Fractures and radiographs for NEET PG: six questions and the line to find first

Answer: D. Drawing 3

Drawing 3. A volar Barton fracture splits off the palmar rim of the radius and runs into the joint, and the carpus slips palmarwards together with that fragment. It is a fracture-subluxation of the radiocarpal joint. The rim fragment is small, but the whole carpus rests on it, so plaster cannot hold it: the carpus pushes the fragment away again. It is fixed open with a palmar buttress plate, which also restores the joint surface and limits later arthritis.

Why the closest rival loses: drawing 2 (C) is an extra-articular Smith fracture: the fragment tilts towards the palm, but the joint surface is intact. Drawing 1 (B) is a Colles fracture, tilted towards the back of the hand, and it also spares the joint. Drawing 4 (A) is a fracture of the tip of the radial styloid, the chauffeur fracture, which does not carry the carpus away.

Recallab question 55246 · Orthopaedic › Injuries Around The Fore Arm & Wrist · reference: Essential Orthopaedics

Answer: B. Pattern 4

Pattern 4. Neer's classification counts displaced parts, not fracture lines: the head, the two tuberosities and the shaft. A part counts only when it is displaced more than 1 cm or angulated more than 45 degrees. In pattern 4 the head is left attached to nothing, so the vessels it draws from the circumflex humeral arteries are torn, and avascular necrosis is likeliest. In an older patient this often leads to arthroplasty rather than fixation.

Why the closest rival loses: pattern 3 (A) is a three-part fracture: the head is still joined to the lesser tuberosity, so some of its supply survives. Pattern 1 (C) has many lines but nothing displaced, so it counts as one part. Pattern 2 (D) is a two-part neck fracture, and the head keeps both tuberosities and their soft tissue.

Recallab question 56166 · Orthopaedic › Injuries Around Shoulder · reference: Apley & Solomon's System of Orthopaedics and Trauma

Answer: C. Drawing 4

Drawing 4. Garden grade four is a complete fracture with full displacement. Full displacement tears the retinacular vessels that run up the neck, on which most of the head's blood supply depends, so the head is left relying on a small foveal branch. That is why a displaced fracture in an older patient is replaced, not fixed. The trap: with the head freed completely, it lies parallel to the acetabulum again, so grade four can look less deformed than grade three.

Why the closest rival loses: drawing 3 (D) is grade three, partly displaced, the head rotated but the retinaculum intact. Drawing 2 (B) is grade two: complete but undisplaced, with the trabeculae lining up throughout. Drawing 1 (A) is grade one, incomplete and impacted in valgus, the most stable.

Recallab question 55045 · Orthopaedic › Spine, Pelvis & Lower Limb Trauma · reference: Apley & Solomon's System of Orthopaedics and Trauma

Answer: C. Fracture 2, the dens waist

Fracture 2, across the waist of the dens. That segment has a poorer blood supply than the base or the tip, and the fracture surfaces have a small area of bone-to-bone contact. Together those give it the highest non-union rate of the three. It often needs anterior screw fixation or a posterior fusion, especially in older patients.

Why the closest rival loses: fracture 3 (A) runs into the vascular cancellous body of the axis, which unites reliably in a collar or halo. Fracture 1 (D), through the tip, is a stable avulsion injury that unites well with external support. A hangman fracture (B) goes through the pedicles of C2, which is not one of the drawn lines, and it unites well in a halo.

Recallab question 55372 · Orthopaedic › Spinal Injuries · reference: Essential Orthopaedics

Answer: B. Tendon 1

Tendon 1, abductor pollicis longus. The oblique fracture runs into the joint and splits off a small fragment that stays tethered to the trapezium by the volar oblique ligament: a Bennett fracture. Tendon 1 inserts on the base of the shaft fragment itself, and its pull draws the shaft upwards and outwards off the trapezium, with adductor pollicis adding to the displacement. The joint surface is split, so fixation is usually needed.

Why the closest rival loses: tendon 2 (A) is adductor pollicis, which adds adduction, but the proximal pull on the shaft is from abductor pollicis longus. Tendon 3 (C), extensor pollicis brevis, inserts on the proximal phalanx and acts across the next joint. The ligament (D) holds the small fragment against the trapezium and displaces nothing.

Recallab question 55767 · Orthopaedic › Hand Injuries · reference: Apley & Solomon's System of Orthopaedics and Trauma

Answer: B. Juvenile Tillaux fracture

A juvenile Tillaux fracture. The distal tibial growth plate closes over about eighteen months in the early teens, starting centrally and medially and finishing at the front outer corner. In that window only the anterolateral part of the epiphysis is still free. An outward twist pulls on the anterior tibiofibular ligament attached there, and the ligament pulls that corner off, the fracture line running down through the epiphysis into the joint. It is a Salter-Harris type III injury, fixed if the step in the joint exceeds two millimetres.

Why the closest rival loses: a type II fracture (A) runs along the plate and out through the metaphysis above it, but this one runs down into the joint. A triplane fracture (C) adds a fragment of bone above the plate on the lateral view, and the inset shows none. A type I separation (D) cannot be right: the medial part of the plate has already fused and the fracture enters the joint.

Recallab question 55965 · Orthopaedic › Injuries To The Leg Ankle & Foot · reference: Apley & Solomon's System of Orthopaedics and Trauma