A premenarchal 12 year old girl presents, following a tripping accident, with acute onset of severe pain in the left hip on weight bearing. There has been a history of vague ipsilateral knee and thigh pain for 3 months

A 35 year old man presents with an unstable vertical shear fracture of the pelvis after falling 10 m from a viewing platform. He has no other associated musculoskeletal injuries. He is in a shocked state.

You, as the Orthopaedic Surgeon on duty, are discussing the treatment with the patient, who is a lawyer and his General Practitioner wife on the day of injury.

  1. Outline the early and late complications of this injury. 30%
  2. Discuss the advantages and disadvantages of (external and (internal fixation with particular reference to their effects on complications. 60%
  3. Discuss the important consent issues. 10%

Question 4. (½ hour)

A premenarchal 12 year old girl presents, following a tripping accident, with acute onset of severe pain in the left hip on weight bearing. There has been a history of vague ipsilateral knee and thigh pain for 3 months

  1. List the differential diagnoses. 10%
  • Discuss in short note form:
  1. Clinical assessment and investigation. 30%
  2. Your treatment plan, which includes informed consent and possible complications of the most likely diagnosis. 30%
  3. The current controversies in the management of the most likely diagnosis. 30%

 

Question 5. (½ hour)

A 65 year old female with widespread joint involvement from sero positive rheumatoid arthritis of ten years duration presents with a six month history of increasing difficulty walking because of a painful and deformed right knee

  1. Briefly list the likely clinical findings related to the knee. 20%

You and your patient agree that total knee replacement is the best treatment option.

  1. Itemise your preoperative (30%),
  2. operative (30%),
  3. postoperative (20%) assessment and management in order to minimise the problems and possible complications related to the rheumatoid disease

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