Dislocations of the Hip Joint MCQs

Answer- A. To prevent blood loss Fracture shaft femur can cause upto 2L of blood loss and severe hypotension, if not immoblized early. the fracture shaft femur should be immoblized early. This can be temporary immobilization by TT splint followed by surgery or can be by immediate surgery.

In adults, the elbow is the second most frequently dislocated major joint, after the shoulder. It is the most commonly dislocated joint in children. More than 90% of all elbow dislocations are posterior dislocations. This injury entails disengagement of the coronoid process of the ulna from the trochlea of the humerus with movement posteriorly. The mechanism of injury is typically a fall onto an outstretched hand with the elbow in extension upon impact.

Most common complication of extracapsular inter trochanteric femur fracture is MALUNION. Most common complication of intracapsular neck of femur fracture is nonunion followed by AVN. Reference- Maheshwari ortho 5 th edition page no 139

Pipkin classification for femur head fracture (#)- Type I - Femoral head # caudal to fovea capitis Type II - Femoral head # cephalad to fovea capitis Type III - Femoral head # associated with femoral neck # Type IV - Any of the above with acetabular # Reference- Maheshwari Essential Ortho 5 th edition, page no 133

MRI is investigation of choice for all occult fractures. Reference- Maheshwari Essential Ortho 5 th edition, page no 134

Open reduction and internal fixation is not done on emergency basis in cases of open fractures. First fracture should be stabilized with external fixator and wound should be debrided. Once wound gets healed and infection is cleared thereafter open reduction and internal fixation is done. For open fractures gustilo and Anderson classification is used for grading. For open fractures like 3B - antibiotics coated intramedullary nails are preferred over K wires. With the evolution of available nails like antibiotic impregnated nails, intramedullary nailing is now performed even in 3B fractures. Although there was initial phobia for the use of intramedullary nails, their usage has become widespread not only in grade 1 and 2 but even in grade 3 injuries. Reference:Anderson JT, Gustilo RB. Orthopedics clinics of North America, 1980; 11:56

In cases of open fracture first fracture should be stabilized with external fixator and wound should be debrided. Once wound gets healed and infection is cleared thereafter open reduction and internal fixation is done. For open fractures Gustilo and Anderson classification is used for grading. For open fractures like 3B antibiotics coated intramedullary nails are preferred over K wires. With the evolution of available nails like antibiotic impregnated nails, intramedullary nailing is now performed even in 3B fractures. Although there was initial phobia for the use of intramedullary nails, their usage has become widespread not only in grade 1 and 2 but even in grade 3 injuries. Reference: Anderson JT, Gustilo RB. Orthopedics clinics of North America, 1980; 11:56