Orthopaedic Techniques

Orthopaedic Techniques Indian Medical PG Question 1: Russell and Taylor classification is used for:

• A. Shaft of tibia fracture
• B. Subtrochanteric femoral fracture (Correct Answer)
• C. Humerus shaft fracture
• D. Fracture of neck of femur

Orthopaedic Techniques Explanation: ***Subtrochanteric femoral fracture*** - The **Russell and Taylor classification** system is specifically designed to classify **subtrochanteric femoral fractures**. - It categorizes these fractures based on the involvement of the **lesser trochanter** and the extension into the **piriformis fossa**, guiding treatment decisions. *Shaft of tibia fracture* - **Shaft of tibia fractures** are typically classified using other systems, such as the **AO/OTA classification**, which focuses on bone segment, morphology, and comminution. - The Russell and Taylor system is not applicable to lower leg fractures. *Humerus shaft fracture* - **Humerus shaft fractures** are commonly classified by systems that describe the **location (proximal, middle, distal third)**, **morphology (transverse, oblique, spiral)**, and **displacement**. - The Russell and Taylor classification does not apply to upper limb fractures. *Fracture of neck of femur* - **Fractures of the neck of the femur** are usually classified by the **Garden classification** (based on displacement) or the **Pauwels classification** (based on angle of fracture line). - These classifications determine the risk of **avascular necrosis** and guide treatment, which is distinct from the Russell and Taylor system.

Orthopaedic Techniques Indian Medical PG Question 2: Which of the following is a treatment option for Volkmann's ischemia?

• A. Bone shortening
• B. Fasciotomy (Correct Answer)
• C. Cock up splint
• D. Turn buckle splint

Orthopaedic Techniques Explanation: ***Fasciotomy*** - **Fasciotomy** is the **emergency surgical treatment** for **acute Volkmann's ischemia** caused by compartment syndrome. - This procedure involves making incisions through the fascia to relieve elevated compartment pressure and restore blood flow, preventing irreversible muscle and nerve damage. - Must be performed urgently to prevent progression to **Volkmann's contracture** (established muscle necrosis and fibrosis). *Bone shortening* - **Bone shortening** is a reconstructive procedure used in **late/established Volkmann's contracture**, not for acute ischemia. - It may be used to facilitate soft tissue reconstruction or correct deformities after muscle necrosis has occurred. - Does not address the acute ischemic emergency. *Cock up splint* - A **cock-up splint** maintains the wrist in extension and is used for **rehabilitation** in chronic/established Volkmann's contracture. - May help prevent further deformity or support weakened extensors after muscle damage has occurred. - Does not treat the acute compartment syndrome or restore blood flow. *Turn buckle splint* - A **turnbuckle splint** is used for **gradual correction of joint contractures** in established Volkmann's contracture. - This is a rehabilitative device for chronic cases, not for acute treatment. - Does not address the acute circulatory compromise or compartment syndrome.

Orthopaedic Techniques Indian Medical PG Question 3: All of the following factors affect osseointegration EXCEPT:

• A. Biocompatibility of implant material.
• B. Implant design.
• C. Patient's blood type (Correct Answer)
• D. Status of the host bed.

Orthopaedic Techniques Explanation: ***Patient's blood type*** - A patient's **blood type** (e.g., A, B, AB, O) is determined by antigens present on red blood cells and plays no direct role in the biological processes of bone healing or the integration of a dental implant with bone. - While systemic factors can influence osseointegration, blood type itself does not affect the cellular and molecular mechanisms required for direct bone-to-implant contact. *Biocompatibility of implant material* - The **biocompatibility** of the implant material (e.g., **titanium**) is crucial for osseointegration, as it must not elicit adverse reactions and must permit host bone growth on its surface. - Materials that are cytotoxic or inflammatory will prevent bone apposition and lead to fibrous encapsulation rather than direct bone contact. *Implant design* - **Implant design**, including features like **surface roughness**, thread pitch, and macro-geometry, significantly influences the initial stability and long-term success of osseointegration. - A greater surface area and appropriate surface treatments can enhance bone cell attachment and differentiation, promoting faster and stronger bone integration. *Status of the host bed* - The **status of the host bone bed** refers to its quality and quantity (e.g., bone density, vascularity), which are critical for the biological processes of osseointegration. - Adequate bone volume and good bone quality provide a stable foundation and sufficient blood supply for bone regeneration around the implant.

Orthopaedic Techniques Indian Medical PG Question 4: What is the biomechanical principle involved in symphyseal fracture with lag screw fixation?

• A. Load bearing
• B. Load sharing (Correct Answer)
• C. Compression osteosynthesis
• D. Adaptation osteosynthesis

Orthopaedic Techniques Explanation: **Load sharing** - Lag screw fixation allows for **interfragmentary compression** while still permitting some load to be borne by the surrounding bone and soft tissues, promoting a more physiological healing response. - This method provides a **stable environment** for bone healing by distributing forces across both the implant and the bone fragments. *Load bearing* - This principle implies that the **implant alone carries the majority of the load**, effectively shielding the fracture site from stress. - While a lag screw provides stability, it is not designed to be the sole load bearer; rather, it facilitates the bone's ability to bear load as it heals. *Compression osteosynthesis* - Although lag screws achieve compression, the term **compression osteosynthesis** is a broader concept that can include techniques like tension banding or plates, with the primary goal of creating stability through direct compression. - While **interfragmentary compression** is a part of lag screw fixation, "load sharing" more accurately describes the overall biomechanical outcome in symphyseal fractures where some physiological stress is beneficial for healing. *Adaptation osteosynthesis* - This refers to fixation designed primarily to **adapt or hold fragments in place** without providing significant compressive forces or the ability to share physiological loads directly with the bone during healing. - It’s typically used for non-weight-bearing fractures or where minimal stress is anticipated, which is not the case for symphyseal fractures.

Orthopaedic Techniques Indian Medical PG Question 5: Mean bone density amongst 2 groups of 50 people each is compared, which would be the best test:

• A. McNemar test
• B. Chi-square test
• C. Student t-test (Correct Answer)
• D. Fisher exact test

Orthopaedic Techniques Explanation: ***Student t-test*** - The **Student's t-test** is the appropriate statistical test for comparing the **means of two independent groups** when the data is continuous and normally distributed. - Bone density is a **continuous variable**, and the scenario involves comparing the mean bone density between two distinct groups. *Fisher exact test* - The **Fisher exact test** is used for analyzing **categorical data** in a 2×2 contingency table, especially when sample sizes are small. - It is not suitable for comparing continuous variables like bone density. *McNemar test* - **McNemar's test** is used to analyze paired nominal data, typically when comparing two related proportions from the same subjects before and after an intervention. - This scenario involves **independent groups**, not paired data. *Chi-square test* - The **chi-square test** is primarily used to compare **categorical variables** to see if there is a significant association between them. - It's not appropriate for comparing the means of continuous data like bone density.

Orthopaedic Techniques Flashcard 1 of 5

Question: Treatment of cubitus _____ is medial open wedge osteotomy or lateral closed wedge osteotomy.

Answer: varus

Orthopaedic Techniques Flashcard 2 of 5

Question: Late management of AVN of femur involves insertion of muscle and its blood supply to the head of the femur also known as _____

Answer: muscle pedicle graft

Orthopaedic Techniques Flashcard 3 of 5

Question: _____ cast and Turn-buckle cast is used for scoliosis

Answer: Risser's

Orthopaedic Techniques Flashcard 4 of 5

Question: _____ can be used for internal fixation of fractures of long bones

Answer: Steinmann pin (K-wire/Steinmann pin)

Orthopaedic Techniques Flashcard 5 of 5

Question: In Mc Murray's osteotomy, the distal fragment is displaced _____ally and abducted

Answer: medi