OTC Orthopaedic Technologist Certified Spinal and Pelvic Immobilization 5 — Questions and Answers
Question 1: Which skin area requires the most vigilant monitoring in a patient wearing a thoracolumbar TLSO brace?
- Anterior chest wall
- Xiphoid process and iliac crests (Correct answer)
- Mid-thoracic spinous processes
- Lumbar paraspinals
Correct answer: Xiphoid process and iliac crests
The xiphoid process and iliac crests are prominent bony areas most prone to pressure injury under rigid orthosis contact.
Question 2: Which imaging modality is preferred for evaluating ligamentous injury of the cervical spine in a trauma patient?
- Plain radiograph
- CT scan without contrast
- MRI (Correct answer)
- Bone scan
Correct answer: MRI
MRI best visualizes soft tissue and ligamentous structures, which are not visible on CT or plain radiographs.
Question 3: A cruciform anterior spinal hyperextension (CASH) brace is most appropriate for which spinal condition?
- Cervical instability
- Thoracic compression fracture (stable) (Correct answer)
- Sacroiliac dysfunction
- Lumbar spondylolisthesis
Correct answer: Thoracic compression fracture (stable)
The CASH brace applies a three-point hyperextension force that offloads the anterior thoracic vertebral body in stable compression fractures.
Question 4: If a halo vest pin site shows early signs of infection (erythema, serous drainage), the most appropriate initial management is:
- Immediate pin removal
- Systemic IV antibiotics only
- Local pin site care with antiseptic cleaning and topical antibiotic (Correct answer)
- Increase pin torque to stabilize the site
Correct answer: Local pin site care with antiseptic cleaning and topical antibiotic
Early pin site infections are managed with meticulous local care; removal or systemic therapy is reserved for refractory or deep infections.
Question 5: When documenting spinal orthosis use, which element is considered most legally and clinically important to record?
- Brand name of the brace
- Patient-reported comfort score
- Wearing schedule, skin checks, and patient education provided (Correct answer)
- Color and material of the brace
Correct answer: Wearing schedule, skin checks, and patient education provided
Documentation of wearing schedule, skin inspection, and patient education demonstrates appropriate care and compliance monitoring.
Question 6: Which of the following best describes the three-column model of spinal stability (Denis classification)?
- Anterior cortex, posterior cortex, spinous process
- Anterior column (anterior 2/3 of vertebral body/disc), middle column (posterior 1/3 of body/disc and PLL), posterior column (posterior elements) (Correct answer)
- Vertebral body, pedicles, and facets
- Disc, endplate, and ligamentum flavum
Correct answer: Anterior column (anterior 2/3 of vertebral body/disc), middle column (posterior 1/3 of body/disc and PLL), posterior column (posterior elements)
Denis described three columns where disruption of the middle column plus one other defines instability requiring surgical consideration.
Question 7: Failure to immobilize a symptomatic odontoid fracture type II appropriately may most likely result in:
- C5-C6 radiculopathy
- Atlantoaxial instability and risk of spinal cord compression (Correct answer)
- Sacral insufficiency fracture
- Thoracic kyphosis progression
Correct answer: Atlantoaxial instability and risk of spinal cord compression
Type II odontoid fractures at the dens base have a high nonunion rate, risking C1-C2 instability and catastrophic cord injury.
OTC Orthopaedic Technologist Certified Spinal and Pelvic Immobilization 5
Which skin area requires the most vigilant monitoring in a patient wearing a thoracolumbar TLSO brace?