image Q. 68 - Grand slam.

Q.  'Tennis leg' is injury to which of these ?

a. Tendo Achilles
b. Soleus
c. Gastrocnemius
d. Fibula
e. Deltoid ligament

Answer -
c

Rupture of medial gastrocnemius during forceful activities is called tennis leg.

The rupture of plantaris tendon is also associated with this but is rare.

image Q. 67 - Finding fixation

Q.   Identify the implant used in below image for treatment of given fracture ?

a. Bent K- wire
b. Enders' nail
c. Rush pin
d. Flexible nail
e. Guide wire

Answer -
d

The below image shows fixation of forearm fracture in pediatric case. They are best managesd by intramedullary nails in children.

An implant with bent tip in the shape of 'hockey stick' is TENS ( titanium elastic nailing system - see in image below the answer). These are also called flexible nails or ESIN ( elastic stable intramedullary nails).

Rush nails are also bend at one end and bevelled at other ,but it is not the end to be inserted, it is the end that remains outside bone.

Enders' nail are straight and bevelled like rush with a hole at other non-inserting  end.

K wire is pointed at both ends and usually is serted as it is so never is bent for that purpose.

imge Q. 66 - Colors of life

Q.  The tubings shown in the images carry necessary gases in hospital supply to opertaion theatres, ICU etc.. Which gas is likely to pass through pipe with blue bonet?

a. Oxygen
b. Ether
c. Nitrous
d. LPG

Answer -
c
The gas cylinder of common gases have colour coding for their ease of identification. Blue colour is associated with nitrous oxide and is best option here. Oxygen cylinders are black/white.  Carbon dioxide oxide is grey and nitrogen is black.

image Q.65 - Free world

Q.   'Free hand technique' is used for which implant ?

a. Nails
b. Plates
c. Wires
d. Screws

Answer -
d

Distal screws or bolts of intramedullary nails are fixed usually with manual method with free hand technique'. The other method is by using dedicated jigs for distal screws.

image Q. 64 - Push your luck

Q.  The intraoperative imaging of the orthopaedic procedure requires less contrast to be required - which of these buttons would you push to achieve the purpose?

a.  a
b.  b
c.  c
d.  d

( click over the image to enlarge)























































































































































Answer -
d

The kVp (kilo-volt peak) and mAs (milliamperage - second) are usual modes to control the presentation of radiographic image.
kVp is associated with ' radiographic contrast' and increasing it decreases the contrast and vice versa.
mAs usually is indicator of ' density' of the film. kVp also affects density but indirectly.

image Q. 63 - Y so serious ?

Q.  Which of these is known as yellow ligament ?


a. posterior longitudinal ligament
b. Interspinous ligament
c. patellar ligament
d. ligamentum flavum
e. Y ligament

Answer -
d

Ligamentum flavum found in spine in Latin translates into the ' yellow ligament'.

Y ligament is found in hip and is one of the strongest ligament also known as ligament of Bigelow.

image Q. 62 - Smooth ride

Q.   All are features of cartilage components except -


a. Tide mark
b. Lamina splendens
c. Caloitied cartilage
d. High intensity zone

Answer -
d

High intensity zone is MRI feature of early intervertebral disc prolapse when annular tear or fissure starts to form usually posteriorly in commoner posterior impending disc prolapse. A bright focal signal is seen in T2/weighted images.

All others are layers of articular cartilage. A brief schematic diagram of articular cartilage layers is given below (with number 1- lamina splendens, 2,3 and 4 are superficial middle and deep layers, 5- tide mark , 6- caloitied layer, 7- subchondral bone and 7 - cancellous bone.

image Q. 61 - Pillow talk

Q.   A patient with below fracture has been admitted in emergency ward. The senior resident has asked you to put a pillow beneath the patient's injured extremity. Where would you put the pillow?

a. Below the leg longitudinally
b. Below knee
c. Above knee
d. Long pillow covering above and below knee.
e. No pillow

Answer -
c

The fracture described here is distal femur fracture and characteristic deformity in such fractures is posterior sagging of distal fragment due to pull of gastrocnemius attached posteriorly that pulls distal fragment posterior and downwards ( see below image).

The pillow works best slightly above knee joint to counter the pull of muscle and maintian alignment.

image Q. 60 - Sidelined

Q.   The patient presents with pain and below posture.  Clinical examination of which area should one proceed with ?


a. Abdomen
b. Spine
c. Gluteal region
d. Hip region
e. Pelvic region

Answer -
d

The patient here holding his/her side in below picture is characteristic of 'C sign'. It is indicative of hip joint pathology like femoroacetabular impingement etc.