Rabu, 26 Oktober 2022

1. Gambarkan Plexus Brachialis

2. Origo, insertion, nerve dan movement dari
rotator cuff

Muscle Origin Insertion Nerve Action

Supraspinatus Supraspinatus Greater Tubercle Suprascapular Abduction &
fossa Nerve forward flexion
Infraspinatur Infraspinatus Greater Tubercle Suprascapular External rotation
fossa Nerve
Teres Minor Lateral of Scapula Greater Tubercle Axillary Nerve External rotation
Subscapularis Subscapular Lesser Tubercle Upper and Lower Adduction &
fossa Subscapular internal rotation
 3. Patofisiologi Osteoporosis

Vitamin D Deficiency
Secondary Increased Bone
Aging Decline Absorption of Ca+
Hyperparathyroidism Resorption
Decline Renal 1.25(OH)

Decreased Physical Loss of Mechanical Decreased Bone Low Bone Mass and loss
Activity Stimulation Formation of bone architecture

Increased RANKL
Menopausal Osteoblast function Increased Bone
Decreased Increased Osteoclast
Estrogen declined declined Resorption
Osteoprogenitor
Kamis, 27 Oktober 2022
4. Perbedaan fraktur pada anak dan dewasa
• Fracture more common
• Stronger and more active periosteum
• More rapid fracture healing
• Special problem of diagnosis
• Spontaneous correction of certain residual deformities
• Differences in complications
• Different emphasys in methods of treatment
• Torn ligament and dislocations less common
• Less tolerance of major blood loss
Jumat, 28 Oktober 2022
5. Indikasi absolut dan relatif operasi pada
fraktur clavicula
Absolute
• open fractures
• displaced fracture with skin tenting
• subclavian artery or vein injury
• floating shoulder (clavicle and scapular neck fracture)
Relative
• displaced with > 2cm shortening
• bilateral displaced clavicle fractures
• brachial plexus injury (questionable because 66% have spontaneous return)
• closed head injury
• seizure disorder
• polytrauma patient
Minggu, 30 Oktober 2022
 6. Stabilizer pada knee

Medial:
• Static: superficial and deep medial collateral ligaments (MCL), posterior
oblique ligament (POL).
• Dynamic: semimembranosus, vastus medialis, medial gastrocnemius, PES
tendons
Lateral:
• Static: lateral collateral ligament (LCL), iliotibial band (ITB), arcuate ligament.
• Dynamic: popliteus, biceps femoris, lateral gastrocnemius
 7. Definisi, anamnesis, pemeriksaan fisik,
diagnosis, klasifikasi dan treatment dari skoliosis
Scoliosis is a coronal plane spinal deformity, that consisting of lateral Classification based on age
Conginetal: abnormal vertebrae due to failure of formation and or failure of
curvature and rotation of the vertebrae
segmentation
History Taking Infantile: < 3 years old
- Age at onset Juvenile: 3-10 years old
- Maturation Adolescent: >10 years old
- Back pain Treatment
1. Congenital
- Neurological symptoms
Bracing not indicated as primary treatment
- Cosmestic complaint about asymetrical back Progression & need for surgery depend on severity/type
- Family histroy 2. Infantile:
Physical Examination: observation if cobb angle less than 30 degrees or RVAD less than 20 degrees
1. Asymetrical shoulder height TLSO if > 30 degree or RVAD >20 degree
Operative if cobb angle>50-60 degrees
2. Scapular prominence
3. Juvenile
3. Chest cage asymetry Observation cobb angle <20 degrees
4. Asymetrical distance between lateral trunk and medial arm Bracing cobb angle 20-50 degrees
5. Asymetrical paraspinal muscle Operative cobb angle >50 degrees
6. Asymetrical Waist Line 4. Adolescent
Observation if cobb angle <25 degree
Diagnosis:
Bracing 25-45 degree in patient with risser sign 0,1,2
>10 degrees abnormal curvature on AP and Lateral standing x-ray Operative >45 degree
8. Mention the composition of bone
Inorganic phase : 60%
-Osteocalcium Phospate
-Calcium hydroxyapetite
Organic phase : 35%
-Type I Collagen
-Proteoglican
-Noncollagen Proteins
-Cells : osteoblast, osteoclast, osteocytes
Water : 5%
Senin, 31 Oktober 2022
 9. Definisi dan klasifikasi cerebral palsy
Cerebral Palsy is a common congenital condition caused by
injury to the immature brain that leads to upper motor
neuron disease and presents with cognitive and
musculoskeletal manifestations of varying severity.
Classification :
Physiologic Classification :
Spastic : Most common. Velocity-dependent increased
muscle tone and hyperreflexia with slow, restricted
movement due to simultaneous contraction of agonist and
antagonist muscles.
Athetoid : Characterized by a constant succession of slow,
writhing, involuntary movements.
Ataxic : Characterized by inability to coordinate muscle
movements. Results in unbalanced, wide based gait.
Mixed : Usually mixed spastic and athetoid features and
involves the entire body.
Hypotonic : Usually precedes spastic or ataxic for 2-3 years
Anatomic Classification :
Quadriplegic : Total body involvement and nonambulatory.
Diplegic : Legs more than arms but usually still ambulatory.
IQ may be normal (injury in brain is midline)
Hemiplegic : Arms and legs on one side of the body, usually
with spasticity. Will eventually be able to walk, regardless of
treatment
Gross Motor Function Classification Scale (GMFCS)
Type I : Near normal gross motor function, independent
ambulator
Type II : Walks independently, but difficulty with uneven
surfaces, minimal ability to jump
Type III : Walks with assistive devices
Type IV : Severely limited walking ability, primary mobility is
wheelchair
Type V : Nonambulator with global involvment, dependent in
all aspects of care
10. Explain about POSI of the hand
The POSI position for safe hand splinting

Objective : Ensures pretension on the collateral

ligaments of the wrist and the MCP and IP joints of
the hand --> avoiding stiffness and contracture.

The POSI position

- Forearm : Supination
- Wrist : 0-30º of extension using plaster roll
- MCP joints : 70-90º of flexion
- IP joints : full extension.
11. Pemeriksaan NVD branch dari brachial
plexus
• Musculocutaenous: Elbow
flexion
• Axillary: Shoulder abduction
test
• Radial: Paper test, thumb up
• Median: Rock Test, OK Sign
(AIN)
• Ulnar: Scissors test
 12. Explain about salter harris classification ! Mention which part
of physis is more common for salter harris? What is thurston
holland fragment? In which classification that fragment is
present?

Salter Harris classification used in pediatric physeal fracture.

Classified into 5 types with SALTR as mnemonic
Type 1: physeal separation
Type 2: fracture traverses physis and exits metaphysis (Above) as the common type
Type 3: fracture traverses physis and exits epiphysis (Lower)
Type 4: fracture passes through epiphysis, physis, metaphysis (Through)
Type 5: crush
Thurston holland fragment defined as fragment of the methaphysis with triangular form and found in salter
harris type 2.
Selasa, 1 November 2022
 13. Mention the differences between osteoporosis and
osteomalacia! (definition, pathophysiology, treatment)
Osteoporosis defined as decreased of bone Osteomalacia is metabolic bone disease caused
mass with no change of ratio between by altered vitamin D or hypophosphatasia with
mineralized and unmineralized bone matrix the production of osteoid is normal but
with the T score below -2,5. subsequent mineralization is inadequate.

Osteoporosis caused by increased of age, Osteomalacia caused by deficiency of vitamin D.

menopause, and metabolic abnormalities so It can be from the low intake, malabsorption,
renal osteodystrophy, hypophosphatemia.
there is imbalance of bone formation and
resorption.
Treatment for osteomalacia using vitamin D
supplementation 1000IU/day and treat the
Treatment for osteoporosis: biphosphonages, underlying disease
conjugated estrogen-progestin hormone
replacement, estrogen-only replacement.
14. What is the differences between calcification
and ossification ! Explain type of ossification
Calcification is the process in which calcium salts build up in tissues, while
ossification is the process of laying down new bone material or formation of
new bone tissue.

Type of Ossification:
1. Intramebranous Ossficiation: Bone develops directly from mesenchymal
cells without a cartilage anlage
2. Endochondral Ossification: Bone replaces a cartilage anlage (template).
Osteoclasts remove the cartilage, and osteoblasts make the new bone
matrix, which is then mineralized
3. Appositional: Osteoblasts make new matrix/bone on top of existing bone.
15. Mention type of bone and mention
examples of bones from each type?
• Long bone: humerus, radius, ulna, femur, tibia fibula
• Short bone: carpal and tarsal bones
• Flat bone: cranium, clavicle, sternum, scapula, pelvis
• Sesamoid bone: patella, pisiform, interphalangeal joint sesamoid,
hallucal sesamoid
• Irregular: vertebrae
16. Please draw brachial plexus and label it!
17. Please draw cross section dorsal
compartment of wrist!
 18. Please describe about bone healing
phase
Secondary bone healing phase
1. Haematoma formation: bleeding occurs from the
bone and tissue at the time of injury
2. Inflammation: 1-7 days after fracture. starts when
the fracture haematoma forms and cytokine are
released until fibrous tissue, cartolage, or bone
formation begins. Osteoclasts are formed to
remove the necrotic ends of bony fragments
3. Soft callus formation: 2-3 weeks, the cells form a
cuff of woven bone periosteally
4. Hard callus formation: 3-4 months, the fracture is
solidly united
5. Remodelling: months to years. The woven bone
slowly replaced by lamellar bone
19. Describe about perkins time table

Perkins time table For normal fracture healing

• A spiral fracture in the upper limb unites in 3 weeks
• Double it for consolidation
• Double it again for the lower limb
• Double it again for a transverse fracture
Rabu, 2 November 2022
20. Explain about wolff law!
Wolff's law is bone remodels in
response to mechanical stress
that applied to it.
 21. Criteria ankylosing spondylitis?
According to 1984 New York Criteria
Clinical Criteria
-Low back pain of at least three months duration with inflammatory characteristics
(improved by exercise, not relieved by rest)
-Limitation of lumbar spine motion in sagittal and frontal planes
-Decreased chest expansion (relative to normal values for age and sex)
Radiological Criteria
-Bilateral sacroiliitis grade 2 or higher
-Unilateral sacroiliitis grade 3 or higher

with requirement of bilateral grade 2-4 or unilateral grade 3-4 sacroiliitis AND any
clinical criteria (see X-Ray Grading of SI joints)
22. Accepted criteria buat humeral fracture
• < 20° anterior angulation
• < 30° varus/valgus angulation
• < 3 cm shortening
 23. Please mention forearm compartement +
origin, insertion, nerve!
Muscles Origin Insertion Nerve

Superficial Flexors

Pronator teres (PT) Lateral radius middle 1⁄3 Median

Humeral head Medial epicondyle
Ulnar (deep) head Proximal ulna

Flexor carpi radialis Medial epicondyle Base of 2nd (and 3rd) Median
(FCR) metacarpal

Palmaris longus (PL) Medial epicondyle Flexor retinaculum/ palmar Median

aponeurosis

Flexor carpi ulnaris 1. Medial epicondyle Pisiform, hook of hamate, 5th Ulnar
(FCU) 2. Posterior ulna metacarpal

Flexor digito- 1. Medial epicondyle proximal ulna Middle phalanges of digits (not Median
rum superficialis (FDS) 2. Anteroproximal radius thumb)
 23. Please mention forearm compartement +
origin, insertion, nerve!

Muscles Origin Insertion Nerve

Deep Flexors

Flexor digitorum Anterior ulna & interosseous Distal phalanx of digits Median/AIN
profundus (FDP) membrane Ulnar

Flexor pollicis longus Anterior radius & proximal ulna Distal phalanx of thumb Median/AIN
(FPL)

Pronator quadratus (PQ) Medial distal ulna Anterior distal radius Median/AIN
 23. Please mention forearm compartement +
origin, insertion, nerve!
Muscles Origin Insertion Nerve

Superficial Extensors

Anconeus Posterior-lateral epicondyle Posterior-proximal ulna Radial

Extensor digitorum communis (EDC) Lateral epicondyle MCP, P2, P3 Radial-PIN

Extensor digiti minimi (EDM) Lateral epicondyle MCP, P2, P3 of 5th digit Radial-PIN

Extensor carpi ulnaris (ECU) Lateral epicondyle Base of 5th metacarpal Radial-PIN

Mobile Wad

Brachioradialis (BR) Lateral condyle Lateral distal radius Radial

Extensor carpi radialis longus Lateral condyle Base of 2nd MC Radial

Extensor carpi radialis brevis Lateral epicondyle Base of 3rd MC Radial-PIN

 23. Please mention forearm compartement +
origin, insertion, nerve!
Muscles Origin Insertion Nerve

Deep Extensors

Supinator Posterior medial ulna Proximal lateral radius Radial-PIN

Abductor pollicis Posterior radius/ulna Base of 1st thumb Radial-PIN

longus (APL) metacarpal

Extensor pollicis brevis Posterior radius Base of thumb prox. Radial-PIN

(EPB) phalanx

Extensor pollicis Posterior ulna Base of thumb distal Radial-PIN

longus (EPL) phalanx

Extensor indicis Posterior ulna MCP, P2, P3 Radial-PIN

proprius (EIP)
 24. Please mention elbow stabilizer!
Primary Stabilizers:
- Ulnohumeral Articulation
- Medial Collateral Ligament
(especially anterior bundle)
- Lateral Collateral Ligament
(especially LUCL)

Secondary Stabilizers:
- Radiocapitellar Articulation (radial
head)
- Anterior and posterior joint capsule
- Common flexor and extensor origins
25. Explain about Vit D Metabolism
26. Mention the differences between
lamellar and woven bone?
lamellar bone woven bone
- stress oriented - non stress oriented
- mature bone - Immature bone
- highly organized - poorly organize
- pathologic process
- occur in callus forming
- less mineralized.
27. Function of synovial fluid
1. Lubrication of Joint
2. Nutrition to articular
cartilage
 28. Pathophysiology of OA & 4 cardinal sign
of OA
Articular Cartilage: Synovial Membrane and Fibrous Capsule:
1. loss of proteoglycan from the matrix -> 1. dead cartilage might float in the fluid which will
susceptible to friction of joint function -> increase 5he giscosity
fissuring 2. fibrous capsule become thicker and limiting
2. in central area loss of articular surface shown joint motion.
by narrowing of cartilage space Muscles
3. in peripheral area, cartilage respods by muscle controlling joint develop spasm in
hypertrophy which outgrowth cartilage to response to pain and might becoame contracted.
become osteophyte. the late resule might become a fibrous ankylosis.
Subchondral Bone:
1.in centeal area, the stress and friction cause cardinal signs of OA
hypetrophy and become radiographically dense
(sclerotic) - joint space narrowing
2. in peripheral, the low stress cause less dense. - subcondral bone sclerosis
3. the excessive pressure lead to development of - osteophyte
cystic lesions. - subcondral cyst
Kamis, 3 November 2022
29. Function of Meniscus
1. load transmission
2. joint congruity abd stability
3. joint lubrication
4. joint nutrition
5. proprioception
30. Draw the anatomy and the vascular zone
of meniscus
 31. Mention zone of physis
• Resting Zone
• Proliferative Zone
• Hypertrophic Zone:
• Maturation Zone
• Degeneration Zone
• Zone of Provisional
Calcification
 32. Anatomy and histology of Nerve &
mention seddon dan sunderland classification

Sunderland Seddon Axon Endoneurium Perineurium Epineurium

I Neurapraxia Intact Intact Intact Intact

II Axonotmesis Disrupted Intact Intact Intact

III Axonotmesis Disrupted Disrupted Intact Intact

IV Axonotmesis Disrupted Disrupted Disrupted Intact

V Neurotmesis Disrupted Disrupted Disrupted Disrupted

 33. Jenis vaksin tetanus, pada pasien trauma based on
luka dan riwayat vaksinasi, klasifikasinya & dosis vaksin
Tetanus Toxoid is a vaccine In trauma patient (especially open fracture) Initiate in emergency room,
depend on:
that prevent tetanus infection Incomplete vaccination history <3 doses:
caused by Clostridium tetani • Clean, minor wound / Gustillo Anderson I: Give Vaccine Only
bacteria. Four kinds of • Gustillo anderson II and III: Give vaccine and immunoglobulin

vaccines used today: Complete vaccination history >3 doses:

• Clean, minor wound / Gustillo Anderson I: Give Vaccine if >10 years since
• Diphtheria and tetanus last vaccination
(DT) vaccines • Gustillo anderson II and III: Give Vaccine if >5 years since last vaccination

• Diphtheria, tetanus, and

pertussis (DTaP) vaccines Dosage
• Tetanus and diphtheria toxoid
• 0.5 mL, regardless of age
(Td) vaccines
immunoglobulin
• Tetanus, diphtheria, and
• < 5 years old receive 75 U
pertussis (Tdap) vaccines • 5-10 years old receive 125 U
• >10 years old receive 250 U
34. Prinsip penanganan fraktur
1. Recognize
2. Reduce
3. Retain
4. Rehabilitation
35. What is compartement syndrome, How to diagnose,
What is the name of technique for measuring
compartement pressure ?
Compartment syndrome is a condition caused by the osseofascial compartment pressure rises to a
level that decreases perfusion to the compartment and may lead to irreversible muscle and
neurovascular damage.

Diagnosed by clinical assessment.

5P: pain on passive stretch (patognomonic), paresthesia, palpable swelling, paralysis, pulselesness.
We can also measure the compartment pressure using:
1. Slit and wick catheters
2. Simple needle manometry
3. Near infrared spectroscopy
4. Whiteside technique
Positive if intracompartmental pressure >30mmHg or diastolic differential pressure <30
 36. Explain type of muscle contraction, mechanism
of muscle contraction and type of muscle
Expaine typeof muscle contraction:
1. Isometric: A muscular contraction in
which the length of the muscle does not
change.
2. Isotonic: A muscular contraction in
which the length of the muscle changes.
• Eccentric: An isotonic contraction
where the muscle lengthens.
• Concentric: An isotonic contraction
where the muscle shortens
3. Isokinetic: A muscular contraction with
constant velocity.
Mechanism of muscle contraction:
1.Depolarisation and calcium ion release
2.Actin and myosin cross-bridge formation
3.Sliding mechanism of actin and myosin
filaments
4.Sarcomere shortening (muscle contraction)
Type of muscle
1. Cardiac
2. Smooth
3. Skeletal
37. Explain type of fiber muscle and mention
the differences
Skeletal muscle fibers are classified as "slow-twitch" (type 1, red) and "fast-
twitch" (type 2, white).

1. Slow-twitch muscle fibers are fatigue resistant muscle. They contain more
mitochondria and myoglobin, and are aerobic in nature compared to fast-twitch
fibers. Slow-twitch fibers are also sometimes called type I or red fibers because
of their blood supply.

2. Fast-twitch muscle fibers provide bigger and more powerful forces, but for
shorter durations and fatigue quickly. They are more anaerobic with less blood
supply, hence they are sometimes referred to as white fibers or type II.
Jumat, 4 November 2022
 38. Explained about DCO, ETC and EAC
Early total care used until 1980, no longer used because lead to Early appropriate care
exacerbation of the second hit in patient with hemodynamic 1. Identifies major trauma patient
instability.
2. Definitively treats the most
time-critical orthopedic injuries
Damage control orthopedics is defined as definitive treatment while;
delayed until physiology has improved, staging definitive 3. Minimizing the secondary
management avoid adding trauma to patient during vulberable inflammatory response (lactate
period. Treated only the potentially life threatening. <4.0mmol/L, pH>7,25, base
The parameters are: ISS score >40 without thoracic trauma, ISS excess >= 5,5mmol/L)
score >20 with thoracic trauma, GCS <9, multiple injuries with The goal is to definitively treat
severe pelvic/abdominal and hemorrhagic, bilateral femora (spine, pelvis, femur, acetabulum)
fractures, pulmonary contusion noted on radiographs, within 36 hours of injury
hypothermia, head injury with AIS >2, Interleukin 6 >500pg
 39. Definition and criteria of multiple trauma
Polytrauma (multitrauma) is a short verbal equivalent used for severely injured patients
usually with associated injury (itwo or more severe injuries in at least two areas of the
body), less often with a multiple injury (two or more severe injuries in one body area).

New Berlin definition :

Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or
more additional variables from five physiologic parameter:
• hypotension [systolic blood pressure ≤ 90 mmHg]
• unconsciousness [GCS ≤ 8]
• acidosis [BE ≤ −6.0]
• coagulopathy [PTT ≥ 40 s or INR ≥ 1.4]
• age [≥70 years])
40. Mention the structure
shown in figure 1-15
1. Humeral shaft 9. Ulnar shaft
2. Lateral 10. Tuberosity of ulna
supracondylar ridge 11. Coronoid process
3. Lateral epicondyle 12. Trochlea
4. Capitallum 13. Medial Epicondyle
5. Head of radius 14. Coronoid Fossa
6. Neck of radius 15. Medial Supracondylar
7. Tuberosity of radius ridge
8. Radial shaft
41. Mention triangle of death
1. Acidosis
2. Coagulopathy
3. Hypothermia
 42. Criteria of adequate resuscitation
Indicators of adequate resuscitation
- urine output 0.5-1.0 ml/kg/hr (30 cc/hr)
- serum lactate levels
• normal < 2.5 mmol/L, < 45 mg/dL
• most sensitive indicator as to whether some circulatory beds remain
inadequately perfused
- gastric mucosal ph
- base deficit:
• normal -2 to +2
 43. Classification of shock, treatment and
target urine output
class 1 : blood loss <15% / <750ml, heart rate normal, blood treatment options :
pressure normal, urine output >30cc/hour, pH normal, mental
state anxious, treatment fluid • fluids : crystalloids
class 2 : blood loss 15-30% / 750-1.500ml, heart rate • blood : universal donoer,
>100x/minute, blood pressure normal, urine output type specific blood,
20-30cc/hour, pH normal, mental state confused irritable cross-matched blood,
combative, treatment fluid
administered in 1:1:1
class 3 : blood loss 30-40% / 1.500-2.000ml, heart rate ratio of red blood cells,
>120x/minute, blood pressure decreased, urine output 5-
15cc/hour, pH decreased, mental state lethargic irritable, fluid platelets, and plasma
and blood
class 4 : blood loss >40% / >2.000ml, heart rate >140x/minute,
blood pressure decreased, urine output negligible, pH target urine output after
decreased, mental state lethargic/coma, fluid and blood therapy : 0,5-1 cc/kg/hour
44. What is spinal shock
Spinal shock is temporary loss of spinal cord function and reflex activity
below the level of spinal cord injury that characterized by :
- Flaccid areflexia paralysis
- absence of Bulbocavernous Reflex
- and usually resolve under 48 hours
 45. Please mention pelvic stabilizer
Rotational stabilizer:
Anterior Sacroiliac ligament,
Short Posterior Sacroiliac
Ligament, iliolumbar ligament,
sacrospinous ligament
Vertical stabilizer:
Long posterios sacroiliac
ligament, sacrotuberous,
lumbosacral ligament
 46. What is RISSER’s sign and correlation with
scoliosis?
Risser sign used to grade skeletal maturity based on iliac crest. Divided into:
0: no apophysis
1: <25% apophysis
2: 25-50% apophysis
3: 50-75% apophysis
4: >75% apophysis
5: mature

Used to know the flexibility and make decision for treatment in scoliosis, bracing
just effective in skeletally immature patient (risser 0,1,2)
 47. Please explain about the Young’s modulus
of elasticity and its function
Young’s modulus describes the relationship between
stress (force per unit area) and strain (proportional
deformation in an object). A solid object deforms when
a particular load is applied to it. The body regains its
original shape when the pressure is removed if the
object is elastic. Many materials are not linear and
elastic beyond a small amount of deformation. The
constant Young’s modulus applies only to linear elastic
substances.

It serves as the basis for selecting implant materials for

orthopedic surgery
 48. Please describe Pirani’s score.
The Pirani Score is a simple and reliable system to determine severity and monitor
progress in the Assessment and Treatment of Clubfoot

The Pirani Scoring System is based on 6 well-described Clinical Signs of Contracture

characterizing a severe clubfoot :
- If the sign is severely abnormal it scores 1
- If it is partially abnormal it scores 0.5
- If it is normal it scores 0

Parameters :
- Midfoot : curved lateral border, medial foot crease, talar head coverage
- Hindfood : posterior crease, rigid equinus, empty heel
Sabtu, 5 November 2022
48. Pathophysiologi of Osteomyelitis
Port de entry of bacteria on the skin secondary to infected scratches,
abrasions, pimples, or boils; mucous membranes of the upper
respiratory tract as a complication of a nose or throat infection.
Initially small focus of bacterial inflammation process & forming of pus
increasing intraosseous pressure and compromising local circulation
and leads to vascular thrombosis & consequent necrosis of bone.
After few days, the infection penetrates periosteum and produce
cellulitis and soft tissue abscess. In joints it becomes septic arthritis
If uncontrolled the infection may lead to metastatic or chronic
osteomyelitis
49. Kenapa hematogenous osteomyelitis
seringnya di daerah metafisis pada anak?
Karena aliran darah di metafisis dipenuhi banyak vaskularisasi
dengan aliran cenderung lambat yang disebabkan terminal dari
arteri di metafisis berbentuk hairpin loop sebelum menjadi vena
sinusoidal sehingga bakteri gampng menempel dan
berkolonisasi.
50. What is definition of Osteosarcoma
Osteosarcoma is high grade
primary skeletal malignancy
characterized by spindle cells
of mesenchymal origin
depositing immature osteoid
matrix.
Minggu, 6 November 2022
51. What is the diagnosis?

ganglion cyst of dorsal left wrist

region
 52. What is the definiton of ganglion cyst? How do
you diagnose? outpatient procedure, and treatment?
definition imaging:
Ganglion Cysts are mucin-filled synovial cysts and are the most
common masses found in the wrist and hand. radiographs: normal
Ultrasound: useful for
diagnosis: differentiating cyst from
history taking: vascular aneurysm
bumb on hand, usually asymptomatic, may cause issues with
cosmesis
treatments
physical exam:
non-operative:
inspection: transilluminates (transmits light through tissue)
palpation: firm and well circumscribed, often fixed to deep -observation, closed rupture,
tissue but not to overlying skin aspiration
vascular exam: Allen's test to ensure radial and ulnar artery operative: surgical resection
flow for volar wrist ganglions
 53. Please explain about
carpal tunnel syndrome
Definition : Carpal Tunnel
Syndrome is a compressive
neuropathy of the median
nerve at the level of the
wrist Physical examination
Inspection : atrophy of thenar muscles
Palpation : numbness in median nerve distribution and loss of thenar
Anamnesis : night pain, muscle mass.
hand weakness/clumsiness, Positive test , tinel sign, phalen test, loss of two-point discrimination test
numbness in median nerve
distribution, certain Treatment :
repepetitive motions and -NSAIDS, splint and activity modification for first line treatment
athletic activities, -Steroid injection as adjunctive therapy
-Operative if no improvement in firstline and adjuntive therapy
Senin, 7 November 2022
 54. Mention clinical findings of Scoliosis
• functional Leg • rib rotational
length discrepancy deformity (rib
• leg length prominence)
inequality • waist asymmetry and
• midline skin
pelvic tilt
defects (hairy
patches, dimples,
• cafe-au-lait spots
nevi) (neurofibromatosis)
• signs of spinal • foot deformities
dysraphism (cavovarus)
• shoulder height • asymmetric
differences abdominal reflexes
• truncal shift
 55. Types of Scoliosis? Explain
1. Congenital scoliosis
In congenital scoliosis, the misalignment occurs as a
result of deformed vertebrae or ribs present at birth.
A variety of developmental factors can cause this
deformity
2. Idiopathic scoliosis
About 80% of cases are considered idiopathic.
There are 3 groups:
- Infantile idiopathic scoliosis: 0-3 years old
- Juvenile idiopathic scoliosis: 4-10 years old
- Adolescent idiopathic scoliosis: 10-18 years old
3. Neuromuscular scoliosis
Neuromuscular scoliosis comes from
underlying neuromuscular conditions.
The development of the spine is
affected by the surrounding
musculature. Conditions such as
cerebral palsy and muscular dystrophy
affect muscle strength and tone and
can affect the spine’s development.
Diseases that affect the spine, such as
spina bifida, can also contribute to
spinal deformity and scoliosis. This
form of scoliosis is often the most
serious, as several factors are at play.
56. When can we say the patient has
scoliosis? Based on radiograph finding
>10 degrees Cobb's Angle on
PA and Lateral standing x-ray
 57. What is wedge fracture, chance fracture,
burst fracture? Explain the difference!
Wedge fracture
hyperflexion injuries to the vertebral body resulting from axial loading.
Commonly on anterior aspect of the vertebral body (single-column
injury)

Brust fracture
high-energy axial loading spinal trauma that results in disruption of a
vertebral body endplate and the posterior vertebral body cortex that
leads to fracture of the anterior and posterior vertebral body (two-
column injury)

Chance fracture
commonly referred as seatbelt fractures, are flexion-distraction type
injuries of the spine that extend to involve all spinal columns (three-
column injury)
 58. Explain about jumper’s knee
Jumper's knee also known as patellar tendinitis Special test:
defined as tendinopathy of the patellar tendon. Basset sign: tenderness to palparion at distal
pole of patella in full extension, but no
Classified into 3 phase tenderness in full flexion
Phase 1: pain after activity Imaging:
Phase 2: Pain during and after activity Xray: enthesophyte +/-
USG: thickening of tendon
Phase 3: Persistent pain
MRI in chronic cases may be thickening of
tendon, loss of the posterior border of fat pad
Diagnosis:
History taking: Pain in the anterior knee at inferior Treatment:
border of patella usually related to activity.
Nonoperative: rest, ice, activity modification,
Physical Exam: physical therapy
- Inspection: swelling +/- over tendon Operative: in stage III disease, chronic pain,
- Palpation: tenderness pastial tears
59. What is the differential diagnose of
jumper’s knee
• Patellar injury
• Patellar dislocation
• Osgood Schaltter disease
• Knee Osteochondritis dissecans
• Meniscus injuries
 60. What is osgood schlatter
disease?
Definition
Osgood-Schlatter disease is
osteochondrosis or traction
apophysitis of the tibial tubercle, Additional Exams
commonly presenting as anterior knee
- Radiographs : irregularity and fragmentation of the tibial
pain in the pediatric population. tubercle
How to diagnose - MRI : soft tissue swelling; thickening and edema of inferior
- Symptoms : pain on anterior aspect patellar tendon; fragmentation and irregularity of
ossification center;
of knee; exacerbated by kneeling;
Treatment
- Physical exam :
- Nonoperative : NSAIDS, rest, ice, activity modification,
* inspection : enlarged tibial tubercle; strapping/sleeves to decrease tension on the apophysitis
tenderness over tibial tubercle; and quadriceps stretching; cast immobilization x 6 weeks;
- Operative : ossicle excision
61. What is terrible triad of elbow?.
A traumatic injury pattern of the elbow that is
characterized by:
-elbow dislocation
-radial head or neck fracture
-coronoid feacture
Senin, 14 November 2022
 62. Function of annular and cruciate pulleys?
• The function of the Annular pulleys
is to enhance effective flexor
tendon functions by holding the
tendons close to the phalanges,
thereby preventing the “bow-
stringing” effect across the small
joints when the digits are in flexion.
• The function of Cruciate pulleys is
to prevent sheath collapse and
expansion during digital motion and
facilitates approximation of annular
pulleys during flexion
Rabu, 16 November 2022
 63. Borders and contents of carpal tunnel?
Borders:
• Roof: transverse carpal ligament
• Floor: central proximal carpal bones
• Medial wall: pisiform and hook of hamate
• Lateral wall: trapezium and scaphoid
tubercle

Contents:
• 4 flexor digitorum superficialis (FDS)
tendons
• 4 flexor digitorum profundus (FDP)
tendons
• flexor pollicis longus (FPL)
• median nerve
 64. Borders and contents of ulnar tunnel?
Borders:
• Roof : volar carpal ligamet
• Floor : transverse carpal ligament
• Medial wall : pisiform
• Lateral wall : hook of hamate

Contents:
• ulnar nerve
• ulnar artery