Orthopaedic Techniques Practice Questions

Q: Which test is being done in the image provided?

Thomas test. ***Thomas test*** - The **Thomas test** (hip flexion contracture test) is a clinical examination technique used to detect a **fixed flexion deformity / hip flexor contracture** of the hip joint. - The patient lies **supine** on the examination table. The examiner maximally flexes one hip (bringing the knee to the chest) to **obliterate the lumbar lordosis**. If the **contralateral (opposite) leg rises off the table**, it indicates a **hip flexion contracture** on that side. - A positive Thomas test suggests **shortening of the iliopsoas muscle**, causing the hip to remain in a position of flexion. - It was described by **Hugh Owen Thomas**, a pioneer in orthopaedic surgery. *Trendelenburg test* - The Trendelenburg test assesses **hip abductor (gluteus medius) weakness**. The patient stands on one leg; if the contralateral pelvis drops, the test is positive. It does **not** involve the supine position seen here. *Ober's test* - Ober's test assesses **iliotibial band (ITB) / tensor fascia lata tightness**. The patient lies in the lateral decubitus (side-lying) position while the examiner abducts and extends the upper leg. This is a different position and purpose from what is shown. *FABER test* - The FABER (Flexion, ABduction, External Rotation) test assesses **hip joint pathology and sacroiliac joint pain**. The patient's leg is placed in a figure-4 position while supine. It does not involve drawing the knee straight to the chest to eliminate lumbar lordosis.

Q: What does the given image show?

K nail impactor. ***K nail impactor*** - The image displays a long, tubular instrument with a telescoping design and a blunt end, consistent with a **K nail impactor**. - This device is used in orthopaedic surgery to **drive K-nails (Kirschner wires)** into bone or to impact other orthopaedic implants. *Kocher bone hook* - A **Kocher bone hook** features a curved hook at the end, designed for retracting or manipulating bone fragments. - The instrument in the image lacks the characteristic hook shape. *Olsen-Hegar needle holder* - An **Olsen-Hegar needle holder** is a scissor-like instrument with jaws for gripping needles and a built-in cutting mechanism. - The instrument shown is a solid, cylindrical piece and not a grasping tool. *Heath mallet* - A **Heath mallet** is a hammer-like instrument, often made of metal or silicone, used for striking osteotomes or chisels during surgery. - While it applies force, the image clearly shows a slender, non-mallet design used for impacting rather than striking.

Q: What does the given image show?

Cobb's spinal elevator. ***Cobb's spinal elevator*** - The instrument shown is a **Cobb's spinal elevator**, which is characterized by its **angled shaft** and flat, curved tip resembling a spoon or spade. - It is primarily used in **spinal surgery** to elevate and dissect soft tissues, like muscles and periosteum, away from the vertebral column. *Capener gouge* - A Capener gouge typically has a **U-shaped cross-section** at its tip, designed for scooping out bone or creating troughs. - Its tip is generally much **deeper** and more curved than the flat, shovel-like tip of the instrument pictured. *Kutscher's diamond pointed awl* - A Kutscher's diamond pointed awl is used for creating small holes, often in bone, and features a **sharp, pointed tip**, which is not seen in the image. - Its design is more akin to a **punch or drill-like instrument** rather than a broad elevator. *Hibbs osteotome* - A Hibbs osteotome is a type of **chisel-like instrument** with a beveled cutting edge, used for cutting or shaping bone. - It usually has a **straight shaft** and a wide, flat tip, distinct from the curved, spoon-like tip and angled shaft of the depicted instrument.

Q: Identify the traction show in the image:

$90-90$ traction. ***$90-90$ traction*** - In this traction, hips and knees are bent at **$90$-degree angles**, and the lower leg is suspended with a traction device, often used for **femur fractures** in young children. - This position helps in aligning bone fragments and providing stable fixation. *Gallow's traction* - **Gallow's traction** involves suspending both legs vertically, with the hips flexed to **$90$ degrees**, and the child's buttocks slightly off the bed. - It is typically used for **femoral shaft fractures** in infants weighing less than **$12$ kg**. *Russell traction* - **Russell traction** involves a sling under the knee and weights applied in longitudinal and vertical directions. - This setup creates a **horizontal force** to align **femoral shaft fractures**. *Smith's traction* - **Smith's traction** is a type of skeletal traction for femoral shaft fractures, usually involving a **pin inserted into the distal femur** or proximal tibia. - This method is characterized by a direct pull on the bone for more effective reduction and stabilization.

Q: Identify the splint shown in the image:

*Bohler-Braun splint* - This splint is designed for the **lower extremity**, specifically to support and immobilize the leg, often used for **tibial fractures**. - It features a distinctive **trapeze frame** with pulleys to allow for traction and elevation of the limb. *Dennis Browne splint* - The Dennis Browne splint is used for **clubfoot** in infants and toddlers. - It consists of a bar connecting two shoes, holding the feet in **external rotation** and abduction. *Cockup splint* - A cockup splint is a **wrist splint** that holds the wrist in a slight degree of extension (dorsiflexion). - It is commonly used for conditions like **carpal tunnel syndrome** or radial nerve palsy. ***Aeroplane splint*** - The pictured splint, with its prominent upright and crossbar supports for the arm, is characteristic of an **Aeroplane splint**. - This type of splint is used to hold the **shoulder in abduction** and external rotation, often for brachial plexus injuries or shoulder dislocations.

Q: The image given below demonstrates which of the following tests being performed on the patient?

Thomas test. ***Thomas test*** - The image shows the patient supine with one hip maximally flexed, bringing the knee towards the chest. If the opposite hip passively flexes and lifts off the table, it indicates a **hip flexion contracture**, which is what the Thomas test assesses. - This test is used to detect **fixed flexion deformities** of the hip, specifically tightness of the iliopsoas muscle. *Straight leg raising test* - This test involves passively **raising the patient's straightened leg** while they are supine to assess for **sciatic nerve irritation**. - It does not involve flexing one hip to observe the movement of the contralateral hip. *Narath sign* - The Narath sign is related to **anterior shoulder dislocations**, where the patient cannot touch the opposite scapula. - This test is irrelevant to hip examination or the position shown in the image. *Trendelenburg's test* - This test is performed with the patient **standing** and asked to lift one leg off the ground to assess the **strength of the hip abductor muscles** (gluteus medius and minimus). - It evaluates dynamic hip stability, not hip flexion contractures in a supine position.

Q: What is the principle of the method shown below?

Distraction histiogenesis. ***Distraction histiogenesis*** - The image shows an **external fixator**, likely an **Ilizarov apparatus**, which is used in distraction osteogenesis (also known as distraction histiogenesis). - This technique involves surgically creating a **corticotomy** (a cut through the bone cortex and into the marrow cavity), followed by a latent period, and then gradual, controlled **distraction** of the bone segments, which stimulates the formation of new bone and soft tissue in the gap. *Tibilization of fibula* - **Tibilization of the fibula** is a surgical procedure where the fibula is transferred and used to replace a portion of the tibia. - While it involves bone reconstruction, it is a specific type of bone grafting and not the general principle depicted by the external fixator. *Epiphyseal corticotomy* - A **corticotomy** is a surgical incision made through the bone cortex, which is a step in distraction histiogenesis. - However, performing a corticotomy at the **epiphysis** (the end part of a long bone) is not the general principle of the method shown, which encompasses the entire callus distraction process. *All of the above* - This option is incorrect because only **distraction histiogenesis** accurately describes the overall principle and method depicted in the image. - The other options describe specific procedures or steps that are either incorrect or only components of a larger process.

Q: Which of the following is the bone holding instrument used in orthopaedic surgeries?

Instrument in upper right quadrant. ***The image in the upper right quadrant*** - This instrument is a **bone-holding clamp/forceps**, characterized by its robust construction and jaws designed to securely grasp and stabilize bone fragments during orthopedic procedures. - The **ratchet mechanism** visible on the handles allows for maintaining a constant grip on the bone without continuous manual pressure. *The image in the upper left quadrant* - This instrument appears to be a **sponge-holding forceps**, distinguishable by its generally lighter build and oval/circular fenestrated (windowed) tips, which are used to hold sponges or swabs. - Its primary role is for **aseptic preparation** of the surgical site or for absorbing fluids, not for bone manipulation. *The image in the lower left quadrant* - This instrument is a **bone rongeur** or **bone cutter**, designed with sharp, cup-like jaws to bite off small pieces of bone or cartilage. - It is used for **debridement**, shaping bone, or extracting bone fragments, rather than holding them. *The image in the lower right quadrant* - This instrument is a **bone awl** or **trephine**, typically used to create holes or puncture the bone marrow cavity. - It has a pointed, sharp tip and a handle for applying force, but it does not have any mechanism for grasping or holding bone.

Q: Which position is being tested on the patient in the image shown below?

External rotation. ***External rotation*** - In the image, the patient's hip is flexed and the examiner is rotating the lower leg *medially*, which causes **external rotation** of the hip joint. - This maneuver assesses the range of motion for **external rotation** at the hip. *Internal rotation* - Internal rotation of the hip would involve rotating the lower leg **laterally**, which is the opposite of what is depicted. - This motion brings the front of the thigh closer to the midline when the hip is flexed. *Abduction* - **Abduction** is the movement of the leg away from the midline of the body, which is not being performed in this image. - This movement primarily involves muscles like the **gluteus medius** and **minimus**. *Flexion* - While the hip is maintained in a **flexed position**, the primary motion being tested by the examiner's manipulation is the *rotation* of the femur within the hip socket, not further flexion. - **Flexion** involves lifting the leg towards the torso, often with a bent knee.

Q: Myodesis is employed in amputations for all of the following indications except:

Ischemia. ***Ischemia*** - **Ischemia** is the primary exception where myodesis is often contraindicated or avoided - In ischemic limbs, compromised blood supply limits muscle viability and healing capacity - Poor vascularity prevents adequate muscle-to-bone integration and increases risk of wound complications - Simple myoplasty (muscle-to-muscle suturing) or guillotine-type procedures are often preferred in severe ischemia to ensure primary healing - The priority is achieving a viable stump rather than optimal functional reconstruction *Trauma* - Trauma is one of the **best indications** for myodesis when adequate healthy tissue is available - Creates a stable, functional residual limb with better proprioception for prosthetic fitting - Muscle-to-bone attachment provides superior control and reduces phantom limb pain - Standard technique in traumatic amputations with good soft tissue coverage *Tumor* - Myodesis can be performed in oncological amputations if surgical margins allow - While oncological clearance is the priority, functional reconstruction with myodesis is still pursued when feasible - Modern limb-sparing principles encourage maintaining function alongside adequate resection *Children* - Children are **excellent candidates** for myodesis - Promotes better skeletal growth and long-term functional adaptation - Maintains soft tissue bulk and provides stable base for prosthetic use as the child grows - Helps prevent muscle atrophy and improves quality of life

Question 1

Which test is being done in the image provided?

Accepted Answer

Thomas test

Answer

Trendelenburg test

Answer

Ober's test

Answer

FABER test

Question 2

What does the given image show?

Accepted Answer

K nail impactor

Answer

Kocher bone hook

Answer

Olsen-Hegar needle holder

Answer

Heath mallet

Question 3

What does the given image show?

Accepted Answer

Cobb's spinal elevator

Answer

Capener gouge

Answer

Kutscher's diamond pointed awl

Answer

Hibbs osteotome

Question 4

Identify the traction show in the image:

Accepted Answer

$90-90$ traction

Answer

Gallow's traction

Answer

Russell traction

Answer

Smith's traction

Question 5

Identify the splint shown in the image:

Answer

Bohler-Braun splint

Answer

Dennis Browne splint

Answer

Cockup splint

Answer

Aeroplane splint

Question 6

The image given below demonstrates which of the following tests being performed on the patient?

Accepted Answer

Thomas test

Answer

Straight leg raising test

Answer

Narath sign

Answer

Trendelenburg's test

Question 7

What is the principle of the method shown below?

Accepted Answer

Distraction histiogenesis

Answer

Tibilization of fibula

Answer

Epiphyseal corticotomy

Answer

All of the above

Question 8

Which of the following is the bone holding instrument used in orthopaedic surgeries?

Accepted Answer

Instrument in upper right quadrant

Answer

Instrument in upper left quadrant

Answer

Instrument in lower left quadrant

Answer

Instrument in lower right quadrant

Question 9

Which position is being tested on the patient in the image shown below?

Accepted Answer

External rotation

Answer

Internal rotation

Answer

Abduction

Answer

Flexion

Question 10

Myodesis is employed in amputations for all of the following indications except:

Accepted Answer

Ischemia

Answer

Tumor

Answer

Children

Answer

Trauma

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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