image based Q. 96 - Animal instinct 2

Q.  All the following animals have their names related to orthopaedic surgery  instruments except?

a. Lion
b. Cat
c. Duckbill
d. Deer

Answer -
d

The Lion toothed forceps also called as  Lion jaw bone holding forceps or Ferguson bone holding forceps, is used in holding bones with minimal damages ( akin to a lioness holding her cub by mouth in a way tooth cause no harm as she carries the cub along).


Cat's paw is little retractor with multiple prongs used widely to retract at smaller incision surgeries.

Duckbill rongeur and duckbill cement grasping forceps are used in orthopaedics.

image based Q. 95 - Music to ears

Q.  All below mentioned bonafide entities are associated with musical instruments in their names/ features except ?


a. Piano
b. Accordion
c. Trumpet
d. Flute
e. Guitar

Answer -
e

Piano key sign is described for assessment of distal radioulnar joint(DRUJ) injury. The distal ulna is unstable and thus can be palpated with pressure as up and down going structure relative to distal radius resembling piano keys playing.

Accordion manoeuvre is done in nonunion maagemelt with the help of ring fixators/Illizarov technique when alternate compression and distraction in a specific way is used to generate bone and help union ( the process resembles accordion that is played by manual opening and closing of its one end.

Trumpet shaped bone is seen in adjacent sessile osteochondroma. It is also seen in various other bone disorders.

Flutes are features of drill bit ends and that of self tapping screws. Presence of flutes helps in bone pentration during insertion into the bone.

image based Q. 94 - Name game

Q.   Olecranisation is procedure performed at which bone/ region?

a. Elbow
b. Knee
c. Ankle
d. Hip
e. Shoulder

Answer -
b

Olecranisation of patella is procedure to stabilise tibia and femur in good alignment and prevent sagging following PCL reconstruction surgery.

This concept was given by Muller and a Steinmann pin is used passing patella into proximal tibia( graphic representation below).

image based Q. 93 - A seat for conscience

Q.   Which aspect of surgical process has the concept of 'three legged stool' been advocated for?

a. Preoperative cleaning of part
b. Preoperative antibiotic strategy
c. Preoperative anaesthetic protocol
d. Preoperative consent process

Answer -
d

The concept of ' three legged stool' has been given (as this stool has good stability) for better consent process.

A consent model suggested by BASS ( British Association of Spinal Surgeons) consists of three key aspects
1. Information booklets - patient friendly in understanding it.
2. Patient - centred dialogue - detailing risks of procedures ( documented and recorded).
3. Consent regarding specific procedure and surgeon guided forms. Also consent for surgical outcone data for national registries.

image based Q. 92 - Milky way

Q.  Which of these is not a described entity in orthopaedics?

a. Milking
b. Milk test
c. Milkman syndrome
d. Milk technique

Answer -
d

Milking is described as a process of disengaging proximal end of fracture of supracondylar humerus when it  pierces brachial is muscle anteriorly and thus is not easily gets reduced.

The slow milking manoeuvre helps the buttonholed proximal end get out and helps reduce fracture before fixation.

We also do 'milking' of synovial fluid on either side of knee when examining for knee effusion in ' bulge test'.

Milkman syndrome is multiple pseudo fractures following abnormal bone quality due to various reasons. The pseudo fractures are also called Looser zones or Umbauzonen.

Milk test ( described by Field) is described for assessing chronic medial elbow instability. The patient tries to grasp the opposite thumb by ipsilateral hand under opposite elbow ( pic below) leading to provocative pain over  medial aspect of elbow.

image based Q. 91 - Animal instinct

Q.   Which one of these animal names is not associated with surgical procedures or methods ?


a. Dog
b. Fish
c. Woodpecker
d. Cobra

Answer -
d

'Dog ear' is known complication of redundant skin when closing the amputation stump. The extra skin forms angular folds at both or single end of the surgical incision wound during closure. Special techniques can  
be used to manage these features.

'Fish scaling' is important part of bone nonunion surgery. The multiple osteoperiosteal chiselling is done to raise small flaps over bone around nonunion site for bone grafts to incorporate better. Also referred as ' petalling'.

'Woodpecker drilling technique' is used in proximal humerus fractures when screws in head region are to be introduced. Drill is advanced slowly and then withdrawn and again forwarded to ensure subchondral bone is reached for better and strong screw placement. This technique also helps avoid joint penetration of drill or screw.

'Cobra plate' is a plate with shape resembling cobrahead. This is used in hip joint fusion and other surgeries. This is an implant and no method or surgical feature thus odd one out here

image based Q. 90 - Core values

Q.  The core decompression consists of multiple drilling in the affected bone to relieve edema and pain in cases of osteonecrosis of that bone. Which one of the following bone requires core decompression of the bone other than the affected bone ?

a. Talus
b. Scaphoid
c. Lunate
d. Femoral condyles

Answer -
c

One of the described, though not widely practiced surgery for osteonecrosis of the lunate bone ( i.e. Keinbock disease) is core decompression of distal rdius. This process increased blood flow to distal area and thus might improve symptoms.

image based Q. 89 - Growing bowing !

Q.  The child presenting with below deformity of leg was provisionally diagnosed as non traumatic bowing of tibia. What important skin lesion can help rule out a particular association of the disorder?

a. Spider naevus
b. Hemangiomas
c. Melanotic patch
d. Cafe au lait spots

Answer -
d

Congenital pseudoarthrosis of tibia (CPT) is an important differential in this case.
The bowing typically is anterolateral and one common association is neurofibromatosis (up to 50%).
Neurofibromatosis has major and minor criteria for diagnosis based on associated clinical features. One important clinical feature is presence of large cafe au lait spots (CALS).

CALS present here have smooth borders thus often referred to ' coast of California' ( in contrast to CALS with irregular borders in Mc Cune Albright syndrome referred as ' coast of Maine).


P.S. - below image shows multiple CALS in the back of same patient and one of them is very large.