1)ATROPHIC TYPE FRACTURE?

*Sclerosis of the bone ends *without callus

formation*Closed marrow cavity
2)ASPECTS OF HAND INJURY EXAMINATION? *skin*tendon* vascular nerve*bone
and joint
3)PRINCIPLES OF TREATMENT OF FRACTURE OF ANKLE?*Regain the anatomical
structure &stability of ankle*Internal fixation is often needed to keep reduction*Distal 1/3
fibula & distal tibio-fibular joint is key structure for the stability of ankle,so reduction
&fast fixation are need
4)ACUTE SEPTIC ARTHRITIS?*Septic arthritis is inflammation of a synovial
membrane with purulent effusion into the joint capsule,usually due to bacterial
infection*It can quickly destroy a joint &can cause many
complications,includingosteomyelitis,bonyerosions,fibrousankylosis,sepsis,bilateral leg
discrepancy& even death*Organisms causing :staphylococcus.A,
H.influenza,streptococcuspyogenes,E.coli
5)ANTEVERTED ANGLE?*in sagittal plane,this angle is b/w the long axis of the
femoral neck &coronal plane of the femoral shaft.*the rang of it is 12-15in adult6)THE
MAIN DIFFUSE PATHWAYS IN ACUTE HEMATOGENOUS
OSTEOMYELITIS?(a)Direct spread through skin wound (exogenous)(b)From distant
infection site through blood flow(hematogenous)(c)From adjacent local soft tissue
(d)Hematogenous:*an infection from another part of the body to the bones*Infected
umbilical cord in infants*Boils,tonsilitis,skin abrasions &UTI in adults*in dwelling arterial
line 7)CLI; FEATURES OF ACUTE OSTEOMYELITIS?*severe pain *reluctant to
move*fever*malaise*toxemia*Tenderness*Reddness*Swelling*Limp*In adults:history of
UTI/urological procedure,diabetic,immune compromised*X-ray(normal in the first(10-
14)days
8)CLINI;MANIFESTATIONS &DIAGNOSIS OF BONE TUMOR?(A)Symptoms :(1)No
symptoms:until pathological fracture(2)Pain:*deep,aching pain although not
sharp/severe,is distressing bcz of its constancy*Pain, persists at night & is unrelieved by
rest is suggestive of malignancy*Mild,dull,aching pain that suddenly becomes severe
following minimal/ no trauma-pathologic fracture.(3)Fever(4)loss of apetite/weight
&previous malignancy which suggest metastasis(4)+ve family history is common in
patients with multiple enchondromas/osteochondromas(B)Signs:(1)Swelling
(2)Mass(3)High skin temprature(4)Superficial vein is engorge (prominent)(5)Tenderness
(6)impairment of joint function(7)signs of compression(8)Cachexialoss weight,anemia
9)BRYANT TRIANGLE?*patient is dorsal position,Bryant triangle is composed by
vertical line that is per anterior superior iliac crest,*horizontal line that is per greater
trochanter& line that link greater trochanter &iliac crest.The bottom line of Bryant
triangle shorten while femoral neck is broken
10)COLLES FRACTURE?*straight type fracture*It happens when wrist extends&
forearm pronate&hand touches ground*it is one of the classification for fracture of distal
radius*Cli; manifestation & diagnosis: *pain,swell, tenderness,fork shape
deformity,riflebayonetdeformity, dysfunction of wrist joint. *Distal fracture piece
displace to radius &dorsal forward*X ray find distal fracture piece displace radial
dorsally*Treatment:*manipulative reduction &external fixation*open reduction &internal
fixation
11)CLASSIFI; OF FRACTURES OF THORACIC &LUMBAR SPINE?1)Simple
compression fracture2)Stable burst fracture3)Unstable burst fracture4)Chance
fracture5)Flexion-distraction injury6)Fracture-dislocations

12)CLASSIFI; OF THE FRACTURES OF CERVICAL SPINE?(a)Flexion

injuries:*Excessive flexion injuries*Bilateral dislocations*Simple compression
fracture(b)vertical compression fracture:*Jefferson fracture(Fracture of C1 arch)*Burst
fracture(c)Hyperextension injuries:*Hangmans fracture or traumatic spondylolisthesis of
the axis,bilateral parts fractures of C2.

13)THERAPEUTIC PRINCIPLES OF CHRONIC INJURY OF KINETIC SYSTEM?(1)Kill

the trigger factor:eliminate harmful factors,correct abnormal gesture
(2)Immobilization:minimizingvulnerateaction,motion of joint without over-loading &
change gesture in order to distract the stress(3)Rehabilitation:physical therapy,
hyperthermia treatment,massage etc.(4)Nonsteroidal anti-inflammatory drug(NSAIDs):
prevent side effects(5)local injection with adrenocortical drug: prednisolone
acetate(6)Surgical technique:Arthrodesis,arthroplasty,tenosynovectomy,excision of
cyst,Ligamentotomy etc

14)CLAW HAND DEFORMITY? *injury of ulnar nerve causes this

condition.*interosseous muscle, the 3 & 4lumbrical muscle paralysis*the ring& little
finger cannot extend PIP & DIP joint.

15)HALLMARK OF CHRONIC OSTEOMYELITIS?(1)Infected dead bone(sequestrum)

(2)Infected dead cavity(purulent material,infected granulation tissue,new bone formed)
(3)sinus track

16)CARPAL TUNNEL SYNDROME?*this a syndrome characterized by compression of

the median nerve as it passes beneath the flexor retinaculum*CAUSES:extrinsic
compression, narrowing of the tunnel,more contents in the tunnel,over-use of wrist

17)CODMAN TRIANGLE?New triangular area of subperioesteal bone formation under

the corners of the raised periosteum when a tumor is arised

18)CLI; FEATURES OF CHRONIC INJURY OF KINETIC SYSTEM?(a)Mild to

moderate pain:most of them are mild pain without evident trauma(b)Continous small
troubles:weakness of the lesion area(muscle/tendon),tubercle in somewhere
(c)Inflammation,but not obvious:normally,without high fever,sever
edema/abcess(d)Local zone,notsystemic:over-active/over-use relate to the region of
pain

19)DELAYED-UNION OF FRACTURE?*Can be observed after 8-12 weeks of

fracture*Pain of fracture site*Fracture line can be seen clearly*A little callus*No
osteosclerosis of the fragments*Fracture has possibility of healing

20)CLASSIFICATIONS OF DISLOCATION?(a)according to causes of disloation:*

Traumatic dislocation*Pathologic dislocation*Habitual dislocation(b)according to interval
from the injury treatment:*fresh dislocation:<2 weeks*old dislocation: >2 weeks
(c)according to the capsule open to the outside:*closed dislocation*open
disocation(d)according to the degree of dislocation:*complete dislocation*incomplete
dislocation /semiluxation

21)DUGAS SIGN (+)?*In shoulder dislocation patient, patient fail to put their flexed
elbow close to the chest while the affected hand is resting in unaffected shoulder

22)THERAUPTIC PRINCIPLE OF DISLOCATION?(1)reduction as early as

possible(2)fixation on the opposite direction of dislocation (3)early functional
training(4)conservative treatment:closed reduction is applied to fresh dislocation;
*anaesthesia *reduce*fixation*functional exercise (5)Operative treatment:*the failure of
closed reduction*having the injury of vessels& nerves*having fractures involve articular
stable& implicate the function of joint.*old dislocation*habitual dislocation

.23)DEBRIDEMENT?*Golden Time:6~8 h(after injury)*Larger bony piece should be

preserved selecting methods of fixation*Repair of nerve,tendon,vessel*Skin Closure

24)WHICH WAYS OCCUR FOR THE ABNORMAL NUCLEAR MOVEMENT &DISC

FRACTURE? *bulge*herniation*prolapse & free disc fragment*schmorl tubercle

25)CLI,MANIF&DIAGNOSIS OF ELBOW DISLOCATION? 1)the history of

trauma2)symptom3)common signs4)specific signs:*elastic fixation*vacuity of joint
cavity*the triangle of elbow is disturbance.5)X ray6)Complication injury:blood vessels&
nerve injury.TREATMENT:*anesthesia*reduction*fixation *functional training

26)ETIOLOGIES OF INFECTION OF BONE &JOINT SYSTEM?*bacteremia*Trauma

*Illness*Malnutrition*Inadequacy of the immune system

27)FINKELSTEIN TEST?*for stenosing tenosynovitis(painful wrist)*hyperflex the

thumb*trap it in the palm with the other fingers*deviates the wrist
ulnarward*+vecomplaint for local pain.(occur.
28)CRITERIONS OF THE FRACTURE CLINICAL HEALING? 1)No tenderness & axial
percussion pain2)No abnormal movement3)No fracture line visible.Callus formation
continuous,bridging fragments4)After splint removal:*arm parallel to ground can hold 1
kg persist in 1min*leg can walk 30 pace in 3 min*good result of fracture site under 2
weeks observation

29)FIBROUS DYSPLASIA?*Normal bone is replaced by fibrous tissue*The mass of

fibrous tissue growth inside the bone & erodes the cortices of the bone from medullary
cavity

30)FROZEN SHOULDER?*also be named periarthritis shoulder/ fifty shoulder*This is a

disease of unknown etiology where the glenohumeral joint becomes painful &stiff bcz of
resilience of the joint capsule, possibly with adhesions b/w its folds.(

31)CAUSES OF NON-UNION OF FRACTURE?*Infection *Inadequate blood

supply*Excessive shearing movement*Interposition of soft tissue *Separation b/w the
fragments*Destruction of bone*Corroding metal*Synovial nonunion

32)DIFF; B/W FEMORAL SHAFT FRACTURE & INTRATROCHANTER FRACTURE?

(A)Femoral shaft fracture:*sex:both male &female*ecchymosis:yes *displacement:
Lateral *X-Ray:shaft*non-union:few *femoral head necrosis:none.(B)Intertrochanter
fracture:*sex:men*ecchymosis:yes *Angle of external rotation:90 degree*X-Ray:
intertrochanter*non-union:few*femoral head necrosis:seldom happen

33)CLI;FEATURES &TRETMENT OF FROZEN SHOULDER?1)adults/old people

2)shoulder pain:night pain which is related to motion of shoulder&position.some severe
cases even cannot raise hand over their head3)signs:*tenderness*stiffness of shoulder
joint4)x-ray.TREATMENT:1)this is self-release disease lasting for 6-9 months or more
than1yr2)physicotherapy3)nonsteroidal anti-inflammatory drugs-NSAIDs4)local inject
with adrenocortical:prednisolone acetate5)exercise6)manage the primary disease

34)CHRONIC INJURY OF KINETIC SYSTEM?*a type of aseptic inflammatory/chronic

injury taking place in kinetic system,caused by longterm,persisited
stress/motion*Causes:persisted stress ,asepeticinflammtory ,failure to compensation

35)DISPLACEMENT PRINCIPLE OF THE CLAVICLE FRACTURE?(1)Initial

treatment:*very painfull fracture*arm immobilizer not color &cuff*ice(2)all undisplaced
fractures can be treated conservatively:*immobilizer sling*discontinued once pain
subsides(3-5 weeks)*self administered ROM &stregthning(3)indications for surgery:
*absolute:openfracture,skincompromise,progressive neurologic deficit*relative:
shortening, displacement,non-union(4)surgical options:*plate fixation*intramedullary
screw(5)plate fixation:*comminution*soft bone/smokers*less compliant patients
(6)intramedullary screw:*2part fracture*young patients*avoid above shoulder ROM first
6 weeks

36)CLI;FEATURES&TREAT OF CARPAL TUNNEL SYNDROME? 1)middle aged

woman is common patient2)tingling,numbness/discomfort in the thumb 3)muscle of
thenar is dystrophy &weakness of palmar opposition of thumb4)Tinels
sign(+)5)Phalens sign (+)6)electrophysiologicstudyedEPS.TREATMENT:1)early
stage:immobilization of wrist in neutral position2)injection with adrenocortical in carpal
tunnel:prednisoloneacetate,not inject into median nerve3)dividing the flexor retinaculum
to decompress the nerve& explore the nerve4)other disease should be treated

37)DE QUERVAIN'S TENDINITIS/RADIAL STYLOID TENDINITIS?*A compartment on

the radial side of the distal radius enclosing two tendons:the abductor pollicis
longus(APL)& extensor pollicis brevis(EPB) *the problem is focused within the 1st dorsal
extensor compartment of the wrist*this condition results in pain& crepitus along the
tendon

38)THERAPEUTIC PRINCIPLES OF De QUERVAIN'S TENDINITIS?1)rest &take

NSAIDs.2)Injections of corticosteroid with or without splinting & physiotherapy usually
give dramatic relief.3)surgical treatment should release the area of stenosis

39)CLI;FEATURES OF FIBROUS DYSPLASIA?(a)The diagnosis is generally made in

the 1st 3 decades of life,with a slight female predominance(b)The most common sites
include the ribs,proximal end of femur & tibia(c)pain,swelling,deformity,pathological
fracture(d)X-ray:*appears as a geographic,intramedullary lesion with a ground glass
appearance*Cortical thinning & expansion*shepherd's crook

40)EWING SARCOMA?*originate from protocell*Mainly effects10-20 year aged

people*sites-diaphysis*cli;features are pain,low-grade fever,swelling,tenderness, warm
skin,WBC/ESR heighten*x-ray shows reactive"onion-skin"periosleal bone formation

41)CLI; FEATURES &TREATMENT OF ENCHONDROMAS?(1)region of lesion:

hands& feet (2)asymptomatic:unless complicated by a pathologic fracture(3)Pain :
dull,aching pain.(4)X-ray :incidental osteolytic radiographic finding is
common.TREATMENT: *Observation*operation

42)THERAPEUTIC PRINCIPLES OF FRACTURE OF

PATELLA?*nonoperativetreatment:is applied to non-displacement fracture*knee extend
& external fixation with plaster for 4-6 weeks*if the hematocele of knee joint is
severe,puncturation&draw hematocele is required*operative

43)CLI;MANIFESTATIONS &DIAGNOSIS OF FRACTURE OF FEMORAL

SHAFT?*History of trauma*Thigh is swell &ecchymosis *Angulation, overlap & rotation
deformity*Dysfuction of hip & knee joint.*PE:tenderness,abnormalmotion,bony
crepitus*X ray:make sure the site & type of fracture*The distal 1/3 fracture: The distal
fracture piece displace to posterior,poplitealartery,vein,tibial nerve & common peroneal
nerve injury should be noted.The blood Circulation,sensation& motion of distal distal
limb end should be examinated

44)COMPLICATIONS OF FRACTURE?(1)Early Period:*Shock*Fat embolism*Injury to

Important Organs& Tissue(nervous &vascular) *Osteo-fascial Compartment
Syndrome*Infection:tetanus,gasgangrene,osteomyelitis *Thromboembolism:deep
venous thrombosis &pulmonary embolism*Acute respiratory distress
syndrome*Multiple-organ dysfunction syndrome (2)Later period:*Systemic

45)CLI. &RADIOLOGICAL FEATURES OF FRACTURE?(1)Systemic

manifestations:*Primary Shock(Neurogenic Shock)*Secondary Shock*Low
Fever/Slight Fever*WBC*ESR (2)Local manifestations:*Traumatic
Inflammation*Pain*Local Swelling*Loss/Impairment of Function*Ecchymosis*Localized
bone tenderness(3)Specific signs:The following features are pathognomonic of
fracture;*Deformity*Abnormal Mobility*Crepitus or Grating(4)Radiologic
examination:*Fracture*Pattern of fracture

of the fracture*Selecting of Treatment

46)CLASSIFICATION OF FRACTURE? (1)From Direct/indirect Communication

between the fracture &wound of the skin &Mucosa:* From Within:Open
Fracture*From Without:Closed Fracture(2)From Stability:*Stable: Transverse
fracture,Greenstickfracture,Impactedfracture,Epiphyseal injury*Unstable: Spiral
fracture,Obliquefracture,Comminutedfracture,Avulsion

47)FACTORS RESPONSIBLE FOR FRACTURE? (1)Direct violence:applied to the

bone also damages surrounding soft tissue.Eg;tappingforce,crushing injury ,penetrating
direct injury(2)Indirect violence:applied to the bone produces significantly less damage
to soft & hard tissues(3)diseases of bone:may cause destruction of bone/may weaken
the bone produces a pathologic fracture.Eg;inflammation,tumor/ tumor -like diseases,
osteogenesis imperfecta,metabolic diseases(4)repeated stresses:which cause fatigue
fractures.These fracture are most frequently encountered in bone of the lower
extremity(5)Muscle pull:avulsion fracture

48)FACTORS INFLUENCE THE FRACTURE HEALING? (1)Systemic:*age*systemic

condition(2)Local:*Pattern of fracture:stable,non-stable*Blood supply(fragment):good
for both fragment,good for one,bad for both,absent*Infection*Injury of soft tissue*Soft
tissue interposition between fragments gap*Local disease(3)Treatment
method:*repetitive reduction/ manipulation*over-traction of fragments*incorrect
reduction/ fixation /debridement*influence of open reduction*incorrect functional
exercise

49)PRINCIPLES OF FRACTURE TREATMENT? (1)REDUCTION:(a)Criteria of

reduction:1)Anatomic reduction2)Functional reduction:*No observe gap
&rotation*Shortening 1~2 cm in the leg*Angulation 15~10*Apposition of the
fragments 1/3(shaft ),or 3/4(epiphyseal)(b)Methods of Reduction:*By closed
manipulation*By mechanical traction with or without manipulation*By open
reduction(2)IMMOBILIZATION:(a)Reasons of Immobilization: *Prevention of
displacement/angulation*Prevention of movement*Relief of pain(b) Methods of
immobilization:*By wooden splint/plaster/Splint(other)*By continuous traction*By
external fixer*By internal fixation(3)REHABILITATION:(a)Active muscular
contraction:After Injury within 2 weeks(b)Active exercises joints of adjacent fracture:
After Injury 2 ~8 weeks(c)Active resistance exercises:After 8 weeks(d)Physiotherapy(e)
Traditional medication

50)FRACTURE?A fracture is a complete/incomplete break in the continuity of a bone*A

fracture is defined as a disruption in the integrity of a living bone,involving injury to the
bone marrow,periosteum&adjacent soft tissues.Many types of fractures exist,such as
pathologic,stress&greenstick fractures

51)FUNCTIONAL POSITION OF HAND?*On this position ,hand can play the greatest
function*As a ball(Like tennis) in hand*After treatment of hand injury finishedthe hand
should be fixed on functional position

52)GAINT CELL TUMOR?*giant cell is osteolysis tumor with variable growth potential
originate from cancellous bone, it is potential malignancy/malignancy.*Adult is the most
population*Consist of cell:giant cell( osteoclast),matrix cell*Site:Lower end of femur,
upper end of tibia,lower end of radius,upper end of humerus

53)PATHOLOGY,CLI;FEATURES &TREATMENT OF GAINT CELL

TUMOR?(A)PATHOLOGY:*Consists of abundant undifferentiated oval/spindle-shaped
cells*The actual cell of origin is uncertain*It metastasisestothelungs *Epiphysial region
&extend to the joint surface *Destroy bone substance &new bone formation-the bone
end becomes expand*Pathology fracture(B)CLI; FEATURES:(1)Pain:vague pain
(2)swelling(3)Tenderness on firm palpation(4)pathological
fracture(5)Radiographs :*Show destruction of the bone substance,with expansion of
cortex.*Soap-bubble appearance*Grow eccentrically(C)TREATMENT:*Excision part
&whole bone:such as clavicle/fibula.*Curettage followed by packing bone graft:such as
femur*Arthroplasty *Amputation*Radiotherapy may induce malignant.(50deformity

54)GALEAZZI FRACTURE?Fracture of distal 1/3 radius associate with ulnar head

dislocation
55)CLI. MANIF &DIAGNOSIS OF ANTERIOR DISLOCATION OF HIP
JOINT?1)history of trauma2)symptom3)common sign4)special signs:*hip is
flexion,abduction&supination*elastic fixation*vacuity of joint cavity5)femoral head can be
touched from groin6)X-ray & CT scan.

56)PRINCIPLE OF TREATMENT OF HAND INJURY?(a)Early debridement(b)Correct

treatment of deep tissue injury (c)As far as possible close wound(d)correct treatment
after operation

57)CLI,MANIF &DIAGNOSIS OF CENTRAL DISLOCATION OF HIP JOINT?1)history

of trauma2)pain &swell in iliac region3)hemorrhagic shock 4)hip abduction& pronation
5)limb shortening6)visceral injury:bladder,internal iliac vessels 7)X-ray & CT
scan.TREATMENT:*rescue treatment*non operative treatment: traction*operative
treatment:for failure of non operativetreatment,fracture& dislocation can not be reduce

58)CLI,MANI;DIAGNOSIS &TREAT OF FRACTURE OF HUMERAL

SHAFT?*Pain,swell,ecchymosis,dysfunction of the upper limb*PE:tenderness,
shortness of the upper limb,angulation,abnormalmotion,bony crepitus*If complicate
radial nerve injury,the patient has wrist drop,metacarpophalangeal joints cannot
extend,lateral side of the back of hand has sensory disability*x-ray*The history of
trauma,clinicalmani; &x ray*Concentrate on nerve injury.TREATMENT:* Conservative
treatment*Operation treatment*Early exercise.

59)CLASSIFICATION OF HUMERAL SUPRACONDYLAR FRACTURE?(A)straight

type fracture:(1)Etiological factors:fall hand touched groundviolence transmit to the
distal humerushumeral condyle is pushed to posteriormeanwhile the weight push
the humeral shaft anterior inferiorly then the weakness of the humeral supracondyle is
broken(2)Cli; manifestation:swell, ecchymosis,dysfunction of the upper
limb(3)PE:tenderness,short of the upper limb, angulation,abnormalmotion,bony
crepitus*Fracture ends can be touched,outer margin of elbow is normal(B)Flexion type
fracture:(1)Etiological factors:fallouter margin of elbow touch on the groundviolence
transmit to the distal humerus&cause fracture(2)Cli;
manifestation:pain,swell,ecchymosis,dysfunction of the upper limb(3)PE:tenderness,the
upper limb short is short,angulation,abnormalmotion,bonycrepitus.Fracture ends can be
touched posteriorly to the outer margin of elbow, triangle of outer margin of elbow is
normal

60)HYPEREXTENSION DISLOCATIONS?*Anterior longitudinal ligament

injuries,intervertebral disc disrupt,anterior border of vertebral body are avulsed
*Superior vertebral body is displaced to posterior& can cause the spinal cord
compression.
61)CLASSIFI;OF SURGICAL NECK OF HUMERUS FRACTURE? According to the
displacement & the direction of displacement it is classified into 4;*No displacement
type*Abduction type*Adduction type*Comminuted type

62)HYPERPLASIA TYPE FRACTURE?*Excess callus formation around the fracture

site with a lucent interval through the callus itself &fragments

63)CLI,MANIF& DIAGNOSIS OF POSTERIOR DISLOCATION OF HIP

JOINT?1)history of trauma2)symptoms3)common sign4)special signs:*hip is
flexion,adduction&pronation*elastic fixation*cavity of joint vacuity5)great trochanter
move up,femoral head can be touched from posterior hip6)X-ray& CT
scan.TREATMENT:*Manipulative reduction*operative treatment

64)JAW OF DEATH? part of the hand b/w the thumb & the index finger

65)FEATURES OF OPEN INJURY OF JOINT?1)Keep Articular cartilage intact 2)Not

toleave foreign bodies in Joint3)Forbid to open draining(Can use irrigation)4)Repair of
capsule &ligaments5)Inject antibiotics into the joint after operation 6)Aspiration is
especially important in hemarthrosis7)The joint should be immobilized with
traction/splint/plaster

66)LIMB-SAVING SURGERY?*indication:low malignant tumors,early diagnosed

malignant tumors.*plan: regular chemotherapy or/&radiotherapy+resection+graft&
reconstruction or+joint replacement

67)CAUSES& CLI;FEATURES OF LUMBAR DISC HERNIATION?CAUSES:*inter

vertebral disc degeneration*trauma*inheritance*pregnancy CLI; FEATURES:(a)
symptom:*Back pain*Leg pain (ischiadicus Nerve pain)(b)Signs:*scliosis*activity
limitation*tenderness(c)spasm of sacrospinalismuscle(d)straight leg raising
&intensitication(e)nervous injury(f)abnormal sensation(g)weakness of muscle(h)reflex
abnormal:*hyperreflexia*hyporeflexia(i)Special examination:*x-ray*CT *MRI*EMG

68)TREATMENT OF LUMBAR DISC HERNIATION?(a)conservation:*bed rest*traction

(persist) *physicotherapy*epidura Injection*chemonucleolysis(b)per- cutaneous lumbar
discectomy(c)operation:(removal of nucleus pulposus)discectomy

69)LATERAL EPICONDYLITIS( TENNIS ELBOW)?*A kind of chronic

inflammatory*Effects Lateral condyle*mostly effect people of age 40-50yrs*Hyper-
pronation/supination-injury to insertion of extensor conjuncted tendon*Persisted action
&over-use cause tendinopathy,mini rapture/calcification of tendon

70)CLI;FEATURES &TREATMENT OF STRAIN OF LUMBAR MUSCLES?*Loacal

pain without inducement:release when relax,be sharp when tired*Fixed pain
point:insertion of muscle,release when given compression *Unhealthy daily habit*Long-
time sitting postureTREATMENT:*Self-
adjustment:morerest,posturechangregularly,lessbending,wear lumbar band
tape*Massage*Local block *NSAIDs/adrenocortical

71)LIGAMENTA FLAVA?*elasticligament,unite laminae of adjacent vertebrae

&complete the posterior wall of vertebral canal* tend to prevent hyperflexion of the
vertebral

72)MAL-UNION OF FRACTURE?Loose of apposition of over criterion of functional

reduction 8)DISLOCATION?Articulation missed its normal anatomic location.The
direction of dislocation is determined by the distal end of the joint.

73)MILLS TEST?*for Lateral epicondylitis(tennis elbow) *the elbow held in

extension*one hand to compress the lateral condyle*the other hand to resist wrist
rotation& distal extension*it will reproduce the patient's pain.

74)6 STAGES OF MUSCLE STRENGTH?*M0-No muscle contraction.*M1-Can feel the

muscle contraction,does not produce action*M2-Can produce action,cannot withstand
gravity*M3-can withstand Gravity,not against a resistance *M4-Can partially resist
resistance *M5-normal

75)MILLS SIGN?With the elbow held in full extension, resisted wrist& distal extension
will reproduce the patient's pain

76)MONTEGGIA FRACTURE?Fracture of proximal 1/3 ulna associate with radial head

77)NON-UNION OF FRACTURE?*Failure of fracture to heal caused by inadequate

blood supply,soft tissue interposition b/w 2 bone ends,closure of medullary cavity with
bone end sclerosis,or inadequate callus formation.It is of two types;*atrophic
type*hyperplasia type

78)NELATON LINE?*patient is dorsal position & hip joint is half flexion*in normal
people,the greater trochanter is just on a line that link the anterior superior iliac spine &
ischial tuberosity*it is superior to the line if the greater trochaner move up

79)NELATONS LINE? *patient is supinate & hip joint is half flexion*in normal
people,the greater trochanter is just on the line that link the anterior superior iliac spine
& ischial tuberosity*it is superior to the line if the greater trochanter moves

80)NECK SHAFT ANGLE?*this angle is b/w the long axis of the femoral neck & the
axis of the femoral shaft*range=110-140*the average=127*if this angle >127,it is
coxa valga*if this angle < 127 ,it is coxa vara.

81)OSTEOMYELITIS?*It is an inflammatory process accompanied by bone destruction

& caused by an infecting microorganism*osteon
(bone),myelo(marrow),itis(inflammation)*occurs when an adequate no;of a sufficiently
virulent organism overcomes the host's natural defenses(inflammatory & immune
responses)*Causes:bacteremia,Trauma,Illness,Malnutrition

82)CLI;FEATURES&TREAT OF OSTEOCHONDROMA?(1)mass:the lesion is a

hard,immovable,smooth mass that is firmly fixed to bone without tenderness unless it
has been traumatized(2)dysfunction of nerve & joint: nerve is compressed & the joint is
blocked by mass(3)X-ray:*peduncu-lated bony protuberance from the metaphysis of a
long bone that points away from the nearby joint.*The radiographic appearance of the
lesion is diagnostic*Malignant change is heralded by growth/pain in a previously static
osteo-chondromaTREATMENT:*observation:indication:Asymptomatic
lesions*Resection: indication:symptomatic exostosis

83)CLI;FEATURES & TREATMENT OF

OSTEOSARCOMA?(A)CLI;FEATURES:*(1)Pain(2)Swelling(3)Superficial vein is
engorge(prominent)(4)Tenderness(5)The overlying skin is warmer than normal bcz of
the vascularity of the tumor(6)The skin appears stretched& shiny.(7)X-ray :*Show
irregular destruction of the metaphysis*Codmans triangle*sun-ray appearance*profuse
formation of new bone*metastases.(B)TREATMENT:*Chemotherapy is usually
commenced before surgical treatment*To control local recurrence& distal
metastatic*limb-saving surgery*Amputation:palliativetreatment,amputation should be
very careful

84)CLI; FEATURES &TREATMENT OF OSTEOID OSTEOMAS?(a)signs

&symptoms:* Children & adolescents(5-25 age)are most requently affected*common
region of lesion: the femur & tibia*painfull lesions-
deep,boring,constant,nocturnal,&frequently relieved by aspirin*no
sign,ortenderness,swelling(b)examination:*X-ray *CT(c)treatment:*take
medicine*operation:curettage

85)OSTEOSARCOMA?*Predominantly a tumour of adolescence*The commonest site

are the lower end of the femur,the upper end of the tibia &the upper end of humerus-
most active growth is occurring*It begins in the metaphysic

86)MANAGEMENT OF CHRONIC OSTEOMYELITIS?(1)Avoid Empiric antibiotics

unless acute exacerbation:Treat acute exacerbation as acute Osteomyelitis (2)Base
management on culture& sensitivity:*Bone biopsy culture &sensitivity (preferred)*Soft-
tissue culture &sensitivity(3)Antibiotic duration for 2 -6 weeks(4)Surgical debridement
with:*Careful&complete debridement is criticial*Dead-space management: Local
myoplasty,Free-tissue transfers,Antibiotic impregnated beads
87)OSTEOCHONDROMA?*One of the most common bone neoplasms.*It is a cartilage-
capped projection of bone from the metaphysis of a long bone near the growth
plate.*Any bone preformed in cartilage can be affected

88)CLASSI;OF OSTEOMYELITIS BASED ON PATHOGENESIS(Waldvogel,1971)?

(1)Hematogenous:an infection from another part of the body to the bones(2)Contiguous
focus of infection: infections from adjacent bone/soft tissues(3)Direct inoculation:
Osteomyelitis can derive from a direct infection of bone,from a source outside the body

89)THERAPEUTIC PRINCIPLES OF ACUTE OSTEOMYELITIS?(1)an appropriate

antibiotic will be effective before pus formation(2)antibiotics will not sterilize avascular
tissues/abscesses& such areas require surgical removal(3)if such removal is
effective,antibiotics should prevent their reformation& therefore primary wound closure
should be safe(4)surgery should not further damage already ischemic bone& soft
tissue(5)antibiotics should be continued after surgeryCOMPLICATIONS:*septicemia
*metastatic infection*septic arthritis*altered bone growth*Chronic osteomyelitis

90)OSTEO FACIAL COMPARTMENT SYNDROME?*Fatal outcome for limbs affected,

caused by increase pressure in limbs compartment bcz of accumulated blood & fluid
post-trauma/injury/ fracture*produce vessels and nerve blockage to affected area &
result in necrosis

91)TREATMENT OF FRACTURE OF PELVIS?1)deal with life threatening

injuries :*Shock(blood transfusion) *Organs injury in the pelvic cavity.2)Treatment of the
pelvic fracture:*Conservative treatment* operation:open reduction& internal
fixation/external fixation

92)CLI;MANIFES%DIAGNOSIS OF FRACTURE OF PATELLA?*the knee is

swelling,ecchymosis,can not move after trauma.*PE:tenderness anterior to
patella,fracture end can be touched,floating patella test(+)bcz of hematocele*X
ray:make sure the fracture site,type& displacement.(35)treatment

93)PARAPLEGIA?The thoracic/thoracolumbar spinal cord injuries may result in

paralysis of the trunk & both lower

94)COMPLICATIONS OF PREDNISOLONE ACETATE? *secondary infection *vessel

spasm*neuritis*tendon rupture*punture injury *paralysis*necrosis*Cushing's syndrome

95)COMPLICATIONNS OF PELVIC FRACTURE?1)Retroperitoneal

hematoma2)Organs injury in the pelvic cavity3)Bladder, urethra injury4)Rectal
injury.5)Nerve injury(Sacrum fracture
96) CLI; MANIFESTATION & DIAGNOSIS OF PELVIC FRACTURE?1)Severe trauma:
road accident,fall2)Shock 3)Swelling,pain,ecchymosis4)Pelvic compression/separation
test 5)X-ray

97)CLASSIFICATION OF PELVIC FRACTURES?(1)Avulsion fracture of pelvic

edge(stable fracture):(a)Avulsion fracture of anterior superior iliac spine(b)Avulsion
fracture of anterior inferior iliac spine(c)Avulsion fracture of ischial tuberosity(2)Isolated
pelvic ring fracture(stable fracture):(a)Fracture of the ilium(b)Fracture of obturator
foramen ring (c)mild separation of the pubic symphysis(d)mild separation of sacroiliac
joint (3)Two sites of pelvic ring fractures (unstable fracture):(a)Unilateral pubic superior
& inferior ramus fractures united separation of pubic symphysis(b)Bilateral pubic
superior &inferior ramus fractures(c)Separation of pubic symphysis united sacroiliac
joint-dislocation(d)Pubic superior & inferior ramus fractures united iliac fracture(e)Pubic
superior & inferior ramus fractures united sacroiliac joint dislocation

98)PAUWELLSANGLE?it is included angle b/w distal fracture line& two iliac crest
line.*adduction fracture:Pauwellsangle>50its unstable fracture*abduction
fracture:Pauwells angle <30,it is stable fracture

99)QUADRIPLEGIA?The cervical spinal cord injuries may result in paralysis of the

trunk & 4 limbs.

100)RADICULAR PAIN?*Pain associated with lesion in nerve root.*The pain will

spread along the nerve branches that originates from the affected nerve root

101)REST POSITION OF HAND?*Tendon & ligament in a state of relative

balance*Once the continuity/power of tendon is hurt,rest position then change

102)RADIONUCLEOTIDE IMAGING,99M TC FEATURES?(a)3 Phase Bone

Scan:*Radionucleotide angiogram*Immediate post injection blood pool*Three hour:
soft tissue,urinary excretion(b)Diagnosis:*Cellulitis:Phases1 &2,no change
3*Osteomyelitis:Phases1& 2,focal 3(c)Results:94% sensitivity,95% specificity

103)FIRST AID &TRANSPORT OF FRACTURE OF SPINE?1)Rolling 2)Level

support3)Fractures of the cervical spine: (immobilize the neck)*cervical collar*sand
bag*head traction

104)WHAT ARE THE COMPLICATIONS WHEN SPINAL CORD ARE INJURED?

*Respiratory failure & respiratory tract infection*Urinary tract infection
&calculus*Bedsore*Body temperature disorder

105)CLI;FEATURES OF INTER &SUPRASPINOUS LIGAMENT?*Lumbar

pain ,especialy when bending*Local pain when compress the sharp point*Sliding of
raptured ligament can be touched*Perfirmed with ultrasonic/MRI examination
106)SMITH FRACTURE?*Flexion type fracture*It happens when wrist flexion& back of
hand touches on the ground.*it is one of the claasification of fracture of didtal
radius*Cli;manifestation&diagnosis:*wristdrop,swell,ecchymosis dysfunction of wrist
joint *X ray find distal fracture piece displace to ulna & palm forward. *Also called
reverse Colles fracture*Treatment:manipulative reduction& external fixation

(107)SKULL TRACTION?*traction refers to the set of mechanisms for straightening

broken bones/relieving pressure on the spine & skeletal system.*Traction of skull is
done when frcture of skull bones happens.(34)SPINAL CORD INJURIES?It is severe
complication of spinal fracture.Fragment of bone protrude into vertebral canal & can
cause spinal cord& caudal equine injuries.(

108)SOLITARY BONE CYST(SBC)?*It is a common lesion of the immature skeleton

*characterized by an intramedullary fluid-filled cavity that forms in the metaphysis,
juxtaposed to or near the physis

109)8CLI,FEATURES AND DIAGNOSIS OF DISLOCATION OF SHOULDER

JOINT?(a)Mechanism of injury:direct /indirect violence(b)specific signs:*square
shoulder deformity+elasticfixation+vacuity of joint cavity *Ducas sign(+)(c)diagnosis
proof: X-Ray + CT(d)Treatment:*Closed reduction+ exam of neurovascular+ high
quality X-Ray *anesthesia:brachial plexus block /joint local block*methods:Hippocratic
technique*immobilization:use sling(3-4 weeks)*functional exercise

110)THERAPEUTIC PRINCIPLES OF SPINAL CORD INJURY?1)Suitable immobilize

the spine to prevent further injury2)Relieve spinal cord edema/secondary spinal cord
injury3)Operation:*Relieve spinal cord compression*Stable spine* reconstruction of the
anatomy structure of the

111)SUDDEN RELEASEMENT SIGN?*begin with sudden sharp pain*Suddenly

released without any treatment*usually due to penetration of abcess

112)SCHMORL NODE?*Protrusion of intervertebral disc cartilage into the vertebral

body inferior to the affected cartilage*found in vertebral disc herniation

113)STRAIN OF LUMBAR MUSCLE?a chronic damaging inflammtory exists in the

insertion,fascia of lumbar muscle or the periosteum that it involved

114)SPINAL CORD SHOCK?*cord transaction:injury is irreparable& anatomical *total

loss of sensation,motion& reflex*motor paralysis is flaccid bcz the cord below level of
injury is in state of shock*after some time,the cord recover from shock & acts as an
independent structure,without any control from higher center
115)SUN-RAY APPEARANCE?*It ia a type of periosteal appearance of sun-ray
secondary to an aggressive periostosis *well marked radiating spicules of new bone r
seen within the tumour(

116)SUPRASPINATUS TEST?*for cuff tear*Extend the elbow*keep the shoulder in the

abduction position*Examiner give an opposite strength on the distal forearm*+ve:patient
cant resistent the force of gravity& feel painful on shoulder.

117)STENOSING FLEXOR TENOSYNOVITIS(TRIGGER FINGER)?*One of the most

common forms of tendinitis is trigger finger*There are idiopathic changes in the 1st
annular pulley that lead to restriction of the gliding motion of the flexor tendons
*Commonly referred to as trigger digits,snapping of flexor tendon function caused by
bunching of the flexor synovium at the annular one(A1)pulley does

118)SHOEMAKER LINE?*a patient is in dorsal position,in a normal patient,the line that

link the greater trochanter & anterior superior iliac spine has a intersection on or above
umbilicus with middle line* the intersection is below umbilicus if the greater trochanter
move up fibers

119)THOMAS SIGN?*Is to test hip joint dislocation/ deformity/ lumbar joints. *patient in
supine position &hyperflex the hip & knee joint of the affected side& pushed towards the
chest*+ve sign is when the unaffected leg also flexed(60)up*+ve test result of femoral
neck fracture when greater trochanter is not passing this line

120)TREATMENT PRINCIPLES OF TENDINITIS?*nonoperative management

*eliminating activities*use of splints,rest,or ergonomic changes to reduce overload*Non-
steroidal anti-inflammatory drugs(NSAIDs)*Steroid injections*surgical treatment

121)CLI;FEATURES &TREATMENT OF TRIGGER FINGER(SFT)?*12-14yrs male

children*pain tenderness *bone protuberance(mass)*X-ray:local large
fragmentationTREATMENT:*rest & take NSAIDs*Injection of corticosteroid into the
tendon sheath is a reliable treatment for trigger finger*When non-operative measures
fail to relieve triggering,A1 pulley release is appropriate*Immobilisation

122)TENDINITIS?*It is a common cause of pain in the hand & wrist*It has become
pervasive in our society,affectingathletes,manuallaborers,keyboard operators,
homemakers,assembly line workers& even computer game enthusiasts*It describes an
inflammatory cellular response to the disruption of intra-tendinous

123)TINEL SIGN?*After nerve injury,axonalregeneration is fast than remyelination,then

axons exposed,allergic phenomenon outside tapping can cause pain,radiating pain & a
sense of shock.*Along the nerve repair cadre,arrived at the front end of neurite
regeneration by far the feeling,which is +ve, that reaches the part of nerve
regeneration.*This experiment can help to judge the nerve injury site,understand the
growth of nerve fiber regeneration after nerve repair