Lift off test is done to assess the function of:
The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -
In which condition is the Hamilton Ruler test sign positive?
Which of the following statements is true regarding a Monteggia fracture?
Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?
Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?
In which of the following deformities is the distal interphalangeal joint extended?
4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -
Undertaker's fracture is seen at the level of cervical vertebra:
NEET-PG 2015 - Orthopaedics NEET-PG Practice Questions and MCQs
Question 21: Lift off test is done to assess the function of:
- A. Supraspinatus muscle function
- B. Infraspinatus muscle function
- C. Subscapularis muscle function (Correct Answer)
- D. Teres Minor muscle function
Explanation: ***Subscapularis muscle function*** - The **Lift-off test**, or Gerber's Lift-off test, specifically assesses the integrity and strength of the **subscapularis muscle** by evaluating its internal rotation and extension strength. - A positive test occurs when the patient is unable to lift their hand off their back, indicating a **subscapularis tear or weakness**. *Supraspinatus muscle function* - The **supraspinatus muscle** is primarily tested with the **empty can test** or full can test, which assess its role in shoulder abduction. - These tests evaluate for **impingement** or **tears** of the supraspinatus tendon. *Infraspinatus muscle function* - The **infraspinatus muscle** is mainly responsible for external rotation and is assessed using tests like the **resisted external rotation test** with the arm at the side. - This test is used to detect **infraspinatus tears** or weakness. *Teres Minor muscle function* - The **teres minor muscle** also contributes to external rotation of the shoulder, often tested in conjunction with the infraspinatus. - Its function can be isolated by testing resisted **external rotation** in 90 degrees of abduction and external rotation.
Question 22: The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -
- A. Supracondylar Fracture of the humerus (Correct Answer)
- B. Monteggia Fracture dislocation
- C. Fracture of Proximal Radius
- D. Fracture lateral condyle of the humerus
Explanation: ***Supracondylar Fracture of the humerus*** - **Anterior humeral line** passes through the **anterior cortex of the humerus** and should intersect the middle third of the capitellum in a normal elbow. - In supracondylar fractures, particularly those with **posterior displacement**, this line is often displaced **anteriorly or posteriorly**, failing to intersect the capitellum correctly. Additionally, the **radiocapitellar alignment** refers to the relationship between the **radius head** and the **capitellum**. Fractures and displacements around the elbow joint, such as supracondylar fractures, can disrupt this alignment. *Fracture lateral condyle of the humerus* - While a fracture of the lateral condyle can affect the elbow joint, it primarily involves a part of the **articular surface** and not necessarily the overall alignment of the entire distal humerus relative to the capitellum in the same way a supracondylar fracture does. - The **lateral condyle** is a smaller segment, and its fracture may not significantly alter the anterior humeral line **unless there is significant displacement** that indirectly affects the alignment of the capitellum. *Monteggia Fracture dislocation* - A **Monteggia fracture** involves a fracture of the **ulna** with dislocation of the **radial head** at the elbow. - While radiocapitellar alignment is severely disrupted, the **anterior humeral line** itself, which assesses the distal humerus, is typically **unaffected** as the primary injury is in the forearm bones and the radial head. *Fracture of Proximal Radius* - A fracture of the proximal radius (e.g., **radial head or neck fracture**) primarily affects the **radial articular surface** and its alignment with the capitellum. - While **radiocapitellar alignment** would clearly be disturbed, the position of the **distal humerus** relative to the capitellum, which the anterior humeral line evaluates, usually remains intact.
Question 23: In which condition is the Hamilton Ruler test sign positive?
- A. Anterior dislocation of shoulder (Correct Answer)
- B. Posterior dislocation of shoulder
- C. Luxatio erecta
- D. Acromioclavicular joint dislocation
Explanation: ***Anterior dislocation of shoulder*** - The **Hamilton Ruler test** is positive when a straight edge, like a ruler, can be laid across the **lateral aspect of the deltoid prominence** from the acromion to the lateral epicondyle. - This is indicative of the **loss of the normal rounded contour of the shoulder**, which occurs due to the humeral head dislocating anteriorly. *Acromioclavicular joint dislocation* - This condition presents with a **"step-off" deformity** at the AC joint and pain directly over the joint, but the overall contour of the shoulder glenohumeral joint is preserved. - The deltoid prominence remains intact, making the Hamilton Ruler test negative. *Posterior dislocation of shoulder* - In posterior dislocation, the **humeral head moves posteriorly**, and the anterior contour of the shoulder might appear flattened, but the characteristic prominent anterior bulge seen in anterior dislocation is absent. - The Hamilton Ruler test specifically assesses for the loss of the lateral deltoid prominence, which is more typical of anterior displacement. *Luxatio erecta* - **Luxatio erecta** is an inferior dislocation of the shoulder where the arm is fixed in an **abducted and externally rotated position**, making it appear "erect". - While a severe type of shoulder dislocation, the specific anatomical changes that lead to a positive Hamilton Ruler test (loss of lateral deltoid prominence with the humeral head moving anteriorly and medially) are not typically present in this configuration.
Question 24: Which of the following statements is true regarding a Monteggia fracture?
- A. Upper ulnar fracture with dislocated radial head. (Correct Answer)
- B. Upper radial fracture with dislocated ulna.
- C. Lower radial fracture with dislocated ulna.
- D. Lower ulnar fracture with dislocated radius.
Explanation: ***Upper ulnar fracture with dislocated radial head.*** - A Monteggia fracture is classically defined as a fracture of the **proximal or middle third of the ulna** accompanied by an **anterior dislocation of the radial head**. - This injury pattern disrupts the alignment of the **forearm bones** and the **elbow joint**, requiring careful reduction and stabilization. *Upper radial fracture with dislocated ulna.* - This statement incorrectly identifies the fractured bone as the radius and the dislocated bone as the ulna. - The defining characteristic of a Monteggia fracture is the **ulnar fracture** and **radial head dislocation**. *Lower radial fracture with dislocated ulna.* - This describes a different type of injury, such as a **Galeazzi fracture**, which involves a **radial shaft fracture** with dislocation of the **distal radioulnar joint**. - It does not fit the criteria for a Monteggia fracture pattern. *Lower ulnar fracture with dislocated radius.* - This description is not consistent with a Monteggia fracture, which specifically involves the **proximal ulna** and **radial head dislocation**. - A lower ulnar fracture with distal radius dislocation is a distinct injury pattern.
Question 25: Fracture neck of femur in 80-year-old male sustained 1 week ago. The treatment of choice is -
- A. Hemiarthroplasty (Correct Answer)
- B. Closed reduction and fixation with three cancellous screws
- C. Longitudinal skin traction for 6 weeks
- D. Excision arthroplasty
Explanation: ***Hemiarthroplasty*** - For an 80-year-old with a **fracture of the femoral neck**, especially if sustained a week ago, **hemiarthroplasty** is the preferred treatment to allow early mobilization and prevent complications of prolonged recumbency. - This procedure replaces the **femoral head** and neck, minimizing the risk of **avascular necrosis** and **non-union** which are common complications in older patients with displaced femoral neck fractures. *Excision arthroplasty* - **Excision arthroplasty**, also known as **Girdlestone arthroplasty**, is a salvage procedure typically reserved for cases of severe infection, failed prosthetic implants, or when other options are not viable. - It involves removing the femoral head, creating a **pseudarthrosis**, and results in a shortened, unstable limb, making it unsuitable as a primary treatment. *Closed reduction and fixation with three cancellous screws* - This option is generally considered for **younger patients** with undisplaced or minimally displaced **femoral neck fractures** due to better bone quality and lower risk of avascular necrosis. - In an 80-year-old, the risks of **non-union** and **avascular necrosis** are significantly higher, and the prolonged weight-bearing restrictions associated with this method are detrimental. *Longitudinal skin traction for 6 weeks* - Prolonged **skin traction** is rarely used for femoral neck fractures, especially in the elderly, due to the high risk of complications such as **skin breakdown**, **deep vein thrombosis**, **pneumonia**, and **muscle atrophy**. - It does not provide definitive fixation and is not a definitive treatment for a bony fracture.
Question 26: Which of the following fractures of the neck of femur are associated with maximal compromise in blood supply ?
- A. Basicervical fracture
- B. Trans cervical fracture
- C. Sub Capital fractures (Correct Answer)
- D. Intertrochanteric fractures
Explanation: ***Sub Capital fractures*** - These fractures occur at the anatomical **neck of the femur**, very close to the femoral head. - Due to their location, they disrupt the main blood supply to the femoral head, primarily from the **retinacular arteries**, leading to a high risk of **avascular necrosis**. *Trans cervical fracture* - This fracture occurs through the **midneck of the femur**, which is still within the intracapsular region. - While it has a significant risk of **ischemia**, the compromise is generally less severe than in subcapital fractures. *Intertrochanteric fractures* - These are **extracapsular fractures** occurring between the greater and lesser trochanters. - They tend to have an **excellent blood supply** and thus a low risk of avascular necrosis, but are associated with more significant blood loss and malunion issues. *Basicervical fracture* - This is an **intracapsular fracture** that occurs at the base of the femoral neck, near the junction with the trochanters. - Although intracapsular, its position is slightly more proximal than subcapital fractures, potentially leaving more of the **retinacular vessels** intact, resulting in a somewhat lower risk of avascular necrosis compared to subcapital fractures.
Question 27: Which type of femur fracture has the HIGHEST risk of Avascular Necrosis (AVN)?
- A. Subcapital fracture (Correct Answer)
- B. Intertrochanteric fracture
- C. Transcervical fracture
- D. None of the options
Explanation: ***Subcapital fracture*** - This fracture type occurs at the **neck of the femur**, very close to the femoral head's blood supply. - Due to the **intracapsular location**, it severely compromises the **medial and lateral circumflex femoral arteries**, leading to a high risk of **avascular necrosis (AVN)**. *Intertrochanteric fracture* - This fracture is **extracapsular**, occurring below the femoral neck between the greater and lesser trochanters. - While significant, its location generally leaves the **blood supply to the femoral head intact**, thus having a much lower risk of AVN compared to intracapsular fractures. *Transcervical fracture* - This is an **intracapsular fracture** of the femoral neck, but it is located more centrally within the neck. - While it does carry a significant risk of AVN due to disruption of blood supply, the subcapital fracture, being more proximate to the head, typically has an even higher risk due to a greater degree of compromise to the main blood vessels. *None of the options* - This option is incorrect because **subcapital fractures** are well-documented for having the highest risk of avascular necrosis among femur fractures due to their specific anatomical location and impact on blood supply.
Question 28: In which of the following deformities is the distal interphalangeal joint extended?
- A. Boutonniere deformity (Correct Answer)
- B. Swan neck deformity
- C. Claw Hand
- D. Z deformity
Explanation: ***Boutonniere deformity*** - This deformity is characterized by **flexion of the proximal interphalangeal (PIP) joint** and **hyperextension of the distal interphalangeal (DIP) joint**. - It often results from injury to the **central slip of the extensor tendon** at the PIP joint. *Swan neck deformity* - This deformity presents with **hyperextension of the PIP joint** and **flexion of the DIP joint**, which is the opposite of the question's premise. - It is commonly associated with underlying conditions like **rheumatoid arthritis** or **lupus**. *Z deformity* - This typically refers to the **thumb in rheumatoid arthritis**, where the carpometacarpal (CMC) joint is flexed, the metacarpophalangeal (MCP) joint is hyperextended, and the interphalangeal (IP) joint is flexed. - It does not primarily describe an extended DIP joint in the context of other fingers. *Claw Hand* - This deformity involves **hyperextension of the MCP joints** and **flexion of the PIP and DIP joints**, particularly of the fourth and fifth fingers. - It is caused by **ulnar nerve palsy**, leading to muscle imbalance.
Question 29: 4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -
- A. Torus Fracture
- B. Greenstick fracture (Correct Answer)
- C. Galleazi Fracture
- D. Monteggia Fracture Dislocation
Explanation: ***Greenstick fracture*** - This fracture type involves a **broken anterior cortex** but an **intact posterior cortex**, leading to an exaggerated bowing of the bone, characteristic of a greenstick fracture. - It occurs predominantly in **children** due to their softer, more flexible bones, which tend to bend rather than fully break when subjected to force like a fall on an outstretched hand. *Torus Fracture* - A torus fracture, or **buckle fracture**, involves compression of the bone leading to a bulging or buckling of the cortex, usually on one side, without a complete break in the bone. - While it occurs in children, it presents as a compression injury and not with a broken cortex and intact posterior cortex with bowing. *Galleazi Fracture* - A Galleazi fracture is a fracture of the **distal radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This fracture pattern involves two bones and two distinct injuries (fracture and dislocation), which is fundamentally different from the described single-bone incomplete fracture. *Monteggia Fracture Dislocation* - A Monteggia fracture involves a fracture of the **proximal ulna** with **dislocation of the radial head** at the elbow. - This injury also involves two bones and two distinct components (fracture and dislocation) and affects a different anatomical location (ulna and elbow) than described.
Question 30: Undertaker's fracture is seen at the level of cervical vertebra:
- A. C5-C6
- B. C6-C7 (Correct Answer)
- C. C3-C4
- D. C1-C2
Explanation: **C6-C7** - An **undertaker's fracture** is a post-mortem injury typically seen in cases of hanging, resulting from the neck's hyperextension. - It commonly affects the lower cervical spine, most frequently at the **C6-C7 level**, due to the biomechanics of the forces involved. *C5-C6* - While cervical fractures can occur at various levels, **C5-C6** is less common for an undertaker's fracture specifically. - This level is more frequently associated with **cervical spondylosis** or traumatic injuries from falls. *C3-C4* - Fractures at the **C3-C4 level** can be life-threatening as they are close to the phrenic nerve origin, but they are not characteristic of "undertaker's fracture." - Injuries at this level are less common in the specific context of post-mortem hyperextension. *C1-C2* - Fractures of **C1 (atlas) and C2 (axis)**, such as a Jefferson fracture or hangman's fracture, are distinct and result from different mechanisms. - They are not typically referred to as "undertaker's fracture," which implies a specific post-mortem injury pattern.