أسئلة الأولى جراحة عظام - رابعة حورس

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Questions and Answers

What type of tissue primarily connects articulating bones in fibrous joints?

  • Fibrous tissue (correct)
  • Synovial membrane
  • Hyaline cartilage
  • Fibrocartilage

Which type of joint is characterized by bones connected by hyaline cartilage?

  • Primary cartilaginous joint (correct)
  • Synovial joint
  • Fibrous joint
  • Secondary cartilaginous joint

Which component is a key characteristic of synovial joints?

  • Fibrous tissue connection
  • Direct bone-to-bone contact
  • Joint cavity (correct)
  • Interosseous membrane

What is the term for a surgical procedure that involves cutting a bone?

<p>Osteotomy (D)</p> Signup and view all the answers

Which of the following best describes the focus of orthopedic surgery?

<p>Diseases of the musculoskeletal system (C)</p> Signup and view all the answers

If a patient has a sideward bending of the spine, which spinal deviation is present?

<p>Scoliosis (B)</p> Signup and view all the answers

A patient presents with a foot fixed in plantar flexion. Which deformity is most likely present?

<p>Equinus (B)</p> Signup and view all the answers

Which of the following best describes the movement occurring during pronation?

<p>Turning the hand so that the palm faces downwards (D)</p> Signup and view all the answers

What is the term for a deformity that can be corrected actively by the patient or passively by a surgeon?

<p>Postural deformity (A)</p> Signup and view all the answers

Which of the following is classified as a cause of acquired deformities?

<p>Bone softening diseases (D)</p> Signup and view all the answers

What term describes the angle of inclination of the long axis of the femoral neck with reference to the transcondylar plane of the distal femur when the inclination is posterior?

<p>Retroversion (C)</p> Signup and view all the answers

In the context of orthopedic alignment, what does 'varus' specifically indicate?

<p>Deviation towards the midline (A)</p> Signup and view all the answers

Which plane of the body divides it into equal front and back halves?

<p>Coronal plane (B)</p> Signup and view all the answers

What is the primary purpose of arthroscopy?

<p>To directly visualize a joint with minimal access (A)</p> Signup and view all the answers

Which of the following best describes the term 'arthroplasty'?

<p>Joint replacement (B)</p> Signup and view all the answers

Which characteristic is associated with fibrous joints?

<p>Bones connected by strong ligaments in a syndesmotic arrangement. (B)</p> Signup and view all the answers

What distinguishes secondary cartilaginous joints from primary cartilaginous joints?

<p>The presence of fibrocartilage as the connecting tissue. (B)</p> Signup and view all the answers

Which statement accurately describes the composition of the musculoskeletal system?

<p>It includes bones, joints, ligaments, tendons, muscles, and nerves. (A)</p> Signup and view all the answers

What is the fundamental difference between a postural deformity and a fixed deformity?

<p>Postural deformities can be corrected actively or passively, while fixed deformities cannot. (A)</p> Signup and view all the answers

Which factor is considered an environmental cause of congenital deformities?

<p>Mechanical factors such as malposition in utero. (D)</p> Signup and view all the answers

In the context of lower limb alignment, what does 'valgus' specifically describe?

<p>Deviation of a bone or joint away from the midline. (C)</p> Signup and view all the answers

Which of the following best explains 'anteversion' in the context of the femoral neck?

<p>The angle of the femoral neck's inclination is rotated anteriorly relative to the distal femur. (D)</p> Signup and view all the answers

What is the primary characteristic of 'pes cavus', a deviation in the foot?

<p>An exaggerated arch of the foot. (D)</p> Signup and view all the answers

What key feature defines kyphosis as a spinal deviation?

<p>Excessive backward curvature of the spine. (D)</p> Signup and view all the answers

During the neurological evaluation of a patient, what does the assessment of 'key muscles' primarily help determine?

<p>The specific neurological level of injury. (A)</p> Signup and view all the answers

What is the primary purpose of closed reduction and external immobilization?

<p>To align a fracture without surgery and maintain its position during healing. (D)</p> Signup and view all the answers

Which surgical subspecialty focuses on diseases and trauma of the musculoskeletal system?

<p>Orthopedic Surgery (B)</p> Signup and view all the answers

If internal rotation occurs when assessing limb torsion, how is this condition classified?

<p>Internal Torsion (B)</p> Signup and view all the answers

A patient presents with a foot that has an exaggerated arch and is turned inward. Which deformity is most likely present?

<p>Pes Cavovarus (B)</p> Signup and view all the answers

Which of the following conditions is commonly associated with bone softening, potentially leading to acquired deformities?

<p>Rickets (D)</p> Signup and view all the answers

Which characteristic primarily differentiates a suture joint from a syndesmotic joint?

<p>Suture joints are exclusive to the bones of the skull. (C)</p> Signup and view all the answers

What is the critical distinction between primary and secondary cartilaginous joints regarding their composition and permanence?

<p>Primary joints are temporary, while secondary joints are permanent. (B)</p> Signup and view all the answers

In synovial joints, what specific role does the fibrous tissue capsule play, and how does it contribute to joint stability?

<p>It encapsulates the joint, providing stability and preventing dislocation. (C)</p> Signup and view all the answers

What is the primary objective of an osteotomy performed to correct a lower limb deformity, like genu varum or valgum?

<p>To realign the bone, shifting the weight-bearing axis to reduce stress on the joint. (C)</p> Signup and view all the answers

How does orthopedic surgery address musculoskeletal tumors, and what is the primary consideration in these interventions?

<p>By balancing tumor removal with preservation of limb function, considering patient age and tumor aggressiveness. (D)</p> Signup and view all the answers

In the context of spinal deviations, what are the key differentiating features between kyphosis and lordosis, and how do they impact posture?

<p>Kyphosis is an excessive backward curvature, while lordosis is an excessive forward curvature. (A)</p> Signup and view all the answers

How do congenital and acquired foot deformities differ in their etiology, and what are some examples of causative factors for each?

<p>Congenital deformities are present at birth, possibly due to genetics or environmental factors, while acquired deformities develop later due to disease or injury. (A)</p> Signup and view all the answers

When assessing limb torsion, what specific anatomical reference points are used to differentiate between internal and external torsion, particularly in the lower limb?

<p>The angle between the femoral neck and the transcondylar axis of the knee. (A)</p> Signup and view all the answers

What is the fundamental biomechanical principle behind correcting limb alignment deformities such as varus or valgus?

<p>Redistributing weight-bearing forces to reduce stress on the affected joint. (B)</p> Signup and view all the answers

How do the sagittal, frontal, and transverse planes intersect, and what movements are primarily associated with each in the context of orthopedic function?

<p>They intersect at the anatomical position; sagittal (flexion/extension), frontal (abduction/adduction), transverse (rotation). (A)</p> Signup and view all the answers

In the context of arthroscopy, what are the key advantages and limitations compared to traditional open surgery for joint-related issues?

<p>Arthroscopy offers minimally invasive access, reduced recovery time, and less scarring but may not be suitable for complex reconstructions. (A)</p> Signup and view all the answers

What are the primary goals and implications of arthroplasty in managing severe joint arthritis or trauma?

<p>To replace the damaged joint surfaces with prosthetic components, restoring function and alleviating pain. (C)</p> Signup and view all the answers

How do genetic factors versus environmental factors contribute to the development of congenital deformities, and what are some specific examples of each?

<p>Genetic factors involve inherited gene disorders, while environmental factors include teratogens affecting prenatal development. (C)</p> Signup and view all the answers

What are the defining characteristics of 'anteversion' and 'retroversion' in the context of femoral neck alignment, and how do these conditions potentially impact hip joint stability and function?

<p>Anteversion represents an increased anterior angle, while retroversion represents a posterior angle of the femoral neck relative to the femur. (C)</p> Signup and view all the answers

How does the neurological evaluation, particularly the assessment of 'key muscles,' contribute to orthopedic diagnosis and treatment planning, especially in cases involving nerve compression or injury?

<p>It identifies the spinal nerve root level affected by evaluating specific muscle strength, guiding surgical or conservative management. (B)</p> Signup and view all the answers

Which statement best differentiates between genetic and environmental causes of congenital deformities?

<p>Genetic causes involve inherited gene disorders, while environmental causes involve teratogenic exposure during gestation. (D)</p> Signup and view all the answers

In the application of the ASIA Impairment Scale (AIS) for neurological evaluation, what is the critical distinction between a 'complete' and an 'incomplete' spinal cord injury?

<p>Complete injuries show no sensory or motor function in the lowest sacral segments (S4-S5), while incomplete injuries have some function. (B)</p> Signup and view all the answers

Considering the biomechanics of limb alignment, how does correcting a varus or valgus deformity impact joint loading and long-term joint health?

<p>It redistributes weight-bearing forces more evenly across the joint surfaces, reducing localized stress and potentially slowing the progression of arthritis. (D)</p> Signup and view all the answers

How do the primary and secondary cartilaginous joints differ in composition, function, and location, impacting their roles in skeletal growth and stability?

<p>Primary cartilaginous joints contain hyaline cartilage and are involved in bone growth, whereas secondary cartilaginous joints contain fibrocartilage and provide stability. (D)</p> Signup and view all the answers

Which of the following best describes the interrelationship between osteomyelitis and the development of acquired deformities?

<p>Osteomyelitis can disturb bone growth, leading to deformities, and may also cause joint contractures that further exacerbate these deformities. (B)</p> Signup and view all the answers

How does arthroscopy differ fundamentally from traditional open surgery in terms of invasiveness, visualization, and potential for diagnostic and therapeutic applications?

<p>Arthroscopy offers minimal access with enhanced visualization for both diagnosis and certain therapeutic procedures, leading to potentially faster recovery compared to open surgery. (D)</p> Signup and view all the answers

When assessing lower limb alignment, what biomechanical consequences result from femoral anteversion or retroversion regarding hip joint stability and muscle function?

<p>Anteversion may lead to increased hip internal rotation and potential instability, while retroversion could limit internal rotation and alter hip muscle mechanics. (A)</p> Signup and view all the answers

Considering the role of key muscles in neurological evaluations, what specific information do their assessments provide about the location and severity of nerve compression or injury in orthopedic patients?

<p>Key muscle assessments allow for the determination of specific nerve root or peripheral nerve involvement, aiding in localizing the level and severity of neurological deficits. (A)</p> Signup and view all the answers

How would you differentiate between a postural deformity and a fixed deformity, especially considering which one responds to active and passive correction?

<p>Postural deformities are correctable actively by the patient or passively by a surgeon, whereas fixed deformities cannot be corrected by either method. (B)</p> Signup and view all the answers

How does the approach to managing musculoskeletal tumors differ from that of traumatic injuries in orthopedic surgery, especially considering the need for oncological safety?

<p>Musculoskeletal tumor management prioritizes limb salvage and complete tumor resection with appropriate margins to prevent recurrence, often requiring specialized reconstruction techniques. (A)</p> Signup and view all the answers

Considering the sagittal, frontal, and transverse planes, how does movement in one plane potentially influence or restrict movement in the others during orthopedic function?

<p>Restrictions or pathologies in one plane (e.g., sagittal) can limit the range of motion attainable in other planes (e.g., frontal or transverse) due to joint mechanics and soft tissue constraints. (A)</p> Signup and view all the answers

Regarding the classification of joints based on tissue type, how do the structural differences between fibrous, cartilaginous (primary vs. secondary), and synovial joints dictate their respective ranges of motion and weight-bearing capabilities?

<p>Fibrous joints provide stability with limited motion; cartilaginous joints offer more motion with some stability; synovial joints offer the greatest mobility but rely on ligaments and muscles for stability. (B)</p> Signup and view all the answers

In the context of spinal deformities, how do kyphosis and lordosis impact the biomechanics of the spine and overall posture, and what compensatory mechanisms might develop?

<p>Increased kyphosis and lordosis alter the spine's center of gravity, which leads to compensatory changes in other regions of the spine and lower limbs to maintain balance. (D)</p> Signup and view all the answers

In orthopedic terminology, what is the critical distinction between 'internal torsion' and 'external torsion' when applied to the assessment of lower limb alignment and function?

<p>Internal torsion refers to rotation occurring in an inward direction, while external torsion refers to rotation in an outward direction. (C)</p> Signup and view all the answers

How does arthroplasty address severe joint arthritis or trauma, and what are the key considerations for implant selection and patient-specific factors influencing long-term outcomes?

<p>Arthroplasty replaces damaged joint surfaces with artificial components to restore function and relieve pain, with implant selection and patient factors like age, activity level, and bone quality influencing longevity. (B)</p> Signup and view all the answers

Flashcards

Joint Definition

Articulation between two or more bones.

Fibrous Joints

Connected by fibrous tissue, e.g., sutures in the skull.

Cartilaginous Joints

Connected by hyaline cartilage (primary) or fibrocartilage (secondary).

Synovial Joints

Articular surfaces covered by hyaline cartilage; joint cavity present.

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Orthopedic Surgery Definition

Diseases and trauma of the musculoskeletal system.

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Sagittal Plane

Median plane dividing the body into left and right halves.

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Frontal (Coronal) Plane

Coronal plane dividing the body into front and back halves.

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Transverse Plane

Horizontal plane dividing the body into top and bottom halves.

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Abduction

Movement away from the midline of the body.

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Adduction

Movement towards the midline of the body.

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Deformity Definition

Abnormality of shape or posture of the spine and limbs.

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Postural Deformity

Actively correctable by patient or surgeon.

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Fixed Deformity

Cannot be corrected actively or passively.

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Varus Definition

Deviation towards the midline.

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Valgus Definition

Deviation away from the midline.

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Primary Cartilaginous Joints

Bones connected by hyaline cartilage

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Secondary Cartilaginous Joints

Bones connected by fibrocartilage.

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Rotation Definition

Movement along the long axis of a limb

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Eversion definition

Upward and outward movement at the sub talar joint

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Pronation Definition

Turning hand so the palm faces downwards.

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Supination Definition

Turning the hand so that the palm is uppermost

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What is a deformity?

Abnormality of the shape or posture of spine/limbs

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Internal Torsion

Rotation occurs in inward direction

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External Torsion

Rotation occurs in outward direction

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Anteversion

If the inclination is anterior.

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Pes Planus

Loss of normal arch of the foot

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Kyphosis Definition

Excessive backward (posterior) curvature of the spine.

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Lordosis definition

Excessive forward (anterior) curvature of the spine.

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Scoliosis Definition

Sideward (lateral) bending of the spine.

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Orthosis

A splint or brace.

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Circumduction definition

Movement of a joint in a circular motion.

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Osteotomy Definition

Surgically cutting the bone.

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Arthroscopy Definition

An operation to directly view a joint with minimal access.

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Arthroplasty Definition

Replacement of joint surfaces.

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Arthrodesis Definition

Joint fusion to eliminate movement.

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Pes Plano-Valgus

Loss of the normal arch of the foot with the foot deviated laterally.

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Pes Cavovarus

The arch is exaggerated, and the foot is deviated medially.

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Retroversion Definition

If the inclination is posterior

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Equinus Definition

A condition where the foot is fixed in plantar flexion.

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Calcaneus Definition

A condition where the foot is fixed in dorsiflexion.

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Pes Cavus Definition

A condition where the arch of the foot is exaggerated.

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Equinocavovarus Definition

Combination of equinus and cavus foot deformities.

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Osteotomy

Surgical cutting of the bone to correct a deformity.

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Orthopaedics

Diseases that focus on the musculoskeletal system.

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Pes Cavovarus definition

Loss of the normal arch of the foot with the foot deviated inwards (medially)

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Study Notes

  • Orthopedics focuses on surgical subspecialties, addressing musculoskeletal system diseases and trauma.
  • The musculoskeletal system includes bones, joints, ligaments, tendons, muscles, and nerves.
  • "Orthopedics" originates from the Greek words 'Ortho,' meaning straight, and 'Pedia,' meaning child.

Orthopedics Subspecialties

  • Pediatrics orthopedics addresses musculoskeletal issues in children.
  • Ankle and foot surgery units specialize in surgical procedures for the foot and ankle.
  • Reconstruction and deformity correction units focus on surgical corrections of deformities.
  • Surgery of the upper limb and hand units specialize in surgical procedures for the upper extremities.
  • Spinal surgery units focus on surgical procedures for the spine.
  • Tumor units specialize in the treatment of bone and soft tissue tumors of the musculoskeletal system.
  • Arthroplasty units specialize in joint replacement surgeries.
  • Trauma surgery units handle surgical management of traumatic musculoskeletal injuries.
  • Knee and sport medicine units specialize in knee surgeries and sports-related injuries.

Topics in Orthopedics

  • Congenital talipes equinovarus (CTEV), also known as clubfoot, is a congenital deformity.
  • Developmental dysplasia of the hip (DDH) is a condition where the hip joint doesn't form correctly.
  • Orthopedic trauma covers fractures, which involve breaks in the bone.
  • Dislocations are injuries where bones move out of their normal position at a joint.
  • Fracture dislocations involve both a fracture and a dislocation at a joint.
  • Osteomyelitis is an infection of the bone.
  • Pyogenic arthritis is a joint infection caused by bacteria.
  • Rheumatic disorders, such as rheumatoid arthritis, affect the joints and connective tissues.
  • Osteosarcoma and Giant cell tumors are types of bone tumors that can occur in the musculoskeletal system.
  • Cerebral palsy and spina bifida are neuromuscular disorders affecting motor function and development.
  • Osteoarthritis is a degenerative joint disease.
  • Rickets is a condition caused by vitamin D deficiency, leading to soft and weakened bones.
  • Osteoporosis is a condition characterized by decreased bone density, increasing the risk of fractures.

Joints

  • Articulation occurs between two or more bones.

Fibrous Joints

  • Articulating bones are connected together by fibrous tissue.
  • Sutures are joints between the bones of the skull.
  • Syndesmotic joints have bones connected by strong ligaments.

Cartilaginous Joints

  • Primary cartilaginous joints: bones are connected by hyaline cartilage.
  • Secondary cartilaginous joints: bones are connected by fibrocartilage.

Synovial Joints

  • Articular surfaces of bones are covered by a thin layer of hyaline cartilage.
  • Articulating bones are separated by a joint cavity.
  • The joint is surrounded by a fibrous tissue capsule.
  • Joints are classified based on the tissue between the bones.

Planes of the Body

  • Sagittal plane: median plane, divides the body vertically into left and right halves of equal size.
  • Frontal plane: coronal plane, divides the body equally into front and back halves.
  • Transverse plane: horizontal plane, divides the body equally into top and bottom halves.

Orthopedic Terminology

  • Abduction: movement away from the midline of the body.
  • Adduction: movement towards the midline of the body.
  • Rotation: movement along the long axis of a limb.
  • Eversion: upward and outward movement at the sub talar joint.
  • Inversion: down and inwards movement of the foot at sub talar joint.
  • Circumduction: movement of a joint in a circular motion.
  • Pronation: turning the hand so that the palm faces downwards.
  • Supination: turning the hand so that the palm is uppermost.

Spinal Deviations

  • Kyphosis: excessive backward (posterior) curvature of the spine.
  • Lordosis: excessive forward (anterior) curvature of the spine.
  • Scoliosis: sideward (lateral) bending of the spine.

Alignment Terminology

  • Varus: deviation towards the midline.
  • Valgus: deviation away from the midline.
  • Internal torsion: rotation occurs in an inward direction.
  • External torsion: rotation occurs in an outward direction.
  • Anteversion: axis inclination is anterior, At birth: 30° & in adults 5-20.
  • Retroversion: axis inclination is posterior.

Foot Deviations

  • Pes planus: loss of normal arch.
  • Pes plano-valgus: foot deviated in an outward direction.
  • Equinus: foot is fixed in plantar flexion.
  • Calcaneus: foot is fixed in dorsiflexion.
  • Pes cavus: exaggerated arch.
  • Pes cavovarus: foot deviated in an inward directionmedially.

Deformities

  • Abnormality of the shape and/ or posture of the spine and limbs.

Types of Deformities

  • Postural Deformity: this can be actively corrected by the patient or passively by the surgeon, e.g. FFF.
  • Fixed Deformity: this cannot be corrected actively or passively, e.g. Rigid flat foot.

Causes of Deformities

  • Genetic
    • Gene disorders have characteristic patterns of inheritance.
    • (autosomal or X-linked and dominant or recessive).
  • Environmental
    • Some teratogenic agents which damage the placenta or embryo during the first few months of gestation are:
    • Mechanical factors (malposition in utero, amniotic bands, oligo- or hydrohydraminos).
    • Viral infection (rubella).
    • Certain drugs (thalidomide).
    • Ionizing radiation.
  • Combined Genetic and Environmental
  • Acquired
  • Posttraumatic: Malunited fracture, unreduced dislocation.
  • Post infection: Osteomyelitis causing disturbance of growth, Arthritis.
  • Paralytic: Poliomyelitis, peripheral nerve injury, Spastic paralysis.
  • Bone softening diseases: Rickets, Osteomalacia, Fibrous dysplasia, Hyperparathyroidism.
  • Contracture.
    • Skin (burns, scars).
    • Fascial ( Dupytren’s contracture).
    • Muscle (Muscle dystrophies and Volkmann’s contracture).

Operative Terminology

  • Orthosis is a splint or brace.
  • Osteotomy is surgically cutting the bone.
  • Arthroscopy is an operation to directly view a joint, minimal access.
  • Arthroplasty is the surgical replacement of a joint.
  • Austin Moore’s prosthesis and Thompson’s prosthesis are examples of implants used in arthroplasty procedures.
  • Arthrodesis is the surgical fusion of a joint.

Devices and Implants

  • Closed reduction and external immobilization includes the use of U-shaped plaster slabs, cast braces, and hanging casts.
  • K-wires, plates and screws, dynamic hip screws (DHS), and multiple cancellous screws are examples of internal fixation devices.
  • Locked IMN (intramedullary nail) and external fixators are also used in orthopedic procedures.

MCQ (Multiple Choice Questions)

  • Calcaneus deformity of the foot refers to the foot being fixed in dorsiflexion.
  • Anterior inclination of the long axis of the femoral neck with reference to the transcondylar plane of the distal femur is known as Anteversion.
  • The type of hip joint is Synovial.

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