INI-CET 2024 — Orthopaedics
2 Previous Year Questions with Answers & Explanations
A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
A 26-year-old male presented with proximal 1/3rd fracture shaft of the femur. What is the treatment of choice in this patient?
INI-CET 2024 - Orthopaedics INI-CET Practice Questions and MCQs
Question 1: A 75-year-old man presents with a fracture of the intracapsular neck of the femur. What is the most common management option for this patient?
- A. Hemiarthroplasty (Correct Answer)
- B. Total Hip Replacement
- C. Dynamic Hip Screw
- D. Conservative Management
Explanation: ### **Explanation: Management of Fracture Neck of Femur in the Elderly** The management of **intracapsular neck of femur (NOF) fractures** is primarily determined by the patient's age, activity level, and the risk of **Avascular Necrosis (AVN)** or non-union due to the precarious retrograde blood supply (medial circumflex femoral artery). #### **Why Hemiarthroplasty is Correct** For an **elderly patient (typically >65–70 years)** with a displaced intracapsular fracture, **Hemiarthroplasty** is the most common management. * **Rationale:** It allows for **early mobilization** (weight-bearing as tolerated), which is crucial to prevent complications like pneumonia, DVT, and pressure sores. * It is preferred over internal fixation because the elderly have poor bone quality and a high risk of fixation failure or AVN. #### **Why Other Options are Incorrect** * **Total Hip Replacement (THR):** While THR provides better long-term functional outcomes and less pain compared to hemiarthroplasty, it is reserved for **active elderly** patients without cognitive impairment or those with pre-existing osteoarthritis. Hemiarthroplasty remains the "most common" choice for the general elderly population due to shorter operative time and lower dislocation risk. * **Dynamic Hip Screw (DHS):** This is the gold standard for **extracapsular (intertrochanteric)** fractures, not intracapsular fractures. * **Conservative Management:** Rarely indicated; only used for patients who are medically unfit for any anesthesia, as it carries a very high mortality rate due to prolonged recumbency. #### **High-Yield Clinical Pearls for NEET-PG/INI-CET** * **Garden’s Classification:** Used for intracapsular fractures. Stage III and IV (displaced) in the elderly require arthroplasty. * **Young Patients (<55-60 years):** Always attempt **Internal Fixation** (e.g., Multiple Cannulated Cancellous Screws) to "Save the Head," regardless of displacement. * **Unipolar vs. Bipolar:** Bipolar hemiarthroplasty is often preferred to reduce acetabular wear. * **Most common complication of Hemiarthroplasty:** Acetabular erosion (protrusio acetabuli) over long-term follow-up.
Question 2: A 26-year-old male presented with proximal 1/3rd fracture shaft of the femur. What is the treatment of choice in this patient?
- A. Hip Spica
- B. Above knee Cast
- C. Above knee Slab
- D. Interlocking Nail (Correct Answer)
Explanation: ### **Explanation** The treatment of choice for a fracture of the shaft of the femur in an adult is **Intramedullary Interlocking Nailing**. #### **Why Interlocking Nail is Correct?** * **Gold Standard:** For almost all femoral shaft fractures in adults (proximal, middle, or distal thirds), interlocking intramedullary nailing is the treatment of choice. * **Biomechanics:** The nail acts as an **internal splint** and a **load-sharing device**, allowing for early mobilization and weight-bearing. * **Biological Fixation:** It preserves the fracture hematoma and periosteal blood supply (unlike open reduction with plating), leading to higher union rates and lower infection risks. * **Rotational Stability:** The "interlocking" screws prevent rotation and shortening, which was a major limitation of older Kuntscher (K-nails). #### **Why Other Options are Incorrect?** * **Hip Spica (A):** Primarily used in **pediatric** femoral fractures (usually children <6 years). In adults, it leads to "fracture disease" (joint stiffness, muscle atrophy, and pressure sores) and has high failure rates. * **Above Knee Cast/Slab (B & C):** The femur is surrounded by heavy musculature (quadriceps and hamstrings). These muscles exert powerful distracting forces that a cast cannot neutralize, leading to malunion or non-union. Casts are insufficient for stabilizing long bone fractures in the thigh of an adult. --- ### **High-Yield Clinical Pearls for NEET-PG / INI-CET** * **Entry Point:** For proximal 1/3rd fractures, the entry point is typically the **Piriformis fossa** or the **Greater Trochanter** (depending on the nail design). * **Positioning:** Proximal 1/3rd fractures often result in a **flexed, abducted, and externally rotated** proximal fragment due to the pull of the Iliopsoas and Gluteal muscles. * **Winquist Classification:** Used to grade the degree of comminution in femoral shaft fractures. * **Complication:** The most common systemic complication of a femur shaft fracture is **Fat Embolism Syndrome**. Early stabilization with a nail significantly reduces this risk.