MedCosmos Orthopaedics
Orthopaedics Lecture Notes, Books, MCQ and Good Articles
Saturday, September 6, 2008
Orthopaedics MCQ
1. Which of the following statements about open fractures is/are
correct?
A. Intravenous antibiotics should be administered as soon as possible.
B. They should be regarded as an emergency.
C. Wound closure is necessary within 8 hours.
D. Systematic wound débridement and irrigation should be
performed.
E. They most often result from low-energy injuries.
Answer: ABD
DISCUSSION: Open fractures represent an orthopedic emergency.
They result most frequently from high-energy injuries. Current
treatment includes administration of intravenous antibiotics,
systematic wound irrigation, and débridement with respect for the
neurovascular bundles. Immediate wound closure is rarely indicated
and should be performed once the wound contamination is
determined to be low.
2. The goals of proper fracture reduction include which of the
following?
A. Providing patient comfort and analgesia.
B. Allowing for restoration of length of the extremity.
C. Correcting angular deformity and rotation.
D. Enabling immediate motion of all fractured extremities.
E. Providing a foundation for bone healing and union.
Answer: ABCE
DISCUSSION: The goals of fracture reduction include patient comfort
and analgesia through stabilization of the bone ends. Furthermore,
restoration of the length, angulation, and rotational alignment of the
extremity should be achieved to allow proper union. Reduction does
not, however, allow immediate motion for all fractures.
,3. Which statement is true about the “three-column concept” of spinal
fracture stability?
A. An unstable spine consists of bone or soft tissue injury in a single
column.
B. An unstable spine involves injury to all three columns.
C. Instability results from injury to two columns plus evidence of
compression of the dural tube.
D. Instability results from significant bone and/or soft tissue injury in
two columns.
Answer: D
DISCUSSION: Denis developed a classification system for a
thoracolumbar spine injury based on a three-column concept. In this
system, the spine is divided into three longitudinal regions or
columns: anterior, middle, and posterior. Although references to such
“columns” is anatomically imprecise, the term is clinically useful in
assessing the stability of the injured spine. In general, instability
results when significant disruption is present in two of the three
columns, regardless of the presence or absence of neurologic deficit.
4. All of the following statements are true of Jefferson's fracture of the
atlas except:
A. The injury results from an axial load to the cervical spine.
B. The fracture fragments characteristically displace into the spinal
canal.
C. Neurologic injury is uncommon.
D. Computed tomography (CT) best demonstrates the fracture's
configuration.
Answer: B
DISCUSSION: Fracture of the atlas (Jefferson's fracture) occurs from an
axial load, usually to the top of the head. The resulting forces fracture
the ring of C1 and displace the fragments outward. This results in an
increase in the cross-sectional area of the spinal canal at the level of
injury. Neurologic injury is, therefore, unusual in this fracture. CT is
the best roentgenographic study available to evaluate fractures of the
atlas.
5. Which of the following statements about burst fractures of the
thoracolumbar spine are correct?
A. The injury most often occurs at the thoracolumbar junction.
B. The injury results from axial loading of the spine, often with
concomitant flexion.
C. Anterior and middle column failure are always present in this
, injury.
D. Laminectomy provides satisfactory decompression.
Answer: ABC
DISCUSSION: Burst fractures result from axial compression of the
spine, frequently associated with varying degrees of flexion. These
injuries, which most often occur at the thoracolumbar junction, are
characterized by circumferential expansion of the entire vertebra with
failure of the anterior and middle spinal columns and in some cases,
the posterior ones. Middle column failure in burst fractures results in
retropulsion of the posterior superior portion of the vertebral body
into the spinal canal. With marked retropulsion, compression of the
dural tube occurs, often with associated neurologic deficit.
Surgical procedures designed to decompress and stabilize
thoracolumbar burst fractures can be performed through anterior or
posterior approaches. The major site of compression is anterior, and
for this reason laminectomy does little to relieve compression of the
spinal cord over an anterior lesion. Indeed, laminectomy further
increases the instability of the spine.
6. The neurovascular structure most commonly injured as a result of
an anterior dislocation of the shoulder is the:
A. Musculocutaneous nerve.
B. Axillary nerve.
C. Axillary artery.
D. Median nerve.
Answer: B
DISCUSSION: The axillary nerve is at greatest risk for injury.
Occasionally a more severe neurologic deficit can occur as a result of
injury to the brachial plexus. Rarely has injury to the axillary artery
been reported.
7. The classification of fractures of the proximal humerus is based on:
A. The number of fracture segments and amount of displacement.
B. The mechanism of injury.
C. Presence or absence of associated dislocations.
Answer: A
DISCUSSION: The classification is based on fracture patterns involving
the four “segments” of the proximal humerus (anatomic neck, surgical
neck, and greater and lesser tuberosities). Fractures are one-, two-,
three-, or four-part fractures, depending on the number of fracture
segments and amount of displacement.
Orthopaedics Lecture Notes, Books, MCQ and Good Articles
Saturday, September 6, 2008
Orthopaedics MCQ
1. Which of the following statements about open fractures is/are
correct?
A. Intravenous antibiotics should be administered as soon as possible.
B. They should be regarded as an emergency.
C. Wound closure is necessary within 8 hours.
D. Systematic wound débridement and irrigation should be
performed.
E. They most often result from low-energy injuries.
Answer: ABD
DISCUSSION: Open fractures represent an orthopedic emergency.
They result most frequently from high-energy injuries. Current
treatment includes administration of intravenous antibiotics,
systematic wound irrigation, and débridement with respect for the
neurovascular bundles. Immediate wound closure is rarely indicated
and should be performed once the wound contamination is
determined to be low.
2. The goals of proper fracture reduction include which of the
following?
A. Providing patient comfort and analgesia.
B. Allowing for restoration of length of the extremity.
C. Correcting angular deformity and rotation.
D. Enabling immediate motion of all fractured extremities.
E. Providing a foundation for bone healing and union.
Answer: ABCE
DISCUSSION: The goals of fracture reduction include patient comfort
and analgesia through stabilization of the bone ends. Furthermore,
restoration of the length, angulation, and rotational alignment of the
extremity should be achieved to allow proper union. Reduction does
not, however, allow immediate motion for all fractures.
,3. Which statement is true about the “three-column concept” of spinal
fracture stability?
A. An unstable spine consists of bone or soft tissue injury in a single
column.
B. An unstable spine involves injury to all three columns.
C. Instability results from injury to two columns plus evidence of
compression of the dural tube.
D. Instability results from significant bone and/or soft tissue injury in
two columns.
Answer: D
DISCUSSION: Denis developed a classification system for a
thoracolumbar spine injury based on a three-column concept. In this
system, the spine is divided into three longitudinal regions or
columns: anterior, middle, and posterior. Although references to such
“columns” is anatomically imprecise, the term is clinically useful in
assessing the stability of the injured spine. In general, instability
results when significant disruption is present in two of the three
columns, regardless of the presence or absence of neurologic deficit.
4. All of the following statements are true of Jefferson's fracture of the
atlas except:
A. The injury results from an axial load to the cervical spine.
B. The fracture fragments characteristically displace into the spinal
canal.
C. Neurologic injury is uncommon.
D. Computed tomography (CT) best demonstrates the fracture's
configuration.
Answer: B
DISCUSSION: Fracture of the atlas (Jefferson's fracture) occurs from an
axial load, usually to the top of the head. The resulting forces fracture
the ring of C1 and displace the fragments outward. This results in an
increase in the cross-sectional area of the spinal canal at the level of
injury. Neurologic injury is, therefore, unusual in this fracture. CT is
the best roentgenographic study available to evaluate fractures of the
atlas.
5. Which of the following statements about burst fractures of the
thoracolumbar spine are correct?
A. The injury most often occurs at the thoracolumbar junction.
B. The injury results from axial loading of the spine, often with
concomitant flexion.
C. Anterior and middle column failure are always present in this
, injury.
D. Laminectomy provides satisfactory decompression.
Answer: ABC
DISCUSSION: Burst fractures result from axial compression of the
spine, frequently associated with varying degrees of flexion. These
injuries, which most often occur at the thoracolumbar junction, are
characterized by circumferential expansion of the entire vertebra with
failure of the anterior and middle spinal columns and in some cases,
the posterior ones. Middle column failure in burst fractures results in
retropulsion of the posterior superior portion of the vertebral body
into the spinal canal. With marked retropulsion, compression of the
dural tube occurs, often with associated neurologic deficit.
Surgical procedures designed to decompress and stabilize
thoracolumbar burst fractures can be performed through anterior or
posterior approaches. The major site of compression is anterior, and
for this reason laminectomy does little to relieve compression of the
spinal cord over an anterior lesion. Indeed, laminectomy further
increases the instability of the spine.
6. The neurovascular structure most commonly injured as a result of
an anterior dislocation of the shoulder is the:
A. Musculocutaneous nerve.
B. Axillary nerve.
C. Axillary artery.
D. Median nerve.
Answer: B
DISCUSSION: The axillary nerve is at greatest risk for injury.
Occasionally a more severe neurologic deficit can occur as a result of
injury to the brachial plexus. Rarely has injury to the axillary artery
been reported.
7. The classification of fractures of the proximal humerus is based on:
A. The number of fracture segments and amount of displacement.
B. The mechanism of injury.
C. Presence or absence of associated dislocations.
Answer: A
DISCUSSION: The classification is based on fracture patterns involving
the four “segments” of the proximal humerus (anatomic neck, surgical
neck, and greater and lesser tuberosities). Fractures are one-, two-,
three-, or four-part fractures, depending on the number of fracture
segments and amount of displacement.
