image based Q. 68 - Cast split

Q.  How much pressure should we expect to drop if plaster of Paris cast is cut in below case?

a. 20%
b. 50%
c. 10%
d. 30%
e. 60%

Answer -
d

 The picture depicts unilateral cutting of cast (i.e. univalving).

Cast splitting relieves pressure in the setting of suspected compartment syndrome in the given degrees.

Univalving - 30% pressure drop and bivalving leads to 60% pressure drop.

image based Q. 67- Castaway

Q.  A baby undergoing corrective casting for the correction of clubfoot has been applied 13 plasters but correction doesn't seem to improve lately and there is swelling of foot on each cast removal. The parents also complain of slipping of the cast noticeable for last few occasions. Which among these would be best option to treat such case?


a. Modification of casting technique
b. Apply loose plaster next time
c. Apply more pressure on casting for speedy correction
d. Do not apply cast
e. Prepare the child for surgical correction

Answer -
d

Slippage of cast and static correction with swollen and often painful foot suggests 'atypical clubfoot'.

The loose and improperly moulded cast leads to slipping of feet inside and that impinges over toes leading to swelling and pain. Thus loose plaster or extra pressure won't help here (option b and c).

Modification of casting is not acceptable as casting follows standard prescribed methodology.

Surgical option is not required for correction in most cases and is limited for certain indications only.

Leaving foot free without cast for 6-8 weeks or till swelling and edema is reduced ( i.e. cast holiday) is best option.

 Casting is resumed after abovementioned status is achieved.

image based Q. 66 - Identity crisis

Q.  A case of psychiatric disorder named BIID ( body identity integrity disorder) is presented to orthopaedic clinic for opinion regarding which feature?


a. Charcot's joint
b. Self mutilation
c. Factitious illness
d. Fake joint pains
e. Amputation
f. Excessive fitness consciousness

Answer -
e

The patient with BIID consults orthopaedicians for amputation of his/her normal limb. The disorder consists of patient's perception of his/her normal limb (certain part or whole) as abnormal, alien or worst belonging to someone else rather than his/her own.
The patient can exactly delineate the level from which that body part appears alien to him/her. The patient bears so much psychological burden that he/she wishes to happily remove it and are often 'cured' after the consented amputation. Thus amputation has a therapeutic effect in these individuals.

image based Q. 65- Preventing HO

Which of these therapy is not  helpful in reducing chances of heterotrpic ossification after major trauma in vulnerable places?


a. Naproxen
b. Etodolac
c. Radiation
d. Indomethacin

Answer -
a

Indomethacin has been linked to decreased chances of HO after major trauma and

recent research has shown etodolac also work similarly in sports injuries.

Radiation in single dose also has been associated with same objectives.

image based Q.64 - Matter of heart

One of the patient of orthopaedics was cancelled for surgery due to a transient condition mimicking acute myocardial infarction. The name the  condition takes origin from a Japanese pot used to catch which one of the seafood?


a. Oyster
b. King Crab
c. Octopus
d. Molluscs
e. Turtles

Answer -
c

A temporary acute stressful condition mimicking acute MI with ST elevation is known as 'Takotsubo Cardiomyopathy'.

 The Japanese pot 'tako-tsubo' is used by fishermen to trap octopus.

The condition is also called 'broken heart syndrome', 'Stress cardiomyopathy', Transient atypical ballooning syndrome' etc.

image based Q. 63. Going Places

Q. Given places have interesting history of their connection with orthopaedic milestones/events. Which two of these are non-operative with huge economical benefit to society at large?


a. Florida
b. Iowa
c. Uganda
d. South Carolina
e. Kurgan

Answer -
b,c.

Moore developed his posterior approach to hip joint for arhroplasty in South Carolina, henceforth the posterior approach to hip joint is also referred to 'southern approach' at times.

Iowa has been working place of renowned Dr Ponseti, who worked entire life in perfecting corrective casting techniques for treating clubfeet. His approach now is most preferred conservative method for clubfoot management.

Florida has witnessed many stalwarts like Dr Dror Paley, who has been instrumental in disseminating art and science of deformity corrections internationally.

Kurgan, a place in Russia (earlier USSR) was made famous by one Dr Gavriil A. Ilizarov, who invented his method of distraction osteogenesis which has since been benefited society by its versatility and effectiveness in myriad musculoskeletal disorders.

Rural Uganda is place where high cost of braces for clubfeet inspired Michael Steenbeek to make light and inexpensive brace out of locally available material for clubfeet now widely used as Steenbeek foot abduction brace (SFAB) that cost a fraction ( approx USD 7) as compared to other braces (in the range USD 400 and beyond).

image based Q.62- Guess who part 1

Q. Identify the notable personality in Orthopaedics credited for his path breaking work ?



a. Martin Kirschner
b. John Charnley
c. Gerhardt Kuntscher
d. Gavriil Ilizarov
e. Abraham Colles

Answer -
d.

Gavriil A. Ilizarov was a russian doctor who discovered the principal of distraction osteogenesis with ring fixators now popularly known as Ilizarov fixators. The technique has wide and versatile implications for various disorders. He made a small city Kurgan a world renowned centre and is often referred with epithets like  'magician from Kurgan' among others.

Martin Kurschner is known for smooth metallic wires with pointed ends 'K- wire' or Kirschner wire. These are one of the most widely used implants in orthopaedics.

John Charnley is hailed as pioneer of joint replacement arthroplasty.

Gerhardt Kuntscher, a German doctor has been instrumental in paving path for intramedullary nailing initiated with his version of nail known as K- nail or Kuntscher's cloverleaf intramedullary nail.

Abraham Colles is known for an eponymous fracture that results from fall in elderly and involves distal radius with specific deformity.

image based Q.61 - Bracing up

Q. Which of these places is not associated with orthosis/brace to its name?


a. Malibu
b. Miami
c. Philadelphia
d. Nebraska
e. Yale

Answer -
d

Most of the mentioned places have cervical orthosis in their name;
Malibu brace,
Miami brace,
Philadelphia collar,
Yale brace etc.
 
 except Nebraska.


 May other notable braces are -

-  Boston brace thoracolumbar disorder,
  -Milwaukee brace for scoliosis ,
 -UCLA (University of California Los Angeles) foot braces etc.

image based Q.60 - Imperfect match

Q.- Which one of these is mismatched? (These are disorders matched with relevant instruments used to measure/diagnose/treat them).


a. Dynamometer - Grip strength
b. RIA (reamer irrigator aspirator) - Fracture nonunion
c. KT 1000 - Ligament testing
d. MARS - Infection

Answer -
d

MARS or metal artifact reduction sequence is specialised MRI scan used to perform in condition when metallic implants is in situ.

KT 1000 is used in diagnosing ligament injuries like ACL, PCL etc.

RIA is used to extract bone marrow from medullary cavity of long bones through reaming and is helpful in nonunion.

Dynamometer is used for measuring hand grip strength eg. Jamar dynamometer