Pediatric Orthopaedics Practice Questions

Q: Slipped capital femoral epiphysis is seen most commonly in which age group?

Adolescents. **Explanation:** **Slipped Capital Femoral Epiphysis (SCFE)** is a classic hip disorder characterized by the displacement of the capital femoral epiphysis from the femoral neck through the physeal plate. 1. **Why Adolescents is correct:** The condition occurs most commonly during the **adolescent growth spurt** (typically ages 10–16 years). During this period, the growth plate (physis) thickens and weakens under the influence of growth hormones, while the periosteum thins. This mechanical instability, often combined with **obesity**, leads to a "slip" where the epiphysis remains in the acetabulum while the neck moves anteriorly and superiorly. 2. **Why other options are incorrect:** * **Infants:** Hip pathology in this group is usually Developmental Dysplasia of the Hip (DDH) or Septic Arthritis. * **Childhood:** The most common hip pathology in younger children (ages 4–8) is **Legg-Calvé-Perthes disease** (avascular necrosis). * **Old age:** Hip issues in the elderly are typically related to Osteoarthritis or Neck of Femur fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Typical Profile:** An obese adolescent male presenting with a limp and hip or **referred knee pain**. * **Clinical Sign:** **Drehmann Sign** (obligate external rotation of the hip during passive flexion). * **Radiology:** Look for **Trethowan’s Sign** (Klein’s line fails to intersect the femoral head). * **Associated Conditions:** If seen in younger children, suspect endocrine disorders like **Hypothyroidism** or Growth Hormone deficiency. * **Management:** The definitive treatment is **In-situ pinning** (Internal fixation with a single cannulated screw).

Q: A 4-year-old child sustained a fall on an outstretched hand. X-rays revealed a fracture line at the physis with a small metaphyseal fragment. There was no epiphyseal fracture. What type of injury, according to the Salter-Harris classification, is this?

Type II. ### Explanation The **Salter-Harris classification** is the standard system used to describe physeal (growth plate) injuries in children. The key to identifying the correct type lies in observing which anatomical components (Physis, Metaphysis, or Epiphysis) are involved. **Why Type II is Correct:** In this case, the fracture line travels through the **physis** and exits through the **metaphysis**, creating a triangular metaphyseal fragment known as the **Thurston-Holland sign**. Crucially, the epiphysis remains uninvolved. Type II is the **most common** type of physeal injury, typically occurring in children over 10 years old, though it can occur at any age. **Analysis of Incorrect Options:** * **Type I (S):** The fracture occurs purely through the physis (Separation). There is no bony fragment from the metaphysis or epiphysis. It is often a clinical diagnosis as X-rays may appear normal. * **Type III (A):** The fracture runs through the physis and exits through the **epiphysis** (Above/Articular). This is an intra-articular fracture and requires anatomical reduction. * **Type IV (T):** The fracture line passes **Through** all three elements: the metaphysis, the physis, and the epiphysis. It carries a high risk of growth disturbance. **NEET-PG High-Yield Pearls:** * **Mnemonic (SALTER):** * **S** (Type I): **S**traight across/Separated. * **A** (Type II): **A**bove (Metaphysis). * **L** (Type III): **L**ower (Epiphysis). * **T** (Type IV): **T**hrough everything. * **ER** (Type V): **ER**asure/Crush of the growth plate (worst prognosis). * **Thurston-Holland Sign:** Pathognomonic for Salter-Harris Type II. * **Prognosis:** Generally, Types I and II have a good prognosis and can be managed closed, while Types III and IV often require ORIF (Open Reduction Internal Fixation) to prevent growth arrest and joint incongruity.

Q: What is the most common fracture in children?

Supracondylar humerus. **Explanation:** **Supracondylar fracture of the humerus** is the most common fracture in children, particularly in the age group of 5–8 years. The underlying anatomical reason is the relative thinning of the distal humerus at the olecranon and coronoid fossae. During a fall on an outstretched hand (FOOSH) with the elbow in extension, the olecranon process acts as a fulcrum against the weak supracondylar bone, leading to an extension-type fracture (95% of cases). **Analysis of Options:** * **A. Supracondylar humerus (Correct):** It accounts for nearly 60% of all pediatric elbow fractures and is the most frequent fracture requiring surgical intervention in children. * **B. Tibia fracture:** While common in toddlers (Toddler’s fracture) and older children due to sports, it is statistically less frequent than distal humerus injuries. * **C. Fracture shaft of the femur:** These usually occur due to high-energy trauma (e.g., RTA) or child abuse (in non-ambulatory infants) but are not the most common. * **D. Metatarsal fracture:** These are common in adolescents and adults but rare in young children compared to upper limb injuries. **High-Yield Clinical Pearls for NEET-PG:** * **Gartland Classification:** Used to grade supracondylar fractures (Type I: Undisplaced; Type II: Displaced with intact posterior cortex; Type III: Completely displaced). * **Most common nerve injured:** Anterior Interosseous Nerve (AIN)—a branch of the Median nerve. * **Most common vascular complication:** Brachial artery injury. * **Late complication:** Cubitus varus deformity (Gunstock deformity) due to malunion. * **Emergency:** Volkmann’s Ischemic Contracture (VIC) is the most dreaded complication of neglected compartment syndrome in these patients.

Q: Which provocative test is used for the detection of developmental dysplasia of the hip (CDH)?

Barlow test. **Explanation:** Developmental Dysplasia of the Hip (DDH), formerly known as Congenital Dislocation of the Hip (CDH), requires early clinical screening. The **Barlow test** is a provocative maneuver used to detect an unstable hip that is currently reduced but "dislocatable." 1. **Why Barlow test is correct:** The test is performed by adducting the hip while applying a posterior force through the femur. If the hip is unstable, the femoral head slips out of the acetabulum with a palpable "clunk." It essentially "pushes the hip out." 2. **Why other options are incorrect:** * **Peterson test:** This is not a standard orthopedic test for DDH; it is often confused with the Perthes disease classification or unrelated clinical signs. * **Perkin’s test:** This refers to **Perkin’s line**, a vertical line drawn downward from the lateral edge of the acetabulum on a pelvic X-ray. It is a radiological marker, not a provocative clinical test. * **Von Rosen test:** This refers to a specific **radiographic view** (AP view with legs abducted 45° and internally rotated) used to diagnose DDH in infants, rather than a clinical provocative maneuver. **High-Yield Clinical Pearls for NEET-PG:** * **Ortolani Test:** The counterpart to Barlow; it is a **reductive maneuver** used to "put the hip back in" by abducting the flexed hip. * **Mnemonic:** **B**arlow **B**acks it out (Dislocates); **O**rtolani **O**pens it (Reduces). * **Galeazzi Sign:** Look for apparent shortening of the femur (uneven knee heights) in older infants. * **Klisic Test:** Used to assess the position of the greater trochanter relative to the iliac spine. * **Ultrasound:** The gold standard for diagnosis in infants <6 months (before the femoral head ossifies).

Q: In Cleidocranial dysostosis, what is the typical morphology of the roots of the permanent teeth?

Thin and short. **Explanation:** Cleidocranial Dysostosis (CCD) is an autosomal dominant skeletal dysplasia caused by a mutation in the **RUNX2 (CBFA1) gene**, which is essential for osteoblast differentiation and dental follicle development. **Why "Thin and Short" is correct:** In CCD, there is a significant delay or failure in the eruption of permanent teeth. The underlying pathology involves a lack of cellular cementum on the roots. Because the teeth remain impacted or erupt very late, the roots do not develop fully, resulting in a characteristic **thin and short (stunted)** morphology. This is often accompanied by a lack of secondary alveolar bone resorption, preventing the teeth from emerging through the dense bone. **Analysis of Incorrect Options:** * **A. Thin and Long:** Roots in CCD are underdeveloped due to the lack of eruptive force and cementum defects; they do not reach normal or excessive lengths. * **C. Thick and Short:** While the roots are short, they are typically gracile/thin. "Thick" roots (hypercementosis) are seen in conditions like Paget’s disease, not CCD. * **D. Fused:** Fusion of roots (taurodontism or concrescence) is not a primary diagnostic feature of CCD, although general crowding is common. **NEET-PG High-Yield Pearls for CCD:** * **Triad:** Delayed closure of cranial sutures (wormian bones), absent/hypoplastic clavicles (ability to touch shoulders in midline), and multiple supernumerary teeth. * **Dental:** Retained deciduous teeth and a "third dentition" (supernumerary teeth). * **Stature:** Patients usually have mildly short stature but normal intelligence. * **Radiology:** Widened symphysis pubis and "drooping shoulder" appearance.

Question 1

Slipped capital femoral epiphysis is seen most commonly in which age group?

Accepted Answer

Adolescents

Answer

Infants

Answer

Old age

Answer

Childhood

Question 2

A 4-year-old child sustained a fall on an outstretched hand. X-rays revealed a fracture line at the physis with a small metaphyseal fragment. There was no epiphyseal fracture. What type of injury, according to the Salter-Harris classification, is this?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 3

What is the most common fracture in children?

Accepted Answer

Supracondylar humerus

Answer

Tibia fracture

Answer

Fracture shaft of the femur

Answer

Metatarsal fracture

Question 4

Which provocative test is used for the detection of developmental dysplasia of the hip (CDH)?

Accepted Answer

Barlow test

Answer

Peterson test

Answer

Perkin's test

Answer

Von Rosen test

Question 5

In Cleidocranial dysostosis, what is the typical morphology of the roots of the permanent teeth?

Accepted Answer

Thin and short

Answer

Thin and Long

Answer

Thick and short

Answer

Fused

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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