Lower Limb Trauma (Hip, Femur, Knee, Tibia, Foot) MCQs

Orthopedics · 81 free questions with answers & explanations.

1. A 75-year-old woman is brought after a fall at home. She cannot bear weight and the right lower limb is shortened, externally rotated, and adducted. X-ray shows a subcapital fracture of the femoral neck. The most important reason to operate early is to prevent:
2. A patient involved in a high-speed road traffic accident is positioned in the ambulance with the right hip flexed, adducted, and internally rotated with a shortened limb. No fracture is visible on the AP pelvis X-ray. The diagnosis is:
3. A 30-year-old footballer sustains a twisting injury to the knee. He felt a pop and his knee swelled immediately within 1 hour. On examination there is positive anterior drawer test and positive Lachman's test. The structure most likely injured is:
4. A 40-year-old pedestrian is hit by a vehicle and sustains a fracture of the proximal tibia. After 12 hours, he complains of severe calf pain worsening on dorsiflexion of the foot, with paraesthesia of the dorsum of the foot. Compartment pressure is 42 mmHg. The most likely affected compartment is:
5. Which of the following is the most common complication of an undisplaced fracture of the neck of femur treated with cannulated screws?
6. A 70-year-old woman with osteoporosis sustains a Garden Type III displaced intracapsular neck of femur fracture. The treatment of choice is:
7. A 55-year-old man sustains an intertrochanteric fracture of the femur classified as AO/OTA 31-A2.2 (unstable 4-part fracture). Which implant provides superior biomechanical stability compared to a Dynamic Hip Screw alone?
8. A 22-year-old athlete twists his knee during football. Examination shows a positive anterior drawer test, positive Lachman test, and a pivot shift. MRI confirms anterior cruciate ligament (ACL) tear with associated medial meniscus tear. Regarding the 'unhappy triad' (O'Donoghue's triad), which three structures are classically involved?
9. A 40-year-old man sustains a pilon fracture (tibial plafond fracture) after a fall from height. The Ruedi-Allgower classification Type III fracture is characterized by:
10. A 35-year-old falls from a height and sustains bilateral calcaneal fractures. CT scan shows a fracture with involvement of the posterior facet of the subtalar joint. The CT classification most widely used for surgical planning of calcaneal fractures is:
11. In the Garden classification of femoral neck fractures, a Type II fracture is defined as:
12. A 70-year-old osteoporotic woman sustains an Evans Type II intertrochanteric fracture of the right hip. The MOST important biomechanical consideration when selecting an implant is:
13. A 25-year-old male sustains a posterior dislocation of the hip in a road traffic accident. After closed reduction, the MOST important next step is:
14. In the Schatzker classification of tibial plateau fractures, a Type IV fracture involves:
15. A calcaneal fracture sustained from a fall from height shows a decreased Bohler's angle (less than 20°). This angle is measured between:
16. A 72-year-old woman sustains a femoral neck fracture after a low-energy fall. Garden classification shows complete displacement with 180° rotation of the femoral head relative to the neck axis. The most appropriate definitive management is:
17. A 55-year-old man with a Seinsheimer Type V subtrochanteric femur fracture is planned for surgery. Which implant provides the greatest biomechanical advantage in this fracture pattern?
18. In the AO classification of distal femur fractures, a fracture coded as '33-C3' represents:
19. A 30-year-old motorcyclist sustains a posterior dislocation of the knee. Which immediate investigation is mandatory before attempting closed reduction?
20. According to the Lauge-Hansen classification of ankle fractures, a supination–adduction (SA) Stage II injury produces which specific fracture combination?
21. A 45-year-old man presents with a fracture of the base of the 5th metatarsal extending into the metaphyseal-diaphyseal junction (Jones zone), without involvement of the 4th–5th intermetatarsal articulation. The most appropriate treatment is:
22. A 78-year-old woman with Garden type III intracapsular femoral neck fracture is admitted within 6 hours of injury. She is independently ambulatory and has mild hypertension controlled on amlodipine. What is the MOST appropriate definitive management?
23. In the Evans classification of intertrochanteric fractures, which pattern is considered inherently UNSTABLE and requires special consideration in implant selection?
24. A 32-year-old man sustains a posterior hip dislocation in a road traffic accident. Closed reduction is achieved under general anaesthesia at 4 hours post-injury. Despite successful reduction, the patient develops avascular necrosis (AVN) of the femoral head at 18 months. Which pathophysiological mechanism is the PRIMARY determinant of AVN in this case?
25. A 40-year-old man falls from a height and sustains a calcaneal fracture. CT scan shows a Sanders type IIC fracture (single fracture line in the middle third of the posterior facet involving both medial and middle columns). What is the PREFERRED treatment?
26. A 23-year-old athlete sustains a Schatzker type IV tibial plateau fracture (medial condyle fracture) after a valgus knee injury. What associated injury MUST be actively excluded?
27. A 72-year-old woman sustains an intertrochanteric femur fracture classified as AO/OTA 31-A2.2 (unstable, 3-part). The BEST implant choice to restore the medial buttress and resist varus collapse is:
28. In Garden's classification of femoral neck fractures, which stage carries the highest risk of avascular necrosis of the femoral head due to complete disruption of the retinacular vessels?
29. A 25-year-old sportsman sustains an isolated posterolateral corner (PLC) injury of the knee confirmed on MRI, with 10 degrees of increased tibial external rotation at 30 degrees flexion but not at 90 degrees. This represents which grade of PLC injury according to LaPrade's classification?
30. A 45-year-old man has a calcaneal fracture after a fall from height. Sanders CT classification shows 4 fracture fragments in the posterior facet. What is the Sanders classification and recommended treatment?
31. Following a tibial plateau fracture treated with ORIF, a patient develops acute compartment syndrome. The threshold for fasciotomy based on absolute compartment pressure is:
32. An 80-year-old woman with displaced femoral neck fracture (Garden Type IV) is evaluated for surgery. Which surgical option is MOST appropriate according to current NICE/AO guidelines?
33. A 35-year-old with a subtrochanteric femur fracture is classified as Seinsheimer Type IIIb. This pattern is best described as:
34. In femoral shaft fractures treated with intramedullary nail, which technique determines the correct rotational alignment before locking?
35. The Schatzker classification of tibial plateau fractures: a Type IV fracture is characterized by which pattern?
36. A 24-year-old basketball player lands awkwardly and sustains an OCD (osteochondritis dissecans) lesion of the medial femoral condyle. Which feature on MRI would indicate an UNSTABLE lesion requiring surgery?
37. A 72-year-old woman sustains a Garden Stage III displaced intracapsular femoral neck fracture. She is independently mobile with no cognitive impairment. Which implant strategy offers the best functional outcome and lowest reoperation rate?
38. A 30-year-old motorcyclist sustains a high-energy femoral shaft fracture (AO 32-C2). Which of the following is the definitive treatment of choice in a haemodynamically stable patient?
39. A 45-year-old man suffers a tibial plateau fracture in a road traffic accident. CT scan shows a lateral plateau depression of 12 mm with a split-depression pattern (Schatzker Type II). What is the standard surgical principle for restoring articular congruence?
40. A 25-year-old football player twists his knee in a valgus-external rotation force. He develops acute haemarthrosis and a positive Lachman test (grade 2) with a firm end-point. MRI shows ACL disruption, medial meniscus tear, and MCL sprain (O'Donoghue's unhappy triad). What is the initial management priority?
41. A 55-year-old man has a displaced trimalleolar ankle fracture. Which component, when fractured and exceeding 25% of the tibial articular surface on CT, mandates open reduction and fixation of the posterior malleolus?
42. A 35-year-old man sustains a posterior hip dislocation in a road traffic accident. On arrival, the limb is shortened, internally rotated, and adducted. The dislocation is reduced within 4 hours. Two weeks later, MRI shows signal abnormality in the femoral head consistent with early avascular necrosis. Which factor most significantly determines the risk of developing AVN after posterior hip dislocation?
43. A 25-year-old footballer sustains an acute anterior cruciate ligament (ACL) rupture confirmed by MRI. He wishes to return to competitive sports. Which graft choice for ACL reconstruction has been shown in prospective studies to have the lowest re-rupture rate in young athletes returning to sport?
44. A 70-year-old woman presents with a Garden Grade III displaced subcapital femoral neck fracture 12 hours after a fall. She is independently ambulatory and has no cognitive impairment. The most appropriate surgical treatment is:
45. A 78-year-old osteoporotic woman sustains a displaced subcapital femoral fracture (Garden IV). The optimal surgical management to minimize morbidity and allow immediate full weight bearing is:
46. The Schatzker classification of tibial plateau fractures: a Type IV fracture is characterized by:
47. Lisfranc fracture-dislocation of the tarsometatarsal joint complex is a diagnostic pitfall. The radiographic finding on weight-bearing AP foot X-ray that confirms significant Lisfranc instability is:
48. A 75-year-old woman sustains an intracapsular femoral neck fracture (Garden type III). She has mild cognitive impairment but was independently mobile with a walking stick. What is the most appropriate surgical treatment?
49. A 30-year-old motorcyclist has a type IIIB open tibial shaft fracture with 8 cm of periosteal stripping. After debridement, which is the preferred method of definitive skeletal stabilisation?
50. A 22-year-old sports player sustains a tri-plane fracture of the distal tibia. This fracture is unique to a specific age group because it occurs during:
51. A 72-year-old woman presents with a displaced subcapital fracture of the femoral neck (Garden IV). She is otherwise medically fit. The preferred surgical management is:
52. A 30-year-old man is involved in a motor vehicle collision and sustains a posterior dislocation of the hip. The hip must be reduced within what time frame to minimise the risk of avascular necrosis of the femoral head?
53. A 25-year-old sportsman injures his knee during football. Examination reveals a positive anterior drawer test, positive Lachman test, and positive pivot shift test. MRI confirms complete anterior cruciate ligament (ACL) rupture. The ACL graft of choice for reconstruction in a young active athlete is:
54. An Ottawa ankle rule guides clinical decision-making for ankle radiographs in trauma. According to this rule, radiographs are indicated if there is bone tenderness at the:
55. A 75-year-old woman presents with a Garden type IV femoral neck fracture. She is functionally independent and walks without aids. The preferred surgical management is:
56. In the management of isolated posterior cruciate ligament (PCL) injuries, the clinical test that most reliably demonstrates posterior tibial sag in a PCL-deficient knee is:
57. The Ottawa Ankle Rules indicate that an ankle radiograph is required if there is:
58. A 22-year-old footballer sustains a knee injury during a tackle. He has hemarthrosis, positive Lachman test, and MRI shows complete ACL tear with associated medial meniscus tear and medial collateral ligament injury. This triad is known as:
59. Garden's classification of femoral neck fractures (FNF) determines treatment strategy. A Garden Stage III fracture is characterized by:
60. An open fracture of the tibia with a wound of 8 cm, moderate contamination, severe periosteal stripping, and arterial injury requiring repair is classified according to Gustilo-Anderson as:
61. A 30-year-old runner develops anterior knee pain aggravated by prolonged sitting, stair climbing, and squatting. Examination reveals lateral patellar tilt on passive patellar mobility testing and positive Clarke's sign. The primary pathological mechanism is:
62. A 78-year-old woman with an undisplaced intracapsular femoral neck fracture (Garden Type I) who is independently ambulant and medically fit is best managed by:
63. A 55-year-old man falls from height and sustains a calcaneal fracture with intra-articular extension. CT scan demonstrates a Sander's Type IV fracture (comminuted, involving all three columns of the posterior facet). The Böhler's tuber-joint angle on lateral radiograph is 5°. For a medically fit, non-diabetic, non-smoking patient, the most appropriate management is:
64. A 32-year-old soccer player sustains an isolated posterior cruciate ligament (PCL) injury. Posterior drawer test is 2+ positive at 90° flexion. MRI confirms complete PCL tear. All other ligaments are intact. The initial management for an isolated acute PCL injury in this setting should be:
65. A 78-year-old woman with a displaced femoral neck fracture (Garden III) is medically fit for surgery. Her pre-injury mobility was limited to indoors with a frame and she has moderate dementia. The most appropriate surgical procedure is:
66. A posterior tibiotalar dislocation with a posterolateral talar dome osteochondral defect is identified on CT scan. After closed reduction, the osteochondral fragment is displaced > 5 mm and the lesion is > 15 mm in diameter. The most appropriate management is:
67. An isolated posterior cruciate ligament (PCL) injury grade III (> 10 mm posterior step-off) in a 30-year-old athlete is confirmed on MRI. Associated posterolateral corner (PLC) structures are intact. After failure of 6 months of conservative rehabilitation, surgical reconstruction is planned. The preferred graft source and technique for isolated PCL reconstruction is:
68. A 75-year-old woman with a displaced intracapsular femoral neck fracture (Garden type IV) is seen 12 hours after injury. She is fit for surgery (ASA II). The optimal treatment to allow immediate full weight-bearing and avoid the risk of avascular necrosis is:
69. A 40-year-old man sustains a knee dislocation after a high-velocity MVA. On examination, both cruciate ligaments and the posterolateral corner (PLC) are disrupted. The vascular structure most at risk in posterior knee dislocation is:
70. In tibial plateau fractures, the Schatzker classification is widely used. Which Schatzker type carries the highest risk of associated neurovascular and ligamentous injuries and requires the most complex surgical management?
71. A 78-year-old woman sustains a Garden grade III displaced intracapsular femoral neck fracture. She was independently ambulatory before the injury. The most appropriate surgical management, accounting for the disrupted blood supply to the femoral head, is:
72. In tibial plateau fractures, Schatzker type VI (bicondylar fracture with metaphyseal-diaphyseal dissociation) is optimally managed by:
73. A patient sustains an isolated talar neck fracture with subtalar dislocation (Hawkins type II). The most feared late complication and its radiographic predictor (the Hawkins sign) are:
74. A 75-year-old woman on anticoagulants sustains a Garden Type IV subcapital femoral neck fracture. She was independently mobile before injury with no significant comorbidities. The optimal surgical treatment is:
75. A 40-year-old man sustains a knee dislocation (tibiofemoral dislocation) in a motorcycle accident. After closed reduction, serial ABI (ankle-brachial index) shows ABI of 0.72 (normal >0.9) in the right lower limb. The next most appropriate step is:
76. A 30-year-old cyclist has a tibial plateau fracture. CT scan shows a lateral plateau split-depression fracture with depression of 10 mm and a fragment involving 40% of the lateral plateau. Ligamentous instability is noted. Schatzker classification of this fracture is:
77. An 80-year-old woman with osteoporosis slips on the floor. X-ray shows a fracture of the neck of the femur with complete displacement; the head is rotated and the limb is shortened and externally rotated. Garden classification would place this as:
78. A 55-year-old man is operated for an intertrochanteric fracture of the femur with a dynamic hip screw (DHS). Which anatomical feature determines the position of the lag screw and is critical for stable fixation?
79. A 25-year-old football player sustains a twisting injury to the knee and is brought to casualty. X-ray shows a vertical fracture of the lateral tibial plateau (Schatzker type I). The mechanism is best explained by:
80. A 30-year-old man sustains a closed tibial shaft fracture from a road traffic accident. The fracture is at the junction of the middle and lower thirds with moderate displacement. The neurovascular status is intact. What is the preferred method of definitive fixation?
81. A 19-year-old athlete has sudden severe ankle pain after being tackled. X-ray shows a spiral fracture of the distal fibula at the level of the ankle mortise with medial clear space widening on the stress view. This corresponds to which Weber/AO classification and what does medial clear space widening indicate?