Orthopaedic Techniques Practice Questions

Q: What material is used in vertebroplasty?

Polymethyl methacrylate. **Explanation:** **Polymethyl methacrylate (PMMA)**, commonly known as "bone cement," is the standard material used in vertebroplasty and kyphoplasty. In these procedures, PMMA is injected into a fractured vertebral body (typically due to osteoporosis or malignancy) to provide immediate internal stabilization and pain relief. * **Why PMMA is correct:** PMMA is a biocompatible polymer that acts as a grout rather than a glue. It undergoes an **exothermic reaction** during polymerization, reaching high temperatures which may contribute to pain relief by destroying local nerve endings (thermal neurolysis). It provides high compressive strength, making it ideal for weight-bearing bones like the vertebrae. * **Why other options are incorrect:** Options A, B, and C (Isomethyl, Isoethyl, and Polyethyl methacrylate) are chemically distinct variants that do not possess the specific mechanical properties, handling characteristics, or long-standing clinical track record required for orthopedic bone augmentation. PMMA remains the gold standard in both arthroplasty (joint replacement) and spinal augmentation. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Bone cement is supplied as a powder (polymer) and a liquid (monomer). The liquid contains **Methyl methacrylate** and an inhibitor (Hydroquinone). * **Radiopacity:** To make the cement visible under fluoroscopy during injection, a radio-opaque agent like **Barium sulphate** or **Zirconium dioxide** is added. * **Complications:** The most feared complication of vertebroplasty is **cement leakage**, which can lead to pulmonary embolism or spinal cord compression. * **BCIS (Bone Cement Implantation Syndrome):** Characterized by hypoxia and hypotension during cementation, often due to fat embolism or monomer toxicity.

Q: Identify the test being performed.

Book test. ***Book test*** - The image depicts a technique used to assess the strength of **interossei muscles**. The examiner attempts to separate the patient's fingers while the patient tries to keep them adducted. This is characteristic of the **Book test**. - A positive test (inability to resist abduction) suggests weakness of the **interossei muscles**, often seen in conditions affecting the **ulnar nerve**. *Egawa test* - The **Egawa test** specifically assesses the function of the **dorsal interossei** of the middle finger. - It involves the patient flexing their middle finger while trying to maintain it in a straight line, resisting abduction or adduction. *Card test* - The **Card test** involves holding a piece of paper or a **card** between the fingers (usually between the thumb and index finger, or between adjacent fingers). - It is used to assess the strength of the **adductor pollicis** (if between thumb and index) or **interossei** (if between adjacent fingers), with a positive test (inability to hold the card) indicating muscle weakness, often due to **ulnar nerve palsy**. *Dugas' test* - **Dugas' test** is used to check for **shoulder dislocation**. - The patient is asked to place the hand of the affected arm on the opposite shoulder and attempt to abduct the elbow to the chest wall. Inability to do so indicates a **shoulder dislocation**.

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

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?

Doyen's periosteal elevator. ***Doyen's periosteal elevator*** - This instrument is characterized by its **curved, spoon-like working end** and solid handle, designed for **elevating the periosteum** from bone. - Doyen's elevator comes in various sizes and angles, but the distinct hook-like curve is a key identifying feature, distinguishing it from other elevators. *Cobb's spinal elevator* - Cobb's elevator typically has a **flat, broad, and slightly curved blade** with a rounded or tapered tip, suitable for dissecting along bony surfaces, particularly in spinal surgery. - Its design prioritizes broad, even separation of tissue layers, contrasting with the more acute curve of the Doyen's. *Leksell's rongeur* - A rongeur is a biting instrument used for **gnawing away bone or tough tissue**, characterized by hinged jaws with sharp, cup-shaped ends. - The image clearly shows a single-piece instrument without hinged jaws, ruling out a rongeur. *Key periosteal elevator* - The Key elevator typically features a **broader, more rounded or slightly angled tip** and a flat, somewhat spatula-like working end, used for general periosteal elevation. - While also a periosteal elevator, its working end does not exhibit the characteristic deep, hook-like curve seen in the Doyen's elevator.

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.

Question 1

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 2

What material is used in vertebroplasty?

Accepted Answer

Polymethyl methacrylate

Answer

Isomethyl methacrylate

Answer

Isoethyl methacrylate

Answer

Polyethyl methacrylate

Question 3

What material is used in veinplasty?

Accepted Answer

Polymethyl methacrylate

Answer

Isobutyl Methacrylate

Answer

Isoethyl Methacrylate

Answer

Silicon

Question 4

Identify the test being performed.

Accepted Answer

Book test

Answer

Egawa test

Answer

Card test

Answer

Dugas' test

Question 5

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 6

Identify the splint shown in the image:

Accepted Answer

Bohler-Braun splint

Answer

Thomas splint

Answer

Denis Browne splint

Answer

Cock-up splint

Question 7

Which test is being done in the image provided?

Accepted Answer

Thomas test

Answer

Trendelenburg test

Answer

Ober's test

Answer

FABER test

Question 8

What does the given image show?

Accepted Answer

K nail impactor

Answer

Kocher bone hook

Answer

Olsen-Hegar needle holder

Answer

Heath mallet

Question 9

What does the given image show?

Accepted Answer

Doyen's periosteal elevator

Answer

Cobb's spinal elevator

Answer

Leksell's rongeur

Answer

Key periosteal elevator

Question 10

What does the given image show?

Accepted Answer

Cobb's spinal elevator

Answer

Capener gouge

Answer

Kutscher's diamond pointed awl

Answer

Hibbs osteotome

Orthopaedic Techniques — MCQs

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