Orthopaedic Techniques Practice Questions

Q: Trendelenberg test is negative in

Normal hip function. ***Normal hip function*** - A **negative Trendelenburg test** indicates that the hip abductor muscles (primarily the **gluteus medius and minimus**) are functioning correctly and can maintain pelvic stability when standing on one leg. - This suggests the absence of **weakness** or **dysfunction** in the hip abductors or their innervation. *Polio myelitis* - **Poliomyelitis** can cause **paralysis** and **weakness** of various muscles, including the hip abductors, leading to a **positive Trendelenburg test**. - The disease damages **motor neurons** in the spinal cord, impairing muscle function. *Inferior Gluteal nerve* - The **inferior gluteal nerve** primarily innervates the **gluteus maximus**, which is responsible for hip extension, not hip abduction. - Weakness due to inferior gluteal nerve damage would manifest as difficulty with activities like **climbing stairs** or **rising from a chair**, but typically would not cause a positive Trendelenburg test. *Superior Gluteal nerve* - The **superior gluteal nerve** innervates the **gluteus medius and minimus**, which are the primary hip abductors. - Damage to this nerve or weakness of these muscles would result in a **positive Trendelenburg test**, where the contralateral pelvis drops when standing on the affected leg.

Q: 'Tube cast' is applied for which of the following fractures?

Forearm. ***Forearm*** - A **tube cast**, also known as a **cylinder cast**, is often used for stabilizing specific forearm fractures, such as those of the **distal radius** or **ulna**. - This cast type provides complete immobilization of the forearm while leaving the elbow and fingers free, which is ideal for fractures in this region. *Pelvis* - Pelvic fractures typically require more extensive immobilization strategies, such as **bed rest**, **external fixation**, or **internal fixation**, due to their complex nature and involvement of weight-bearing structures. - A simple tube cast would be insufficient for stabilizing the large, irregularly shaped bones of the pelvis. *Hip* - Hip fractures usually involve the **femoral neck** or **intertrochanteric region** and almost always necessitate **surgical intervention** (e.g., hip replacement, internal fixation) due to significant instability. - A tube cast would not provide adequate support or immobilization for a hip fracture. *Ankle* - Ankle fractures are commonly treated with **short leg casts** or **walking boots** that immobilize the foot and ankle while allowing for some weight-bearing or ambulation. - A tube cast is not typically used for ankle fractures as it would not extend sufficiently to provide proper immobilization of the foot.

Q: What is application of Plaster of Paris all around the surface called ?

Cast. ***Cast*** - A **cast** is a rigid dressing made from plaster of Paris or fiberglass that completely encircles a limb or body part. - Its primary application is to provide **immobilization** and support for fractures, dislocations, or other injuries, allowing for proper healing. *Slab* - A **slab** is an incomplete wrap, typically providing support on one side of a limb, acting more like a splint. - Unlike a cast, it does not completely encircle the limb and may be less restrictive to allow for swelling. *Spica* - A **spica** cast is a specific type of cast that includes the trunk and one or more extremities, often used for hip or shoulder immobilization. - While it uses plaster of Paris and involves complete coverage of specific areas, it's a specialized type of cast, not the general term for all-around application. *None of the options* - This option is incorrect because **cast** accurately describes the application of plaster of Paris all around the surface.

Q: What is the primary purpose of a cobra head plate in orthopedic surgery?

Stabilizing the hip joint during arthrodesis. ***Stabilizing the hip joint during arthrodesis*** * A **cobra head plate** is specifically designed with a curved, broad 'head' portion that conforms to the anatomy of the **ilium** (pelvic bone) and a shaft that extends down the **femur**. * This design provides **stable fixation** for **hip arthrodesis** (surgical fusion of the hip joint), which is performed to relieve pain in severely damaged hips by immobilizing the joint. *Stabilizing the knee joint during arthrodesis* * Plates used for **knee arthrodesis** typically involve straight or slightly contoured plates applied to the distal femur and proximal tibia. * The unique shape of the **cobra head plate** is not suitable for the bony contours and mechanical loads of the knee joint. *Stabilizing the ankle joint during arthrodesis* * **Ankle arthrodesis** commonly uses plates designed to span the **tibia, talus, and calcaneus**, providing compression and stability across the ankle. * The configuration of a cobra head plate does not match the anatomical requirements for fusing the ankle joint. *Stabilizing the elbow joint during arthrodesis* * **Elbow arthrodesis** typically involves straight or pre-contoured plates applied to the **humerus** and **ulna**. * The intricate anatomy and rotational forces at the elbow joint are not amenable to fixation with a **cobra head plate**.

Q: Continuous fixed traction is provided by?

Thomas splint. ***Thomas splint*** - A Thomas splint provides **continuous fixed traction** by applying a counterforce against the ischial tuberosity while the limb is pulled distally. - This type of traction is primarily used for **femur shaft fractures** to reduce pain and prevent shortening. *BB splint* - The BB splint (Braun Boehler splint) is mainly used for **supporting fractured limbs**, particularly those of the tibia or femur, to elevate and immobilize them. - While it aids in immobilization, it does not provide active, **continuous fixed traction** in the same manner as a Thomas splint. *Hamilton Russel* - Hamilton Russel traction is a form of **balanced suspension traction** that applies a longitudinal pull using a system of pulleys and weights. - This system provides **dynamic traction** rather than fixed traction, allowing for some movement and adjustment of the pulling force. *Gallows* - Gallows traction (Bryant's traction) is typically used for **femur fractures in young children** (under 2 years old), where both legs are suspended vertically. - This is a form of **suspension traction**, but it is not considered continuous fixed traction in the same context as the Thomas splint, and it carries a risk of vascular compromise.

Q: Thomas test is used for testing?

Hip flexor tightness. ***Hip flexor tightness*** - The **Thomas test** is a diagnostic maneuver used specifically to assess for the presence of **flexion contractures** within the hip joint. - It helps identify tightness in muscles such as the **iliopsoas**, rectus femoris, and tensor fasciae latae. *Knee flexion* - While hip flexor tightness can indirectly affect knee position, the Thomas test does not primarily measure the range of motion of **knee flexion** itself. - **Other tests**, such as goniometric measurements of the knee joint, are used to assess knee flexion directly. *Hip abduction* - The Thomas test is not designed to evaluate **hip abduction** range of motion. - Hip abduction is tested through maneuvers that move the leg away from the midline of the body, often with the patient in a side-lying or supine position, assessing muscles like the **gluteus medius** and minimus. *Hip rotation* - The Thomas test does not assess **hip rotation** (internal or external). - Hip rotation is typically evaluated with the hip and knee flexed to 90 degrees, assessing the rotational range of the **femoral head within the acetabulum**.

Q: All of the following are true regarding the application of POP Cast except -

It is anhydrous Calcium phosphate. ***It is anhydrous Calcium phosphate*** - **Plaster of Paris (POP)** is chemically **calcium sulfate hemihydrate** (CaSO₄·½H₂O), not anhydrous calcium phosphate. - Adding water to calcium sulfate hemihydrate causes an exothermic reaction, forming **calcium sulfate dihydrate**, which is the hardened cast. *Putting the Plaster roll in warm water hastens setting time* - **Warm water** increases the rate of the chemical reaction that causes POP to set, thus **hastening the setting time**. - While it speeds up setting, excessively hot water can lead to a cast that sets too quickly or becomes brittle. *It can be applied in presence of extreme swelling* - Applying a non-flexible POP cast in the presence of **extreme swelling** is contraindicated because swelling will rapidly resolve, making the cast loose and ineffective. - Furthermore, if swelling increases unexpectedly under a tight cast, it can lead to dangerous **compartment syndrome**. *Gangrene is known complication of a tight plaster cast* - A **tight plaster cast** can compromise blood supply to the limb by compressing arteries and veins, potentially leading to **ischemia**. - Prolonged ischemia due to a tight cast can cause **tissue necrosis** and ultimately **gangrene** if not identified and treated promptly.

Q: What is the purpose of the Insall-Salvati index?

To assess patellar height and tendon length ratio. ***To assess patellar height and tendon length ratio*** - The **Insall-Salvati index** is a radiographic measurement used to determine **patellar height** by comparing the length of the patellar tendon to the greatest diagonal length of the patella. - It helps in diagnosing conditions like **patella alta** (high-riding patella) or **patella baja** (low-riding patella), which can contribute to knee pain and instability. *To evaluate elbow joint stability* - **Elbow joint stability** is typically assessed through clinical examination for ligamentous integrity (e.g., UCL, RCL) and sometimes dynamic imaging, not by the Insall-Salvati index. - The Insall-Salvati index is specific to the **knee joint** and **patellar position**. *To measure ankle dorsiflexion range* - **Ankle dorsiflexion range** is measured clinically using a goniometer or in 3D motion analysis, not with the Insall-Salvati index. - This index is a specialized measurement for the **patellofemoral joint**. *To assess wrist bone alignment* - **Wrist bone alignment** is evaluated using various radiographic measurements such as the scaphoid-lunate angle or carpal height ratio. - The Insall-Salvati index has no application in the assessment of the **wrist**.

Q: What type of cast is primarily associated with the development of Cast syndrome?

Hip spica cast. ***Hip spica cast*** - A **hip spica cast** encases the trunk and one or both legs, increasing intra-abdominal pressure due to its extensive coverage. - This pressure can compress the **superior mesenteric artery** against the **duodenum**, leading to Cast syndrome (also known as superior mesenteric artery syndrome). *Full arm cast* - A full arm cast does not cover the abdomen and therefore does not exert pressure on the **superior mesenteric artery** or duodenum. - It is associated with complications like compartment syndrome or nerve impingement in the upper extremity, but not Cast syndrome. *Short arm cast* - Similar to a full arm cast, a short arm cast is limited to the forearm and hand and poses no risk for **abdominal compression**. - Complications are localized to the distal upper limb, such as carpal tunnel syndrome or skin breakdown. *Above knee cast* - An above knee cast covers the lower leg and thigh but does not extend to the abdomen. - It does not contribute to the increased intra-abdominal pressure necessary for the development of **superior mesenteric artery syndrome**.

Q: Compression osteosynthesis may be used in all these areas except?

Comminuted fractures of the mandible. ***Comminuted fractures of the mandible*** - **Compression osteosynthesis** is generally **contraindicated** in comminuted fractures because the application of compression can further **displace or fragment** the multiple bone pieces. - Such fractures often require **tension band plating** or **reconstruction plates** to stabilize the fragments without causing additional compression or displacement. *FZ suture (provides anatomical support)* - The **frontozygomatic (FZ) suture** is an area where compression osteosynthesis can be effectively used to achieve **stable fixation** and **anatomical reduction**. - Compression helps to **stabilize the bone segments** at the suture line, leading to better healing and restoration of orbital rim integrity. *Bone graft fixation (promotes healing)* - Compression osteosynthesis is often employed in **bone graft fixation** to promote **intimate contact** between the graft and the host bone, which is crucial for successful **graft incorporation and healing**. - This compression enhances **vascularization** and reduces movement, creating a more favorable environment for **osteogenesis**. *Root of zygomatic arch (maintains structural integrity)* - Compression osteosynthesis can be effectively used at the **root of the zygomatic arch** to maintain **structural integrity** and achieve stable fixation of fractures in this region. - Applying compression helps to **reduce fracture gaps** and provides stability, which is essential for restoring the contour and function of the midface.

Question 1

Trendelenberg test is negative in

Accepted Answer

Normal hip function

Answer

Polio myelitis

Answer

Inferior Gluteal nerve

Answer

Superior Gluteal nerve

Question 2

'Tube cast' is applied for which of the following fractures?

Accepted Answer

Forearm

Answer

Pelvis

Answer

Hip

Answer

Ankle

Question 3

What is application of Plaster of Paris all around the surface called ?

Accepted Answer

Cast

Answer

Slab

Answer

Spica

Answer

None of the options

Question 4

What is the primary purpose of a cobra head plate in orthopedic surgery?

Accepted Answer

Stabilizing the hip joint during arthrodesis

Answer

Stabilizing the knee joint during arthrodesis

Answer

Stabilizing the ankle joint during arthrodesis

Answer

Stabilizing the elbow joint during arthrodesis

Question 5

Continuous fixed traction is provided by?

Accepted Answer

Thomas splint

Answer

BB splint

Answer

Hamilton Russel

Answer

Gallows

Question 6

Thomas test is used for testing?

Accepted Answer

Hip flexor tightness

Answer

Knee flexion

Answer

Hip abduction

Answer

Hip rotation

Question 7

All of the following are true regarding the application of POP Cast except -

Accepted Answer

It is anhydrous Calcium phosphate

Answer

It can be applied in presence of extreme swelling

Answer

Gangrene is known complication of a tight plaster cast

Answer

Putting the Plaster roll in warm water hastens setting time

Question 8

What is the purpose of the Insall-Salvati index?

Accepted Answer

To assess patellar height and tendon length ratio

Answer

To measure ankle dorsiflexion range

Answer

To evaluate elbow joint stability

Answer

To assess wrist bone alignment

Question 9

What type of cast is primarily associated with the development of Cast syndrome?

Accepted Answer

Hip spica cast

Answer

Full arm cast

Answer

Short arm cast

Answer

Above knee cast

Question 10

Compression osteosynthesis may be used in all these areas except?

Accepted Answer

Comminuted fractures of the mandible

Answer

FZ suture (provides anatomical support)

Answer

Bone graft fixation (promotes healing)

Answer

Root of zygomatic arch (maintains structural integrity)

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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