2. 1. coles fracture, barton fracture , and smith fracture
Colles fracture: Extraarticular distal radius fracture with displacement of the distal
fragment to the dorsal aspect of the wrist
Smith fracture: Extraarticular distal radius fracture with displacement of the distal
fragment to the volar aspect of the wrist
Barton fracture: fracture of the distal radius which extends through the dorsal
aspect of the articular surface
3. 2. Calcification of carpal bone
Capitate : 1 year
Hamate : 2 years
Triquetrum : 3 years
Lunate: 4 years
Scaphoid : 5 years
Trapezium: 5-6 years
Trapezoid : 6-7 years
Pisiform : 9-10 years
5. 4. What is hill sach and bankart lesion
Hill-Sachs lesion is a fracture in the long bone in the upper arm (humerus) that
connects to the body at the shoulder.
A Bankart lesion is a lesion of the anterior part of the glenoid labrum of the
shoulder usually caused by anterior shoulder dislocation
6. 5. Difference between erb and klumpkee (penyebab lokasi
lesi dan deformitasnya apa aja)
erb's palsy:
results from lateral flexion of the head towards the contralateral shoulder with depression of the ipsilateral shoulder producing traction on plexus
upper lesion (C5,6)
adducted, internally rotated shoulder; pronated forearm, extended elbow (“waiter’s tip”)
klumpke's palsy:
usually arm presentation with subsequent traction/abduction from trunk
lower lesion (C8,T1)
claw hand”
- wrist in extreme extension because of the unopposed wrist extensors
- hyperextension of MCP due to loss of hand intrinsics
- flexion of IP joints due to loss of hand intrinsics
8. 1. Stage of avascular necrosis of the hip joint
Steinberg Classification
Stage 0: Normal Xray, Normal MRI and bone scan
Stage I: Normal Xray, Abnormal MRI and/or bone scan
Stage II: Cystic or sclerosis changes in Xray, Abnormal MRI and/or bone scan
Stage III: Crescent sign (subchondral collapse) in xray, Abnormal MRI and/or bone scan
Stage IV: Flattening of femoral head in xray, Abnormal MRI and/or bone scan
Stage V:Narrowing of joint, Abnormal MRI and/or bone scan
Stage VI: Advanced degenerative changes, Abnormal MRI and/or bone scan
9. 2. Diagnosis of hip dislocation anam pf sampe pp
history taking:
acute pain, inability to bear weight, deformity
physical exam:
posterior dislocation: hip and leg in slight flexion, adduction, and internal rotation
anterior dislocation: hip and leg in extension, abduction, and external rotation
imaging:
radiographs (AP, inlet/outlet view)
- loss of congruence of femoral head with acetabulum
- disruption of shenton's line
anterior dislocation:
- femoral head appears larger than contralateral femoral head
- femoral head is medial or inferior to acetabulum
posterior dislocation:
- femoral head appears smaller than contralateral femoral head
- femoral head superimposes roof of acetabulum
- decreased visualization of lesser trochanter due to internal rotation of femur
CT Scan: helps to determine direction of dislocation, loose bodies, and associated fractures
10. 3. Classifcation of pelvic fracture tile and burgess
Tile Classification
A: Stable
A1: fracture not involving the ring (avulsion or iliac wing fracture)
A2: stable or minimally displaced fracture of the ring
A3: transverse sacral fracture (Denis zone III sacral fracture)
B : Rotationally unstable, vertically stable
B1: open book injury (external rotation)
B2: lateral compression injury (internal rotation)
B2-1: with anterior ring rotation/displacement through ipsilateral
rami
B2-2-with anterior ring rotation/displacement through contralateral
rami (bucket-handle injury)
B3: bilateral
C: Rotationally and vertically unstable
C1 : unilateral
C1-1: iliac fracture
C1-2: sacroiliac fracture-dislocation
C1-3: sacral fracture
C2: bilateral with one side type B and one side type C
C3: bilateral with both sides type C
Young-Burgess Classification
Anterior Posterior Compression (APC)
APC I : Symphysis widening < 2.5 cm
APC II :
Symphysis widening > 2.5 cm.
Anterior SI joint diastasis.
Posterior SI ligaments are intact.
Disruption of sacrospinous and sacrotuberous ligaments
APC III :
Disruption of anterior and posterior SI ligaments (SI dislocation).
Disruption of sacrospinous and sacrotuberous ligaments.
APCIII associated with vascular injury
Lateral Compression (LC)
LC I : Oblique or transverse ramus fracture and ipsilateral anterior sacral ala
compression fracture
LC II : Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent
fracture).
LC III :
Ipsilateral lateral compression and contralateral APC (windswept pelvis).
Common mechanism is rollover vehicle accident or pedestrian vs auto.
Vertical Shear (VS) :
Posterior and superior directed force.
Associated with the highest risk of hypovolemic shock (63%); mortality rate up
to 25%
11. 4. Common cause of shock in pelvic injury
Pelvic fractures associated with hemorrhage commonly involve disruption of the
posterior osseous ligamentous complex (i.e., sacroiliac, sacrospinous,
sacrotuberous, and fibromuscular pelvic floor), evidenced by a sacral fracture, a
sacroiliac fracture, and/or dislocation of the sacroiliac joint.
Most common sources of hemorrhage is venous injury (80%) derived from pelvic ring injury causing the shearing injury of
posterior thin walled venous plexus which leads to retroperitoneal hematoma (can hold up to 4L of blood).
Bleeding can also caused by bleeding from cancellous bone, arterial injury (10-20%) derived from injury of superior gluteal
(most common) due to posterior ring injury or Anterior Posterior Compression pattern, internal pudendal from anterior ring
injury, Lateral Compression pattern, and obturator artery from Lateral compression pattern.
12. 5. Knee stabilizer mention
Medial:
Static—superficial and deep medial collateral ligaments (MCL), posterior oblique
ligament (POL).
Dynamic—semimembranosus, vastus medialis, medial gastrocnemius, PES tendons
Lateral:
Static—lateral collateral ligament (LCL), iliotibial band (ITB), arcuate ligament.
Dynamic—popliteus, biceps femoris, lateral gastrocnemius
13. 6. Patella alta vs patella baja explain
Patella Alta the patella is abnormally elevated relative to the femoral trochlea and engagement occurs later in flexion with
the contact area between the patella and trochlea diminished. Insall Salvati ratio > 1.2
Patella Baja refers to an abnormal inferior location of the patella relative to the femoral trochlea with the patella remaining
engaged within the trochlear groove in full knee extension Insall Salvati ratio <0.8
14. 7. Tibial plateau fracture classification
Schatzker classification
Type I -> Lateral split fracture -> young patient
with strong subchondral bone
Type II -> Lateral Split-depressed fracture -> Most
Common
Type III -> Lateral Pure depression fracture ->
uncommon, elderly osteoporotic
Type IV -> Medial plateau fracture -> associated
fracture dislocation high rate of nerve and
ligamentous injuries
Type V -> Bicondylar Fracture -> tibial spines
remain continuous with shaft
Type VI -> Metaphyseal-diaphyseal disassociation
-> significant soft-tissue injury
Hohl and Moore Classification of
proximal tibia fracture-dislocations
Type I -> Coronal split fracture
Type II -> Entire condylar fracture
Type III -> Rim avulsion fracture of
lateral plateau
Type IV -> Rim compression fracture
Type V -> Four-part fracture
15. 8. winsquit classification
1. Minor chip (comminution <25%)
2. Butterfly fragment (comminution 25-50%)
3. Large butterfly fragment (comminution >50%)
4. Segmental defect
16. 9.mention test for acl,meniscus , pcl ,mcl and acl rupture
ACL
- Lachman test
- Anterior drawer test
- Pivot shift test
PCL
- Posterior Drawer test
- Posterior sag sign
- Quadriceps active test
- Reverse pivot shift test
Meniscus
- Joint line tenderness
- Mcmurray test
- Apley's compression test
Collateral Ligaments
- Valgus stress
- Varus stress
17. 10. Ankle fracture classification lauge hansen and weber
fracture
Supination - Adduction (SAD)
1. Talofibular sprain or distal fibular avulsion
2. Vertical medial malleolus and impaction of anteromedial distal tibia
Supination - External Rotation (SER)
1. Anterior tibiofibular ligament sprain
2. Lateral short oblique fibula fracture (anteroinferior to posterosuperior)
3. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
4. Medial malleolus transverse fracture or disruption of deltoid ligament
Pronation - Abduction (PAB)
1. Medial malleolus transverse fracture or disruption of deltoid ligament
2. Anterior tibiofibular ligament sprain
3. Transverse comminuted fracture of the fibula above the level of the
syndesmosis
Pronation - External Rotation (PER)
1. Medial malleolus transverse fracture or disruption of deltoid ligament
2. Anterior tibiofibular ligament disruption
3. Lateral short oblique or spiral fracture of fibula (anterosuperior to
posteroinferior) above the level of the joint
4. Posterior tibiofibular ligament rupture or avulsion of posterior malleolus
Danis-Weber classification for ankle fracture :
A : infrasyndesmotic (generally not associated with ankle
instrability)
B : transsyndesmotic
18. 11. Ottawa ankle rules apa aja for ankle and foot injury
Ankle x-ray series is only required if there is any pain in the malleolar zone and any of these findings :
1) Bone tenderness at posterior edge or tip of lateral malleolus, or
2) Bone tenderness at posterior edge or tip of medial malleolus, or
3) inability to bear weight both immediately and in the ED
Foot x-ray series is only required if there is any pain in the midfoot zone and any of these findings :
1) Bone tenderness at base of 5th metatarsal, or
2) Bone tenderness at navicular, or
3) inability to bear weight both immediately and in the ED
19. 12. Compartment syndrome most commonly happen in
which compartment
The anterior compartment of the leg is the most common site for Acute Compartment Syndrome
(https://www.uptodate.com/contents/acute-compartment-syndrome-of-the-extremities#H1)
Volar compartment of forearm (https://www.orthobullets.com/trauma/1064/hand-and-forearm-compartment-syndrome)
deep posterior and anterior compartment of leg (http://upload.orthobullets.com/journalclub/free_pdf/10795056.pdf)
20. 13. What is jones fracture
â—Ź Fracture of base 5th metatarsal -> among the most common fractures of the
foot and are predisposed to poor healing due to the limited blood supply to
the specific areas of the 5th metatarsal base.
â—Ź Diagnosis is made with plain radiographs of the foot.
â—Ź Treatment can include protected weight bearing, immobilization or surgery
depending on location of fracture, degree of displacement, and athletic level
of patient.
21. 14. What is Q angle, anatomical axis , mechanical axis?
â—Ź Q angle -> line drawn from
the anterior superior iliac
spine -> middle of patella ->
tibial tuberosity,
â—‹ Normal Q angle in extension
â– Males 13 degrees
â– Females 18 Degrees
â—‹ Normal Q angle in Flexion
â– 8 Degrees
â—Ź Mechanical Axis -> Angle
formed by a line drawn
from the center of the
femoral head to the
medial tibial spine and a
line drawn from the
medial tibial spine and the
center of the ankle joint;
â—Ź Anatomical Axis ->
lines that intersect
the tibia and the
femur intersect at
knee, this angle
averages 6 deg
22. 15. 9 joint line in pelvic
1. Iliopectineal line
2. Ilioischial ine
3. Teardrop
4. Acetabular roof
5. Anterior acetabulum wall
6. Posterior acetabulum wall
7. Shenton line
8. Hilgenreiner line
9. Perkin’s line
23. 16. Apa itu acetabular index , perkins line, hilgenreiner ,
shenton line berapa normalnya / kapan dikatan abnormal
acetabular index (AI) : angle formed by Hilgenreiner's
line and a line from a point on the lateral triradiate
cartilage to a point on lateral margin of acetabulum
- should be < 25° in patients older than 6 months
Perkin's line: line perpendicular to Hilgenreiner's line
through a point at the lateral margin of the acetabulum
- femoral head ossification should be medial to this line
Hilgenreiner's line: horizontal line through the right and
left triradiate cartilage
- femoral head ossification should be inferior to this line
Shenton's line: arc along the inferior border of the
femoral neck and the superior margin of the obturator
foramen
- arc line should be continuous
25. 1. Definition DDH ,CTEV and therapy for each disease
* Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in
dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity
and mechanical instability. Diagnosis can be confirmed with ultrasonography in the first 4
months and then with radiographs after femoral head ossification occurs (~ 4-6 months).
Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on
the age of the patient, underlying etiology, and the severity of dysplasia.
* Clubfoot, also known as congenital talipes equinovarus, is a common idiopathic
deformity of the foot that presents in neonates. Diagnosis is made clinically with a
resting equinovarus deformity of the foot. Treatment is usually ponseti method casting.
Supplemental surgical procedures such as tendoachilles lengthening and tibialis anterior
transfer may be required during the course of treatment to correct residual deformity.
26. 2. Indication for dexa in osteoporosis case
- Woman age 65 years or older
- Women ages 60 or older who have a higher chance of getting a fracture
- Men age 70 years or older
- Have been taking medicines called oral glucocorticoids for 3 months or more
glucocorticoids are used to treat inflammation, but can also cause weakened
bones
- Have a health condition, such as arthritis, that can lead to low bone density
- Women during the menopausal transition and men younger than 70 with risk
factors for low bone mass including low body weight and prior fracture
- Adults with a disease or condition associated with low bone mass or bone
loss
27. 3. What is paget disease
Paget's disease of bone is a chronic disease of the skeleton. In healthy bone, a
process called remodeling removes old pieces of bone and replaces them with
new, fresh bone. Paget’s disease causes this process to shift out of balance,
resulting in new bone that is abnormally shaped, weak, and brittle. Paget’s
disease most often affects older people, occurring in approximately 2 to 3% of the
population over the age of 55.
28. 4. What is stoss therapy
Stoss therapy is the oral or intramuscular administration of high-dose vitamin D in the short term. In this method, the total dose of vitamin D
administered is 300,000 IU (7500 µg) to 500,000 IU (12,500 µg), as a single dose or two to four divided doses, given at intervals of days to several
weeks
30. 1. What is codmann triangle
Codman triangle is a radiologic sign seen most commonly on musculoskeletal plain films. It is the name given to a periosteal reaction
that occurs when bone lesions grow so aggressively that they lift the periosteum off the bone and do not allow the periosteum to lay
down new bone.
31. 2. Explain about enneking classification
two systems - one for malignant lesions and one for benign lesions
- benign lesions are defined using Arabic numbers (1,2,3)
1 = latent lesion
2 = active lesion
3 = aggressive lesion
- malignant lesions are defined using Roman numerals (e.g. I, II, III)
- Stage IA: low grade, T1-intracompartmental, M0
- Stage IB: low grade, T2-extracompartmental, M0
- Stage IIA: High grade, T-1 intracompartmental, M0
- Stage IIB: High grade, T-2, M0
- Stage III: Metastatic, T1 or T2, intra or extracopartmental, M1 (regional or distant)
32. 3. What is MSTS score
The Musculoskeletal Tumor Study (MSTS) is a staging system for primary tumours of bone that seperates staging systems for benign
and malignant mesenchymal tumors.
33. 4. Mention all the tumor most commonly affected each part
of bone meta dia and epi
Diaphysis :
- Round Cell Lesions : Ewing Sarcoma, Reticulum cell sarcoma,
myeloma
- Cortical Fibrous Dysplasia
- Osteoid Osteoma
- Fibrous Dysplasia
- Fibrosarcoma
- Chondromyxoid Fibroma
Metaphysis :
- Osteosarcoma
- Osteochondroma
- Endchondroma
- Chondrosarcoma
- Fibroxanthoma
- Bone cyst
- Ostoblastoma
Epiphysis :
- Chondroblastoma
- Giant Cell Tumor (Child : Metaphyseal, Adult : End of Bone)
- Articular Osteochondroma
34. 5. Characteristic of osteosarcoma
Osteosarcoma is the most common primary pediatric bone malignancy, derived from primitive bone-forming (osteoid producing)
mesenchymal cells. It occurs in primary (no underlying bone pathology) and secondary forms (underlying pathology which has
undergone malignant degeneration/conversion), accounting for approximately 20% of all primary bone tumors.
-Bimodal distribution of occurrence : first peek is the second decade of life (10-14 years of age is most common), the second peak is in patients
over 65.
-Primarily affects the metaphyseal region of long bones of the appendicular skeleton.
-Most common sites are the distal femur and proximal tibia.
-Presented with pain (with axial loading if lower extremity lesion), swelling, palpable mass, tenderness to palpation over area of concern, may have
decreased range of motion if large soft-tissue mass, can also cause nerve or vascular compression with mass effect.
-Radiographic characteristic : blastic and destructive lesion, sun-burst or hair on end pattern of matrix mineralization, periosteal reaction (Codman's
triangle), and large soft-tissue mass evidenced by soft-tissue shadow.
35. 6. What is onion skin lesion
Multilayered periosteal reaction, also known as a lamellated or onion skin periosteal reaction, demonstrates multiple concentric
parallel layers of new bone adjacent to the cortex, reminiscent of the layers on an onion. The layers are thought to be the result of
periods of variable growth and indicate a pathological process of intermediate aggressiveness.
36. 7.different between sarcoma and carcinoma
Sarcoma is a malignant neoplasms taking cellular origin from mesenchyme or its derivatives (connective tissue cells like deep skin tissues, fat,
muscles, blood vessels, nerves, bones, and cartilage).
Whereas, carcinoma originated from epithelial tissue (skin and peripheral organ surfaces)
37. 8. What is pathological fracture
Pathological fracture is a fracture that occurs through an abnormal bone that is pathological,
weaker, and more susceptible to fracture than normal bone which makes the bone so weak that it
is fractured by a trivial injury or even spontaneously by normal use.
38. 9. Pathognomonic for
A. Osteoid osteoma: Cortex long bone (Tibia), pain reduce with nsaid, <1,5cm central nidus, PGE2, curretage
B. Osteochondroma: Ext1,Ext2,ext 3, multiple hereditary exostosis, cartilage cap coverage, most common, resection
C. Chondrosarcoma: central skeleton, moth eaten, large blue balls
D. Fibrous dysplasia: GS alpha protein mutation, failure production lamellar bone, "punched-out" lesion, well-defined margin sclerotic
bone, cafe au lait spots, biphosponate for pain control, surgical for scoliosis/coxa vara
E. gct: C-myc oncogene, P53, Knee, soap and bubble appearance, curretage & radiation
F. Abc: benign hemmorhagic cyst, blood, Classical ABC/secondary/solid/soft tissue aneurysmal cyst
D. Sbc: benign serous cyst, fluid, UBC/partially seperated SBC,
E. Echondroma: Medula small bone (hand/feet), olier disease, maffuci’s syndrome
F. Ewing: t11,t12, diaphysis, fever, onion skin appearance, small blue cell
G. Osteosarcoma : bimodal, metaphysis knee, pRB, paget, Li Fraumeni, Sunburst appearance, Codman triangle
39. Benign Tumor
-Slow growing mass
-Smooth surface
-Definite border
-Ussualy no pain or response to
NSAID
- No periosteal reaction in Xrays
10 Difference between malignant and benign tumor from
clinical and xray
Malignant tumor:
- rapidly growing mass
- irregular surface
- spread and metastasis
- Wide zone of transition infiltrate
surrounding normal bone
- periosteal reaction in Xrays
