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SQ of Paper II
1. Wrist drop
Ans.: Wrist remains in palmer flexion due to weakness of dorsiflexor.
It is seen in radius nerve palsy.
2. Sequestrum
Ans.: It is a piece of dead bone, surrounded by ineffectual
granulation fiber trying to cut away the sequestrum. It is a
complication of osteomyelitis.
3. Splints
Ans.: Splints are a device used for immobilizing fractures, either
temporarily during transportation or for definitive treatment.
- Also used in other orthopedic condition like infection, congenital
dislocation of hip etc.
4. Nonunion
- When the process of fracture healing comes to a stand before its
complications the fracture is said to have gone in non-union. It is not
before 6 months a fracture can labeled non-union.
- Mainly of two types
a) Atrophic
b) Hypertrophic
5. Pathological fractures
- A pathological fracture is a bone fracture caused by disease that lead
to weakness of bone structure. This process is most commonly due
to osteoporosis but may be due to other pathologies such as;
o Cancer
o Infarction
o Inheriterited bone disorder
o Bone cyst
6. Osteoporosis
- It is the commonest metabolic bone disease. Characterized by a
diffuse reduction in bone density due to decrease in the bone mass.
It occurs when route of bone resorption exceed the rate of bone
formation
7. Osteosynthesis
- Osteosynthesis is the reduction and internal fixation of a bone
fracture with implantable devices that are made of metal. It is a
surgical procedure with an open or percutaneous approach in the
fractured bone.
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8. Arthroplasty
Ans.:
- Arthroplasty is an operation for construction of new movable joints.
- Indications
Osteoarthritis of hip and knee
Ankylosis of elbow
Un-united femoral neck fracture.
- Mainly of three types
Excision Arthroplasty
Hemiarthroplasty of half joint replacement
Total replacement Arthroplasty
9. Guyons canal syndrome
- Caused by entrapment of the ulnar nerve in Guyons canal as it
passes through the wrist. Start with a feeling of pins and needles in
the ring finger before progressing to a loss of sensation and/or
impaired motor function of the intrinsic muscle of hand which are
innervated by ulnar nerve
- Mainly seen in regular cyclists.
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Mortons metatarsalgia
It is a benign neuroma of a intermetatarsal planter nerve, most
commonly of the second and third metatarsal spaces which result
entrapment of the affected nerve
Main symptoms are pain and/or numbness relieved by removing
footwear.
11.Bicipital tendinitis
- It is an inflammatory process of the long head of the biceps tendon
and a common cause of shoulder pain.
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Dupuytrens contracture
Characterized by a flexion deformity of one or more fingers due to a
thickening and shortening of the palmer aponeurosis.
Ring finger is most commonly affected
Flexion at metcarpo-phalangeal joint and proximal interphalangeal
joint.
Trendelenbergs test
To detect the incompetence of the saphano-femoral junction and/or
the other communicating system.
Patient lie down on the couch in supine position limb elevated above
the level of heart to allow the varicose veins empty
Thumb is place on the saphano-femoral opening. Patient is asked to
stand up quickly.
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Findings:
- Pressure is not released and gradual fillings of veins from
below. It suggest incompetence of ley perforator.
- Pressure is released quickly feeling from above
- Incompetence of valves at saphano-femoral junction.
Both are called Trendelenbergs test positive.
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Accessory navicular
The accessory navicular is an extra bone or cartilage located on the
inner side of the foot just above the arch. It is incorporated in the
posterior tibial tendon.
It is congenital and present from birth may give rise to accessory
navicular syndrome.
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Neletons line
Theoretical line in the moderately flexed hip, drawn from
Anterior superior iliac spine to
Tuberosity of the ischium
Normally the greater trochanter of femur lies below this line, in case
of iliac joint dislocation of the hip or fracture of the neck of femur the
trochanter is felt above the line.
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Spina ventousa
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Axonotmesis
It is condition of nerve injury in which axon use damaged but the
internal architecture of the nerve is preserved
Wallarian degeneration occurs recovery may occurs spontaneously
but may take month.
Volkmans sign
Helps in cure of the flexor deformity of finger
o In this sign, it is possible to extend the fingers fully at the
interphalangeal joint only when the wrist is flexed. On
extending the wrist fingers get flexed at interphalangeal joint.
This because the wrist extended the shortened flexor muscle tendon
unit is stitched over the front of wrist, resulting in the flexion at finger.
Mainly seen in Volkmans Ischemic contracture
Stress fracture
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Trigger finger
Condition resulting from the contraction of the fibrous digital sheath,
so that free gliding of the contained flexor tendon does not occur.
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Froments sign
Sign used for ulnar nerve injury in which adductor pollicis will be
paralyzed.
Pattern will hold the book by using the flexor pollicis longer. If
examiner tries to pull the book this increases the already produced
flexion at interphalangeal joint at thumb
This sign is known as Froments sign or book test.
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Tennis elbow
Conditions characterized by pain and tenderness of the lateral
epicondyle of the humerus due to non-specific inflammation at the
origin of the exterior muscles of forearm.
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Neuropraxia
It is a physiological disruption of conduction in the nerve fibre. No
structural changes occur. Recovery occurs spontaneously within a
few weeks and is complete.
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Thomas splint
It is also known as Thomas- knee bed splint commonly used for the
immobilization of hip and thigh
injuries
- Parts:
1. A ring
2. Two side bars joined distally
- Ring is at 1200 to inside burn,
outside burn has a curve near its
junation with ring to accommodate
greater trochanter.
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36. Tourniquet
- A tourniquet is a constricting or a compressing device specifically a
bandage, used to control venous and arterial circulation to and from
extremity for a period of time.
37. Codmans triangle
- In osteosarcoma - X-Ray a triangular area of subperiosteal new
bone is seen at the tumour-host cortex junction at the ends of the
tumour.
38. Enumerate types of shoulder dislocation
1. Anterior dislocation preglenoid, subcoracoid, subclaviular
2. Posterior dislocation
3. Luxatio erecta
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39. PTB
Patellar tendon bearing prosthesis used in below-knee Amputation.
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o Skin changes
42. Green stick fracture
43. Erbs palsy
- It is a paralysis of the arm caused by injury to upper arms main
nerve specifically severing of the upper trunk C5-C6 nerves of the
brachial plexus.
- It is most commonly from shoulder dystocia during a difficult birth.
44. Colles cast
In Colles fracture a plastic cast extending from below elbow to the
metacarpal heads maintaining the wrist in
o Palmar flexion
o Ulnar deviation
- This is called Colles cast
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75. Osteoarthritis
- Osteoarthritis is a degenerative joint disease primary affecting the
articular cartilage characterized by pain and stiffness in joints.
76. Pes cavus
- Longitudinal arches of the foot are exaggerated. This deformity of leg
is called pes cavus.
77. Fracture patella
- A direct or indirect blow to the anterior aspect of the flexed knee
result in fracture of patella. Mainly of two types
o Pro part fracture
o Stellate fracture (communited fracture in all part of patella )
78. Saturday night palsy
- Results from falling asleep with ones arm hanging over the arm rest
of chair compressing the radial nerve at spiral grove.
83. Torticollis
- Deformity of neck where head and neck are turned and twisted to
one side due to spasm of sternocleido-mastoid muscle.
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Classification of compound fracture
Two types
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What is Osteomyelitis?
Infection of the bone by micro-organisms is called
Osteomyelitis it may be acute or chronic.
Tatlors brace
Tatlor brace is an orthosis which is reasonably efficient in
preventing flexion, extension & lateral motion of tharocic &
tharoco-lumber spines.
H.O. Thomas
Considered as father of orthopaedic surgery.
Contribution
In Rx of fractures & TB.
Thomas allar to Rx TB of cervical spine.
Thomas maneuver to investigate fracture of hip
Thomas test to detect deformity of hip
Thomas wrench for reducing fractures.
March fracture
Also known as fatigue fracture of metatarsal bone is a
fracture of distal 1/3 of one of metatarsal occurring because
of recurrent stress while marching.
Froments sign
Is a special test for wrist to test palsy of ulnar nerve,
specifically action of adductor pollicis.
Patient is asked to hold paper or flat object between thumb
& index finger & then examiner then attempts to pull the
object out of the subjects hands.
Spinal shock
It is a loss of sensation accompanied by motor paralysis
with initial loss but gradual recovery of reflexes following a
spinal cord injury most often complete transaction.
Neuropraxia
A condition in which a nerve remains in place after a severe
injury although it no longer transmits impulses due to nerve
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Thomas test
It is a test described by Hugh Owen Thomas used to rule
out hip flexion contracture & psoas syndrome
Patient lies supine position on examination table brings one
knee towards chest while other leg extended test called +ve
if patients
Opposite/contralateral hip flexes without knee extensionthigh + Iliopsoas
Hip abducts tight tensor Fascia Lata
Knee extension occurs -Tight Rectus femoris
Lateral rotation of Tibia-Tight Biceps Femoris.
Madelungs deformity
It is an epiphyseal growth plate disturbance characterized
by dorsal & radial bowing of the radius with resultant
cosmetic effects & decreased grip strength.
Osteoid osteoma
It is the commonest true benign tumour of the bone.
Pathologically it consists of a nidus of tangled or rays of
partially mineralized osteiod trabeculae surrounded by
dense sclerotic bone.
Mc murray
It is used to evaluate individuals for tears in the meniscus of
the knee. It is a rotation test for demonstrating the torn
cartilage of knee. A tear in meniscus may cause a
pedunculated tag of meniscus which may become jammed
between joint surfaces.
Thoms splint
These are mostly commonly used to treat complete long
bone fractures of leg, femur not for tibia & fibula area.
It refers to a splinting device that uses straps attaching over
the pelvis or the hip as an anchor, metal rod to mimic
normal bone stability & limb length, a mechanical device to
apply traction to the limb.
124.
Dislocation of HIP
3 main types
1. Posterior
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2. Anterior
3. Central fracture dislocation
All these may be associated with fracture of lip of acetabulum.
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Delayed union
When a fracture takes more than usual time to unite it is
said to have gone in delayed union.
Complications of a dislocation
Myositis ossificans
Persistent instability
Joint stiffness
Recurrence
Osteoarthritis
Avascular necrosis
Traction in management of a fracture
It is used for reduction of fractures and dislocation & their
maintenance.
For immobility a painful inflamed joint.
Prevention of deformity by counteracting the muscle spasm
associated with painful joint conditions.
Correction of soft tissue contractures by pulling them out.
Spin Bifida
Birth defect where there is incomplete closing of spinal
canal & meninges of spinal cord.
Bakers cyst
It is also known as a popliteal cyst a benign swelling of
semimembranous or more rarely some synovial bursa found
behind the knee joint seen behind the knee joint.
Coxa vara deformity
Deformity of hip where the angle between the head & shaft
of the femur is reduced to less than 120o degrees.
C.T.E.V
Congenital talipus equino varus in which a child presents
with either one or both feet pointing downwards (planter
flexion) & turns inwards (invasion & adduction). Two types
1) Postural
2) Structural
Pulse polio programme
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Calcitonin
It is a polypeptide hormone produced by parafollicular cells
of thyroid gland, acts to reduce blood calcium.
Jaw reflex
It is a stretch reflex used to test the status of patients
trigeminal nerve, the lower jaw is trapped at angle just
below the lips at the chin while the mouth is held slightly
open. In response masseter muscle will jerk the mandible
upwards.
Normally this reflex is absent or very slight however in
individuals with upper motor neuron lesions the jaw jerk
reflex can be quite pronounced.
Jumpers knee
Patellar tendinitis also known as jumpers knee is relatively
common cause of pain in inferior patellar region in athletes.
Common with frequent jumping. Rest, ice, compression,
elevation is a conservative treatment.
Hangmans fracture
It is a fracture through the pedicle & lamina of C 2 vertebra,
subluxation of C2 over C3 sustained in hanging.
INH toxicity (TB drug)
Acute INH toxicity frequently manifests as altered mental
status or seizures seen in children, suicidal intent or patient
taking extra dose for missed dose.
Chronic INH toxicity manifests as peripheral neuropathy
Hepatotoxicity.
Whitlow
Second most common infection of tip of finger, commonly
resulting from a pin prick; index finger& thumb are affected
most Often. In it terminal pulp-space (volar space of distal
digit) which is filled with compact fat is infected. The pulp is
swollen tense & tender characterized by severe throbbing
pain & exquisite tenderness suggest suppuration
Lepra bacilli
Mycobacterium leprae is known as lepra bacili
Gram +ve
Acid fast bacterium
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Pattern
Long Case
Obstructive Jaundice
Hernia
PVD
Ca Breast/ Lump in Breast
Thyroid
Head & Neck Swelling
Lump in Abdomen
Varicose Vein
Prostate
Short case - 1 Surgery
Ulcer
Hernia
Amputation
Colostomy
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Ileostomy
Lymph node swelling
Swelling - Sabaceous cyst
Oral cavity ulcer
Short case -2 Orthopaedics
Hip/Knee Examination
Peripheral Nerve Examination
Median Nerve
Radial Nerve
Ulnar nerve
Common Peroneal Nerve
Sciatic Nerve
Tibial Nerve
Fixator
Osteomyelitis
Radius fracture
Collis fracture
Table
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