Increased Callus formation is seen in increased
mobilization.


Healing by callus, though less direct (indirect
healing) has distinct advantages: it ensures
mechanical strength while the bone ends heal,
and with increasing stress the callus grows
stronger and stronger (according to Wolff's law)


Wolff's law states that the architecture and
mass of the skeleton are adjusted to withstan
the prevailing forces imposed by functional ne
or deformity.


The bone either heals by primary (without callus
formation) or secondary (with callus formation)
fracture healing.

Correct Answer-B
Ans. is
i.e., Common in female
Paget disease
• Paget's disease is characterized by increased bone turnover and
enlargement and thickening of the bone, but the internal architecture
is abnormal and the bone is usually brittle. Primary defect is in
osteoclasts with increased osteoclastic activity. This results
secondarily increase in osteoblastic activity (normal osteoclasts and
osteoblasts act in a co-ordinated manner). So, characteristic cellular
change is a marked increase in osteoclastic and osteoblastic
activity. Bone turnover is acclerated, plasma alkaline phosphatase is
raised (a sign of osteoblastic activity) and there is increased
excretion of hydroxyproline in urine (due to osteoclastic activity)
Clinical features of Paget's disease
• Paget's disease is slightly more common in males and is seen after
40 years of age.
• The pelvis and tibia being the commonest sites, and femur, skull,
spine (vertebrae) and clavicle the next commonest o Most of the
patient with Paget's disease are asymptomatic, the disorder being
diagnosed when an x-ray is taken
• for some unrelated condition or after the incidental discovery of
raised serum alkaline phosphatase.

Osteoblastic activity is seen at the compression
site (and not Osteoclastic)


According to Wolffs law, trabeculae are
fashioned (or refashioned) in accordance with
the stresses imposed upon the bone, the thicker
and stronger trabeculae following the
trajectories of compressive stress and the finer
trabeculae lying in the planes of tensile stress


◦ At the tension site, Osteoclastic activity is
predominant thus forming fine trabeculae.
. At the compression site, Osteoblastic activity
is predominant thus forming thick trabeculae


Note: Bone remodeling unit consists of both
Osteoblast and Osteoclast.


Osteocytes are formed from 0steoblasts
whereas Osteoclast belongs to Monocyte-
Macrophage family.

A phemister bone graft is placed sub
periosteally and is most commonly used in the
tibial injuries.


Other options:


◦ Acancellous bone graft is useful in defects
less than 2.5 cm. it is rapidly revascularised.
◦ A cortical bone graft provides fixation and
osteogenesis. It can be used for the non
union of shafts of long bones.

The gold standard for filling bone defects
is Autogenous bone graft.


Although autogenous material, such as iliac
crest bone, remains the gold standard for filling
bone defects caused by trauma, infection,
tumor, or surgery, its use increases the morbidity
of the surgical procedure, increases anesthesia
time and blood loss, and often causes
significant post-operative donor-site
complications (e.g., pain, cosmetic defect,
fatigue fracture, heterotopic bone formation).


The amount of autogenous bone available for
grafting also is limited. Because of these
limitations, a number of bone graft substitutes
have been developed.

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Correct Answer -C
Ans. is 'c' i.e., Rotator cuff tendon
Painful arc syndrome
Pain in the shoulder and upper arm during mid range of
glenohumeral abduction.
• Causes- supraspinatus tendon tear or tendinitis, subacromial
bursitis, fracture of greater tuberosity
• The space between the upper end of humerus and the acromion
gets compromised so that during mid abduction the tendon of rotator
cuff gets nipped between the greater tuberosity and acromion.

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Correct Answer -C
Ans. is 'c' i.e., DDH
Radiological features o DDHCDH
• In Von Rosen's view following parameters should be noted
Perkin's line : Vertical line drawn at the outer border of acetabulum
?. Hilgenreiner's line : Horizontal line drawn at the level of tri-radiate
cartilage
3. Shenton's line : Smooth curve formed by inferior border of neck of
femur with superior margin of obturator foramen
!. Acetabular index : Normally is 30°
CE angle of Wiberg : Normal value is 15-30°
• Normally the head lies in the lower and inner quadrant formed by
two lines (Perkin's & Hilgenreiner's). lu DDH the head lies in outer &
upper quadrant
• Shenton's line is broken
• Delayed appearance & retarded development of ossification of head
of femur
• Sloping acetabulum
.| Superior & lateral displacement of femoral head
Von-Rosen's line
• This is a line, which helps in the diagnosis of DDH in infants less
than 6 months.
• For this AP view of pelvis is taken with both lower limb in 45°


abduction and full internal rotation.
• Upward prolongation of long axis of shaft of the femur points
towards the lateral margin of the acetabulum and crosses the pelvis
in the region of sacroiliac joint
• In CDH, upward prolongation of this line points towards anterior
superior iliac spine and crosses the midline in the lower lumber
region ---> Positive Von-Rosen's s

Correct Answer -B
Ans. is. B. Transverse fractures