Download 1. Talipes Equinovarus is the proper name for :-

LMCC Orthopedic Review Lecture
April, 2009
“Back to Basics”
Dr. P.R. Thurston
Fractures
&
Dislocations
Definitions
Fracture:-
A discontinuity in the structural
integrity of a bone.
Infraction:-
An incomplete fracture.
Dislocation:-
Complete loss of contact of the
articular surfaces of a
joint.
Subluxation:-
Non-concentric joint surfaces.
Reduction:-
Returning a fracture or dislocation to an
anatomical alignment.
Comminution:-
Multiple fragments.
Fractures
Definition :-
A discontinuity in the structural
integrity of a bone.
A fracture occurs because the force applied
exceeds the breaking strength of the bone so that the
Load can no longer be transferred across that zone
of the bone.
Fractures
All fractures ultimately begin with kinetic energy,
released by misadventure and applied to the human
body.
Some of that energy is absorbed and some is
transmitted to the surroundings.
Absorbed energy must be dissipated, ie. distributed,
through the soft tissues and bones.
Fractures occur when the bone can not dissipate all of
the energy absorbed.
Fractures
Mechanical Properties of Bone
Bone is a two-phase material :Calcium HydroxyApatite
Osteoid
Ca10(PO4)6(OH)2
Collagen type I and III
= mineral
= fibrous
Calcium is strong in compression, but weak in tension.
Osteoid is strong in tension, but weak in compression.
Fractures
BUT :-
(for adult bone)
Calcium is stronger in compression
than Osteoid is in tension
And therefore :Bone always fails first in tension
Fractures
A bone consists of three
areas :the Diaphysis
the Metaphysis
the Epiphysis.
Each region has its own
fracture characteristics.
Fractures
Diaphyseal
Metaphyseal
Epiphyseal
Bending
Torque
Direct
Traction
Compression
Intra-articular
Pediatric
Oblique
Spiral
Transverse
Mixed
Fractures
Salter-Harris Classification
I
IV
II
III
V
Fractures
Salter-Harris Classification
1)
Fractures interfering with growing bones.
2)
Worse prognosis with increasing number.
3)
Probability of surgery increases with
number.
Fractures
A fracture can occur in :normal bone subject to abnormal forces.
= Traumatic Fractures.
abnormal bone subject to normal forces.
= Pathologic Fractures.
normal bone subject to cyclic forces.
= Fatigue or Stress Fractures.
Fracture Description
This fracture is angulated
laterally, since it points
laterally.
The distal fragment is tilted
medially
Description
Medially Displaced
Closed
Comminuted
Short Oblique
Fracture of the
Proximal Humerus
Caused by a direct fall
Fracture Description
1) The distal fragment is always described with
relation to the proximal segment.
2) Displacement = Translation of bone ends.
3) Angulation = Orientation of bone ends.
4) Angulation identifies to where the fracture
points.
5) For clarity, the tilt of the distal fragment is
often used to describe angulation.
Indications for Closed Reduction
There is significant displacement.
Reduction is possible.
The reduction, if gained, can be held.
The fracture has not been produced by a
traction force.
The Periosteal Bridge
The Periosteal Bridge is
intact on the concave
side of the fracture.
Reversal of the
mechanism of the
fracture tightens the
bridge and stabilizes
the fracture.
The Periosteal Bridge
Tightening the periosteal
bridge locks the fracture
together.
Holding the bridge tight
requires three point
fixation.
“It takes a bent cast to
produce a straight bone”
J. Charnley
Indications for Open Reduction
1)
2)
3)
4)
5)
6)
7)
8)
There is a significant Displacement.
Open Fractures.
Intra-articular Fractures.
Un-reducible Fractures
Reductions that cannot be maintained in a cast.
Comminuted or Segmental Fractures.
Floating Joints.
Fractures with Neurovascular damage.
Open Fractures
Classification :1. < 1 cm., inside-out, little soft tissue damage.
=
low potential for infection.
2. 1 cm. – 10 cms., outside-in, requires
debridement, but no flap or skin graft.
=
moderate potential for infection.
3. > 10 cms., outside-in, high energy, devitalized
muscle, comminution or bone loss, soft tissue
loss.
Open Fractures
Classification :3A. No loss of soft tissue cover, no flap required.
3B. Flap required due to soft tissue stripping.
3C. Associated vascular injury.
Type 1. Open Fracture = 6 mm, extend & debride
Degloving Mechanism
Degloving Mechanism
Type III C Injuries – Vascular Injury
Note pallor of the ankle
No pulses
Fracture Complications
1.
2.
3.
4.
Pulmonary Fat Emboli
Compartment Syndromes
Stress Fractures
Pathologic Fractures
Pulmonary Fat Emboli :-
A.R.D.S.
- Long bone fractures, burns, contusions.
- Interstitial pneumonitis due to free fatty acids
- S.O.B. & confusion in young adults.
- Axillary & Subconjunctival Petechiae.
- Serum lipase elevated.
- pAO2 reduced – if < 50 – 20% mortality.
- Ventillatory support
- Dexamethazone.
- 5 day course.
Compartment Syndromes
- increased interstitial tissue pressure.
- fractures, burns, tight dressings.
- normal pressure < 25 mm. Hg.
- when the tissue pressure > venous capillary pressure,
but less than the arteriolar pressure.
- 5 P’s
- pain.
- pallor.
- pulselessness.
- paresthesias.
- paralysis.
Compartment Syndrome
Symptom: Pain out of proportion to that
expected for the injury.
Signs:
1. Loss of function of muscle due to
ischemia within the compartment.
2. Pain with passive stretch
3. Numbness etc. are LATE findings!
4. If neuro symptoms present, potential
for full neuro recovery is only 10 %
Rx Compartment Syndrome
Release all compressive
dressings / plaster.
Elevate extremity to
heart level.
Fasciotomies.
4 compartment
fasciotomy
Compartment Syndrome
Careful monitoring.
Recognise it - 5 P’s
Call Orthopaedic Surgeon
Pressure measurements
Stress or Fatigue
Fracture
Repeated loading below acute
failure threshold.
Eventual fatigue failure.
Military recruits, runners,
aerobics.
Tibia, metatarsals, femoral neck.
Initial x-ray can be negative.
Bone tenderness – Bone scan.
Pathologic Fractures
Failure through abnormally
weakened bone
Minimal trauma – BEWARE
Osteoporosis
Metastasis
Tumour:- Benign,
Malignant
(Myeloma).
Metabolic Bone Disease
Pathologic Fractures
Metastases:
Lytic
-
Lung
Colon
Thyroid
Renal
Breast
Blastic
-
Prostate
Pathologic Fractures
Metastases:
- require fixation to prevent fracture if they are > 1/3.
- produce pain on weight bearing in the lower limb.
- survival > 3 months.
- cannot be managed by medical therapy.
- radiotherapy after fixation (2 weeks)
(radiotherapy induced osteonecrotic fractures)
Pathologic Fractures
Dislocations
The articular surfaces are no longer in contact.
Commonly affects Shoulders > PIP joints > Elbows > Ankles.
Often associated with fractures.
Often associated with neurologic injuries
Shoulder Dislocations
95 % anterior
1 % posterior
Luxatio erecta
Medial
Axillary nerve injury
Rapid reduction
Shoulder Dislocations
Conscious sedation.
Traction reduction.
Immobilization.
Recurrent.
Voluntary
Habitual.
Multiaxial instability.
Elbow Dislocation
Posterolateral.
Median nerve injury.
Ulnar nerve injury.
Rapid reduction.
Early mobilization.
Back Pain
Classification: Mechanical
(MacKenzie)
 Postural
syndrome
• normal tissues become painful by the application of
prolonged stresses (sitting, bending etc)
 Dysfunction syndrome
• soft tissues are shortened and stiff. Usually >30 year
old, poor posture, under exercised, reduced mobility
 Derangement syndrome
• Disc derangement (tears and herniation)
Causes and Classification of
Back Pain: McNab





Viscerogenic
Vasculogenic
Neurogenic
Psychogenic
Spondylogenic
Spondylogenic
Osseus:
•
•
•
•
•
•

Trauma
Infection
Neoplasms
Inflammatory
Metabolic (eg.Pagets)
Deformities
Soft tissues:
•
•
•
•
Muscles
SI joints
Disc
Facets
Non operative Treatment of
Back Pain
Do nothing
Activity modification
Medications
Exercise and physiotherapy
Braces
Manipulation
Massage therapy
Traction/inversion therapy
Vitamins/Supplements/Diets
Weight control
Every Suzanne Summers sponsored abs exerciser
Anatomy
Extension
Flexion
Three joint complex
(Kirkaldy Willis, Farfan)
Recurrent rotational strain
Synovial reaction facet joint
Disc circumferencial tears
Cartilage destruction
Osteophyte formation
Capsular laxity
Subluxation
Enlargement of articular process
radial tear
Disc herniation
Instability
Lateral n. ent
Central stenosis
Internal disc disruption
decrease disc height
osteophytes
Disc herniation
Ms J.H. 25 y.o. female presented with cauda equina syndrome
Spinal stenosis

Symptoms:





unilateral radicular pain
bilateral claudication
better with forward
flexion of trunk
better walking uphill
rare bowel/bladder
involvement
Signs:



usually no neuro signs
look for pulses
stress test
Investigations:




XR
CT
Myelo-CT
MRI
Cauda Equina Syndrome
Sciatica associated with bowel or bladder dysfunction.
Perineal numbness.
Low or Sequestrated Lumbar Disc.
Pressure on S1, S2 and/or S3 nerve roots.
Requires immediate Decompression to avoid
permanent disability.
Time for a 10 minute break!
1. Talipes Equinovarus is the proper
name for :a.
b.
c.
d.
e.
Flat feet
In-toeing
Club feet
Knock knees
Wry neck
1. Talipes Equinovarus is the proper
name for :c. Club feet
1. Talipes Equinovarus is the proper
name for :a.
b.
c.
d.
e.
Flat feet
In-toeing
Club feet
Knock knees
Wry neck
Pes Planus
Metatarsus Adductus
Genu Valgus
Torticolis
Talipes Equinovarus
congenital deformity of the foot
Equinus, Inversion, Adduction, Supination
2 per 1000 live births
50% bilateral
M >F 2:1
Serial corrective casts at birth
Surgery if resistant
EARLY TREATMENT IS ESSENTIAL
2. Trendelenburg refers to :a.
b.
c.
d.
e.
Leg length discrepancy
Gait abnormality
Knee recurvatum
Scoliosis
Hip Contracture
2. Trendelenburg refers to :-
b. Gait abnormality
3. All of these are signs of D.D.H.
except :a.
b.
c.
d.
e.
Limited Abduction
Ortolani Sign
Asymmetric Skin Folds
Galeazzi’s Sign
McMurray Sign
3. All of these are signs of D.D.H.
except :-
e. McMurray Sign
3. All of these are signs of
D.D.H. except :a.
b.
c.
d.
e.
Limited Abduction
Ortolani Sign
Asymmetric Skin Folds
Galeazzi’s Sign
McMurray Sign
Dislocated
Reducible
Dislocated
Knee height
Torn Meniscus
Developmental Dysplasia of the Hip
Acetabular dysplasia
Femoral anteversion
Adduction Contracture
50% bilateral, F > M 8:1
Test ALL newborns at birth
Conservative Rx at birth – Pavlik, D.diaper
Surgical Rx if resistant
4. The most common congenital
Spinal abnormality is :a.
b.
c.
d.
e.
Scoliosis
Spina Bifida
Torticolis
Klippel – Feil Syndrome
Multiple Hereditary Osteochondroma
4. The most common congenital
Spinal abnormality is :-
b. Spina Bifida
Spinal Bifida
defect of neural tube closure
Lumbar spine, commonly low
2 per 1000
myelodysplasia
Mild to complete paraplegia
Occulta, meningocoele, Myelomeningocoele
Bowel and bladder dysfunction
5.
Polydactyly
6.
Syndactyly
7.
Sprengel’s Deformity
Omovertebral Bone
8.
A 6 year old boy with delayed physical
development, convulsions, tetany,
weakness, blue sclera and bony deformities is
most likely suffering from :a.
b.
c.
d.
e.
Physical Abuse
Ehlers – Danlos Syndrome
Osteogenesis Imperfecta
Multiple Hereditary Exostoses
Myositis Ossificans
8.
A 6 year old boy with delayed physical
development, convulsions, tetany,
weakness, blue sclera and bony deformities is
most likely suffering from :-
c. Osteogenesis Imperfecta
9.
A 6 year old boy with delayed physical
development, a rachitic rosary, weakness and
bony deformities is most likely suffering from :a.
b.
c.
d.
e.
Physical Abuse
Rickets
Scurvy
Osteitis Deformans
Myositis Ossificans
9.
A 6 year old boy with delayed physical
development, a rachitic rosary, weakness and
bony deformities is most likely suffering from :-
b. Rickets
9.
9.
Etiology
Alkaline
Phosphatase
Calcium
Phosphate
Normal
Urea
Vitamin D
Deficiency
Rickets
Up
Down
Normal
Renal
Insufficiency
(Renal Rickets)
Up
Down
Up
Up
Renal
Tubular
Insufficiency
(HypoPhosphatemia)
Up
Down
Down
Normal
10. This is :-
a.
b.
c.
d.
e.
Osteomyelitis
Osteomalacia
Osteoporosis
Osteitis Deformans
Leprosy
10. This is :-
d. Osteitis Deformans
Osteitis Deformans
Paget’s Disease
4% of pop. Over 40 yrs.
accelerated bone turnover
often assymptomatic
monostotic > polyostotic
loss of stature
AV shunting
pathologic bone
11. A child with knee pain has a ____
problem until proven otherwise.
a.
b.
c.
d.
e.
Knee
Femoral
Tibial
Hip
Patella
11. A child with knee pain has a ____
problem until proven otherwise.
d.
Hip
Obdurator Nerve
11. All of the following are part of the
differential of hip pain in a 6 year old,
except :a.
b.
c.
d.
e.
Femoral Osteomyelitis
Septic Hip
Transient Synovitis
Legg-Perthes Osteochondritis
Slipped Capital Femoral
Epiphysis
11. All of the following are part of the
differential of hip pain in a 6 year old,
except :-
e.
Slipped Capital Femoral
Epiphysis
Ages for Hip Disease
D.D.H.
Septic Hip
Legg-Perthes
Transient Synovitis
S.C.F.E.
Birth
Birth – 11
3 – 11
3 – 11
11 - 16
12. Osteomyelitis in children is
produced by what route of infection?
a.
b.
c.
d.
e.
Direct extension from another focus
Hematogenous spread
Perforating wounds
Lymphatic spread
Septic hip
12. Osteomyelitis in children is
produced by what route of infection?
b.
Hematogenous spread
Osteomyelitis
Acute infection,metaphyseal
90% Staph.,20% mortality
100% growth abnormality
Periosteal elevation, osteolysis
Sequestrum, Involucrum
13.
13.
Paronychia
14.
14.
Felon
15. All of these are findings of a
Herniated L5-S1 disc, except :a.
b.
c.
d.
e.
Absent Achilles reflex
Lateral foot numbness
Sciatica
Low back pain
Extensor Hallucis Longus weakness
15. All of these are findings of a
Herniated L5-S1 disc, except :-
e.
Extensor Hallucis Longus weakness
15. All of these are findings of a
Herniated L5-S1 disc, except :a.
b.
c.
d.
e.
f.
Absent Achilles reflex
Lateral foot numbness
Sciatica
Low back pain
Extensor Hallucis Longus weakness
Knee jerk
S1
S1
S1
L5
L4
16. Avascular necrosis of the femoral
head is associated with all of the following
except :a.
b.
c.
d.
e.
Steroid use
Alcohol
Deep sea diving
Lipid storage disease
Diabetes
16. Avascular necrosis of the femoral
head is associated with all of the following
except :-
e.
Diabetes
17.
8 year old boy
What is the
Diagnosis?
17.
8 year old boy
Legg – Perthes
Osteochondosis
Legg-Perthe’s Disease
Osteochondrosis (avascular necrosis)
Proximal Femoral Epiphysis
Necrosis, revascularization, fragmentation, healing
3 – 11 yrs., M > F 4:1, 15% bilat.
Subluxation laterally, Coxa plana, Coxa magna
Osteoarthritis 50 yrs.
19. Diagnosis?
19. Gout
Gout
Urate crystalopathic arthritis
Crystals in periarticular tissues
Inconsistant elevated serum urate
Allopurinol and colchicine
Tophi in periarticular soft tissues
Deposits in non-articular cartilage
Juxta-articular erosions
20.
L4
L5
Spondylolytic
Spondylolisthesis
Spondylolisthesis
Lumbosacral junction defect
Spondylolysis of Pars Interarticularis
Traumatic or congenital
Acute – immobilize
Chronic - surgery
21. The Salter- Harris Classification is
used to assess the severity of :a.
b.
c.
d.
e.
Epiphyseal Fractures
Developmental Dysplasia of the Hip
Legg – Perthe’s Disease
Club Foot
Osteomyelitis
21. The Salter- Harris Classification is
used to assess the severity of :a. Epiphyseal Fractures
22. What is this deformity?
22. A Diner Fork Deformity
Probable Diagnosis?
22. Colles
Fracture
22. Colle’s Fracture
distal radial fracture
FOOSH
occurs at all ages
commonly 60 yrs. +
osteoporosis
intra-articular
CR & K-Wires
External vs Internal Fixation
23. The common complication
of this fracture is :-
23. Proximal pole Avascular Necrosis
24. This is a :-
a. Buckle Fracture
b. Greenstick Fracture
c. Stress Fracture
d. Pathologic Fracture
e. Growth Arrest line
24. This is a :-
a. Buckle Fracture
24.
This is a :a. Buckle Fracture
b. Greenstick Fracture
c. Stress Fracture
d. Pathologic Fracture
e. Growth Arrest line
24.
Greenstick
Fractures
25. Is this fracture treated by Closed or
Open Reduction?
25.
ORIF
25. Fractures of Necessity
26. What is the Diagnosis?
26. Posterolateral Dislocation of the Elbow
26. Reduction by traction.
TRACTION
27. What is the Diagnosis?
27. Anterior Dislocation of the
Shoulder
27. Reduction by traction
28.
This is a :a. Supracondylar #
b. Olecranon #
c. Dislocation
d. Forearm #
e. Radial Head #
28.
This is a :a. Supracondylar #
28. Supracondylar Fracture
29.
The complications of a Supracondylar
fracture in children include all of the
following except :a. Malunion
b. Volkmann’s Ischemic Contracture
c. Compartment Syndrome
d. Cubitus Varus
e. Peripheral Nerve Injuries
f. Pulmonary Fat Embolus
29.
The complications of a Supracondylar
fracture in children include all of the
following except :-
f. Pulmonary Fat Embolus
30. The only sign of a Compartment
Syndrome that is always present
is :a. Pain
b. Pallor
c. Pulselessness
d. Paresthesias
e. Paralysis
30. The only sign of a Compartment
Syndrome that is always present
is :a. Pain
31. Compartment pressures
indicating the need for
fasciotomy :a. 0 – 15 mms. Hg
b. 15 – 25 mms. Hg
c. > 25 mms. Hg
d. > 50 mms. Hg
e. > 75 mms. Hg
31. Compartment pressures
indicating the need for
fasciotomy :-
c. > 25 mms. Hg
32. A 20 yr. old male with a fractured
femur has findings of confusion,
tachypnea and conjunctival petechia.
The most likely diagnosis is :a. Pneumonia
b. Pulmonary Fat Emboli
c. Cerebral Contusion
d. Cardiac Contusion
e. Transient Stress Reaction
32. A 20 yr. old male with a fractured
femur has findings of confusion,
tachypnea and conjunctival petechia.
The most likely diagnosis is :b. Pulmonary Fat Emboli
35. The commonest complication
of this fracture is :-
35. A Radial Nerve Palsy
36. Does this fracture
require surgery?
36. Does this fracture
require surgery?
Yes
37. Does this fracture require surgery?
37. Does this fracture require surgery?
No
38. This patient
most likely
has a fracture
of the --------.
38. This patient
most likely
has a fracture
of the --------.
Hip
38. This patient
most likely
has a fracture
of the hip.
External Rotation
Shortening
Hip Flexion
38.
39. What’s the Diagnosis?
39. Sub-Capital Hip Fracture.
40. All of the following are
complications of this fracture except :a. Malunion
b. Avascular necrosis
c. Fat emboli
d. Non-union
e. Thrombophlebitis
40. All of the following are
complications of this fracture except :-
c. Fat emboli
40. Blood Supply of Femoral Head
40. Save Head versus Replacement
40. Subcapital Hip Fractures
Properties
1. Avascular Necrosis - 30%
2. Malunion - 30%
3. Non-union - 30%
4. Surgery required
5. Older population
6. Pathologic - Osteoporotic
41. What’s the Diagnosis?
41.
Intertrochanteric Hip Fracture
41. Intertrochanteric Fractures
Properties
1. Varus deformity
2. Well - Healing
3. Traumatic + Osteoporosis
4. Surgery required
5. Mid-range Age population
43.
Surgery
or not?
43.
Surgery
or not?
Yes
44. Surgery or not?
44. Surgery or not?
Yes
45. What is the approach to this fracture?
23 y.o. male
Basketball injury
Open fracture
Numbness dorsum
toes
45.
Reduce dislocation
Sterile dressing
Splint extremity
Re-check NV status
IV Antibiotics
Tetanus
Surgery
48.
A 45 yr. old male, who was previously in good health,
has sudden onset of transverse low back pain and right
sided sciatica to his foot, after chopping wood at the
cottage. Upon arising the following morning, he notices
numbness on the outer border of his right foot and
some weakness in the right leg. He has no bowel or
bladder problems.
The most likely diagnosis would be:a.
b.
c.
d.
e.
Lumbar Muscular Strain.
Herniated Lumbar Disc.
Herniated Lumbosacral Disc.
Cauda Equina Syndrome.
Spinal Stenosis.
48.
A 45 yr. old male, who was previously in good health,
has sudden onset of transverse low back pain and right
sided sciatica to his foot, after chopping wood at the
cottage. Upon arising the following morning, he notices
numbness on the outer border of his right foot and
some weakness in the right leg. He has no bowel or
bladder problems.
The most likely diagnosis would be:-
c.
Herniated Lumbosacral Disc.
49.
Your initial approach to this problem would
include some or all of the following:-
a.
b.
c.
d.
e.
f.
g.
h.
Bedrest.
Anti-inflammatories.
Muscle Relaxants.
Spinal X-rays.
Physiotherapy.
Orthopedic/Neurosurgical referral.
CT-Myelogram or MRI
Discectomy
49.
Your initial approach to this problem would
include some or all of the following:-
a.
?
b.
c.
d.
e.
f.
g.
h.
Bedrest.
Anti-inflammatories.
Muscle Relaxants.
Spinal X-rays.
Physiotherapy.
Orthopedic/Neurosurgical referral.
CT-Myelogram or MRI
Discectomy
50. During the work-up for this problem, the patient
complains that he has unaccountably soiled his
underwear, without knowing it. Your response to this
would be to:-
a.
b.
c.
d.
Reassure the patient that this is not serious
Order an urgent MRI
Get an urgent referral to Neuro/Orthopedics
Place the patient on immediate bedrest.
50. During the work-up for this problem, the
patient complains that he has unaccountably soiled
his underwear, without knowing it. Your response to
this would be to:-
c.
Get an urgent referral to Neuro/Orthopedics
51. A lumberjack felling a tree is unfortunately
struck on the back by the tree, knocking him to the
ground and injuring his left lower extremity. In the
ER, his left hip is in flexion, adduction and internal
rotation. The most likely diagnosis is:-
a.
b.
c.
d.
e.
Fracture of the Hip.
Fracture of the Femur.
Anterior Hip Dislocation.
Posterior Hip Dislocation.
Fracture of Pelvis.
51. A lumberjack felling a tree is unfortunately
struck on the back by the tree, knocking him to the
ground and injuring his left lower extremity. In the
ER, his left hip is in flexion, adduction and internal
rotation. The most likely diagnosis is:-
d.
Posterior Hip Dislocation.
52. Which of the following signs and
symptoms are consistent with a torn
medial meniscus of the knee:-
a.
b.
c.
d.
e.
Inability to squat
Pain on descending stairs
Locking
Recurrent effusions
All of the above.
52. Which of the following signs and
symptoms are consistent with a torn
medial meniscus of the knee:-
a.
b.
c.
d.
e.
Inability to squat
Pain on descending stairs
Locking
Recurrent effusions
All of the above.
53. A 35 yr. old male falls jogging and sustains an
undisplaced lateral malleolar fracture of the ankle. He is
treated in a Below-knee Walking cast, but returns to the
ER 24 hrs. later complaining of increased, persistent,
burning pain at the ankle.
Your response to this situation would be to:-
a.
b.
c.
d.
Re-X-ray the ankle.
Remove the cast.
Measure the compartment pressures.
Instruct the patient to elevate the
limb and prescribe an anti-inflamatory.
53.. A 35 yr. old male falls jogging and sustains an
undisplaced lateral malleolar fracture of the ankle. He is
treated in a Below-knee Walking cast, but returns to the
ER 24 hrs. later complaining of increased, persistent,
burning pain at the ankle.
Your response to this situation would be to:-
b.
Remove the cast.
54. The most common dislocations of the
shoulder are:-
a.
b.
c.
d.
Medial.
Posterior.
Luxatio Erecta.
Anterior.
54. The most common dislocations of the
shoulder are:-
d.
Anterior.
55.
Metastatic lesions to bone, of the
following tumours, usually produce lytic
defects except:a.
b.
c.
d.
e.
Thyroid.
Pancreas.
Prostate.
Kidney.
Lung.
55.
Metastatic lesions to bone, of the
following tumours, usually produce lytic
defects except:-
c.
Prostate.
Th - Tha – That’s all folks!