Chapter 6

1) Patient D., 52 years, was delivered to the admission department with complains of pain in the

area of the right leg, inability to support on the limb. Fell at the street 2 hours ago. During

examination was determined closed transverse fracture of the middle third of the femoral

diaphysis with fragments longitudinal dislocation for 7 cm. Which treatment method is indicated

to this patient?

A. Open reduction of fragments, osteosynthesis.

B. Skeletal traction.

C. Plaster immobilization.

D. Functional.

E. Transosseal osteosynthesis.

Based on the description provided, Patient D. has a closed transverse fracture of the middle third of the
femoral diaphysis with a 7 cm longitudinal dislocation.

In general, this type of fracture requires surgery to realign and stabilize the fracture, either using
internal fixation or external fixation. Therefore, options B, C, and D (skeletal traction, plaster
immobilization, and functional treatment) are not the preferred methods of treatment for this type of
fracture.

Option E, transosseal osteosynthesis, is a less commonly used method of fracture treatment that
involves drilling through the bone and passing wires or pins through the bone fragments to stabilize the
fracture. While it may be an option in some cases, internal fixation with screws, rods, or plates is
typically the preferred method for this type of fracture.

Therefore, option A, open reduction of fragments and osteosynthesis, is the most appropriate
treatment method for Patient D. This involves realigning the fractured bone fragments and fixing them
in place with screws, rods, or plates to facilitate proper healing and restore function. This method of
treatment can be performed through a surgical incision in the skin, known as an open reduction, which
allows for precise alignment of the bone fragments.

2) Patient S., 56 years, was delivered to the admission department from the car accident. Open

fracture of both shin bones in the middle third was determined during examination. Which

treatment method is indicated to the patient?

A. Skeletal traction.

B. Fixation with plaster cast.

C. Open reduction of fragments, internal osteosynthesis.

E. Functional.

Patient S. has an open fracture of both shin bones in the middle third, which is a serious injury that
requires urgent medical attention.

In general, the treatment for open fractures typically involves thorough wound cleaning, administration
of antibiotics to prevent infection, and stabilization of the fracture.

Option A, skeletal traction, may be used in some cases to stabilize the fracture, but it is not typically the
preferred method for open fractures of the lower extremities.

Option B, fixation with a plaster cast, is not typically used for open fractures, as it does not allow for
thorough wound cleaning and monitoring.

Option D, extrafocal transosseal osteosynthesis, is not commonly used for fractures of the lower
extremities.

Option E, functional treatment, is not appropriate for this type of injury as it involves immediate
mobilization and weight-bearing on the affected limb, which can worsen the injury and lead to
complications.

Therefore, the most appropriate treatment for Patient S. with an open fracture of both shin bones in the
middle third is option C, open reduction of fragments and internal osteosynthesis. This involves
realigning the fractured bone fragments and fixing them in place with screws, rods, or plates to facilitate
proper healing and restore function. Additionally, thorough wound cleaning and administration of
antibiotics to prevent infection are also required in this case.

3) Patient R., 38 years. Open fracture of shin bones, wound of 5 cm in diameter, with compound

margins and skin defect were determined. Which method of the operative treatment is preferred?

A. Transosseal osteosynthesis with the external fixation device.

B. Intramedullar blocking osteosynthesis.

C Reduction osteosynthesis with screws.

D. Osteosynthesis with AO plates.

E. Osteosynthesis with Kirschner's pins and screws.

All options can be reasonable however option D seems to be the best given the question information.
4) Patient J., 36 years, get into the car accident, loss consciousness for the short period of time;

does not remember, what happened. Complains of sharp pain in the right knee joint, only passive

movements are possible, very painful. During examination: deformation of the right knee joint

contours, limb axis impairment; limb shortening, passive position of the lower limb with external

shin rotation; limitation of active and passive movements in the injured knee joint. During

palpation- local tenderness of the distal femoral metaepiphysis and knee joint, "patella

ballottement" sign; pathologic mobility. Make the preliminary diagnosis.

A. Condylar fracture of the femoral bone.

B. Patella dislocation.

C. Condylar fracture of the tibia.

D. Shin dislocation.

E. Hip fracture in the lower third.

The symptoms of sharp pain in the right knee joint, limited active and passive movements in the injured
knee joint, and local tenderness of the distal femoral metaepiphysis and knee joint suggest an injury to
the knee joint. The deformation of the knee joint contours, limb axis impairment, limb shortening, and
passive position of the lower limb with external shin rotation are indicative of a significant knee joint
injury. The "patella ballottement" sign and pathologic mobility are further evidence of a severe knee
joint injury.

A condylar fracture of the femoral bone is a fracture that occurs in the lower part of the thigh bone
(femur) where it meets the knee joint. It is a serious injury that can cause significant pain, swelling, and
limitation of movement in the affected leg. It typically requires prompt medical attention and
appropriate treatment, which may involve surgical intervention.

The other options may still be plausible but need further investigation.

5) Patient C., 60 years, delivered to the traumatology department with complains of the acute

pain in right ankle joint, that occur after the ankle sprain. Objective status: swelling and

tenderness of the joint. At radiographs: longitudinal clear line along the lateral malleolus and

transverse - at the medial malleolus. Incongruency of articular surfaces take place. What

diagnosis corresponds to the radiologic data?

A. Foot dislocation.

B. Bimalleolar fracture of the right ankle joint, foot subluxation.

C. Bimalleolar fracture.
D. Fracture of the medial malleolus, rupture of the tibiofibular syndesmosis, foot subluxation.

E. Fracture of the lateral malleolus, posterior tibial margin, foot subluxation.

The radiological findings described suggest the diagnosis of a bimalleolar ankle fracture. The longitudinal
clear line along the lateral malleolus and transverse line at the medial malleolus indicate that both the
lateral and medial malleoli have been fractured. The incongruency of the articular surfaces also suggests
that there has been significant disruption of the ankle joint.

Option B, which describes a bimalleolar fracture of the right ankle joint with foot subluxation, is the
most accurate description of the radiologic data presented.

6) Patient E., 42 years, was for 10 days at the treatment with the constant skeletal traction

because of the closed fusiform fracture of the tibia lower third. Fragments reduction was not

reached. Which treatment method is indicated to the patient?

A. Fixative with plaster casts.

B. Osteosynthesis with extramedullar constructions.

C. Continue skeletal traction with fragments reduction.

D. Transosseous osteosynthesis with rods.

E. Functional with the plaster tutor.

In this case, option B or D may be indicated, depending on the specific characteristics of the fracture and
the patient's overall health and medical history.

Option B (Osteosynthesis with extramedullar constructions) is a surgical treatment option that involves
stabilizing the fracture with plates, screws, or other hardware. This may be indicated for unstable
fractures, but may not be necessary for all types of fractures.

Option D (Trans osseous osteosynthesis with rods) is another surgical treatment option that involves
stabilizing the fracture with pins or wires inserted through the bone. This may be indicated for certain
types of fractures, but may not be necessary for all.

7) After the patient’s T. ,56 years, examination, the diagnosis was made: closed transverse

fracture of the femoral bone lower third with fragments dislocation. Which treatment method is

better to use?

A Closed intramedullary blocking osteosynthesis.

B. Fixation with plaster cast.

C. Skeletal traction.

D. Transosseous osteosynthesis according to Elizarov.

The best treatment method for a closed transverse fracture of the femoral bone with fragment
dislocation depends on various factors such as the severity of the fracture, the age and overall health of
the patient, and the expected recovery time. However, based on the information provided, the most
appropriate treatment option would likely be option A, closed intramedullary blocking osteosynthesis.

8) Patient S., 65 years, fall in the flat and contused the right side of the body. Get to the bed by

herself lies in the supine position, right lower limb with the external rotation, there is no visible

limb shortening can sit up in the bed with the help of relatives. What is the most probable

preliminary diagnosis?

A. Pelvis and chest contusion.

B. Right hip joint contusion.

C. Impacted fracture of the femoral bone proximal part.

D. Pelvic bones fractures.

E Impacted fracture of the femoral diaphysis.

Based on the information provided, the most probable preliminary diagnosis would be option B, right
hip joint contusion.

The patient's symptoms of external rotation of the right lower limb and the ability to sit up in bed with
the help of relatives suggest that the injury may be localized to the hip joint. The absence of visible limb
shortening may indicate that there is no significant displacement of the fracture or that the injury is a
contusion rather than a fracture.

9) Patient L., 26 years, is working at chemical factory, complained of the pain in the right hip

joint at physical loads during the last 2 months, does not come for medical help. Unsuccessfully

get out from the bus when was going to the work (fall down of the right foot), the pain in the

right hip joint and supporting ability loss develop after this. During examination - external

rotation of the right limb, its shortening for more than 3 cm. What is the most probable

preliminary diagnosis?

A. Pathologic fracture of the femoral bone.

B. Femoral neck fracture.

C. Exacerbation of the lumbosacral osteochondrosis.

D. Acute arterial thrombosis.

The patient's history of pain in the right hip joint during physical loads for the last two months, coupled
with the sudden onset of pain and loss of supporting ability after a fall, suggest an acute traumatic event
that has worsened an underlying condition. The external rotation of the right limb and shortening of
more than 3 cm are typical signs of a femoral neck fracture.

10) During examination of the patient D., 37 years, who sustained earlier the fracture of the

femoral bone lower third, the following movements range is determined in the knee joint:

extension - 180°, flexion 150. Which type of movements limitation is in this patient?

A. Rigidity.

B. Fibrous ankylosis.

C. Osseous ankylosis.

D. Contracture.

E. Extraarticular ankylosis.

less than the normal range of 0-135°. The term used to describe a limitation in the range of motion due
to a soft tissue problem, such as muscle or tendon shortening, is "contracture." Therefore, the correct
answer is D. Contracture.

11) Patient K.. 39 years, was admitted to hospital with the closed fracture of the lateral tibial

condyle without dislocation. Which treatment method is better to use?

A. Operative (metalosteosynthesis).

B. Fixation with the plaster cast.

C. Skeletal traction.

D. Fixation with elastic bandage.

E. Transosseous osteosynthesis with the external fixation device.

In the case of a closed fracture of the lateral tibial condyle without dislocation, if the fracture is stable
and there is no significant displacement, non-operative management with fixation using a plaster cast or
an elastic bandage may be appropriate. However, if the fracture is complex or unstable, operative
(metalosteosynthesis) treatment or transosseous osteosynthesis with an external fixation device may be
necessary

12) Patient В., 52 years, was admitted to hospital with the comminuted fracture of the patella

with fragments dislocation less than 2 cm. Which treatment method is better to use?

A. Operative (metalosteosynthesis).

B. Fixation with the plaster cast.

D. Fixation with elastic bandage.

E. Transosseous osteosynthesis with the external fixation device.

In the case of a comminuted fracture of the patella with fragment dislocation less than 2 cm, the most
appropriate treatment method would likely be operative (metalosteosynthesis) treatment.

Transosseous osteosynthesis with an external fixation device may also be considered in some cases, but
the use of this method would depend on the specific characteristics of the fracture and the patient's
overall health.