http://online.fliphtml5.com/ighv/etmv/#p=15 MULTIPLE CHOICE UE!TIO"! I" OTHOP$E%IC! $"% T$UM$ 1. &hich i' the 't(onge't lig)ment: $ Ilio*femo()l lig)ment + I'chio*femo()l lig)ment , P-o*femo()l lig)ment % T()n've('e )cet)-l)( lig)ment E Lig)ment-m te(e'. A Ilio-femoral ligament blends with anterior part of hip joint capsule and is the strongest ligament at hip joint.
. &hich p)(t of 0-)(icep' m-'cle i' mo't f(e0-entl2 fi(o'e in po't in3ection 0-)(icep' cont()ct-(e: $ ect-' femo(i' + 4)'t-' mei)li' , 4)'t-' inte(mei-' inte(me i-' % 4)'t-' l)te()li' l)te() li' E $ll of )ove. D Vastus lateralis is most frequently affected probably because injections are usually given in this area of thigh.
. )ion-cleie one 'c)nning i' mo't -'ef-l in: $ $v)'c-l)( nec(o'i' nec(o 'i' + M)lign)nc2 , he-m)toi )(th(iti' % !t(e'' f()ct-(e' E $c-te o'teom2eliti'. В adionucleide bone scanning is most useful in defining e!tent of primary tumour" locating unsuspected metastasis and primary malignant tumour. tumour. In all other conditions mentioned its use is more of academic interest
6. Commone't c)-'e of f)il-(e of )(th(og()ph2 i': $ E7t()*)(tic-l)( in3ection of cont()'t + 8-ling of )i( in the 3oint , 9)l'e po'itive inte(p(et)tion % 9)l'e neg)tive inte(p(et)tion E $lle(gic $lle(gic (e)ction. A
#!tra-articular injection of contrast medium is the commonest
cause of failure of arthrography art hrography especially in smaller and deep situated joints. Allergic reaction to contrast medium is rare but when it happens e!amination will have to be discontinued. $ther factors also ma%e this procedure futile.
5. M2elog()ph2 i' nece'')(2 in folloing conition': $ !-'picion of )n int()'pin)l t-mo-( + Conflicting clinic)l fining' )n C.T. 'c)n , Ev)l-)tion of p(evio-'l2 ope()te 'pine % $ll of )ove E !ome of )ove. D Due to its complications and since it is an invasive technique" myelography has been replaced by &' scan. (ow a days primary indications of myelography are as mentioned in the question.
;. $(th(o'cope $(th(o'cope )' invente )n fi('t -'e 2: $ T)<)gi + &)t)n)e , %)n2 % )c<'on E P)tel. A )irst prototype of arthroscope was made and used by 'a%agi a%agi in in *+*,. odern day arthroscope was made by 'a%agi 'a%agi and atanabe. atanabe. Dandy" /ac%son and 0atcl are some of the leaders of arthroscopic surgery nowadays.
>. &h)t i' the g-ieline to eltopecto()l g(oove: $ $7ill)(2 vein + Ceph)lic vein , M-'c-lo*c-t)neo-' ne(ve % Mei)n ne(ve E "one of )ove. В &ephalic vein lies in deitopedoral groove and serves as landmar% in identification of plane between deltoid and pectaralis major during anterior e!posure of shoulder. shoulder.
?. Mo't 'e(io-' complic)tion of )(th(o'cop2 i': $ H)emo((h)ge in the 3oint 3oint + %)m)ge to )(tic-l)( c)(til)ge , Comp)(tment '2n(ome % ! @ no vi)l fi't-l) E 8(e)<)ge of in't(-ment.
cause of failure of arthrography art hrography especially in smaller and deep situated joints. Allergic reaction to contrast medium is rare but when it happens e!amination will have to be discontinued. $ther factors also ma%e this procedure futile.
5. M2elog()ph2 i' nece'')(2 in folloing conition': $ !-'picion of )n int()'pin)l t-mo-( + Conflicting clinic)l fining' )n C.T. 'c)n , Ev)l-)tion of p(evio-'l2 ope()te 'pine % $ll of )ove E !ome of )ove. D Due to its complications and since it is an invasive technique" myelography has been replaced by &' scan. (ow a days primary indications of myelography are as mentioned in the question.
;. $(th(o'cope $(th(o'cope )' invente )n fi('t -'e 2: $ T)<)gi + &)t)n)e , %)n2 % )c<'on E P)tel. A )irst prototype of arthroscope was made and used by 'a%agi a%agi in in *+*,. odern day arthroscope was made by 'a%agi 'a%agi and atanabe. atanabe. Dandy" /ac%son and 0atcl are some of the leaders of arthroscopic surgery nowadays.
>. &h)t i' the g-ieline to eltopecto()l g(oove: $ $7ill)(2 vein + Ceph)lic vein , M-'c-lo*c-t)neo-' ne(ve % Mei)n ne(ve E "one of )ove. В &ephalic vein lies in deitopedoral groove and serves as landmar% in identification of plane between deltoid and pectaralis major during anterior e!posure of shoulder. shoulder.
?. Mo't 'e(io-' complic)tion of )(th(o'cop2 i': $ H)emo((h)ge in the 3oint 3oint + %)m)ge to )(tic-l)( c)(til)ge , Comp)(tment '2n(ome % ! @ no vi)l fi't-l) E 8(e)<)ge of in't(-ment.
В Apart from mfection" damage to articular cartilage by arthroscope" instilments and irrigation needle is most serious complication" instrument brea%age is not the problem with newer modern day instruments. $ther complications mentioned can occur but are uncommon.
A. &hich of the folloing i' mo't 'e(io-' complic)tion of m2elo* g()ph2: $ $lle(gic (e)ction + He))che , T()n'ient T()n'ient ne-(ologic)l eficit % $()chnoiiti' E "ec< 'tiffne''. В If performed in proper aseptic manner" manner" fever is not the usual complication while all others are the dangers of myelography. 'hese 'hese complications are fairly common with nonabsorbable" oily contrast mediums rather than with newer water soluble contrast medium.
1B. &h)t )(e cont()inic)tion' of )(th(o'cop2: $ P)(ti)l o( complete )n<2lo'i' of 3oint + i'< of int(o-cing 'ep'i' f(om ) ne)(2 '
11. Commone't Commone't c)-'e of 0-)(icep' cont()ct-(e i': $ Congenit)l + I'ch)emic m2o'iti' , 9olloing femo()l 'h)ft f()ct-(e % 9olloing ope()tion' on thigh E Po't in3ection fi(o'i'.
# 0ost injection fibrosis usually occurs after repeated intramuscular injections or saline infusions in an infant. 'his is the commonest cause in India and other causes are less common.
1. &h)t i' the e)(lie't inic)tion of 4ol
1. &hich of the folloing i' inco((ect )o-t i'loc)tion of 'te(nocl)vic-l)( 3oint: $ $nte(io( i'loc)tion occ-(' -e to ini(ect in3-(2 )n i' common t2pe of i'loc)tion + Po'te(io( i'loc)tion i' ()(e )n occ-(' -e to i(ect in3-(2 ove( mei)l en of cl)vicle , !te(nocl)vic-l)( i'loc)tion i' common comp)(e to )c(omiocl)vic-l)( i'loc)tion % T()che) c)n e comp(e''e in po'te(io( i'loc)tion E M)nip-l)tive (e-ction i' often -n't)le )n fi7)tion ith i(e m)2 e (e0-i(e. 1 Dislocation of sternoclavicular joint is much less frequent than acromioclavicular joint dislocation. All other statements are true and briefly describe the salient features of sterooclavicular joint dislocation.
16. &hich of the folloing i' the e)(lie't l)o()to(2 fining in ) c)'e of f)t emoli'm: $ Inc(e)'e 'e(-m chole't(ol + Inc(e)'e 'e(-m lip)'e , Inc(e)'e 'e(-m f)tt2 )ci' % Lip-(i) E Inc(e)'e )l<)line pho'ph)t)'e.
D 0resence of fat dropiet in urine is the earliest laboratory finding in fat embolism. 2ut it most be remembered that the diagnosis is mainly clinical and one should not wait for any inves before instituting treatment.
15. 9i('t t(e)tment p(io(it2 in p)tient ith m-ltiple in3-(ie' i': $ $i()2 m)inten)nce + 8leeing cont(ol , Ci(c-l)to(2 vol-me (e'to()tion % !plinting of f()ct-(e' E e-ction of i'loc)tion. 3 3.В.1. 4Airway" bleeding and circulation5 are the priorities in management of seriously injured patient in that order.
1;. &hich of the folloing f()ct-(e oe' not -'-)ll2 nee open (e-ction )n inte(n)l fi7)tion: $ Mi 'h)ft f()ct-(e of fem-( + P)thologic)l f()ct-(e' , T(och)nte(ic f()ct-(e in ele(l2 % %i'pl)ce int()*)(tic-l)( f()ct-(e' E %i'pl)ce f()ct-(e of oth one' of fo(e)(m in )-lt'. A $ut of the fractures mentioned" femoral shaft fracture is least li%ely to need operative treatment. In this fracture operation is done to get patient out of traction early. All other fractures mentioned will almost always need open reduction and internal fi!ation.
1>. Commone't c)-'e of f)il-(e of inte(n)l fi7)tion i': $ Infection + Co((o'ion , Met)l (e)ction % Imm-ne eficient p)tient E !t(e'' f()ct-(e of impl)nt. A ost common and seriot advantage of open reduction and mfpmal fi!ation is infection which will ultimately lead to implant becoming loose and non-union. Immune deficient patient does not behave differently as regards fracture healing. &orrosion" metal reaction and stress fracture cf implant are rare.
1?. %e)th )2' )fte( pelvic f()ct-(e i' mo't li
1A. Inte(n)l fi7)tion of f()ct-(e i' cont()inic)te in hich 'it-)tion: $ $ctive infection + &hen one g)p i' p(e'ent , In epiph2'e)l in3-(ie' % In compo-n f()ct-(e E In p)thologic)l f()ct-(. A Active infection is the only definite contiaind%a on of internal fi!ation7 and in this situation 89 e!ternal :;8<= or e!ternal immobili>ation is the treatment of choice. In pathological fractures and in presence of bone gap internal fi!ation is qmie oftea mandatory. &ompound fracture is a relative contimnrlicarion.
B. Mo't often open (e-ction of f()ct-(e i' (e0-i(e in: $ Clo'e f()ct-(e ith ne(ve in3-(2 + Compo-n f()ct-(e , 9()ct-(e in chil(en % Un')ti'f)cto(2 clo'e (e-ction E "on -nion. D ?nsatisfactory closed reduction is the commonest reason for performing open reduction. (e!t commonest reason for this is non-union. )ractures in children rarely require open reduction. &ompound fractures and fractures associated with nerve injury are also uncommon reasons.
1. In fe )2' ol f()ct-(e hich of the folloing oe' not occ-(: $ C)pill)(2 p(olife()tion + P(olife()tion of o'teogenic cell' ove( eno'te-m )n one en'
, Loc)l pH i' )ci % Loc)l pH i' )l<)line E The(e i' ve(2 little (i'e in level of )l<)line pho'ph)t)'e )t f()ct-(e 'ite. D ?pto a wee% after fracture local p@ remains acidic and only after this period p@ becomes al%aline and level of al%aline phosphatase mar%edly rises. All other statements are true.
. 9()ct-(e i'e)'e c)n e p(evente 2: $ Pl)'te( immoiliF)tion of f()ct-(e + C)'t ()ce t(e)tment of f()ct-(e , Inte(n)l fi7)tion of f()ct-(e % E7te(n)l fi7)tion of f()ct-(e E Ph2'iothe()p2 # )racture disease in some measure always occurs and none of the methods of treatment of fracture can prevent it. It can only be minimised by regular physiotherapy to reduce oedema" improve muscle tone and maintain functional movements in joints which have not been immobili>ed.
. &hich of the folloing i' commone't m)te(i)l -'e to m)
6. 8one g()ft o(<' 2 p(oviing folloing mech)ni'm'. &hich of the'e i' mo't impo(t)nt. $ 8one in-ction f)cto( + O'teogenic cell' , Living o'teol)'t' % Mine()l 'c)ffol fo( v)'c-l)( p(olife()tion E 8(iging the one g)p. D 0rovision of mineral scaffold into which newly forming vascular channels can grow is the most useful function of bone graft and that is why
ban% bone" heterogenous bone and homografts succeed. 2one inducing factor" osteogenic cells and living osteoblasts are supplied only by fresh autogenous grafts.
5. Commone't complic)tion hile -'ing e7te(n)l fi7)to( i': $ Pin t()ct infection + Comp)(tment '2n(ome , Loo'ening of pin' % 9i7)tion of m-'cle' E oint 'tiffne''. A 0in tract infection is by far the commonest problem. In addition to complications mentioned" neurovascular damage can occur while inserting the pins and refracture can occur after removal of fi!ator.
;. $ p)tient ho h)' '-'t)ine open o-n on leg i' leeing p(of-'el2. 8efo(e p)tient )((ive' in ho'pit)l the ')fe't metho to 'top leeing i': $ Elev)tion of leg + Loc)l p(e''-(e on o-n )n elev)tion of leg , Lig)tion of leeing ve''el % U'e of to-(ni0-et E P(e''-(e ove( femo()l )(te(2 in g(oin. В ocal pressure on wound and elevation of leg is the safest and most effective method to stop bleeding. 'ourniquet can be dangerous if not properly used. #levation alone and local pressure on femoral artery is ineffective.
>. &hich of the folloing i' )n )'ol-te cont()inic)tion of open (e-ction: $ $ctive infection + !m)ll 'iFe f()gment , 4e(2 'oft one % Dene()l meic)l complic)tion' E !eve(e 'c)((ing of )3)cent 'oft ti''-e'. A Active infection is a contraindication for open reduction as this may lead to further complications and even more difficulty in salvage. In other conditions mentioned open reduction can produce problem and should not be lightly underta%en.
?. &hich of the folloing i' the e't )2 to p(e'e(ve )mp-t)te p)(t fo( (epl)nt)tion: $ Imme('ion in col ')line + Imme('ion in col (inge( l)ct)te , Imme('ion in col )ntiiotic 'ol-tion % %(2 cooling ith ice E %eep f(eeFing. D Dry cooling with ice is the best way to preserve amputated part as this causes least alteration of tissue structures.
A. &hich of the folloing f()ct-(e i' 'loe't to he)l )n often evelop' non*-nion: $ Int()c)p'-l)( femo()l nec< f()ct-(e + !c)phoi , Loe( thi( of tii) % P(o7im)l h-me(-' E %i't)l fem-(. A Intracapsular femoral nec% fractures are slowest to heal and develop non-union in higher percentage of cases compared to scaphoid and distal tibial fractures" both of which also tend to heal slowly due to deficient blood supply of one fragment. 0ro!imal humerus and distal femoral fractures do not usually go to delayed union.
B. Commone't c)-'e of f)il-(e of inte(n)l fi7)tion of f()ct-(e i': $ Infection + 9)tig-e f()ct-(e of impl)nt , Co((o'ion in impl)nt % Loo'ening of impl)nt E Met)l (e)ction. A
Infection following an open operation is the commonest cause of failure
following internal fi!ation. All other factors can also lead to complications but. statistically they are not as important
1. Chemic)ll2 Pl)'te( of P)(i' i': $ C)lci-m c)(on)te + C)lci-m pho'ph)te , C)lci-m '-lph)te % $nh2(o-' c)lci-m '-lph)te E Hemih2()te c)lci-m '-lph)te.
#
0owder of plaster of pans chemically is hemihydrated calcium sulphate.
. &hich of the folloing i' not 'een in ) c)'e of f)t emoli'm: $ 9)t glo-le' in -(ine + Left he)(t 't()in on ECD , !no 'to(m )ppe)()nce on che't *)2 % "o(m)l c)(on io7ie ten'ion in )(te(i)l loo E Lo o72gen ten'ion in )(te(i)l loo. В
#&B will show right heart strain and not the left heart strain.
. Clo'e (e-ction ith pe(c-t)neo-' J*i(e fi7)tion i' e't '-it)le fo(: $ 8ennett f()ct-(e + L)te()l m)lleol-' f()ct-(e , Mei)l m)lleol-' f()ct-(e % L)te()l tii)l con2le f()ct-(e E Cl)vicle f()ct-(e. D alunited fractures are the commonest cause of deformity in long bones since the incidence of fracture is much higher than congenital" developmental" metabolic" infective and neoplastic conditions.
6. In ) he)ling f()ct-(e )mo-nt of c)(til)ge fo(m)tion inc(e)'e 2: $ igi immoiliF)tion + Movement )t f()ct-(e 'ite , "ec(o'i' of one en' % Comp(e''ion pl)ting E Infection. В ore the movement at fracture site" more will be cartilage formation and non union can occur. &ompression plating helps in conversion of cartilage into bone and thereby fracture healing can occur in a delayed or non-union. Infection retards all the stages of fracture repair.
5. Mo't '-cce''f-l metho of t(e)tment of non*-nion i': $ Comp(e''ion pl)ting + Comp(e''ion 2 e7te(n)l fi7)to( , $ition of 8.M.P. % 8one g()fting E Elect(ic)l 'tim-l)tion
D 2one grafting is most successful and useful method of treating non-union. 2..0.42one morphogenetic protein5 has not been isolated as yet $ther three methods are suitable in certain specific situations only.
;. &hich of the folloing m-'cle oe' not fo(m (ot)to( c-ff of 'ho-le(: $ !-'c)p-l)(i' + !-p()'pin)t-' , Inf()'pin)t-' % Te(e' mino( E Te(e' m)3o(. # #!cept teres major all other muscles mentioned are closely applied to the capsule of shoulder joint and form rotator cuff.
>. of $ + , % E
&h)t i' the commone't complic)tion of f()ct-(e of mi 'h)ft h-me(-': M)l-nion "on -nion )i)l ne(ve p)()l2'i' 8()chi)l )(te(2 in3-(2 Uln)( ne(ve in3-(2.
A ost of humeral shaft fractures are treated conservatively and malunion 4usually neither cosmetically disfiguring nor functionally impairing5 is the commonest complication. If fracture has been treated by internal fi!ation this will become rare complication. (e!t commonest complication is radial nerve injury in spiral groove where nerve is in direct contact with bone. (on union is uncommon and brachial artery injury is rare.
?. Commone't c)-'e of c-it-' v)(-' efo(mit2 folloing m)l-nite '-p()con2l)( f()ct-(e of h-me(-' i': $ ot)tion)l m)l)lignment + Mei)l i'pl)cement , P(o7im)l i'pl)cement % Po'te(io( i'pl)cement E Epiph2'e)l )m)ge. A Internal rotation deformity of distal fragment mainly contributes to cubitus varus. Cecond factor is medial displacement of distal fragment. 0ro!imal and posterior displacement do not cause cubitus varus. 'he fracture occurs well above the epiphyses of distal humerus and epiphyseal injury does not occur.
A.
Mo't commonl2 f()ct-(e one i':
$ + , % E
H)m)te T(i0-et(-m L-n)te C)pit)te !c)phoi.
# Ccaphoid is most commonly injured carpal bone. unate is second most commonly injured carpal bone although it does not fracture but is involved in dislocation of lunate and perilunar dislocation of carpus.
6B. &h)t i' the mo't 'e(io-' complic)tion of inte(n)l fi7)tion of f()ct-(e of oth one' of fo(e)(m: $ Infection + C(o'' -nion , Limit)tion of fo(e)(m (ot)tion % ef()ct-(e E "on -nion. A Development of infection following open reduction of fracture is the most serious complication. All other complications mentioned can also occur following open reduction and internal fi!ation.
61. &hich of the folloing -(') p(o-ce' '2mptom' in 'ho-le( impingement '2n(ome: $ !-)c(omi)l -(') + !-eltoi -(') , 8-(') in (el)tion of '-'c)p-l)(i' tenon % 8-(') in (el)tion to l)ti''im-' o('i E 8-(') eteen co()coi p(oce'' )n c)p'-le. A Cymptoms of impingement syndrome are produced when subacromial bursa is pressed between humeral head and undersurface of coraco-acromial arch.
6. &h)t i' the commone't complic)tion of '-p()con2l) f()ct-(e of h-me(-': $ M)l-nion + M2o'iti' o''ific)n' , !tiffne'' of elo % 4ol
A al union" especially rotational malalignment7 is the commonest complication and results in the deformity of cubitus varus. (on union is very rare and all other complications are not common" ost serious complication is Vol%manns iscnaemia.
6. &h)t i' the e)(lie't inic)tion of 4ol
66. &hich of the folloing i' t(-e )o-t Monteggi) f()ct-(e: $ It i' -'-)ll2 )''oci)te ith po'te(io( inte(o''eo-' ne(ve p)()l2'i' + It c)n e -'-)ll2 t(e)te con'e(v)tivel2 in )-lt' , It i' not )n in3-(2 of chil(en % It i' ) comin)tion of f()ct-(e of ()i-' ith i't)l ()io*-ln)( 3oint i'loc)tion E It i' ) comin)tion of f()ct-(e' of p(o7im)l -ln) ith i'loc)tion # onteggia fracture comprises of fracture of pro!imal ulna with dislocation of radial head. It can occur in children. In adults most of cases will need internal fi!ation of ulna whereas in children most can be treated conservatively. It is also not normally associated with posterior interosseous nerve paralysis.
65. $ coll)( )n c-ff )n)ge ill e mo't '-it)le t(e)tment fo( hich of the folloing in3-(2: $ Mi'h)ft f()ct-(e of h-me(-' + Uni'pl)ce f()ct-(e of nec< of h-me(-' , Monteggi) f()ct-(e % %i'loc)tion of elo E 9()ct-(e of ()i)l he). В All undisplaced humeral nec% fractures at all ages and most
displaced fractures in elderly can be safely treated in collar and cuff sling. All other injuries mentioned need more elaborate treatment. After reduction of elbow dislocation elbow can sometimes be immobili>ed in fle!ion in collar and cuff bandage but this is not a safe method of treatment.
6;. &hich of the folloing i' not )pplic)le to ()i)l nec< f()ct-(e: $ It i' ) common in3-(2 in chil(en th)n )-lt' + $ng-l)tion c)n -'-)ll2 e (e-ce 2 m)nip-l)tion , Open (e-ction i' 'ometime' (e0-i(e % Mech)ni'm of in3-(2 i' f)ll on o-t't(etche h)n E It i' )n epiph2'e)l in3-(2 of ')lte( t2pe*4. # adial nec% fracture is an epiphyseal injury of C alter typeE. In children radial head should never be e!cised as this will lead to reduction in length of radius" dislocation of inferior radio-ulnar joint and limitation of forearm rotation. ?sually manipulation succeeds in reducing the tilt and rarely open reduction is required.
6>. &hich of the folloing 't)tement i' t(-e )o-t '-p()con2l)( f()ct-(e of h-me(-': $ $nte(io( i'pl)cement of i't)l f()gment i' common th)n po'te(io( i'pl)cement + C-it-' v)lg-' i' common th)n c-it-' v)(-' folloing m)i-nion , "e-(ologic)l complic)tion' )(e -'-)ll2 t()n'ito(2 % &e)
6?. &hich of the folloing 'c)phoi f()ct-(e i' mo't p(one to evelop )v)'c-l)( nec(o'i': $ 9()ct-(e of )i't of 'c)phoi + 9()ct-(e of t-e(cle , 9()ct-(e of i't)l pole % $ll of )ove E "one of )ove.
A Almost +FG scaphoid fractures occur through its waist. 2lood supply to scaphoid enters at tubercle and in a narrow ridge at waist. Due to this peculiar arrangement of blood supply pro!imal half often becomes avascular after fracture at waist.
6A. P-ll of hich of the folloing m-'cle m)
5B. P-tti*Pl)tt ope()tion i' -'e fo(: $ "on -nion of h-me(-' + %i'loc)tion of p)tell) , %i'loc)tion of ()i)l he) % ec-((ent i'loc)tion of 'ho-le( E ec-((ent i'loc)tion of pe(one)l tenon'. D 0utti-0latt operation consists of reefing of anterior capsule of shoulder joint and subscapularis muscle and is used for treatment of recurrent dislocation of shoulder. Aim of operation is to limit e!ternal rotation which causes humeral head to dislocate.
51. 8e't t(e)tment fo( h-me()l nec< f()ct-(e in ) ;B 2e)( ol p)tient ill e: $ Coll)( )n c-ff )n)ge folloe 2 ph2'iothe()p2 + Open (e-ction )n pl)'te( 'pic) , Open (e-ction )n inte(n)l fi7)tion % Clo'e m)nip-l)tion )n pl)'te( 'pic) E H)nging c)'t A Choulder stiffness is most serious problem than the worry about alignment 4malalignment can be ta%en care by wide range of shoulder motion5 and union 4union always occurs as this is mainly cancellous bone with good vascularity5. 0laster spica is contraindicted as this will ma%e shoulder stiff and painful. @anging cast is the treatment for humeral shaft fracture. Internal fi!ation of humeral nec% fracture may be required rarely in displaced fractures in young age.
5. In)ilit2 to e7ten inte(ph)l)nge)l 3oint of th-m fe ee<' )fte( Colle' f()ct-(e inic)te' evelopment of: $ Comp)(tment '2n(ome + Po'te(io( inte(o''eo-' ne(ve p)l'2 , $v-l'ion of in'e(tion of e7ten'o( pollici' long-' % $tt(ition (-pt-(e of e7ten'o( pollici' long-' tenon )t the 'ite of f()ct-(e E Te)( of e7ten'o( pollici' long-' m-'cle ell2. D 'his attrition rupture is more common after undisplaced and minimally displaced &olles fracture. Cince it is attrition rupture" tendon ends are frayed and direct repair is not possible. 'reatment therefore consists of transfer of e!tensor indicis tendon to the distal stump of e!tensor pollicis longus tendon. &ompartment syndrome is an early complication.
5. &h)t i' the -'-)l t(e)tment fo( '2mptom)tic ol )c(omio* cl)vic-l)( i'loc)tion: $ $(th(oe'i' of )c(omio*cl)vic-l)( 3oint + K*i(e fi7)tion of 3oint , L)g 'c(e fi7)tion of 3oint % e'ection of o-te( en of cl)vicle E $c(omionpl)'t2. D esection of outer *H of clavicle and capsulorraphy produces satisfactory amelioration of symptoms. 'ransfer of tip of coracoid with its attached muscles is ne!t best method of treatment. -wire and lag screw fi!ation are the treatment of acute dislocation. Arthrodesis of acromio-clavicular joint is almost impossible to achieve and if achieved will greatly impair the mobility of shoulder girdle. Acromionplasty is used for intractable cases of impingement syndrome
56. eg)(ing f()ct-(e of cl)vicle hich of the folloing 't)tement i' inco((ect: $ 9()ct-(e i' commone't in mei)l thi( + "on -nion i' ()(e , Mo't c)'e' c)n e t(e)te con'e(v)tivel2 % 9()ct-(e -'-)ll2 occ-(' -e to ini(ect in3-(2 E 9()ct-(e i' common in mile thi(. A &lavicle fractures usually by fall on outstretched hand and the force transmitted brea%s the bone at place where two curves meet and therefore fractures are most common in the middle third of bone. All other statements about union and treatment of clavicle fracture are correct.
55. &hich of the folloing i' inco((ect )o-t i'loc)tion of l-n)te: $ %i'loc)te l-n)te )ppe)(' t(i)ng-l)( in'te) of (ect)ng-l)( on $.P. 7*()2 + %i'loc)tion i' mo't e)'il2 (ecogni'e on l)te()l vie 7*()2 , $v)'c-l)( nec(o'i' i' common folloing i'loc)tion % L-n)te i'loc)te' po'te(io(l2 E Mei)n ne(ve comp(e''ion c)n occ-(. D In total dislocation of lunate the bone dislocates anteriorly and that is why median nerve can be compressed. If closed deduction fails open reduction is performed from antenor Jch )urthermore anterior approach permits spbung K C' retinaculum to decompress carpal tunnel and med"an nerve. All other statements are correct.
5;. &hich of the folloing i' not )pplic)le to 'c)phoi f()ct-(e: $ Mech)ni'm of in3-(2 i' f)ll on o-t't(etche h)n. + It i' common in )-lt' th)n ele(l2 pe('on' , Often non -nion evelop' % 9()ct-(e )t )i't i' commone't E $v)'c-l)( nec(o'i' i' ()(e. # Avascular necrosis of pro!imal fragment is fairly common since the blood supply to this part comes in a retrograde direction and whole of pro!imal pole is covered by articular cartilage and does not have any place for vascular channels to enter in this part of bone.
5>. &hich of the folloing 't)tement i' t(-e )o-t i'loc)tion of inte(ph)l)nge)l 3oint of finge(: $ It i' ) fle7ion in3-(2 + It i' )n e7ten'ion in3-(2 , e-ction i' often -n't)le % %i't)l ph)l)n7 i' i'pl)ce )nte(io(l2 in (el)tion to the p(o7im)l ph)l)n7 E The(e i' no nee to te't fo( 't)ilit2 )fte( (e-ction of i'loc)tion. В Dislocation of interphalangeal joints is an e!tension injury an the distal phalan! is displaced dorsally in relation to pro!imo phalen!. ost often reduction is stable and its stability must L chec%ed immediately after manipulation. ?nstable reducoa is usually due to associated fracture which can be recognised a !-ray and needs internal fi!ation.
5?. &h)t i' -'-)l t(e)tment fo( '2mptom)tic non-nion of 'c)phoi in ) 2o-ng p)tient:
$ %(illing of f()gment' of 'c)phoi + %(illing of f()gment' of 'c)phoi )n one g()fting , 8one g()fting )n e7ci'ion of ()i)l 't2loi % $(th(oe'i' of (i't E E7ci'ion of 'c)phoi. 1 2one grafting and e!cision of radial styloid is the usual treatment for symptomatic non-union of scaphoid. Drilling alone is of no value. #!cision of scaphoid leaves behind a wea% and unstable wrist. hen bone grafting has failed e!cision of radial styloid will relieve symptoms to a great e!tent. (on union of scaphoid can in long term produce radio carpal degenerative anthritis requiring arthrodesis of wrist. hen non-union of scaphoid is an incidental finding with out symptoms it can be left without any treatment
5A. &hich of the folloing in3-(2 i' D)me
;B. &hich of the folloing i' not t(-e )o-t po'te(io( i'loc)tion of 'ho-le(: $ ec-((ent i'loc)tion c)n evelop + e-ction c)n e -n't)le , P)tient' ith -n(e-ce i'loc)tion c)n h)ve goo f-nction % Clinic)l i)gno'i' i' e)'2 E $7ill)(2 ne(ve in3-(2 i' -ncommon. D Diagnosis of posterior shoulder dislocation can be often missed and is not easy both clinically and radiologically. eduction is quite often unstable and shoulder spica is required with shoulder in abduction and e!ternal rotation. ecurrent dislocation can develop and a!illary nerve injury is uncommon since posterior dislocation does not stretch the nerve which courses from posterior to anterior.
;1. Commone't c)-'e of efo(mit2 in ) long one i': $ O'teopo(o'i' + ic
;. &h)t i' the 'econ mo't impo(t)nt )'pect in the t(e)tment of f()ct-(e' of long one': $ $e0-)te n-t(ition of p)tient + $cc-()te )n)tomic)l (e-ction , ImmoiliF)tion % e'to()tion of one )lignment E $ntiiotic'. 1 )irst and foremost requisite to ensure healing of long bone fractures to restore function is the reduction of bone fragments into good alignment so that malunion does not occur. Accurate anatomical reduction is not necessary. Cecond important aspect is immobili>ation of the fracture.
;. &hich efo(mit2 in m)l-nite f()ct-(e i' mo't li
;6.
&h)t i' mo't impo(t)nt )'pect of the t(e)tment of c(-'h
'2n(ome involving )n e7t(emit2: $ $mp-t)tion + 9l-i )n elect(ol2te )l)nce , %i)l2'i' % $ntiiotic' E H2e()(ic o72gen. A Amputation pro!imal to the level of injury is the most important aspect of treatment. At the same time maintenance of fluid balance is also important. Dialysis may be required. Antibiotics really are of prophylactic value. @yperbaric o!ygen has no role.
;5. $ + , % E
In inte(f()gment)(2 fi7)tion 'c(e o(<' 2 p(o-cing: Comp(e''ion %i't()ction $ntiglie mech)ni'm Inc(e)'e 'he)( "one of )ove.
A Ccrew wor%s by converting torsional stress 4used during its insertion5 into compressive force and this %eeps fracture surfaces in close apposition. 'his is the basic mechanism on which screw wor%s.
;;. 8)'ic t(e)tment of mo't non*-nion' i': $ Comp(e''ion pl)ting + Contin-)tion of e7te(n)l 'plint)ge , Elect(ic)l 'tim-l)tion % 8one g()fting E Phemi'te( g()fting. D In an established non-union freshening of bone ends and bone grafting is the usual treatment. #lectrical stimulation and compression plating is indicated in certain limited cases only. 0hemister grafting is one method of bone grafting in cases where bone fragments are in good alignment.
;>. E7te(n)l fi7)to( i' not inic)te in: $ Commin-te f()ct-(e + 9()ct-(e )''oci)te ith 'eve(e 'oft ti''-e )m)ge , Infecte f()ct-(e' % !imple clo'e f()ct-(e of h-me()l 'h)ft E 9()ct-(e )''oci)te ith -(n'. D ?se of e!ternal fi!ator is contraindicated in an uncomplicated fracture. It is an indispensable method of treatment of fracture in association with
infection" burn and severe soft tissue damage requiring repeated dressing and s%in grafting. #!ternal fi!ator is also used e!tensively for purpose of limb lengthening.
;?. Commone't c)-'e of (ef()ct-(e )fte( (emov)l of e7te(n)l fi7)to( i': $ Pin t()ct infection + 9()ct-(e th(o-gh pin t()ct , $'ence of pe(io'te)l c)ll-' % %e't(e''ing p(o-cing c)ncell)tion of co(te7 E $v)'c-l)( nec(o'i' of one f()gment'. A 0in tract infection is by far the commonest problem. In addition to complications mentioned" neurovascular damage can occur while inserting the pins and refracture can occur after removal of fi!ator.
;A. 9olloing femo()l 'h)ft f()ct-(eN ation after femoral fracture are important.
>B. &h)t i' the mo't 'e(io-' i')v)nt)ge of e7te(n)l fi7)to(: $ Pin t()ct infection + Loo'ening of pin' , !t(e'' p(otection o'teopo(o'i' % 9()ct-(e c)n not e comp(e''e E $nothe( f()ct-(e c)n occ-( th(o-gh pin t()ct. A 0in tract infection is the most frequent and serious complication of use of e!ternal fi!ator. If a very rigid fi!ator assembly has been used" its removal should be in stages to overcome stress protection osteoporosis. In most good fi!ators it is possible to either compress or distract the fracture. oosening of pins can be minimi>ed by %eeping the pins under compression. ater fracture through pin tract is another potentially serious problem with use of e!ternal fi!ator.
>1. &h)t i' the e't t(e)tment fo( )n oli0-e tii) 'h)ft f()ct-(e hich h)' (ei'pl)ce )fte( initi)l goo clo'e (e-ction )n pl)'te( immoiliF)tion
$ + , % E
&eging of pl)'te( em)nip-l)tion )n pl)'te( Open (e-ction )n inte(n)l fi7)tion !
1 $blique fractures are difficult to hold in plaster and best treatment is internal fi!ation if reduction can not be achieved or has been lost after closed manipulation. C%eletal traction from calcaneal or supramalleolar pin is the ne!t best option available. 'raction has to be maintained for 6-M wee%s until early union has occured. At this stage when fracture is deformable but not displacable plaster or cast brace can be applied. &ast brace can not be used until there is early union of fracture.
>. 8-mpe( f()ct-(e i' the n)me given to: $ 9()ct-(e of tii) )n fi-l) + 9()ct-(e of l)te()l tii) con2le , 9()ct-(e of p)tell) % 9()ct-(e of l)te()l femo()l con2le E 9()ct-(e of tii)l 'pine. 2 @istorically tibial condylar fractures have been referred to as HbumperH or HfenderH fractures. 2ut falls from height are also N common causes of these injuries.
>. Int()me-ll)(2 n)iling of femo()l 'h)ft f()ct-(e i' cont()* inic)te: $ &hen the(e i' compo-ning + &hen the f()ct-(e i' t()n've('e , &hen f()ct-(e i' in n)((oe't p)(t of one % In non -nion in )-lt' E In ) chil. # Intramedullary nailing is contraindicated in children because of danger of damage to growing ends of bone and also when the child grows the nail will become totally embedded deep inside bone and can not be removed. In compound fractures any internal fi!ation device should be used after due consideration of complications. All other indications are ideal for intramedullary nail fi!ation.
>6. $ p)tient evelop' comp)(tment '2n(ome G'ellingN p)in )n n-mne'' folloing m)nip-l)tion )n pl)'te( fo( f()ct-(e of oth one' of leg. &h)t i' the e't t(e)tment: $ !plit the pl)'te(
+ , % E
Elev)te the leg Inf-'ion of lo molec-l)( eight e7t()n Elev)te the leg )fte( 'plitting the pl)'te( %o ope()tive ecomp(e''ion of f)ci)l comp)(tment.
# henever diagnosis of compartment syndrome is confirmed 4increased compartment pressure measured by transducer5 or suspected7 safest and best course of action is operative decompression of tight facial compartment. Any delay will produce irreversible muscle necrosis. All other treatments mentioned are an accompaniment to decompression operationO
>5. &hich of the folloing i' mo't impo(t)nt 'tep hen J*n)iling i' one fo( fi7)tion of f(e'h femo()l 'h)ft f()ct-(e'. $ Doo (e)ming of me-ll)(2 c)n)l to t)
>;. &hich of the folloing i' commone't complic)tion of Colle' f()ct-(e: $ !tiffne'' of finge(' + !tiffne'' of (i't , !tiffne'' of 'ho-le( % !-l-7)tion of infe(io( ()io -ln)( 3oint ith p)in E !-ec<' o'teo2't(oph2. A All the complications mentioned can occur after &olles fracture but out of these stiffness of fingers is the commonest complication. (e!t commonest complication is malunion followed ne!t in frequency by stiffness of shoulder. $ther are less common but by no means rare. east common complication is spontaneous rupture of e!tensor pollicis longus tendon. (on union is very rare.
>>. M)l-nite Colle' f()ct-(e p(o-ce' &hich of the folloing efo(mit2: $ D)(en 'p)e efo(mit2 + %inne( fo(< efo(mit2 , M)el-ng efo(mit2
% !)n nec< efo(mit2 E 8o-tonnie(e efo(mit2. В
alunited &ollesP fracture produces dinner for% deformity.
>?. &h)t i' the -'-)l t(e)tment fo( '2mptom)tic ol )c(omio* cl)vic-l)( i'loc)tion: $ $(th(oe'i' of )c(omio*cl)vic-l)( 3oint + K*i(e fi7)tion of 3oint , L)g 'c(e fi7)tion of 3oint % e'ection of o-te( en of cl)vicle E $c(omionpl)'t2. D esection of outer *H of clavicle and capsulorraphy produces satisfactory amelioration of symptoms. 'ransfer of ?p of coracoid with its attached muscles is ne!t best method of treatment. -wire and lag screw fi!ation are the treatment of acute dislocation. Arthrodesis of acromioclavicular joint is almost impossible to achieve and if achieved will greatly impair the mobility of shoulder girdle. Acromionplasty is used for intractable cases of impingement syndrome.
>A. eg)(ing f()ct-(e of cl)vicle hich of the folloing 't)tement i' inco((ect: $ 9()ct-(e i' commone't in mei)l thi( + "on -nion i' ()(e , Mo't c)'e' c)n e t(e)te con'e(v)tivel2 % 9()ct-(e -'-)ll2 occ-(' -e to ini(ect in3-(2 E 9()ct-(e i' common in mile thi(. A &lavicle fractures usually by fall on outstretched hand and the force transmitted brea%s the bone at place where two curves meet and therefore fractures are most common in the middle third of bone. All other statements about union and treatment of clavicle fracture are correct.
?B. &hich of the folloing 't)tement i' not co((ect )o-t )n
of )n
?1. $ + , % E
In )n
# An%le sprain is an inversion injury and anterior talo-fibular ligament is first to be damaged. ore severe injury can also damage origin of e!tensor digitorum brevis and calcaneo-fibular ligament.
?. &hich of the folloing in3-(2 i' c)lle $vi)to(' f()ct-(e $ Pott' f()ct-(e + Tot)l i'loc)tion of t)l-' , 9()ct-(e nec< of met)t)(')l % !-t)l)( i'loc)tion E 9()ct-(e of nec< of t)l-'. # Cudden dorsifle!ion of an%le" when aircraft crashes" produces impingement of anterior margin of distal tibia against nec% of talus producing a fracture. 'his used to be the commonest mode of fracture of nec% of talus and was therefore termed aviators fracture. Came injury now a days quite often occurs in motorcycle and car accidents.
?. $-ctionN e7te(n)l (ot)tion in3-(2 p(o-ce' oth the %-p-2t(en' )n M)i'onne-ve f()ct-(e. &hich of the folloing in3-(2 iffe(enti)te' one f(om the othe(: $ Level of f()ct-(e in mei)l m)lleol-' + Level of f()ct-(e in l)te()l m)lleol-' , Level of f()ct-(e in fi-l) % P(e'ence o( )'ence of i)'t)'i' of infe(io( tiio*fi-l)( 3oint E P(e'ence o( )'ence of thi( m)lleol-'.
1 2oth Dupuytrens and aisonneuve fractures are similar injuries resulting in fracture of medial malleolus or rupture of deltoid ligament" tear in interosseous membrane" diastasis and fracture of fibula. evel of fracture in fibula differentiates one from the other. In Dupuytrens fracture fibular fracture is in its lower third while in aisonneuve fracture fibular fracture is located in its pro!imal third.
?6. Conce(ning int()*)(tic-l)( f()ct-(e' )t
?5. In c)'e' of leg f()ct-(e'N )ove
?;. &hich of the folloing f()ct-(e' of femo()l 'h)ft )(e mo't '-it)le to inte(n)l fi7)tion 2 J-nt'chne( n)il: $ T()n've('e f()ct-(e of mi 'h)ft + !pi()l f()ct-(e of mi 'h)ft , Oli0-e f()ct-(e of i't)l thi( of 'h)ft % !-t(och)nte(ic f()ct-(e E 4e(2 commin-te f()ct-(e of mi 'h)ft. A Intramedullary nail 4-nail5 is most suitable in transverse mid shaft fractures as the medullary canal is narrow and fracture becomes very stable. Cpiral and long oblique fractures are best treated by plating. )ractures of
distal third are in area where medullary canal is wide and intramedullary nail fi!ation is not rigid. 'hese and subtrochanteric fractures are treated by nail plate devices. &omminuted fractures do not provide all round support for nail and can not be treated by this method. 'hey should either be treated conservatively or by plate fi!ation.
?>. 8e't t(e)tment fo( ) 'i7t2 five 2e)( ol p)tient ith fo-( ee< ol int()c)p'-l)( femo()l nec< f()ct-(e i': $ Inte(n)l fi7)tion + Inte(n)l fi7)tion ith m-'cle peicle g()ft , Me M-(()2 o'teotom2 % Hemi(epl)cement )(th(opl)'t2 E Tot)l Hip (epl)cement. D In old patients irrespective of the duration since injury hemireplacement arthroplasty is the procedure of choice as the patient can be mobili>ed early" thus avoiding general complications of immobili>ation. In old fracture internal fi!ation is ineffective. Internal fi!ation with muscle pedicle graft is useful procedure as it induces vascularity to aid in fracture union and also restores normal anatomy. ith this operation and also with e urray osteotomy weight bearing has to be delayed for many months and therefore these operations are used only in younger patients.
??. &hich of the folloing i' p(efe()le t(e)tment fo( 'i7 ee<' ol int()'c)p-l)( f()ct-(e of femo()l nec< in ) thi(t2 five 2e)( ol m)n: $ Hemi(epl)cement )(th(opl)'t2 + Me M-(()2 O'teotom2 , !mith Pete('on ")iling % Moo(e' pin fi7)tion E Pl)'te( 'pic). В In an old intracapsular femoral nec% fracture any form of e!ternal immobili>ation is of no use. Internal fi!ation is suitable in fresh fractures when nec% is not absorbed and fracture surfaces are fresh. After three wee%s some absorption of fractured ends starts and accurate reduction is not possible. At this stage e urray osteotomy is most useful procedure as it will increase the vascularity" reduce stress on fracture line and does not need accurate alignment of fractured ends.
?A. &hich of folloing i' the commone't c)-'e of loo'e o2 in the
% !2novi)l o'teochon(om)to'i' E To(n meni'c-'. # Ctatistically torn meniscus is the commonest cause of loose body in the %nee joint )ractures and osteochondritis dissecans are second and third common causes of intra-articular loose body.
AB. &hich of the folloing i' mo't t(-e )o-t i'pl)ce inte(con2l)( f()ct-(e GT*R f()ct-(e of i't)l fem-(: $ C)n e t(e)te )e0-)tel2 2 '
A1. &h)t i' t(-e )o-t '-p()con2l)( f()ct-(e' of fem-(: $ %i't)l f()gment tilt' po'te(io(l2 -e to p-ll of g)'t(ocnemi-' + %i't)l f()gment tilt' )nte(io(l2 -e to p-ll of 0-)(icep' , C)n e t(e)te 0-ite ell 2 J*n)iling % C)n -'-)ll2 e t(e)te ith -''ell t()ction E C)n e complic)te 2 in3-(2 to 'ci)tic ne(ve. A Bastrocnemius pulls the distal fragment and its upper end tilts posteriorly and malunion in this position will cause genu recurvatum deformity. It can be treated conservatively by reduction and traction with %nee in MQR fle!ion" and for this reason ussel traction and traction on 'homas splint with %nee straight are useless. 2est treatment for these fractures is internal fi!ation with angled blade plate appliance or #nder nails.
A. &hich of the folloing i' not 'een in int()c)p'-l)( f()ct-(e of femo()l nec<. $ Coll)p'e of he) )fte( -nion of f()ct-(e + M)i -nion ith mo(e th)n of 'ho(tening , $v)'c-l)( nec(o'i' of femo()l he)
% "on -nion E Mi''e i)gno'i'. В If the fracture has united shortening is only due to co!a vara and is usually not e!cessive. Diagnosis of undisplaced" impacted fracture can be missed on clinical e!amination since the patient can move the hip with little discomfort and may at times be able to wal% also. (on union and avascular necrosis are well %nown complications and their incidence is appro!imately EQG each. Although fracture can unite but still enough of blood supply to femoral head may have been jeopardi>ed to produce avascular necrosis which in turn can lead to collapse of femoral head.
A. !henton line i' (o
A6. 9o( ) i'tene
A5. &hich of the folloing i' t(-e )o-t )c-te (-pt-(e of tenc c)lc)ne-' Gteno*)chilli': $ It occ-(' -e to i(ect in3-(2 + )iog()ph ill confi(m the i)gno'i' , Comp(e''ion of c)lf m-'cle' p(o-ce' pl)nte(fle7ion of )n
D 'his is injury of middle aged persons usually occuring due to unaccustomed e!ercise. Direct injury is not the cause of tendon N rupture although most patients feel as if something has hit. S-ays are of no value in diagnosis. 0lanterfle!ion of an%le on compression of calf occurs when the tendon is intact and its absence signifies tendon rupture. Curgical repair is preferable treatment.
A;. !t)ilit2 of ing structures are muscles. enisci and tendons do not contribute significantly to stability.
A>. Complete (-pt-(e of teno c)lc)ne-' i' e't t(e)te 2: $ Ph2'iothe()p2 + $(th(oe'i' of )n
A?. $ + , % E
In )n
# An%le sprain is an inversion injury and anterior talo-fibular ligament is first to be damaged. ore severe injury can also damage origin of e!tensor digitorum brevis and calcaneo-fibular ligament.
AA. &hich of the folloing 't)tement i' not t(-e )o-t f()ct-(e of p)tell). $ Even -ni'pl)ce f()ct-(e' (e0-i(e p)tellectom2 + -)(icep' e7p)n'ion m)2 e int)ct in i(ect in3-(2 , -)(icep' e7p)n'ion i' (-pt-(e hen g)p i' p)lp)le eteen p)tell)( f()gment' % Jnee c)n not e )ctivel2 e7ten if 0-)(icep' e7p)n'ion i' (-pt-(e E %i'pl)ce p)tell)( f()ct-(e' (e0-i(e ope()tive t(e)tment. A ?ndisplaced fractures do not have significant roughening oi articular surface and quadriceps mechanism also remains intact therefore patellectomy is not indicated. $peration is required to repair quadriceps e!pansion and to either realign and fi! displaced patellar fragments if a reasonably smooth articular surface can be restored" or to e!cise pateilar fragments when fracture is so comminuted that patellar articular surface will remain rough.
1BB. &hich of the folloing 't)tement i' not t(-e )o-t 'eve(e v)(-' 't()in in3-(2 of ation with %nee 6F degrees fle!ed. S-ray may quite often be normal or may only show avulsion fracture of head of fibula. Ctress radiographs or e!amination under anaesthesia will reveal full e!tent of damage. ateral popliteal nerve can also be damaged due to traction injury.
1B1. Ho oe' p)()l2tic 'colio'i' iffe( f(om iiop)thic 'colio'i': $ P(og(e'' of c-(ve 'top' )fte( m)t-(it2 + !colio'i' c)n p(og(e'' even )fte( m)t-(it2 , C-(ve' )(e -'-)ll2 'ho(t % 8()cing i' 0-ite effective in cont(olling p(og(e'' E C-(ve neve( ecome' ve(2 'eve(e. В Asymmetrical paralysis of paraspinal muscles produces paralytic scoliosis. &urve can develop and progress even after maturity" is usually long and can become very severe. 2racing is not as effective in controlling paralytic scoliosis as it is in controlling
