Orthopaedic Techniques Practice Questions

Q: Which type of amputation is shown below?

Krukenberg's. ***Krukenberg's*** - Creates a **bifurcated forearm** by separating the **radius and ulna** to form a functional pincer-like grip mechanism. - Particularly indicated for **bilateral below-elbow amputees**, especially **blind patients**, as it provides tactile feedback and functional grasping ability. *Syme's* - An **ankle disarticulation** amputation that removes the foot while preserving the **heel pad** for weight-bearing. - Performed at the **ankle joint level**, not involving forearm structures like the case shown. *Lisfranc's* - A **foot amputation** through the **tarsometatarsal joints**, removing the metatarsals and toes. - Preserves the **midfoot and hindfoot**, allowing for some weight-bearing capacity with prosthetic fitting. *Chopart's* - A **midtarsal amputation** through the **talonavicular and calcaneocuboid joints**, removing the forefoot. - Results in **equinus deformity** and requires **tendon transfers** to maintain proper foot positioning.

Q: The abduction contracture at the hip joint is evaluated clinically by which test?

Ober's test. **Explanation:** The correct answer is **Ober’s test**. This test is specifically designed to evaluate for tightness or contracture of the **Iliotibial (IT) Band** and the **Tensor Fasciae Latae (TFL)**. Since the TFL and IT band act as stabilizers and abductors of the hip, a contracture in these structures results in an **abduction contracture**. * **Mechanism of Ober’s Test:** The patient lies in a lateral decubitus position with the affected side up. The clinician flexes the knee to 90°, abducts and extends the hip to clear the greater trochanter, and then attempts to adduct the thigh toward the table. If the thigh remains abducted and fails to adduct past the midline, the test is positive, indicating an abduction contracture. **Analysis of Incorrect Options:** * **Thomas Test:** Used to assess **fixed flexion deformity (FFD)** of the hip. It identifies tightness in the iliopsoas muscle. * **Gerhardt’s Test:** Not a standard orthopedic hip test; it is typically associated with vocal cord paralysis (neurology/ENT). * **Ely’s Test:** Used to assess **Rectus Femoris tightness**. A positive test occurs when the hip spontaneously flexes as the clinician passively flexes the patient's knee. **NEET-PG High-Yield Pearls:** * **Trendelenburg Test:** Evaluates the strength of hip abductors (Gluteus medius/minimus). * **Galeazzi Sign:** Used to assess limb length discrepancy (often due to DDH). * **Adams Forward Bend Test:** Used for clinical screening of Scoliosis. * **Contracture vs. Deformity:** Remember that Ober’s specifically targets the lateral structures (IT Band), which are the primary culprits in abduction contractures of the hip.

Q: What is the maximum tourniquet time for the upper limb?

90 minutes. **Explanation:** The correct answer is **90 minutes (Option C)**. **1. Why 90 minutes is correct:** The primary goal of a pneumatic tourniquet is to provide a bloodless surgical field. However, prolonged ischemia leads to metabolic changes (acidosis, hyperkalemia) and potential nerve injury. In clinical practice and standard orthopaedic textbooks (like Campbell’s), the generally accepted safe upper limit for continuous tourniquet inflation in the **upper limb is 90 minutes**. For the lower limb, the limit is slightly higher (up to 120 minutes) due to larger muscle mass and better tolerance to ischemia. If the surgery exceeds this time, the tourniquet should be deflated for 10–15 minutes (reperfusion period) before re-inflation. **2. Why other options are incorrect:** * **30 & 60 minutes (Options A & B):** These durations are well within the safety margin but are too short for many standard orthopaedic procedures. While safe, they do not represent the *maximum* recommended threshold. * **120 minutes (Option D):** While 120 minutes is the standard maximum for the **lower limb**, applying this duration to the upper limb increases the risk of "tourniquet paralysis" and nerve compression injuries, particularly to the radial nerve. **3. High-Yield Clinical Pearls for NEET-PG:** * **Pressure Settings:** Usually **100 mmHg above systolic BP** for the upper limb and **2x systolic BP** (or 100-150 mmHg above) for the lower limb. * **Nerve Vulnerability:** The **Radial nerve** is the most common nerve injured by a tourniquet in the upper limb. * **Post-Tourniquet Syndrome:** Characterized by edema, pallor, and stiffness after deflation, usually due to prolonged ischemia. * **Contraindications:** Sickle cell anemia (risk of crisis), severe peripheral vascular disease, and crush injuries.

Q: Which of the following describes the type of traction shown in the image?

Gallow's traction. ***Gallow's traction*** - Gallow's traction (also called **Bryant's traction**) is a form of **bilateral vertical skin traction** applied to both lower limbs simultaneously - Indicated for **femoral shaft fractures in children under 2 years of age** (or < 12 kg body weight) - Both legs are suspended **vertically** with **bandages/adhesive skin traction**, and the child's **buttocks are just lifted off the bed** (about 2–3 cm clearance) - Advantages: simplicity, good fracture alignment, easy nursing care - Key complication: **vascular compromise** (ischemia of the toes/foot due to tight bandaging) — must check distal circulation regularly *Russell's traction* - Skin traction applied to **one leg** with a sling behind the knee to flex it - Used for femoral shaft fractures in **older children and adults** - Not bilateral or vertical — distinguishable from Gallow's traction *Perkin's traction* - A form of **skeletal traction** through a **Steinmann pin** in the proximal tibia - Used for femoral fractures in **adults**; not applicable to infants *Dunlop's traction* - Traction used specifically for **supracondylar fractures of the humerus** in children - Involves the **upper limb** positioned in a specific orientation — completely different region from the bilateral leg traction seen in the image

Q: Identify the splint shown in the image:

Bohler-Braun splint. ***Bohler-Braun splint*** - The **Böhler-Braun splint** is a metal frame traction splint with a characteristic **inclined plane (triangular) design** that elevates and supports the lower limb - **Primary indication**: Balanced skeletal traction for **femoral shaft fractures** and distal femur/condylar fractures — it maintains limb alignment while allowing longitudinal traction to reduce muscle spasm and fracture displacement - The inclined plane supports both the thigh and the leg, distributing the limb weight and facilitating nursing care *Thomas splint* - Also used for femoral shaft fractures but primarily for **emergency transport and pre-hospital immobilization** - Consists of a **proximal ring** fitting around the upper thigh with two side rods — does not have an inclined plane frame; structurally distinct from the Böhler-Braun design *Denis Browne splint* - Used for **congenital talipes equinovarus (club foot)** in infants - Consists of **two foot plates connected by an adjustable crossbar** — a completely different device used in neonates, not a traction frame for fractures *Cock-up splint* - Used for **wrist drop** caused by radial nerve palsy - An **upper limb splint** that holds the wrist in dorsiflexion — entirely unrelated to lower limb traction frames

Question 1

Which type of amputation is shown below?

Accepted Answer

Krukenberg's

Answer

Syme's

Answer

Lisfranc's

Answer

Chopart's

Question 2

The abduction contracture at the hip joint is evaluated clinically by which test?

Accepted Answer

Ober's test

Answer

Thomas test

Answer

Gerhardt's test

Answer

Ely's test

Question 3

In the surgical anterolateral approach to the tibia, why is the incision taken over the tibialis anterior muscle mass rather than over the shaft?

Accepted Answer

All the above

Answer

Medially based flap

Answer

Less chances of wound dehiscence

Answer

Can be converted to an extensile approach

Question 4

All of the following are principles of tendon transfers except?

Accepted Answer

The line of pull must be straight

Answer

There should be no contracture at the joint

Answer

One tendon must do one function only

Answer

A muscle power less than 3 can also be used

Question 5

What is the maximum tourniquet time for the upper limb?

Accepted Answer

90 minutes

Answer

30 minutes

Answer

60 minutes

Answer

120 minutes

Question 6

What is the most important technical consideration at the time of performing a below-knee amputation?

Accepted Answer

The posterior flap should be longer than the anterior flap.

Answer

The stump should be long.

Answer

The stump should be short.

Answer

The anterior flap should be longer than the posterior flap.

Question 7

In lag screw technique, what is the function of countersink?

Accepted Answer

Assures an appropriate receptacle for the screw head.

Answer

The hole made in the distal fragment that engages the screw threads.

Answer

The hole made in the proximal segment that does not engage the screw threads.

Answer

Non-functional.

Question 8

Which of the following is the primary use of the instrument shown below?

Accepted Answer

Used as a nibbler to remove fibrous tissue from a non-union site

Answer

Cutting ribs in spinal surgery

Answer

Smoothening of the edges in amputation surgery

Answer

Holding hard tissues

Question 9

Which of the following describes the type of traction shown in the image?

Accepted Answer

Gallow's traction

Answer

Russell's traction

Answer

Perkin's traction

Answer

Dunlop's traction

Question 10

Identify the splint shown in the image:

Accepted Answer

Bohler-Braun splint

Answer

Thomas splint

Answer

Denis Browne splint

Answer

Cock-up splint

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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