UNIVERSITEIT VAN STELLENBOSCH FAKULTEIT GESONDHEIDSWETENSKAPPE MB CHB IV - ORTOPEDIE MUSKULOSKELETALE SISTEEM 471

TYD/TIME: 2'/2uur/2'/2hrs PUNTETOTAAL/TOTAL MARKS: 100 OK.T/OCT2004

GEEN SAKREKENAARS WORD TOEGELAAT NIE / NO CALCULATORS ARE ALLOWED SKRYF ELKE AFDELING IN 'N NUWE BOEK / WRITE EACH SECTION IN A NEW BOOK

AFDELING A / SECTION A: Vraag 1: Bespreek kortliks u evaluering van 'n pasient met 'n bekken fraktuur. (10) Question 1: Briefly discuss your evaluation of a patient with a pelvic fracture. (10) Memo: Clinical evaluation: General: 1. ABC - airway, breathing, cardiovascular (shock) 2. Neurology - lower limbs 3. Abdomen abdominal injuries (tension signs) 4. Chest - diaphragm rupture (examen lungs) 5. Urogenital injuries blood meatus, sistogram 6. Local Closed, open fractures Skin lesions, degloving - anterior, posterior, lateral Perineal injuries - rectal examination vaginal essential Radiological: 7. AP pelvis, inlet view, oulet view, lateral sacrum

Vraag 2: Bespreek die kliniese tekens van 'n kroniese, posterior kniisligament besering van die kniegewrig. -~ (5) Question 2: Discuss the clinical signs of a chronic, posterior cruciate ligament injury of the kneejoint (5)

Memo: (+) Posterior draw sign(1) Posterior lateral instability with a reversed pivot shift.(2) Increased external rotation of the tibia on lateral stress with the knee flexed at 90

Vraag3: Bespreek kortliks die komplikasies van suprakondilere humerus frakture in kinders. (10) Question 3: Briefly discuss the complications of supracondylar humerus fractures in children. Memo: Acute: Neurovascular injuries, medial, radial, ulnar N Volksmann's Ischaemia Chronic: Malunion Cubitus varus, valgus Gunstock deformity Tardy ulnar nerve palsy Loss of flexion, extension Volksmann's contractures Miositis ossificans Vraag 4 Bespreek kortliks die hantering van femurskag frakture in kinders. (5) Question 4: Briefly discuss the management of femur shaft fractures in children. Memo: < 12 kg: > 12kg: gallows traction skin traction POP spica Thomas splint ORIF for proximal & distal shaft fractures - plaat fiksasie Intramedullary titanium rods

Vraag 5 a) Noem en klassifiseer Blount se siekte. (6) b) Hoe verskil Bloirnt se siekte van 'n fisiologiese Genu Varum? (10) c) Bespreek kortliks die behandeling van Blount se siekte. (4)

Question 5: a) Name and classify Blounts disease. (6) b) How does Blounts disease differ form physiological Genu Varum? (10) c) Briefly discuss the management of Blounts disease. (4)

Memo: a) Tibia vara Infantile Early onset I - 3 years Juvenile Late onset 4 - 10 years Adolescent - over 11 years (6)
b)

Blounts: Physiological: Unilateral or bilateral Bilateral Femur also bowed Femur normal Medial physis slopes, underdeveloped Physis tibia N Drennans angle > I I ' Drennans angle < 11 Metaphyseal changes (collapse) Metaphysis N (10)

c)

Management of Blounts: 1. Early Onset: Brace (Orthotics) If there is a lateral thrust - proximal Tib/Fib osteotomy 2. Late Onset: Tibia osteotomy (proximally) Often recurs, repeat osteotomy if necessary 3. Adolescent: Tibia osteotomy (proximally) (4)

Vraag 6 / Question 6: Dui die korrekte antwoord vir eike vraag aan. Daar mag meer as I korrekte antwoord wees. Indicate the correct statement for each question. There may be more than I correct answer. (1) Patologiese frakture as gevolg van 'n metastase:-

a. b. c. d. e.
(1)

Moet altyd intern fikseer word Benodig nooit profilaktse fiksasie nie Moet gefikseer word as > 50% korteks betrek Is die mees algemene voorkoms van 'n osteosarkoom Kompliseer dikwels eenvoudige been siste

Pathological fractures due to a metastasis a. Always require prophylactic fixation b. Never require prophylactic internal fixation c. Require fixation if they are bigger than 50% of the bone diameter d. Are the most common presenting feature in osteosarcoma e. Commonly complicate simple bone cyst

(2) Radioterapie is aangedui in: a. Behandeling van osteosarkoom voor amputasie b. Reusesel tumore c. Behandeling van 'n maligne tumor na marginale eksisie d. Al die bogenoernde e. Geen van die bogenoernde

(2) Radiotherapy is indicated in: a. Treatment of an osteosarcoma before amputation b. Giant cell tumours of bone c. Treatment of a malignant tumour after marginal excision d. All of the above e. None of the above PLEASE SEE DIFFERENCE IN ANSWER 3 ARIKAANS (a;b) ENGLISH (a;c) (3) Die volgende tumore word as ekspansiel beskou a. Tiroied metastase b. Anerismalebeensist c. Osteoiede osteoom d. Reusesel tumore e. Geen van die bogenoernde (3) The tumours below may be markedly expansile a. Thyroid tumour metastasis b. Osteoid osteoma c. Aneurismal bone cyst d. Giant cell tumour e. None of the above (4) Algemene komplikasies van posteriorheuponwrigting is: a. Trombose van die femorale vena b. Ruptuur van die blaas c. Avaskulerenekrose van die heup d. "Drop" Voet e. Al die bogenoernde (4) Common complications complicating posterior hip dislocations are: a. Thrombosis of the femoral vein b. Urinary bladder rupture c. Avascular necrosis of the hip d. Drop foot

e. All of the above (5) Komplikasies van kalkaneus frakture mag die volgende insluit: a. Frakture van LI werwel b. Lisfrank fraktuur c. Fraktuur van die mediale malleolus d. Al die bogenoernde e. Geen van die bogenoernde (5) Complications ofcalcaneus fractures commonly include: a. Fracture of LI vertebra b. Lisfranc foot fractures c. Medial malleolar fractures d. All of the above e. None of the above

(6) Patellere frakture a. Benodig fiksasie met skroewe as > 3mm verplaas b. Mag met gips behandel word as nie verplaas nie c. Tensieband bedrading is nodig as die ekstensiemeganisme versteur is d. Patellektomie geindikeerd as transversftakture > 5mm verplaas e. Geen van die bogenoernde (6) Patellar fractures a. Require fixation with screws if more than 3mm displaced . b. May be treated in a cast if undisplaced c. Tension band wiring is indicated if the patellar extension mechanism is disturbed d. Patellectomy is indicated in transverse fractures more than 5mm displaced e. None of the above (7) 'n Lipohemartrose mag gediagnoseer word a. As daar troebelvog is op aspirasie b. Op standelaterale X-straal opname c. Op laterale X-straal met die been in 'n horisontale posisie d. Ballottering van die patella (7) A lipohaemarthrosis of the knee may be diagnosed: a. As turbid fluid on aspiration b. Using a standing lateral X-ray c. Using a horizontal position on lateral X-ray d. By ballottement of the patella (8) Sluiting van die knie is 'n algemene sirntoom in:a. Posterior kniisligament besering b. Anterior kruisligament ruptuur c. Osteochondritis dissicans d. Mediate meniskus besering e. Al die bogenoernde (8) Locking of the knee is a common symptom in:-

a. b. c. d. e.

Posterior crucuciate ligament injury Anterior cruciate ligament rupture Osteochondritis dissicans Medial meniscus injury All of the above

Vraag 7 'n 23-jarige man presenteer by u kliniek met 'n 9 maand oue fraktuur van die linker tibia. Hy was met 'n debridement en bobeen gips behandel. Die wond is tans goed geheg en daar is geen neurologiese uitval nie. X-strale toon 'n hipertrofiese vertraagde hegting van die distale derde van die linker tibia. Die skag is goed belyn.

Question 7

A 23 year old man presents to your clinic with a nine month old fracture of the left tibia. He had previously been treated by means of a debridement and above knee plaster cast. The wound is well healed and there is no neurological fallout. X-rays show signs of a hypertrophic delayed union of the distal third of the tibia. The shaft is well aligned. a. Describe the X- ray findings b. Discuss your further management (6) Memo: a. No bridging callus, "elephants foot" appearance. b. Check for sepsis, FBC and ESR. Conservative - dynamic cast - PTB, Operative debridement / sequestrectomy if septic, bone graftObtain stability Vraag 8: Noem drie maligne toestande met skeletale aantasting wat tipies voorkorn in pasiente onder die ouderdom van 10 jaar. (3) Question 8 Mention three malignant conditions with skeletal involvement that typically occur in patients under the age of 10 years. (3) Memo: Ewing se sarkoom Leukemie Neuroblastoom - metastases Vraag 9: Walter noodsaaklike klinies-patologiese inligting is nodig vir die akkurate diagnose van beentumore? (5) Question 9: What essential clinicopathological information is necessary for the accurate diagnosis of bone tumours? (5) Memo: Pasient ouderdom Kliniese beeld pyn, aantal letsels, predisponerende faktore, ens. Tumorligging XF, CT, MR = makroskopiese patologie

Biopsie = histopatologie, EM, genetika (5) Vraag 10: ('/i punt per feit) Noem 4 komplikasies van chroniese piogene osteomielitis. Question 10: (1/2 mark per fact) Mention 4 complications of chronic pyogenic osteomyelitis. (2) Memo: Dreinering van etter deur chroniese velsinusse Plaveiselkarsinoom in velsinusse Patologiese fraktuur Amiloi'dose