A 65 yrs old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best treatment option ?
A. Conservative management
B. Arthroscopic washing
C. Partial knee replacement
D. Total knee replacement
1. Ans D. Total knee replacement
Grade III always do total knee replacement.
Most common nerve injured in supracondylar fracture humerus?
d. Anterior interosseus nerve
2. Ans. d. Anterior interosseus nerve
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
The order is Anterior Interosseus Nerve> Median > Radial >Ulnar
Nerve injuries occur in about 40% of type III (Gartland’s classification) supracondylar fractures
Earlier literature stated that radial nerve was the most commonly injured nerve in supracondylar fractures
But recent studies indicate that the anterior interosseous branch of median nerve is mostly
Nerve involvement differ with the type of fracture
Anterior interosseous nerve is mostly affected during posterolateral displacement of the distal fragment
Radial nerve is mostly affected with posteromedial displacement
Ulnar nerve is involved in flexion type of supracondylar fracture
Blount’s disease is:
A. Genu valgum
B. Genu varum
C. Genu recurvatum
D. Menisceal injury
3. Ans. B. Genu varum
Blount’s disease is a growth disorder of the shin bone (tibia) in which the lower leg turns inward, resembling a bow
Causes, incidence, and risk factors
Blount’s disease occurs in young children and adolescents. The cause is unknown but is thought to be due to the
effects of weight on the growth plate. The inner part of the shin bone, just below the knee, fails to develop
Unlike bowlegs, which tend to straighten as the child develops, Blount’s disease slowly gets worse. It can cause
severe bowing of one or both legs.
This condition is more common among African-American children. It is also associated with obesity and early
Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity,
excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee
hyperextension and back knee. This deformity is more common in women and people with familial ligamentous
A Teenaged girl complains of pain in knee on climbing stairs and on getting up after sitting for a long time.
What is the probable diagnosis?
A. Chondromalacia patellae
B. Plica syndrome
C. Bipartite patella
D. Patello-femoral osteoarthritis
4. Ans. A. Chondromalacia patellae
Patellofemoral syndrome; Knee pain - chondromalacia
Chondromalacia patella is the softening and breakdown of the tissue (cartilage) that lines the underside of the
It is a common cause of anterior knee pain.
Chondromalacia of the patella occurs in adolescents and young adults.
The condition is more common in females. It can be related to the abnormal position of the knee.
• A grating or grinding sensation when the knee is flexed (moved so that the ankle is brought closer to
the back of the thigh)
• Knee pain in the front of the knee that occurs when you get up after sitting for a long period
• Knee pain that worsens when you use stairs or get out of a chair
• Knee tenderness
Plica syndrome of the knee is a constellation of signs and symptoms that occur secondary to injury or overuse.
An otherwise normal structure, a plica can be a significant source of anterior knee pain.
A bipartite patella occurs when the patella, or kneecap, occurs as two separate bones. Instead of fusing
together in early childhood, the patella remains separated. A bipartite patella is usually not a problem; it occurs
in at least 1 percent of the population, and perhaps more.
First structure to be fixed after amputation is?
A. Bone fixing
B. Arterial repair
C. Venous repair
D. Nerve repair
5. Ans. A. Bone fixing
The goal of replantation (commonly known as re-implantation or re-attachment surgery) after traumatic
amputation is successful restoration of function. Simply returning circulation to an amputated part does not in
itself define success. The aim of the both the patient and the surgeon is useful function - replantation of a part
that will not perform useful activity should be avoided.
Bone Fixation (Osteosynthesis)
If the part is deemed to be replantable, bone fixation is performed first. Most commonly, fixation with kwires
After bone fixation is performed, the dorsal extensor tendon (above) and flexor tendon (below) are repaired. With
all the “macro” structures repaired - bone, extensor and flexor tendon - attention is then turned to the
microsurgical portion of the procedure.
Microsurgical Artery and Nerve Repair
The microsurgical repair of an artery can now be performed with the operating microscope. A digital vessel, which
is approximately 1 millimeter in size, can be repaired with 6 to 8 sutures of nylon. Removal of the vascular clamps
reveals whether circulation can be re-established to the finger.
Microsurgical Vein Repair
Attention is then usually turned to the dorsal aspect of the finger where the venous system is present that drains
blood from the finger. Usually one or occasionally two veins are repaired with the operating microscope. The veins
are often much smaller and more fragile than the arteries and hence more prone to clotting post-operatively.
Skin Closure and Splinting
The skin is then closed, often with a skin graft, depending on the swelling and the nature of the injury.
The hand is usually placed in a splint and the patient is monitored closely for circulatory changes in the finger
during the post-operative period.