• Corrections in Maheshwari-◦ M/C # at birth--> Clavicle◦ Thurston Holland sign--> Salter harris type 2◦ M/C nerve injury in supracondylar # -->

▪ Ant. interosseous nerve▪ Median▪ Radial▪ Ulnar

◦ Cast in CTEV--> Above knee cast

28. Which of the following about facial bone fractures is not true-1. Maxillary #’s are classified into Le-fort #s2. Le fort II # which involves floor of the orbit is also called blow out # ------ans3. Tear drop sign is a feature of blow-out fractures4. Tripod # is the fractures of zygoma

Discussion- (Dhingra= 175)Blow out #

• only orbit of eye is involved(not maxillary bone)• Tear drop sign(X-Ray finding)--> Rx: Caldwell luc Sx

46.Hypophosphatemic rickets: all are true except-1.Secondary hyperparathyroidism-----ans2.Defect in PCT of kidneys3.No Rachitic rosary4.X - linked dominantDiscussion-hypophosphetemia-->dentin part is effected

• Synovial fluid exerts an inhibitory effect on bone union by dissolving the callus.• Brittain's procedure : extraarticular arthrodesis of hip joint usually performed for tuberculosis of the hip joint.

This involves sub-trochanteric osteotomy and placement of a tibial cortical graft across the osteotomy site into the ischium, and then application of a hip spica. Internal fixation is *not used.

• Dunlop's traction is used in--> supracondylar fracture humerous• Bowler's thumb - perineural fibrosis due to repeatative compression of digital nerve of the thumb while grasping

ball.• Compartment syndrome- Most commonly a/w *supracondylar fracture of the humerous and tibial shaft. Lack

of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment

• Volkman's sign *- It is possible to extend the fingers only when wrist is flexed (P-85 Maheshwari)• M/C site of injury in swimmers- shoulder• Excision of head of the radius in children- Proximl migration of the radius resulting in *subluxation of the

inferior radio-ulnar joint and instability.• Jump sign- tenderness with withdrawal (grading used in soft tissue tenderness)• Bulge sign - Seen in knee effusion (also called ballotment of patellae)• Kanavel's four cardinal signs for tenosynovitis-

1. Finger is uniformly swollen2. Finger held in slight flexion for comfort3. Course of inflamed sheath is markedly tender4. Passive finger extension causes intense pain (Highly sensitive for flexor tendon infection)

Kanavel's sign does not include high temperatre though it may be present.

• Night cries are characteristic of--> Tubercular arthritis• Acro-osteolysis seen in SLE. • Limping in a Child.... 3 most common cause and they occur in 3 different age groups....

◦ Congenital hip dysplasia - 0-3 years, Dx by Ortolani test and Ultrasound....... ◦ Legg-Perthes - 4-8 years, avascular necrosis of femoral head ...painless initially.... later pain appear....Pain

may be referred to knee...... ◦ Slipped capital femoral epiphysis - >11 years obese adolescent, think deficient gonads ( Androgens causes

closure of epiphysis ) Pain may be referred to knee...... • Tom smith arthritis of hip joint is d/t: Pyogenic infection• The only difference b/n endochondral and intramembranous ossification is the *microenvironment in which

bone formation occurs. The bones formed can not be distinguished microscopically or macroscopically.▪ Intramembranous ossification - In flat bones of the skull, bone formation occurs through the

differentiation of osteoprogenitor cells from mesoderm and is accompanied by vascularisation▪ Endochondral ossification - Osteoprogenitor cells differentiate into chondrocytes and establish a cartilage

model of long bones which is used as a scaffolding for bone formation.

• Psoriatic arthropathy- ◦ Presentation is like RA(a polyarthritis but with distal IP joints of hands involved)◦ Classic skin lesions◦ Radiography- DIP involvement, including the classic "pencil-in-cup" deformity; marginal erosions with

adjacent bony proliferation ("whiskering"); small-joint ankylosis; osteolysis of phalangeal and metacarpal bone, with telescoping of digits; and periostitis and proliferative new bone at sites of enthesitis. There is cup-like erosions and bony proliferation with expansion at the base of the terminal phalanges and tapering of the proximal phalanges.

◦ Rx: Steroids

• Sharpey's fibres (bone fibres, or perforating fibres) are a matrix of connective tissue consisting of bundles of strong collagenous fibres connecting periosteum to bone .

• DDH- M/C in girls, on left side, breech presentation(more in extended breech), first born child , CS• Ilizarovs technique principle- osteogenesis requires dynamic state--> either a controlled distraction or a

controlled compression• JOINT INVOLVEMENT IN NEUROLOGIC DISORDERS

◦ SYRINGOMYELIA affects upper limbs jts- glenohumeral jt, elbow and wrist◦ TABES DORSALIS affects lower limb jts- knee, hip and ankle◦ DIABETES MELLITUS affects Tarsal and Tarso metatarsal joint.

• INDICATIONS OF OPEN REDUCTION ARE "NO CAST" :◦ Non union◦ Open fracture◦ Compromise in neurovascular structures◦ Articular fracture◦ Salter harris III IV V◦ Trauma

• Gustilo and Anderson classification of open fractures• Type I: clean wound smaller than 1 cm in diameter, appears clean, simple fracture pattern, no skin crushing.• Type II: a laceration larger than 1 cm but without significant soft tissue crushing, including no flaps,

degloving, or contusion. Fracture pattern may be more complex.• Type III: an open segmental fracture or a single fracture with extensive soft tissue injury. Also included are

injuries older than 8 hours. Type III injuries are subdivided into three types:• Type IIIA: adequate soft tissue coverage of the fracture despite high energy trauma or extensive

laceration or skin flaps.• Type IIIB: inadequate soft tissue coverage with periosteal stripping. Soft tissue reconstruction is

necessary.• Type IIIC: any open fracture that is associated with vascular injury that requires repair.

Major advantage of open redction is shorter period of immobilisation. Hematomas at the site of fracture may be important for early healing; open reduction which generally involves removing the clots in the field, could contribute

to a delay in bone healing and to non-union.

• Joint disease with synovial fluid having normal to slightly elevated neutrophil count and normal mucin clot study-->Osteoarthritis(OA and neuropathic arthropathy are the two noninflammatory joint diseases. Inflammatory joint diseases have high neutrophil count and poor mucin clot test)

• Third degree sprain-o Complete tear of ligamento Often the pain is minimalo Hemarthrosis is noticed within 2 hourso Joint will open upif ligament is stressedo Requires surgical repair

• M/C involved muscle in VIC--> flexor pollicis longus,flexor digitorum profundus• Fracture of lateral condyle of humerous is a type IV epiphysial injury, accurate reduction is important if normal

growth of the elbow is to be expected, and it is treated by ORIF usig two K-Wires• Earliest diagnosis of acute osteomyelitis--> Bone scan(it shows increased blood flow to the bone at the site of

infection.• Sub-metaphyseal translucency is the classic radiologic finding in child with leukaemia.• Ankylosing spodylitis-

o Seronegative(negative rheumatoid factor)o *HLA B-27 positiveo Involves primarily young man between 15-30 yrso C/F-

Insidious onset of morning stiffness in lower back that persists for >3mths and improves as day progresses or with exercise

Sclerotic changes in the sacroiliac area are the first radiographic evidence of disease. Patients have diminished anterior flexion of the spine, which is documented with the Schober test(measure the ability of a patient to flex his/her lower back). Eventually the vertebral column fuses to produce the classic bamboo spine*

o Serum ANA is negative because it is not a collagen vascular disease or a variant of rheumatoid arthritis.

Patrick test- done for sacroilitis.......

• Various tests-o Finkelsein test*--> chronic stenosing tenosynovitis (de Quervain’s test)o M cMurrey test--> evaluation of knee for meniscal tearso Ortolani test--> evaluates newborns for congenital hip dislocation

• Kite’s angle: > 35 degree (reduced in CTEV)o Kite index- Telocalcaneal angles in AP and Lateral views

• Bohler’s angle-->Reduced in most # of calcaneumo angle b/n talus and calcaneumo N--> 35 degree

• Borden's view--> diagnosis of *Calcaneal fractures.• Oblique popliteal ligament is extra-articular in knee joint.• Iliac crest are the commonest site for taking bone grafts.

o When the graft is required for osteogenic purpose(as in non-union), cancellous bone grafts are preferred. It is available in plenty from iliac crests and upper end of tibia.

o When graft is used for providing stability(as for filling bone gaps), cortical graft is used. Fibulae are the common source of cortical bone grafts.

• Fracture of the clavicle-o Common fracture of all the age groupso Common site is junction of middle & outer thirdo Outer fragment displaces medially and downwards because of the gravity and pull by the pectoralis

major muscle attached to it

o Shoulder stiffness is a common complication• Avascular necrosis after trauma is seen in-

o Head of femuro Proximal pole of scaphoido Body of taluso Proximal pole of lunate

Basic science and anatomy-

1. Calcium ion transport mediated by-1. Osteoblast2. Osteocyte---------------ans3. Osteoclast4. All

Discussion- • Osteoblasts-

▪ Principle bone froming cell. Osteoblasts are modified fibroblasts.▪ Rich in alk. Phosphate.▪ Normal osteoblasts are able to lay down type-1 collagen and form new bone.▪ Form ruffled borders

• Osteocyte- ▪ Spent osteoblast▪ Role in osteolysis (main role--> though all are involved)▪ Involved in Ca and other mineral transport

• Osteoclasts- ▪ Osteoclasts, on the other hand, are members of the monocyte family. ▪ Rich in TRAP (Tartarate resistant acid phophate)▪ Bone resoption▪ Lie on houship lacune▪ Ruffled borders exist on osteoclast

2. Cells in howships lacunae-1. Osteoblast2. Osteocyte3. Osteoclast--------------ans4. All

3. Guyons canal is for1. Median nerve2. Ulnar nerve---------------ans3. Radial nerve4. PIN

Discussion- • Guyton's canal-

◦ Content- wrist--> ulnar nerve, ulnar artery◦ Medially--> pisiform and hammate form the boundry

Handlebar palsy- Ulnar nerve compressed

4. Gerdys tubercle is-1. Attachment of iliotibial band---------------------ans2. Anterior aspect of lower end femur3. Posterior aspect tibia 4. Medial aspect tibia

Discussion-

• Located on upper tibia anterolateral aspect--> attachment of iliotibial band• Polio--> iliotibial band contracture--> Ober test• Triple deformity of knee--> PERF

• P- Posterior subluxation of tibia• ER- External rotation of tibia• F- Flexion of knee

◦ Causes of triple deformity of knee-PERT• P- Polio• E- Excessive bleeding(hemophilia)• R- RA• T- TB

5. Tip of index finger is autonomous zone of-1. Median----------ans2. Ulnar3. Radial4. Pin

Discussion- • Nerve supply-

◦ Tip of index finger- Median nerve◦ Tip of little finger- Ulnar nerve◦ Dorsum of hand- Radial nerve

• Horn's sign- All 3 nerve intact• U lnar nerve injury--> Claw hand--> use knuckle bender cast

• Sensory supply of hand- ◦ Thumb- C6◦ Index and middle finger- *C7◦ Ring and little finger- C8

• C7 block- to check brachial plexus block by anesthetics

6. C7 supplies-1. Index finger2. Middle finger---------------ans3. Little finger4. Thumb

7. Lumbricals function is (pgi)-1. MCP flexion2. IP extension3. Both-------------------ans4. None

8. All are part of lateral condyle except-1. Capitellum2. Physis3. Metaphysis4. None------------------ans

Discussion- • Parts of lateral condyle humerous-

• Lateral epicondyle• Capitulum• Lateral half of trochlea

• Physis+Metaphysis

11. Elbow ossifies at-1. 16 years---------------------ans2. 18 years3. 14 years4. 20 years

Discussion- Gaon me jab bacca mature(18 saal ka) ho jata hai to maan baap kehte hain apne ghutnon par kahre ho jao aur shoulder par ghar ka bojh samhalo.....(Alternate with 16 yrs at adjacent jts.)

12. Forearm has ____ compartements-1. 12. 23. 34. 4 ----------------ans

13. Trendelenberg test is positive due to injury to-1. Sup gluteal n ------------ans2. Inf gluteal n3. Obturator n4. Tibial n

Discussion- • Gluteal fold are the landmark--> not ASIS• Parts-

◦ F emoral head- Fulcrum◦ Neck- Lever arm◦ Effort- Abductors (gluteal medius and minimus)--> response is assesed by level of buttock fold

• Positive trendelenberg's test is seen in-◦ Pain on weight bearing◦ Hip abductor wekness◦ Shortening of femoral neck◦ Disocation of hip joint

Neurology-

14. In post. radical neck dissection syndrome all are seen except (aiims)-1. Shoulder drooping2. Restricted range of movement of shoulder joint3. Shoulder pain4. Normal electromyographic finding----------------------ans

Discussion- • EMG showing defibrillation potentials--> nerve damaged

• EMG shows the earliest menifestation on nerve recovery

Strength duration curve--> Shift to left indicates recovery (cram)

15. Froments sign tests-1. Abductor pollicis brevis2. Adductor pollicis------------------ans3. Flexor polllicis brevis4. Interossei

Discussion- (Maheshwari- 54)• Pen test- Abductor pollicis brevis--> Median nerve• Foment's sign- +ve in adductor pollicis injury--> Ulnar nerve• Card test--> Palmer interossei--> Ulnar nerve

16. Neuroma in continuity according to sunderland classification is-1. Stage 12. Stage 23. Stage 34. Stage 4 ---------------ans

Discussion- • Cassification of nerve injuries-

Seddon's Sunderland

Neuropraxia- Physiological block in conduction--> 100% recovery. Comes back like lightening

Type I

Axenotemesis- damage to axonal sheath--> recovery never complete Type II, III, IV

Neurotemesis- Complete transection. No recovery without surgery Type V

• Neuroma--> Proximal to injury• Glioma--> Distal to injury

Neuroma in continuity--> crushed nerve--> stage IV

17. Cheralgia paraesthetica is-1. Compression of lateral cutaneous nerve of thigh2. Compression of superficial radial nerve--------------------------ans3. Compression of ulnar sensory branch4. Compression of superficial peroneal nerve

18. VIC most common nerve involved-1. AIN-----------------------ans

2. PIN3. Ulnar4. Musculocutaneous

Discussion- Maheshwari- 83• Compartment syndrome sequele-

◦ <6 hrs --> Vischaemia◦ >6hrs --> Gangrene--> amputation

• VIC--> Brachial artery compressed--> ◦ deep flexor compartment of forearm(m/c involved)- FFP

▪ F- Flexor digitorum profundus (m/c involved)--> Lateral half supplied by AIN(BDC-104)▪ F- Flexor pollicis longus▪ P- Pronator quadratus

• AI artery is the m/c artery involved d/t VIC--> Branch of Ul. A. (other branch Post. I. A.)

• VIC-◦ Splint: *Turn buckle splint (Volkman's splint)◦ Sx: Muscle sliding operation (Maxpage operation)

19. Which of the following is not true regarding Klumpke’s paralysis:(ai)1. Site of injury is upper trunk of brachial plexus----------ans2. The nerve root involved mainly is t13. Claw hand is the typical deformity4. Homer’s syndrome can be a presentation

Discussion- BDC-53

Brachial plexus injury-

• Erb's palsy-◦ Best prognosis◦ M/C nerve- C5, C6◦ Policeman tip hand◦ Movements lost are-

▪ SERaB• S- Supination• ER- External rotation• aB- Abduction

• Klumpke's paralysis-◦ Injury to C8, T1◦ a/w horner's

• Leffert's classification- Used in brachial plexus injury

20. All are involved in entrapment neuropathy except (ai 09)-1. Median nerve2. Tibial nerve3. Femoral nerve--------------------ans4. Lat cutaneous of thigh

Discussion- • Neck- Thoracic outlet yndrome• Shoulder- Supraclavicular neuritis• Elbow- Ulnar neuritis, median neuritis, Radial neuritis• Wrist- Carpal tunnel, Ulnar neuritis

• Hip- Piriformis syndrome (Sciatic nerve compressed), Meralgia paresthetica• Lower leg- Compartment syndrome• Foot- Tarsal tunnel syndrome, Digital neuritis• Leg is the m/c area where compartment syndrome is seen (children--> forearm)

Inury to hip joint is related to--> Sciatic nerve

Cast and Splints -

Name of cast Use

Colle's cast Colle's fracture

Cyllinder cast/tube cast Fracture of the patella

Hanging cast Fracture of the humerous (Maheshwari-77)

Hip spica* Fracture of the femur

Minerva cast Cervical spine

Petric cast/Broom stick: Perthe d/s

PTB cast (ptellar tendon bearing) Fracture of the tibia

Risser's turn buckle cast Scoliosis

Shoulder spica* Shoulder immobilisation

U-slab Fracture of the humerous

*Spica is a cast where limb and part of trunk are included

22. Cock up splint is used for-1. Radial nerve injury-------------------ans2. Median nerve injury3. Ulnar nerve injury4. Brachial plexus injury

Discussion-

Splint Name UseCock-up splint Radial nerve palsyKnuckle-bender splint Ulnar nerve palsyAero-plane splint Brachial plexus injuryToe raising splint For foot drop

23. Turn buckle splint is used for-1. VIC-------------------------------------ans2. Ulnar nerve palsy3. Median nerve palsy4. Radial nerve palsy

24. Tension band principle can be used by-1. Wiring2. Plating3. Both-----------------ans4. None

Discussion- • Principle- Conversion of distractive force into compressile force--> done by wiring or plating• Uses-

◦ Patella #

◦ Olecranon #◦ Medial malleolus #

Dynamic splints are better than static (DB splints used in CTVS are dynamic splints)

25. Dennis brown splint is used for-1. CTEV----------------------------------ans2. Cong vertical talus3. Fibular hemimelia4. Tibial hemimelia

26. CTEV shoes have a/e-1. Straight inner border2. Outer shoe raise3. Inner shoe raise--------------ans4. No heel

Discussion- • Straight inner border• Outer shoe raise*• No heel

27. Rissers localizer cast is used in the conservative management of- (aiims)1. Dorsolumbar scoliosis2. Idiopathic scoliosis-------------------ans(Maheshwari- 233--> M/C scoliosis)3. Kyphosis4. Spondylolisthesis grade iii

Discussion- • Reisser's sign- fusion of the ossified apophysis to the ilium in scoliosis thus there is no possibility of curve

worsening

28. Velpeau sling and swath bandage is used in-1. Acromio clavicular dislocation---------------------ans2. Shoulder dislocation3. Fracture scapula4. Fracture clavicle

Discussion- Maheshwari-73• Acromio-clavicular jt. Injuries clasified by-

◦ Type I-III: Described on the basis of ligamentous injuries. Managed by velpeau sling and swath bandage◦ Type IV-VI: Classified on the basis of lateral end of clavicle displacement. Managed by operative

intervention

• # clavicle-▪ Junction of middle and outer thirds▪ Outerpart- Displaced medially and downwards by pectoralis major▪ Inner- Displaced upwards by sternocleidomastoid

Classifications-

29. Salter harries type 3 is-1. Split of epiphysis------------------------ans2. Separation of epiphysis3. Split+metaphyseal part4. Crushing

30. Verdans zone is defined for-

1. Extensor tendon zone2. Flexor tendon zone------------------ans3. Thumb tendons4. Carpal tunnel

Discussion-

• No man's land is--> Verdan zone type II--> Since multiple adhesions form after surgery• Between distal palmer crease and proximal interphalangeal jt.

• Gartland classification is used in supracondylar # humerous• Milch- lateral condylar #• Mason's- Radial head # (pgi)• Wilkins- radial neck #

33. Skin lesion in closed fracture is classified by-1. Gustiloanderson2. MESS SCORE3. Mirels score4. Tscherne----------------ans

Discussion- • Breech in continuity of cortex: microscopic/macroscopic• Any # hematoma communicating with exterior: open #• Tscherrne classification--> Soft tissue injury in closed #

• Osteoblastic secondaries--> Prostate, Carcinoid• Breast Ca--> Usually osteolytic• Mirel's score(>7 then bone metastasis may #)-

◦ Size◦ Site◦ Type◦ Pain

• Mangles extrimity sverity score (MESS Score)- (>7 --> Amputation)◦ Soft tissue injury◦ BP◦ Circulation◦ Age

Recent advances-

34. What is the most common cause of death after total hip replacement in elderly lady-1. Infection2. Deep vein thrombus3. Pulmonary embolism------------------ans4. Pneumonia

Discussion- MI is m/c cause of death then Cardiopulmonary arrest then Pul. embolism

38. Chemonucleosis is done by-1. Osmic acid2. Trypsin3. Chymopapain----------------------ans4. Chymotrypsin

Discussion- • Nucleous pulposis destroyed--> Chemopapain (from papaya)• Osmic acid--> Chemical synevectomy

39. Which of the following is used in osteoporosis for decreasing bone resorption and increasing bone formation-1. Teriparatide2. Calcitonin3. Strontium ranelate----------------ans4. Bisphosphate

Discussion- • Rx of osteoporosis-

◦ Calcitonin--> decreases bone resoption (ck--> see PTH also given)◦ Low dose PTH/ or PTH related peptide--> Teriparatide--> Stimulates osteoblasts◦ NaF--> Same Action◦ Bisphosphonates--> inhibits osteoclasts◦ Estrogen--> Stimulates bone formation◦ Ca + Vit.D --> bone formation◦ Strontium--> has both action

Though bone mineralisation is normal in osteoporosis total bone mass and trabecular volume are decreased.

Tumors-

40. MULTIPLE ENCHONDROMAS WITH SUBCUTANEOUS HEMANGIOMAS (AIIMS/AI)-1. OLLIERS2. MAFUCCI--------------------------------ans3. GOLTZ SYNDROME4. ALBRIGHT

Discussion- • Syndromes-

◦ Ollier's--> only multiple enchondromas◦ Mafucci--> Multiple enchondroma with subcutaneous angiomas with phlebolith (calcified vessels)◦ McCune albright- (PPP)

▪ Polyostotic fibrosis dysplasia▪ Precocious puberty▪ Pigmentation

3 points about tumors-

Benign Malignant

No dilated veins Dilated veins on surface

Well defined margins Ill defined margin

Uniform consistency Variable consistency

• Epiphysial tumors- GCT (Osteoclastoma), Chondroblastoma• Diaphyseal tumors- Ewings sarcoma, Osteid osteoma, Admantinoma• Metaphysis- Most common location of all tumors--> also infections

Enchondroma is metaphysial (correction AA)

Periosteal reaction- The periosteum responds to traumatic stimuli or pressure from an underlying growing tumor by depositing new bone. Seen in tubercular osteomyelitis. Solid or single periosteal reaction seen in benign bone tumors and acute osteomyelitis. Multiple layer of laminated or onion peel appearence seen in ewings. Triangular piece of bone scan at angle of periosteoum--> seen in malignant tumors specially OS

Simple bone cyst Aneurysmal bone cyst (Maheshwari-227)

0-10 yrs 5-15 yrs

Most common upper end of humerous Upper end of tibia

Single cavity Multiple cavities

Straw coloured fluid Hemorrhagic fluid

Rx: Observation Rx: Usually curettage and bone grafting

Fallen fragment sign/Trap door sign; Fallen leaf sign

Simple curettage combined with other chemicals like phenol is called extended curettage. M/C Rx these days of cavity.

36. Embolization is treatment option for-1. ABC----------------------ans 2. UBC3. GCT4. Osteosarcoma

41. Nidus of osteoid osteoma is best seen on-1. X rays2. USG3. CT scan-------------------ans4. MRI

Discussion- • Imaging in orthopaedics - X-Ray is for screening for any bone. CT Scan is best for bone or any calcified tissue.

MRI is best for soft tissues and bone marrow edema and cartialge. Arthroscopy is best for joints. Bone scans for mutiple lesions all over the body. Open biopsy is diagnostic of tumor.

• Osteoid osteoma-◦ Commonest true benign tumor of bone◦ Diaphysis affected most◦ Pain worst at night◦ Rx: NSAIDs◦ Latest Rx --> Radiofrequency ablation

42. Fallen fragment sign is seen in-1. abc2. ubc-------------------------ans (Unicameral/Solitary/Simple)3. GCT4. Chondroblastoma

43. Treatment for giant cell tumor used most commonly is-1. Resection2. Curettage + bone graft ---------------ans3. Radiotherapy4. Chemotherapy

Discussion- Maheshwari-216• GCT(Osteoclastoma) occurs b/n 20-40 yrs i.e. after skeletal maturity• G CT is only tumor common in girls(wrong in AA) others are common in males

44. Massada classification is for-1. Exostosis-------------------------------ans2. Enchondromas3. Osteosarcomas4. Chondroblastoma

Discussion-

• Madelung deformity- a named deformity usually characterized by malformed wrists and wrist bones and short stature and is often associated with Léri-Weill dyschondrosteosis. Massaga classification used. It is a/w- TITLI

◦ T- Trauma◦ T-Tumor◦ I- Infection◦ L- Léri-Weill dyschondrosteosis (madelung d/e + dwarfism)◦ T- Turner's syndrome

45. Most common tumor of hand-1. Enchondroma2. SCC--------------------------ans3. Chondroblastoma4. Melanoma

Discussion- if question is on bones of hand then--> enchondroma

46. Pulsatile bone tumor-1. OS---------------ans2. MFH3. FS4. SBC

49. 8 year male progressive swelling upper end tibia-irregular,local temperature raised ,variable consistency and ill defined margins-

1. Giant cell tumor2. Ewings sarcoma3. Osteogenic sarcoma----------------------ans4. Secondary metastasis

Discussion- • Ewing's sarcoma-

◦ Tumor melts like ice on radiotherapy but recurs.◦ Chemo is the best if single type of treatment is to be given

▪ Chemo regimen- (ABCD)• A- Actinomycin• B- Bleomycin• C- Cyclophosphamide• D- Doxorubicin

◦ Otherwise combination-▪ C+Sx▪ R+S▪ R+C

◦ Best t/t: SCR◦ Metastaiss- Control of mets is done by chemotherapy

Arthritis-

50. Osseous loose bodies in joints common in all except-1. Osteochondritis dissecans2. Osteoarthritis3. Osteochondral fractures4. Rheumatoid arthritis----------------ans

Discussion- Osteochondritis dessicans is most common of loose bodies in joints of lateral part of medial femoral condyle.

51. Primary structure affected in RA:1. Synovium----------------ans2. Cartillage3. Bone4. Capsule

Discussion-

• OA- Cartilage• Maximum incidence of tumors--> Tibia• Maximum incidence of open # --> Tibia• Best exercise in Ankylosing spondylitis--> Swimming > Cycling (axial skeletan affected so axial excercise is

preffered)• <2.5 chest expansion --> diagnostic of AS (P-248)• Fleche test--> Diagnosing cervical spine flexion• Diagnosis of AS--> Sacroilitis + one of the following-

• Decreased chest expansion• decreased lumbar flexion• inflammatory diarrhoea (HLA B27 is of lesser value)

52. Diagnosis of AS are all except-1. Sarcoiliitis2. Decreased chest expansion3. Decreased lumbar flexion4. Presence of HLA-B27 ----------------ans

53. All of the following are associated with charcot joints except-1. Syrngomyelia2. Syphilis3. Tuberculosis-----------------ans4. Leprosy

Discussion- • Charcoat's jt are described for – tabes dorsalis• In today's world DM causes charcot's mostly—> midfoot involvement is most common• M/C joint involved is --> Knee jt.• Leprosy can affect the jts. of hand and mid-foot• Amyloidosis is a rare cause

54. True about synovial fluid all except-1. Secreted by Type A cells-------------------------ans2. Follows Non-Newtonian fluid kinetics3. Contains hyaluronic acid4. Viscosity co efficient is variable

Discussion- • Synovial fluid secreted by type B cells; and synovial does not contain basement membrane• Except OA where viscocity is normal all other d/e of jt. viscocity is decreased.

55. Joint not involved in RA according to 1987 modified ara criteria is-1. Metatarsophalangeal2. Tarsometetersal--------------------ans3. Ankle4. Elbow

Avascular necrosis-

56. Double line sign is seen in-1. AVN of hip--------------ans2. Scfe3. TB hip 4. DDH

Discussion- Maheshwari- 271• M/C cause is idiopathic• Clinical signs-

◦ Sectoral signs--> sector of bone affected--> decreased rotation at jt.

◦ Crescent's sign◦ Double line sign--> Seen on MRI

• Rx:◦ Cove(ck) decompression◦ Rotational osteotomies◦ Joint replacement

57. AVN can occur at a/e-1. Femur neck---------------------ans(head not neck.....)2. Body of talus3. Proximal scaphoid4. None

58. Osteonecrosis associated with all except-(dpg 09)1. Sickle cell disease2. Gauchers3. Polycythemia----------------------ans4. Hyperparathyroidism

Discussion- Deranged lipid profile/Deranged coagualtion profile --> AVN(Osteonecrosis)

Infections-

59. Earliest sign of osteomyelitis on x-rays-1. Loss of muscle and fat plane--------------------ans2. Periosteal reaction3. Callus formation4. Presence of sequestrum

Discussion- Maheshwari-156• Loss of muscle and fat plane is seen in 24-48 hrs• Earlier bony change seen in--> 10 days• DOC--> Cephalosporin + Aminoglycoside combination• Chronic osteomyelitis-->

◦ dead bone(Marker)◦ Sequestrum

• Two characteristic of dead bone-◦ White on X-Ray (it is sclerosed)◦ Light in weight

• Lower end of femur effected m/c in Acute osteomyelitis.

• TB of bone and joints- Maheshwari- 171◦ TB usually primary focus is lungs. ◦ M/C bone is spine--> pott's spine(dorsolumbar region)--> 50% (paradiscal m/c).◦ Rx of TB:

▪ ATT▪ Rest to part▪ Surgery when indicated

◦ Indication of Sx in any disease of spine-▪ B/B involvement▪ Increasing neurologocal deficit▪ Failure of improvement on conservative Mx

60. Anterolateral decompression is done in-1. Left lateral position2. Right lateral position------------------ans

3. Supine4. Prone

Discussion- Done for pott's spine--> Anterolateral decompression. IVC is friable not Aorta (i.e done on aorta)

61. Chronic osteomyelitis pathognomic1. Dead bone--------------ans2. Reactive bone3. Wound4. Cloacae

62. 8 year male progressive swelling since 6 months over upper end tibia on x ray there is lytic lesion with sclerotic margin-

1. Osteogenic sarcoma2. Osteoclastoma3. Brodies abscess-----------------ans(see not ewing's)4. Ewings sarcoma

63. The incorrect statement about osteomyelitis is-1. Staphylococcus aureus is the commonest causative organism2. Upper tibial metaphysic is the commonest-----------------------------ans(lower femoral)3. Hematogenous osteomyelitis is the commonest4. Cefotaxime and amikacin are drugs of choice

Soft tissue injuries-

64. Tennis elbow is characterized by1. Tenderness medial epicondyle2. Tendonitis common extensor origin---------------ans3. Tendonitis common flexor origin4. Painful flexion and extension

Discussion- Maheshwari-257Rx:

• Inj. of steroid at lateral epicondyle• Also taking patient's own blood and injecting may be helpful

Test- Painful dorsiflexion of wrist joint(Cozen test)Ext. Carpi radialis brevis-->wrist extension--> N.S.--> PIN(C7,C8)

65. Prolapsed intervertebral disc is most common at-1. C10-C112. C2-C33. L3-L44. L5-S1 --------------ans

Discussion-• M/C level is L4-L5• 2nd common--> C5-C6• 3rd--> L5-S1

67. Athletic pubalgia is due to-1. Abdominal muscle strain----------------ans2. Quadriceps strain3. Rectus femoris strain4. Gluteus maximus strain

Discussion- • Ext. Oblique aponeurosis torn• Tear in conjoint tendon• Conjoint tendon torn from pubic tubercle

68. Not a treatment for chronic backache-1. NSAID2. Bed rest for 3 months-------------------------ans3. Exercises 4. Epidural steroid injection

Discussion- In any case of backache rest is not given for more than 48 hrs

All acute osteomyelitis eventually turn into chronic osteomyelitis sine bones can not be sterlised once infected

69.Which is best for diagnosing post longitudinal ligament calcification-1. MRI2. CT------------------------ans3. USG4. X-RAY

70. In posterior compartment syndrome which passive movement causes pain-1. Dorsiflexion of foot2. Foot inversion3. Toe dorsiflexion-----------------------ans4. Foot abduction

Discussion- More specific than A

71. Most common cause of insertion tendinitis of tendoachilles is-1. Improve shoe wear2. Runners and jmpers3. Overuse------------------------------ans4. Intralaisonal steroid inj

Discussion-• M/C cause of non-insetional tendinitis is runners and jumpers (occurs at 3-6 cm above insertion of tendo-achillis)• M/C cause of insetional tendinitis is overuse

Bone metabolism-

72. Milkman fracture-1. Pseudo fracture-------------------------------ans2. Fracture of metatarsals3. Fracture of distal end of radius4. Fracture of 5th metacarpal

Discussion-• Also called--> Umbauzanon/Looser's zone• Seen in osteomalacia• M/C area Femor neck(Harrison)>Pubic rami>Vertebral bodies• Rx:

◦ Rest to part◦ Ca + Vit. D

73. BEST MARKER VITAMIN D DEFECIENCY-1. ALP2. ACID PO43. SERUM PO44. VIT D LEVELS---------------------ans

74. Osteoporosis is defined as-1. T score -1 to -2.52. T score less than -2.5 --------------ans

3. Z score 0 to -14. Z score -1 to -2.5

Discussion- • Mesured by bone marrow density scan(Dexa scan)• T Score

◦ 0 to -1 (N)◦ -1 to -1.5 (Osteopenia)◦ >2.5 (osteoporosis)

• Severe osteoporosis- Any osteoporosis with # is severe osteoporosis

75. Alkaline phosphatase and phosphate in children is-1. Same as adults2. More than adults--------------------------ans3. Alp more phosphate less4. Alp less phosphate more

Discussion-• Multiplied by 3-5 times adult values (ALP)• PO4 --> A+1mg/dl

76. Not seen in osteopetrosis-1. Pancytopenia2. Osteomyelitis of mandible3. Compression of nerve4. Delayed healing of fractures-------------------ans

Discussion- • Two conditions a/w increased pathological # but normal bone healing-

◦ Osteopetrosis◦ Osteogenesis imperfecta

77. Ivory vertebrae/picture frame vertebrae/cotton wool skull/elderly/snhl/increased alp/normal ca/normal po4 found in-

1.Fibrous dysplasia 2.Pagets---------------------------ans3.METS4.Osteoporosis

Discussion- • P agets--> Pelvis(m/c affected part) > Prostate• Normal Calcium, Normal Phosphorus, Increased ALP

MM + # --> ALP increased

Paediatrics orthopaedics-

78. Treatment of choice for CTEV in 18 year old is-1. Footwear 2. Triple arthrodesis---------------ans3. Quadruple fusion4. CSTR

Discussion- Dont follow Maheshwari for treatment of CTEV

Treatmaent of CTEV- Read with ROAMS-687• Kites- not followed now

◦ MOM x 2 Weeks◦ Every 2 week case◦ AIE

◦ Cuboid joint--> hands put there◦ 6 mths

• Ponsetti-◦ Day cast◦ per week◦ AIE (all together)◦ Talus◦ 6 wks

Treatment for neglected cases-• < 3yrs--> PMSTR +Soft tissue release• 3-8 yrs-

◦ Shortening of lateral column of foot◦ Cuboid decancellation◦ Cuboid or calcaneal wedge resection--> Evan's

• > 5yrs--> Dweyer's ostetomy to connect heel varus• 8-12 yrs--> Wedge tarsectomy• > 12 yrs-

◦ Triple arthrodesis(TN/TC/CC all three joints fused)◦ Ilizarov fixator◦ JESS (Joshi's external stabilising system)

79. Polimyelitis is1. Lower motor neuron------------------ans2. Upper motor neuron3. Both 4. none

80. Klipper-Feil syndrome results from(ai)-1. Congenital contracture of the sternoclei-domastoid muscle2. Failure of descent of the scapula3. Failure of closure of the third branchial arch4. Failure of segmentation of mesodermal sornites------------------------ans

Discussion- • Occurs d/t fusison of cervical vertebrae d/t failure of segmentation of mesodermal somites. • Triad-

◦ Low post. hairline◦ Short neck◦ Restricted range of movement

81. Child presenting with absent thumb, radial deviation of hand bowing of the forearm; which investigation is not needed-

1. Karyotyping2. Echo3. BM---------------------ans4. Platelet count

Discussion- • Radial claw hand (FATEH)-

◦ F- Fanconi's◦ A- Anorectal malformation◦ T- Trisomies 13, 18/TAR syndrome (Thrombocytopenia and Absent Radius)◦ E- Ectodermal dysplasia◦ H- Holt oram (ASD)

82. Most common defect in DDH-

1. Coxa valga2. Anteversion3. Shallow acetabulum-----------------ans4. Waddling gait

Discussion- Maheshwari- 200• Barlow's test--> hip being tested is Adducted• Ortolani test--> Abducted• Conditions a/w DDH-

▪ Oligohydramnios▪ Family history▪ Breech▪ Females ▪ Hormone induced joint laxity (Maternal relaxin)▪ First born child▪ Crowding phenomenon- Torticollis/CTEV/ Genu recurvaratum(knee hyper-extension) and

metatassus adductans• Also-

83. Triple arthrodesis involves a/e-1. Talonavicular2. Talocalcaneal3. Calcaneocuboid4. Tibiotalar---------------------ans

Fractures and dislocations-

84. Supracondylar fracture can involve-1. Median nerve2. Radial nerve3. Ulnar nerve4. All----------------------ans

Discussion- Maheshwari-85• M/C- AIN>Median>Radial>Ulnar• M/C complication-

◦ Early- Volkman's ischemia◦ Late- Malunion (Cubitus varus--> Gunstock deformity)

Dunlop traction is used in the management.......

85. Most common fracture involved in algodystrophy-1. Colles-------------------ans2. Supracondylar3. Forearm4. Humerus

Discussion- Maheshwari-96• Also known as Sudeck's dystrophy/Complex regional pain syndrome• Patient has sensory symptom more than motor symptoms• Red hot shiny skin• Pathy osteoporosis (diagnostic)• Both active and passive excercises are encouraged• M/C associated # - Colle's #• Treatment of colle’s is essentially conservative with colle's cast

86. Cylinder cast is used for(ai)-1. STI(Soft tissue injury) knee2. # patella3. Both--------------ans4. none

Discussion- • Test for knee-

◦ ACL-▪ Anterior drawer test▪ Lachman test (both in acute and chronic condition it is better)

◦ McMurrey test- Both menisci◦ Alpey's grinding test- Both menisci

87. Pivot shift test is for-1. Anterolateral instability---------------------ans2. ACL3. PCL4. Medial meniscus

Discussion-

• Pivot shift test- used for anterolateral area of knee (Consist of ant. Criciate ligament, lateral collateral ligament, lateral half of capsule)

89. All are used in fat embolism except- 1. Heparin2. Dextran3. Steroids4. Calcium-----------ans

Discussion- • Diagnostic- 1 major + 4 minor• Major-

1. Pulmonary edema2. PaO2 <60, FiO2 < 0.4 --> i.e. hypoxemia3. CNS depression dysproportionate to hypoxemia4. Petechiae in vest distribution

• Minor-

1. Fever2. Tachycardia3. Thrombocytopenia4. Fat in sputum5. Fat in urine6. Increased ESR7. Retinal emboli8. Anemia

90. Recurrent dislocation is rare in-1. Ankle-----------ans2. Hip3. Shoulder4. Patella

Discussion- • Shoulder--> Ant. dislocation • Others--> Posterior

Most common dislocation- Shoulder > Patella > Ankle (rarest)

Vessel injury in # and dislocation-• Clavicle # --> Subclavian artery• Shoulder dislocation --> Axillary A.• Hip dislocation --> Sup. gluteal A.• Knee --> Popliteal A.

Shoulder dislocation: Axillary N > Musculocutaneous

• Monteggia # dislocation- MMM◦ Monetggia--> Mdial bone--> Towards mouth

◦ Ulnar # --> dislocation of radial head--> PIN pierces the supinator and takes aturn around radial head--> so m/c involved in Monteggia #

• Galleazi # dislocation--> lower lateral

91. According to Mullers classification humerus fractures are given number-1. 1 --------ans2. 23. 34. 4

92. Knee dislocation m.c vascular injury-1. Femoral2. Popliteal ----------------ans3. Posterior tibial4. Anterior tibial

93. Monteggia fracture Nerve injury-1. AIN2. PIN-----------------ans3. MEDIAN4. ULNAR

94. OSSIFICATION IN Myositis ossificans is-1. Uniform throughout2. Inside out3. Outside in --------------ans

4. NoneDiscussion- In osteosarcoma ossification is at the centre.........

96. After shoulder most common joint to dislocate is-1. Hip2. Elbow3. Patellofemoral--------------ans4. Pip

97. Bennetts fracture is-1. Intra articular2. Intra articular with dislocation--------------ans(ROAMS-661)3. Extra articular4. Extra articular with dislocation

98. Motor weakness of upper limbs out of proportion to lower limbs is-1. Central cord syndrome------------ans2. Anterior cord syndrome3. Posterior cord syndrome4. Brown sequard syndrome

99. Unsolved fracture is-1. Fracture scaphoid2. Fracture talus3. Fracture neck of femur--------------ans4. All

Discussion- Read classifications (Maheshwari-112)

• Rules of fixation-◦ Upper limb bones are plated. Lower limb bones have nails◦ Articular/Periarticular # in children are treated with K-wires.◦ Principle of mangement of ant joint injury is early mobilisation

100. Fracture neck femur most common complication-1. AVN------------------ans2. Nonunion3. Osteoarthritis4. DVT

Q. The collagenous protein in bone sub-serves which of the following functions-1. Growth factor2. Binding of ionic calcium and physiologic hydroxyapatite3. Formation of three dimentional lattice of the matrix---------ans(GT 87; Q-283)4. Cell attachment

Q- A 13 yr old boy presents with a slowly enlarging lesion that involves the distal portion of his right femur. X-ray reveals a large destructive lesion that focally lifts the periosteum to form a triangular shadow between the cortex and the raised end of the periosteum. Lab examination reveals elevated serum alkaline phosphatase. Histologic changes likely to be seen in a biopsy taken from this bone lesion is-

1. Multiple blood filled spaces that are not lined by endothelial cells2. Hephazardous arrangement of immature bony trabeculae forming 'chinese letters'3. Lobules of hyaline cartilage with few cells4. Malignant anaplastic cells secreting osteoid-------------ans

Discussion- Osteosarcoma--> malignant anaplastic cells secreting osteoidOption 1--> Aneurysmal bone cystOption 2--> Fibrous dysplasia

Q. A case of breast ca stage-4 wth secondary in upper third shaft of femur. There is impendin pathological fracture. Treatment-

1. Intramedullary nailing-------------ans2. RT 3. Plate fixation 4. Bed rest

Discussion- Patient with bone mets. has to be stage 4 anyways,, as stage 4 means any Grade(T), any lymph nodes(N), with distant metastasis....Wheeless' textbook of orthopaedics /Metastatic breast Ca. says following about the treatment-

• Surgical Fixation- Permeative destruction of the proximal femur is the most common type of destruction leading to a pathologic fracture. For pts with this type of destruction involving more than 50% of the shaft diameter on any radiographic view, consider prophylactic internal fixation of femoral neck & subtrochanteric region.

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