Orthopaedic Techniques Practice Questions

Q: What is the recommended rate of distraction for small bone segments?

0.5 to 0.7 mm/day. **Explanation:** The question pertains to **Distraction Osteogenesis**, a biological process of new bone formation between two bone segments that are gradually separated by controlled traction. This technique is most commonly associated with the **Ilizarov method**. **1. Why 0.5 to 0.7 mm/day is correct:** The rate of distraction is critical for successful bone formation. For **small bone segments** (such as the metacarpals, metatarsals, or phalanges), the surface area of the bone ends is smaller, and the blood supply is more delicate compared to long bones. A rate of **0.5 to 0.7 mm/day** (usually divided into 2–4 increments) is recommended to allow the regenerate (new bone) to form without outstripping the local microvasculature. **2. Analysis of Incorrect Options:** * **A (0.3 to 0.5 mm/day):** This rate is generally too slow. Slow distraction can lead to **premature consolidation**, where the bone heals across the gap before the desired length is achieved, halting the process. * **C & D (0.7 to 1.0 mm/day):** While **1.0 mm/day** is the standard "gold vertical" rate for **large long bones** (like the femur or tibia), it is too aggressive for small bones. Distracting small bones at 1.0 mm/day often leads to **non-union** or poor-quality regenerate because the soft tissues and blood vessels cannot adapt quickly enough. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Rate:** 1 mm/day (for long bones). * **Rhythm:** The frequency of distraction. 0.25 mm four times a day is superior to 1 mm once a day (promotes better osteogenesis). * **Latency Period:** The waiting period between corticotomy and the start of distraction, typically **5 to 7 days**. * **Stages of Ilizarov:** Corticotomy → Latency → Distraction phase → Consolidation phase (usually twice as long as the distraction phase).

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 Kebab treatment is used for the treatment of which of the following conditions?

Osteogenesis imperfecta. **Explanation:** The **Kebab treatment** (also known as the **Sillence technique** or **Sofield-Millar procedure**) is a classic surgical intervention for **Osteogenesis Imperfecta (OI)**. In patients with OI, bones are extremely fragile and prone to multiple fractures, leading to severe bowing and deformities. The "Kebab" technique involves performing multiple osteotomies (cutting the bone) along the shaft of a long bone (usually the femur or tibia). These segments are then realigned and threaded onto a single, long intramedullary rod—much like pieces of meat on a skewer (kebab). This provides internal stabilization, corrects the deformity, and prevents future fractures. Modern variations use **telescoping rods** (e.g., Bailey-Dubow or Fassier-Duval rods) that elongate as the child grows. **Why other options are incorrect:** * **Paget’s Disease:** Treated primarily with bisphosphonates (medical) or joint replacement if secondary arthritis occurs. * **Osteoarthritis:** Managed with lifestyle changes, analgesics, and ultimately Total Joint Replacement (Arthroplasty). * **Myositis Ossificans:** Managed with rest, NSAIDs, and surgical excision only after the ectopic bone has matured (usually after 6–12 months). **High-Yield Clinical Pearls for NEET-PG:** * **Osteogenesis Imperfecta:** Caused by a defect in **Type I Collagen** synthesis. * **Clinical Triad:** Blue sclera, fragile bones (multiple fractures), and early-onset deafness (otosclerosis). * **Drug of Choice:** Bisphosphonates (e.g., Pamidronate/Zoledronate) to increase bone mineral density. * **Radiology:** Look for "Popcorn calcifications" near the growth plates and "Codfish vertebrae."

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.

Question 1

What is the purpose of compensatory extractions?

Accepted Answer

To preserve the occlusal relationship of the buccal segment.

Answer

To prevent midline shift.

Answer

Both of the above.

Answer

None of the above.

Question 2

What is the recommended rate of distraction for small bone segments?

Accepted Answer

0.5 to 0.7 mm/day

Answer

0.3 to 0.5 mm/day

Answer

0.7 to 0.9 mm/day

Answer

1.0 mm/day

Question 3

Which type of amputation is shown below?

Accepted Answer

Krukenberg's

Answer

Syme's

Answer

Lisfranc's

Answer

Chopart's

Question 4

The Kebab treatment is used for the treatment of which of the following conditions?

Accepted Answer

Osteogenesis imperfecta

Answer

Paget's disease

Answer

Osteoarthritis

Answer

Myositis ossificans

Question 5

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 6

Which of the following tests is known for assessing De Quervain's tenosynovitis?

Accepted Answer

Finkelstein Test

Answer

Tinel's sign

Answer

Phalen's test

Answer

Cozen's test

Question 7

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 8

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 9

What is the maximum tourniquet time for the upper limb?

Accepted Answer

90 minutes

Answer

30 minutes

Answer

60 minutes

Answer

120 minutes

Question 10

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.

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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