Traumatology and Orthopedics MCQs with Answers: 50 Questions for Exam Preparation

In patients with frailty syndrome, the Damage Control Orthopedics (DCO) approach is used to minimize surgical stress in the acute period to reduce the risk of decompensation of comorbid conditions.

Acute compartment syndrome is accompanied by a critical increase in subfascial pressure, requiring emergency surgical decompression (fasciotomy) to prevent irreversible ischemic necrosis of muscles and nerves.

Definitive wound closure (secondary suturing or skin grafting) after fasciotomy is usually performed in 7–10 days, when muscle edema has completely subsided and the risk of compartment syndrome recurrence is reduced.

The deep peroneal nerve runs within the anterior fascial compartment of the leg, which innervates the skin of the first web space, and contains the foot extensor muscles, whose ischemia leads to foot drop.

In the phenotypic model of frailty (Fried criteria), low physical activity is assessed using the Minnesota Leisure Time Physical Activity Questionnaire and is less than 383 kcal per week for men and less than 270 kcal per week for women.

The deep fibular (peroneal) nerve runs in the anterior fascial compartment of the leg, which is frequently affected in compartment syndrome. The sensory branch of this nerve innervates the skin exclusively in the area of the first web space of the foot.

During surgical debridement of an osteomyelitic focus, bone resection is performed until capillary bleeding from Haversian canals appears—the "bloody dew" sign. This sign indicates good blood supply and viability of the remaining bone tissue.

The mainstay of sarcopenia treatment is resistance training to stimulate muscle growth and adequate protein intake to provide structural building blocks.

The administration of preformed antibodies in the form of plasma or immunoglobulins provides an immediate but temporary immune response, which is the mechanism of passive immunization.

A pedicled muscle flap has a good blood supply, which helps eliminate residual infection, reliably obliterates the dead space, and stimulates reparative processes in the bone.

The mainstay of osteomyelitis treatment is surgical debridement of the purulent focus, whereas conservative therapy plays an auxiliary role in preparing for surgery and in the postoperative period.

Simultaneous limb shortening of more than 4–5 cm carries a high risk of major vessel kinking and nerve trunk stretching, which can lead to acute ischemia and neuropathy.

The posterior tibial artery runs in the deep posterior fascial compartment of the leg, not the lateral one. The lateral compartment lacks its own large major artery and is supplied by perforating branches of the fibular artery.

Impaired vision and hearing are directly associated with a high risk of falls, social isolation, and progression of cognitive impairment. Therefore, their screening evaluation is part of the mandatory comprehensive geriatric assessment.

Acute compartment syndrome requires emergency surgical intervention to reduce tissue pressure and prevent muscle necrosis. The gold standard and only effective treatment is decompressive fasciotomy.

In Russian traumatology, it is generally accepted that the clinical and radiological picture of acute post-traumatic osteomyelitis (a purulent-necrotic process directly within the bone) develops on average 2–4 weeks after an open fracture. Earlier on, the inflammation is usually regarded as soft tissue suppuration of the wound.

The deep peroneal nerve runs within the anterior fascial compartment of the leg. Its sensory branch innervates only a small area of skin—the first web space of the foot; therefore, when the nerve is compressed, paresthesia occurs precisely in that area.

Impacted femoral neck fractures may not be visualized on initial radiographs; therefore, if clinical symptoms persist, CT, MRI, or follow-up radiography 10–14 days after the injury is indicated.

Insufficiency fractures occur when normal physiological loads are applied to bone with reduced mineral density and compromised microarchitecture, such as in osteoporosis.

In a femoral neck fracture, the anatomical (absolute) length of the femur does not change, as the fracture line passes above the greater trochanter. However, due to upward displacement of the femur along with the pelvis, relative shortening of the limb occurs, measured from the anterior superior iliac spine.

For the Shkolnikov-Selivanov intrapelvic blockade, a large volume of a weak anesthetic is traditionally used—250–300 ml of 0.25% procaine (novocaine) solution per side. This safely creates a massive infiltrate in the loose pelvic connective tissue, blocking the lumbar and sacral plexuses.

Femoral neck stress fractures on the superior surface (tension side) carry a high risk of complete displacement and osteonecrosis. If conservative therapy fails or if there is an initially high risk of complications, surgical stabilization (osteosynthesis) is indicated.

Magnetic resonance imaging and bone scintigraphy have the highest sensitivity for the early diagnosis of stress fractures. MRI visualizes bone marrow edema long before radiographic signs of cortical disruption appear.

In an impacted femoral neck fracture, bone support is preserved, allowing the patient to actively lift the straight leg. In a displaced fracture, biomechanics are disrupted, making it impossible to lift the straightened leg (positive "stuck-on" heel sign).

Magnetic resonance imaging has high sensitivity to bone marrow edema and allows precise assessment of the degree of stress fracture consolidation. This makes it possible to objectively determine the readiness of the bone tissue to resume athletic loads.

Magnetic resonance imaging allows detailed visualization of the articular cartilage and subchondral bone, as well as assessment of the stability of the osteochondral fragment. It is precisely these data that determine the indications for surgical intervention or conservative therapy.

Magnetic resonance imaging has high soft-tissue contrast and is the gold standard for visualizing cartilage tissue and detecting its local defects.

If adequate conservative therapy for symptomatic full-thickness cartilage defects is ineffective within 3–6 months, surgical treatment is indicated (e.g., microfracturing or mosaicplasty).

According to the Pauwels classification, the more vertically oriented the femoral neck fracture line is (Type III, angle 50–90°), the higher the shearing forces, which maximizes the risk of nonunion and pseudoarthrosis formation.

According to the universal AO/ASIF fracture classification, the first digit denotes the bone (3 — femur) and the second denotes its segment (1 — proximal segment).

The sacroiliac joint "functional blockade" syndrome is caused by the entrapment of the capsular-ligamentous apparatus between the articular surfaces, which causes pain without disrupting the integrity of the pelvic ring.

Axial loading and muscle traction during walking can lead to the loss of initial fragment stability. This causes fracture disimpaction with subsequent displacement and a sharp deterioration in the prognosis for the joint.

In an abduction injury mechanism, the neck-shaft angle increases, and the central fragment impacts into the spongy bone of the peripheral fragment. Therefore, valgus femoral neck fractures are usually impacted and relatively stable.

According to the AO/ASIF classification, type C pelvic fractures are characterized by rotational and vertical instability. This is due to a complete disruption of both the anterior and posterior pelvic rings, including injury to the ligamentous apparatus and pelvic floor.

Rhizarthrosis is deforming osteoarthritis of the first carpometacarpal joint, formed by the base of the first metacarpal bone and the trapezium bone.

In the classical Russian classification by S.T. Zatsepin, giant cell tumor (osteoblastoclastoma) was traditionally classified under neoplasms of undetermined genesis, as its exact cellular origin remained a subject of debate for a long time.

The boutonnière deformity occurs due to rupture or stretching of the central slip of the extensor tendon, leading to flexion at the proximal interphalangeal joint and compensatory hyperextension at the distal one.

Osteochondritis dissecans (Panner disease) most commonly affects the knee joint and is accompanied by the formation of loose bodies that cause joint locking. A similar clinical picture with pain and mechanical obstacles to movement is observed in meniscal injuries and synovial chondromatosis.

In the late stage of osteochondritis dissecans, a loose intra-articular body ("joint mouse") forms, the entrapment of which between the articular surfaces causes sudden restriction of movement—joint locking, similar to that seen in meniscal tears.

During an acute gout attack, blood uric acid levels may drop to normal values due to its active deposition in tissues and enhanced renal excretion driven by inflammation. Therefore, normouricemia during an exacerbation does not rule out the diagnosis.

Paget's disease is often polyostotic, affecting multiple bones simultaneously. To assess the true extent of the process and identify asymptomatic lesions, the standard of care is skeletal scintigraphy or radiography of all bones.

The presence of crystals in synovial fluid does not rule out a concomitant infectious process (septic arthritis). To reliably exclude bacterial inflammation, it is necessary to perform a leukocyte count, Gram-stained smear microscopy, and bacterial culture of the joint aspirate.

Spasm of the anterior scalene muscle leads to compression of the subclavian artery and the lower primary trunk of the brachial plexus, causing vascular disorders and pain in the innervation zone of the ulnar nerve.

When radiography is uninformative, MRI allows the detection of bone marrow edema of the sesamoid bones, inflammation of the surrounding tendons, and the exclusion of aseptic necrosis.

Bacterial (septic) arthritis is characterized by a pronounced purulent effusion with a leukocytosis of more than 50,000 cells/mm³, whereas in Lyme arthritis inflammation is less aggressive and the leukocyte count is typically significantly lower.

Postmenopausal osteoporosis is characterized by preferential loss of trabecular bone tissue, leading to compression wedge fractures of the vertebral bodies and the formation of thoracic kyphosis.

Arthroscopy allows visual assessment of the condition of the articular surfaces, determination of the exact depth and area of cartilage damage, and palpation to assess its density. This makes it the most objective method for direct diagnosis of intra-articular pathology.

Historically, the term "podagra" (from Greek *pous* — foot, and *agra* — trap) was used specifically to denote acute arthritis of the first metatarsophalangeal joint of the foot. This is the most frequent and classic localization of the first disease attack.

Mammary Paget's disease is a malignant neoplasm in which atypical cells infiltrate the epidermis of the nipple and areola. The disease clinically manifests as eczema-like changes and is often associated with ductal carcinoma in situ.

Sudden severe restriction of movement followed by rapid recovery after passive movements is the classic clinical picture of the entrapment of a loose intra-articular body ("joint mouse"). In osteoarthritis, such bodies most often consist of detached fragments of osteophytes or degenerated cartilage.