Exam Corner - Jan 2011 Answers
Exam Corner - Jan 2011 Answers
Exam Corner - Jan 2011 Answers
The FRCS (Tr & Orth) 1. Which of the following structures is at risk of Division of the sympathetic nerve supply to the
examination has injury while carrying out a posterior approach to physis can result in unrestricted vasodilatation
the hip joint? and hyperaemia leading to an increase in physeal
three components:
Answer: c. The sciatic nerve. growth. Other conditions that contribute to
MCQs, Vivas and The sciatic nerve is at risk when performing a localised physeal hyperaemia and potentially
Clinical Examination. posterior approach to the hip joint. The incidence accelerated physeal activity include adjacent
The Vivas are further of damage to the nerve ranges from 0.3% to 3.7% infection, neoplasia, arteriovenous malformations
and the risk is potentially increased in cases with a and dyspituitarism.
divided into four past history of developmental dysplasia of the hip,
sections comprising post-traumatic arthritis and limb lengthening. 4. Which of the following is NOT a feature of an
ideal routine screening test?
Basic Science, Adult
2. Which one of the following has the highest Answer: c. Low incidence of disease.
Pathology, Hands osteogenic potential? The disease being screened must have an
and Childrens Answer: a. Cancellous autograft. incidence high enough to allow screening.
Orthopaedics and Osteogenic cells include primitive mesenchymal
cells, osteoblasts and osteoclasts. Cancellous 5. A laceration of the radial nerve high in the axilla
Trauma. The Clinical interferes with all of the following functions,
autograft has excellent osteogenic potential and
Examination section revascularises and incorporates rapidly. except:
is divided into Upper Answer: a. Pronation of the forearm.
3. Which of the following can lead to an increase in Pronation of the forearm results from contraction
and Lower Limb cases. physeal growth? of the pronator teres and the pronator quadratus,
The aim of this section Answer: b. Division of sympathetic nerve supply. which are innervated by the median nerve.
in the Journal is to
focus specifically on
the trainees preparing
for the exam and
to cater to all the
Vivas Answer: Further information required would be
sections of the exam history of steroid use, alcohol abuse and whether
every month. The he has had any radiotherapy. Also it is essential
Adult Pathology
to rule out sickle-cell disease, storage disorders,
vision is to complete A 38-year-old man presents to you with a 6-week Gauchers disease and decompression sickness.
the cycle of all history of pain in his left groin. There is no history of
relevant exam topics trauma. This is his radiograph (Fig. 1).
3. What further investigations would you request if
(as per the syllabus) in any?
four years. Answer: MRI scan
Hands
A 64-year-old man presents with a history of a deformity of his
little finger, which has been increasing over the last 8 months
(Fig. 4).
Fig. 2
Fig. 4
Stress
Answer: Polyethylene, commonly used as a bearing surface
Stess relaxation
for joint replacements.
Time
Childrens Orthopaedics
1. What is the likely diagnosis? (Fig. 7)
Answer: Congenital talipes equinovarus (club foot).
Fig. 6
3. How is it manufactured?
Answer: Addition polymerisation occurs when a free radical Fig. 7
is added to a monomer that contains a double carbon bond.
The free radical breaks the carbon bond and occupies one of 2. What are the deformities in this condition?
the bonding sites. This results in one carbon having a free Answer: Forefoot adductus and supination; hindfoot
bonding site, which then proceeds to react with another free equinus and varus. Talar neck deformity (medial and plantar
radical, and the reaction progresses. deviation) with medial rotation of the calcaneum and medial
displacement of navicular and cuboid.
4. How can one alter the properties of this material to improve The deformities in this condition can be remembered by the
its wear characteristics? mnemonic CAVE6:
Answer: The wear of polyethylene can be altered by Cavus (midfoot)
increasing the cross-linking of the polyethylene molecules Adductus (forefoot)
by irradiating the material. Varus (hindfoot)
Equinus (hindfoot)
5. What do you understand by the terms Creep and Stress
Relaxation? 3. How are they usually corrected and in what order?
Answer: Creep is a time-dependant deformation in response Answer: The disorder is normally corrected by the Ponseti
to a constant load. Stress relaxation is a time-dependant method of cast manipulation using the head of the talus as a
decrease in load required to maintain a material at a fulcrum. Cavus is corrected first by dorsiflexing the first ray.
constant strain. With the cavus corrected the forefoot is abducted and the
heel goes into valgus by the coupling on the subtalar joint.
6. Could you explain these terms graphically? Finally the equinus is corrected. Serial casts are changed
Answer: These terms would be graphically explained as5: weekly. Residual equinus requires tendo Achillis release in
the majority of patients.
Plastic strain
Time t
Fig. 8a Fig. 8b
5. What is this deformity? (Figs 9a and 9b)
Answer: Rocker-bottom foot because of over-manipulation
of the club foot. Os calcis and talus are parallel unlike
a congenital vertical talus wherein they are convergent.
Fig. 10
References
1. Ficat R. Idiopathic bone necrosis of the femoral head; early diagnosis and
treatment. J Bone Joint Surg [Br] 1985;67-B:3-9.
Fig. 9a Fig. 9b 2. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one
thousand and twenty-five open fractures of long bones: retrospective and
prospective analyses. J Bone Joint Surg [Am] 1976;58-A:453-8.
3. Sorger JI, Kirk PG, Ruhnke CJ, et al. Once daily, high dose versus divided, low
Answer: Overcorrected club foot with a dorsal bunion. Hind dose gentamicin for open fractures. Clin Orthop 1999;366:197-204.
foot is in calcaneus because of the slack tendo Achillis and 4. Hayton, MJ, Gray, ICM. Dupuytrens contracture: a review. Curr Orthop
the great toe flexes to compensate along with the unopposed 2003;17:1-7
action of the tendo Achillis. 5. Ramachandran M. Basic orthopaedic sciences: the stanmore guide. London:
Hodder Arnold, 2007:149-50,161
7. How would you manage this condition? 6. Miller MD. Review of orthopaedics. Fifth ed. Philadelphia: Saunders Elsevier,
Answer: With a lapidus procedure. 2008:236-7