Corrections in Maheshwari-

M/C # at birth--> Clavicle

Thurston Holland sign--> Salter harris type 2
M/C nerve injury in supracondylar # -->
nt! interosseous nerve
Median
"adial
#lnar
Cast in CT$%--> bove &nee cast
28. Which of the following about facial bone fractures is not true-
'! Ma(illary #)s are classi*ied into +e-*ort #s
2! +e *ort ,, # which involves *loor o* the orbit is also called blow out # ------ans
-! Tear drop sign is a *eature o* blow-out *ractures
.! Tripod # is the *ractures o* /ygo0a
1iscussion- 21hingra3 '456
7low out #
only orbit o* eye is involved2not 0a(illary bone6
Tear drop sign28-"ay *inding6--> "(9 Caldwell luc S(
46.Hypophosphatemic rickets: all are true except-
'!Secondary hyperparathyroidis0-----ans
2!1e*ect in :CT o* &idneys
-!;o "achitic rosary
.!8 - lin&ed do0inant
1iscussion-hypophosphete0ia-->dentin part is e**ected
Synovial *luid e(erts an inhibitory e**ect on bone union by dissolving the callus!
7rittain<s procedure 9 e(traarticular arthrodesis o* hip joint usually per*or0ed *or tuberculosis o* the hip joint!
This involves sub-trochanteric osteoto0y and place0ent o* a tibial cortical gra*t across the osteoto0y site into
the ischiu0= and then application o* a hip spica! ,nternal *i(ation is >not used!
unlop!s traction is used in--> supracondylar *racture hu0erous
7owler<s thu0b - perineural *ibrosis due to repeatative co0pression o* digital nerve o* the thu0b while grasping
ball!
"ompartment syn#rome- Most co00only a/w >supracondylar *racture o* the hu0erous and tibial sha*t! +ac&
o* pulse rarely occurs in patients= as pressures that cause co0part0ent syndro0e are o*ten well below arterial
pressures and pulse is only a**ected i* the relevant artery is contained within the a**ected co0part0ent
$olkman!s sign >- ,t is possible to e(tend the *ingers only when wrist is *le(ed 2:-?5 Maheshwari6
M/C site o* injury in swi00ers- shoulder
$(cision o* head o* the radius in children- :ro(i0l 0igration o* the radius resulting in >sublu(ation o* the
in*erior radio-ulnar joint and instability!
%ump sign- tenderness with withdrawal 2grading used in so*t tissue tenderness6
&ulge sign - Seen in &nee e**usion 2also called ballot0ent o* patellae6
@anavel<s *our cardinal signs *or tenosynovitis-
'! Ainger is uni*or0ly swollen
2! Ainger held in slight *le(ion *or co0*ort
-! Course o* in*la0ed sheath is 0ar&edly tender
.! :assive *inger e(tension causes intense pain 2Highly sensitive *or *le(or tendon in*ection6
@anavel<s sign does not include high te0peratre though it 0ay be present!
;ight cries are characteristic o*--> Tubercular arthritis
cro-osteolysis seen in S+$!
+i0ping in a Child!!!! - 0ost co00on cause and they occur in - di**erent age groups!!!!
Congenital hip dysplasia - B-- years= 1( by Crtolani test and #ltrasound!!!!!!!
+egg-:erthes - .-? years= avascular necrosis o* *e0oral head !!!painless initially!!!! later pain appear!!!!:ain
0ay be re*erred to &nee!!!!!!
Slipped capital *e0oral epiphysis - >'' years obese adolescent= thin& de*icient gonads 2 ndrogens causes
closure o* epiphysis 6 :ain 0ay be re*erred to &nee!!!!!!
To0 s0ith arthritis o* hip joint is d/t9 :yogenic in*ection
The only di**erence b/n endochondral and intra0e0branous ossi*ication is the >microen'ironment in which
bone *or0ation occurs! The bones *or0ed can not be distinguished 0icroscopically or 0acroscopically!
,ntra0e0branous ossi*ication - ,n *lat bones o* the s&ull= bone *or0ation occurs through the
di**erentiation o* osteoprogenitor cells *ro0 0esoder0 and is acco0panied by vascularisation
$ndochondral ossi*ication - Csteoprogenitor cells di**erentiate into chondrocytes and establish a cartilage
0odel o* long bones which is used as a sca**olding *or bone *or0ation!
(soriatic arthropathy-
:resentation is li&e "2a polyarthritis but with distal ,: joints o* hands involved6
Classic s&in lesions
"adiography- 1,: involve0ent= including the classic Dpencil-in-cupD de*or0ityE 0arginal erosions with
adjacent bony proli*eration 2Dwhis&eringD6E s0all-joint an&ylosisE osteolysis o* phalangeal and 0etacarpal
bone= with telescoping o* digitsE and periostitis and proli*erative new bone at sites o* enthesitis! There is cup-
li&e erosions and bony proli*eration with e(pansion at the base o* the ter0inal phalanges and tapering o* the
pro(i0al phalanges!
"(9 Steroids
)harpey!s fibres 2bone fibres= or perforating fibres6 are a 0atri( o* connective tissue consisting o* bundles o*
strong collagenous *ibres connecting periosteu0 to bone !
11H- M/C in girls= on le*t side= breech presentation20ore in e(tended breech6= *irst born child = CS
*li+aro's techni,ue principle- osteogenesis reFuires dyna0ic state--> either a controlled distraction or a
controlled co0pression
GC,;T ,;%C+%$M$;T ,; ;$#"C+CH,C 1,SC"1$"S
SI",;HCMI$+, a**ects upper li0bs jts- glenohu0eral jt= elbow and wrist
T7$S 1C"S+,S a**ects lower li0b jts- &nee= hip and an&le
1,7$T$S M$++,T#S a**ects Tarsal and Tarso 0etatarsal joint!
,;1,CT,C;S CA C:$; "$1#CT,C; "$ D;C CSTD 9
;on union
Cpen *racture
Co0pro0ise in neurovascular structures
rticular *racture
Salter harris ,,, ,% %
Trau0a
-ustilo an# .n#erson classification of open fractures
Type ,9 clean wound s0aller than ' c0 in dia0eter= appears clean= si0ple *racture pattern= no s&in crushing!
Type ,,9 a laceration larger than ' c0 but without signi*icant so*t tissue crushing= including no *laps=
degloving= or contusion! Aracture pattern 0ay be 0ore co0ple(!
Type ,,,9 an open seg0ental *racture or a single *racture with e(tensive so*t tissue injury! lso included are
injuries older than ? hours! Type ,,, injuries are subdivided into three types9
Type ,,,9 adeFuate so*t tissue coverage o* the *racture despite high energy trau0a or e(tensive
laceration or s&in *laps!
Type ,,,79 inadeFuate so*t tissue coverage with periosteal stripping! So*t tissue reconstruction is
necessary!
Type ,,,C9 any open *racture that is associated with vascular injury that reFuires repair!
Major advantage o* open redction is shorter period o* i00obilisation! He0ato0as at the site o* *racture 0ay be
i0portant *or early healingE open reduction which generally involves re0oving the clots in the *ield= could contribute
to a delay in bone healing and to non-union!
Goint disease with synovial *luid having nor0al to slightly elevated neutrophil count and nor0al 0ucin clot
study-->Csteoarthritis2C and neuropathic arthropathy are the two nonin*la00atory joint diseases!
,n*la00atory joint diseases have high neutrophil count and poor 0ucin clot test6
Third degree sprain-
o "omplete tear o* liga0ent
o C*ten the pain is minimal
o He0arthrosis is noticed within 2 hours
o Goint will open upi* liga0ent is stressed
o "eFuires surgical repair
M/C involved 0uscle in %,C--> *le(or pollicis longus=*le(or digitoru0 pro*undus
Aracture o* lateral condyle o* hu0erous is a type ,% epiphysial injury= accurate reduction is i0portant i* nor0al
growth o* the elbow is to be e(pected= and it is treated by C",A usig two @-Jires
$arliest diagnosis o* acute osteo0yelitis--> 7one scan2it shows increased blood *low to the bone at the site o*
in*ection!
Sub-0etaphyseal translucency is the classic radiologic *inding in child with leu&ae0ia!
.nkylosing spo#ylitis-
o Seronegative2negative rheu0atoid *actor6
o >H+ 7-24 positive
o ,nvolves pri0arily young 0an between '5--B yrs
o C/A-
,nsidious onset o* 0orning sti**ness in lower bac& that persists *or >-0ths and i0proves as day
progresses or with e(ercise
Sclerotic changes in the sacroiliac area are the *irst radiographic evidence o* disease! :atients
have di0inished anterior *le(ion o* the spine= which is docu0ented with the )chober
test20easure the ability o* a patient to *le( his/her lower bac&6! $ventually the vertebral colu0n
*uses to produce the classic bamboo spine/
o Seru0 ; is negative because it is not a collagen vascular disease or a variant o* rheu0atoid arthritis!
:atric& test- done *or sacroilitis!!!!!!!
%arious tests-
o 0inkelsein test/--1 chronic stenosing tenosynovitis 2de Kuervain)s test6
o 2 c2urrey test--1 evaluation o* &nee *or meniscal tears
o 3rtolani test--1 evaluates newborns *or congenital hip dislocation
4ite5s angle: > -5 degree 2reduced in CT$%6
o @ite inde(- Telocalcaneal angles in : and +ateral views
&ohler5s angle--1"educed in 0ost # o* calcaneu0
o angle b/n talus and calcaneu0
o ;--> -5 degree
&or#en!s 'iew--1 diagnosis o* >Calcaneal *ractures!
3bli,ue popliteal ligament is e(tra-articular in &nee joint!
,liac crest are the co00onest site *or ta&ing bone gra*ts!
o Jhen the gra*t is reFuired *or osteogenic purpose2as in non-union6= cancellous bone gra*ts are
pre*erred! ,t is available in plenty *ro0 iliac crests and upper end o* tibia!
o Jhen gra*t is used *or providing stability2as *or *illing bone gaps6= cortical gra*t is used! Aibulae are the
co00on source o* cortical bone gra*ts!
Aracture o* the clavicle-
o Co00on *racture o* all the age groups
o Co00on site is junction o* 0iddle L outer thir#
o Cuter *rag0ent displaces me#ially an# #ownwar#s because o* the gravity and pull by the pectoralis
0ajor 0uscle attached to it
o Shoulder sti**ness is a co00on co0plication
vascular necrosis a*ter trau0a is seen in-
o Head o* *e0ur
o :ro(i0al pole o* scaphoid
o 7ody o* talus
o :ro(i0al pole o* lunate
&asic science an# anatomy-
6. "alcium ion transport me#iate# by-
'! Csteoblast
2! Csteocyte---------------ans
-! Csteoclast
.! ll
1iscussion-
3steoblasts-
:rinciple bone *ro0ing cell! Csteoblasts are 0odi*ied *ibroblasts!
"ich in al&! :hosphate!
;or0al osteoblasts are able to lay down type-' collagen and *or0 new bone!
Aor0 ru**led borders
3steocyte-
Spent osteoblast
"ole in osteolysis 20ain role--> though all are involved6
,nvolved in Ca and other 0ineral transport
3steoclasts-
Csteoclasts= on the other hand= are 0e0bers o* the 0onocyte *a0ily!
"ich in T": 2Tartarate resistant acid phophate6
7one resoption
+ie on houship lacune
"u**led borders e(ist on osteoclast
2. "ells in howships lacunae-
'! Csteoblast
2! Csteocyte
-! Csteoclast--------------ans
.! ll
7. -uyons canal is for
'! Median nerve
2! #lnar nerve---------------ans
-! "adial nerve
.! :,;
1iscussion-
Huyton<s canal-
Content- wrist--> ulnar nerve= ulnar artery
Medially--> pisi*or0 and ha00ate *or0 the boundry
Handlebar palsy- #lnar nerve co0pressed
4. -er#ys tubercle is-
'! ttach0ent o* iliotibial band---------------------ans
2! nterior aspect o* lower end *e0ur
-! :osterior aspect tibia
.! Medial aspect tibia
1iscussion-
+ocated on upper tibia anterolateral aspect--> attach0ent o* iliotibial band
:olio--> iliotibial band contracture--> Cber test
Triple de*or0ity o* &nee--> :$"A
:- :osterior sublu(ation o* tibia
$"- $(ternal rotation o* tibia
A- Ale(ion o* &nee
Causes o* triple de*or0ity o* &nee-:$"T
:- :olio
$- $(cessive bleeding2he0ophilia6
"- "
T- T7
8. 9ip of in#ex finger is autonomous +one of-
'! Median----------ans
2! #lnar
-! "adial
.! :in
1iscussion-
;erve supply-
Tip o* inde( *inger- Median nerve
Tip o* little *inger- #lnar nerve
1orsu0 o* hand- "adial nerve
Horn<s sign- ll - nerve intact
# lnar nerve injury--> Claw hand--> use &nuc&le bender cast
Sensory supply o* hand-
Thu0b- CM
,nde( and 0iddle *inger- >C4
"ing and little *inger- C?
C4 bloc&- to chec& brachial ple(us bloc& by anesthetics
6. ": supplies-
'! ,nde( *inger
2! Middle *inger---------------ans
-! +ittle *inger
.! Thu0b
:. ;umbricals function is <pgi=-
'! MC: *le(ion
2! ,: e(tension
-! 7oth-------------------ans
.! ;one
8. .ll are part of lateral con#yle except-
'! Capitellu0
2! :hysis
-! Metaphysis
.! ;one------------------ans
1iscussion-
:arts o* lateral condyle hu0erous-
+ateral epicondyle
Capitulu0
+ateral hal* o* trochlea
:hysisNMetaphysis
66. >lbow ossifies at-
'! 'M years---------------------ans
2! '? years
-! '. years
.! 2B years
1iscussion- Haon 0e jab bacca 0ature2'? saal &a6 ho jata hai to 0aan baap &ehte hain apne ghutnon par &ahre ho jao aur
shoulder par ghar &a bojh sa0halo!!!!!2lternate with 'M yrs at adjacent jts!6
62. 0orearm has ???? compartements-
'! '
2! 2
-! -
.! . ----------------ans
67. 9ren#elenberg test is positi'e #ue to in@ury to-
'! Sup gluteal n ------------ans
2! ,n* gluteal n
-! Cbturator n
.! Tibial n
1iscussion-
Hluteal *old are the land0ar&--> not S,S
:arts-
A e0oral head- Aulcru0
;ec&- +ever ar0
$**ort- bductors 2gluteal 0edius and 0ini0us6--> response is assesed by level o* buttoc& *old
:ositive trendelenberg<s test is seen in-
:ain on weight bearing
Hip abductor we&ness
Shortening o* *e0oral nec&
1isocation o* hip joint
Aeurology-
64. *n post. ra#ical neck #issection syn#rome all are seen except <aiims=-
'! Shoulder drooping
2! "estricted range o* 0ove0ent o* shoulder joint
-! Shoulder pain
.! ;or0al electro0yographic *inding----------------------ans
1iscussion-
$MH showing de*ibrillation potentials--> nerve da0aged
$MH shows the earliest 0eni*estation on nerve recovery
Strength duration curve--> Shi*t to le*t indicates recovery 2cra06
68. 0roments sign tests-
'! bductor pollicis brevis
2! dductor pollicis------------------ans
-! Ale(or polllicis brevis
.! ,nterossei
1iscussion- 2Maheshwari- 5.6
:en test- bductor pollicis brevis--> Median nerve
Ao0ent<s sign- Nve in adductor pollicis injury--> #lnar nerve
Card test--> :al0er interossei--> #lnar nerve
66. Aeuroma in continuity accor#ing to sun#erlan# classification is-
'! Stage '
2! Stage 2
-! Stage -
.! Stage . ---------------ans
1iscussion-
Cassi*ication o* nerve injuries-
)e##on!s )un#erlan#
;europra(ia- :hysiological bloc& in conduction--> 'BBO recovery! Co0es bac&
li&e lightening
Type ,
(enote0esis- da0age to a(onal sheath--> recovery never co0plete Type ,,= ,,,= ,%
;eurote0esis- Co0plete transection! ;o recovery without surgery Type %
;euro0a--> :ro(i0al to injury
Hlio0a--> 1istal to injury
;euro0a in continuity--> crushed nerve--> stage ,%
6:. "heralgia paraesthetica is-
'! Co0pression o* lateral cutaneous nerve o* thigh
2! Co0pression o* super*icial radial nerve--------------------------ans
-! Co0pression o* ulnar sensory branch
.! Co0pression o* super*icial peroneal nerve
68. $*" most common ner'e in'ol'e#-
'! ,;-----------------------ans
2! :,;
-! #lnar
.! Musculocutaneous
1iscussion- Maheshwari- ?-
Co0part0ent syndro0e seFuele-
PM hrs --> %ischae0ia
>Mhrs --> Hangrene--> a0putation
%,C--> 7rachial artery co0pressed-->
deep *le(or co0part0ent o* *orear020/c involved6- AA:
A- Ale(or digitoru0 pro*undus 20/c involved6--> +ateral hal* supplied by ,;271C-'B.6
A- Ale(or pollicis longus
:- :ronator Fuadratus
, artery is the 0/c artery involved d/t %,C--> 7ranch o* #l! ! 2other branch :ost! ,! !6
%,C-
Splint9 >Turn buc&le splint 2%ol&0an<s splint6
S(9 Muscle sliding operation 2Ma(page operation6
6B. Which of the following is not true regar#ing 4lumpke5s paralysis:<ai=
'! Site o* injury is upper trun& o* brachial ple(us----------ans
2! The nerve root involved 0ainly is t'
-! Claw hand is the typical de*or0ity
.! Ho0er)s syndro0e can be a presentation
1iscussion- 71C-5-
&rachial plexus in@ury-
>rb!s palsy-
7est prognosis
M/C nerve- C5= CM
:olice0an tip hand
Move0ents lost are-
S$"a7
S- Supination
$"- $(ternal rotation
a7- bduction
4lumpke!s paralysis-
,njury to C?= T'
a/w horner<s
+e**ert<s classi*ication- #sed in brachial ple(us injury
2C. .ll are in'ol'e# in entrapment neuropathy except <ai CB=-
'! Median nerve
2! Tibial nerve
-! Ae0oral nerve--------------------ans
.! +at cutaneous o* thigh
1iscussion-
;ec&- Thoracic outlet yndro0e
Shoulder- Supraclavicular neuritis
$lbow- #lnar neuritis= 0edian neuritis= "adial neuritis
Jrist- Carpal tunnel= #lnar neuritis
Hip- :iri*or0is syndro0e 2Sciatic nerve co0pressed6= Meralgia paresthetica
+ower leg- Co0part0ent syndro0e
Aoot- Tarsal tunnel syndro0e= 1igital neuritis
+eg is the 0/c area where co0part0ent syndro0e is seen 2children--> *orear06

,nury to hip joint is related to--> Sciatic nerve
"ast an# )plints -
Aame of cast Dse
Colle<s cast Colle<s *racture
Cyllinder cast/tube cast Aracture o* the patella
Hanging cast Aracture o* the hu0erous 2Maheshwari-446
Hip spica> Aracture o* the *e0ur
Minerva cast Cervical spine
:etric cast/7roo0 stic&9 :erthe d/s
:T7 cast 2ptellar tendon bearing6 Aracture o* the tibia
"isser<s turn buc&le cast Scoliosis
Shoulder spica> Shoulder i00obilisation
#-slab Aracture o* the hu0erous
>Spica is a cast where li0b and part o* trun& are included
22. "ock up splint is use# for-
'! "adial nerve injury-------------------ans
2! Median nerve injury
-! #lnar nerve injury
.! 7rachial ple(us injury
1iscussion-
)plint Aame Dse
Coc&-up splint "adial nerve palsy
@nuc&le-bender splint #lnar nerve palsy
ero-plane splint 7rachial ple(us injury
Toe raising splint Aor *oot drop
27. 9urn buckle splint is use# for-
'! %,C-------------------------------------ans
2! #lnar nerve palsy
-! Median nerve palsy
.! "adial nerve palsy
24. 9ension ban# principle can be use# by-
'! Jiring
2! :lating
-! 7oth-----------------ans
.! ;one
1iscussion-
:rinciple- Conversion o* distractive *orce into co0pressile *orce--> done by wiring or plating
#ses-
:atella #
Clecranon #
Medial 0alleolus #
1yna0ic splints are better than static 217 splints used in CT%S are dyna0ic splints6
28. ennis brown splint is use# for-
'! CT$%----------------------------------ans
2! Cong vertical talus
-! Aibular he0i0elia
.! Tibial he0i0elia
26. "9>$ shoes ha'e aEe-
'! Straight inner border
2! Cuter shoe raise
-! ,nner shoe raise--------------ans
.! ;o heel
1iscussion-
Straight inner border
Cuter shoe raise>
;o heel
2:. Fissers locali+er cast is use# in the conser'ati'e management of- <aiims=
'! 1orsolu0bar scoliosis
2! ,diopathic scoliosis-------------------ans2Maheshwari- 2----> M/C scoliosis6
-! @yphosis
.! Spondylolisthesis grade iii
1iscussion-
"eisser<s sign- *usion o* the ossi*ied apophysis to the iliu0 in scoliosis thus there is no possibility o* curve
worsening
28. $elpeau sling an# swath ban#age is use# in-
'! cro0io clavicular dislocation---------------------ans
2! Shoulder dislocation
-! Aracture scapula
.! Aracture clavicle
1iscussion- Maheshwari-4-
cro0io-clavicular jt! ,njuries clasi*ied by-
Type ,-,,,9 1escribed on the basis o* liga0entous injuries! Managed by velpeau sling and swath bandage
Type ,%-%,9 Classi*ied on the basis o* lateral end o* clavicle displace0ent! Managed by operative
intervention
# clavicle-
Gunction o* 0iddle and outer thirds
Cuterpart- 1isplaced 0edially and downwards by pectoralis 0ajor
,nner- 1isplaced upwards by sternocleido0astoid
"lassifications-
2B. )alter harries type 7 is-
'! Split o* epiphysis------------------------ans
2! Separation o* epiphysis
-! SplitN0etaphyseal part
.! Crushing
7C. $er#ans +one is #efine# for-
'! $(tensor tendon /one
2! Ale(or tendon /one------------------ans
-! Thu0b tendons
.! Carpal tunnel
1iscussion-
;o 0an<s land is--> %erdan /one type ,,--> Since 0ultiple adhesions *or0 a*ter surgery
7etween distal pal0er crease and pro(i0al interphalangeal jt!
Hartland classi*ication is used in supracondylar # hu0erous
Milch- lateral condylar #
Mason<s- "adial head # 2pgi6
Jil&ins- radial nec& #
77. )kin lesion in close# fracture is classifie# by-
'! Hustiloanderson
2! M$SS SCC"$
-! Mirels score
.! Tscherne----------------ans
1iscussion-
7reech in continuity o* corte(9 0icroscopic/0acroscopic
ny # he0ato0a co00unicating with e(terior9 open #
Tscherrne classi*ication--> So*t tissue injury in closed #
Csteoblastic secondaries--> :rostate= Carcinoid
7reast Ca--> #sually osteolytic
Mirel<s score2>4 then bone 0etastasis 0ay #6-
Si/e
Site
Type
:ain
Mangles e(tri0ity sverity score 2M$SS Score6- 2>4 --> 0putation6
So*t tissue injury
7:
Circulation
ge
Fecent a#'ances-
74. What is the most common cause of #eath after total hip replacement in el#erly la#y-
'! ,n*ection
2! 1eep vein thro0bus
-! :ul0onary e0bolis0------------------ans
.! :neu0onia
1iscussion- M, is 0/c cause o* death then Cardiopul0onary arrest then :ul! e0bolis0
78. "hemonucleosis is #one by-
'! Cs0ic acid
2! Trypsin
-! Chy0opapain----------------------ans
.! Chy0otrypsin
1iscussion-
;ucleous pulposis destroyed--> Che0opapain 2*ro0 papaya6
Cs0ic acid--> Che0ical synevecto0y
7B. Which of the following is use# in osteoporosis for #ecreasing bone resorption an# increasing bone formation-
'! Teriparatide
2! Calcitonin
-! Strontiu0 ranelate----------------ans
.! 7isphosphate
1iscussion-
"( o* osteoporosis-
Calcitonin--> decreases bone resoption 2c&--> see :TH also given6
+ow dose :TH/ or :TH related peptide--> Teriparatide--> Sti0ulates osteoblasts
;aA--> Sa0e ction
7isphosphonates--> inhibits osteoclasts
$strogen--> Sti0ulates bone *or0ation
Ca N %it!1 --> bone *or0ation
Strontiu0--> has both action
Though bone 0ineralisation is nor0al in osteoporosis total bone 0ass and trabecular volu0e are decreased!
9umors-
4C. 2D;9*(;> >A"H3AF32.) W*9H )D&"D9.A>3D) H>2.A-*32.) <.**2)E.*=-
'! C++,$"S
2! MA#CC,--------------------------------ans
-! HC+TQ SI;1"CM$
.! +7",HHT
1iscussion-
Syndro0es-
Cllier<s--> only 0ultiple enchondro0as
2afucci--1 2ultiple enchon#roma with subcutaneous angiomas with phlebolith <calcifie# 'essels=
McCune albright- 2:::6
:olyostotic *ibrosis dysplasia
:recocious puberty
:ig0entation
- points about tu0ors-
&enign
2alignant
;o dilated veins 1ilated veins on sur*ace
Jell de*ined 0argins ,ll de*ined 0argin
#ni*or0 consistency %ariable consistency
$piphysial tu0ors- HCT 2Csteoclasto0a6= Chondroblasto0a
1iaphyseal tu0ors- $wings sarco0a= Csteid osteo0a= d0antino0a
Metaphysis- Most co00on location o* all tu0ors--> also in*ections
$nchondro0a is 0etaphysial 2correction 6
(eriosteal reaction- The periosteu0 responds to trau0atic sti0uli or pressure *ro0 an underlying growing tu0or by
depositing new bone! Seen in tubercular osteo0yelitis! Solid or single periosteal reaction seen in benign bone tu0ors and
acute osteo0yelitis! Multiple layer o* la0inated or onion peel appearence seen in ewings! Triangular piece o* bone scan
at angle o* periosteou0--> seen in 0alignant tu0ors specially CS
)imple bone cyst .neurysmal bone cyst 2Maheshwari-2246
B-'B yrs 5-'5 yrs
Most co00on upper end o* hu0erous #pper end o* tibia
Single cavity Multiple cavities
Straw coloured *luid He0orrhagic *luid
"(9 Cbservation "(9 #sually curettage and bone gra*ting
Aallen *rag0ent sign/Trap door signE Aallen lea* sign
Si0ple curettage co0bined with other che0icals li&e phenol is called e(tended curettage! M/C "( these days o* cavity!
76. >mboli+ation is treatment option for-
'! 7C----------------------ans
2! #7C
-! HCT
.! Csteosarco0a
46. Ai#us of osteoi# osteoma is best seen on-
'! 8 rays
2! #SH
-! CT scan-------------------ans
.! M",
1iscussion-
,0aging in orthopaedics - G-Fay is *or screening *or any bone! "9 )can is best *or bone or any calci*ied tissue!
2F* is best *or so*t tissues and bone 0arrow ede0a and cartialge! .rthroscopy is best *or joints! &one scans
*or 0utiple lesions all over the body! Cpen biopsy is diagnostic o* tu0or!
Csteoid osteo0a-
Co00onest true benign tu0or o* bone
1iaphysis a**ected 0ost
:ain worst at night
"(9 ;S,1s
+atest "( --> "adio*reFuency ablation
42. 0allen fragment sign is seen in-
'! abc
2! ubc-------------------------ans 2#nica0eral/Solitary/Si0ple6
-! HCT
.! Chondroblasto0a
47. 9reatment for giant cell tumor use# most commonly is-
'! "esection
2! Curettage N bone gra*t ---------------ans
-! "adiotherapy
.! Che0otherapy
1iscussion- Maheshwari-2'M
HCT2Csteoclasto0a6 occurs b/n 2B-.B yrs i!e! a*ter s&eletal 0aturity
H CT is only tu0or co00on in girls2wrong in 6 others are co00on in 0ales
44. 2assa#a classification is for-
'! $(ostosis-------------------------------ans
2! $nchondro0as
-! Csteosarco0as
.! Chondroblasto0a
1iscussion-
2a#elung #eformity- a na0ed de*or0ity usually characteri/ed by 0al*or0ed wrists and wrist bones and short
stature and is o*ten associated with +Rri-Jeill dyschondrosteosis! Massaga classi*ication used! ,t is a/w- T,T+,
T- Trau0a
T-Tu0or
,- ,n*ection
+- +Rri-Jeill dyschondrosteosis 20adelung d/e N dwar*is06
T- Turner<s syndro0e
48. 2ost common tumor of han#-
'! $nchondro0a
2! SCC--------------------------ans
-! Chondroblasto0a
.! Melano0a
1iscussion- i* Fuestion is on bones o* hand then--> enchondro0a
46. (ulsatile bone tumor-
'! CS---------------ans
2! MAH
-! AS
.! S7C
4B. 8 year male progressi'e swelling upper en# tibia-irregularHlocal temperature raise# H'ariable consistency an#
ill #efine# margins-
'! Hiant cell tu0or
2! $wings sarco0a
-! Csteogenic sarco0a----------------------ans
.! Secondary 0etastasis
1iscussion-
$wing<s sarco0a-
Tu0or 0elts li&e ice on radiotherapy but recurs!
Che0o is the best i* single type o* treat0ent is to be given
Che0o regi0en- 27C16
- ctino0ycin
7- 7leo0ycin
C- Cyclophospha0ide
1- 1o(orubicin
Ctherwise co0bination-
CNS(
"NS
"NC
7est t/t9 SC"
Metastaiss- Control o* 0ets is done by che0otherapy
.rthritis-
8C. 3sseous loose bo#ies in @oints common in all except-
'! Csteochondritis dissecans
2! Csteoarthritis
-! Csteochondral *ractures
.! "heu0atoid arthritis----------------ans
1iscussion- Csteochondritis dessicans is 0ost co00on o* loose bodies in joints o* lateral part o* 0edial *e0oral condyle!
86. (rimary structure affecte# in F.:
'! Synoviu0----------------ans
2! Cartillage
-! 7one
.! Capsule
1iscussion-
C- Cartilage
Ma(i0u0 incidence o* tu0ors--> Tibia
Ma(i0u0 incidence o* open # --> Tibia
7est e(ercise in n&ylosing spondylitis--> Swi00ing > Cycling 2a(ial s&eletan a**ected so a(ial e(cercise is
pre**ered6
P2!5 chest e(pansion --> diagnostic o* S 2:-2.?6
Aleche test--> 1iagnosing cervical spine *le(ion
1iagnosis o* S--> Sacroilitis N one o* the *ollowing-
1ecreased chest e(pansion
decreased lu0bar *le(ion
in*la00atory diarrhoea 2H+ 724 is o* lesser value6
82. iagnosis of .) are all except-
'! Sarcoiliitis
2! 1ecreased chest e(pansion
-! 1ecreased lu0bar *le(ion
.! :resence o* H+-724 ----------------ans
87. .ll of the following are associate# with charcot @oints except-
'! Syrngo0yelia
2! Syphilis
-! Tuberculosis-----------------ans
.! +eprosy
1iscussion-
Charcoat<s jt are described *or S tabes dorsalis
,n today<s world 1M causes charcot<s 0ostlyT> 0id*oot involve0ent is 0ost co00on
M/C joint involved is --> @nee jt!
+eprosy can a**ect the jts! o* hand and 0id-*oot
0yloidosis is a rare cause
84. 9rue about syno'ial flui# all except-
'! Secreted by Type cells-------------------------ans
2! Aollows ;on-;ewtonian *luid &inetics
-! Contains hyaluronic acid
.! %iscosity co e**icient is variable
1iscussion-
Synovial *luid secreted by type 7 cellsE and synovial does not contain base0ent 0e0brane
$(cept C where viscocity is nor0al all other d/e of jt. viscocity is decreased.
88. %oint not in'ol'e# in F. accor#ing to 6B8: mo#ifie# ara criteria is-
'! Metatarsophalangeal
2! Tarso0etetersal--------------------ans
-! n&le
.! $lbow
.'ascular necrosis-
86. ouble line sign is seen in-
'! %; o* hip--------------ans
2! Sc*e
-! T7 hip
.! 11H
1iscussion- Maheshwari- 24'
M/C cause is idiopathic
Clinical signs-
Sectoral signs--> sector o* bone a**ected--> decreased rotation at jt!
Crescent<s sign
1ouble line sign--> Seen on M",
"(9
Cove2c&6 deco0pression
"otational osteoto0ies
Goint replace0ent
8:. .$A can occur at aEe-
'! Ae0ur nec&---------------------ans2head not nec&!!!!!6
2! 7ody o* talus
-! :ro(i0al scaphoid
.! ;one
88. 3steonecrosis associate# with all except-2dpg BU6
'! Sic&le cell disease
2! Hauchers
-! :olycythe0ia----------------------ans
.! Hyperparathyroidis0
1iscussion- 1eranged lipid pro*ile/1eranged coagualtion pro*ile --> %;2Csteonecrosis6
*nfections-
8B. >arliest sign of osteomyelitis on x-rays-
'! +oss o* 0uscle and *at plane--------------------ans
2! :eriosteal reaction
-! Callus *or0ation
.! :resence o* seFuestru0
1iscussion- Maheshwari-'5M
+oss o* 0uscle and *at plane is seen in 2.-.? hrs
$arlier bony change seen in--> 'B days
1CC--> Cephalosporin N 0inoglycoside co0bination
Chronic osteo0yelitis-->
dead bone2Mar&er6
SeFuestru0
Two characteristic o* dead bone-
Jhite on 8-"ay 2it is sclerosed6
+ight in weight
+ower end o* *e0ur e**ected 0/c in cute osteo0yelitis!
9& of bone an# @oints- Maheshwari- '4'
T7 usually pri0ary *ocus is lungs!
M/C bone is spine--> pott<s spine2dorsolu0bar region6--> 5BO 2paradiscal 0/c6!
"( o* T79
TT
"est to part
Surgery when indicated
,ndication o* S( in any disease o* spine-
7/7 involve0ent
,ncreasing neurologocal de*icit
Aailure o* i0prove0ent on conservative M(
6C. .nterolateral #ecompression is #one in-
'! +e*t lateral position
2! "ight lateral position------------------ans
-! Supine
.! :rone
1iscussion- 1one *or pott<s spine--> nterolateral deco0pression! ,%C is *riable not orta 2i!e done on aorta6
66. "hronic osteomyelitis pathognomic
'! 1ead bone--------------ans
2! "eactive bone
-! Jound
.! Cloacae
62. 8 year male progressi'e swelling since 6 months o'er upper en# tibia on x ray there is lytic lesion with sclerotic
margin-
'! Csteogenic sarco0a
2! Csteoclasto0a
-! 7rodies abscess-----------------ans2see not ewing<s6
.! $wings sarco0a
67. 9he incorrect statement about osteomyelitis is-
'! Staphylococcus aureus is the co00onest causative organis0
2! #pper tibial 0etaphysic is the co00onest-----------------------------ans2lower *e0oral6
-! He0atogenous osteo0yelitis is the co00onest
.! Ce*ota(i0e and a0i&acin are drugs o* choice
)oft tissue in@uries-
64. 9ennis elbow is characteri+e# by
'! Tenderness 0edial epicondyle
2! Tendonitis co00on e(tensor origin---------------ans
-! Tendonitis co00on *le(or origin
.! :ain*ul *le(ion and e(tension
1iscussion- Maheshwari-254
"(9
,nj! o* steroid at lateral epicondyle
lso ta&ing patient<s own blood and injecting 0ay be help*ul
Test- :ain*ul dorsi*le(ion o* wrist joint2Co/en test6
$(t! Carpi radialis brevis-->wrist e(tension--> ;!S!--> :,;2C4=C?6
68. (rolapse# inter'ertebral #isc is most common at-
'! C'B-C''
2! C2-C-
-! +--+.
.! +5-S' --------------ans
1iscussion-
M/C level is +.-+5
2
nd
co00on--> C5-CM
-rd--> +5-S'
6:. .thletic pubalgia is #ue to-
'! bdo0inal 0uscle strain----------------ans
2! Kuadriceps strain
-! "ectus *e0oris strain
.! Hluteus 0a(i0us strain
1iscussion-
$(t! CbliFue aponeurosis torn
Tear in conjoint tendon
Conjoint tendon torn *ro0 pubic tubercle
68. Aot a treatment for chronic backache-
'! ;S,1
2! 7ed rest *or - 0onths-------------------------ans
-! $(ercises
.! $pidural steroid injection
1iscussion- ,n any case o* bac&ache rest is not given *or 0ore than .? hrs
ll acute osteo0yelitis eventually turn into chronic osteo0yelitis sine bones can not be sterlised once in*ected
6B.Which is best for #iagnosing post longitu#inal ligament calcification-
'! M",
2! CT------------------------ans
-! #SH
.! 8-"I
:C. *n posterior compartment syn#rome which passi'e mo'ement causes pain-
'! 1orsi*le(ion o* *oot
2! Aoot inversion
-! Toe dorsi*le(ion-----------------------ans
.! Aoot abduction
1iscussion- More speci*ic than
:6. 2ost common cause of insertion ten#initis of ten#oachilles is-
'! ,0prove shoe wear
2! "unners and j0pers
-! Cveruse------------------------------ans
.! ,ntralaisonal steroid inj
1iscussion-
M/C cause o* non-insetional tendinitis is runners and ju0pers 2occurs at --M c0 above insertion o* tendo-achillis6
M/C cause o* insetional tendinitis is overuse
&one metabolism-
:2. 2ilkman fracture-
'! :seudo *racture-------------------------------ans
2! Aracture o* 0etatarsals
-! Aracture o* distal end o* radius
.! Aracture o* 5th 0etacarpal
1iscussion-
lso called--> #0bau/anon/+ooser<s /one
Seen in osteomalacia
M/C area Ae0or nec&2Harrison6>:ubic ra0i>%ertebral bodies
"(9
"est to part
Ca N %it! 1
:7. &>)9 2.F4>F $*9.2*A >0>"*>A"I-
'! +:
2! C,1 :C.
-! S$"#M :C.
.! %,T 1 +$%$+S---------------------ans
:4. 3steoporosis is #efine# as-
'! T score -' to -2!5
2! T score less than -2!5 --------------ans
-! Q score B to -'
.! Q score -' to -2!5
1iscussion-
Mesured by bone 0arrow density scan21e(a scan6
T Score
B to -' 2;6
-' to -'!5 2Csteopenia6
>2!5 2osteoporosis6
Severe osteoporosis- ny osteoporosis with # is severe osteoporosis
:8. .lkaline phosphatase an# phosphate in chil#ren is-
'! Sa0e as adults
2! More than adults--------------------------ans
-! lp 0ore phosphate less
.! lp less phosphate 0ore
1iscussion-
Multiplied by --5 ti0es adult values 2+:6
:C. --> N'0g/dl
:6. Aot seen in osteopetrosis-
'! :ancytopenia
2! Csteo0yelitis o* 0andible
-! Co0pression o* nerve
.! 1elayed healing o* *ractures-------------------ans
1iscussion-
Two conditions a/w increased pathological # but nor0al bone healing-
Csteopetrosis
Csteogenesis i0per*ecta
::. *'ory 'ertebraeEpicture frame 'ertebraeEcotton wool skullEel#erlyEsnhlEincrease# alpEnormal caEnormal po4
foun# in-
'!Aibrous dysplasia
2!:agets---------------------------ans
-!M$TS
.!Csteoporosis
1iscussion-
: agets--> :elvis20/c a**ected part6 > :rostate
;or0al Calciu0= ;or0al :hosphorus= *ncrease# +:
MM N # --> +: increased
(ae#iatrics orthopae#ics-
:8. 9reatment of choice for "9>$ in 68 year ol# is-
'! Aootwear
2! Triple arthrodesis---------------ans
-! Kuadruple *usion
.! CST"
1iscussion- 1ont *ollow Maheshwari *or treat0ent o* CT$%
Treat0aent o* CT$%- "ead with "CMS-M?4
@ites- not *ollowed now
MCM ( 2 Jee&s
$very 2 wee& case
,$
Cuboid joint--> hands put there
M 0ths
:onsetti-
1ay cast
per wee&
,$ 2all together6
Talus
M w&s
Treat0ent *or neglected cases-
P -yrs--> :MST" NSo*t tissue release
--? yrs-
Shortening o* lateral colu0n o* *oot
Cuboid decancellation
Cuboid or calcaneal wedge resection--> $van<s
> 5yrs--> 1weyer<s osteto0y to connect heel varus
?-'2 yrs--> Jedge tarsecto0y
> '2 yrs-
Triple arthrodesis2T;/TC/CC all three joints *used6
,li/arov *i(ator
G$SS 2Goshi<s e(ternal stabilising syste06
:B. (olimyelitis is
'! +ower 0otor neuron------------------ans
2! #pper 0otor neuron
-! 7oth
.! none
8C. 4lipper-0eil syn#rome results from<ai=-
'! Congenital contracture o* the sternoclei-do0astoid 0uscle
2! Aailure o* descent o* the scapula
-! Aailure o* closure o* the third branchial arch
.! Aailure o* seg0entation o* 0esoder0al sornites------------------------ans
1iscussion-
Cccurs d/t *usison o* cervical vertebrae d/t *ailure o* seg0entation o* 0esoder0al so0ites!
Triad-
+ow post! hairline
Short nec&
"estricted range o* 0ove0ent
86. "hil# presenting with absent thumbH ra#ial #e'iation of han# bowing of the forearmJ which in'estigation is not
nee#e#-
'! @aryotyping
2! $cho
-! 7M---------------------ans
.! :latelet count
1iscussion-
"adial claw hand 2AT$H6-
A- Aanconi<s
- norectal 0al*or0ation
T- Triso0ies '-= '?/T" syndro0e 2Thro0bocytopenia and bsent "adius6
$- $ctoder0al dysplasia
H- Holt ora0 2S16
82. 2ost common #efect in H-
'! Co(a valga
2! nteversion
-! Shallow acetabulu0-----------------ans
.! Jaddling gait
1iscussion- Maheshwari- 2BB
7arlow<s test--> hip being tested is dducted
Crtolani test--> bducted
Conditions a/w 11H-
Cligohydra0nios
Aa0ily history
7reech
Ae0ales
Hor0one induced joint la(ity 2Maternal rela(in6
Airst born child
Crowding pheno0enon- Torticollis/CT$%/ Henu recurvaratu02&nee hyper-e(tension6 and
0etatassus adductans
lso-
87. 9riple arthro#esis in'ol'es aEe-
'! Talonavicular
2! Talocalcaneal
-! Calcaneocuboid
.! Tibiotalar---------------------ans
0ractures an# #islocations-
84. )upracon#ylar fracture can in'ol'e-
'! Median nerve
2! "adial nerve
-! #lnar nerve
.! ll----------------------ans
1iscussion- Maheshwari-?5
M/C- ,;>Median>"adial>#lnar
M/C co0plication-
$arly- %ol&0an<s ische0ia
+ate- Malunion 2Cubitus varus--> Hunstoc& de*or0ity6
1unlop traction is used in the 0anage0ent!!!!!!!
88. 2ost common fracture in'ol'e# in algo#ystrophy-
'! Colles-------------------ans
2! Supracondylar
-! Aorear0
.! Hu0erus
1iscussion- Maheshwari-UM
lso &nown as Sudec&<s dystrophy/Co0ple( regional pain syndro0e
:atient has sensory sy0pto0 0ore than 0otor sy0pto0s
"ed hot shiny s&in
:athy osteoporosis 2diagnostic6
7oth active and passive e(cercises are encouraged
M/C associated # - Colle<s #
Treat0ent o* colle)s is essentially conservative with colle!s cast
86. "ylin#er cast is use# for<ai=-
'! ST,2So*t tissue injury6 &nee
2! # patella
-! 7oth--------------ans
.! none
1iscussion-
Test *or &nee-
C+-
nterior drawer test
+ach0an test 2both in acute and chronic condition it is better6
McMurrey test- 7oth 0enisci
lpey<s grinding test- 7oth 0enisci
8:. (i'ot shift test is for-
'! nterolateral instability---------------------ans
2! C+
-! :C+
.! Medial 0eniscus
1iscussion-
:ivot shi*t test- used *or anterolateral area o* &nee 2Consist o* ant! Criciate liga0ent= lateral
collateral liga0ent= lateral hal* o* capsule6
8B. .ll are use# in fat embolism except-
'! Heparin
2! 1e(tran
-! Steroids
.! Calciu0-----------ans
1iscussion-
1iagnostic- ' 0ajor N . 0inor
Major-
'! :ul0onary ede0a
2! :aC2 PMB= AiC2 P B!. --> i!e! hypo(e0ia
-! C;S depression dysproportionate to hypo(e0ia
.! :etechiae in vest distribution
Minor-
'! Aever
2! Tachycardia
-! Thro0bocytopenia
.! Aat in sputu0
5! Aat in urine
M! ,ncreased $S"
4! "etinal e0boli
?! ne0ia
BC. Fecurrent #islocation is rare in-
'! n&le-----------ans
2! Hip
-! Shoulder
.! :atella
1iscussion-
Shoulder--> nt! dislocation
Cthers--> :osterior
Most co00on dislocation- Shoulder > :atella > n&le 2rarest6
%essel injury in # and dislocation-
Clavicle # --> Subclavian artery
Shoulder dislocation --> (illary !
Hip dislocation --> Sup! gluteal !
@nee --> :opliteal !
Shoulder dislocation9 (illary ; > Musculocutaneous
Monteggia # dislocation- MMM
Monetggia--> Mdial bone--> Towards 0outh
#lnar # --> dislocation o* radial head--> (*A pierces the supinator and ta&es aturn around radial head--> so
0/c involved in Monteggia #
Hallea/i # dislocation--> lower lateral
B6. .ccor#ing to 2ullers classification humerus fractures are gi'en number-
'! ' --------ans
2! 2
-! -
.! .
B2. 4nee #islocation m.c 'ascular in@ury-
'! Ae0oral
2! :opliteal ----------------ans
-! :osterior tibial
.! nterior tibial
B7. 2onteggia fracture Aer'e in@ury-
'! ,;
2! :,;-----------------ans
-! M$1,;
.! #+;"
B4. 3))*0*".9*3A *A 2yositis ossificans is-
'! #ni*or0 throughout
2! ,nside out
-! Cutside in --------------ans
.! ;one
1iscussion- ,n osteosarco0a ossi*ication is at the centre!!!!!!!!!
B6. .fter shoul#er most common @oint to #islocate is-
'! Hip
2! $lbow
-! :atello*e0oral--------------ans
.! :ip
B:. &ennetts fracture is-
'! ,ntra articular
2! ,ntra articular with dislocation--------------ans2"CMS-MM'6
-! $(tra articular
.! $(tra articular with dislocation
B8. 2otor weakness of upper limbs out of proportion to lower limbs is-
'! Central cord syndro0e------------ans
2! nterior cord syndro0e
-! :osterior cord syndro0e
.! 7rown seFuard syndro0e
BB. Dnsol'e# fracture is-
'! Aracture scaphoid
2! Aracture talus
-! Aracture nec& o* *e0ur--------------ans
.! ll
1iscussion- "ead classi*ications 2Maheshwari-''26
"ules o* *i(ation-
#pper li0b bones are plated! +ower li0b bones have nails
rticular/:eriarticular # in children are treated with @-wires!
:rinciple o* 0ange0ent o* ant joint injury is early 0obilisation
6CC. 0racture neck femur most common complication-
'! %;------------------ans
2! ;onunion
-! Csteoarthritis
.! 1%T
K. 9he collagenous protein in bone sub-ser'es which of the following functions-
'! Hrowth *actor
2! 7inding o* ionic calciu0 and physiologic hydro(yapatite
-! Aor0ation o* three di0entional lattice o* the 0atri(---------ans2HT ?4E K-2?-6
.! Cell attach0ent
K- . 67 yr ol# boy presents with a slowly enlarging lesion that in'ol'es the #istal portion of his right femur. G-ray
re'eals a large #estructi'e lesion that focally lifts the periosteum to form a triangular sha#ow between the cortex
an# the raise# en# of the periosteum. ;ab examination re'eals ele'ate# serum alkaline phosphatase. Histologic
changes likely to be seen in a biopsy taken from this bone lesion is-
'! Multiple blood *illed spaces that are not lined by endothelial cells
2! Hepha/ardous arrange0ent o* i00ature bony trabeculae *or0ing <chinese letters<
-! +obules o* hyaline cartilage with *ew cells
.! Malignant anaplastic cells secreting osteoid-------------ans
1iscussion- Csteosarco0a--> 0alignant anaplastic cells secreting osteoid
Cption '--> neurys0al bone cyst
Cption 2--> Aibrous dysplasia
K. . case of breast ca stage-4 wth secon#ary in upper thir# shaft of femur. 9here is impen#in pathological
fracture. 9reatment-
'! ,ntra0edullary nailing-------------ans
2! "T
-! :late *i(ation
.! 7ed rest
1iscussion- :atient with bone 0ets! has to be stage . anyways== as stage . 0eans any Hrade2T6= any ly0ph nodes2;6=
with distant 0etastasis!!!!
Jheeless< te(tboo& o* orthopaedics /Metastatic breast Ca! says *ollowing about the treat0ent-
Surgical Ai(ation- :er0eative destruction o* the pro(i0al *e0ur is the 0ost co00on type o* destruction
leading to a pathologic *racture! Aor pts with this type o* destruction involving 0ore than 5BO o* the sha*t
dia0eter on any radiographic view= consider prophylactic internal *i(ation o* *e0oral nec& L subtrochanteric
region!
$0ail- drapoorvVg0ail!co0