Orthopedic Ordeals Trivia Quiz

Answer: Narrowing of joint space

The thumb in the X-ray is abnormally close to the hand and the bones of the thumb are close to the other bones in the hand. This is because there is a reduction of joint space which is a characteristic feature of osteoarthritis. Other features (although not seen in the X-ray) are formation of abnormal bone formations called osteophytes. Osteoarthritis (OA) is a degenerative disease of joints.

Treatment of this condition would include drugs such as analgesics, which are drugs that relieve the pain.

Answer: Humerus

Supracondylar fracture of the humerus occurs at the lower end of the humerus, just above the elbow region. It is very commonly seen when a child falls on an outstretched arm and also when there is hyperextension of the arm. The fracture splits the bone into two fragments, the proximal (closer to body or above) and distal (further from body or below) fragments. Based on the displacement of the distal fragment, this fracture can be of flexion type or extension type.

This fracture is associated with a number of complications like injury to the brachial artery and a condition called myositis ossificans. Volkmann's ischemia is another such complication which can occur two or three days after a fracture. In this condition, occlusion of the brachial artery can cause injury to muscles and nerves in the forearm causing severe pain and immobility.

Answer: Sun ray appearance

The sun ray appearance of osteosarcoma on an X-ray is because the tumor grows into the surrounding soft tissues and new bone is formed in these areas with blood vessels. This gives the characteristic sun ray or sunburst appearance.

X-ray, bone biopsy and bone scan are some of the investigations that can be carried out. Local control of the tumor before distant metastasis has occurred includes amputation of the limb. Radiotherapy and chemotherapy can be done if the tumor is in a surgically inaccessible site.

Answer: Old age

Osteoporosis is due to a diffuse reduction in bone density and bone mass. In this disease, the rate of bone resorption exceeds that of bone formation. One of the major associations of osteoporosis is old age. Other risk factors include menopause, protein deficiency due to malnutrition or malabsorption, hyperthyroid states and pre existing Cushing's disease. Clinical features of this disease include loss of strength and increased curvature of the spine. Exercises are recommended in patients at risk of osteoporosis. Special braces for supportive treatment are also available.

Answer: Myositis ossificans

Myositis ossificans is a form of post traumatic ossification and most commonly occurs as a complication of fractures. The formation of the new bone mass around the joint disrupts the structure of the joint and may sometimes completely restrict movements at that joint.

The treatment of myositis ossificans in advanced cases is excision of the mass but, in early stages, physiotherapy and adequate rest is important.

Answer: Antibiotics

Acute osteomyelitis is a disease in which an infection by microorganisms occurs in bones. The most common pathogen involved is Staphylococcus aureus which reaches the bone through the blood. After this, the bone initiates an inflammatory reaction which leads to bone destruction and formation of pus.

This disease is mostly diagnosed in childhood and may present with fever, acute pain and pus discharge. Treatment of this disease includes antibiotics.

Answer: Congenital talipes equinovarus

The term equinus comes from the Latin word for horse. In congenital talipes equinovarus (CTEV), there is a deformity called equinus deformity at the ankle joint which makes the foot bend downwards and as the patient walks, it looks as if he/she is walking on their toes as a horse would. Secondary CTEV can be due to paralytic disorders or due to a condition called arthrogryposis multiplex congenita (AMC).

There are various abnormalities that occur in the anatomy of people with CTEV which include a considerably smaller calcaneum bone (the bone in the heel), adduction (outward bending) of the forefoot, underdevelopment of calf muscles, shortened ligaments in the side of the foot and deep creases of skin on the affected foot.

Answer: Wrist joints

The characteristic fracture in Colle's fracture occurs at the lower end of the radius, at what is called the corticocancellous junction. It is commonly seen in people above 40 years of age, postmenopausal women or if someone falls on an outstretched arm.

A few other injuries associated with Colle's fracture are rupture of ulnar collateral ligament and fracture of ulnar styloid. Clinical features of this fracture include pain, swelling and deformity. Immobilization of the upper limb below the elbow is ideal for recovery and can be done with a cast.

Answer: Knock knees

Genu valgum, or knock knees, is a condition in which the knees are abnormally bent to be close to each other and the ankles are abnormally bent away from each other facing away from the body. It is sometimes seen in children of age two to three and it corrects itself by the age of six. This condition can arise after a fracture or dislocation, or be due to cancer. This deformity also commonly occurs in children with rickets, which is a condition that is caused by the deficiency of vitamin D. Treatment of genu valgum would include wearing shoes which have one side raised.

There is another condition called genu varum which is also known as bow knees. In this condition, the knees are divergent and the ankles are approximated.

Answer: Tennis elbow

The epicondyles are parts of the humerus and are very close to the elbow joint. Each humerus have two epicondyles, lateral and medial. Inflammation and pain at the lateral epicondyle is called tennis elbow or lateral epicondylitis. It affects the muscles in the forearm that help in extension or forward bending. The pain felt is aggravated by stretching the muscles. Treatment of this condition includes analgesics or painkillers like paracetamol, anti inflammatory drugs and sometimes, an injection of hydrocortisone, a steroid that reduces the inflammation.

If the inflammation occurs at the medial epicondyle, it is called Golfer's elbow or medial epicondylitis. This affects the flexor tendons of the forearm. Treatment would be the same as for tennis elbow.