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Orthopedic VIVA Made Easy

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 Orthopedic
VIVA Made
Easy
Amit Joshi, MS
Professor, Department of Orthopedics.
Kist Medical College & Teaching Hospital, Imadol, Lalitpur, Nepal.
Deputy Director, AKB Center for Arthroscopy, Sports Injuries &
Regenerative Medicine.
B&B Hospital, Gwarko, Lalitpur, Nepal.

Forewords by:
Arjun Lamichhane
Bachchu Ram KC
J. Maheshwari
Ashok K. Banskota

Publisher & Distributor

Samiksha Publication (P.) Ltd.
 Orthopedic VIVA
Made Easy
Published by:
Samiksha Publication Pvt. Ltd.
Corporate Office/ Sales
Ghattekulo Rautahadevi Marga, Kathmandu-29
Tel.: +977-4438282, 4435257
E-mail: info@samikshapublication.com.np
www.samikshapublication.com.np

Distribution and sales

Samiksha Books Centre
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Phone: +977-1-4230184, 4244456

Distribution and sales

Samiksha Books Pvt. Ltd.
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Phone: +977-1-4440611, 01-6922095
© All rights reserved with the author, 2020
Author All rights reserved. No part of this
Amit Joshi publication may be reproduced, stored
in a retrieval system, or transmitted
Edition in any form or by any means without
First 2020 (2077) the prior written permission of the
publisher.
Copyright
ISBN: 978-9937-710-78-7
Author

Layout & Design

Samiksha Computer Department
Foreword
Orthopedics as a subject has developed rapidly for the last few decades. Few
years back it was a part of general surgery. In curriculum of many universities
in Nepal and abroad, orthopedics is still a component of general surgery.
Nepal medical council has recognized orthopedics as a major subject and
enforcing strict requirements. Institute of Medicine, Tribhuvan University
has taken the initiative to make orthopedics as a separate and complete
subject and established a board examination in fourth year, which includes
cases, OSCE and Viva. Looking at the volumes of orthopedic cases, it has
become essential that every MBBS graduates be aware of basic knowledge
of orthopedic diseases, so that early diagnosis could be made and referred
for timely management. Since orthopedics is vast subject, it is not possible
for the MBBS students to go through and understand this subject in short
period of time and get prepared for the practical examination by reading large
textbooks.

Dr Amit Joshi in his book “Orthopedic Viva Made Easy” is able to gather
most of the information needed for a MBBS student. He has compiled all the
important topics like Anatomy, Metallurgy, X-ray, Orthosis and prosthesis,
plaster of Paris and application techniques, basics of tourniquet applications,
basic orthopedic implants and instruments and sample questions for the
OSCE as well, which is so important for practical examination.

This book compiles such an important information on those topics. I fell that it
will be handy for PG students as well to have background knowledge.

It is a matter of pride and pleasure for me to recommend this excellent book

by Dr. Joshi for every student who is appearing for orthopedic final practical
exam.

Prof. Arjun Lamichhane, MS (Ortho).

Former Head of Department
Department of Orthopedics, TU Teaching
Hospital Maharajgunj Medical Campus, Institute
of Medicine Tribhuvan University, Nepal
Foreword
I know Dr. Amit Joshi since 1999, when he joined Shree Birendra Hospital
as young energetic medical officer. I saw him growing as a professional
and ultimately to an orthopedic surgeon and sports surgeon. During our
work together in department of orthopedics, his enthusiasm to learn and
teach students was evident, and no wonder he came up with an excellent
book.

“Orthopedic Viva made easy” a handbook especially compiled and

designed for medical students, is going to be a useful guide for both UG
and PG students.

Viva is usually a nightmare for every examinee. Not knowing what and
how will the questions be asked is one of the biggest problems of Viva.
A book to guide the systematic approach to respond the questions gives
the student confidence as well as reproducible knowledge.

This book is concise yet comprehensively written in simple understandable

language. It explains the basic approach to questions, clarifies
characteristics, specific features and functions of implant, instruments,
orthoses, prosthese and many more chapters, which every exam going
students must know.

I hope this effort of Dr. Amit Joshi will be useful and meet the expectations
of the students as well. I would like to congratulate Dr. Amit and wish him
all the best for future endeavors.

Prof. Bachchu Ram KC, MS (Ortho)

Maj. General (Rtd.)
Former Executive Director
Nepalese Army Institute of Health Sciences
Foreword
Practice of orthopaedics has changed vastly over last few decades. Not
only does one need to know the evergreen clinical medicine, but also so
much new in advanced diagnostic modalities. Added to this, particularly
in orthopaedics is the need to know tools and implants, in this so much
tools and implants dependent field of surgery. One needs to know the
metals used in implants, the implant characteristics, what are they meant
for, and finally, how to use then effectively.

This book forms a good companion to available orthopaedic books which

talk more about basics of orthopaedics. To my knowledge, orthopaedics
being a minor subject at MBBS level, possibly so much is not expected
(or shall I say, should not be expected) from an undergraduate, but surely
this knowledge set is crucial and mandatory for budding orthopaedic
surgeons.

Dr. Amit Joshi has done a wonderful job of collecting all this necessary
information in one volume, and thus a handy book for junior orthopaedic
surgeons and practicing orthopaedic surgeons. It has complete set of
information on topics not easy to find in such comprehensive way. The
clarity of concepts is amazing, the typeset is reader-friendly, and pictures
are well-drawn and well-placed. I myself enjoyed reading the book, and
got to know so many new things.

This book should be a necessary companion of any budding orthopaedic

surgeons, practicing orthopaedic surgeons and some of those
undergraduate whose thrust for knowledge is un-ending. It should be an
essential haves for all orthopaedic teaching hospitals.

I wish the effort all the success.

Dr. J. Maheshwari
(Formerly Professor of Orthopaedics, AIIMS,
New Delhi.)
Author of ‘ESSENTIAL ORTHOPAEICS
completed 25 years as a leading orthopaedic book.
Director and Head of orthopaedics, Max Hospital,
Saket, New Delhi. India
Director, Knee & Shoulder Clinic, New Delhi
Foreword
There are plenty of stories of “brutal experiences” in medical viva
examinations of candidates who had the misfortune to face the examiner,
determined to “massacre”! Many examinees have realized at the 12th
hour that, had there been an organized methodology to pursue the
numerous facts to be remembered for the viva experience might have
been better! For the student the subspecialty subjects might pose even
greater frustrations at the brink of the final exams.

Dr. Amit Joshi has compiled this very manageable sized book for quick
reference and recall for the students before their examination. The
material is well organized into sections and appropriately illustrated with
examples. Commonly asked questions are also posted.

Dr. Amit has to be congratulated on this well-done job. I have had

the personal experience of observing his steadily improving skills in
orthopedic surgery and in particular, the subspecialty of sports medicine.
His enthusiasm to educate the aspiring medical students as well as
upcoming surgeons is most commendable. I have no doubt that Dr. Amit
will continue in his endeavors to further orthopedic medical education.

Prof. Ashok K. Banskota, MD, FACS

Chairman, Department of Orthopedics.
B&B Hospital, Gwarko, Lalitpur and
Hospital and Rehabilitation Center for Disabled
Children (HRDC) Banepa, Kavre
 PREFACE
Since my medical school I always dreamt of a book which is precise, concise as well as
exam oriented. Throughout the year many books are read, many places were searched,

but during exam a review was always difficult for me. I always thought of a review book
that is based on standard textbooks, which I have already read, and summarized for final
preparation of exams.

I started my teaching career as a postgraduate (PG) teacher in NAMS (National academy

of Medical Sciences) on 2008. When I started teaching the undergraduates, I realized that
Undergraduate (UG) teaching is much more difficult than PG. Because, so many
subjects have to be covered and so many exams have to be passed in a short span of
time. On top of that, expectations from students have also been increased in last few years.
Tribhuvan University (TU) has implemented a separate examination on orthopedics,
which includes separate theory paper, and elaborated practical examinations including
Cases, OSCE and VIVA in fourth year. Apart from Orthopedics, MBBS students have
to take Ophthalmology and ENT exams also in similar pattern. Similarly by the time
we join PG in orthopedics, many things that we have learnt in MBBS days are already
forgotten. So there is a need of consize book to forush up ones memory.

Although passing practical are equally important, there are very few books available to
guide practical examination. Textbooks are available for the preparation of theory exams,
but practical exams always remained in shadow. With few years’ experience of
being examiner of UG and PG student and talking with other experienced examiners,
I realized the need of a book, which reviews probable questions asked in practical
examination. This is an effort to compile salient points of practical examinations in a
form of a book. I myself feel that there are many deficiencies, which will be improved in
subsequent editions.

Kathmandu, 2020
Amit Joshi
dramitjoshi7@gmail.com
 Dedication
To my brilliant and beautiful wife Dr. Meena,for letting me devote
time to these things.
To my two angels Samridi and Shreeana, the most beautiful
creation of nature.
To my teachers, for teaching me the teacher’s quality.
To my Colleagues, for all the encouragements.
To my students, for sharing ideas.
To my parents, for their sacrifice to make me a doctor.
Contributors
Dr. Bishnu Babu Thapa Dr. Dipendra Maharjan
Associate Professor, Department of Department of Orthopedics Shree
Orthopedics Birendra Hospital
Shree Birendra Hospital
Dr. Bibek Basukala
Dr. Sushil Rana Magar Consultant Orthopedic Surgeon
Assistant Professor, Department of AKB Center for Arthroscopy, Sports
Orthopedics injuries and Regenerative Medicine, B&B
Hospital, Gwarko.
Shree Birendra Hospital

Dr. Nirab Kayastha Dr. Nagmani Singh

Consultant Orthopedic Surgeon
Associate Professor, Department of
Orthopedics AKB Center for Arthroscopy, Sports
injuries and Regenerative Medicine, B&B
Shree Birendra Hospital
Hospital, Gwarko.

Dr. Ritesh Sinha

Dr. Ishor Pradhan
Assistant Professor, Department of
HoD, Department of Orthopedics.
Orthopedics
AKB Center for Arthroscopy, Sports
Shree Birendra Hospital
injuries and Regenerative Medicine, B&B
Hospital, Gwarko.
Dr. Rajesh Pratap Shah
Assistant Professor, Department of Dr. Navin Tripathi
Orthopedics
Lecturer, Department of Orthopedics
Shree Birendra Hospital Gandaki Medical College, Pokhara
 Table of Contents
1. Metals Used In Orthopedics............................................................................................1
Stainless Steel...................................................................................................................2
Titanium..............................................................................................................................2
2. Screws................................................................................................................................4
2.1 General.....................................................................................................................5
2.2 Cortical Screw.........................................................................................................8
2.3 Cancellous Screw...................................................................................................8
2.4 Locking Screws..................................................................................................... 11
2.5 Special Screw....................................................................................................... 11
3. Plates.................................................................................................................................14
3.1 Dynamic Compression Plate (DCP)..................................................................15
3.2 1/3 Rd Tubular Plate............................................................................................16
3.3 Reconstruction Plate (Recon Plate)..................................................................17
3.4 Buttress Plate........................................................................................................17
3.5 Locking Compression Plates (LCP)...................................................................17
3.6 Special Plates.......................................................................................................19
4. Intramedullary Nails........................................................................................................21
4.1 General...................................................................................................................22
4.2 K-nail (Kuntscher Nail).........................................................................................25
4.3 Intramedullary Interlocking Nails (IMIL Nails)...................................................26
5. Other Implants.................................................................................................................29
5.1 K-wire (Kirschner Wire).......................................................................................30
5.2 Steinmann Pin.......................................................................................................30
5.3 Denham Pin...........................................................................................................30
5.4 Schanz Pin.............................................................................................................31
5.5 Guide Wire.............................................................................................................31
5.6 Rush Nails.............................................................................................................32
6. Orthopedic Instruments..................................................................................................33
6.1 Langenbeck (Army-navy) Retractor...................................................................34
6.2 Hook Retractor......................................................................................................34
6.3 Periosteal Elevator...............................................................................................34
6.4 Hohmann Retractor..............................................................................................34
6.5 Kern Bone Holding Forceps................................................................................35
6.6 Self-centering Bone Holding Forceps...............................................................35
6.7 Reduction Forceps...............................................................................................35
6.8 Drill Bit....................................................................................................................36
6.9 Depth Gauze.........................................................................................................37
6.10 Tap...............................................................................................................................................37
 6.11 Screw Driver..........................................................................................................37
6.12 Chisel......................................................................................................................38
6.13 Osteotome.............................................................................................................38
6.14 6.14. Multipurpose Plier.......................................................................................38
6.15 Awl..........................................................................................................................39
6.16 Reamers.................................................................................................................39
6.17 Imil Nail Guide Wire.............................................................................................40
6.18 Instruments used for Hemi Arthroplasty............................................................40
7. Prosthesis And Orthoses................................................................................................42
7.1 Prostheses.............................................................................................................43
7.2. Orthoses.................................................................................................................46
8. Tourniquet................................................................................................................................50
Tourniquet Palsy...............................................................................................................51
Exsanguination................................................................................................................53
9. Plaster Of Paris (Pop).....................................................................................................54
10. Anatomy............................................................................................................................61
10.1 Femur.....................................................................................................................62
10.2 Tibia........................................................................................................................67
10.3 Humerus.................................................................................................................71
10.4 Scapula..................................................................................................................78
10.5 Clavicle...................................................................................................................81
10.6 Radius....................................................................................................................84
10.7 Ulna.........................................................................................................................89
10.8 Vertebrae...............................................................................................................91
11. X-ray .................................................................................................................................96
11.1 X-ray - General Principles...................................................................................97
11.2 Bone Anatomy.......................................................................................................97
11.3 Joint Anatomy........................................................................................................98
11.4 Bone and Joint Alignment....................................................................................99
11.5 Exercise...............................................................................................................113
12. Tractions........................................................................................................................ 121
Introduction.................................................................................................................... 122
13. Walking Aids.................................................................................................................. 125
Cane .............................................................................................................................. 126
Crutches......................................................................................................................... 128
Walkers.......................................................................................................................... 131
14. Osce .............................................................................................................................. 133
15. Specimens..................................................................................................................... 146
Bibliography............................................................................................................................ 152

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