Orthopaedic Technologist Certified Spinal and Pelvic Immobilization Questions and Answers — Questions and Answers
Question 1: An Orthopaedic Technologist is assisting with the application of a pelvic binder on a trauma patient. To be MOST effective at reducing pelvic volume and controlling hemorrhage, the center of the binder should be positioned over which anatomical landmark?
- The iliac crests
- The umbilicus
- The greater trochanters (Correct answer)
- The lumbar spine at L4-L5
Correct answer: The greater trochanters
The correct placement for a pelvic binder is centered over the greater trochanters of the femurs. This position allows for the most effective circumferential compression of the pelvic ring, which helps to reduce the pelvic volume, stabilize the fracture, and tamponade bleeding sources. Placing it higher over the iliac crests is incorrect and less effective, and positioning over the umbilicus or lumbar spine would serve no therapeutic purpose for a pelvic fracture.
Question 2: A patient with a suspected spinal injury needs to be moved from the floor onto a backboard. Which of the following is an essential principle of the log-rolling maneuver?
- The rescuer at the feet is responsible for giving the command to roll.
- The patient's arms should be crossed over their abdomen to keep them secure.
- The roll should be a segmented movement, starting with the shoulders then the hips.
- The rescuer maintaining manual in-line stabilization of the head is in command of the roll. (Correct answer)
Correct answer: The rescuer maintaining manual in-line stabilization of the head is in command of the roll.
During a log roll, the person at the patient's head is solely responsible for maintaining manual in-line stabilization of the cervical spine and giving the commands for each coordinated movement. This ensures the head, neck, and torso move as a single unit, preventing any twisting or flexion that could worsen a potential spinal cord injury. The commands do not come from the feet, the roll must be a unified (not segmented) motion, and arms are typically kept at the patient's sides.
Question 3: Prolonged immobilization of a patient on a rigid long spine board is MOST associated with an increased risk of which of the following complications?
- Hypertension
- Pressure ulcer formation (Correct answer)
- Improved respiratory function
- Deep vein thrombosis
Correct answer: Pressure ulcer formation
The hard, unforgiving surface of a long spine board creates significant pressure over bony prominences like the sacrum, scapulae, and occiput. Prolonged time on the board can restrict blood flow to the skin and underlying tissues, leading to ischemia and the formation of pressure ulcers (pressure injuries). Immobilization can also restrict respiration, not improve it. While DVT is a risk of general immobility, pressure ulcers are the most direct and well-documented complication of the backboard itself.
Question 4: What is the primary therapeutic purpose of applying a pelvic binder or circumferential sheet to a patient with a suspected unstable pelvic fracture?
- To provide definitive anatomical reduction of the fracture fragments.
- To reduce pelvic volume and provide compression to control hemorrhage. (Correct answer)
- To immobilize the femurs and prevent lower extremity rotation.
- To allow for early, partial weight-bearing during transport.
Correct answer: To reduce pelvic volume and provide compression to control hemorrhage.
The main life-threatening risk of an unstable pelvic fracture is massive internal hemorrhage. A pelvic binder works by applying circumferential compression to close the pelvic ring, which reduces the internal volume of the pelvis. This action helps to stabilize the fracture temporarily and, most importantly, creates a tamponade effect to control venous and bony bleeding. It is a temporary, life-saving measure, not a tool for definitive reduction, and it does not allow for weight-bearing.
Question 5: Which of the following spinal orthoses is specifically designed to limit flexion of the thoracolumbar spine by applying a three-point pressure system?
- Soft lumbar corset
- Milwaukee brace
- Jewett brace (Correct answer)
- Philadelphia collar
Correct answer: Jewett brace
The Jewett brace, a type of hyperextension orthosis, uses a three-point pressure system to control spinal flexion. It has a posterior pad at the thoracolumbar junction that pushes anteriorly, and two anterior pads (one sternal, one suprapubic) that push posteriorly. This system effectively prevents the patient from bending forward and is often used for stable compression fractures. A soft corset provides support but minimal motion restriction, a Milwaukee brace is primarily for scoliosis, and a Philadelphia collar immobilizes the cervical spine.
Question 6: When applying a rigid cervical collar to a trauma patient, what is the MOST critical initial action before the device is placed around the neck?
- Log-rolling the patient to inspect the posterior neck.
- Asking the patient to actively move their neck to assess the range of motion.
- Maintaining manual in-line stabilization of the head and neck. (Correct answer)
- Selecting the collar size based on the patient's weight.
Correct answer: Maintaining manual in-line stabilization of the head and neck.
Before, during, and immediately after the application of a cervical collar, the patient's head and neck must be held in a neutral, in-line position by a trained rescuer. This manual stabilization is the highest priority to prevent any movement that could cause or worsen a neurological injury. All other actions, such as sizing the collar (based on neck length, not weight), inspecting the back, or applying the device, are secondary to maintaining continuous manual control of the C-spine. Asking the patient to move is strictly contraindicated.
Orthopaedic Technologist Certified Spinal and Pelvic Immobilization Questions and Answers
An Orthopaedic Technologist is assisting with the application of a pelvic binder on a trauma patient.
To be MOST effective at reducing pelvic volume and controlling hemorrhage, the center of the binder should be positioned over which anatomical landmark?