Question I (One Hour)
A 64-year-old semi-retired accountant presents 6 weeks following a cemented total hip arthroplasty with an acute posterior dislocation of the joint. The dislocation occurred while he was trying to do up his shoelace.
Clinical examination reveals a shortened and internally rotated lower limb with disturbed sensation in the leg and foot and MRC Grade IV weakness of ankle dorsiflexion.
He is otherwise in good health apart from mild, treated essential hypertension and mild symptoms of benign prostatic hypertrophy.
Question 2 (30 Minutes)
Blood transfusions are frequently part of the perioperative management of orthopaedic patients.
Question 3 (30 Minutes)
A thirty year old renal transplant recipient suffered a closed short oblique fracture of the right tibia at the junction of the middle and distal thirds in a motor vehicle accident eighteen months ago.
Closed intramedullary nailing with locking screws was undertaken within twenty four hours, and the patient discharged within one week, partial weight bearing. He failed to attend for follow up.
He complains of pain at the fracture site. Examination produces pain when the fracture site is stressed, and x-ray reveals an established non-union
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