Orthopaedic Techniques

Orthopaedic Techniques Indian Medical PG Question 1: Russell and Taylor classification is used for:

• A. Shaft of tibia fracture
• B. Subtrochanteric femoral fracture (Correct Answer)
• C. Humerus shaft fracture
• D. Fracture of neck of femur

Orthopaedic Techniques Explanation: ***Subtrochanteric femoral fracture*** - The **Russell and Taylor classification** system is specifically designed to classify **subtrochanteric femoral fractures**. - It categorizes these fractures based on the involvement of the **lesser trochanter** and the extension into the **piriformis fossa**, guiding treatment decisions. *Shaft of tibia fracture* - **Shaft of tibia fractures** are typically classified using other systems, such as the **AO/OTA classification**, which focuses on bone segment, morphology, and comminution. - The Russell and Taylor system is not applicable to lower leg fractures. *Humerus shaft fracture* - **Humerus shaft fractures** are commonly classified by systems that describe the **location (proximal, middle, distal third)**, **morphology (transverse, oblique, spiral)**, and **displacement**. - The Russell and Taylor classification does not apply to upper limb fractures. *Fracture of neck of femur* - **Fractures of the neck of the femur** are usually classified by the **Garden classification** (based on displacement) or the **Pauwels classification** (based on angle of fracture line). - These classifications determine the risk of **avascular necrosis** and guide treatment, which is distinct from the Russell and Taylor system.

Orthopaedic Techniques Indian Medical PG Question 2: Which of the following is a treatment option for Volkmann's ischemia?

• A. Bone shortening
• B. Fasciotomy (Correct Answer)
• C. Cock up splint
• D. Turn buckle splint

Orthopaedic Techniques Explanation: ***Fasciotomy*** - **Fasciotomy** is the **emergency surgical treatment** for **acute Volkmann's ischemia** caused by compartment syndrome. - This procedure involves making incisions through the fascia to relieve elevated compartment pressure and restore blood flow, preventing irreversible muscle and nerve damage. - Must be performed urgently to prevent progression to **Volkmann's contracture** (established muscle necrosis and fibrosis). *Bone shortening* - **Bone shortening** is a reconstructive procedure used in **late/established Volkmann's contracture**, not for acute ischemia. - It may be used to facilitate soft tissue reconstruction or correct deformities after muscle necrosis has occurred. - Does not address the acute ischemic emergency. *Cock up splint* - A **cock-up splint** maintains the wrist in extension and is used for **rehabilitation** in chronic/established Volkmann's contracture. - May help prevent further deformity or support weakened extensors after muscle damage has occurred. - Does not treat the acute compartment syndrome or restore blood flow. *Turn buckle splint* - A **turnbuckle splint** is used for **gradual correction of joint contractures** in established Volkmann's contracture. - This is a rehabilitative device for chronic cases, not for acute treatment. - Does not address the acute circulatory compromise or compartment syndrome.

Orthopaedic Techniques Indian Medical PG Question 3: All of the following factors affect osseointegration EXCEPT:

• A. Biocompatibility of implant material.
• B. Implant design.
• C. Patient's blood type (Correct Answer)
• D. Status of the host bed.

Orthopaedic Techniques Explanation: ***Patient's blood type*** - A patient's **blood type** (e.g., A, B, AB, O) is determined by antigens present on red blood cells and plays no direct role in the biological processes of bone healing or the integration of a dental implant with bone. - While systemic factors can influence osseointegration, blood type itself does not affect the cellular and molecular mechanisms required for direct bone-to-implant contact. *Biocompatibility of implant material* - The **biocompatibility** of the implant material (e.g., **titanium**) is crucial for osseointegration, as it must not elicit adverse reactions and must permit host bone growth on its surface. - Materials that are cytotoxic or inflammatory will prevent bone apposition and lead to fibrous encapsulation rather than direct bone contact. *Implant design* - **Implant design**, including features like **surface roughness**, thread pitch, and macro-geometry, significantly influences the initial stability and long-term success of osseointegration. - A greater surface area and appropriate surface treatments can enhance bone cell attachment and differentiation, promoting faster and stronger bone integration. *Status of the host bed* - The **status of the host bone bed** refers to its quality and quantity (e.g., bone density, vascularity), which are critical for the biological processes of osseointegration. - Adequate bone volume and good bone quality provide a stable foundation and sufficient blood supply for bone regeneration around the implant.

Orthopaedic Techniques Indian Medical PG Question 4: What is the biomechanical principle involved in symphyseal fracture with lag screw fixation?

• A. Load bearing
• B. Load sharing (Correct Answer)
• C. Compression osteosynthesis
• D. Adaptation osteosynthesis

Orthopaedic Techniques Explanation: **Load sharing** - Lag screw fixation allows for **interfragmentary compression** while still permitting some load to be borne by the surrounding bone and soft tissues, promoting a more physiological healing response. - This method provides a **stable environment** for bone healing by distributing forces across both the implant and the bone fragments. *Load bearing* - This principle implies that the **implant alone carries the majority of the load**, effectively shielding the fracture site from stress. - While a lag screw provides stability, it is not designed to be the sole load bearer; rather, it facilitates the bone's ability to bear load as it heals. *Compression osteosynthesis* - Although lag screws achieve compression, the term **compression osteosynthesis** is a broader concept that can include techniques like tension banding or plates, with the primary goal of creating stability through direct compression. - While **interfragmentary compression** is a part of lag screw fixation, "load sharing" more accurately describes the overall biomechanical outcome in symphyseal fractures where some physiological stress is beneficial for healing. *Adaptation osteosynthesis* - This refers to fixation designed primarily to **adapt or hold fragments in place** without providing significant compressive forces or the ability to share physiological loads directly with the bone during healing. - It’s typically used for non-weight-bearing fractures or where minimal stress is anticipated, which is not the case for symphyseal fractures.

Orthopaedic Techniques Indian Medical PG Question 5: Mean bone density amongst 2 groups of 50 people each is compared, which would be the best test:

• A. McNemar test
• B. Chi-square test
• C. Student t-test (Correct Answer)
• D. Fisher exact test

Orthopaedic Techniques Explanation: ***Student t-test*** - The **Student's t-test** is the appropriate statistical test for comparing the **means of two independent groups** when the data is continuous and normally distributed. - Bone density is a **continuous variable**, and the scenario involves comparing the mean bone density between two distinct groups. *Fisher exact test* - The **Fisher exact test** is used for analyzing **categorical data** in a 2×2 contingency table, especially when sample sizes are small. - It is not suitable for comparing continuous variables like bone density. *McNemar test* - **McNemar's test** is used to analyze paired nominal data, typically when comparing two related proportions from the same subjects before and after an intervention. - This scenario involves **independent groups**, not paired data. *Chi-square test* - The **chi-square test** is primarily used to compare **categorical variables** to see if there is a significant association between them. - It's not appropriate for comparing the means of continuous data like bone density.

Orthopaedic Techniques Indian Medical PG Question 6: Open reduction (OR) is not required in which fracture?

• A. Fracture of the patella
• B. Fracture of the outer one-third of the radius (Correct Answer)
• C. Displaced fracture of the olecranon
• D. Fracture of the condyle of the humerus

Orthopaedic Techniques Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.

Orthopaedic Techniques Indian Medical PG Question 7: Which of the following classifications is used to assess the fracture shown below?

• A. Gustilo classification
• B. Salter and Harris classification
• C. Pipkins classification (Correct Answer)
• D. Weber classification

Orthopaedic Techniques Explanation: ***Pipkins classification*** - The image shows a **femoral head fracture**, indicated by the arrow, with internal fixation. The Pipkins classification system specifically categorizes fractures of the **femoral head**. - This system helps guide treatment and prognostication for these particular hip injuries, differentiating based on location and associated injuries. *Gustilo classification* - The Gustilo classification is used for **open fractures**, assessing the extent of soft tissue damage and contamination. - The image displays a post-operative X-ray of a surgically fixed fracture, and the classification is not applicable here as it pertains to the initial presentation of an open fracture. *Salter and Harris classification* - The Salter-Harris classification system is used for **growth plate (physeal) fractures** in children. - The image shows a fracture in an adult bone (as evidenced by the fused growth plates and the morphology of the bone), making this classification irrelevant. *Weber classification* - The Weber classification is used for **ankle fractures**, specifically those involving the distal fibula. - The fracture shown in the image is of the **femoral head**, not the ankle, hence the Weber classification is not appropriate.

Orthopaedic Techniques Indian Medical PG Question 8: Locking compression plating is commonly indicated in which of the following fracture types?

• A. Periaicular fractures
• B. Transverse or oblique fractures of long bones (Correct Answer)
• C. Interochanteric fractures
• D. Fracture of long bones

Orthopaedic Techniques Explanation: ***Transverse or oblique fractures of long bones*** - **Locking compression plates (LCPs)** are particularly well-suited for **transverse or oblique fractures of long bones** because they provide angular stability, preventing screw pullout even in compromised bone. - Their design allows for a **fixed-angle construct**, which helps maintain alignment and promotes biological healing by minimizing periosteal stripping. *Periaicular fractures* - While LCPs can be used in some **periarticular fractures**, their primary indication is not specifically these fractures, and their benefit is often related to the bone quality of the metaphysis rather than the articulation itself. - These fractures often require careful contouring of plates to conform to the complex anatomy, and sometimes require different fixation strategies. *Interochanteric fractures* - **Intertrochanteric fractures** of the femur are typically treated with intramedullary nails (e.g., trochanteric entry nails) or dynamic hip screws, which are better suited for load-sharing in this weight-bearing region. - Plates, especially LCPs, are generally not the first-line treatment for these fractures due to the high biomechanical forces and risk of cutout. *Fracture of long bones* - This option is too general; while LCPs are used for some **long bone fractures**, it is not indicated for all types. Many long bone fractures are better treated with intramedullary nailing or traditional non-locked plating. - The specific fracture pattern (e.g., comminuted, transverse, oblique) and location within the long bone determine the most appropriate fixation method.

Orthopaedic Techniques Indian Medical PG Question 9: False about fracture of vertebrae

• A. Fracture dislocation is common in flexion rotation injury
• B. Chance fracture occurs due to flexion distraction injury
• C. Wedge compression causes flexion injury
• D. Anterior longitudinal ligament runs along the posterior surface of vertebral bodies (Correct Answer)

Orthopaedic Techniques Explanation: ***Anterior longitudinal ligament runs along the posterior surface of vertebral bodies*** - The **anterior longitudinal ligament (ALL)** runs along the **anterior aspect** of the vertebral bodies, preventing hyperextension. - The **posterior longitudinal ligament (PLL)** runs along the posterior surface of the vertebral bodies, within the vertebral canal. *Fracture dislocation is common in flexion rotation injury* - **Flexion-rotation injuries** are highly unstable and frequently lead to **fracture-dislocations** of the vertebral column. - The combined forces cause significant disruption of both bony and ligamentous structures, increasing the likelihood of displacement. *Chance fracture occurs due to flexion distraction injury* - A **Chance fracture** (or seatbelt fracture) is caused by a **flexion-distraction injury**, typically seen in individuals wearing lap belts during deceleration. - This mechanism results in a horizontal splitting of the vertebral body and posterior elements. *Wedge compression causes flexion injury* - A **wedge compression fracture** is the most common type of vertebral fracture and results from a **flexion injury** (hyperflexion). - The anterior portion of the vertebral body collapses, creating a wedge shape, while the posterior column remains intact.

Orthopaedic Techniques Indian Medical PG Question 10: What is the best treatment for a 60-year-old man with intracapsular femoral neck fracture?

• A. Hemiarthroplasty (Correct Answer)
• B. Total hip replacement
• C. Internal fixation
• D. Casting

Orthopaedic Techniques Explanation: **Hemiarthroplasty** * **Hemiarthroplasty** is generally preferred in older patients with **displaced intracapsular femoral neck fractures** due to the high risk of **avascular necrosis** and non-union with internal fixation. * In a 60-year-old, a hemiarthroplasty provides a good balance between **mobility** and avoiding the complexities of a total hip replacement, especially if the patient has lower functional demands or comorbidities. *Total hip replacement* * **Total hip replacement** might be considered for younger, more active patients with minimal comorbidities, or older patients with pre-existing **hip arthritis**, as it offers better long-term function and pain relief. * However, it's a more extensive procedure with a higher risk of complications like **dislocation** and necessitates careful selection based on the patient's physiological age and functional expectations. *Internal fixation* * **Internal fixation** is primarily used for **non-displaced** or minimally displaced intracapsular femoral neck fractures in active patients, or displaced fractures in younger patients (usually <60 years old) to preserve their native femoral head. * In a 60-year-old with a displaced fracture, the risk of **avascular necrosis** of the femoral head and **non-union** is significantly higher with internal fixation, making it a less preferred option. *Casting* * **Casting** is not an appropriate treatment for a femoral neck fracture. * Femoral neck fractures are **intra-articular** and require surgical stabilization to achieve stability and allow for early mobilization.

Orthopaedic Techniques Flashcard 1 of 10

Question: Treatment of cubitus _____ is medial open wedge osteotomy or lateral closed wedge osteotomy.

Answer: varus

Orthopaedic Techniques Flashcard 2 of 10

Question: Late management of AVN of femur involves insertion of muscle and its blood supply to the head of the femur also known as _____

Answer: muscle pedicle graft

Orthopaedic Techniques Flashcard 3 of 10

Question: _____ cast and Turn-buckle cast is used for scoliosis

Answer: Risser's

Orthopaedic Techniques Flashcard 4 of 10

Question: _____ can be used for internal fixation of fractures of long bones

Answer: Steinmann pin (K-wire/Steinmann pin)

Orthopaedic Techniques Flashcard 5 of 10

Question: In Mc Murray's osteotomy, the distal fragment is displaced _____ally and abducted

Answer: medi

Orthopaedic Techniques Flashcard 6 of 10

Question: _____ screws have a smaller thread, low pitch, compression produced by over drilling proximal cortex

Answer: Cortical

Orthopaedic Techniques Flashcard 7 of 10

Question: The following is a _____ fixator or LRS (limb reconstruction system)

Answer: Rail

Orthopaedic Techniques Flashcard 8 of 10

Question: The following instrument is a _____

Answer: osteotome

Orthopaedic Techniques Flashcard 9 of 10

Question: Name the following technique of reducing a dislocated shoulder: _____

Answer: Stimson's hanging arm method

Orthopaedic Techniques Flashcard 10 of 10

Question: The following instrument is a _____

Answer: bone nibbler