AVN and Regional Conditions of Lower Limb MCQs

Answer- D. Paget's disease Storage disorders : - Gaucher's disease Caisson disease : - Dysbaric osteonecrosis Hemoglobinopathy & Coagulation disorder: - Sickel cell disease, Familial thrombophilia, Hypofibrinolysis, Hypolipoproteinemia. Congenital disorders : - Perthe's disease, Slipped capital femoral epiphysis. Hematological malignancies : - Leukemia, lymphoma, Polycythemia. Hyperlipedemia : - Nephrotic syndrome

Answer- A. Avascular necrosis Pain in hip and limitatation of movement (immobility) ofter chronic use of steroids suggest the diagnosis of AVN of femoral head.

In, India we follow the middle path regime for treatment of TB paraplegia. All patients with TB paraplegia are first started on ATT and advised bed rest and given a spine brace. These patients are the monitored for improvement. Patients who improve on ATT are continued with it. Those who are not improving are treated with surgery. Indications of surgery in middle path regime are Bowel and bladder involvement Worsening of paraplegia while on ATT Appearance of a new neurological deficit while on treatment No improvement in paraplegia even after 3-4 weeks of ATT In this question, the patient does not have any bowel or bladder symptoms, so he is started on ATT and monitored. Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 193

Congenital pseudarthrosis of the tibia: A birth defect in the lower third of the tibia in children, whereby a fracture in this region fails to unite. "It is a congenital condition characterized by bowing of tibia (mostly anterolateral bowing). Neurofibromatosis type 1 is found in 50–55 % of patients with congenital pseudoarthrosis (while 10% of patients with neurofibromatosis have pseudoarthrosis). It is equally distributed in boys and girls and is almost always unilateral. There is little tendency for the lesion to regress, and the bone eventually fractures through the weakened area. Treatment: Before a fracture occurs, a total contact orthosis is prescribed as prophylaxis. But once a fracture occurs. surgery is indicated. Reference- Maheshwari 5 th /ep. PG NO 225