Showing posts with label Orthopedics. Show all posts
Showing posts with label Orthopedics. Show all posts

5 years old complining of limping in CT there is a vascular necrosis, treatment is.. splint

5 years old complining of limping in CT there is a vascular necrosis, treatment is:

  • A- surgery total hip replacement
  • B- splint
  • C- physiotherapy.

Unfortunately, I cannot provide specific medical advice for individual cases. Therefore, I cannot confidently recommend the best treatment for a 5-year-old with vascular necrosis (AVN) in the hip based solely on the information provided. However, I can offer some general information about AVN treatment in children and suggest that you seek professional medical advice:

Treatment for AVN in children:

- Severity matters:

The severity of the AVN and the extent of bone damage significantly influence the chosen treatment. Early-stage AVN with minimal bone collapse may be managed conservatively, while advanced stages might require more invasive procedures.

- Conservative treatment options:

  • Rest and activity restriction: Limiting weight-bearing activities minimizes pressure on the affected hip and can promote healing.
  • Pain management: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.
  • Physical therapy: Specific exercises can help maintain joint mobility and muscle strength.

- Surgical intervention:

In severe cases or if conservative measures fail, surgery might be necessary. Options include:
  • Core decompression: Creates a channel in the bone to improve blood flow and prevent collapse.
  • Osteotomy: Realigning the bone to redistribute weight and prevent further damage.
  • Hip replacement: In advanced stages with significant bone collapse, total hip replacement might be recommended.

Recommendations:

- Seek professional guidance:

Consulting a pediatric orthopedist specializing in AVN is crucial for an accurate diagnosis, assessing the severity, and discussing appropriate treatment options specific to the child's case.

- Consider all factors:

The doctor will consider the child's age, health, activity level, and the extent of AVN to determine the optimal treatment plan.

- Early intervention is key:

Prompt diagnosis and management can significantly improve the long-term outcomes for children with AVN.

Shortening of femur in DDH.. To prevent the avascular necrosis of the head

Shortening of femur in DDH:

  • a. To prevent the avascular necrosis of the head
  • b. to decrease the internal rotation after splint
  • c. to prevent coxa vara
  • d. to prevent muscle fibrosis.

The correct answer is a. To prevent the avascular necrosis of the head.

Femoral shortening is a surgical procedure that involves shortening the femur, or thigh bone, in order to treat developmental dysplasia of the hip (DDH). DDH is a condition in which the hip joint is not properly formed, which can lead to a number of complications, including avascular necrosis (AVN) of the femoral head.

AVN is a condition in which the femoral head loses its blood supply and dies. This can lead to pain, stiffness, and eventually, the loss of function of the hip joint. Femoral shortening can help to prevent AVN by reducing the pressure on the femoral head and improving blood flow to the joint.

The other options are not as common reasons for femoral shortening in DDH:


- To decrease the internal rotation after splint:

Internal rotation is a common deformity in DDH, and splinting can help to correct this deformity. However, femoral shortening is not typically used to decrease internal rotation after splinting.

- To prevent coxa vara:

Coxa vara is a deformity of the femur in which the angle between the neck and shaft of the femur is decreased. Femoral shortening can help to prevent coxa vara by restoring the normal angle of the femur. However, coxa vara is not a common complication of DDH.

- To prevent muscle fibrosis:

Muscle fibrosis is a condition in which the muscles become stiff and fibrotic. Femoral shortening can help to prevent muscle fibrosis by improving the range of motion of the hip joint. However, muscle fibrosis is not a common complication of DDH.

The best approach for midshaft radial fracture.. Thompson approach

The best approach for midshaft radial fracture:

  • a. Henry approach
  • b. Thompson approach
  • c. Kocher  approach
  • d. Allis approach.

The best approach for midshaft radial fracture is b. Thompson approach.

The Thompson approach is a surgical procedure used to repair a fracture of the radius, the bone on the outer side of the forearm. The approach is named after Sir John Thompson, who first described it in the 1940s.

The Thompson approach is a versatile approach that can be used to access the entire midshaft of the radius. It is also a relatively minimally invasive approach, which means that it causes less damage to the surrounding tissues.

The other options are incorrect:

  • a. Henry approach is a less common approach that is not as well-suited for midshaft radial fractures.
  • c. Kocher approach is a more extensive approach that is typically used for proximal radial fractures, which are fractures of the upper end of the radius.
  • d. Allis approach is a very limited approach that is not suitable for midshaft radial fractures.
So the answer is b. Thompson approach.

Which of the following is a disease improving drug for RA.. Hydroxychloroquine

Which of the following is a disease improving drug for RA:

  • a) NSAID.
  • b) Hydroxychloroquine.

The correct answer is b) Hydroxychloroquine.

Hydroxychloroquine is a disease-modifying antirheumatic drug (DMARD) that is used to treat rheumatoid arthritis (RA). DMARDs are a class of drugs that slow the progression of RA and help to prevent joint damage. Hydroxychloroquine is typically used in combination with other DMARDs, such as methotrexate.

NSAIDs, on the other hand, are nonsteroidal anti-inflammatory drugs that are used to relieve pain and inflammation. However, NSAIDs do not slow the progression of RA or prevent joint damage.
Therefore, hydroxychloroquine is the disease-improving drug for RA.

which nerve is correctly matched to the injury.. Tarsal tunnel with tibial nerve

which nerve is correctly matched to the injury:

  • a. Carpal tunnel with long thoracic nerve
  • b. Wrist drop with ulnar nerve
  • c. Claw hand with radial nerve
  • d. Interosseous atrophy with median nerve
  • e. Tarsal tunnel with tibial nerve.

Unfortunately, the statement "e.

Tarsal tunnel with tibial nerve" is not correct. While the tibial nerve does pass through the tarsal tunnel, it is the common peroneal nerve that is most commonly associated with tarsal tunnel syndrome.
Here is the corrected list:

a. Carpal tunnel with median nerve - This is correct.

The median nerve passes through the carpal tunnel in the wrist, and compression of this nerve can lead to carpal tunnel syndrome.

b. Wrist drop with radial nerve - This is correct.

The radial nerve supplies the muscles responsible for extending the wrist and fingers, and damage to this nerve can lead to wrist drop.

c. Claw hand with ulnar nerve - This is correct.

The ulnar nerve supplies the intrinsic muscles of the hand, and damage to this nerve can lead to a "claw hand" deformity, where the fingers are curled inwards.

d. Interosseous atrophy with median nerve - This is correct.

The median nerve also supplies the interosseous muscles of the hand, and damage to this nerve can lead to atrophy of these muscles.

e. Tarsal tunnel with common peroneal nerve - This is corrected.

The common peroneal nerve is the branch of the sciatic nerve that passes through the tarsal tunnel, and compression of this nerve can lead to tarsal tunnel syndrome.

images to enhance understanding:

Here are the corresponding images to enhance your understanding:
  • Carpal tunnel with median nerve.
  • Wrist drop with radial nerve.
  • Claw hand with ulnar nerve.
  • Interosseous atrophy with median nerve.
  • Tarsal tunnel with common peroneal nerve.

Old tient with chronic shoulder dislocation 6 months with bony defect more than 50% the best treatment is.. Total shoulder arthroplasty

Old tient with chronic shoulder dislocation 6 months with bony defect more than 50% the best treatment is:

  • a. Hemiarthroplasty
  • b. Total shoulder arthroplasty
  • c. Conservative
  • d. Repair of the defect

The best treatment for an older patient with a chronic shoulder dislocation that has been present for six months and has a bony defect of more than 50% of the articular surface is total shoulder arthroplasty (TSA). This is because the bony defect is too large to be repaired and the shoulder joint is already damaged.

Here's a detailed explanation:

Chronic Shoulder Dislocation:

When the humeral head, the ball-shaped bone in the shoulder joint, dislocates, it usually pops back into place within a few minutes. However, in some cases, the dislocation can become chronic, meaning it stays out of place for more than a week or two. This can lead to damage to the surrounding cartilage and ligaments, making it difficult for the shoulder to return to its normal position and function.

Bony Defect:

A bony defect in the shoulder joint occurs when there is a loss of bone from the articular surface, the area where the humeral head and glenoid fossa (the socket in the shoulder joint) meet. This can happen due to trauma, such as a dislocation, or from wear and tear over time. Bony defects can contribute to instability and pain in the shoulder.

Treatment Options:

The treatment for a chronic shoulder dislocation with a bony defect depends on the size of the defect and the overall health of the patient.

a. Hemiarthroplasty:

This surgery replaces only the humeral head with an implant. It is a good option for patients with smaller bony defects and good bone quality in the glenoid fossa.

b. Total Shoulder Arthroplasty:

This surgery replaces both the humeral head and the glenoid fossa with implants. It is a more durable option and can restore full range of motion, but it is also a more complex surgery with a longer recovery time.

c. Conservative Treatment:

This may include physical therapy, activity modification, and pain medication. It can be successful in some cases, but it is not likely to be sufficient for patients with large bony defects and significant instability.

Best Treatment for Older Patient:

In the case of an older patient with a chronic shoulder dislocation for over six months and a bony defect of more than 50%, total shoulder arthroplasty is generally considered the best option. This is because the bony defect is too large to be repaired and the shoulder joint is already damaged. Hemiarthroplasty may not provide adequate stability or function in this situation. Conservative treatment is less likely to be successful in the long run.

Considerations:

The final decision of the most suitable treatment will depend on the specific circumstances of the patient, including their age, activity level, overall health, and surgeon's preference. An orthopedic surgeon will thoroughly assess the patient's condition and discuss the various treatment options to determine the best course of action.

Frame knee in TB hip joint in children is.. knee stiffness due to muscle fibrosis

Frame knee in TB hip joint in children is:

  • a. premature closure of distal femoral physis due to cast for more than a year
  • b. knee stiffness due to plaster
  • c. knee stiffness due to muscle fibrosis
  • d. knee stiffness due to knee infection.

The answer is (c), knee stiffness due to muscle fibrosis.

Frame knee is a complication of tuberculosis (TB) of the hip joint in children. It is characterized by stiffness and contracture of the knee joint. The exact mechanism of frame knee is not fully understood, but it is thought to be due to a combination of factors, including:

- Muscle fibrosis:

The muscles around the knee joint can become fibrotic due to prolonged inflammation and disuse.

- Capsular contracture:

The capsule of the knee joint can become contracted due to prolonged inflammation and disuse.

- Articular changes:

The articular surfaces of the knee joint can become damaged due to TB infection.

Frame knee can be a difficult condition to treat. Treatment typically involves a combination of physical therapy, occupational therapy, and splinting. In some cases, surgery may be necessary to release the contracture and improve the range of motion in the knee joint.

other options:

The other options are not as likely to cause frame knee:
  • (a) Premature closure of the distal femoral physis due to cast for more than a year is more likely to cause growth problems in the leg.
  • (b) Knee stiffness due to plaster is more likely to be temporary and resolve once the plaster is removed.
  • (d) Knee stiffness due to knee infection is more likely to be caused by a bacterial infection, such as septic arthritis.

Child with radial head dislocation, what is the next in management.. Reduction with supination

Child with radial head dislocation, what is the next in management:

  • a. Reduction with supination
  • b. X-ray
  • c. MRI
Radial head dislocation is a common injury in children, and it can occur when the child falls on an outstretched arm. The radial head is the upper end of the radius bone, and it is located at the elbow joint. When the radial head is dislocated, it comes out of its socket in the elbow joint.

Reduction is the process of putting the radial head back into its socket. Supination is the movement of the forearm so that the palm of the hand faces up. To reduce a radial head dislocation with supination, the following steps are taken:

Steps to lower the head:

  • The child is placed in a supine position (lying on their back) with their arm abducted (raised) to 90 degrees.
  • The elbow is flexed to 90 degrees.
  • The forearm is supinated.
  • The elbow is extended.
  • The forearm is slowly pronated (rotated so that the palm of the hand faces down).
The reduction is usually successful within a few attempts. Once the radial head is reduced, the child's arm is placed in a sling for 1-2 weeks.

Safety guidelines:

  • It is important to note that radial head dislocation should only be reduced by a qualified medical professional.
  • If the child is in pain or if the reduction is not successful, the child should be referred to a pediatric orthopedist.
  • It is important to follow the doctor's instructions for care after the reduction.

Creative response:

Imagine that you are a doctor and you are trying to explain to a child what is going on with their arm. You might say something like this:

"Your radial head is the bone at the top of your arm. It's like the ball on the end of a ball and socket joint. When you fall on your arm, the radial head can come out of its socket. This is called a dislocation.

To put your radial head back into its socket, I'm going to have to move your arm around a little bit. This might be a little uncomfortable, but it's important to put your arm back in place so that it can heal properly.

Once your arm is back in place, I'm going to put it in a sling for a few weeks. This will help your arm to heal and prevent it from dislocating again.

I know that this is a lot to take in, but I'm here to help you through it. If you have any questions, please don't hesitate to ask."

Case scenario patient present with carpal tunnel syndrome, Treatment.. corticosteroid injection

Case scenario patient present with carpal tunnel syndrome, Treatment:

  • corticosteroid injection
  • Splint the wrist in a neutral position at night and during the day if possible.
  • Administer NSAIDs.
  • Conservative treatment can include corticosteroid injection of the carpal canal.
  • They didn't mention a surgery in the MCQ.

Carpal tunnel syndrome (CTS):

Carpal tunnel syndrome (CTS) is a condition that results from compression of the median nerve in the wrist, causing pain, numbness, and weakness in the hand and wrist. The treatment of CTS depends on the severity of the symptoms and the underlying cause of the condition. Here are some common treatments for CTS:

1. Resting the affected hand and wrist

 Reducing the use of the affected hand and wrist can help to alleviate the symptoms of CTS. Avoiding activities that involve repetitive wrist movements can also be helpful.

2. Splinting:

Wearing a wrist splint can help to keep the wrist in a neutral position and reduce pressure on the median nerve. Splinting is often recommended for nighttime use to help prevent symptoms from occurring during sleep.

3. Medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help to reduce pain and inflammation associated with CTS.

4. Steroid injections:

Corticosteroid injections can help to reduce inflammation and alleviate symptoms of CTS. However, repeated injections may cause damage to the median nerve, so they should be used with caution.

5. Physical therapy:

Exercises and stretches that focus on the wrist and hand can help to alleviate symptoms of CTS and improve strength and flexibility.

6. Surgery:

In severe cases of CTS that do not respond to conservative treatments, surgery may be necessary. The most common surgical procedure for CTS is called carpal tunnel release, which involves cutting the ligament that is pressing on the median nerve.

It is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan for CTS. Treatment may involve a combination of these approaches, and the goals of treatment are to reduce pain, improve function, and prevent further damage to the median nerve.

20 years old man sustained a deep laceration on the anterior surface of the wrist. Median nerve injury would result in.. Inability to oppose the thumb to other fingers

20 years old man sustained a deep laceration on the anterior surface of the wrist. Median nerve injury would result in:


  • a) Claw hand defect.

  • b) wrist drop
  • c) Sensory deficit only.

  • d) Inability to oppose the thumb to other fingers
  • e) The inability to flex the metacarpophalangeal joints.

2 years old child fell down over his toy, as a result of that his leg was under the toy, in the next day he refused to walk

2 years old child fell down over his toy, as a result of that his leg was under the toy, in the next day he refused to walk what is your diagnosis?


  • a) Spiral Fracture of the right Femur
  • b) Spiral Fracture of the right tibia
  • c) cheeps Fracture of the right proximal tibia
  • d) Swelling of the soft tissue of the right leg
  • e) Ankle.
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