Free Orthopedic MCQs 2023, Aug, 31 | 12:00 am

Orthopedic MCQs Online Bank - Improve Your Knowledge and Skills

Orthopedics Quiz

Question 1: A 26-year-old woman sustained a femoral neck fracture treated with percutaneous cannulated screws. At her 3-month follow-up, she reports hip pain and inability to ambulate. What is the next best treatment option?

Bone grafting and revision open reduction and internal fixation
Hemiarthroplasty
Dynamic hip screw without angular correction
Valgus intertrochanteric osteotomy
Core decompression

Discussion:

Femoral neck fracture nonunion is more common in young adults and more prone to nonunion due to shear stress. Salvage of the femoral head is preferred if vascularity remains intact. The most common treatment is valgus intertrochanteric osteotomy of the femur. This functionally converts shear into compressive forces and corrects the varus position of the fracture.

Question 2: Which fracture pattern is shown in Figures 2a through 2c?

Anterior column
Anterior wall
Posterior column
Both column
Transverse

Discussion:

The interruption of only the ilioischial line on the AP pelvis and the intact iliopectineal line and outline of the posterior wall on the obturator oblique view indicate a fracture of the posterior column.

Question 3: What letter in Figure 3 indicates the correct starting point for an external fixation half pin in the anterior inferior iliac spine (AIIS)?

A
B
C
D
E

Discussion:

The correct starting point for an external fixation half pin in the AIIS is seen on an obturator outlet view and is best started at least 2 cm proximal to the hip joint to avoid placing a pin within the hip capsule. Blunt dissection and a guide sleeve should be used to prevent damage to the lateral femoral cutaneous nerve.

Question 4: After an initial closed reduction, what is the preferred treatment for the fracture shown in Figures 4a and 4b?

Open reduction and internal fixation of the radial head and immobilization
Medial collateral ligament repair
Radial head replacement, ulnar nerve transposition, and external fixation
Coronoid repair, radial head replacement, and lateral ligamentous repair
Nonsurgical management in a hinged elbow brace

Discussion:

This elbow fracture-dislocation involving a radial head fracture, coronoid fracture, and ulnohumeral dislocation (terrible triad) requires surgical treatment. The treatment should address the radial head, and replacement is preferred over repair in comminuted fractures. The coronoid may be addressed at the time of radial head excision and replacement. Lateral and medial ligamentous repairs are done during closure of the elbow capsule.

Question 5: A 25-year-old football player sustains a suspected Lisfranc sprain. What is the next step in evaluation?

CT
MRI
Standing radiographs
Measurement of compartment pressures
Bone scan

Discussion:

A dynamic radiographic study, such as a physician-assisted midfoot stress exam or standing weight-bearing radiographs, is the first step in diagnosing a Lisfranc sprain. There is no evidence of compartment syndrome, and expensive tests such as CT, MRI, and bone scan are not warranted.

Question 6: What is the best course of action for a nondisplaced transverse fracture of the proximal phalanx shown in Figures 5a through 5c?

Immobilization of the hand with the MCP joints in flexion and the IP joints in extension
Immobilization of the hand with the MCP joints in extension and the IP joints in extension
Percutaneous pinning of the proximal phalanx
Open reduction and internal fixation of the proximal phalanx
Early motion and pain management

Discussion:

Immobilization in the intrinsic plus position prevents MCP joint stiffness for stable fractures of the phalanges.

Question 7: What management strategy should be followed for a patient with a scaphoid fracture involving the proximal pole shown in Figure 6?

Closed reduction and long arm cast immobilization
Closed reduction and short arm cast immobilization
Closed reduction and percutaneous pinning
Open reduction and internal fixation with Kirschner wires
Open reduction and internal fixation with a headless, cannulated compression screw

Discussion:

Surgical treatment is recommended for scaphoid fractures of the proximal pole due to the prolonged period of cast immobilization required with nonsurgical management. A cannulated compression screw inserted in the central scaphoid via a dorsal approach provides biomechanical advantage and is more stable for fracture healing than Kirschner wires. Arthroscopic-assisted percutaneous fixation is also an option.

Question 8: What is the most appropriate treatment for the oblique fracture shown in Figures 8a through 8c?

Closed reduction and splinting in MCP and PIP joint extension
Closed reduction and splinting in MCP joint flexion and PIP joint extension
Reduction and percutaneous intramedullary Kirschner wire fixation
Reduction and lag screw fixation
Buddy taping and early range of motion

Discussion:

The oblique nature of the fracture and extension of the fracture to the condyles implies an unstable fracture. Lag screw fixation provides an excellent chance of union, and early range of motion can be started.

Question 9: What is the most appropriate management for a patient with a significant hemothorax and bilateral closed femoral fractures with a base deficit of 2 and urine output of 3 mL/kg?

Continued skin traction
Skeletal traction of both femurs
External fixation of both femurs
Intramedullary nailing of one femur and external fixation and delayed nailing for the other femur
Intramedullary nailing of both femurs

Discussion:

External fixation of both femurs is an unnecessary step in the treatment algorithm. The patient needs continued resuscitation and minimal additional blood loss. Irrigation and debridement, external fixation of the ankle, foot, and femur, and splinting of the forearm is the most appropriate treatment.

Question 10: What is the appropriate course of action for a patient with a direct blow to the middle finger and inability to move the PIP or DIP joints as shown in Figures 8a through 8c?

Orthopedic MCQs Online Bank - Improve Your Knowledge and Skills

Search in this site

Orthopedic MCQs Online Bank - Improve Your Knowledge and Skills

Orthopedics Quiz

Question 1: A 26-year-old woman sustained a femoral neck fracture treated with percutaneous cannulated screws. At her 3-month follow-up, she reports hip pain and inability to ambulate. What is the next best treatment option?

Discussion:

Question 2: Which fracture pattern is shown in Figures 2a through 2c?

Discussion:

Question 3: What letter in Figure 3 indicates the correct starting point for an external fixation half pin in the anterior inferior iliac spine (AIIS)?

Discussion:

Question 4: After an initial closed reduction, what is the preferred treatment for the fracture shown in Figures 4a and 4b?

Discussion:

Question 5: A 25-year-old football player sustains a suspected Lisfranc sprain. What is the next step in evaluation?

Discussion:

Question 6: What is the best course of action for a nondisplaced transverse fracture of the proximal phalanx shown in Figures 5a through 5c?

Discussion:

Question 7: What management strategy should be followed for a patient with a scaphoid fracture involving the proximal pole shown in Figure 6?

Discussion:

Question 8: What is the most appropriate treatment for the oblique fracture shown in Figures 8a through 8c?

Discussion:

Question 9: What is the most appropriate management for a patient with a significant hemothorax and bilateral closed femoral fractures with a base deficit of 2 and urine output of 3 mL/kg?

Discussion:

Question 10: What is the appropriate course of action for a patient with a direct blow to the middle finger and inability to move the PIP or DIP joints as shown in Figures 8a through 8c?

Discussion: