Orthopedics

5 years SAQ Solution (2015-2019)

14. Classify Fracture Neck of Femur.

Answer:

Classification of Fracture Neck of Femur:

A) In relation with Capsule:

1) Intracapsular Fracture
a) Subcapital fracture
b) Transcervical fracture
c) Basal

2) Extracapsular Fracture
a) Trochanteric fracture
b) Sub trochanteric fracture

15. Management of Fracture Neck of Femur in elderly.

Answer:

Management of Fracture Neck of Femur in elderly:

Investigations:

1) X ray of the pelvis including both hip joint showing fracture neck of femur
2) Technetium 99 scan, hot spot around the neck of femur
3) MRI
4) Routine Investigations for GA: Blood sent for blood grouping and Rh typing, CBC,
RBS, Serum creatinine, Blood urea, CXR, ECG, ECHO.

Specific Treatment:

 If intracapsular fracture them replacement hemiarthroplasty.

 If fracture in young person then immediate fixation with multiple cannulated screw.
 If trochanteric or subtrochanteric fracture then fixation by dynamic hip screw.
16. List the complications of pyogenic osteomyelitis. List the bacteria responsible for acute
osteomyelitis in children.

Answer:

Complications of pyogenic osteomyelitis:

1. Chronic Osteomyelitis
2. Pyogenic arthritis
3. Pathological fracture
4. Deformity
5. Growth Retardation
6. Septicemia
7. Pyaemia
8. DIC

Bacteria Responsible for acute osteomyelitis:

1. Staphylococcus aureus
2. Streptococcus
3. Pneumococcus
4. Staphylococcus Albus
5. Salmonella
6. Pseudomonas
7. Proteus
8. E. Coli
9. Klebsiella
10.Hemophilus

17. Classify Bone Tumor. Classify the malignant bone tumor.

Answer:

Classification of Bone Tumor:

A. Primary Bone Tumor:

Source Benign Malignant

1. Osteogenic tumour Osteoid Osteoma Osteosarcoma
2. Chondrogenic tumour Osteochondroma Chondrosarcoma
3. Giant Cell tumour Giant Cell tumour Malignant giant cell tumour
4. Notochordal tumour Benign notochordal tumour Chordoma
5. Vascular tumour Haemangioma Angiosarcoma
6. Lipogenic tumour Lipoma of bone Liposarcoma of bone
7. Undefined tumour Ewing’s sarcoma
 B. Secondary Bone Tumor Arises from:
1. Breast
2. Lung
3. Prostate
4. Kidney
5. Thyroid

18. Clinical and radiological features of Osteosarcoma.

Answer:

Clinical features of Osteosarcoma:

1. Age group: Bimodal distribution, commonly found in children of age 10-20 years
(75%) and (25% in old age).
2. Sex: Male>Female
3. Site: Growing end of long bone-around the knee joint (90%), lower end of femur,
upper end of tibia and fibula, lower end of radius and ulna, upper end of humerus, ribs.
4. Progressive pain and swelling.
5. Bony hard, margin is ill defined, fixed with underlying structure
6. Raised temperature of the overlying skin and the skin is tense with engorged vein.
7. Foot drop if common peroneal and anterior tibial nerves are involved.
8. Pathological fracture may be present
9. Other features include: weight loss, anorexia, cough, dyspnea, jaundice.

Radiological features of Osteosarcoma:

X ray of affected side with both views shows:

 Osteolytic lesion (Irregular destruction of metaphysis) and Osteoblastic changes.

 Codman’s triangle (Evidence of new bone formation under the corners of the raised
periosteum)
 Sun ray appearance: Well marked radiating spicules of new bone seen within the
tumour.

19. What are the medical indications of amputation? Complication of midthigh amputation.
How can you counsel a patient before amputation?

Answer:

Medical indications of Amputation:

A) Dead Limb:
 Gangrene of the limb
 B) Deadly Limb:
 Wet gangrene
 Spreading cellulitis
 Peripheral vascular disease
 Malignant tumors
 Arteriovenous fistula

C) Damn Nuisance:
 The limb becomes a burden.

Complications of mid thigh amputation:

A) Early:
1) Reactionary hemorrhage
2) Hematoma
3) Infection
4) Abscess formation
5) Gas gangrene
6) Wound dehiscence
7) Deep vein thrombosis
8) Pulmonary embolism

B) Late:
1) Phantom Limb
2) Bone spur
3) Amputation neuroma

Counselling of patient before amputation:

The patient is described by the surgeon the current state of his/her limb, that it might turn
worse if not amputed. For example, a malignancy in the limb may spread, or a necrosed limb
may cause necrosis of more portion of the limb if not removed. So, amputation is mandatory
and that after amputation the patient can use prosthesis which will be similar looking to his
limb to perform his day to day activities.

20. What is osteomyelitis? Classify osteomyelitis.

Answer:

Osteomyelitis is an inflammation of bone and bone marrow caused by infecting organism.

Osteomyelitis can be classified as below:

A) Based on duration:
1) Acute osteomyelitis: <2 weeks
2) Subacute osteomyelitis: 2-6 weeks
3) Chronic osteomyelitis: > 6 weeks
 B) Based on mechanism:
1) Exogenous
2) Hematogenous

C) Based on host response:

1) Pyogenic/Granulomatous

21. Radiological features of chronic pyogenic osteomyelitis?

Answer:

Radiological features of chronic pyogenic osteomyelitis:

1) Localized osteopenia and trabecular destruction.

2) Sequestrum is seen with irregular sharply demarcated edges.
3) Sub periosteal new bone may be seen (involucrum) which causes thickening of cortex.