1. Orthopaedics – MCQ 22 – Differential diagnosis of lesion, histologically resembling giant cell tumour
2. AIIMS May 2011 – MCQ 129
3. Orthopaedics – MCQ 27 – Eccentric osteolytic lesion

Clinical features:

• Generalised pain in the knee
• Pain and stiffness in the knee with prolonged sitting (Theater sign / Movie sign – experienced after sitting at a movie theater for a long time)
• There is also pain during climbing stairs
• Swelling in the knee due to effusion with positive patellofemoral grinding test occurs in late stages

Investigations:

• Radiographs show irregular patellar surface
• Arthroscopy can help visualise the damaged articular cartilage

Treatment:

• Application of ice
• Ultrasound massage
• Realignment of the patella in the patellar groove by orthotic therapy
• Arthroscopic shaving of the retropatellar surface

References:
Textbook of Orthopedics, Ebnezar, 4th edition, p426
Sports Medicine Essentials: Core Concepts in Athletic Training and Fitness … By Jim Clover
Fundamentals of sports injury management By Marcia K. Anderson

1. Episcleritis – Etiopathogenesis, Clinical features, Treatment
2. Vocal nodule – Etiology, Pathogenesis, Clinical features and Management
3. Anatomy – MCQ 71 – Articular cartilage

References:
The elbow and its disorders By Bernard F. Morrey, Joaquin Sanchez-Sotelo, Page 226
Skeletal trauma in children, Volume 3 By Neil E. Green, Marc F. Swiontkowski, Page 212

1. AIPGMEE 2011 – MCQ 15 – Nerve injury in supracondylar fracture
2. Orthopaedics – MCQ 21 – Complications of supracondylar fracture of humerus in children
3. Orthopaedics – MCQ 17 – Malunion of supracondylar fracture of the humerus

• Type I – Undisplaced
• Type II – Displaced, but posterior cortex is intact
• Type III – Displaced but posterior cortex is not intact. The distal fragment may be displaced in one of the 2 possible ways
  • Posteromedial
  • Posterolateral

Nerve injuries and other complications are more common in type III supracondylar fractures.

1. Nerve injury in supracondylar fracture of humerus
2. Orthopaedics – MCQ 21 – Complications of supracondylar fracture of humerus in children
3. AIPGMEE 2011 – MCQ 15 – Nerve injury in supracondylar fracture

Spondylotic changes to look for in lateral view radiograph of neck:

• Osteophytes
• Disc space narrowing
• Loss of cervical lordosis
• Uncovertebral joint hypertrophy
• Apophyseal joint osteoarthritis
• Decreased vertebral canal diameter

Other imaging modalities for diagnosing cervical spondylosis:

• CT scan
• CT myelography
• MRI – investigation of choice

1. Anatomy – MCQ 14 – Difference between typical cervical & thoracic vertebrae?
2. Forensic medicine – MCQ 8 – Shape of nulliparous cervical canal
3. Orthopaedics – MCQ 38 – Fracture dislocation of cervical spine

Scoliosis is a deformity of the spine which is characterised by lateral curvature of the spine in upright position in the coronal plane

Problems due to scoliosis:

• Cosmetic
• Deranged force and load transmission through spine
• Impairment of functioning of vital organs like heart and lungs
• Difficult to treat

Types of scoliosis:

• Structural
  • Fixed curvature
  • Non flexible
  • Does not get corrected by side bending
• Non structural
  • Flexible curvature
  • Gets corrected by side bending

Mechanism of non structural scoliosis

• Compensatory – to compensate for leg length deformities / fixed flexion deformities of hip
• Sciatic – due to inflammation / irritation due to lumbar disc disease
• Postural – due to bad posturing

1. Tension band principle
2. Mass lesion – Left lungs – X-ray
3. Dermatology – MCQ 23 – 27 year old male with vesiculobullous lesion

1. Swan neck deformity
2. Anterior wedge compression fracture – Xray
3. Orthopaedics – MCQ 17 – Malunion of supracondylar fracture of the humerus

Reference:
Obesity in childhood and adolescence By Wieland Kiess, Claude Marcus, Martin Wabitsch

1. Ophthalmology – MCQ 31 – Ophthalmic examination in NIDDM
2. Pathology – MCQ 95 – Prognostic factors for Hodgkin’s disease
3. Ophthalmology – MCQ 4 – Disease with autosomal dominant inheritance

• Knee Ankle Foot Orthosis (used in orthopedics)

1. Blount’s disease
2. Orthopaedics – MCQ 12 – Pigmented villonodular synovitis
3. T handle – Orthopedics instrument

1. ASIF – Acronym
2. Orthopaedics – MCQ 32 – 30 year old man with breathlessness 2 days after RTA
3. Surgery – MCQ 78 – Most common cause of acquired arteriovenous fistula

(Click on  image for an enlarged view)

• Compression fracture of the anterior part of vertebral body occurring in forward flexion
• Usually does not produce neurological deficits
• It is a stable fracture as only the anterior column of spine is involved
• Caused by : Road traffic accidents, Fall from height
• Predisposing factors : Osteoporosis

1. Denis’ three column concept of spine stability
2. Healed fracture rib
3. Orthopaedics – MCQ 38 – Fracture dislocation of cervical spine

Denis’ three column concept of spine stability

According to the three column concept, the spine is considered to have 3 columns:

• Anterior
• Middle
• Posterior

The anterior column is composed of:

• Anterior longitudinal ligament
• Anterior half of vertebral body and intervertebral disc

The middle column is composed of:

• Posterior longitudinal ligament
• Posterior half of vertebral body and intervertebral disc

The posterior column is composed of:

• Transverse process
• Spinous process
• Pedicle
• Lamina
• Faceted joints
• Interspinous ligament
• Supraspinous ligament
• Ligamentum flavum

Spinal injury and Three column concept:

• One column injury is stable
• Two column injury is unstable
• Three column injury is invariably unstable

1. Orthopaedics – MCQ 38 – Fracture dislocation of cervical spine
2. Anterior wedge compression fracture – Xray
3. PGIMER November 2011 – MCQ 29

Bones of the hand

(Click on  image for an enlarged view)

Swan neck deformity refers to a structural deformity of the hand in which

• proximal interphalangeal joints are in hyperextension
• distal interphalangeal joints are in hyperflexion

• Commonly seen in injuries or inflammatory conditions like rheumatoid arthritis
• Seen in 50% of patients with rheumatoid arthritis
  
• Treatment is by surgical correction
  

1. Orthopaedics – MCQ 40 – Heberden’s Arthropathy
2. PGIMER November 2011 – MCQ 7
3. Step deformity

1. Undisplaced fracture – Inferior pubic ramus
2. Pathology – MCQ 41 – A 70 year old male with a pathologic fracture of femur
3. Healed fracture rib

External links:

1. “Fish” or “Fish Mouth” Vertebrae? – American Journal of Roentgenology
   

1. Anatomy – MCQ 14 – Difference between typical cervical & thoracic vertebrae?
2. Denis’ three column concept of spine stability
3. Spondylotic changes – cervical vertebrae – X-ray

(Click on the image for an enlarged view)

Differential diagnosis

• Looser’s zone seen in osteomalacia

1. Undisplaced fracture
2. Normal indentations on the esophagus in barium swallow – Right anterior oblique view chest X-ray
3. Galeazzi’s Fracture – X-ray

1. Minus desk – Recommended desk for school children
2. Proximal attachment (origin) of deltoid – Mnemonic
3. Gartland’s classification of supracondylar fractures in children

1. RGUHS Karnataka PGET 2011 – MCQ 88
2. Sattler’s layer
3. Haller’s layer

• Primary compressive
• Primary tensile
• Secondary compressive
• Secondary tensile

Ward’s traingle is an area of the femoral neck formed by the intersection of 3 bundles of trabeculae

• primary compressive trabeculae medially
• primary tensile and secondary compressive trabeculae laterally

1. Ward’s Triangle
2. AIPGMEE 2011 – MCQ 3 – Main blood supply of neck of femur
3. Orthopaedics – MCQ 35 – Subtrochanteric fractures of femur

• primary compressive trabeculae medially
• primary tensile and secondary compressive trabeculae laterally

• It is an area of low bone density
• Contains thin, loosely packed trabeculae
• Seen in x-rays as a radiolucent area

1. Trabecular pattern of proximal femur
2. Secondary myelofibrosis – Etiology, Pathogenesis, Investigations and Management
3. Amino acid content of bone after death

1. LCDCP – Acronym
2. JESS – Acronym
3. RGUHS Karnataka PGET 2011 – MCQ 72

1. EECP – Acronym
2. SRS – Acronym
3. MEDLARS – Acronym

(Click on image for an enlarged view)

1. Bucket handle malformation seen in Imperforate anus
2. ROM – Acronym
3. Nicolas Andry – Grandfather of orthopedics

Galeazzi’s Fracture

(Click on  image for and enlarged view)

• Fracture of radius at the junction of its middle third and distal third
• with dislocation of distal radioulnar joint
• Called fracture of necessity – always requires open reduction and internal fixation (ORIF)

1. Orthopaedics – MCQ 38 – Fracture dislocation of cervical spine
2. Anatomy – MCQ 23 – Supination & pronation
3. RGUHS Karnataka PGET 2011 – MCQ 81

DEXA scanning, is currently the most widely used method to measure bone mineral density.

1. Radiology – MCQ 28 – Gold standard investigation for diagnosis of osteoporosis
2. LDL
3. HDL

Healed fracture rib

Healed fracture rib, seen as increased density and deformity of the ninth rib on the right side near the margin of the thorax, the commonest site of rib fracture.

1. Galeazzi’s Fracture – X-ray
2. Orthopaedics – MCQ 42 – Commonest site of fracture in children
3. Anterior wedge compression fracture – Xray

Bilateral cervical rib

1. Spondylotic changes – cervical vertebrae – X-ray
2. Healed fracture rib
3. Destruction of 2nd rib

X-ray of knee joint showing epiphyseal plates

X-ray of knee joint showing femur above and tibia and fibula below with knee joint. The epiphyseal plates are seen as transluscent lines near the end of the the bones (yellow arrows). The region beyond the the ephiphyseal plate and adjoining the joint is the epiphysis. The densely calcified outer region of the shaft is known as the cortex and the inner region which holds the bone marrow is known as medulla (blue arrows).

1. Orthopaedics – MCQ 9 – Muscle atrophy in osteoarthritis of knee joint
2. Pathology – MCQ 10 – A diabetic patient is undergoing dialysis. Aspiration done around the knee joint would show?
3. Blood supply of bone

Ref: Ortho Maheshwari – p161

1. Sequestrum
2. Rhinitis caseosa – Epidemiology, Pathology, Clinical features, Treatment
3. Tension band principle

Ref: Ortho Maheshwari – p161

1. Involucrum
2. Tension band principle
3. Anatomy – MCQ 62 – Growth at epiphyseal plate