Orthopaedic Techniques Practice Questions

Q: Identify the clinical sign being tested in the image:

Hawkins test. ***Hawkins test*** - The image depicts the **Hawkins-Kennedy test**, a specific orthopedic maneuver used to assess **shoulder impingement syndrome**. - The test involves **shoulder flexion to 90°**, **elbow flexion to 90°**, followed by **forceful internal rotation**, which reproduces pain if subacromial impingement is present. *Neer test* - The **Neer impingement test** involves **passive forward flexion** of the arm while stabilizing the scapula, not the position shown in the image. - This test compresses the **supraspinatus tendon** against the anterior acromion, causing pain in impingement syndrome. *Sag sign* - The **posterior sag sign** is used to test for **posterior cruciate ligament (PCL) injury** in the knee joint. - It involves observing for **posterior displacement** or "sag" of the tibia relative to the femur when the knee is flexed to 90°. *Capener sign* - The **Capener sign** is associated with **scaphoid fractures** in the wrist and refers to a specific **radiographic finding**. - It indicates **displacement of a scaphoid fracture fragment** seen on X-rays, not a physical examination maneuver.

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: Which is correct about the image shown below?

Hip spica and von Rosen splint. ***Hip spica and von Rosen splint*** - The image displays a **hip spica cast** on the left child, characterized by its wide abduction of the hips and stabilization across the trunk and both thighs. - The right child is wearing a **von Rosen splint**, indicated by the rigid, H-shaped metal brace that holds the hips in abduction and external rotation. *Craig splint and von Rosen splint* - A **Craig splint** involves holding the hips in 90 degrees of flexion and maximal internal rotation using a bar between the knees, which is not shown. - While the von Rosen splint is correctly identified, the other brace is a hip spica, not a Craig splint. *Bohler-Braun splint and von Rosen splint* - A **Bohler-Braun splint** is a traction frame typically used for lower limb fractures, which is very different from the hip bracing devices shown. - The von Rosen splint is correct, but the first device is not a Bohler-Braun splint. *Hip spica and Craig splint* - The hip spica is correctly identified on the left, but the brace on the right is a **von Rosen splint**, not a Craig splint. - A Craig splint positions the hips differently, as described above.

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: The following view of the knee joint is known as:

Sunset view. ***Sunset view*** - Also known as the **skyline view** or **tangential view** of the patella, this view is taken with the knee flexed (typically 30–60°), allowing visualization of the **patellofemoral joint space** in axial projection. - It is excellent for diagnosing **patellar tracking issues**, patellar fractures, **chondromalacia patellae**, and assessing the patella's articulation with the **femoral trochlea**. *Merchant's view* - The Merchant's view is another tangential axial view of the patella, performed with the patient **supine and the knees flexed at 45°** over the edge of the table with the X-ray beam angled caudally. - While it also visualizes the **patellofemoral joint**, the patient positioning and beam angulation differ from the standard sunset/skyline view. *Tunnel view* - Also called the **notch view** or **intercondylar view**, this is a PA projection with the knee flexed at 40–50°, used to visualize the **intercondylar notch** and posterior femoral condyles. - It is primarily used to detect **osteochondral defects**, loose bodies in the notch, and **osteochondritis dissecans**. *Rosenberg view* - The Rosenberg view is a **weight-bearing PA view** taken with the knee flexed at 45°, used to assess **joint space narrowing** in the posterior tibiofemoral compartment. - It is more sensitive than a standing AP view for detecting **early osteoarthritis** of the knee.

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: Identify the implant shown in the image:

Dynamic hip screw. ***Dynamic hip screw*** - The image shows a **lag screw** inserted into the femoral neck and head, which slides within a **side plate** attached to the femoral shaft with cortical screws. - This construct allows for controlled **dynamic collapse** and impaction at the fracture site, promoting healing and providing stable fixation for **extracapsular hip fractures**. *Cannulated hip screw* - Cannulated screws are typically used in a **parallel configuration** or as a single large screw for hip fractures, particularly **femoral neck fractures**. - They do not feature a **side plate** that extends down the femoral shaft for additional fixation. *Condylar hip screw* - A condylar hip screw (DCS) is used for **distal femur fractures**, often extending into the **condyles**. - It involves a different angulation and design compared to the proximal femoral implant seen, which is fixed to the femoral shaft. *Intramedullary nail* - An intramedullary nail is inserted into the **medullary canal** of the bone, running through its center. - While some hip nails (e.g., trochanteric nails) have a cephalic screw component, they primarily stabilize the shaft from within, unlike the **extracortical side plate** seen here.

Q: Locking compression plating is indicated in

Periarticular fractures. ***Periarticular fractures*** - **Locking compression plates (LCPs)** are designed with threaded screw holes that lock the screws into the plate, providing **angular stability**. - This construct is particularly beneficial in **periarticular fractures** where the bone quality is often poor and comminution is common, as it prevents screw pull-out and maintains reduction. *Fracture shaft of femur* - For diaphyseal fractures of the femur, **intramedullary nailing** is generally the preferred treatment due to its load-sharing capabilities and minimally invasive nature. - While plates can be used in certain situations, LCPs are not the primary indication for routine femoral shaft fractures. *Fracture shaft of humerus* - Many humerus shaft fractures can be treated non-operatively with a brace or functional casting, especially if they are closed and stable. - Surgical intervention often involves **intramedullary nailing** or conventional plating, but LCPs are not selectively indicated over other plating systems for straightforward diaphyseal humerus fractures. *Intertrochanteric fracture* - **Intertrochanteric fractures** of the hip are typically treated with **intramedullary nails** (e.g., Gamma nail, Trochanteric Fixation Nail) or dynamic hip screws. - These devices allow for controlled collapse and impaction, which is crucial for stability in these osteoporotic fractures; LCPs are not the standard treatment.

Question 1

Identify the clinical sign being tested in the image:

Accepted Answer

Hawkins test

Answer

Sag sign

Answer

Capener sign

Answer

Neer test

Question 2

Identify the splint shown in the image:

Answer

Bohler-Braun splint

Answer

Dennis Browne splint

Answer

Cockup splint

Answer

Aeroplane splint

Question 3

Which is correct about the image shown below?

Accepted Answer

Hip spica and von Rosen splint

Answer

Craig splint and von Rosen splint

Answer

Bohler-Braun splint and von Rosen splint

Answer

Hip spica and Craig splint

Question 4

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 5

The following view of the knee joint is known as:

Accepted Answer

Sunset view

Answer

Merchant's view

Answer

Tunnel view

Answer

Rosenberg view

Question 6

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 7

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 8

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 9

Identify the implant shown in the image:

Accepted Answer

Dynamic hip screw

Answer

Cannulated hip screw

Answer

Condylar hip screw

Answer

Intramedullary nail

Question 10

Locking compression plating is indicated in

Accepted Answer

Periarticular fractures

Answer

Fracture shaft of femur

Answer

Fracture shaft of humerus

Answer

Intertrochanteric fracture

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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