Orthopaedic Techniques — MCQs

Orthopaedic Techniques Indian Medical PG Practice Questions and MCQs

Question 81: What is application of Plaster of Paris all around the surface called ?

A. Slab
B. Cast (Correct Answer)
C. Spica
D. None of the options

Explanation: ***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.

Question 82: Chepuwa is:

A. Force-feeding substances
B. Compressing the thigh after putting between two rods (Correct Answer)
C. Submerging the head under water
D. Beating the soles

Explanation: ***Compressing the thigh after putting between two rods*** - **Chepuwa** is a form of **torture** that involves compressing a person's **thigh** between two **rods**, causing intense pain and potential injury. - This method is used to inflict severe pain without necessarily leaving easily detectable external marks, making it a particularly insidious form of abuse. *Force-feeding substances* - This practice, while also a form of abuse and torture, is distinct from Chepuwa, which specifically refers to the mechanical compression of a limb. - Force-feeding involves the involuntary administration of food or other substances, often used to punish, control, or coerce. *Submerging the head under water* - This describes **waterboarding**, a severe form of torture that simulates **drowning** and causes extreme distress and a sensation of suffocation. - It is a different method of torture with distinct physiological and psychological effects compared to limb compression. *Beating the soles* - This torture technique is known as **falanga** or **flogger** and involves repeatedly striking the **soles of the feet**. - While it causes significant pain and swelling, it targets a different body part and uses a different mechanism of injury than Chepuwa.

Question 83: Continuous fixed traction is provided by?

A. Thomas splint (Correct Answer)
B. BB splint
C. Hamilton Russel
D. Gallows

Explanation: ***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.

Question 84: What is the primary purpose of a cobra head plate in orthopedic surgery?

A. Stabilizing the knee joint during arthrodesis
B. Stabilizing the ankle joint during arthrodesis
C. Stabilizing the hip joint during arthrodesis (Correct Answer)
D. Stabilizing the elbow joint during arthrodesis

Explanation: ***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**.

Question 85: Thomas test is used for testing?

A. Knee flexion
B. Hip abduction
C. Hip rotation
D. Hip flexor tightness (Correct Answer)

Explanation: ***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**.

Question 86: All of the following are true regarding the application of POP Cast except -

A. It can be applied in presence of extreme swelling
B. Gangrene is known complication of a tight plaster cast
C. Putting the Plaster roll in warm water hastens setting time
D. It is anhydrous Calcium phosphate (Correct Answer)

Explanation: ***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.

Question 87: What is the purpose of the Insall-Salvati index?

A. To measure ankle dorsiflexion range
B. To assess patellar height and tendon length ratio (Correct Answer)
C. To evaluate elbow joint stability
D. To assess wrist bone alignment

Explanation: ***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**.

Question 88: What type of cast is primarily associated with the development of Cast syndrome?

A. Full arm cast
B. Short arm cast
C. Hip spica cast (Correct Answer)
D. Above knee cast

Explanation: ***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**.

Question 89: Tension band wiring is indicated in fracture of which of the following ?

A. Olecranon (Correct Answer)
B. Fracture of the humerus
C. Fracture of the tibia
D. Fracture of the spine

Explanation: ***Olecranon*** - **Tension band wiring** is a widely used and effective technique for fixing transverse and short oblique **olecranon fractures**. - This method converts **distractive forces**, typically exerted by the triceps muscle, into **compressive forces** at the fracture site, promoting healing and stability. *Fracture of the humerus* - While various fixation methods exist for humeral fractures, **tension band wiring** is not a primary or common technique due to the complex anatomy and diverse fracture patterns of the humerus. - Humerus fractures often require **plates, screws, or intramedullary nails** for stable fixation, especially in diaphyseal or intricate joint fractures. *Fracture of the tibia* - **Tibial fractures** typically involve significant weight-bearing forces and often require strong internal fixation like **intramedullary nailing** or **plate and screw constructs**. - **Tension band wiring** is generally not suitable for the robust forces across the tibia and is rarely used alone for these fracture types. *Fracture of the spine* - **Spinal fractures** require highly specialized surgical approaches, often involving **pedicle screws, rods, or anterior instrumentation**, depending on the fracture stability and neurological involvement. - **Tension band wiring** is not an appropriate technique for stabilizing spinal fractures due to the complex biomechanics and critical neural structures involved.

Question 90: Most common bone for which nailing is done

A. Radius
B. Ulna
C. Tibia (Correct Answer)
D. Humerus

Explanation: ***Tibia*** - The **tibia** is the most common long bone for which **intramedullary nailing** (IM nailing) is performed, particularly for fractures of the **tibial shaft**. - Its subcutaneous location and strong cortical bone make it amenable to this type of internal fixation, promoting stability and healing. *Radius* - Fractures of the **radius**, especially distal radial fractures, are more commonly treated with **plate and screw fixation** or external fixation, rather than intramedullary nailing. - While IM nailing can be used for some radial shaft fractures, it is not the most common bone for this procedure. *Ulna* - Like the radius, the **ulna** is less frequently fixed with intramedullary nails; **plate and screw fixation** is generally preferred for ulnar shaft fractures. - Its triangular cross-section and the presence of the interosseous membrane complicate IM nailing in some cases. *Humerus* - While **humeral shaft fractures** can be treated with intramedullary nailing, especially in comminuted or pathological fractures, it is overall less common than tibial nailing. - The risk of shoulder and elbow stiffness, as well as radial nerve injury, are considerations with humeral nailing.

Practice by Chapter

Principles of Internal Fixation

Practice Questions

External Fixation

Practice Questions

Intramedullary Nailing

Practice Questions

Plate Osteosynthesis

Practice Questions

Tension Band Wiring

Practice Questions

Minimally Invasive Orthopaedic Surgery

Practice Questions

Arthroscopic Techniques

Practice Questions

Suture Techniques in Orthopaedics

Practice Questions

Navigation and Robotics

Practice Questions

3D Printing Applications

Practice Questions

Bone Grafting Techniques

Practice Questions

Local Flaps and Soft Tissue Coverage

Practice Questions

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