Orthopaedic Techniques Practice Questions

Q: In neuropraxia, what is the pathological finding?

Physiological conduction block with intact axon. ***Physiological conduction block with intact axon*** - Neuropraxia represents the mildest form of nerve injury according to the Seddon classification, characterized primarily by a localized **physiological conduction block**. - The **axon remains intact**, which allows for a rapid and complete recovery of nerve function once the local demyelination or ionic disruption resolves. *Nerve trunk damage* - This term is too general and typically implies more severe injuries like **neurotmesis**, where the entire nerve structure is severed. - Neuropraxia does not involve structural disruption of the nerve trunk or its connective tissue layers. *Perineurium damage* - Damage to the perineurium or epineurium is generally associated with more severe injuries such as **axontmesis** or **neurotmesis**. - In neuropraxia, the structural integrity of all nerve connective tissue components remains preserved. *Axon disruption* - Axon disruption defines **axonotmesis**, where the axon is damaged while the connective tissue sheath may remain intact. - Unlike axonotmesis, neuropraxia does not involve **Wallerian degeneration** because the axonal continuity is maintained.

Q: Agnes hunt traction is used for which of the following conditions?

Flexion deformity of the hip. **Explanation:** **Agnes Hunt Traction** is a specialized form of traction used specifically for the correction of **Flexion Deformity of the Hip**. The underlying medical concept involves applying traction to the affected limb while the contralateral (normal) limb is immobilized in a plaster cast in a position of maximum flexion. This stabilizes the pelvis and prevents compensatory lumbar lordosis, allowing the traction to act directly on the hip joint to gradually stretch the flexor contractures. **Analysis of Options:** * **A. Flexion deformity of the hip (Correct):** It is the classic indication. By neutralizing pelvic tilt, it effectively reduces fixed flexion deformities (FFD). * **B. Trochanteric fracture:** These are typically managed with skeletal traction (like Hamilton Russell traction) or, more commonly, surgical fixation (DHS or PFN). * **C. Fracture shaft of humerus:** This is managed using a U-slab, hanging cast, or skin traction like **Dunlop’s traction** (though Dunlop's is primarily for supracondylar fractures). * **D. Low backache:** This is usually managed with **Pelvic traction**, which helps in relieving muscle spasms and distracting the neural foramina. **High-Yield Clinical Pearls for NEET-PG:** * **Thomas Splint:** Used for immobilization of fractures of the shaft of the femur. * **Bryant’s Traction (Gallows):** Used for femur fractures in children below 2 years of age (weight <15-18kg). * **Russell’s Traction:** Used for trochanteric and subtrochanteric fractures; it uses a sling under the knee. * **Buck’s Traction:** A simple skin traction used for temporary immobilization of hip fractures or to reduce muscle spasms. * **90-90 Traction:** Commonly used in pediatric femoral shaft fractures to maintain the hip and knee at 90 degrees of flexion.

Q: A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?

Marsupialisation. **Explanation:** The procedure described is **Marsupialisation**. This technique involves opening the cyst (deroofing), evacuating its contents, and suturing the edges of the remaining cyst wall to the adjacent soft tissue or periosteum. This creates a permanent "pouch" or window, allowing the cavity to remain open to the exterior and heal by secondary intention. It is typically used for large cysts where complete removal (enucleation) might risk damaging vital structures or causing a pathological fracture. **Analysis of Options:** * **Decortication:** This involves the removal of the outer shell or "cortex" of a bone. In orthopaedics, it is often performed in cases of chronic osteomyelitis or non-union to improve vascularity and promote healing. * **Saucerization:** This is the surgical excavation of a bone cavity (usually in chronic osteomyelitis) to create a shallow, saucer-like depression. Unlike marsupialisation, it involves removing the overlying bone to allow the wound to heal from the base upwards, but it does not involve suturing the cyst wall to the periosteum. * **Enucleation:** This refers to the complete removal of a cyst in its entirety (shelling it out) without rupture. It is the treatment of choice for smaller, well-defined cystic lesions. **High-Yield Facts for NEET-PG:** * **Marsupialisation** is most commonly associated with the treatment of **Odontogenic Keratocysts (OKC)** in the jaw or large unicameral bone cysts. * **Brodie’s Abscess:** The surgical treatment of choice for this chronic localized bone abscess is **Saucerization** and curettage. * **Orr’s Technique:** A classic treatment for chronic osteomyelitis involving debridement, saucerization, and packing the wound open.

Q: What is this mode of treatment called as?

Gallows traction. ***Gallows traction*** - Also known as **overhead** or **Bryant's traction**, specifically designed for infants and children under 2 years weighing less than **12-15 kg**. - Both legs are suspended **vertically** with hips flexed at **90 degrees**, allowing the buttocks to just clear the bed surface for effective femoral fracture treatment. *Russell's traction* - Uses a **sling under the knee** with the leg supported horizontally, combining skin traction with **balanced suspension**. - Primarily indicated for **adult femoral shaft fractures** and hip fractures, not suitable for infants due to different anatomical requirements. *90-90 traction* - Involves hip and knee both flexed at **90 degrees** with the thigh vertical and lower leg horizontal using a **boot or pin**. - Used for **older children** and adolescents with femoral fractures, requiring more skeletal maturity than seen in infant applications. *Buck's traction* - **Straight skin traction** applied to the leg with the limb lying flat on the bed or slightly elevated. - Used for **hip fractures** in adults and **muscle spasms**, but lacks the bilateral vertical suspension characteristic of gallows traction.

Q: Who is considered the father of distraction osteogenesis?

Ilizarov. **Explanation:** **Gavriil Abramovich Ilizarov** is universally recognized as the **Father of Distraction Osteogenesis**. He pioneered the "Tension-Stress Effect," which describes how slow, steady traction on living tissues creates a metabolic stimulus that activates both proliferative and biosynthetic functions. This biological principle allows for the formation of new bone (callus) between two vascularized bone surfaces that are gradually pulled apart. Ilizarov developed the **Circular External Fixator** (Ilizarov Apparatus) to treat complex fractures, non-unions, and limb-length discrepancies. **Analysis of Incorrect Options:** * **Codivilla (A):** Alessandro Codivilla was the first to report a surgical technique for femoral lengthening in 1905. While he was a pioneer, his methods lacked the biological stability and gradual distraction principles perfected by Ilizarov. * **Snyder (B):** Snyder is associated with early experimental work in distraction, but he did not establish the clinical framework or the biological laws governing the process. * **Alexander (C):** Not a significant figure in the history of distraction osteogenesis; likely included as a distractor. **High-Yield Clinical Pearls for NEET-PG:** * **The Ilizarov Principle:** Distraction is typically performed at a rate of **1 mm per day**, divided into four increments (0.25 mm every 6 hours) to minimize soft tissue trauma and optimize osteogenesis. * **Latency Period:** The time between corticotomy and the start of distraction (usually **5–7 days**). * **Consolidation Phase:** The period where the newly formed bone (regenerate) matures and mineralizes; it usually takes twice as long as the distraction phase. * **Corticotomy:** Ilizarov emphasized a "low-energy" corticotomy to preserve the endosteal and periosteal blood supply, which is crucial for bone formation.

Q: Perkins traction is used in which of the following conditions?

Fracture shaft of femur. **Explanation:** **Perkins Traction** is a specific type of **skeletal traction** used primarily for the management of **fractures of the shaft of the femur**. 1. **Why Option A is Correct:** Perkins traction is a "balanced" or "dynamic" traction system. Unlike fixed tractions, it does not use a Thomas splint. Instead, a Steinman pin is inserted through the proximal tibia, and the limb is placed on a specialized bed or a simple pillow. The key feature is that it allows for **early knee mobilization** while the traction is still being applied. This prevents knee stiffness (quadriceps fibrosis), which is a common complication of femoral shaft fractures. 2. **Why Other Options are Incorrect:** * **Foot drop:** This is a neurological deficit (often involving the common peroneal nerve). Management involves orthotic devices like an **AFO (Ankle Foot Orthosis)** or surgical tendon transfers, not traction. * **CTEV (Clubfoot):** The primary treatment follows the **Ponseti method**, which involves serial casting, Achilles tenotomy, and bracing (Denis Browne splint). * **Developmental Dysplasia of the Hip (DDH):** While traction (like Gallow’s or Bryant’s) was historically used to reduce the femoral head, Perkins traction is specifically designed for shaft fractures and knee movement, not hip reduction. **High-Yield Clinical Pearls for NEET-PG:** * **Bryant’s Traction (Gallow's):** Used for femur fractures in children <2 years old (weight <12-15kg). Both legs are suspended vertically. * **Russell’s Traction:** Used for trochanteric or femoral shaft fractures; it uses a sling under the knee to provide a resultant force along the femur. * **Hamilton Russell Traction:** Often used for hip fractures in the elderly. * **Thomas Splint:** Originally designed for TB spine, but most commonly used for the emergency immobilization of femur fractures.

Q: A 55-year-old female presents with hip flexor contracture. What is the most likely test to be performed in this case?

Thomas test. ### Explanation **Correct Option: B. Thomas Test** The **Thomas test** is the clinical gold standard for assessing **fixed flexion deformity (FFD)** of the hip. In a normal individual, the lumbar spine has a natural lordosis that can be obliterated by flexing the contralateral hip. In a patient with a hip flexor contracture (most commonly involving the Iliopsoas muscle), the patient compensates for the deformity by increasing lumbar lordosis to keep the leg flat on the table. * **Mechanism:** When the clinician flexes the unaffected hip to flatten the lumbar spine against the examination table, the affected thigh spontaneously lifts off the table. The angle between the affected thigh and the table represents the degree of the flexion contracture. **Analysis of Incorrect Options:** * **A. Allis Test (Galeazzi Sign):** Used to assess **shortening of the femur or tibia**. It is performed by flexing both knees and hips with feet flat on the table; a difference in knee height indicates limb length discrepancy. * **C. Ober Test:** Used to identify contracture or tightness of the **Iliotibial (IT) band**. The patient lies on the unaffected side, and the clinician abducts and extends the affected hip; if the IT band is tight, the leg remains abducted and fails to adduct toward the table. * **D. Trendelenburg Test:** Assesses the stability of the hip and the strength of the **hip abductors (Gluteus medius and minimus)**. A positive sign occurs when the pelvis drops on the unsupported side during single-leg standing. **High-Yield Clinical Pearls for NEET-PG:** * **Thomas Test Pre-requisite:** Ensure the lumbar spine is flat (checked by placing a hand under the patient's lower back). * **Modified Thomas Test:** Can also assess tightness of the Rectus femoris (if the knee fails to flex to 90° while the hip is extended). * **Common Causes of Hip FFD:** Osteoarthritis, Rheumatoid Arthritis, and Psoas abscess.

Q: What is true about locking compression plates?

They are mechanically superior to conventional plates.. ### Explanation **Locking Compression Plates (LCP)** represent a significant advancement in internal fixation, acting as an **"internal-external" fixator**. **Why Option C is correct:** LCPs are mechanically superior because the screw heads lock into the plate, creating a **fixed-angle construct**. Unlike conventional plates, which rely on friction between the plate and bone (requiring high torque), LCPs do not need to be pressed against the bone to achieve stability. This provides superior pull-out strength and stability, especially under axial loading. **Analysis of Incorrect Options:** * **Option A:** LCPs are actually the **implant of choice for osteoporotic bone**. In poor-quality bone, conventional screws often strip the threads; however, the fixed-angle stability of LCPs prevents "toggle" and screw back-out. * **Option B:** Conventional plates require tight bone-to-plate contact, which can compress and damage the periosteal blood supply. LCPs sit slightly off the bone, **preserving periosteal perfusion** and reducing the risk of necrosis. * **Option C:** LCPs feature **"Combi-holes"** (an oblong hole and a threaded hole). This allows them to be used for both dynamic compression (using cortical screws) and locking fixation, making them highly versatile. **High-Yield Clinical Pearls for NEET-PG:** * **Point Contact:** LCPs follow the "Limited Contact" principle to minimize vascular interference. * **Primary vs. Secondary Healing:** When used as a bridge plate (locking mode), LCPs allow for micromotion leading to **callus formation (secondary healing)**. When used in compression mode, they lead to **primary healing**. * **Hybrid Fixation:** Surgeons often use a combination of conventional screws (to reduce the fracture) and locking screws (to maintain the reduction).

Q: Which of the following bones is typically addressed with a tube cast?

Knee. **Explanation:** A **Tube Cast** (also known as a Cylinder Cast) is a specialized orthopedic cast that extends from the upper thigh to just above the malleoli of the ankle. **Why the Knee is Correct:** The primary purpose of a tube cast is to provide **immobilization of the knee joint** while allowing the patient to remain weight-bearing. It is specifically indicated for conditions where the knee must be kept in extension but the ankle and foot do not require stabilization. Common indications include: * Patellar fractures (undisplaced). * Rupture of the patellar tendon or quadriceps tendon (post-repair). * Reduced knee dislocations. * Stable tibial plateau fractures. **Why the other options are incorrect:** * **Ankle:** Injuries to the ankle require a **Below-Knee (Short Leg) Cast** or an **Above-Knee (Long Leg) Cast**. A tube cast is contraindicated here because it stops above the ankle, providing no stability to the joint. * **Shoulder:** The shoulder is typically immobilized using a **Shoulder Spica**, a U-slab, or a simple sling/immobilizer. A circular cast is rarely used due to the complexity of the joint. * **Elbow:** Elbow injuries are managed with an **Above-Elbow (Long Arm) Cast** or a posterior slab. The upper limb equivalent of a tube cast (immobilizing only the elbow) is rarely used because maintaining the cast's position without it slipping is difficult. **High-Yield NEET-PG Pearls:** * **Cylinder Cast Precaution:** Always ensure the cast is molded well above the femoral condyles and proximal to the malleoli to prevent "telescoping" (slipping down). * **Walking Cast vs. Tube Cast:** A walking cast includes the foot; a tube cast allows the patient to wear their own shoe. * **Position:** The knee is typically immobilized in **0–5° of flexion** to prevent stiffness in full extension while allowing for a functional gait.

Question 1

In neuropraxia, what is the pathological finding?

Accepted Answer

Physiological conduction block with intact axon

Answer

Nerve trunk damage

Answer

Perineurium damage

Answer

Axon disruption

Question 2

Agnes hunt traction is used for which of the following conditions?

Accepted Answer

Flexion deformity of the hip

Answer

Trochanteric fracture

Answer

Fracture of the shaft of the humerus

Answer

Low backache

Question 3

A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?

Accepted Answer

Marsupialisation

Answer

Decortication

Answer

Saucerization

Answer

Enucleation

Question 4

What is this mode of treatment called as?

Accepted Answer

Gallows traction

Answer

Russell's traction

Answer

90-90 traction

Answer

Buck's traction

Question 5

Who is considered the father of distraction osteogenesis?

Accepted Answer

Ilizarov

Answer

Codivilla

Answer

Snyder

Answer

Alexander

Question 6

Perkins traction is used in which of the following conditions?

Accepted Answer

Fracture shaft of femur

Answer

Foot drop

Answer

Congenital Talipes Equinovarus (CTEV)

Answer

Developmental dysplasia of the hip

Question 7

A 55-year-old female presents with hip flexor contracture. What is the most likely test to be performed in this case?

Accepted Answer

Thomas test

Answer

Allis test

Answer

Ober test

Answer

Trendelenburg test

Question 8

What is true about locking compression plates?

Accepted Answer

They are mechanically superior to conventional plates.

Answer

They should not be used in osteoporotic patients.

Answer

They usually cause periosteal necrosis.

Answer

They cannot be used as compression plates.

Question 9

Tapping is required in a screw which is:

Accepted Answer

Non fluted

Answer

Fluted

Answer

Self drilling

Answer

Self tapping

Question 10

Which of the following bones is typically addressed with a tube cast?

Accepted Answer

Knee

Answer

Ankle

Answer

Shoulder

Answer

Elbow

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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