Orthopaedic Techniques Practice Questions

Q: Treatment of choice for a non-united fracture of the lower 1/4th of the tibia, characterized by multiple discharging sinuses and various puckered scars, with a 4cm shortening of the leg?

Ilizarov's fixator. ***Ilizarov's fixator*** - The presence of **multiple discharging sinuses** and **puckered scars** indicates chronic osteomyelitis, making bone transport and compression-distraction osteogenesis with an Ilizarov frame ideal. - The **4cm shortening** of the leg can be simultaneously corrected by limb lengthening through distraction osteogenesis using the Ilizarov technique. *External fixator* - While an external fixator can provide stability, a standard external fixator does not offer the same capabilities for **bone transport** or precise **limb lengthening** needed to address osteomyelitis and 4cm shortening simultaneously. - It would be less effective in managing the **infected non-union** and leg length discrepancy compared to an Ilizarov. *Plating* - **Plating** is generally contraindicated in cases of **active infection** (indicated by discharging sinuses) due to the high risk of further bacterial colonization of the implant and implant failure. - It would not address the **bone defect** or the **4cm shortening** effectively in an infected context. *Intramedullary nail* - **Intramedullary nailing** is absolutely contraindicated in the presence of **active infection** and discharging sinuses, as it would spread the infection throughout the medullary canal. - It also does not allow for **segmental bone resection** and subsequent limb lengthening to address both the infection and shortening.

Q: Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:

Fracture of the tibia. ***Fracture of the tibia*** - A **patellar tendon-bearing (PTB) cast** is specifically designed to bypass the knee joint and transfer weight from the patellar tendon to the cast, offloading the tibia. - This design is particularly useful for **stable, distal tibia fractures** where partial weight-bearing is desired to promote healing. *Fracture of the patella* - A PTB cast would place direct pressure on the **patella**, which is contraindicated in a patellar fracture. - Patellar fractures often require a **cylinder cast** or surgical fixation to immobilize the knee. *Fracture of the femur* - Femoral fractures are typically **more proximal** and require **traction**, **internal fixation**, or a **spica cast** for stabilization. - A PTB cast would not provide adequate immobilization or weight-bearing relief for a femoral fracture due to its design. *Fracture of the medial malleolus* - Medial malleolus fractures involve the **ankle joint**, which is distal to the area covered by a PTB cast. - These fractures typically require a **short leg cast** or surgical repair, focusing on ankle stabilization.

Q: The instrument below which is used in orthopedic surgeries is

Bone nibbler. ***Bone nibbler*** - A bone nibbler, also known as a **rongeur**, is specifically designed for cutting and excising small pieces of bone or tissue, particularly for **debriding** or shaping bone edges. - Its characteristic "jaw-like" or "spoon-shaped" tips with sharp edges allow for controlled bone removal. *Bone cutter* - A bone cutter is typically a more robust instrument, often resembling heavy-duty scissors or shears, used for **transecting larger bones**. - It is designed for gross bone resection rather than for nibbling or shaping smaller fragments. *Bone holding forceps* - Bone holding forceps are used to **stabilize and grasp bone fragments** during surgical procedures, ensuring they remain in the correct position. - They do not have a cutting or excising function; their primary role is to provide a secure grip. *Maxim Baum scissor* - Maxim Baum scissors are specifically designed for **cutting sutures**, drapes, or other soft tissues, and are not intended for use on bone. - They feature fine, sharp blades suitable for precise cutting of soft materials.

Q: Which type of amputation is depicted in the provided image?

Krukenberg's. ***Krukenberg's*** - The image clearly depicts an upper limb with the **radius and ulna separated**, creating a pincer-like grasp, which is the hallmark of a Krukenberg's amputation. - This type of amputation is a unique surgical procedure that converts a forearm stump into a **functional forceps-like grip**, allowing for prehension and tactile sensation. *Chopart's* - This is a **partial foot amputation** that involves disarticulation through the midtarsal joint (talonavicular and calcaneocuboid joints). - It would not result in the distinct forearm morphology seen in the image. *Syme's amputation* - A Syme's amputation is an **ankle disarticulation** where the foot is removed at the ankle joint, but the heel pad is preserved and used to cover the distal tibia. - This procedure is performed on the lower limb, not the upper limb as shown. *Lisfranc amputation* - A Lisfranc amputation is a **disarticulation of the foot** through the tarsometatarsal joints, removing the toes and metatarsals while preserving the tarsal bones. - Like Chopart's and Syme's, this is a lower limb amputation and does not match the image.

Q: Trendelenburg's test is positive in all except which of the following conditions?

Tuberculosis of hip joint. ***Tuberculosis of hip joint*** - While **tuberculosis of the hip joint** can cause pain and limping, a positive Trendelenburg's test is not a direct or consistent finding. The test primarily indicates weakness of the **hip abductor muscles** or an unstable hip joint, which is not the primary presentation in hip TB unless there's associated muscle atrophy or severe joint destruction. - The characteristic signs of hip tuberculosis often include **night cries**, muscle spasm, and joint stiffness rather than gluteal muscle weakness. *Poliomyelitis affecting hip abductor muscles* - **Poliomyelitis** can cause **flaccid paralysis** and weakness of muscles, including the hip abductors. - Weakness of the **gluteus medius** and **minimus** muscles directly leads to a positive Trendelenburg's sign. *Femoral neck fracture* - A **femoral neck fracture** often leads to an **unstable hip joint** and pain, making it difficult for the patient to bear weight on the affected side. - The pain and instability inhibit the effective action of the hip abductors, resulting in a positive **Trendelenburg's test**. *Posterior dislocation of the hip* - A **posterior dislocation of the hip** disrupts the normal anatomical relationship of the femoral head and acetabulum, leading to mechanical instability. - This instability prevents the hip abductors from effectively stabilizing the pelvis during single-limb stance, thus causing a positive **Trendelenburg's sign**.

Q: In Wits' appraisal, the AO and BO measurements represent the relationship between which of the following?

Maxillary apical base to mandibular apical base. ***Maxillary apical base to mandibular apical base*** - Wits' appraisal uses the projection of points A (maxillary apical base) and B (mandibular apical base) onto the **occlusal plane** to assess the anteroposterior relationship between the maxilla and mandible. - The distance between these projected points, **AO and BO**, indicates the sagittal skeletal discrepancy. *Maxilla to cranium* - Measurements like **SNA (sella-nasion-A point)** are used to assess the anteroposterior position of the maxilla relative to the cranial base, not directly by Wits' appraisal. - While cranial reference points are used in cephalometrics, Wits' directly compares the **apical bases** to each other. *Mandible to cranium* - Measurements such as **SNB (sella-nasion-B point)** evaluate the anteroposterior position of the mandible relative to the cranial base. - Wits' specifically focuses on the inter-jaw relationship, rather than each jaw's individual relationship to the skull. *Cranial base to maxilla* - This relationship is assessed by angles like **SNA**, providing information on maxillary protrusion or retrusion in relation to the cranium. - Wits' appraisal eliminates the influence of cranial base variations by comparing the projected points directly on the **occlusal plane**.

Q: Pioneer of distraction osteogenesis is:

Ilizarov. ***Ilizarov*** - **Gavriil Abramovich Ilizarov** is widely recognized as the pioneer of **distraction osteogenesis**, developing the biological principles and surgical techniques in the 1950s. - His method involved gradually separating a corticotomy site to stimulate new bone formation, a technique now fundamental in limb lengthening and reconstructive surgery. *Codivilla* - **Alessandro Codivilla** was an Italian surgeon who performed limb lengthening in the early 20th century, but his method involved acute distraction, which often led to complications like joint subluxation and non-union. - His work predated Ilizarov's systematic approach to gradual distraction and neo-osteogenesis. *Snyder* - **Snyder** is not specifically recognized as a pioneer in the early development of distraction osteogenesis in the same historical context as Ilizarov or Codivilla. - His contributions, if any, are not central to the fundamental principles or widespread adoption of the technique. *Alexander* - The name **Alexander** is not directly associated with the pioneering work or development of distraction osteogenesis in orthopedic surgery. - While many surgeons have contributed to advancements in the field, Alexander is not credited with its fundamental principles.

Question 1

Treatment of choice for a non-united fracture of the lower 1/4th of the tibia, characterized by multiple discharging sinuses and various puckered scars, with a 4cm shortening of the leg?

Accepted Answer

Ilizarov's fixator

Answer

External fixator

Answer

Plating

Answer

Intramedullary nail

Question 2

Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:

Accepted Answer

Fracture of the tibia

Answer

Fracture of the patella

Answer

Fracture of the femur

Answer

Fracture of the medial malleolus

Question 3

The instrument below which is used in orthopedic surgeries is

Accepted Answer

Bone nibbler

Answer

Bone cutter

Answer

Bone holding forceps

Answer

Maxim Baum scissor

Question 4

Which type of amputation is depicted in the provided image?

Accepted Answer

Krukenberg's

Answer

Chopart's

Answer

Syme's amputation

Answer

Lisfranc amputation

Question 5

Trendelenburg's test is positive in all except which of the following conditions?

Accepted Answer

Tuberculosis of hip joint

Answer

Poliomyelitis affecting hip abductor muscles

Answer

Femoral neck fracture

Answer

Posterior dislocation of the hip

Question 6

In Wits' appraisal, the AO and BO measurements represent the relationship between which of the following?

Accepted Answer

Maxillary apical base to mandibular apical base

Answer

Maxilla to cranium

Answer

Mandible to cranium

Answer

Cranial base to maxilla

Question 7

Pioneer of distraction osteogenesis is:

Accepted Answer

Ilizarov

Answer

Codivilla

Answer

Snyder

Answer

Alexander

Orthopaedic Techniques — MCQs

Orthopaedic Techniques — MCQs

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