ORTHOPAEDICS

BY
Dr. Priyesh Nayak
(MBBS. M.S. Orthopaedics)

instagram ID: - doctor_priyesh

 Topics we will covered in Rapid Revision
1. Basics About Orthopaedics
2. Trauma
3. Regional Condition
4. Nerve Injuries
5. Pediatric Orthopaedics
6. Joint Disorder
7. Metabolic bone disease
8. Bone Tumor
9. Bone Infection
10. Osteochondrities
11. Spine
12. Basic bone physiology
 BASICS ABOUT ORTHOPEDICS

 90% of operative cases are of trauma

10% other diseases

 In 90% cases Nail or Plate is used to fix the fracture

 Two methods of fixation-

Open reduction or close reduction

 In 90% of cases 2 view is used

Anteroposterior or lateral view

 Upper limb, Lower limb, Pelvis, Spine covered in Orthopedics

 Basics of any fracture fixation-

Try for close reduction

Align the fracture (anatomical reduction)

If not align then open reduction

Then put the implant

 Extramedullary and Intramedullary implants

 Arthroplasty –Replacement of joint

 Arthroscopy- Minimal invasive procedure to examine

joint
Slab

– Type of plaster ,which is partial cast that cover only one

side allowing room for swelling ,It applies in the

beginning of fracture usually applied for 1 week

Cast

– Type of plaster ,completely encircles the limb . It is

applied when swelling reduces after 1 week of slab

application for 4 Weeks

Boot and Bar-Derotation bar used in IT fracture

Why 2 fracture fragment separated –because of muscle

pull
Thomas knee splint

- Immobilization and stablization of femur fracture

BB splint

- Immobilization of lower limb

Always has to follow ATLS protocol for Patient who

came in emergency

For Pelvic fracture

– Blood loss is huge so Pelvic Binder is used for

Pelvic Tamponade

Open fracture –Fracture associated with wound

Close fracture-Only fracture with no wound

 CRUSH syndrome-Myonecrosis of Crushed Limb

Type of Cast – Below elbow cast

Above elbow cast
Below knee cast
Above knee cast
Cylindrical cast
Figure of 8 bandage – Clavicle fracture
External fixator –Used for open fracture
Illzarove fixator –Used for non union ,Open fracture
Vaccum assisted closure –also known as negative pressure therapy
Amputation-
Closed
Open
Principle of Amputation-
Myodesis-Muscle is sutured to bone
Myoplasty-Muscle is sutured to muscle
Bone is cut 5 cm shorter than soft tissue

Upper limb Amputation-

 Shoulder Disarticulation
 Transhumeral Amputation (Above Elbow Amputation)
 Elbow disarticulation
 Below Elbow Amputation
 Wrist Disarticulation
 Hip disarticulation
 Transfemoral (Above knee Amputation)
 Knee Disarticulation
 Below Knee Disarticulation
 Below Knee Disarticulation
 Syme’s Amputation
 Chopart Amputation-Intertarsal Joints
 Lisfranc –TarsoMetatarsal Joints
Prosthesis
SACH foot – doesn’t look like normal
dorsiflexion., inversion, eversion absent
Squatting not possible
Jaipur Foot-
Appears normal
Walking barefoot possible, dorsiflexion, inversion, eversion
possible
 Trauma
Clavicle
-M/C bone fracture at time of birth, in Newborn
Treatment- Figure of 8 , CRIF Nail, ORIF plate
- Indication- for Operative fixation
- Open fracture
- Brachial plexus injury
Complication
- Malunion, Neurovascular injury

- Shoulder joint
It is most mobile joint in body, Mobility came at cost of stability,
- Most unstable joint
- Stabilizer
- Rotator cuff
- Capsule
- Labrum
- Glenohumeral ligament
Shoulder Dislocation
1.Anterior(M/c)- Subcoracoid ( Most common)
2.Posterior
3.Inferior.
In Anterior- Arm is in abduction and external rotation
Nerve injured
-Axillary Nerve (M/C)
Test used
1. Hamilton ruler-Ruler touching acromian and lateral epicondyle Humerus
2. Dugas Test-Difficulty to touch opposite shoulder
3. Callaway test-Girth is more in affected shoulder
4. Bryant test-Increased circumference on affected side
Reduction Maneuver-

1.Modified Kocher –TEAM Traction, External

Rotation, Adduction, Medial Rotation

2. Stimpson Technique- Patient lying prone and

hanging arm

3. Hippocrates- Placing foot in axilla using it as

a fulcrum Complication -Bankart-AI –BAI

Hillsachs –PL Reverse Bankart -PI

Trick to Learn Anterior Shoulder Dislocation
‘ABER HAD CAB AT KOSHI’
'AB-Abduction Posterior Shoulder Dislocation
ER-External Rotation - Light Bulb sign
- Adduction and internal rotation
HA-Hamilton Ruler Test
D-Dugas Test - Inferior dislocation-luxatio erecta
CA-Callaway Test
B-Bryant Test
AT-Axillary Nerve (M/c nerve injured)
KO-Kocher maneuver
S-Stimpson Maneuver
HI-Hippocrates maneuver
Most common complication of shoulder dislocation-Recurrent Shoulder
dislocation
Proximal Humerus fracture
Seen in Old age
Axillary nerve
– Most common injured
Shaft humerus fracture
- Radial nerve injury
- U slab applied
- ORIF plate
- CRIF nail
Holstein lewis fracture
- Lower 1-3 of humerus nerve entrapped during reduction
Treatment -Cock up splint n wait
- 3 point bony relationship
-Medial ,Lateral epicondyle and olecranon
 Maintained in- S/C Humerus Fracture
Lost in – All those which involve joint line
Like Lateral condyle of Humerus fracture
Interocondylar humerus fracture

Lateral condyle Humerus fracture

-Intraarticular fracture
-Intracapsular fracture so prevent healing
-Fracture of necessity
Complication -
-Non union
-Cubitus valgus “L” in lateral condyle “L” in cubitus valgus
- Stiffness of elbow
- Tardy Ulnar nerve palsy
Fracture of Necessity
“PAGAL MONTE NE OLA LATE KAR DI”

PA-PATELLA FRACTURE
GAL-GALLEAZI FRACTURE DISLOCATION

Monte-Monteggia fracture dislocation

NE-Neck Femur fracture
OLA-Olecranon fracture

Late-Lateral condyle of Humerus fracture

KAR-Articular fracture
Di
S/C humerus Fracture
M/C fracture around elbow
'BAG CAFÉ’
'B-Brachial Artery -M/c Vessel injury
A-Anterior introsseous Nerve- M/C nerve injury
G-Gartland classification -M/c classification used
CA-Cubitus varus- M/C late complication
F-Fish tail sign- Seen in supracondylar humerus fracture
E-Extension Type- M/C type of injury Gartland classification
Gartland classification
Type 1 Undisplaced
Type 2- Displacement with intact posterior cortex
Type 3- Totally displaced
M/C late complication -Cubitus Varus
Treatment- Undisplaced - POP slab
Displaced -K wire
Cubitus varus also known as Gun stock deformity
Extension and flexion decides on
- Basis of distal fragment which can go anterior and posterior
Fat pad sign
- Fat pushed by fracture hematoma appears as lucency
Complication of S/C humerus
- Brachial artery injury
- Anterior introsseuous nerve
- Compartment syndrome
- Volkman ischemia
 COMPARTMENT SYNDROME
 Flexor group of muscles affected by ischemia  Paresthesia
 FDP affected first  Pulselessness
 Ischemia leads to inflammation then compression  Paralysis
Necrosis then fibrosis then contractures  Treatment -Fasciotomy
 It is a Complication of S/c humerus fracture
 M/C cause of compartment syndrome-Tibia
Diaphyseal fracture
 Most common cause in children - S/C humerus
 Pressure >30 mm Hg
6 P involve-
 Pain on passive stretch
 Pallor
 Paralysis
Myossitis ossificans CRITOE
- Due to massage - C – Capitulum-1 Y
- M/c muscle – Brachialis - R – Radial head – 3 Y
- M/ C joint – Elbow - I – Internal Epicondyle – 5 Y
- Treatment – NSAID - T – Trochlea – 7 Y
Sideswipe injury - O – Olecranon – 9 Y
- Sitting in car with elbow outside car - E – ext.epicondyle – 11 Y
window
Pulled elbow
- Seen in children below 3 to 5 yr
Forearm fracture-

Galleazi fracture

GAR - Distal 1/3 radius fracture with DRUJ disruption

Piano Key sign

- Dorsal migration of ulna

Treatment

– ORIF plating

Night stick fracture

- Minimally displaced fracture of ulna

Terrible triad of elbow Monteggia fracture

'RACE MONA- Proximal 1/3 ulna fracture with

'RA-Radial head fracture
Radial head dislocation
C-Coronoid fracture
E-Elbow dislocation BAP - Bado Classification used

PIN –Injured

Treatment

– ORIF plating
DER fracture -
Colle's fracture
Smith fracture
Barton fracture
Chauffer fracture
EX ko CODE SENT kar diye
Extraarticular fracture
CO -Colles mein
Distal fracture dorsally displace h Mx-Below elbow cast
In ulnar deviation ,palmar flexion
S-Smith mein Distal fragment vENTrally displaced h
BAR m INTRY kar k VODKA piya
BARTON FRACTURE
Intry- Intraarticular fracture
VODKA- can b Ventrally or dorsally both displaced
 M/c carpal bone fracture -scaphoid
Chauffer fracture Pain in anatomical snuff box
CHIRA

CH-Chauffer fracture Scapholunate dislocation-Terry

I-Intraarticular fracture thomas sign
RA-Radial styloid fracture

Colles dorsal displaced h looking

like dinner fork

Smith -Garden spade

Most common dislocation

- Lunate

- Most common Bone Fracture in carpals- Scaphoid

- Proximal pole fracture goes in AVN

- Pain in anatomical snuff box

- Treatment - Glass holding cast

- Displaced fracture - Herbert screw

 LOWER LIMB TRAUMA

Pelvis –

Shenton line –Continuous Arch starts from inferior margin of superior Pubic ramus

Normally Breach in Shenton line –seen in

• Neck of femur fracture

• Hip Dislocation

• Proximal femur fracture

• Pelvis fracture –Huge blood loss

• Pelvic Binder applied

Trendelenburg Gait-seen in superior gluteal nerve injury

If patient has Superior gluteal Nerve injury on right side

And if he stand on right side then opposite side pelvis drops

Malgaigne Fracture-Sacral Ala+superior and inferior pubic
Pelvis Trauma- rami fracture
Straddle Fracture-Bilateral Superior and inferior pubic
Tiles Type A- stable injuries Rami fracture
Bucket Handle Fracture-Pubic rami fracture on one
Tiles Type B-Rotational Unstable Side and SI joint Disruption on other side

Tiles type C-Vertical instability,Rotationally unstable

Mx-follow ATLS protocol

Pelvic Binder which is Wrapped Round Pelvis

JUDET view –is used in Xray

Posterior hip dislocation – (M/C )-Dash board injury
Shortening
Flexion, Adduction, Internal rotation(FADIR)
Complication-AVN
Hip Reduction Maneuver-
'BEAST’
'B-Bigelow
E-East Baltimore
A-Allis
ST-Stimson Mx-Close Reduction
Anterior Hip dislocation -Rare
Femoral nerve injury
Flexion,Abduction,External Rotation(FABER)
 Neck femur n Intertrochantric femur
fracture
Both fracture have so much
similarity u don’t have to confuse
Age –old age
Mode of trauma –Trivial trauma
Shortening in both

Neck femur-less Intertrochantric femur

shortening fracture-more shortening

1. Pain in femoral 1. Pain in trochanteric

triangle region

2. Mild pain 2. Severe pain

3. Intracapsular 3. Extra capsular

4. AVN 4. Malunion
Blood supply of femur is precarious
Thats why it cause non union in femur neck fracture
Causes of non union neck femur fracture –
1- Synovial fluid inhibit healing
2- Periosteum around neck of femur lacks cambium layer that has progenitor osteoblast
3- Decreased vascularity
Neck femur fracture
- Anatomical classification-
1- Subcapital
2- Transcervical
3- Basicervical
Pauwel classification Talus fracture
Type - 1 – 30 - Cause AVN Precarious blood supply
Type -2 - 30-50 - Cause no muscle attached
Type -3 - >50 - Hawkins classification used
Garden classification- Lisfranc fracture
Type -1 Undisplaced incomplete - Increased gap in 1st and 2nd MT
Type -2 Undisplaced complete
Type -3 omplete fracture, incompletely displaced
Type -4 complete fracture ,completely displaced
Patella fracture
- Mostly 2 part fracture
Treatment
- Tension band wiring
Plafond fracture –Distal end of tibia fracture
Shaft femur fracture
Treatment-
<5 yr - Hip spica
5 -15 yr - TENS nail or flexible Nail
>15 Yr -Interlock Nailing

Fat Embolism -24 -48 hr after long bone fracture

PDD
P -Petechie
D-Dyspnea
D-Disorientation
Common after femur fracture
Knee injuries-
4 ligament
ACL
PCL
MCL
LCL

Meniscus – Medial Meniscus ,Lateral Meniscus

ACL- ALA anterior drawer, Lachman done in 30 degree knee flexion

Prevent tibia to go anteriorly
PCL- Posterior drawer
Prevent tibia to go posteriorly
Meniscus Test
- Mcmurray test Unhappy Triad of Knee-
- Apley’s grinding test “MAM”-O Donoghue triad
- Thessaly test
Treatment -Arthroscopic repair
 Regional condition
Frozen shoulder - DM type 2
Tennis elbow -Lateral epicondylitis’ TEL’
Inflammation of extensor origin(Cozen test is used)
Golfer elbow -Medial epicondylitis Inflammation of
flexor origin GM
Frozen Shoulder –F>M Tennis elbow
- Adhesive Capsulitis - lateral Epicondylitis
- Fibrosis and adherence of capsule to Treatment
humerus - Steroid injection
- Seen in type 2 DM Seen who are using frequent wrist extensor
Treatment Cozen Test
- Physiotherapy, Steroid injection - Done for Tennis elbow
Rotator cuff Impingement Syndrome-Pain in
- S- Subscapularis Abduction
- I- Infraspinatus Subacromial bursitis
- T-Teres Minor AKA-Painful arc Syndrome
- S-Supraspinatus TREATMENT-
Repaired by Arthroscopically Conservative
Medications-NSAIDs
Golfer elbow –Swimmer’s Elbow
- Pain at medial epicondyle, Reverse Cozen Test used
- Repetitive injury to wrist flexor
Dupuytren Contracture
- Abnormal fibrosis in Palm
- Alcoholic Type 2 DM,
- M/C finger -Ring finger
Treatment -Physiotherapy
Game keeper thumb
- Avulsion of UCL
Treatment
- Thumb spica cast
Ganglion cyst
- Unilocular cyst containing mucinous fluid
Baker cyst

- Popliteal cyst

Haglund deformity

- Retrocalcaneal bursitis

Hallux valgus

Gout

- 1St MTP joint involve

- Due to increase in uric acid level

Dequervain Tenosynovities-Painful inflammatory condition caused by

tendons on the side of wrist at base of thumb APL and EPB tendon

affected

Cause-Chronic overuse activites such as playing piano,fly fishing,

carpentry or activities by office workers

Treatment--Conservative treatment NSAIDs-immobilisation with splint

Eichoff test

- thumb kept in palm and fist closed in neutral position then deviate to

ulnar leads to severe pain

Finkelstien test- Used in dequervian

Tenosynovities

Trigger finger-Stenosing Tenosynovitis of A1

pulley

Mallet finger- Hyper flexion injury Avulsion of

Extensor digitorum at DIP joint ‘MAF’

Jersey finger- Hyperextension injury

Avulsion of FDP

Housemaid knee- Prepatellar buraities

Clergyman knee -Infrapatellar bursitis

 Nerve injury-
- Neuropraxia
- Axonotmesis
- Neurotmesis
Tinel sign
- Nerve progression

Nerves
Median Nerve -
- All flexor except Flexer carpi ulnaris n medial half of
flexor digitorum profundus
- Hand- All Thenar except Adductor pollocis
- Sensory Supplies-Lateral 3 and ½ palmar aspect
- And tips of lateral 3 and half in dorsal aspect
 Median nerve supplies
 Lumbricals 1 and 2
 All thenar (APB,FPB,OP)
except Adductor pollicis
 Anterior interosseous nerve -Supplies FPL And
lateral half of FDP
 Purely motor nerve
Kiloh nevin sign
- weak OK sign AIN palsy
PPPP
P-Pen test
P-Pincer grasp
P-pointing index sign
(Benedict sign)
P-Ape hand deformity
AIN is branch of median injury leads
to kiloh nevin sign -unable to make O
Ulnar nerve
- Deep branch - supplies hypothenar And intrinsic muscles of hand
- Forearm -Flexor carpi ulnaris and FDP medial aspect
- Hand -Hypothenar and 3,4th lumbricals,Dorsal interossei,adductor
- Pollocis, SENSORY-Medial 1 and half finger volar and dorsal
- Palmar Interossei – Adduction
- If action is lost
- Card test positive
Injury cause
Partial claw hand
B- Book Test
C-Card Test
D-E-Egawa test
F-Froment's sign
Knuckle bender splint used
Radial nerve -all extensor ,

PIN-supplies - Extensor of thumb and fingers,

Very high high radial nerve - Inabilty to extend elbow

High radial nerve- thumb drop ,finger drop,wrist drop, sensory loss

Injury proximal to ECRL - Wrist drop

Injury distal to ECRL - No wrist drop

PIN-Finger drop and thumb drop

Cock up splint used

Carpal tunnel syndrome -Median nerve compression

- Median nerve - Burning, Tingling and numbness paraesthesia in middle

of night,- Female affected

Phalen test is used

Durkan test for Carpal Tunnel

- direct median nerve compression Erb’s Palsy-Policeman Tip,Waiter Tip C5,C6 involve

ARM adducted ,Medially Rotated,Elbow Extended

IOC

- nerve conduction velocity

Klumpke Palsy-C8 ,T1 involved
Melagia parasthetica
Claw hand,Wrist extended ,Horner Syndrome
- Entrapment of lateral cutaneous nerve

Piriformis syndrome
Cubital Tunnel- Ulnar Nerve
- Entrapment of sciatic nerve Guyan’s canal-Ulnar Nerve

Tarsal tunnel syndrome

- posterior Tibial nerve

 Pediatric Orthopaedics
Fracture
- Convex side
tensile surface
- Concave side
- Compression surface
Torus fracture
- Bulge on compression side / inner surface /
concave side
Green stick fracture
- Unicortical fracture
Saltar harris classification-
Torticollis - Tilting of head to one side Leads to
chin pointing to opposite side
This is due to sternocleidomastoid contracture
Madelung deformity

- Ulna continues to grow Defect in radius growth

Phocomelia

- Long bones absent short bones present

Hemimelia

- Longitudinal deficiency of limb

Radial club hand

Radius absent

Poland syndrome

- Pectoralis muscle absent

Coxa vara <120 degree
Coxa valga >130 degree
Normal-125 degree
SCFE –Bilateral 40%
Causes -
Hypothyroidism, Hypogonadism
- Epiphysis slip
Male>female
Idiopathic
X ray -Trethowan sign
IOC- MRI
Klein line- extended line drawn from lateral part of
neck femur Intersect lateral part of head
Treatment -CRIF screw fixation
DDH - Female>male,
Idiopathic
Female > Male, in Indians incidence is low
Pathology- lax ligamentum teres
- Pulvinar fat
Alpha angle – Reduced
Beta angle – Increased
Hilgenreiner line- horizontal line along inferior aspect of triradiate cartilage
Perkins - Line drawn at lateral border of acetabulam
Barlow-BAD –Adduction causes dislocation
Ortlani- Abduction cause reduction
Galleazi sign -DDH limb is at lower level
Treatment-
0-6 months - Pavlik harness
6-18 months - Close or Open reduction
CTEV –
1/1000
Male>female
Idiopathic
Associated with spina bifida Deformity
Joints in foot-
Ankle joint
Subtalar or talo calcaneum joint
Tarsometatarsal joint
Cavus- Exaggeration of medial longitudinal arch
Adduction-adduction at metatarsotarsal joint
Varus-internal rotation at tibiotalar joint
Equnius - plantar flexion at ankle joint
Kites angle- In CTEV reduced
Normal- 20* Dorsiflexion test positive -Dorsiflexion is not possible in
Treatment -
Ponsetti correction method
1. Cavus
2. Adduction and Varus
3. Equnius
Ponsetti method- Talar head as a fulcrum;
Earlier Kite’s method used-CC joint as fulcrum
Correction in 4-6 cast
Then after CTEV shoes and dennis brown splint
1-3 yr – PMSTR
3-5 yr- PMSTR- Dilwyns evans procedure
5-8 yr -PMSTR +Dilwyn evans +dwyer osteotomy
8-10 yr - Wedge tarsectomy
>10 yr - Triple arthrodesis
Achondroplasia -

- Defect in endochondral ossification

- Frontal bossing

- Champagne glass pelvis

JOINT DISORDER

OSTEOARTHRITIS RHEUMATOID ARTHRITIS

 MCP JOINT SPARED  DIP JOINT SPARED
 PIP,DIP INVOLVE  MCP AND PIP INVOLVE

 1ST CMC INVOLVED

 Joint disorder
Osteoarthrities –
M/c Joint disease
Degenerative disease of cartilage
Cartilage destroyed so bone ends rub each other
Causes- Pain
-Sclerosis
-Regeneration of osteophytes
-Medial side joint space reduced

Decreased joint space –Earliest X ray finding

X ray finding –
JOSS
J-Joint space narrowing
O-Osteophytes
S-Subchondral sclerosis
S-Subchondral Cyst
BP -Bouchard's nodes Swelling at PIP
HD- Heberden Nodes swelling at DIP

Treatment- Physiotherapy in initial stage

Young patient - High tibial osteotomy
Late stage - TKR
Rheumatoid arthritis-
Inflammatory arthritis
Erosive type
Female>Male
Autoimmune disease
Investigation- RA factor
Leading to inflammation and destruction of synovium
In late stages it causes fibrosis
Fibrous ankylosis
‘ABCDEFGH STUVWXYZ’
A-Autoimmune Disease
B-Boutonnière Deformity
C-AntiCCP is most Specific
D-DIP joint is spared NO SCLEROSIS AND NO OSTEOPHYTES BOTH
E-Erosive Arthritis THESE FEATURE ARE FOUND IN
F-Fibrous Ankylosis OSTEOARTHRITIES
G-Genu valgum
Association-
H-Hallux valgus
 Carditis
S-Swan neck Deformity
 Pleuritis
T-Triple Deformity of knee
 Felty syndrome
U-Ulnar deviation of finger
V-Vasculities Treatment-Physiotherapy, Methotrexate
W-Windswipe Deformity
X-x ray show juxtaarticular erosion
Y-
Z-Z deformity
Ankylosing Spondylitis
• Inflammatory Arthritis
• Axial>Appendicular skeleton
• HLA B27
• Uveitis
• Morning stiffness
• Cardiac manifestation
• Decrease chest expansion
• Male > female
• Young male
• Uveitis mainly
• Axial skeleton affected mostly
• M/C site SI joint
• Pathology- Enthesopathy
• Calcification or bone formation
• Inflammation Causes erosion
Then regeneration then calcification
Restriction of movement
• FABER test is used
Trick To Remember Clinical and Radiological Feature
of Ankylosing Spondylitis –

'BB NE SAMOSA DIYA THA’-

B- Bridging Syndesmophytes

B- Bamboo Spine-

NE-Enthesitis-
SA-Sacroiliitis-
MO-Morning Stiffness-
S-Squaring of Vertebra-
A-Anterior Uveitis –
DIYA-Dagger Sign-
THA- Trolley Track Sign

Treatment- physiotherapy
NSAIDs
Romanus sign /Shiny corner sign

Test - FABER test figure of 4 test

Psoariatic arthritis-

 Casper criteria is used

 Arthritis multilans

 Sausage digits

 Pencil in cup deformity

Pseudogout - CPPD crystal deposits in

Knee Joint
METABOLIC BONE DISEASE
 METABOLIC BONE DISEASE
Primary hyperparathyroidism
Phalanges
- Secretion of excessive PTH
- Subperiosteal resorption, Osteitis fibrosa Cystica
Secondary Hyperparathyroidism
Bone
- Hypocalcemia induce to release PTH
- Brown tumor
Action of PTH- - Painful bones
Kidney - Renal stones
- Calcium absorption
Abdominal groans
- Phosphate excretion
- Nausea and vomiting
Skull
Psychiatric moans
- Salt n pepper appearance - Lethargy ,Fatigue
Teeth
Brown Tumor
- Resorption of lamina dura - Accumulation of blood In cavity
Renal Rickets
Treatment
- causes secondary Parathyroidism,Rugger Jersey spine
- Surgical excision
PTH action
1- Increase calcium absorption and phosphate excretion
from kidney
2- absorption of calcium and phosphate from GIT

Rickets-
 Vitamin D deficiency
 Skull - Craniotabes /Ping pong like skull
 Softening of skull(Earliest change)
 Rachitic rosary- non tender costochondral swelling
 Delayed closure of frontanelle
 Wide suture
 Bowing of legs
 Bow knees Rickets types –
 Genu valgum,
Vitamin D dependent
 genu varum ,
 wind swept deformity Type 1 - mutation in 1- alpha Hydroxylase gene
Vitmin D dependent
Type 2 - Receptor Resistance of vitamin D
HARA PIG DC HO GYA’
HA-Harrison Sulcus
Ra-Rachitic Rosary
PI-Ping pong like skull
G-Genu varum
D-Delayed closure of frontanelle
C-Craniotabes
Ho-Hypoplasia of enamel
Gya-Genu valgum

Lab finding
- Calcium - decrease or normal
PTH - Increased
X ray
CSF
Cupping ,splaying,fraying of metaphysis
Widening of epiphyseal plate
Osteomalacia-
Milkman fracture , looser’s zone
Looser's zone seen in osteomalacia
Pulsation of arteries around bone causes stress fracture
ROOPA HYFI
R-Renal osteodystrophy
O-Osteogensis imperfecta
O-Osteomalacia
PA-Paget's disease
Hy-Hyperthyroidism
Fi-fibrous dysplasia
PCT

P-Protrusio Acetabuli

C-Champagne glass pelvis

T-Triradiate pelvis

Treatment-3 lakh-6lakhIU

IM or oral
SCURVY-
Vitamin C deficiency
Scurvy - Collagen maturity defect
'(THE WEST BENGAL PUBLIC SERVICE COMMISSION)*2’
T-Trummerfeld Zone
T-Tender Joints
W-Wimberger Ring Sign
W-White line of Frenkel
B-Brittle Hair
B-Bleeding Gums
S-Scorbutic Rosary
S-Subperiosteal Hemorrhage
C-Collagen maturity Defect
C-Vitamin-C Deficiency
Scorbutic rosary are tender
Bone
Pencil thin cortex
Lab parameter are normal
As mineralisation is normal
White line of frenkel-
HER LEP IS COSY
HER- Healing Rickets
LE-Leukemia
P-Plumbism
IS –Scurvy
COSY-Congenital Syphllis
Osteoporosis-
Bone quality is normal
But quantity is less
Female involved
Pain in back -Earliest symptom
M/C earliest fracture- Vertebral fracture

Type of osteoporosis-
Type 1 - Primary Post menopausal Senile
Type 2- Secondary Drug induced
M/C complication- fragility fracture
Kyphosis due to vertebral compression
Z score used in older population
T score in younger population
DEXA SCAN-IOC,
 ABCDEF’
Treatment: -
A-Age -Most common cause
Decrease bone resorption- Bisphosphonate
B-Bisphosphonates -Drug of choice
Denosumab
C-Cod fish Vertebra Radiological
SERM- raloxifene
Feature
HRT
D-Dexa scan -investigation Of choice
Increase bone formation – Teriparatide
E-Estrogen -protective in Osteoporosis
Bisphosphonates - Inhibit Bone resorption
F-Females- more commonly involve
Zoledronate - Given once in a year
than male Kyphosis coz of vertebral
Romosuzumab - Anti sclerostin
compression
Vertebroplasty for kyphosis
Paget's disease-Male >Female
3 stages –
Lytic
Mixed
Blastic
M/C manifestation-Pain
Paramyxovirus association
Pelvis > Tibia
 Increased osteoclastic activity
 Increase bone resorption
 Increase bone formation by osteoblast
 Increase bone turnover
 Increase in ALP
 Enlarged head
 Headache
 Cranial nerve stenosis
DEAF COP TAM CO IV CANULA लगाया’
DEAF – Deafness
CO-Cotton Wool Skull
P-Picture frame Vertebra
TAM-Tam 'O' Shanter skull
C-Cranial Foreman Stenosis
O-Otoscelerosis
IV-Ivory Vertebra
Canula-Cardiac Output High
Bone - Warm to touch,Thick weak bone
Frequent change in hat sizes
M/C cause of death- cardiac failure
Radiologically-
Lytic Phase- Osteogensis Circumscripta,
Flame shaped, blade glass of appearance
Mixed phase –
PIC
P-Picture frame vertebra
I-Ivory Vertebra
C-Cotton wool skull
Blastic phase-Tam 'O' shanter skull

Osteogenesis Imperfecta-
Multiple frequent fracture
COLA 1 gene defect
Feature- Blue sclera
Bruising
Delayed dentition
 Serum Calcium Serum PTH Serum ALP
Phosphate

Rickets Decrease / Increase Decrease Increase

Normal
Osteomalacia

Renal Highly decrease Increase Highly increase Increase

Osteodystrophy

Osteoporosis Normal Normal Normal Normal

Primary Hype Highly increase Highly increase Decrease Increase

Parathyroidism

Paget’s Normal Normal Normal Increase

Disease
 Bone tumor
Enneking staging of bone tumor
Benign-
Latent - low grade
Active - High grade
Aggressive- Metastasis
Intracompartmental - Tumor grows within the bone
Extracompartmental - Tumor grows beyond bone n soft tissue
Benign Bone tumor-
'OOOOGAS’
O-Osteoblastoma
O-Osteochondroma
OO-Osteoid osteoma
G-Giant cell tumor
A-Aneurysmal bone cyst
S-Simple bone cyst
Trick to learn Malignant Tumor of bone
'CHAT O CHESS’
CH-Chordoma
AT – Adamantinoma
O- Osteosarcoma
CH-chondrosarcoma
ES-Ewing sarcoma
Trick for diaphyseal Origin of Bone tumor
'FADOOES’
F-Fibrous Dysplasia
AD-admantinoma
OO-Osteoid Osteoma
ES-Ewing Sarcoma

Trick To Remember Metaphyseal origin of bone Tumor

'OOANU’
O-Osteochondroma
O-Osteosarcoma
A-Aneurysmal Bone cyst
N-Non ossifying Fibroma
U-Unicameral Bone cyst
Trick to Remember pulsatile bone tumor
'GOA ME RENT’
G-Giant cell tumor
O- osteosarcoma
A- aneurysmal bone cyst
Me-Mets
From
Ren- Renal
T-Thyroid

5-25 yr Ewing sarcoma

10-20 yr Primary osteosarcoma
20-40 yr Giant cell Tumor
40-60 yr Chondrosarcoma
>60 yr Multiple myeloma
M/c Benign Bone Tumor-Osteochondroma
M/c True benign Bone tumor-Osteoid Osteoma
M/c Malignant Bone Tumor-Metastasis
M/c Primary malignant Bone Tumor - Multiple myeloma
Shepherd Crook deformity- Fibrous Cortical Dysplasia
Trap door sign/fallen fragment sign- Simple bone cyst
Onion peel appearance- Ewing sarcoma
Sunburst appearance-Osteosarcoma
Codman triangle-Osteosarcoma
Polka dot Sign on CT-Hemangioma
Soap bubble appearance-GCT
Egg shell cracking clinically-GCT
Fibrous dysplasia-Shepherd crook deformity
- Distal femur
- Metaphysis
Developmental anomaly
X ray
- Ground glass appearance- Lucency and
haziness
Rind sign - Dense sclerotic area around lucency

Associated syndrome -
-Mc cune albright syndrome –
P- Polystotic fibrous dysplasia
P- Pigmentation
P- Precocious puberty

Mazabraud Syndrome
-Polystotic Fibrous dysplasia
Intramural muscular myxoma

M/c site -Distal femur

Biopsy-Chinese letter sign
 Simple bone cyst/Aneurysmal bone cyst

SIMPLE BONE ANEURYSMAL BONE CYST

1. Meta diaphysis 1. Metaphysis
2. Cyst – clear liquid and 2. Cyst – contain blood
unilocular with giant cell

Simple bone cyst - extended curettage

- Aspiration injection
Excision and curettage
Trap door sign
Fallen fragment sign
Osteochondroma-Exostosis
Distal femur- M/c site, stop growing after skeletal maturity
Large to feel small on x ray
Cause of pain is bursitis
Hereditary multiple Exostosis
-5% can progress into chondrosarcoma
Enchondroma-M/c tumor of hand
Arise from medullary cavity
Ollier disease- Multiple enchondroma
Mafucci syndrome-multiple enchondroma + Cavernous
hemangioma
Chondroblastoma-
- Codman tumor, xray –stippled calcification
- Biopsy-Chicken wire calcification
- Distal femur -Most common site
Treatment - Excision and curettage
Osteoid osteoma- M/c true benign Tumor
Diaphyseal
Night pain, Central nidus, Release prostaglandin
Relived by taking analgesic, Mx-Radio frequency ablation
GCT-
Most common site - Distal femur
Eccentric
Females>males
Clinically-Egg shell cracking
X ray - Soap bubble appearance

Biopsy- Multinucleated giant cell

Treatment-Extended curettage
Liquid nitrogen, Bone cement ,phenol
Hemangioma
- CT -Polka dot sign
- X ray shows - Vertical striation
- Corduroy appearance
 Bone tumor part 2

Osteosarcoma
-M/c bone tumor in children in 2nd Decade
Types – Primary, Secondary
Primary - Occurs in 10 to 20 yrs of age
Secondary Osteosarcoma- occurs in 40 to 60 yrs of age
Bone forming Tumor

Radioresistant
M/c radiation induced bone tumor-
Radiation induced osteosarcoma - after 10 yr of
exposure
Codman triangle-Elevated periosteum
Metastasis to lungs

Sunburst appearance
On x ray
Treatment- Chemo
Amputation
Chondrosarcoma-
Popcorn appearance
hyperglycaemia
Radio n chemo resistant
Treatment-Surgery,
Ewing sarcoma-
M/ c tumor of 1st decade
Diaphyseal origin
Onion peel appearance on x ray
11'22 t translocation,mic 2 (CD 99)PAS -+

Chordoma-
seen in sacrum
Physalliferous cells of primitive notochord

Adamantinoma-
diaphyseal
M/c site-Tibia
Soap bubble appearance
Treatment- wide resection
Characteristics of secondaries-

Purely blastic -

- P- prostate

- C-Carcinoids

- M-Medulloastoma

Purely lytic -

– Kidney

Thyroid

Breast - lytic n mixed

 BONE INFECTION
Osteomyelitis- Infection of bone
Septic arthritis - infection of joints
M/c route -Hematogenous
All 'Most common' from Acute Osteomyelitis which
can be asked in Exam
'EK HUMAN K CSF Me PAANI HEIN’
EK-Eiknella - 'Human' bite causing Osteomyelitis
M/C Organism
C-Chronic Osteomyelitis-M/C complication of Acute
osteomyelitis
F-Femur bone-M/C bone involved in Children in
Acute Osteomyelitis
Me-Metaphysis - most common location for
osteomyelitis PA- Pasteurella - ANI-Animal bite
causing Osteomyelitis M/C organism He-
Route of infection
- Hematogenous
- Direct
Stap aureus: - Most common organism
Metaphysis of bone
In Infant- femur affected
Adult- Vertebra
Metaphysis- Hair pin loop
Because it is Most vascular
Periosteum synthesis new bone - Periosteal reaction
MRI- earliest
Bone scan can be used
Gold standard- biopsy
Sickle cell disease - salmonella
Acute osteomyelitis-Before formation of
sequestrum
Chronic osteomyelitis-After formation of
sequestrum
Wbc increased
ESR, CRP increased
Complication of acute OM- Chronic Osteomyelitis
Acute osteomyelitis-Fever ,Pain
Chronic Osteomyelitis-Sinus
Seuestrum-Hallmark
Sequestrum-Dead bone seperated from normal

bone,curettage till fresh bleed-Paprika sign

Treatment - Sequestrectomy

Involucrum -New bone that contain infection

Cloaca-Opening in involucrum through which pus

came out through sinus

Investigation -MRI earliest to diagnose
Gold standard -Biopsy

Treatment -Antibiotics

<2 weeks - Acute osteomyelitis

2-4 week -Subacute osteomyelitis

Greater than 4 weeks- chronic osteomyelitis

Complication of Acute osteomyelitis-Chronic

osteomyelitis

Chronic osteomyelitis > 4 weeks of infection

 Sequestrum

BURA COP FIVE COAT COCA TUPKA RIA HAIN

BU-BUTTON HOLE SEQUESTRUM RA- Radiation

CO -Coralliform sequestrum -P-Perthe's disease
FI-Fine sandy VE-Viral osteomyelitis
COA-Coarse sandy sequestrum T-TB
CO-Coke sequestrum CA-cancellous bone
TU-Tubular sequestrum P-pyogenic Osteomyelitis
RI-Ring sequestrum- A-amputation sequestrum

Treatment of Chronic OM-

Sequestrectomy
Debridement n curettage
Brodies abscess-
1. Localized sub acute ostromyelitis
2. Long bone involved
3. Intermittent pain
4. Local tenderness
5. X ray – lytic lesion, sclerotoic rim
6. S.aureus in 50%

GarRe Osteomyelitis
7. Active periosteum proliferation
8. Formation sub periosteal bone
9. No purulent exudate

Septic Arthritis-
- infection of joint
- Seen in infants
- Mostly of hip
- Stap aureus
- Hematogenous spread
- Treatment- Arthrotomy,antibiotics
- Tom smith arthritis- septic hip in infancy
- Transient synovitis of hip-self limiting
TB -Most commonly involve Vertebra-POTT spine
Paradiscal –M/c type
Earliest symptom-Pain
IOC-MRI
Complication-POTTs Paraplegia
Treatment-Middle path regimen,ATT

TB HIP stage-

1 synovitis

2 early arthritis

3. Late arthritis

4. wandering acetabulam

5. fibrous ankylosis
Osteochondrities- Avascular necrosis occuring

at junction of bone and cartilage

KONA - KO- Kohler disease - NA-Navicular bone

KILU-KI- Keinbock's disease-LU- lunate

PANCA- PAN-Panner disease-CA-Capitulam

OT-O-Osgood schaltter disease- T-Tibial tuberosity

Freiberg Disease-2nd Metatarsal Head

Iselin Disease- 5th Metatarsal Base

Severe’s Disease-Calcaneal epiphysis

Scheuermann disease-Ring epiphysis of Vertebra

 “SPINE”
Spine trauma-
Stable injuries-can be managed conservatively
Unstable injuries-requires decompression and fixation
Movement of spine-Flexion,Extension,rotation,Translation,lateral flexion
M/C mode of injury-fall from height
M/C mechanism of injury-Flexion
M/c site of fracture-Lower thoracic D12
Jefferson fracture-fracture of C1 vertebra anterior and posterior arches
Hangman fracture-Fracture dislocation of C2 over C3
Whiplash Injury-Due to Hyperextension due to impact from back
Clay Shoveler fracture-fracture of spinous process
Chance fracture-Horizontal spine injury that occur when spine is flexed and
distracted
Mx of spine injuries-ATLS protocol,logroll method,Steroids
PIVD- prolapsed intervertebral disc prolapse
Disc bulges out posteriorly
M/C location-L4-L5>L5-S1

Predisposing factor-untrained young adult lifting heavy weight or sitting bending forward
Clinical features-pain starting from back raditing to limbs

Types-Paracentral,Lateral,Central
Dx-Straight leg raising test
Flexion beyond particular point causes pain

Spondylolisthesis-Vertebra slips over one another

M/C location-L5-S1

Spondylolysis-fracture in pars Intra articularis

Spondylitis-inflammation of spine
Spondylolisthesis-Slipping of one vertebra over another
Spondylosis-Pars inartericularis fracture
Scoliosis-Lateral Deviation of spine
Lordosis-Bendind spine backward
Kyphosis-Bending Spine forward
Bone Physiology-
- Bone -Organic
- cells
- osteoblast, Osteoclast, Osteocyte

Inorganic - 60-65%
Calcium phosphate

Organic
- Protein matrix 90-95%
- Collagen 1
- Osteocalcin
- Osteonectin
Osteoblast
- bone formation
Osteoclast
- bone resorption
Osteocyte
- mature osteoblast
 Bone markers
- Procollagen 1
- Osteocalcin
- Osteonectin

Bone breakdown markers

- Hydroxyproline
- Hydroxylysine
N and C telopeptide

Type of bone
- Spongy
- Cancellous Compact
- Cortical bone
Bone Graft
- Iliac crest
Osteogenesis
Osteoconduction
Osteoinduction
Osteoblast -Bone forming cell
Osteoclast -Bone resorption cell
Osteocyte-Remnant of osteoblast
Bone forming marker-procollagen 1 Osteocalcin
Breakdown marker- Hydroxyproline Hydroxylysine

Traumatic fracture pattern

1.Transverse
2. oblique
3. spiral
4. communited
5. segmental
Stage of fracture healing

Hematoma formation

Granulation tissue

Callus formation

Consolidation

Bone remodelling

Non union > 9 month

Hypertrophic

Atropic

Oligotropic
Open Fracture-fracture with wound

Gustilo Anderson Classification used-

Type 1-wound <1cm long

Type 2-wound 1-10 cm but without soft tissue stripping

Type 3-A wound >10 cm with gross contamination

Type 3B – soft tissue damage along with peiosteal

stripping

Type 3C- vascular injury with large wound

Most Important Named fracture
1-Galleazi fracture- distal 1/3 of radius fracture with DRUJ
disruption
2-Monteggia fracture-proximal1/3 of ulna fracture with
radial head dislocation
3-colle's fracture- DER fracture with distal fragment
dorsally displaced
4-smith fracture-DER fracture with distal fragment volarly
displaced
5-barton fracture-Intraarticular DER with distal fragment
dorsally and ventrally displaced with carpal subluxation
6-chauffer fracture-isolated radial styloid fracture
7-bennet fracture-intraarticular 1st metacarpal partial
fracture
8-Rolando fracture-intraarticular 1st metacarpal
fracture complete fracture
9-Boxer fracture- 5th metacarpal neck fracture
10-Bumper fracture- lateral condyle of tibia
fracture
11-Runner fracture- stress fracture of fibula
12-pott's fracture- medial and lateral malleolus
fracture
13- cotton's fracture- medial,lateral,posterior
malleolus fracture
14- Nightstick fracture- minimal displace fracture
of ulna
15 Holestein lewis- distal 1/3 of humerus fracture
with radial nerve entrapment
Q1. What is this type of Amputation called?
 Below knee:
 Above Knee
 Lisfranc's .
 Chopart's

q2. Q. A child sustained an injury as shown in the below radiograph. What is the
classification used and what is the grade?
 Gartland's classification, Type IV
 Salter Harris classification, Type III
 Salter Harris classification, Type IV
 Garland's classification, Type III

Q3. The following device was used to fix the left proximal femur fracture. Identify
the implant?
 Dynamic Hip screw
 Dynamic condylar screw
 Dynamic Trochanteric plate
 Limited contact condylar plate
NEET PG 2024
Q4. An 18 year old boy complains of fever, and pain in the lower limb. There
is localized rise of temperature and tenderness in the region shown in the
radiograph. ESR is raised. What is the most probable diagnosis?
 Ewing's sarcoma
 Osteomyelitis
 Osteosarcoma
 Germ cell tumour
Q5. 8-year-old child has fever with pain and swelling in mid-thigh. Xray
Reveals Lamellated appearance and Codman's triangle. Histopathology shows
small round cell tumor positive for MIC-2. The Diagnosis is?
 Osteosarcoma
 Ewing's sarcoma
 Chondroblastoma
 Multiple myeloma
Q6. A young lady after intense workout of lifting heavy weights, presents to you
with a lower back ache involving right hip and radiating to right ankle. MRI
shows the following finding. What nerve root is likely to get involved?
 L3
 L4
 L5
 S1
Q7. A patient met with road traffic accident and complains of severe back ache. X-
ray is as shown below. What fracture does the patient have?
 Chance fracture
 Burst fracture
 Compression fracture
 Fracture of spinous process

Q8. A patient sustained a fracture of the base of the fifth metatarsal in left foot. He
was advised below knee pop cast. How long should the cast be used?
 6-8 weeks
 2-3 weeks
 3-5 weeks
 16-20 weeks

Q9. A fracture line passing through which of these will impair longitudinal growth of
the bone.
 Epiphyseal plate
 Epiphysis
 Metaphysis
 Diaphysis
Q10. A child fell while playing and a Cast was applied. On removal of the cast the
following deformity was seen. What is the most likely injury to have caused this
deformity?
 Supracondylar humerus fracture
 Radial Head fracture
 Lateral Condyle Humerus #
 Mid shaft # of humerus
Q11. A 10 year old child fell down the stairs. X-ray was done. Identify the structure
injured as marked in the X-ray.
 Medial tubercle /
 Tibial tuberosity
 Gerdy's tubercle
 Anterior intercondylar area

Q12. A 56 year old woman presented with chronic lower back pain. CT of lower
back shows the following findings. Identify the diagnosis.
 Renal osteodystrophy
 Spinal TB
 Spondylolisthesis
 Spinal metastasis
Q13. Patient presented with a twisting injury of the knee. No bony injury was
noted. Identify the test being performed.
 Lachman's test
 Anterior drawer test
 Posterior drawer test
 McMurray's test

Q14. A 56-year-old woman with history of pathological fracture of neck of femur.

She has elevated ALP and N-Telopeptide. Her DEXA scan confirmed a diagnosis
of osteoporosis. Which of the following would be raised?
 Tartrate resistant acid phosphatase
 Aspartate aminotransferase
 Alanine transaminase
 Lactate dehydrogenase

Q15. A child sustained a fracture after a fall. It was corrected and X-ray was
taken post correction. By which of the following mechanisms will healing
occur?
 Primary healing
 Secondary healing
 Creeping substitution
 Intramembranous ossification
Q1) What is the correct pair for the image shown below?
 Knuckle bender splint, Ulnar Nerve
 Knuckle bender splint, Median Nerve
 Cockup splint, Radial Nerve
 Turnbuckle splint, Volkmann ischemic contracture

Q2) A Female patient complains of tingling and numbness in lateral 3 &

half fingers, she usually wakes up in the night because of pain. She gets
relief by hanging her hands at the edge of the bed What is the correct pair
NEET PG
of diagnosis and the clinical test that can be performed?
 Carpal tunnel, Froment sign 2023
 Guyon canal syndrome, Durkan test
 Carpal tunnel, Durkan test
 Guyon canal syndrome, Froment sign

Q3) A patient complains of knee pain for last 3 months. There is no

history of trauma. Following is her Radiograph. What is the correct pair
of diagnosis and management?
 Avulsion fracture of patella- tension Band wiring
 Fracture of upper pole of patella Cast Placement
 Avulsion fracture of patella- Interfragmentary screw fixation
 Bipartite Patella- Advise Xray of another knee
Q4) A 22-year-old female presented with swelling in forearm. Radiograph is
given below. What is the likely Diagnosis?
 GCT
 Aneurysmal bone cyst
 Chondroblastoma
 Osteochondroma

Q5) A Child presents with deformity in the lower limbs. Radiograph is shown
below. He also has hypopigmented patches on the skin. What is the likely
diagnosis?
 Fibrous dysplasia
 Non ossifying fibroma
 Paget's Disease
 Osteogenesis imperfecta
Q1) An intrauterine scan at the 13th week showed a fetus with multiple long
bone fractures. What is commonly associated with this finding? Antenatal USG
showing multiple fractures of long bones. Which of the following is the most
possible diagnosis?
 Achondroplasia
 Osteogenesis imperfecta
 Cretinism
NEET PG
 Marfan syndrome
2022
Q2) A patient sustained a crush injury in lower limb and was managed as shown
in the image below. The procedure was indicated for which of the following?
 Femur fracture fixed with Ilizarov
 Tibia fracture fixed with a spanning fixator
 Femur fracture fixed with a spanning fixator
 Periarticular knee fracture, fixed with a spanning fixator

Q3) A child was brought to the OPD following a fall on the RIGHT shoulder
while riding a bicycle. He was holding his RIGHT arm with his LEFT hand.
What is the most likely injury sustained by him?
 Fracture of Acromion
 Lateral border scapula fracture
 Proximal humerus fracture
 Fracture of Clavicle
Q4)A 6 years old child has sustained an injury and his X ray is shown. Identify
the best choice which marks the delayed set of complications seen in this injury
 Median nerve, Cubitus valgus
 Damage to ulnar nerve, nonunion
 Radial nerve, Myositis ossificans
 Non union and cubitus varus
Q5)A male child was brought in with previous history of URTI and Headache. He
currently has fever, fatigue and pain on walking for which USG and joint fluid
aspiration was done and antibiotics were given. Xray shows a lytic lesion in the
lower end of femur, The Peripheral SMEAR shows the following finding.
What is the most probable organism that can be isolated from the joint aspirate?
 E. coli
 Salmonella
 Staphylococcus aureus
 Streptococcus
Q6) A 40 y/o F presented with presented with multiple swelling in hand and wrist.
Following finding was seen on x - ray. What is likely Diagnosis?
 Multiple exostosis
 Multiple brown tumors
 Multiple enchondromas / Olliers disease
 Multiple fibrous dysostosis
Q7) RTA patient presents with multiple injuries, after 2 days develops dyspnea,
petechiae involving the whole body, low saturation (80%?), low blood pressure.
What is the likely diagnosis?
 Thromboembolism
 Fat embolism
 Pulmonary hypertension
 D. Air embolism

Q8) Q. An RTA Patient presented to the emergency department for this fracture.
Which is the next step in management ?
 NV assessment and CR and slab application
 NV assessment and CR and cast application
 NV assessment and immediate surgery
 NV assessment and immediate open reduction
Q1) The following test is performed to assess:
 Posterior interosseous nerve
 Median nerve
 Ulnar nerve
 Musculocutaneous nerve

Q2)A patient was brought to the hospital with complaints of pain around the left hip
joint following a road traffic accident. On examination, the affected limb was flexed,
adducted and medially rotated with obvious shortening. What is the most likely
diagnosis?
 Anterior dislocation of hip
 Posterior dislocation
 Transcervical fracture
 Intertrochanteric fracture
Q3) A 5-year-old child was brought to the pediatrician with complaints of bilateral
knee joint pain. His bone mineral density is normal. X-ray image of the joints is
given below. What is the most likely diagnosis?
 Rickets
 Scurvy
 Metaphyseal dysplasia NEET PG 2021
 Pyknodysotosis
Q4) A 60-year-old postmenopausal female with previous history of colles fracture
came with complaints of lower backache. On evaluation, her T score was -2.5.
Which of the following statements are false about the management of her
condition?
 Teriparatide should be started before supplementing with bisphosphonates
 Bisphosphonates are not given for more than a year
 Calcium requirement is 1200 mg per day
 Oral vitamin D3 is given along with oral calcium
Q5) A 20-year-old male patient presented with a history of lower backache and early
morning stiffness for two years, He also gave a history of bilateral heel pain for 6
months. Which of the following is the most likely diagnosis?
 Mechanical back pain
 Ankylosing spondylitis
 TB Spine
 Disc prolapse
Q6) A 28-year-old man presented with complaints of backache, morning stiftness and
redness of the eyes. X-ray image of the spine is given below. Which of the following
is the most likely diagnosis?
 Rheumatoid arthritis
 Ankylosing Spondylitis
 Osteopetrosis
 Paget's disease
Q7) A 30-year-old male patient presented with complaints of a gradually progressive
swelling around his wrist joint for 3 months. Given below is the image of the swelling and
the X-ray film. What is the most likely diagnosis?
 Ewing's sarcoma
 Osteosarcoma
 Osteoclastoma
 Osteochondroma

Q8) An old lady slipped and fell at home. She was diagnosed with a Colles fracture and
managed with a POP cast. What is the correct sequence of reduction?
 Traction, Ulnar deviation, Palmar flexion, POP
 Traction, Palmar flexion, Ulnar deviation, POP
 Traction, POP, Palmar flexion, Ulnar deviation,
 Palmar flexion, Ulnar deviation, Traction, POP
Q9) Match the name of the fracture with the site
 A - 1, B - 2, C - 4,D-3
 А - 1, В - 4, С - 3, D - 2
 A - 1, B - 3, C - 2, D-4
 A - 1, B - 2, C - 3, D- 4
Q10) 15-year-old boy was brought to the ER following a motor vehicle collision
complaining of pain over the hip. The x-ray is given below. What is the next step of
management?
 Closed reduction and assessment of hip stability
 CT and 3D reconstruction
 High weight skeletal traction
 Open reduction and Posterior pillar of acetabulum reconstruction
Q11) Which of the following is seen in osteoporosis?
 Calcium normal and ALP increase
 Calcium normal and ALP normal
 Calcium decreased and ALP normal
 Calcium increased, ALP increased
Q12) Which of the following findings appear late in compartment syndrome?
 Pallor
 Pulselessness
 Paralysis
 Pain on passive stretch
Q13) Which of the following is true about an open fracture?
1. Tibia and phalanges are most commonly involved
2. Usually no co-existing injuries
3. Compartment syndrome does not occur in open fractures
4. Early debridement should be done
 1 and 4
 1 and 2
 2 and 4
 2 and 3
Q1) Hyper extension at MCP and flexion of IP joints in hands is suggestive of
injury to
 Adductor pollicis
 Abductor pollicis brevi
 Interossei and Lumbrica NEET PG
 Extensor digitorum

Q2) Shown angle in the image is known as

2020
 Cobb's angle
 Bohler's angle
 Ferguson angle
 Bauman's angle

Q3) Patient is presenting with pain around base of the thumb. What are the two
marked tendons
in the image.
 APB and EPL
 APL and EPB
 APB and EPB
 APL and EPL
Q4) Patient is presenting with deformity of the finger as shown. The PIP is
involved but
 DIP is spared
 Osteoarthritis
 Rheumatoid arthritis
 Psoriatic rthritis
 Ankylosing spondylitis

Q5) Most commonly drug for osteoporosis in a postmenopausal female is

 Bisphosphonates
 Estrogen
 Raloxifen
 denosumab

Q6) What is the most likely diagnosis of a 55 years old female complaining of
chronic back ache
 Osteoporosis
 Hurler's syndrome
 Paget's disease
 Renal osteodystrophy
Q7) What is the most likely age of this child, a victim of rape being examined under
POSCO act (**Pisiform was absent, rest all carpals were seen)
 4 years
 7 years
 10 years
 13 years

Q8) A 4 year child while playing suddenly spinned around his elbow from her
servant maid’s hand and now continuously crying and not allowing anyone to touch
the elbow. He is keeping the elbow in extended state. What is the most likely
diagnosis
 Radial head fracture
 Pulled elbow
 Supracondylar fracture
 Elbow dislocation

Q9) What is the most likely diagnosis for the image shown
 Popeye' sign
 Griesinger sign
 Rising sun sign
Q10) A patient received 12 hours after fracture of tibia is having Pa02 as 60%. On
rebreathing unit maintaining the saturation of 100%, but remains confused. Chest
is clear. What is most likely diagnosis
 Pulmonary contusion
 Fat embolism syndrome
 Pulmonary symbolism

Q11) Patient aged 30 years presented with swelling around knee. Aspirate shows
giant cells and mononuclear cells. Most likely diagnosis is
 GCT
 Osteosarcoma
 Chondroblastoma
 Ewing's sarcoma

Q12) History of arthritis with involvement of PIP and DIP and lst
MCP and sparing of wrist and ankle diagnosis asked
 Osteoarthritis
 RA
 Psoriatic arthritis
 Gout
 INICET NOV. 2024

1) Q. A 40-year-old male comes with intracapsular fracture of femur. What is the surgery
of
choice?
 Open reduction internal fixation
 Closed reduction internal fixation
 Hemiarthroplasty
 Total Hip Arthroplasty
2) Q. During walking, the hip bone on the side of the suspended leg is raised by the action of
which muscle present in the supporting leg?
 Gluteus Medius
 Gluteus maximus
 Obturator internus
 Quadratus femoris

3) Q. Injury to the posterior interosseous nerve leads to?

 Loss of extension of digits
 Loss of extension of wrist
 Loss of supination
 Wrist drop
4) Q. A 35-year-old patient presents with complaints of back pain, stiffness and recurrent
episodes of Uveitis. Imaging done was suggestive of Sacroiliitis. Which of the following HLA
is commonly involved?
 HLA DQB1
 HLA DR3
 HLA B27
 HLA DR4

5) Q. FRAX is related to:

 Fracture risk assessment
 Fracture rehabilitation assessment
 Fracture repair assessment
 Fracture reduction assessment
1) Q. Which layer is affected in Salter Harris type 1 fracture?
 Through the whole of epiphysis
 Hypertrophic zone of the growth plate
 Resting zone of the growth plate
 Calcific layer of the growth plate INICET MAY. 2024
2) Q. Which of the following is the most common site of osteoporotic fracture?
 Vertebra
 Glenoid
 Subtrochanteric fracture
 Mid shaft of humerus
3) Q. A 75 year old man presents with a fracture of intracapsular neck of femur. What
is the "standard of care" for this patient?
 Boot and bar cast
 Russell's traction
 Hemiarthroplasty
 Intramedullary nailing

4) Q. A 70 year old female presents with extracapsular neck of femur fracture. What is
the best management?
 Boot and bar cast
 Russell's traction
 Hemiarthroplasty
 Intramedullary nailing
5) Q. A 26 year old female presented with proximal one-third fracture of shaft of
femur. What is the treatment of choice?
 Intramedullary nailing
 Above knee slab
 Hip spica
 Above knee cast

6) What is the diagnosis of the following X-ray?

 Tibial condyle fracture
 Hemarthrosis of knee joint
 Patella #
 Rheumatoid Arthritis

7) A 22 year old came with thigh pain. X-ray was done as shown below. What is the
diagnosis?
 Osteosarcoma
 Osteomalacia
 Chronic osteomyelitis
 Ewing's sarcoma
8) Q. Which of the following is false about Ankylosing Spondylitis?
 Affects males more than females
 Begins at the age of early 20 years and is rarely seen after 40 years
 In 85-95% patients, HLA-B27 is positive
 Non-Erosive arthritis of the joint with sclerosis is seen
1) Q. True statements about bankart lesion?
 Avulsion of the anteroinferior glenoid labrum
 Avulsion of the anterosuperior glenoid labrum
 Depression in posteroinferior part of the head of the humerus
 Depression in posterosuperior part of the head of the humerus
INICET NOV. 2023
2) Q. Three-point bony relationship of the elbow will not be damaged in?
 Supracondylar fracture humerus
 Intercondylar fracture humerus
 Elbow dislocation
 Lateral epicondyle fracture

3)Q. Choose the true statements:

i. Most commonly fractured carpal bone is the lunate
ii. Scaphoid is most commonly fractured at the waist
iii. The cast for scaphoid fracture is set in a glass-holding position
iv. Kienböck’s disease is due to osteonecrosis of the lunate
 ii, ili and iv only
 i, iii only
 iii, iv only
 i, ii only
4)Q. A female patient presented with swollen and tender joints. There is symmetric involvement
of multiple joints such as wrists, hands, and feet, which is bilateral, along with morning stiffness
lasting more than 1 hour. Erythema is absent. What is the most probable diagnosis?
 Gout
 Rheumatoid arthritis
 Osteoarthritis
 Psoriatic arthritis

5) Q. What type of gait will be seen following a fracture in this region?

 Waddling
 High stepping
 Wide-stepping gait
 Stamping

6) Q. Hawkin's classification is used for which fractures?

 Talus
 Navicular
 Tibia
 Calcaneum
1) Q. A 25-year-old male had an injury in his arm and presented with symptoms of inability
to flex the distal interphalangeal joint of the 4th and 5th digits. He was also not able to hold
a piece of paper between his fingers. What is the likely site of injury
С
A
D
B
INICET MAY 2023
2) Q. A 14-year-old male presented with a mushroom like tumor in the distal femur for the
past 2 years. Which of the following features will help the clinician to identify a malignant
transformation?
 Initially growth of the tumor was away from the joint, now tumor growth is towards the
joint
 Hyaline cap thickness on MRI is 2cm
 Tumor does not have malignant transformation potential
 Tumor is in continuation with bone marrow cavity of the normal bone
3) Q. A 14-year-old girl presents with multiple swellings & multiple brown rashes. She has
increased uptake on bone scan over femur, skull & ribs. Biochemical parameters are
abnormal. She also has a history of hypothyroidism. Following is her Xray. Which of the
following is the likely diagnosis?
 Neuroma with bone involvement
 Papillary carcinoma of thyroid
 McCune Albright syndrome
 Langerhans cell histiocytosis
4) Q. A Patient came with history of RTA and shaft of femur fracture. Patient was
stabilized. After 12 hrs, he developed sudden onset breathlessness, confusion and
petechial skin rashes over axilla & chest. What is the probable diagnosis?
 Fat embolism
 Head injury
 Blunt trauma to chest
 Hemorrhagic shock

5) Q. A patient has sustained a pelvic fracture in an RTA and is bleeding and is in shock.
Immediate management for this case should be?
 Immediate internal fixation
 Immediate external fixation
 Give blood transfusion
 Tie a bed sheet around the pelvis

6) Q. A 25-year-old man sustained a shoulder injury & presented with swelling of

shoulder. Xray is shown below, Which is/are the ligaments) injured?
 Acromio clavicular ligament
 Coraco acromial ligament
 Coraco humeral ligament
 Both Acromio clavicular & Coraco clavicular ligament
1) Q. A 65 years old postmenopausal female came with persistent backache not responding
to conservative treatment. History of lifting heavy weight 4 months back with progressively
increasing pain that worsens on walking. The pain starts radiating down her legs after
walking for around 100m distance, she however feels no pain on climbing up the stairs,
most probable diagnosis is ?
 Osteoporotic Vertebral compression fracture
 Lumbar canal stenosis INICET NOV. 2022
 Atherosclerosis
 Buerger's disease / Thromboangitis obliterans
2) Q. Book test is used to assess the function of adductor pollicis, Which of the following
nerve supplies the muscle?
 Median Nerve
 Ulnar nerve
 Posterior interosseus nerve
 D. Radial Nerve

3)Q. 6 years old boy sustained fracture lateral condyle of humerus, gradually developed
elbow deformity, which of the following are the likely outcomes ?
 Ape thumb deformity
 Pointing index
 Kiloh nevin sign
 Inability to adduct the fingers
4) Q. A Patient had difficulty climbing upstairs, when he was made to bear weight on right
lower limb, the pelvis of the left side dropped down. Which is the structure involved
causing this problem?
 Right superior gluteal nerve
 Left superior gluteal nerve
 Right inferior gluteal nerve
 Left inferior gluteal nerve

5) Q. Name the nerve that is likely injured in the following Fracture ?

 Sciatic nerve
 Common peroneal nerve
 Femoral nerve
 Tibial nerve

6) Q. Which of the following is incorrect about lesion shown on the image? 30% malignant
transformation
 Epiphyseal
 Ground glass opacity is diagnostic
 Can occur in Metaphysis in children
 Most Commonly Occurs in ages 40 to 60 years
7) Q. You visit a newborn near your house & Identify that the child has CTEV. When will
you advice the baby's parents to put a cast? Q. You see a child with CTEV, when will you
ask the parents to seek treatment (First cast
application)?
 1 year of age
 3 months of age
 2 weeks of age
 When the child starts walking
8) Q. Patient standing on one side has Trendelenburg sign positive, What is the Action of
the muscle tested in Trendelenburg test ?
9) Q. What is not required in an emergency management of an open femur fracture ?
 Open Reduction Internal Fixation
 Closed Reduction External Fixation
 Antibiotic Coverage
 Open Reduction External Fixation

10) Q. Open fracture of femur - What is the Treatment?

 Closed Reduction & Internal fixation
 Open reduction & internal fixation
 Open reduction & external fixation
 Closed reduction & external fixation

11) Q. Feature of Klumpke's Palsy involving the lower trunks lead to ?

 Wrist drop
 Ape thumb deformity
 Claw hand
 D. Policeman tip deformity

12) Q. A 35-year-old man presented with knee pain. The X-ray of his knee joint is
given below. What is the probable diagnosis?
 Chondroblastoma
 Osteochondroma
 Osteoclastoma
 Fibrous dysplasia
13) Q. First deformity corrected in CTEV ?
 Cavus
 Forefoot adduction
 Varus
 Equinus

14) Q. A Child comes to you with difficulty in walking. Labs show ALP is 1322IU. What is
your likely diagnosis?
 Osteomalacia
 Osteogenesis imperfecta -
 Rickets
 Paget's disease

15) Q. Which of the following marked structures affected in the terrible triad
 A, B, D
 A, E, D
 А, В, С
 F, E, D
16)Q. Terrible triad includes injury to?
 ACL alone:
 ACL & Medial collateral ligament
 Lateral Collateral ligament
 ACL, Medial collateral ligament & Medial Meniscus
1) Q.Anterior dislocation of the shoulder is likely to result in the damage of which of the
following nerves?
 Axillary nerve
 Median nerve
 Radial nerve
 Suprascapular nerve INICET MAY. 2022
2) Q. Which of the following is false regarding hip dislocation?
 Posterior dislocation of hip has flexion and adduction
 Vessel injury more common in anterior
 Nerve injury more common in anterior
 Posterior dislocation is more common than anterior
3) Q. Most common pattern of Pott's spine involvement is
 Paradiscal
 Central
 Anterior
 D. Posterior
4) Q. 60-year-old patient presents with limping gait and left hip pain. What is the
likely diagnosis?
 TB hip
 RA
 Ankylosing spondylitis
 AVN

5) Q. A 10-year-old child comes with a swelling in the tibial diaphysis, Xray shows
reaction on the surface of the bone, Biopsy of the lesion shows small round cells and
MIC2 mutation. What is the likely diagnosis?
 Ewing Sarcoma
 Clear Cell Osteosarcoma
 Neuroectodermal Tumor Metastasis
 ALL