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SEPTEMBER, 2006

ALL questions must be answered - Question 1 (50%) & Questions 2 & 3 (25% each)

Question 1 (One Hour) - 100 marks

A 67 year old man has Paget's Disease affecting his lright femur and left tibia. He has had worsening pain in the right hip region for two years ano now reportsa recentsudden increase in pain. The pain is worse with weight bearing.
Radiographs show Paget's Disease affecting the proxim.al half of the femur with a varus deformity and
degenerative changes in the right hip.

1. Outline the likely causes of his hip region pain and means of differentiating between them. (25 marks) .
   
2. Discuss treatment options (except hip replacement) for each of these causes. (40 marks)
   
3. Discuss total hip replacement in this patient. (35 marks)

Question 2 (30mins) - 50 marks

A twelve years and nine months, 47 kilogram, skeletally immature male presents to your Hospital Emergency Dept with a closed, short oblique fracture of the mid-shaft of the right femur. This is the only injury. The limb has no neuro vascular injury. Appropriate resuscitation has been undertaken and the limb splinted.

The patient is the grandchild of a recently retired senior orthopaedic surgeon who has guardianship of the child while his parents are overseas. He directs you to unqertake definitive treatment using an ante-grade femoral nail.

Your opinion is that this is not appropriate management for this patient.

1. Discuss in detail your reasons for this. (10 marks)
   
2. Discuss all other treatment options for this fracture, including potential complications of each treatment. Discuss in detail your preferred option. (25 marks)
   
3. Despite your concerns, the grandfather is adamant that the fracture is to be treated by an antegrade IM nail. You again consider that this is completely inappropriate. Discuss how you would manage this situation. ( 15 marks)
   

Question 2 (30mins)

You are asked to see a 65-year-old male who has had a painful ankle for 2 years.

1. Discuss your assessment. (25 marks)
   
2. The major finding is that X-rays reveal moderate degenerative joint disease of the ankle. Describe the principles of management and the options available. (15 marks)
   
3. You recommend and wish to perform a total ankle replacement - a procedure with which you have no experience. How do you approach this issue? (10 marks)

Question 3 (30mins)

A 25 year old indigenous New Guinean woman, injured in a car accident, sustained a closed transverse fracture of the right humeral shaft at the junction of the upper two thirds and lower third. A radial nerve palsywas noted. The fracture was treated in a hanging cast for 3 weeks, followed by a simple sling.
Three months post injury, the patient, who does.not speak English is brought to your hospital (in Australia or New Zealand) for treatment. The fracture is mobile and displaced. The radial nerve palsy remains.

1. Describe your ongoing management of this patient from presentation at three months.

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