image based Q.33- Elbow injury in a Child

Q. Which of these structure is commonly involved in following elbow injury in a child ?



1. Ulnar nerve
2. Anterior interosseous nerve
3. Radial nerve
4. Median nerve

Answer - 1.

 The image shows supracondylar fracture of humerus , Flexion type.

The ulnar nerve is at risk in flexion type fractures .




The commoner fracture pattern is Extension type ( in approx. 98% cases)

The anterior interosseous nerve  (a br. of median nerve ) is commonly at risk with extension type fractures.


The ulnar nerve is also common at risk in cases managed by K wire fixation.

image based Q. 35- Elbow trauma in children

Q. What is the ideal time to assess radiograph to rule out displacement of minimally displaced below fracture managed conservatively?




1. 7 days
2. 10 days
3. 21 days
4. 15 days

Answer . 1

The radiograph depicts a minimal displaced Lateral condyle fracture of humerus
Most of the fractures displace in first week so check radiograph must be done weekly in first few weeks.

image based Q.34- Injured Thigh of a child

Q. Which among these is a major complication of managing the below fracture in a child with conventional femoral interlocking nails as in adults?


1. Nerve injury
2. Abductor muscle weakness
3. Growth arrest
4. Avascular necrosis of femur head

Answer -



The avascular necrosis (AVN)  of femoral head is grave complication of nailing through pyriform fossa as is usually done in adults. This may be a consequence of  arterial injury at nail insertion site.

Medial femoral circumflex artery (MFCA) is chief supply to head of femur.

Elastic stable intramedullary nails (ESIN) or Titanium elastic nail system (TENS) are better implants and widely used as they avoid these complications..

image based Q. 32- Hip injury

Q. Which among these is not a technique for reduction of the below injury?


1. Allis
2. Whistler
3. Stimson
4. Snowbird

Answer -

The injury in the radiograph is posterior dislocation of hip.
 
The first three options are described methods of reduction for hip dislocation.

The Snowbird is a one of the many techniques for reduction of shoulder joint dislocation.



Other techniques for shoulder reduction-

Kocher
Milch
Spaso
Scapular manipulation
External rotation
modified Hippocratic


Note - The Stimson technique is one each for shoulder and hip dislocation.

image based Q. 31 - Multiple bony swelling.

Q. What is the likelyhood that is closest for developement of malignant changes in below patient ?



1. 30-40%
2. upto 1%
3. 3-4%
4. None

Answer -


The picture depicts multiple knobby bony protuberances in femur and tibia metaphyses and thus suggestive of a case with HME (Hereditary Multiple Exostoses).

The chances of malignant transformation ( into Chondrosarcoma) are approximately  as follows -


Solitaru osteochondroma - upto 1%

HME - 2-4%

Multiple Enchondroma (Ollier disease) or Maffuci Syndrome (i.e enchondroma with various hemangioma) have higher chances - 10-40%

image based Q.30 - Structure around knee

Q. Which of tese structure is vulnerable to injury approximately 4-5 cm distal to lateral tibial plateau on posterior aspect? (The red portion indicated in diagram below)



1. Anterior tibial artery
2. Posterior tibial artery
3. popliteal artery
4. common peroneal nerve

Answer -


The anterior tibial artery crosses the interosseus membrane at roughly  46mm (range 27 to 62 mm) disstal to lateral tibial plateau.

politeal artery divides into anterior and posterior tibial branches at popliteal foramen level.

Common peroneal nerve slopes close to fibula and surrounds neck of fibula.

image based Q.29 - Inside Articular Cartilage

Q. - An artistic presentation of microstructure of human articular cartilage is depicted below along with a zoomed version of a portion of it. What the orange line in this picture represents?




1. Proteoglycan
2. Collagen
3. Branched protein
4. Hyaluronic acid

Answer -  4


Proteoglycal aggrecan molecules with negative charge are arranged in the 'backbone' of hyaluronic acid. They interact with positive charge of water molecule that constitute a major part of cartilage.