delayed or non-union.
Infection retards all the stages of fracture repair.
6. Most s'ccess$'l !etho- o$ tret!ent o$ non#'nion is"
A Co!+ression +lting
% Co!+ression ( e3ternl $i3tor
& A--ition o$ 4.M.P.
D 4one gr$ting
E Electricl sti!'ltion
D 2one grafting is most successful and useful method of treating
non-union. 2..0.42one morphogenetic protein5 has not been isolated as yet
$ther three methods are suitable in certain specific situations only.
8. Which o$ the $ollo7ing !'scle -oes not $or! rottor c'$$ o$
sho'l-er"
A S'(sc+'lris
% S'+rs+int's& In$rs+int's
D Teres !inor
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E Teres !/or.
# #!cept teres major all other muscles mentioned are closely
applied to the capsule of shoulder joint and form rotator cuff.
;. Wht is the co!!onest co!+liction o$ $rct're o$ !i- sh$to$ h'!er's"
A Ml'nion
% Non 'nion
& R-il ner)e +rlsis
D 4rchil rter in/'r
E Ulnr ner)e in/'r.
A ost of humeral shaft fractures are treated conservatively and
malunion 4usually neither cosmetically disfiguring nor functionally impairing5is the commonest complication. If fracture has been treated by internal
fi!ation this will become rare complication. (e!t commonest complication is
radial nerve injury in spiral groove where nerve is in direct contact with bone.
(on union is uncommon and brachial artery injury is rare.
. Most co!!onl $rct're- (one is"
A H!te
% Tri,'etr'!
& L'nte
D C+itte
E Sc+hoi-.
# Bcaphoid is most commonly injured carpal bone. Cunate is second most
commonly injured carpal bone although it does not fracture but is involved indislocation of lunate and perilunar dislocation of carpus.
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2?. Wht is the !ost serio's co!+liction o$ internl $i3tion o$
$rct're o$ (oth (ones o$ $orer!"
A In$ection
% Cross 'nion
& Li!ittion o$ $orer! rottion
D Re$rct'reE Non 'nion.
A De)elo+!ent o$ in$ection $ollo7ing o+en re-'ction o$ $rct're is the !ost serio's
co!+liction. All other co!+lictions !entione- cn lso occ'r $ollo7ing o+en re-'ction n-
internl $i3tion.
21. Which o$ the $ollo7ing ('rs +ro-'ces s!+to!s in sho'l-er
i!+inge!ent sn-ro!e"
A S'(cro!il ('rs% S'(-eltoi- ('rs
& 4'rs in reltion o$ s'(sc+'lris ten-on
D 4'rs in reltion to ltissi!'s -orsi
E 4'rs (et7een corcoi- +rocess n- c+s'le.
A Bymptoms of impingement syndrome are produced when subacromial
bursa is pressed between humeral head and undersurface of coraco-acromial
arch.
2*. Wht is the co!!onest co!+liction o$ s'+rcon-l
$rct're o$ h'!er's"
A Ml'nion
% Mositis ossi$icns
& Sti$$ness o$ el(o7
D 0ol9!nn@s contrct're
E Non 'nion.
A al union" especially rotational malalignment7 is the commonest
complication and results in the deformity of cubitus varus. (on union is very
rare and all other complications are not common" ost serious complication is
Vol%manns iscnaemia.
2. Wht is the erliest in-iction o$ 0ol9!nn@s ische!i"
A Pin
% Pllor n- +oor c+illr $illing
& Presthesi in !e-in ner)e re
D Contrct're o$ $ingers
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E ngrene o$ ti+s o$ $ingers.
A #arliest sign of vascular compromise is persistent pain which is
e!acerbated on passive e!tension of fingers. Action must be ta%en at this stage.
0allor" poor capillary filling" absent radial pulse and paraesthesia in median
nerve area are also early signs but may not be present in every case and oneshould not wait for these signs. &ontracture and gangrne is a very late
phenomenon.
22. Which o$ the $ollo7ing is tr'e (o't Monteggi $rct're"
A It is 's'll ssocite- 7ith +osterior interosseo's ner)e
+rlsis
% It cn (e 's'll trete- conser)ti)el in -'lts
& It is not n in/'r o$ chil-renD It is co!(intion o$ $rct're o$ r-i's 7ith -istl r-io#'lnr /oint
-isloction
E It is co!(intion o$ $rct'res o$ +ro3i!l 'ln 7ith -isloction
# onteggia fracture comprises of fracture of pro!imal ulna with dislocation
of radial head. It can occur in children. In adults most of cases will need
internal fi!ation of ulna whereas in children most can be treated
conservatively. It is also not normally associated with posterior interosseous
nerve paralysis.
26. A collr n- c'$$ (n-ge 7ill (e !ost s'it(le tret!ent $or
7hich o$ the $ollo7ing in/'r"
A Mi-sh$t $rct're o$ h'!er's
% Un-is+lce- $rct're o$ nec9 o$ h'!er's
& Monteggi $rct're
D Disloction o$ el(o7
E 5rct're o$ r-il he-.
All undisplaced humeral nec% fractures at all ages and most
displaced fractures in elderly can be safely treated in collar and cuff sling. All
other injuries mentioned need more elaborate treatment. After reduction of
elbow dislocation elbow can sometimes be immobili>ed in fle!ion in collar and
cuff bandage but this is not a safe method of treatment.
28. Which o$ the $ollo7ing is not ++lic(le to r-il nec9 $rct're"
A It is co!!on in/'r in chil-ren thn -'lts
% Ang'ltion cn 's'll (e re-'ce- ( !ni+'ltion& O+en re-'ction is so!eti!es re,'ire-
D Mechnis! o$ in/'r is $ll on o'tstretche- hn-
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E It is n e+i+hsel in/'r o$ slter t+e#0.
# adial nec% fracture is an epiphyseal injury of B alter typeE. In children
radial head should never be e!cised as this will lead to reduction in length of
radius" dislocation of inferior radio-ulnar joint and limitation of forearm
rotation. ?sually manipulation succeeds in reducing the tilt and rarely openreduction is required.
2;. Which o$ the $ollo7ing stte!ent is tr'e (o't s'+rcon-lr $rct're o$
h'!er's"
A Anterior -is+lce!ent o$ -istl $rg!ent is co!!on thn
+osterior -is+lce!ent
% C'(it's )lg's is co!!on thn c'(it's )r's $ollo7ing !i'nion
& Ne'rologicl co!+lictions re 's'll trnsitorD We9ness o$ el(o7 $le3ion is co!!on co!+liction o$ this
in/'r
E Q'ite o$ten el(o7 /oint -e)elo+s (on n9losis $ollo7ing this
in/'r.
1 Injury to any of three major nerves can occur but it is more li%ely to be
neurapra!ia or a!onotmesis. &omplete division of nerve is rare. 0osterior
displacement of distal fragment is common and so is development of varus
deformity following malunion. ea%ness of elbow fle!ion and bony an%ylosis
do not occur.
2
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D O++onens +ollicis
E A(-'ctor +ollicis long's.
# )ollowing 2ennetts fracture" shaft of metacarpal is displaced by
the unopposed pull of abductor pollicis longus muscle.
6?. P'tti#Pltt o+ertion is 'se- $or"
A Non 'nion o$ h'!er's
% Disloction o$ +tell
& Disloction o$ r-il he-
D Rec'rrent -isloction o$ sho'l-er
E Rec'rrent -isloction o$ +eronel ten-ons.
D 0utti-0latt operation consists of reefing of anterior capsule of
shoulder joint and subscapularis muscle and is used for treatment ofrecurrent dislocation of shoulder. Aim of operation is to limit e!ternal rotation
which causes humeral head to dislocate.
61. 4est tret!ent $or h'!erl nec9 $rct're in 8? er ol- +tient 7ill (e"
A Collr n- c'$$ (n-ge $ollo7e- ( +hsiother+
% O+en re-'ction n- +lster s+ic
& O+en re-'ction n- internl $i3tion
D Close- !ni+'ltion n- +lster s+ic
E Hnging cst
A Bhoulder stiffness is most serious problem than the worry about
alignment 4malalignment can be ta%en care by wide range of shoulder motion5
and union 4union always occurs as this is mainly cancellous bone with good
vascularity5. 0laster spica is contraindicted as this will ma%e shoulder stiff and
painful. @anging cast is the treatment for humeral shaft fracture. Internal
fi!ation of humeral nec% fracture may be required rarely in displaced
fractures in young age.
6*. In(ilit to e3ten- inter+hlngel /oint o$ th'!( $e7 7ee9s
$ter Colles@ $rct're in-ictes -e)elo+!ent o$"
A Co!+rt!ent sn-ro!e
% Posterior interosseo's ner)e +ls
& A)'lsion o$ insertion o$ e3tensor +ollicis long's
D Attrition r'+t're o$ e3tensor +ollicis long's ten-on t the site o$
$rct're
E Ter o$ e3tensor +ollicis long's !'scle (ell.
D 'his attrition rupture is more common after undisplaced and minimally
displaced &olles fracture. Bince it is attrition rupture" tendon ends are frayed
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and direct repair is not possible. 'reatment therefore consists of transfer of
e!tensor indicis tendon to the distal stump of e!tensor pollicis longus tendon.
&ompartment syndrome is an early complication.
6. Wht is the 's'l tret!ent $or s!+to!tic ol- cro!io#cl)ic'lr -isloction"
A Arthro-esis o$ cro!io#cl)ic'lr /oint
% #7ire $i3tion o$ /oint
& Lg scre7 $i3tion o$ /oint
D Resection o$ o'ter en- o$ cl)icle
E Acro!ion+lst.
D esection of outer *H of clavicle and capsulorraphy produces satisfactory
amelioration of symptoms. 'ransfer of tip of coracoid with its attachedmuscles is ne!t best method of treatment. -wire and lag screw fi!ation are
the treatment of acute dislocation. Arthrodesis of acromio-clavicular joint is
almost impossible to achieve and if achieved will greatly impair the mobility of
shoulder girdle. Acromionplasty is used for intractable cases of impingement
syndrome
62. Regr-ing $rct're o$ cl)icle 7hich o$ the $ollo7ing
stte!ent is incorrect"
A 5rct're is co!!onest in !e-il thir-
% Non 'nion is rre
& Most cses cn (e trete- conser)ti)el
D 5rct're 's'll occ'rs -'e to in-irect in/'r
E 5rct're is co!!on in !i--le thir-.
A &lavicle fractures usually by fall on outstretched hand and the force
transmitted brea%s the bone at place where two curves meet and therefore
fractures are most common in the middle third of bone. All other statements
about union and treatment of clavicle fracture are correct.
66. Which o$ the $ollo7ing is incorrect (o't -isloction o$ l'nte"
A Dislocte- l'nte ++ers tring'lr inste- o$ rectng'lr on
A.P. 3#r
% Disloction is !ost esil recognise- on lterl )ie7 3#r
& A)sc'lr necrosis is co!!on $ollo7ing -isloction
D L'nte -isloctes +osteriorl
E Me-in ner)e co!+ression cn occ'r.
D In total dislocation of lunate the bone dislocates anteriorly and that is why
median nerve can be compressed. If closed deduction fails open reduction is
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performed from antenor Jch )urthermore anterior approach permits spbung
K B' retinaculum to decompress carpal tunnel and med"an nerve. All other
statements are correct.
68. Which o$ the $ollo7ing is not ++lic(le to sc+hoi- $rct're"
A Mechnis! o$ in/'r is $ll on o'tstretche- hn-.% It is co!!on in -'lts thn el-erl +ersons
& O$ten non 'nion -e)elo+s
D 5rct're t 7ist is co!!onest
E A)sc'lr necrosis is rre.
E A)sc'lr necrosis o$ +ro3i!l $rg!ent is $irl co!!on since the (loo- s'++l to this +rt
co!es in retrogr-e -irection n- 7hole o$ +ro3i!l +ole is co)ere-( rtic'lr crtilge n-
-oes not h)e n +lce $or )sc'lr chnnels to enter in this +rt o$ (one.
6;. Which o$ the $ollo7ing stte!ent is tr'e (o't -isloction o$inter+hlngel /oint o$ $inger"
A It is $le3ion in/'r
% It is n e3tension in/'r
& Re-'ction is o$ten 'nst(le
D Distl +hln3 is -is+lce- nteriorl in reltion to the +ro3i!l
+hln3
E There is no nee- to test $or st(ilit $ter re-'ction o$
-isloction.
Dislocation of interphalangeal joints is an e!tension injury an the distal
phalan! is displaced dorsally in relation to pro!imo phalen!. ost often
reduction is stable and its stability must L chec%ed immediately after
manipulation. ?nstable reducoa is usually due to associated fracture which
can be recognised a !-ray and needs internal fi!ation.
6
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anthritis requiring arthrodesis of wrist. hen non-union of scaphoid is an
incidental finding with out symptoms it can be left without any treatment
6>. Which o$ the $ollo7ing in/'r is J!e9ee+er@s th'!(J"
A R'+t're o$ 'lnr collterl lig!ent o$ 7rist% R'+t're o$ 'lnr collterl lig!ent o$ !etcr+o+hlngel /oint
o$ th'!(
& R'+t're o$ 'lnr collterl lig!ent o$ inter+hlngel /oint o$
th'!(
D 5rct're o$ (se o$ th'!( !etcr+l
E 5rct're o$ nec9 o$ th'!( !etcr+l.
Injury occurs due to forcible abduction at metacarpophalangcal joint of
thumb" and was classically described in persons wringing nec% of smallanimals caught during hunting. Diagnosis can be confirmed by ta%ing stress
view !-rays. 0artial rupture can be treated by scaphoid type plaster but for
complete rupture operative repair is advisable.
8?. Which o$ the $ollo7ing is not tr'e (o't +osterior -isloction o$
sho'l-er"
A Rec'rrent -isloction cn -e)elo+
% Re-'ction cn (e 'nst(le
& Ptients 7ith 'nre-'ce- -isloction cn h)e goo- $'nction
D Clinicl -ignosis is es
E A3illr ner)e in/'r is 'nco!!on.
D Dignosis o$ +osterior sho'l-er -isloction cn (e o$ten !isse- n- is not es (oth clinicll
n- r-iologicll. Re-'ction is ,'ite o$ten 'nst(le n- sho'l-er s+ic is re,'ire- 7ith sho'l-er
in (-'ction n- e3ternl rottion. Rec'rrent -isloction cn -e)elo+ n- 3illr ner)e in/'r is
'nco!!on since +osterior -isloction -oes not stretch the ner)e 7hich co'rses $ro! +osterior to
nterior.
81. Co!!onest c'se o$ -e$or!it in long (one is"
A Osteo+orosis% Ric9ets
& Pget@s -isese
D Ml'nite- $rct're
E 5i(ro's -s+lsi.
Cocal pressure on wound and elevation of leg is the safest and
most effective method to stop bleeding. 'ourniquet can be dangerous if not
properly used. #levation alone and local pressure on femoral artery is
ineffective.
8*. Wht is the secon- !ost i!+ortnt s+ect in the tret!ent o$
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$rct'res o$ long (ones"
A A-e,'te n'trition o$ +tient
% Acc'rte nto!icl re-'ction
& I!!o(ilition
D Restortion o$ (one lign!ent
E Anti(iotics.
& 5irst n- $ore!ost re,'isite to ens're heling o$ long (one $rct'res to restore $'nction is
the re-'ction o$ (one $rg!ents into goo- lign!ent so tht !l'nion -oes not occ'r. Acc'rte
nto!icl re-'ction is not necessr. Secon- i!+ortnt s+ect is i!!o(ilition o$ the $rct're.
8. Which -e$or!it in !l'nite- $rct're is !ost li9el to correct 7ith
re!o-elling"
A Ang'lr -e$or!it in the !i--le o$ -i+hsis in the +lne o$
!otion o$ ner( /oint% Ang'lr -e$or!it in +lne o$ !otion o$ ner( /oint 7hen
-e$or!it is in !et+hsel re
& Rottionl !llign!ent
D Ang'lr -e$or!it ner en- o$ (one 7hen ng'ltion is in
+lne >?K to the +lne o$ !otion o$ ner( /oint.
E Shortening o$ (one length.
Angular deformity in the plane of motion of nearby joint has
ma!imum potential for remodelling. emodelling is still better if deformity isnear the end of bone. 'he process is rapid in growin of children and slows
down as the adulthood is reached. otations malalignment never corrects.
Bhortening of bone length" will the some e!tent correct in a growing child
since the fracture induct little overgrowth in a long bone.
82. Wht is !ost i!+ortnt s+ect o$ the tret!ent o$ cr'sh
sn-ro!e in)ol)ing n e3tre!it"
A A!+'ttion
% 5l'i- n- electrolte (lnce
& Dilsis
D Anti(iotics
E H(er(ric o3gen.
A Amputation pro!imal to the level of injury is the most important aspect
of treatment. At the same time maintenance of fluid balance is also important.
Dialysis may be required. Antibiotics really are of prophylactic value.
@yperbaric o!ygen has no role.
86. In inter$rg!entr $i3tion scre7 7or9s ( +ro-'cing"
A Co!+ression
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% Distrction
& Antigli-e !echnis!
D Increse- sher
E None o$ (o)e.
A Bcrew wor%s by converting torsional stress 4used during its insertion5into compressive force and this %eeps fracture surfaces in close apposition.
'his is the basic mechanism on which screw wor%s.
88. 4sic tret!ent o$ !ost non#'nions is"
A Co!+ression +lting
% Contin'tion o$ e3ternl s+lintge
& Electricl sti!'ltion
D 4one gr$ting
E Phe!ister gr$ting.
D In an established non-union freshening of bone ends and bone grafting
is the usual treatment. #lectrical stimulation and compression plating is
indicated in certain limited cases only. 0hemister grafting is one method of
bone grafting in cases where bone fragments are in good alignment.
8;. E3ternl $i3tor is not in-icte- in"
A Co!!in'te- $rct're
% 5rct're ssocite- 7ith se)ere so$t tiss'e -!ge
& In$ecte- $rct'resD Si!+le close- $rct're o$ h'!erl sh$t
E 5rct're ssocite- 7ith ('rns.
D ?se of e!ternal fi!ator is contraindicated in an uncomplicated fracture.
It is an indispensable method of treatment of fracture in association with
infection" burn and severe soft tissue damage requiring repeated dressing and
s%in grafting. #!ternal fi!ator is also used e!tensively for purpose of limb
lengthening.
8
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8>. 5ollo7ing $e!orl sh$t $rct'reF 9nee sti$$ness occ'rs -'e to"
A 5i(rosis o$ )st's inter!e-i's
% Shortening o$ rect's $e!oris
& 5i(rosis o$ +tellr retinc'lD A-hesion o$ +tell to $e!orl con-les
E All o$ (o)e
# All the factors mentioned prevent distal e!cursion of patella
and thereby limit %nee fle!ion. 'his is why early quadriceps e!ercises and
patellar mobili>ation after femoral fracture are important.
;?. Wht is the !ost serio's -is-)ntge o$ e3ternl $i3tor"
A Pin trct in$ection
% Loosening o$ +ins
& Stress +rotection osteo+orosis
D 5rct're cn not (e co!+resse-
E Another $rct're cn occ'r thro'gh +in trct.
A 0in tract infection is the most frequent and serious complication
of use of e!ternal fi!ator. If a very rigid fi!ator assembly has been used" its
removal should be in stages to overcome stress protection osteoporosis. In
most good fi!ators it is possible to either compress or distract the fracture.
Coosening of pins can be minimi>ed by %eeping the pins under compression.Cater fracture through pin tract is another potentially serious problem with
use of e!ternal fi!ator.
;1. Wht is the (est tret!ent $or n o(li,'e ti(i sh$t $rct're 7hich hs
re-is+lce- $ter initil goo- close- re-'ction n- +lster i!!o(ilition
A We-ging o$ +lster
% Re!ni+'ltion n- +lster
& O+en re-'ction n- internl $i3tion
D S9eletl trctionE Cst (rcing.
1 $blique fractures are difficult to hold in plaster and best treatment is
internal fi!ation if reduction can not be achieved or has been lost after closed
manipulation. B%eletal traction from calcaneal or supramalleolar pin is the
ne!t best option available. 'raction has to be maintained for 6-M wee%s until
early union has occured. At this stage when fracture is deformable but not
displacable plaster or cast brace can be applied. &ast brace can not be used
until there is early union of fracture.
;*. 4'!+er $rct're is the n!e gi)en to"
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A 5rct're o$ ti(i n- $i('l
% 5rct're o$ lterl ti(i con-le
& 5rct're o$ +tell
D 5rct're o$ lterl $e!orl con-le
E 5rct're o$ ti(il s+ine.
2 @istorically tibial condylar fractures have been referred to as HbumperH
or HfenderH fractures. 2ut falls from height are also N common causes of these
injuries.
;. Intr!e-'llr niling o$ $e!orl sh$t $rct're is contr#
in-icte-" K
A When there is co!+o'n-ing
% When the $rct're is trns)erse& When $rct're is in nrro7est +rt o$ (one
D In non 'nion in -'lts
E In chil-.
E Intr!e-'llr niling is contrin-icte- in chil-ren (ec'se o$ -nger o$ -!ge to
gro7ing en-s o$ (one n- lso 7hen the chil- gro7s the nil 7ill (eco!e totll e!(e--e- -ee+
insi-e (one n- cn not (e re!o)e-. In co!+o'n- $rct'res n internl $i3tion -e)ice sho'l-
(e 'se- $ter -'e consi-ertion o$ co!+lictions. All other in-ictions re i-el $or
intr!e-'llr nil $i3tion.
;2. A +tient -e)elo+s co!+rt!ent sn-ro!e s7ellingF +in
n- n'!(ness $ollo7ing !ni+'ltion n- +lster $or
$rct're o$ (oth (ones o$ leg. Wht is the (est tret!ent"
A S+lit the +lster
% Ele)te the leg
& In$'sion o$ lo7 !olec'lr 7eight -e3trn
D Ele)te the leg $ter s+litting the +lster
E Do o+erti)e -eco!+ression o$ $cil co!+rt!ent.
# henever diagnosis of compartment syndrome is confirmed 4increased
compartment pressure measured by transducer5 or suspected7 safest and best
course of action is operative decompression of tight facial compartment. Any
delay will produce irreversible muscle necrosis. All other treatments
mentioned are an accompaniment to decompression operationO
;6. Which o$ the $ollo7ing is !ost i!+ortnt ste+ 7hen
#niling is -one $or $i3tion o$ $resh $e!orl sh$t $rct'res.
A oo- re!ing o$ !e-'llr cnl to t9e in 7i-est -i!eter nil
% No re!ing o$ !e-'llr cnl& Close- niling sho'l- (e -one
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D 4one gr$ting !'st l7s (e -one long 7ith
E S!ll -i!eter nil sho'l- (e selecte-.
A Adequate reaming of medullary canal to accept widest diameter nail is
most important step as this increases the rigidity of fi!ation. After this ne!t
important step is to use a nail of proper length. &losed nailing is a difficultprocedure and for practical purposes open nailing is adequate. 2one graft
should be added in old fractures" comminuted fractures and non unions.
;8. Which o$ the $ollo7ing is co!!onest co!+liction o$
Colles@ $rct're"
A Sti$$ness o$ $ingers
% Sti$$ness o$ 7rist
& Sti$$ness o$ sho'l-er
D S'(l'3tion o$ in$erior r-io 'lnr /oint 7ith +inE S'-ec9@s osteo-stro+h.
A All the complications mentioned can occur after &olles fracture but out
of these stiffness of fingers is the commonest complication. (e!t commonest
complication is malunion followed ne!t in frequency by stiffness of shoulder.
$ther are less common but by no means rare. Ceast common complication is
spontaneous rupture of e!tensor pollicis longus tendon. (on union is very
rare.
;;. Ml'nite- Colles@ $rct're +ro-'ces Which o$ the $ollo7ing
-e$or!it"
A r-en s+-e -e$or!it
% Dinner $or9 -e$or!it
& M-el'ng -e$or!it
D S7n nec9 -e$or!it
E 4o'tonniere -e$or!it.
% Ml'nite- Colles $rct're +ro-'ces -inner $or9 -e$or!it.
;
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attached muscles is ne!t best method of treatment. -wire and lag screw
fi!ation are the treatment of acute dislocation. Arthrodesis of acromio-
clavicular joint is almost impossible to achieve and if achieved will greatly
impair the mobility of shoulder girdle. Acromionplasty is used for intractable
cases of impingement syndrome.
;>. Regr-ing $rct're o$ cl)icle 7hich o$ the $ollo7ing stte!ent is
incorrect"
A 5rct're is co!!onest in !e-il thir-
% Non 'nion is rre
& Most cses cn (e trete- conser)ti)el
D 5rct're 's'll occ'rs -'e to in-irect in/'r
E 5rct're is co!!on in !i--le thir-.
A &lavicle fractures usually by fall on outstretched hand and the force
transmitted brea%s the bone at place where two curves meet and therefore
fractures are most common in the middle third of bone. All other statements
about union and treatment of clavicle fracture are correct.
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D Clcneo $i('lr lig!ent
E Anterior tlo#$i('lr lig!ent.
# An%le sprain is an inversion injury and anterior talo-fibular ligament is
first to be damaged. ore severe injury can also damage origin of e!tensor
digitorum brevis and calcaneo-fibular ligament.
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3 3..1. 4Airway" bleeding and circulation5 are the priorities in
management of seriously injured patient in that order.
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D In old patients irrespective of the duration since injury
hemireplacement arthroplasty is the procedure of choice as the patient can be
mobili>ed early" thus avoiding general complications of immobili>ation. In old
fracture internal fi!ation is ineffective. Internal fi!ation with muscle pedicle
graft is useful procedure as it induces vascularity to aid in fracture union and
also restores normal anatomy. ith this operation and also with e urrayosteotomy weight bearing has to be delayed for many months and therefore
these operations are used only in younger patients.
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E Perc'tneo's +in $i3tion is (est tret!ent.
'his fracture results in disruption of articular surface and should be
accurately reduced and internally fi!ed. B%eletal traction may at times suffice
for undisplaced fracture. 'hese fractures can not be satisfactorily reduced by
closed manipulation and therefore percutaneous pin fi!ation is not possible.0in fi!ation will also not be so strong as to start early %nee movements which
is important due to danger of %nee stiffness which can be quite severe inspite
of accurate reduction. (on union is rare as the fracture occurs in area of
abundant cancellous bone with good blood supply.
>1. Wht is tr'e (o't s'+rcon-lr $rct'res o$ $e!'r"
A Distl $rg!ent tilts +osteriorl -'e to +'ll o$ gstrocne!i's
% Distl $rg!ent tilts nteriorl -'e to +'ll o$ ,'-rice+s
& Cn (e trete- ,'ite 7ell ( #nilingD Cn 's'll (e trete- 7ith R'ssell trction
E Cn (e co!+licte- ( in/'r to scitic ner)e.
A astrocnemius pulls the distal fragment and its upper end tilts
posteriorly and malunion in this position will cause genu recurvatum
deformity. It can be treated conservatively by reduction and traction with
%nee in MPQ fle!ion" and for this reason ussel traction and traction on
'homas splint with %nee straight are useless. 2est treatment for these
fractures is internal fi!ation with angled blade plate appliance or #nder nails.
>*. Which o$ the $ollo7ing is not seen in intrc+s'lr $rct're o$
$e!orl nec9.
A Coll+se o$ he- $ter 'nion o$ $rct're
% Mi 'nion 7ith !ore thn J o$ shortening
& A)sc'lr necrosis o$ $e!orl he-
D Non 'nion
E Misse- -ignosis.
If the fracture has united shortening is only due to co!a vara andis usually not e!cessive. Diagnosis of undisplaced" impacted fracture can be
missed on clinical e!amination since the patient can move the hip with little
discomfort and may at times be able to wal% also. (on union and avascular
necrosis are well %nown complications and their incidence is appro!imately
EPG each. Although fracture can unite but still enough of blood supply to
femoral head may have been jeopardi>ed to produce avascular necrosis which
in turn can lead to collapse of femoral head.
>. Shenton line is (ro9en in ll o$ $ollo7ing e3ce+t"A Posterior -isloction o$ hi+
% I!+cte- $rct're o$ $e!orl nec9
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& Congenitl -isloction o$ hi+
D Pthologicl -isloction o$ hi+
E To! S!ith rthritis.
Bhenton line will be bro%en in all cases when head is displaced
away from acetabulum 4dislocation5 due to any aetiology. It will not be bro%enin undisplaced impacted femoral nec% fractures.
>2. 5or -isten-e- 9nee /oint 7hich o$ the $ollo7ing +osition is
!ost co!$ort(le"
A 5'll e3tension
% ?K $le3ion
& 8?K $le3ion
D >?K $le3ion
E 1*?K $le3ion.
In 6FQ fle!ion" %nee joint has ma!imum capacity and pressure of
contained fluid or blood is minimum and consequently there is least pain.
&apacity of %nee joint decreases and pain thereby increases when the %nee is
fully e!tended or fle!ed more than 6FQ-MPQ.
>6. Which o$ the $ollo7ing is tr'e (o't c'te r'+t're o$ ten-c clcne's
ten-o#chillis"
A It occ'rs -'e to -irect in/'r
% R-iogr+h 7ill con$ir! the -ignosis
& Co!+ression o$ cl$ !'scles +ro-'ces +lnter$le3ion o$ n9le
D It 's'll occ'rs in !i--le ge- +ersons
E S'rgicl re+ir is 'nnecessr.
D 'his is injury of middle aged persons usually occuring due to
unaccustomed e!ercise. Direct injury is not the cause of tendon N rupture
although most patients feel as if something has hit. R-ays are of no value in
diagnosis. 0lanterfle!ion of an%le on compression of calf occurs when the
tendon is intact and its absence signifies tendon rupture. Burgical repair ispreferable treatment.
>8. St(ilit o$ 9nee /oint -e+en-s !inl on"
A 4on con$ig'rtion
% M'scles
& Lig!ents
D Ten-ons
E Menisci.
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1 In %nee as well as other joints li%e interphalangeal" wrist and
intervertebral joint stability mainly depends on ligaments. In ball and soc%et
joint li%e hip" stability is provided by bony configuration. In very mobile
shoulder joint main stabili>ing structures are muscles. enisci and tendons do
not contribute significantly to stability.
>;. Co!+lete r'+t're o$ ten-o clcne's is (est trete- ("
A Phsiother+
% Arthro-esis o$ n9le n- s'(tlr /oint
& Rise- shoe
D Ten-on trns$er
E S'rgicl e3+lortion n- re+ir.
# upture of tendo-achillis whether spontaneons or traumatic should be
treated by surgical repair as soon as possible after injury. ?nunited tendon
produces severe disability in wal%ing as the push off is lost. If repaired later
fascial or tendon graft has to be used to bridge the gap and post operative
recovery is slow and end result is less than perfect.
>
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articular surface can be restored" or to e!cise pateilar fragments when
fracture is so comminuted that patellar articular surface will remain rough.
1??. Which o$ the $ollo7ing stte!ent is not tr'e (o't se)ere )r's strin in/'r
o$ 9nee"A Us'll no s+eci$ic tret!ent is re,'ire-
% 5rct're o$ he- o$ $i('l sho'l- ro'se s's+icion o$ this in/'r
& Lterl +o+litel ner)e cn (e -!ge-
D Stress r-iogr+hs re re,'ire- to con$ir! the -ignosis
E Plin G#r cn (e nor!l e)en in the +resence o$ e3tensi)e -!ge.
A If the injury is severe operative repair of torn structures 4lateral
collateral ligament" lateral capsule and biceps femoris5 is required followed by
plaster immobili>ation with %nee 6F degrees fle!ed. R-ray may quite often benormal or may only show avulsion fracture of head of fibula. Btress
radiographs or e!amination under anaesthesia will reveal full e!tent of
damage. Cateral popliteal nerve can also be damaged due to traction injury.
1?1. Ho7 -oes +rltic scoliosis -i$$er $ro! i-io+thic scoliosis"
A Progress o$ c'r)e sto+s $ter !t'rit
% Scoliosis cn +rogress e)en $ter !t'rit
& C'r)es re 's'll short
D 4rcing is ,'ite e$$ecti)e in controlling +rogress
E C'r)e ne)er (eco!es )er se)ere.
Asymmetrical paralysis of paraspinal muscles produces paralytic
scoliosis. &urve can develop and progress even after maturity" is usually long
and can become very severe. 2racing is not as effective in controlling paralytic
scoliosis as it is in controlling
paralytic scoliosis.
1?*. In !elo!eningocele scoliosis occ'rs -'e to"
A As!!etricl +rlsis o$ s+inl n- (-o!inl !'scles% Congenitl -e$or!ities o$ )erte(re
& 5i3e- +el)ic o(li,'it
D An o$ (o)e
E None o$ (o)e.
D In --ition to c'ses !entione-F scoliosis cn lso occ'r -'e to sttic $orces o$ chronic
!l+ost're necessitte- ( +rlsis or ( +erio- o$ rec'!(enc $or cre o$ $re,'entl
reclining ischil or trochnteric +ress're sores.
1?. 4e$ore s'rgerF $orci(le correction o$ se)ere scoliosis c'r)e cn
(e chie)e- ("
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A Hlter trction
% Hlo#+el)ic trction
& T'rn('c9le cst
D Riser /c9et
E Cotrel cst.
A Hlter trction -oes not +ro)i-e eno'gh $orce to correct se)ere scoliosis -e$or!itF $or
7hich n o$ the other !entione- !etho-s cn (e 'se-.
1?2. Co!!onest lte co!+liction o$ s+inl $'sion in scoliosis is"
A Rec'rrence o$ -e$or!it
% Pse'-orthrosis
& Ne'rologicl -e$icit
D All o$ (o)eE None o$ (o)e.
% Pse'-orthrosis is the co!!onest co!+liction n- this in so!e cses le-s to
-e)elo+!ent o$ rec'rrence o$ -e$or!it.