image Q. 59 - No mean feet

Q.  To clinically  assess the below case to rule out neurological involvement , what should be done?

a. Press the tibia
b. test for Babinski sign
c. Stroke the sole
d. Achilles tendon reflex

Answer -
c

The deformity appears to be bilateral clubfeet in the given picture.

 Plantar stimulation of the feet can be done to check neurological status in a clubfoot.
Lack of dorsiflexion of the toes and resting position in plantar flexion, i.e. “The Drop Toe Sign,”  indicates a neurological etiology of the clubfoot deformity.

image Q. 58 - Perched

Q.  'Perched' injury is related to which structure in below image?

a. Radial head
b. Proximal radioulnar joint
c. Radiocapitellar joint
d. Ulnohumeral joint

Answer -
d

The spectrum of elbow joint dislocation ranges from subluxation then perched elbow( when the trichlea is perched over the coronoid but still not dislocated) and followed by dislocation in more common posterior dislocation of elbow.

Perched thus is intermediate stage and sometimes cases present with this stage.

Apart from this the ' perched' deformity is related to facet joints of vertebrae. Unilatwral or bilateral perched facet joints may occasionally present in clinical scenario.

image Q. 57 - Pit is hit

Q.    The arrow in below image of the back of a person denotes which of these?


a. Sacroiliac joint
b. Lumbosacral junction
c. First Sacral level
d. Second Sacral level

Answer-
a,d

The arrow indicate a normal depression over back region well appreciated in non-obese people. This anatomical landmark is called ' dimple of Venus'.

This landmark is approximately at level of  sacroiliac joint.

and that point also is considered to be at level of second sacral vertebra in many texts.

image Q. 56 - The meeting point

Q.   The arrow in given radiograph denotes which of these anatomical structure?

a. acetabular dome
b. Nonossified ischium
c. Nonossified pubis
d. Triradiate cartilage
e. Pulvinar

Answer -
d

The acetabulum is composed by junction of all three innominate bones of pelvis viz ilium, ischium and pubis. The area is called triradiate cartilage.

image Q. 55 - Membrane

Q.   Interosseous membrane is affected in which of these fractures?

a. Montaggia fracture
b. Galleazzi fracture
c. Comminuted midshaft both bone forearm fracture
d. Essex Lopresti fracture

Answer -
d

Essex Lopresti injury consists of comminuted fracture of radial head and disruption of distal radioulnar joint (DRUJ). The DRUJ separation occurs as result if interosseous membrane rupture all along. Out of all options , this injury causes severest injury to interosseous membrane.

image Q. 54 - C you soon

Q.   Identify the below machine that is integral part of orthopaedic fracture fixation ?

a. Portable radiography
b. Image intensifier
c. Fracture press
d. Fracture hand table

Answer -
b

The image intensifier or better known as C- arm as the shape of the main part of machine resembles letter 'C' is used for intraoperative imaging of bones during fracture surgery and also helps implant fixation. Low radiation imaging is possible and the machine can be moved in diverse ways to achieve desired imaging of the part.

image Q. 53 - Natural cushion

Q.   Thickest articular cartilage is found in -

a. Hip joint
b. Patella
c. Distal femur
d. Proximal tibia
e. Ankle joint

Answer -
b

Patella has got the thickest articular cartilage and may be up to 5 cm in certain places.

image Q. 52 - Walk the talk

Q.   Which phase of gait cycle would be affected in below patient?

a. Swing phase
b. Cadence
c. Stance phase
d. Speed

Answer -
a

The radiograph of the patient shows unilateral. hip pathology and must be painful on that side. Thus stance phase of the affected extremity would be reduced during gait to avoid weight bearing in that limb due to pain. The resultant gait , thus would be painful or antalgic gait.

Cadence is number of steps per minutes and that too would be affected due to painful walking as well as the speed.

Swing phase involves the affected limb off the ground and is  least painful to patient thus would have minimal affliction.

image Q. 51 - All that glitters..

Q.   'Golden surgery' is related to which procedure in orthopaedics? 

a. Arthroscopy 
b. Spine surgery 
c. Joint replacement 
d. Hand surgery 
e. Musculoskeletal tumor surgery

Answer -
 c 

'Gold knee replacement' surgery is a new concept that involves total knee replacement with specialized implant. 
The implant, however is not made of gold. The seven protective layers in a conventional cobalt- chromium implant helps longevity and better infection or allergy prophylaxis. 
The implant, however, is golden in color.

image Q. 50 - 'dis..' is good.

Q.    Traumatic dislocation is serious injuries which require urgent relocation of joint by trained doctors.  Which of the joint, on the contrary in certain cases, is dislocated by surgeons to treat many of its pathologies?

a. Hip
b. Ankle
c. Elbow
d. Shoulder

Answer -
a

'Surgical dislocation of hip' is a recognised technique to treat many disorders of femoral head like fractures, osteonecrosis or femoroacetabular impingement.

It is done in a manner not to jeopardise the critical vascular supply of femoral head and is termed 'safe surgical dislocation' of hip by various methods.

image Q. 49 - Much 'apo' about nothing

Q.  Apophyses are all except?

a. Ilium
b. Olecranon
c. Trochanter
d. Calcaneum
e. all of the above

Answer -
e

Apophysis are non-joint forming ends of a bone and differ from epiphyses which take part in joint formation.

Mostly these  work as attachement site for important tendon or ligaments.

Besides the above-mentioned options examples of other important apophysis are -
Malleolar,tibial tuberosity and base of fifth metatarsal.

image Q. 48 - Back to bag

Q.  ' bag of bones' is term associated with which of these?

a. autologous bone grafts
b. artificial bone substitutes
c. comminution fracture
d. severely crushed limb

Answer -
c
Highly comminuted fractures that are not suitable for internal fixation as there are numerous small comminuted fracture pieces and difficult to manage with implants. These are managed with conservative method involving plaster support in  'as it is' manner which is called bag of bones'.

The method has been mostly described with respect to fractures of distal humerus.

The method usually is reserved for cases not fit for surgery due to comorbidities.