All Orthopaedics III

Question 1

grade III MCL tear.

Answer 1

The MCL usually tears from the femoral side

Question 2

a volar PIP dislocation, what is the block to reduction

Answer 2

Lateral band

Question 3

humeral shaft fractures

Answer 3

Approximately 5% nonunion rate

Question 4

open midshaft femur fracture with 3cm bone loss How should the bone loss be managed?

Answer 4

Wait 16-20 weeks, and if union does not occur, bone graft

Question 5

young modulus

Answer 5

Question 6

Poor outcome factors and A less favorable prognosis for functional recovery following surgery of RCT

Answer 6

1. Age > 65, Female
2. Associated delamination of sub-scap and/or infra-spinatus
3. extent of fatty degeneration of the infraspinatus and subscapularis muscles
4. Size of the tear/ massive tear
5. Quality of the tissue
6. Presence of chronic rupture of long head of biceps
7. Degree of pre-op shoulder weakness
8. Anterior Deltoid detachment or denervation
9. Difficult mobilization of tissue
10. Smoking
11. Poor Compliance
12. Previous Surgery
13. Head-to-Acromion Distance <7 mm
14. Chronic Pain
15. Osteoporosis

Question 7

Repair of the pars defect is indicated for

Answer 7

1. L1 through L4 spondylolytic defects
2. Spondylolytic defects of multiple vertebral levels
3. Low-grade but reducible spondylolisthesis at levels cephalad to L5
4. An intact vertebral disk at the level of slippage.
5. No radicular symptoms are the best candidates for pars repair

Question 8

Types of observational studies

Answer 8

1. Case-control study
2. Cross-sectional study
3. 4. Longitudinal study
4. Cohort study or Panel study
5. Ecological study

Question 9

Clinical features of Osteoporosis

Answer 9

1. Kyphosis or height loss
2. Untreated early menopause (age less than 45 yrs)
3. Radiologist report of “osteopenia” or “osteoporosis” on plain X-ray
4. Corticosteroid treatment
5. Prednisolone in a dose of 7.5mg daily or more for greater than 3 months.
6. Family history of Osteoporosis
7. Low trauma hip fracture in a parent or sibling
8. Vertebral fracture in a parent or sibling
9. Co-existing disease that predisposes to Osteoporosis
10. Inflammatory bowel disease
11. Inflammatory arthritis
12. Coeliac Disease or malabsorption
13. Chronic renal failure
14. Primary Hyperparathyroidism
15. Lactose Intolerance
16. Anorexia nervosa

Question 10

Osteo,chondro SARCOMA

Answer 10

Question 11

ATLS PROTOCOL

Answer 12

Irrigation & Debridement

• soft tissue
  
  • all devitalized and necrotic tissue should be removed
  • extensive debridement is essential to eradicate the infection
• bone work
  
  • sequestrum must be eliminated from the body, or infection is likely to recur
  • debride bone until punctate bleeding is seen - “paprika sign”
• hardware removal
  
  • any non-essential hardware should be removed
• dead space management
  
  • goal is to replace dead bone and scar tissue with vascularized tissue
  • options include
    
    • vascularized bone grafts
    • local tissue flaps or free flaps
    • antibiotic-impregnated acrylic beads (PMMA)
    • vacuum-assisted closure
      
      • improve wound healing and dead space closure in multiple ways
        
        • remove interstitial fluids
        • eliminate superficial purulence or slime
        • allow arterioles to dilate, which allows granulation tissue to proliferate
        • decrease in capillary afterload to promote inflow of blood
        • mechanical force on wound edges draws them in
• instrumentation
  
  • bony stability is required for successful eradication of infection
  • external fixation preferred to internal fixation
  • surgical fixation techniques
• • Ilizarov technique
    
    • intramedullary nail with or without external fixation
    • Masquelet technique
    • in situ reconstruction
• mechanism is thought to be related to improved angiogenesis
• outcomes
  
  • often requires staged approach with multiple debridements and delayed soft tissue coverage
  • when combined with postoperative antibiotics tailored to a specific organism, treatment is often successful