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.

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

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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