Fractures (Basics, Complications, Healing, Principles of Management) MCQs

Orthopedics · 77 free questions with answers & explanations.

1. A 32-year-old man sustains a closed fracture of the shaft of femur. Two days after skeletal traction, he develops sudden onset dyspnoea, petechiae over the chest and upper limbs, and confusion. Arterial blood gas shows PaO2 of 58 mmHg. Which complication has occurred?
2. In fracture healing, the stage at which callus bridging the fracture gap consists primarily of woven bone and the fracture is clinically united but radiologically the line is still visible is called:
3. A 45-year-old woman is brought after a road traffic accident with suspected fracture of both bones of forearm. The most important initial step in managing this closed fracture is:
4. A 28-year-old construction worker develops severe pain, paraesthesia, and tense swelling of the forearm 6 hours after a crush injury without apparent fracture. Passive extension of fingers worsens the pain markedly. The most appropriate immediate management is:
5. Which of the following best describes delayed union of a fracture?
6. A 35-year-old man sustains a closed midshaft tibial fracture. At 6 months post-intramedullary nailing, X-ray shows persistent fracture gap with sclerotic bone ends and no callus bridging. The most appropriate next step is:
7. In Gustilo-Anderson classification of open fractures, a Type IIIB fracture is specifically characterized by:
8. A 28-year-old motorcyclist sustains a comminuted femur fracture. Intraoperative reaming of the medullary canal for IM nail insertion poses which of the following specific risks?
9. The Arbeitsgemeinschaft für Osteosynthesefragen (AO/OTA) classification for a distal radius fracture with intra-articular extension involving both the radiocarpal and radioulnar joints would be classified as:
10. A 45-year-old patient with a healed femoral shaft fracture complains of knee pain and instability 8 months later. X-ray shows callus but the limb has 15° varus angulation. The complication best explaining the knee symptoms is:
11. A 28-year-old motorcyclist sustains a closed femoral shaft fracture. Intramedullary nailing is planned. According to the AO/OTA classification, the fracture pattern that carries the WORST prognosis for healing with unreamed nailing is:
12. A stress fracture of the medial cortex of the femoral neck (tension-side) in a 19-year-old military recruit is detected on MRI. The MOST appropriate management is:
13. Hypertrophic non-union of a tibial shaft fracture is BEST managed by:
14. Volkmann's ischaemic contracture results from compartment syndrome most commonly associated with which fracture in children?
15. In Gustilo-Anderson open fracture classification, which type mandates IMMEDIATE plastic surgery consultation for soft tissue coverage within 72 hours to prevent osteomyelitis?
16. A 35-year-old man sustains a closed diaphyseal femur fracture in a road traffic accident. Intramedullary nailing is planned. Which of the following best describes the mechanism by which reamed intramedullary nailing achieves fixation stability?
17. In the AO/OTA fracture classification, the suffix '.C3' in a long bone fracture code indicates:
18. Regarding Gustilo-Anderson classification of open fractures, a tibial fracture with a 4 cm wound, moderate soft-tissue damage, and no periosteal stripping but with adequate soft-tissue cover is classified as:
19. A 52-year-old woman on long-term bisphosphonate therapy presents with a low-energy subtrochanteric femur fracture. X-ray shows cortical thickening of the lateral femoral cortex with a simple transverse or oblique fracture line. The most accurate diagnosis is:
20. Which of the following best describes the 'biological osteosynthesis' principle in fracture fixation?
21. A 35-year-old motorcyclist sustains a closed tibial shaft fracture. Intramedullary nailing is planned. Reaming of the canal is performed. Which of the following statements best describes the biological consequence of reaming on fracture healing?
22. During operative stabilisation of a femoral shaft fracture, a tourniquet is inadvertently left inflated for 3.5 hours. Postoperatively the patient has foot drop and loss of dorsal foot sensation. The nerve injury is most likely at which level and of which type?
23. Which AO/OTA fracture classification subtype indicates the worst prognosis for union in a femoral shaft fracture and specifically describes a comminuted, non-contact, segmental pattern?
24. A patient with a closed diaphyseal tibial fracture is being managed in a below-knee cast. On day 3, the patient complains of pain on passive extension of the toes that is disproportionate to the injury. Compartment pressure is measured at 38 mmHg with a diastolic BP of 80 mmHg. What is the delta pressure (ΔP) and should fasciotomy be performed?
25. A 45-year-old man has delayed union of a tibial shaft fracture at 5 months. X-ray shows periosteal reaction and sclerotic fracture ends without a bridging callus. Which of the following best describes the radiological type of non-union present?
26. A 35-year-old male sustains a closed femoral shaft fracture. Intramedullary nailing is planned. The reamer diameter is 1 mm larger than the final nail diameter. Which biomechanical principle does reaming achieve in this scenario?
27. In the AO/OTA fracture classification, a 'C3' designation in any long bone segment indicates which characteristic?
28. A 55-year-old on bisphosphonate therapy for 8 years presents with a prodromal aching thigh pain. X-ray shows lateral cortical thickening of the subtrochanteric femur with a transverse fracture line. This is BEST described as which fracture type?
29. During fracture healing, the transition from soft to hard callus is primarily driven by which cellular and molecular event?
30. A 40-year-old male has a closed tibial shaft fracture treated with intramedullary nailing. Six months post-op, X-ray shows no callus and the fracture gap remains visible. Screw breakage is noted. According to the Diamond Concept of fracture non-union management, which FOUR factors must be optimised?
31. A 34-year-old motorcyclist sustains a closed tibial shaft fracture. Radiograph shows >50% cortical contact but 10° of varus angulation. According to the principle of acceptable reduction for tibial shaft fractures, which of the following is BEYOND acceptable limits?
32. A Gustilo-Anderson Type IIIC open femur fracture is defined by which characteristic?
33. In fracture healing, which growth factor is primarily responsible for the transition from soft to hard callus by promoting chondrocyte hypertrophy and endochondral ossification?
34. A 60-year-old woman sustains a distal radius fracture treated with cast immobilization. At 8 weeks, X-ray shows no bridging callus. Which of the following definitions best applies to this situation?
35. The AO/OTA classification of fractures uses three hierarchical alphanumeric levels. Which level indicates the fracture 'type' based on morphology?
36. A 35-year-old man sustains a closed femoral shaft fracture treated with intramedullary nailing. On the third postoperative day he develops acute respiratory distress, petechiae over the chest and axillae, and confusion. His PaO2 is 62 mmHg. Which pathophysiological mechanism is MOST responsible for the hypoxia?
37. The AO/OTA classification grades open fractures based on periosteal stripping, bone vascularity, and contamination. Which Gustilo–Anderson grade specifically requires vascular repair for limb viability?
38. During remodelling of a fracture callus, which cellular mechanism allows angular deformity correction in children under 10 years?
39. A 50-year-old diabetic is treated with a below-knee cast for a distal tibia fracture. Four days later she reports burning pain and paraesthesia in the sole. Cast is removed and compartment pressures are 45 mmHg with an arterial pressure of 90 mmHg diastolic. The delta pressure (diastolic BP minus compartment pressure) is 45 mmHg. What is the correct next step?
40. In Danis–Weber classification of ankle fractures, which type correlates with injury to the inferior tibiofibular syndesmosis and always requires syndesmotic screw fixation?
41. A patient with a closed tibial shaft fracture develops compartment syndrome 6 hours after immobilization in a backslab. The measured compartment pressure is 38 mmHg, and the patient's diastolic BP is 65 mmHg. The absolute compartment pressure threshold for fasciotomy in this context is reached. Which formula and threshold confirms the indication for fasciotomy?
42. A 55-year-old woman develops fat embolism syndrome 48 hours after intramedullary nailing of a femoral shaft fracture. The Gurd and Wilson criteria for diagnosis include which combination?
43. A 65-year-old on long-term bisphosphonate therapy (alendronate for 8 years) presents with sudden onset thigh pain after minimal trauma. X-ray shows a complete subtrochanteric femoral fracture with a horizontal fracture line and lateral cortical beaking. Which fracture type is this, and what is the mechanism?
44. Fat embolism syndrome (FES) after long bone fracture typically presents with the classic triad 24–72 hours post-injury. The Gurd and Wilson criteria for clinical diagnosis require at least one major and four minor criteria. Which of the following is classified as a MAJOR criterion?
45. In the management of an open tibia fracture (Gustilo-Anderson Grade IIIB), the preferred timing for soft tissue reconstruction after initial wound debridement is:
46. The principle underlying intramedullary nailing for femoral shaft fractures is classified as 'load sharing' rather than 'load bearing.' This means:
47. A 25-year-old man with an open tibial fracture classified as Gustilo-Anderson IIIB is brought to the emergency department. After irrigation and debridement, which definitive soft tissue management is most appropriate for Gustilo IIIB?
48. A 45-year-old with a tibial fracture develops progressive compartment syndrome. Intracompartmental pressure is measured at 42 mmHg in a patient with a diastolic blood pressure of 70 mmHg. The threshold for fasciotomy based on delta pressure (ΔP = diastolic BP − compartment pressure) is:
49. Secondary bone healing (indirect/callus healing) is characterised by which sequence of stages in the correct order?
50. A 32-year-old woman develops fat embolism syndrome 48 hours after a femoral shaft fracture. Which triad of clinical findings is classic for fat embolism syndrome?
51. A 28-year-old woman develops fat embolism syndrome 36 hours after an intramedullary nailing of a closed femoral shaft fracture. The classic triad of fat embolism syndrome includes:
52. A 45-year-old man with a radial head fracture develops wrist and elbow pain one year later. X-ray shows a 'carpal supination' deformity with ulnar head prominence at the wrist. The injury most likely also disrupted:
53. The 'unhappy triad' of the knee (O'Donoghue triad), typically seen in a valgus twisting injury, consists of injury to:
54. In fracture healing by secondary (indirect) intention, the mechanical stimulus that drives conversion of the cartilaginous soft callus to hard (bony) callus is:
55. A 65-year-old woman on long-term bisphosphonate therapy for osteoporosis presents with a low-energy subtrochanteric femoral fracture. Plain X-ray shows a transverse fracture with cortical thickening of the lateral cortex and a 'beaking' pattern. This is classified as:
56. A 32-year-old male presents 3 months after tibial shaft fracture with no bridging callus on X-ray and the fracture gap is well-vascularized on bone scan. The most appropriate treatment for this hypertrophic non-union is:
57. In which fracture pattern is the risk of avascular necrosis of the femoral head HIGHEST?
58. A 25-year-old male sustains a closed tibial shaft fracture treated with intramedullary nailing. 48 hours later he develops worsening pain out of proportion, pain on passive toe extension, and a tense calf. Compartment pressure is measured at 42 mmHg. In a normotensive patient, this finding:
59. A 28-year-old man sustains a closed tibial shaft fracture managed with an intramedullary nail. At 6 months post-surgery, radiograph shows bridging callus on 3 cortices but no remodelling. He has mild pain on full weight-bearing. This is best described as:
60. A 42-year-old man with a severely comminuted open tibial fracture (Gustilo IIIB) undergoes emergency debridement. The definitive fracture stabilization method that allows wound access, avoids implant contamination, and maintains length while enabling soft tissue coverage is:
61. A 35-year-old patient develops fat embolism syndrome (FES) 48 hours after stabilization of bilateral femoral shaft fractures. Which clinical triad is pathognomonic of FES?
62. A 35-year-old sustains a tibial shaft fracture treated with intramedullary nailing. At 9 months, the fracture line remains visible with minimal callus and the patient has persistent pain. Plain radiographs show sclerotic fracture ends with a sealed medullary canal. This is best classified as:
63. In Gustilo–Anderson classification of open fractures, which grade is characterised by adequate soft tissue coverage of the bone despite extensive soft tissue laceration, with a wound >10 cm?
64. A 25-year-old develops acute compartment syndrome of the forearm after a both-bone forearm fracture and closed reduction. The diagnosis of compartment syndrome relies on measuring compartment pressure. The critical threshold for fasciotomy based on the delta pressure (diastolic pressure minus compartment pressure) is:
65. Fat embolism syndrome (FES) classically occurs 24–72 hours after long bone or pelvic fractures. The diagnostic triad of FES (Gurd's criteria) comprises:
66. A 25-year-old man sustains a closed diaphyseal femur fracture. After intramedullary nailing, fat embolism syndrome (FES) develops 24–48 hours post-surgery. The Gurd criteria for clinical diagnosis of FES requires at least one major criterion. Which is a MAJOR Gurd criterion for FES?
67. A 35-year-old man with a supracondylar femur fracture undergoes ORIF. At 6 months, X-ray shows bridging callus on three cortices but persistent fracture line on one cortex. There is no pain. This is classified as:
68. A 28-year-old man sustains a closed midshaft tibial fracture. After conservative management with long-leg cast, follow-up X-ray at 12 weeks shows 'elephant foot' callus with persistent fracture gap and no progression over the last 6 weeks. This pattern of non-union implies:
69. A 45-year-old undergoes intramedullary nailing of a diaphyseal tibial fracture. At 8 months, the fracture line is still clearly visible on radiograph and callus bridges the fracture at less than 25% of the cortical diameter. There is no pain or tenderness. The most appropriate next step is:
70. Compartment syndrome is confirmed in a 19-year-old after closed tibial fracture. Intracompartment pressure is 42 mmHg and diastolic blood pressure is 70 mmHg. The critical pressure differential (delta-P) that mandates fasciotomy is:
71. Fat embolism syndrome (FES) following long bone fractures classically presents 24–72 hours post-injury with the triad of:
72. Fat embolism syndrome (FES) typically develops 24–72 hours after a major long bone fracture. The definitive diagnostic criteria (Gurd's criteria) requiring 2 major OR 1 major + 4 minor criteria include a pathognomonic finding that distinguishes FES from other causes of respiratory distress. This pathognomonic finding is:
73. Hypertrophic non-union of a tibial shaft fracture (with radiological callus present but failure to bridge) indicates that the fracture site has adequate biology but inadequate mechanical stability. The principle underlying the treatment choice is:
74. Compartment syndrome of the forearm is most reliably diagnosed by measuring compartment pressure. The threshold for fasciotomy based on absolute compartment pressure (ΔP = diastolic BP − compartment pressure) is:
75. A patient develops fat embolism syndrome (FES) 24–48 hours after closed bilateral femoral shaft fractures. The Gurd and Wilson criteria for diagnosis of FES require which combination?
76. Wolff's Law states that bone remodels in response to mechanical stress. The cellular mechanism mediating this mechanotransduction is best attributed to:
77. A patient develops compartment syndrome of the forearm following a supracondylar humerus fracture. The earliest reliable clinical finding that mandates fasciotomy is: