Fractures of Femur MCQs

Answer- B. Complete fracture with undisplaced neck Garden stage I: undisplaced incomplete, including valgus impacted fractures medial group of femoral neck trabeculae may demonstrate a greenstick fracture Garden stage II: undisplaced complete no disturbance of the medial trabeculae

Answer- B. AVN AVN is the most common complication of femoral neck fracture. Non-union is the second most common complication of femoral neck fracture.

The leg is shortened and externally rotated in most fractured neck of femurs. The main source of blood to the femoral head is via the vessels running within cancellous bone from the diaphysis. The blood supply to the head is increased by vessels in the capsular retinacula and it is this which prevents avascular necrosis of the head after an intertrochanteric fracture the ligamentum teres. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Lower Limb, Page number - 554

Explanation: Immobilisation and calf swelling with pain suggest DVT , caused by thrombus formation in the deep veins. Risk factors include stasis, endothelial injury, and hypercoagulability (Virchow's triad) . Features: calf pain, tenderness, swelling, erythema, and warmth. Explanation of other options: Chronic osteomyelitis (Option A): Involves chronic bone infection with sequestrum and sinus, not acute calf swelling. Compartment syndrome (Option C): Severe pain, numbness, tense compartment, usually within 48 hrs of trauma/surgery. Pulses preserved but foot cold. Arterial claudication (Option D): Intermittent exertional calf pain from PAD; not acute, not linked to immobilisation.

Vascular sign of Narath: inability to feel femoral pulse against femoral head in the inguinal region. It is positive in all conditions where the femoral head is not present in its normal position. Eg. Traumatic hip dislocation, DDH, Tom Smith arthritis and Girdlestone arthroplasty Useful signs in orthopedics VIC: Volkmann’s sign Piano key sign: Distal radio ulnar joint instability (e.g., Madelung deformity, Malunited colles fracture etc.) De Quervain’s syonvitis: Finkelstein test Flexor tenosynovitis: Kanavel’s signs AVN hip: Sectoral sign Iliopsoas tendonitis: Ludloff sign Reference- Fundamentals of Orthopedics Mohindra and Jain 1 st edition, page no 100

Type 3B fractures are usually treated with external fixation. However if the wound is not very contaminated and patient presents early to the orthopedic center, then antibiotic coated nailing can be performed. Reference- Anderson JT, Gustilo RB. Orthopedics clinics of North America, 1980; 11:56

Solitary bone cyst is the diagnosis of a 12 years old boy, who presents with a symmetric, expansile cystic lesion in the proximal humerus. Solitary Bone Cyst: Common in first two decades, primarily between 5-15 years More common in males MC site: Proximal humerus(50-60%) >Femur(25-30%) Cyst appears as centrally radioluscent lesions, on the metaphyseal side of the growth plate of a long bone Treatment: Curettage Methylprednisolone acetate injection into lesion Radiographic contrast injection into lesion Intralesional injection of sclerosing agents Reference: Chapman's Orthopedic Surgery, 3rd edition, Pg: 3392-3394.