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LMCC Orthopedic Review Lecture
April, 2004
“Back to Basics”
Dr. P.R. Thurston
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Syllabus
1. Diagnosis, Treatment & Complications of Fractures /Dislocations.
2. Diagnosis & Treatment of Arthritis.
3. Assessment and Management of Low Back Pain.
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&
Fractures
Dislocations
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Fractures
A discontinuity in the structural integrity of a bone.
Definition :-
A fracture occurs because the force applied exceeds the breaking strength of the bone so that the Load can no longer be transferred across that zone of the bone.
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All fractures ultimately begin with kinetic energy, released by misadventure and applied to the human body.
Some of that energy is absorbed and some is transmitted to the surroundings.
Absorbed energy must be dissipated, ie. distributed, through the soft tissues and bones.
Fractures occur when the bone can not dissipate all of the energy absorbed.
Fractures
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Thus :-
1 ) A fracture occurs when the energy transferred to a bone exceeds the ability of the bone to dissipate that energy.
2 ) Further energy dissipation produces :-
- comminution.
- soft tissue damage (open fractures).
- displacement.
- other fractures.
Fractures
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DefinitionsFracture:- A discontinuity in the structural
integrity of a bone.
Infraction:- An incomplete fracture.
Dislocation:- Complete loss of contact of the articular surfaces of a joint.
Subluxation:- Non-concentric joint surfaces.
Reduction:- Returning a fracture or dislocation to an anatomical alignment.
Comminution:- Multiple fragments.
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Bone is a two-phase material :-
Calcium HydroxyApatite Ca10(PO4)6(OH)2 = mineral
Osteoid Collagen type I and III = fibrous
Calcium is strong in compression, but weak in tension.
Osteoid is strong in tension, but weak in compression.
Mechanical Properties of BoneFractures
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BUT :- (for adult bone)
Calcium is stronger in compression than Osteoid is in tension
And therefore :-
Bone always fails first in tension
Fractures
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For immature bone, this effect is reversed.
The Buckle or Torus fracture occurs because the bone fails in compression first.In children, the Osteoid is stronger than the Mineral phase.
Generally, the dislocation in youth becomes the fracture in the adult.
Fractures
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A bone consists of three areas :-
the Diaphysis
the Metaphysis
the Epiphysis.
Each region has its own Each region has its own fracture characteristics.fracture characteristics.
Fractures
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Bending
Torque
Direct
Traction
Compression
Intra-articular
Pediatric
Diaphyseal
Metaphyseal
Epiphyseal
Oblique
Spiral
Transverse
Mixed
Fractures
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Bending produces a transverse fracture line, with or without a lip.
When load is added, the lip becomes a butterfly fragment.
With more loading, the fracture line becomes oblique.
BendingFractures
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- Rotatory shear produces a continually changing line of failure, giving the typical “Bayonet Spikes” at the ends of the bones.
- The greater the load the longer the fracture.
- These occur only in long bones and are referred to as:-
‘Spiral Fractures’
TorqueFractures
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$piral
The butterfly segment is different from the oblique bending fracture.
Torque
$$
Fractures
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If no butterfly, then the ends are Bayonet in appearance.
Fractures
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“tapping fractures”.
Fractures of “dying momentum”.
Tension produced on the opposite side of the bone.
Comminution produced on the impact side of the bone.
High energy injuries.
Direct BlowFractures
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Direct Blow
Transverse Fractures
Comminution on the opposite side to a bending fracture, ie. at the point of impact.
“The Nightstick Fracture”.
Fractures
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The Metaphysis is subject to all of the diaphyseal patterns plus:-
1) Traction – Avulsion.
2) Compression.
Traction – Avulsion.
MetaphysealFractures
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are transverse since the tension is equal on both sides of the bone.
-are caused by ligament or tendon traction.
always occur adjacent to joints.
Metaphyseal
Traction-AvulsionFractures
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Traction – Avulsion.
Fractures
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Crush fractures
Impacted fractures
Usually comminuted
Usually axial skeleton
- Vertebrae
- Calcanei
Compression Fractures
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The Epiphysis is subject to all of the diaphyseal and metaphyseal patterns plus:-
1) Intra-articular Fractures.
2) Pediatric Fractures about the Epiphyseal plate.
EpiphysealFractures
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Intra-articular Fractures
- Always require accurate reduction.
- Usually require surgical treatment.
- Are often comminuted.
- Frequently threaten Post-traumatic Osteoarthritis.
EpiphysealFractures
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Pediatric Epiphyseal Fractures
- Produce fracture patterns specific to children.
- Always require accurate reduction.
- Can produce growth abnormalities.
- Salter-Harris Classification.
EpiphysealFractures
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Salter-Harris Classification
II IIII IIIIII
IVIV VV
Fractures
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Salter-Harris Classification
1) Fractures interfering with growing bones.
2) Worse prognosis with increasing number.
3) Probability of surgery increases with number.
Fractures
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A fracture can occur in :-
normal bone subject to abnormal forces.= Traumatic Fractures.
abnormal bone subject to normal forces. = Pathologic Fractures.
normal bone subject to cyclic forces.= Fatigue or Stress Fractures.
Fractures
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Description
1) Displacement - Angulation
2 ) Closed or Open.
3 ) Simple or Comminuted.
4 ) Fracture Pattern eg. Spiral, Transverse etc.
5 ) Anatomical Area.
6 ) Mechanism.
Fractures
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Fracture Description
This fracture is angulated laterally, since it points laterally.
The distal fragment is tilted medially
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Description
Medially Displaced
Closed
Comminuted
Short Oblique
Fracture of the
Proximal Humerus
Caused by a direct fall
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Fracture Description
1) The distal fragment is always described with relation to the proximal segment.
2) Displacement = Translation of bone ends.
3) Angulation = Orientation of bone ends.
4) Angulation identifies to where the fracture points.
5) For clarity, the tilt of the distal fragment is often used to describe angulation.
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The Periosteal Bridge
The Periosteal Bridge is intact on the concave side of the fracture.
Reversal of the mechanism of the fracture tightens the bridge and stabilizes the fracture.
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The Periosteal Bridge
Tightening the periosteal bridge locks the fracture together.
Holding the bridge tight requires three point fixation.
“It takes a bent cast to produce a straight bone”
J. Charnley
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Treatment
Closed or Open ( Surgical ).
- Both require an understanding of fracture healing.
- Closed requires reversal of mechanism of injury.
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Indications for Closed Reduction
There is significant displacement.
Reduction is possible.
The reduction, if gained, can be held.
The fracture has not been produced by a traction force.
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Indications for Open Reduction
1 ) There is a significant Displacement.
2 ) Open Fractures.
3 ) Intra-articular Fractures.
4 ) Un-reducible Fractures
5 ) Reductions that cannot be maintained in a cast.
6 ) Comminuted or Segmental Fractures.
7 ) Floating Joints.
8 ) Fractures with Neurovascular damage.
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Open Fractures
Classification :-
1. < 1 cm., inside-out, little soft tissue damage.
= low potential for infection.
2. 1 cm. – 10 cms., outside-in, requires debridement, but no flap or skin graft.
= moderate potential for infection.
3. > 10 cms., outside-in, high energy, devitalized muscle, comminution or bone loss, soft
tissue loss.
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Open Fractures
Classification :-
3A. No loss of soft tissue cover, no flap required.
3B. Flap required due to soft tissue stripping.
3C. Associated vascular injury.
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Type 1. Open Fracture = 6 mm, extend & debride
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Degloving Mechanism
Degloving Mechanism
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Type III C Injuries – Vascular Injury
Note pallor of the ankleNo pulses
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Fracture Complications
1. Pulmonary Fat Emboli
2. Compartment Syndromes
3. ‘Cast Disease’
4. Stress Fractures
5. Pathologic Fractures
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Pulmonary Fat Emboli :- A.R.D.S.
- Long bone fractures, burns, contusions.
- Interstitial pneumonitis due to free fatty acids
- S.O.B. & confusion in young adults.
- Axillary & Subconjunctival Petechiae.
- Serum lipase elevated.
- pAO2 reduced – if < 50 – 20% mortality.
- Ventillatory support
- Dexamethazone.
- 5 day course.
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Compartment Syndromes
- increased interstitial tissue pressure.- fractures, burns, tight dressings.
- normal pressure < 25 mm. Hg.- when the tissue pressure > venous capillary
pressure, but less than the arteriolar pressure.- 5 P’s
- pain.- pallor.- pulselessness.- paresthesias.- paralysis.
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Compartment Syndrome
Symptom: Pain out of proportion to that
expected for the injury.
Signs: 1. Loss of function of muscle due to
ischemia within the compartment.
2. Pain with passive stretch
3. Numbness etc. are LATE findings!
4. If neuro symptoms present, potential
for full neuro recovery is only 10 %
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Rx Compartment Syndrome
Release all compressive dressings / plaster.
Elevate extremity to heart level.
Fasciotomies.
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Rx Compartment Syndrome
Increased girth.
Pallor of the foot.
Recent surgery.
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4 compartment fasciotomy
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Compartment Syndrome
Careful monitoring.
Recognise it - 5 P’s
Call Orthopaedic Surgeon
Pressure measurements
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Stress or Fatigue Fracture
Repeated loading below acute failure threshold.
Eventual fatigue failure.
Military recruits, runners, aerobics.
Tibia, metatarsals, femoral neck.
Initial x-ray can be negative.
Bone tenderness – Bone scan.
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Pathologic Fractures
Failure through abnormally weakened bone
Minimal trauma – BEWARE
Osteoporosis Metastasis Tumour:- Benign,
Malignant (Myeloma).
Metabolic Bone Disease
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Pathologic Fractures
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Fractures
an understanding of the mechanism that produces them,
Ultimately, the treatment of fractures requires
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An understanding of the diagnostic tools available,
Fractures
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And the current technologies used in their treatment
Fractures
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Dislocations
The articular surfaces are no longer in contact.
Commonly affects -
Shoulders > PIP joints > Elbows > Ankles.
Often associated with fractures.
Often associated with neurologic injuries
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Shoulder Dislocations95 % anterior
1 % posterior
Luxatio erecta
Medial
Axillary nerve injury
Rapid reduction
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Shoulder Dislocations
Conscious sedation.
Traction reduction.
Immobilization.
Recurrent.
Voluntary
Habitual.
Multiaxial instability.
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Elbow Dislocation
Posterolateral.
Median nerve injury.
Ulnar nerve injury.
Rapid reduction.
Early mobilization.
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Back Pain
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Classification: Mechanical (MacKenzie)
Postural syndromenormal tissues become painful by the application of
prolonged stresses (sitting, bending etc)
Dysfunction syndromesoft tissues are shortened and stiff. Usually >30 year
old, poor posture, under exercised, reduced mobility
Derangement syndromeDisc derangement (tears and herniation)
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Causes and Classification of Back Pain: McNab
Viscerogenic Vasculogenic Neurogenic Psychogenic Spondylogenic
SpondylogenicOsseus:
Trauma Infection Neoplasms Inflammatory Metabolic (eg.Pagets) Deformities
– Soft tissues: Muscles SI joints Disc Facets
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Non operative Treatment of Back Pain
Do nothing
Activity modification
Medications
Exercise and physiotherapy
Braces
Manipulation
Massage therapy
Traction/inversion therapy
Vitamins/Supplements/Diets
Weight control
Every Suzanne Summers sponsored abs exerciser
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Degenerative Conditions of the Lumbar Spine
Congenital
Disc herniation
Degenerative Disc Disease
Spinal Stenosis
Degenerative Spondylolisthesis
Degenerative Scoliosis
“And when did you first notice that your back had gone out?”
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Congenital Anomalies
Congenital scoliosis
Arthrogryposis
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Congenital anomalies
Spina bifida
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Anatomy
Extension Flexion
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Three joint complex(Kirkaldy Willis, Farfan)
C ap su la r laxity
E n la rg em en t o f a rt icu la r p rocess
S u b lu xa tion
O s teop h yte fo rm ation
C artilag e d es tru c tion
S yn ovia l reac tion face t jo in t
D isc h ern ia tion
os teop h ytes
d ec rease d isc h e ig h t
In te rn a l d isc d is ru p tion
rad ia l tea r
D isc c ircu m feren c ia l tea rs
R ecu rren t ro ta tion a l s tra in
Instability
Lateral n. ent
Central stenosis
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Disc herniation
Ms J.H. 25 y.o. female presented with cauda equina syndrome
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Spinal stenosis
Symptoms:– unilateral radicular
pain– bilateral claudication– better with forward
flexion of trunk– better walking uphill– rare bowel/bladder
involvement
Signs:– usually no neuro signs– look for pulses– stress test
Investigations:– XR– CT– Myelo-CT– MRI
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Spinal stenosis
lateral AP
myelogram
Post myelogram CT
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Degenerative Spondylolisthesis
Most common cause of spinal stenosis
More common in women, hemisacralization of L5, diabetics and women with BSO
OA of hip also in 11-17%
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Isthmic spondylolisthesis
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Severe spondylolisthesis
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Time for a 10 minute break!
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Pediatric Orthopedics
1. Developmental Dysplasia of the Hip.
2. Legg-Perthes Disease.
3. Slipped Capital Femoral Epiphysis.
4. Club Feet.
5. Osteomyelitis.
6. Septic Hip.
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1. Talipes Equinovarus is the proper name for :-
a. Flat feet
b. In-toeing
c. Club feet
d. Knock knees
e. Wry neck
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1. Talipes Equinovarus is the proper name for :-
c. Club feet
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1. Talipes Equinovarus is the proper name for :-
a. Flat feet
b. In-toeing
c. Club feet
d. Knock knees
e. Wry neck
Pes Planus
Metatarsus Adductus
Genu Valgus
Torticolis
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Talipes Equinovarus
congenital deformity of the footEquinus, Inversion, Adduction, Supination2 per 1000 live births50% bilateralM >F 2:1Serial corrective casts at birthSurgery if resistant
EARLY TREATMENT IS ESSENTIAL
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2. Trendelenburg refers to :-
a. Leg length discrepancy
b. Gait abnormality
c. Knee recurvatum
d. Scoliosis
e. Hip Contracture
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2. Trendelenburg refers to :-
b. Gait abnormality
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2. Trendelenburg refers to :-
a. Leg length discrepancy – Apparent vs Real
b. Gait abnormality
c. Knee recurvatum – straightens past 1800
d. Scoliosis – lateral curvature, lordosis, kyphosis
e. Hip Contracture – Thomas test
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3. All of these are signs of D.D.H. except :-
a. Limited Abduction
b. Ortolani Sign
c. Asymmetric Skin Folds
d. Galeazzi’s Sign
e. McMurray Sign
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3. All of these are signs of D.D.H. except :-
e. McMurray Sign
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3. All of these are signs of D.D.H. except :-
a. Limited Abduction
b. Ortolani Sign
c. Asymmetric Skin Folds
d. Galeazzi’s Sign
e. McMurray Sign
DislocatedReducible
Knee heightTorn Meniscus
Dislocated
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Developmental Dysplasia of the Hip
Acetabular dysplasia
Femoral anteversion
Adduction Contracture
50% bilateral, F > M 8:1
Test ALL newborns at birth
Conservative Rx at birth – Pavlik, D.diaper
Surgical Rx if resistant
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4. The most common congenital Spinal abnormality is :-
a. Scoliosis
b. Spina Bifida
c. Torticolis
d. Klippel – Feil Syndrome
e. Multiple Hereditary Osteochondroma
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4. The most common congenital Spinal abnormality is :-
b. Spina Bifida
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4. The most common congenital Spinal abnormality is :-
a. Scoliosis
b. Spina Bifida
c. Torticolis – ‘Wry Neck’
d. Klippel – Feil Syndrome – Congenital Fusion
e. Multiple Hereditary Osteochondroma
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Spinal Bifida
defect of neural tube closure
Lumbar spine, commonly low
2 per 1000
myelodysplasia
Mild to complete paraplegia
Occulta, meningocoele, Myelomeningocoele
Bowel and bladder dysfunction
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5. Polydactyly
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6. Syndactyly
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7.
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Sprengel’s Deformity
Omovertebral Bone
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8. A 6 year old boy with delayed physical development, convulsions, tetany, weakness, blue sclera and bony deformities is most likely suffering from :-
a. Physical Abuse
b. Ehlers – Danlos Syndrome
c. Osteogenesis Imperfecta
d. Multiple Hereditary Exostoses
e. Myositis Ossificans
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8. A 6 year old boy with delayed physical development, convulsions, tetany, weakness, blue sclera and bony deformities is most likely suffering from :-
c. Osteogenesis Imperfecta
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8. A 6 year old boy with delayed physical development, convulsions, tetany, weakness, blue sclera and bony deformities is most likely suffering from :-
a. Physical Abuse
b. Ehlers – Danlos Syndrome
c. Osteogenesis Imperfecta
d. Multiple Hereditary Exostoses
e. Myositis Ossificans
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9. A 6 year old boy with delayed physical development, a rachitic rosary, weakness and bony deformities is most likely suffering from :-
a. Physical Abuse
b. Rickets
c. Scurvy
d. Osteitis Deformans
e. Myositis Ossificans
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9. A 6 year old boy with delayed physical development, a rachitic rosary, weakness and bony deformities is most likely suffering from :-
b. Rickets
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9.
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9.
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Etiology Alkaline Calcium Phosphate Urea Phosphatase
Vitamin D Up Down Normal NormalDeficiencyRickets
Renal Up Down Up UpInsufficiency(Renal Rickets)
Renal Up Down Down NormalTubular Insufficiency(HypoPhosphatemia)
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10. This is :-
a. Osteomyelitis
b. Osteomalacia
c. Osteoporosis
d. Osteitis Deformans
e. Leprosy
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10. This is :-
d. Osteitis Deformans
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10. This is :-
a. Osteomyelitis
b. Osteomalacia
c. Osteoporosis
d. Osteitis Deformans
e. Leprosy
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Osteitis DeformansPaget’s Disease
4% of pop. Over 40 yrs.
accelerated bone turnover
often assymptomatic
monostotic > polyostotic
loss of stature
AV shunting
pathologic bone
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11. A child with knee pain has a ____ problem until proven otherwise.
a. Knee
b. Femoral
c. Tibial
d. Hip
e. Patella
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11. A child with knee pain has a ____ problem until proven otherwise.
d. Hip Obdurator Nerve
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11. All of the following are part of the differential of hip pain in a 6 year old, except :-
a. Femoral Osteomyelitis
b. Septic Hip
c. Transient Synovitis
d. Legg-Perthes Osteochondritis
e. Slipped Capital Femoral Epiphysis
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11. All of the following are part of the differential of hip pain in a 6 year old, except :-
e. Slipped Capital Femoral Epiphysis
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11. All of the following are part of the differential of hip pain in a 6 year old, except :-
a. Femoral Osteomyelitis
b. Septic Hip
c. Transient Synovitis
d. Legg-Perthes Osteochondritis
e. Slipped Capital Femoral Epiphysis
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Ages for Hip Disease
D.D.H. Birth
Septic Hip Birth – 11
Legg-Perthes 3 – 11
Transient Synovitis 3 – 11
S.C.F.E. 11 - 16
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12. Osteomyelitis in children is produced by what route of infection?
a. Direct extension from another focus
b. Hematogenous spread
c. Perforating wounds
d. Lymphatic spread
e. Septic hip
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12. Osteomyelitis in children is produced by what route of infection?
b. Hematogenous spread
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Osteomyelitis
Acute infection,metaphyseal
90% Staph.,20% mortality
100% growth abnormality
Periosteal elevation, osteolysis
Sequestrum, Involucrum
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13.
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13.
Paronychia
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14.
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14.
Felon
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15. All of these are findings of a Herniated L5-S1 disc, except :-
a. Absent Achilles reflex
b. Lateral foot numbness
c. Sciatica
d. Low back pain
e. Extensor Hallucis Longus weakness
![Page 128: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/128.jpg)
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15. All of these are findings of a Herniated L5-S1 disc, except :-
e. Extensor Hallucis Longus weakness
![Page 129: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/129.jpg)
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15. All of these are findings of a Herniated L5-S1 disc, except :-
a. Absent Achilles reflex S1
b. Lateral foot numbness S1
c. Sciatica S1
d. Low back pain
e. Extensor Hallucis Longus weakness L5
f. Knee jerk L4
![Page 130: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/130.jpg)
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16. Avascular necrosis of the femoral head is associated with all of the following except :-
a. Steroid use
b. Alcohol
c. Deep sea diving
d. Lipid storage disease
e. Diabetes
![Page 131: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/131.jpg)
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16. Avascular necrosis of the femoral head is associated with all of the following except :-
e. Diabetes
![Page 132: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/132.jpg)
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16. Avascular necrosis of the femoral head is associated with all of the following except :-
a. Steroid use
b. Alcohol
c. Deep sea diving
d. Lipid storage disease
e. Diabetes
![Page 133: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/133.jpg)
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17.
8 year old boy
What is the Diagnosis?
![Page 134: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/134.jpg)
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17.
8 year old boy
Legg – Perthes
Osteochondosis
![Page 135: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/135.jpg)
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Legg-Perthe’s Disease
Osteochondrosis (avascular necrosis)
Proximal Femoral Epiphysis
Necrosis, revascularization, fragmentation, healing
3 – 11 yrs., M > F 4:1, 15% bilat.
Subluxation laterally, Coxa plana, Coxa magna
Osteoarthritis 50 yrs.
![Page 136: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/136.jpg)
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Osteochondroses
Freiberg’s Disease
Osgoode-Sclatter’s
Scheuermann’s
Kienbock’s
Osteochondritis Disecans
2nd Metatarsal Head
Tibial TubercleSpineCarpal Lunate
Lateral Femoral Condyle
18.
![Page 137: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/137.jpg)
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19. Diagnosis?
![Page 138: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/138.jpg)
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19. Gout
![Page 139: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/139.jpg)
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Gout
Urate crystalopathic arthritis
Crystals in periarticular tissues
Inconsistant elevated serum urate
Allopurinol and colchicine
Tophi in periarticular soft tissues
Deposits in non-articular cartilage
Juxta-articular erosions
![Page 140: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/140.jpg)
140140
20.
L5
L4
Spondylolytic Spondylolisthesis
![Page 141: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/141.jpg)
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Spondylolisthesis
Lumbosacral junction defect
Spondylolysis of Pars Interarticularis
Traumatic or congenital
Acute – immobilize
Chronic - surgery
![Page 142: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/142.jpg)
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21. The Salter- Harris Classification is used to assess the severity of :-
a. Epiphyseal Fractures
b. Developmental Dysplasia of the Hip
c. Legg – Perthe’s Disease
d. Club Foot
e. Osteomyelitis
![Page 143: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/143.jpg)
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21. The Salter- Harris Classification is used to assess the severity of :-
a. Epiphyseal Fractures
![Page 144: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/144.jpg)
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I II III
IV V
![Page 145: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/145.jpg)
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22. What is this deformity?
![Page 146: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/146.jpg)
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22. A Diner Fork Deformity
Probable Diagnosis?
![Page 147: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/147.jpg)
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22. Colles Fracture
![Page 148: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/148.jpg)
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22. Colle’s Fracture
distal radial fracture
FOOSH
occurs at all ages
commonly 60 yrs. +
osteoporosis
intra-articular
![Page 149: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/149.jpg)
149149
CR & K-Wires
![Page 150: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/150.jpg)
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External vs Internal Fixation
![Page 151: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/151.jpg)
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23. The common complication of this fracture is :-
![Page 152: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/152.jpg)
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23. Proximal pole Avascular Necrosis
![Page 153: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/153.jpg)
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![Page 154: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/154.jpg)
154154
24. This is a :-
a. Buckle Fracture
b. Greenstick Fracture
c. Stress Fracture
d. Pathologic Fracture
e. Growth Arrest line
![Page 155: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/155.jpg)
155155
24. This is a :-
a. Buckle Fracture
![Page 156: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/156.jpg)
156156
This is a :-
24.
a. Buckle Fracture
b. Greenstick Fracture
c. Stress Fracture
d. Pathologic Fracture
e. Growth Arrest line
![Page 157: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/157.jpg)
157157
Greenstick Fractures
24.
![Page 158: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/158.jpg)
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25. Is this fracture treated by Closed or Open Reduction?
![Page 159: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/159.jpg)
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ORIF
25.
![Page 160: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/160.jpg)
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25. Fractures of Necessity
![Page 161: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/161.jpg)
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26. What is the Diagnosis?
![Page 162: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/162.jpg)
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26. Posterolateral Dislocation of the Elbow
![Page 163: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/163.jpg)
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26. Reduction by traction.
TRACTION
![Page 164: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/164.jpg)
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27. What is the Diagnosis?
![Page 165: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/165.jpg)
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27. Anterior Dislocation of the Shoulder
![Page 166: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/166.jpg)
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27. Reduction by traction
![Page 167: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/167.jpg)
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28.
This is a :-
a. Supracondylar #
b. Olecranon #
c. Dislocation
d. Forearm #
e. Radial Head #
![Page 168: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/168.jpg)
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28.
This is a :-
a. Supracondylar #
![Page 169: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/169.jpg)
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28. Supracondylar Fracture
![Page 170: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/170.jpg)
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29. The complications of a Supracondylar fracture in children include all of the following except :-
a. Malunion
b. Volkmann’s Ischemic Contracture
c. Compartment Syndrome
d. Cubitus Varus
e. Peripheral Nerve Injuries
f. Pulmonary Fat Embolus
![Page 171: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/171.jpg)
171
29. The complications of a Supracondylar fracture in children include all of the following except :-
f. Pulmonary Fat Embolus
![Page 172: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/172.jpg)
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29. The complications of a Supracondylar fracture in children include all of the following except :-
a. Malunion
b. Volkmann’s Ischemic Contracture
c. Compartment Syndrome
d. Cubitus Varus
e. Peripheral Nerve Injuries
f. Pulmonary Fat Embolus
![Page 173: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/173.jpg)
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30. The only sign of a Compartment Syndrome that is always
present is :-
a. Pain
b. Pallor
c. Pulselessness
d. Paresthesias
e. Paralysis
![Page 174: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/174.jpg)
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30. The only sign of a Compartment Syndrome that is always
present is :-
a. Pain
![Page 175: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/175.jpg)
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30. The only sign of a Compartment Syndrome that is always
present is :-
a. Pain
b. Pallor
c. Pulselessness
d. Paresthesias
e. Paralysis
![Page 176: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/176.jpg)
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31. Compartment pressures indicating the need for fasciotomy :-
a. 0 – 15 mms. Hg
b. 15 – 25 mms. Hg
c. > 25 mms. Hg
d. > 50 mms. Hg
e. > 75 mms. Hg
![Page 177: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/177.jpg)
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31. Compartment pressures indicating the need for fasciotomy :-
c. > 25 mms. Hg
![Page 178: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/178.jpg)
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Compartment Syndrome
fractures, crush injuries, burns
collapse of venous return compartment pressure > 25 mms. Hg
engorgement of muscle within
necrosis of muscle tissue
Volkmann’s Ischemic Contracture
Fasciotomy
![Page 179: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/179.jpg)
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32. A 20 yr. old male with a fractured femur has findings of confusion,
tachypnea and conjunctival petechia. The most likely diagnosis is :-
a. Pneumonia
b. Pulmonary Fat Emboli
c. Cerebral Contusion
d. Cardiac Contusion
e. Transient Stress Reaction
![Page 180: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/180.jpg)
180180
32. A 20 yr. old male with a fractured femur has findings of confusion,
tachypnea and conjunctival petechia. The most likely diagnosis is :-
b. Pulmonary Fat Emboli
![Page 181: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/181.jpg)
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32. Pulmonary Fat Embolus
2% - long bone #’s 10% - multiple #’s
tissue thromboplastin ---> extrinsic cascade VII
A.R.D.S. - aterial hypoxemia
petechia across chest, in axillae and conjunctiva
early fixation decreases PFE, but increases infection rates
no current lab tests or treatment protocol
![Page 182: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/182.jpg)
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33. Name the Fracture :-
![Page 183: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/183.jpg)
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33. Monteggia Fracture
![Page 184: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/184.jpg)
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33. Monteggia Fracture
![Page 185: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/185.jpg)
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33. Monteggia Fracture
![Page 186: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/186.jpg)
186186
34. Name this fracture :-
![Page 187: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/187.jpg)
187187
34. Name the fracture :-
Galeazzi Fracture
![Page 188: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/188.jpg)
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GaleazziFracture
34.
![Page 189: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/189.jpg)
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35. The commonest complication of this fracture is :-
![Page 190: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/190.jpg)
190190
35. A Radial Nerve Palsy
![Page 191: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/191.jpg)
191191
36. Does this fracture require surgery?
![Page 192: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/192.jpg)
192192
36. Does this fracture require surgery?
Yes
![Page 193: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/193.jpg)
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37. Does this fracture require surgery?
![Page 194: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/194.jpg)
194194
37. Does this fracture require surgery?
No
![Page 195: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/195.jpg)
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38. This patient most likely
has a fracture of the --------.
![Page 196: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/196.jpg)
196196
38. This patient most likely
has a fracture of the --------.
Hip
![Page 197: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/197.jpg)
197197
38. This patient most likely
has a fracture of the hip.
External Rotation
Shortening
Hip Flexion
![Page 198: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/198.jpg)
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38.
![Page 199: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/199.jpg)
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39. What’s the Diagnosis?
![Page 200: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/200.jpg)
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39. Sub-Capital Hip Fracture.
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40. All of the following are complications of this fracture except :-
a. Malunion
b. Avascular necrosis
c. Fat emboli
d. Non-union
e. Thrombophlebitis
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40. All of the following are complications of this fracture except :-
c. Fat emboli
![Page 203: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/203.jpg)
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40. Blood Supply of Femoral Head
![Page 204: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/204.jpg)
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40. Save Head versus Replacement
![Page 205: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/205.jpg)
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40. Subcapital Hip Fractures
1. Abduction
2. Minimally displaced
3. 50% Displaced
4. Completely Displaced
Garden Classification
![Page 206: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/206.jpg)
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40. Subcapital Hip Fractures
1. Avascular Necrosis - 30%
2. Malunion - 30%
3. Non-union - 30%
4. Surgery required
5. Older population
6. Pathologic - Osteoporotic
Properties
![Page 207: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/207.jpg)
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41. What’s the Diagnosis?
![Page 208: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/208.jpg)
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41. Intertrochanteric Hip Fracture
![Page 209: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/209.jpg)
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41. Intertrochanteric Fractures
![Page 210: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/210.jpg)
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41. Intertrochanteric Fractures
Properties
1. Varus deformity
2. Well - Healing
3. Traumatic + Osteoporosis
4. Surgery required
5. Mid-range Age population
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42. What is the Diagnosis?
![Page 212: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/212.jpg)
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42. What is the Diagnosis?
Subtrochanteric Hip Fracture
![Page 213: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/213.jpg)
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42. Subtrochanteric Fractures
Properties
1. Non-union
2. Traumatic
3. Surgery required
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43.
Surgery or not?
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43.
Surgery or not?
Yes
![Page 216: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/216.jpg)
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44. Surgery or not?
![Page 217: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/217.jpg)
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44. Surgery or not?
Yes
![Page 218: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/218.jpg)
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44. Ankle Fractures Eversion Injuries
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44. Ankle Fractures
Inversion
Injuries
![Page 220: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/220.jpg)
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23 y.o. male
Basketball injury
Open fracture
Numbness dorsum toes
45. What is the approach to this fracture?
![Page 221: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/221.jpg)
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Reduce dislocation
Sterile dressing
Splint extremity
Re-check NV status
IV Antibiotics
Tetanus
Surgery
45.
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46. Surgery or not?
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46. Surgery or not?
Yes
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47. Surgery or not?
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47. Surgery or not?
Yes
![Page 226: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/226.jpg)
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47. Surgery or not?
Yes
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48. A 45 yr. old male, who was previously in good health, has sudden onset of transverse low back pain and right sided sciatica to his foot, after chopping wood at the cottage. Upon arising the following morning, he notices numbness on the outer border of his right foot and
some weakness in the right leg. He has no bowel or bladder problems.
The most likely diagnosis would be:-
a. Lumbar Muscular Strain.b. Herniated Lumbar Disc.c. Herniated Lumbosacral Disc.d. Cauda Equina Syndrome.e. Spinal Stenosis.
![Page 228: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/228.jpg)
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48. A 45 yr. old male, who was previously in good health, has sudden onset of transverse low back pain and right sided sciatica to his foot, after chopping wood at the cottage. Upon arising the following morning, he notices numbness on the outer border of his right foot and
some weakness in the right leg. He has no bowel or bladder problems.
The most likely diagnosis would be:-
c. Herniated Lumbosacral Disc.
![Page 229: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/229.jpg)
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49. Your initial approach to this problem would
include some or all of the following:-
a. Bedrest.
b. Anti-inflammatories.
c. Muscle Relaxants.
d. Spinal X-rays.
e. Physiotherapy.
f. Orthopedic/Neurosurgical referral.
g. CT-Myelogram or MRI
h. Discectomy
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49. Your initial approach to this problem would
include some or all of the following:-
a. Bedrest.
b. Anti-inflammatories.
c. Muscle Relaxants.
d. Spinal X-rays.
e. Physiotherapy.
f. Orthopedic/Neurosurgical referral.
g. CT-Myelogram or MRI
h. Discectomy??
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50. During the work-up for this problem, the patient complains that he has unaccountably soiled his underwear, without knowing it. Your response to this would be to:-
a. Reassure the patient that this is not serious
b. Order an urgent MRI
c. Get an urgent referral to Neuro/Orthopedics
d. Place the patient on immediate bedrest.
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50. During the work-up for this problem, the patient complains that he has unaccountably soiled his underwear, without knowing it. Your response to this would be to:-
c. Get an urgent referral to Neuro/Orthopedics
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50. During the work-up for this problem, the patient complains that he has unaccountably soiled his underwear, without knowing it. Your response to this would be to:-
a. Reassure the patient that this is not serious
b. Order an urgent MRI
c. Get an urgent referral to Neuro/Orthopedics
d. Place the patient on immediate bedrest.
![Page 234: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/234.jpg)
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51. A lumberjack felling a tree is unfortunately struck on the back by the tree, knocking him to the ground and injuring his left lower extremity. In the ER, his left hip is in flexion, adduction and internal rotation. The most likely diagnosis is:-
a. Fracture of the Hip.b. Fracture of the Femur.c. Anterior Hip Dislocation.d. Posterior Hip Dislocation.e. Fracture of Pelvis.
![Page 235: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/235.jpg)
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51. A lumberjack felling a tree is unfortunately struck on the back by the tree, knocking him to the ground and injuring his left lower extremity. In the ER, his left hip is in flexion, adduction and internal rotation. The most likely diagnosis is:-
d. Posterior Hip Dislocation.
![Page 236: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/236.jpg)
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52. Which of the following signs and symptoms are consistent with a torn medial meniscus of the knee:-
a. Inability to squat
b. Pain on descending stairs
c. Locking
d. Recurrent effusions
e. All of the above.
![Page 237: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/237.jpg)
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52. Which of the following signs and symptoms are consistent with a torn medial meniscus of the knee:-
a. Inability to squat
b. Pain on descending stairs
c. Locking
d. Recurrent effusions
e. All of the above.
![Page 238: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/238.jpg)
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53. A 35 yr. old male falls jogging and sustains an undisplaced lateral malleolar fracture of the ankle. He is treated in a Below-knee Walking cast, but returns to the ER 24 hrs. later complaining of increased, persistent, burning pain at the ankle.
Your response to this situation would be to:-
a. Re-X-ray the ankle.
b. Remove the cast.
c. Measure the compartment pressures.
d. Instruct the patient to elevate the limb and prescribe an anti-inflamatory.
![Page 239: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/239.jpg)
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53.. A 35 yr. old male falls jogging and sustains an undisplaced lateral malleolar fracture of the ankle. He is treated in a Below-knee Walking cast, but returns to the ER 24 hrs. later complaining of increased, persistent, burning pain at the ankle.
Your response to this situation would be to:-
b. Remove the cast.
![Page 240: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/240.jpg)
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53. A 35 yr. old male falls jogging and sustains an undisplaced lateral malleolar fracture of the ankle. He is treated in a Below-knee Walking cast, but returns to the ER 24 hrs. later complaining of increased, persistent, burning pain at the ankle.
Your response to this situation would be to:-
a. Re-X-ray the ankle.
b. Remove the cast.
c. Measure the compartment pressures.
d. Instruct the patient to elevate the limb and prescribe an anti-inflamatory.
![Page 241: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/241.jpg)
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54. The most common dislocations of the shoulder are:-
a. Medial.
b. Posterior.
c. Luxatio Erecta.
d. Anterior.
![Page 242: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/242.jpg)
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54. The most common dislocations of the shoulder are:-
d. Anterior.
![Page 243: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/243.jpg)
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55. Metastatic lesions to bone, of the following tumours, usually produce lytic defects except:-
a. Thyroid.
b. Pancreas.
c. Prostate.
d. Kidney.
e. Lung.
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55. Metastatic lesions to bone, of the following tumours, usually produce lytic defects except:-
c. Prostate.
![Page 245: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/245.jpg)
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55. Metastatic lesions to bone, of the following tumours, usually produce lytic defects except:-
a. Thyroid.
b. Pancreas.
c. Prostate.
d. Kidney.
e. Lung.
![Page 246: 1 LMCC Orthopedic Review Lecture April, 2004 “Back to Basics” Dr. P.R. Thurston](https://reader036.vdocument.in/reader036/viewer/2022081513/56649d985503460f94a81fd5/html5/thumbnails/246.jpg)
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Th - Tha – That’s all folks!