Developmental Dysplasia of Hip — MCQs
Which of the following best indicates poor prognosis in Developmental Dysplasia of Hip?
Salter's pelvic osteotomy is done for treatment of-
What condition is characterized by a waddling gait?
Blount Disease is involvement of
A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?
Keinbock's disease is osteochondritis of ?
The commonest complication of fracture of clavicle is :
Avascular necrosis (AVN) is commonly associated with which type of femoral neck fracture?
Open reduction (OR) is not required in which fracture?
79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
Developmental Dysplasia of Hip Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following best indicates poor prognosis in Developmental Dysplasia of Hip?
- A. Breech Presentation
- B. Female Gender
- C. Delayed Diagnosis > 3 years (Correct Answer)
- D. Bilateral Involvement
Explanation: ***Delayed Diagnosis > 3 years*** - A diagnosis of **Developmental Dysplasia of Hip (DDH)** beyond 3 years of age signifies a more advanced stage of the condition, often with significant secondary changes in the hip joint. - This delay leads to **less effective non-surgical treatments** and a higher likelihood of needing complex surgical interventions, with a greater risk of residual deformity, **osteoarthritis**, and long-term functional limitations. *Breech Presentation* - While **breech presentation** is a well-known risk factor for DDH, it is a factor in the *etiology* and *prevalence* of the condition, not directly an indicator of poor prognosis once DDH is diagnosed. - Many cases of DDH in infants born via breech presentation are detected early and managed successfully with **Pavlik harness** or other non-surgical methods. *Female Gender* - **Female gender** is also a significant risk factor for DDH, making females more susceptible to the condition. - However, being female itself does not imply a worse prognosis compared to males with DDH, assuming the diagnosis and treatment are initiated at a similar stage. *Bilateral Involvement* - **Bilateral involvement** indicates that both hips are affected, which can present greater challenges in management and require more extensive treatment. - While bilateral DDH can be more complex to treat, an early diagnosis and appropriate intervention for bilateral cases can still lead to a good prognosis, whereas a delayed diagnosis in a unilateral case can have a worse outcome.
Question 2: Salter's pelvic osteotomy is done for treatment of-
- A. SCFE
- B. DDH (Correct Answer)
- C. CTEV
- D. None of the options
Explanation: ***DDH*** - **Salter's innominate osteotomy** is a surgical procedure used to treat **developmental dysplasia of the hip (DDH)** by improving the acetabular coverage of the femoral head. - This procedure involves an osteotomy of the pelvis anterior to the acetabulum, redirecting the acetabulum to a more anatomical position. *SCFE* - **Slipped capital femoral epiphysis (SCFE)** is typically treated with in situ fixation using a **single screw**. - Osteotomies for SCFE are usually performed at the femoral neck or subtrochanteric region, not primarily pelvic osteotomies like Salter's. *CTEV* - **Congenital talipes equinovarus (CTEV)**, or clubfoot, is primarily treated with the Ponseti method of manipulation and casting, followed by **Achilles tenotomy**. - Surgical intervention for CTEV, if required, involves soft tissue releases and bony corrections of the foot, not pelvic osteotomies. *None of the options* - The Salter osteotomy is a specific procedure developed for the treatment of **DDH**, which is listed as an option.
Question 3: What condition is characterized by a waddling gait?
- A. Bilateral congenital dysplasia of hip (Correct Answer)
- B. Coxa valga
- C. CTEV
- D. Muscular dystrophy
Explanation: ***Bilateral congenital dysplasia of hip*** - A **waddling gait**, also known as a **Trendelenburg gait**, occurs due to weakness of the hip abductor muscles (gluteus medius and minimus) on both sides. - In bilateral congenital dysplasia of the hip, the **femoral heads are poorly seated** or dislocated, leading to ineffective abductor function and the characteristic gait. *Coxa valga* - This condition involves an **increased angle** between the femoral neck and shaft, which can alter biomechanics but does not typically cause a waddling gait in isolation. - While it can be associated with other hip pathologies, **coxa valga itself is not the primary cause** of a waddling gait. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It affects the patient's ability to walk normally, but results in a different type of gait abnormality, typically involving limping or walking on the outer edge of the foot, **not a waddling gait**. *Muscular dystrophy* - While many forms of muscular dystrophy can lead to a waddling gait due to **proximal muscle weakness**, it is a broad category of genetic disorders. - Without further context or specific type of muscular dystrophy, **bilateral congenital hip dysplasia is a more direct and specific cause** for the symptom described.
Question 4: Blount Disease is involvement of
- A. Distal femur
- B. Distal tibia
- C. Proximal tibia (Correct Answer)
- D. Proximal femur
Explanation: ***Proximal tibia*** - Blount disease, also known as **tibia vara**, is a growth disorder affecting the **tibia** (shin bone) in children. - It specifically involves the **medial physis of the proximal tibia**, leading to abnormal growth in this area and resulting in a **bow-legged** deformity. *Distal femur* - Malformations or growth disturbances of the **distal femur** are typically associated with conditions like genu valgum (**knock-knees**) or other angular deformities originating higher up in the leg. - Blount disease's primary pathology does not originate from the distal femur. *Distal tibia* - Conditions affecting the **distal tibia** can lead to ankle deformities or foot problems. - Blount disease is distinctly a problem of the knee region, not the ankle. *Proximal femur* - Problems in the **proximal femur** are commonly associated with conditions like Legg-Calvé-Perthes disease or developmental dysplasia of the hip. - While these can also cause gait abnormalities, Blount disease's characteristic bowing deformity originates from the tibia.
Question 5: A child presented to an orthopaedic clinic with a limp. The surgeon suspected him to have a fixed flexion deformity of the hip. Which test should the surgeon perform to confirm his finding?
- A. Thomas test (Correct Answer)
- B. Trendelenburgs test
- C. Telescoping test
- D. Nelaton's test
Explanation: ***Thomas test*** - The **Thomas test** is specifically designed to detect a **fixed flexion deformity of the hip**, where the hip cannot fully extend. - During the test, the patient's hip is flexed to flatten the lumbar spine, and if the contralateral leg then rises off the table, it indicates a fixed flexion deformity. *Trendelenburg's test* - The **Trendelenburg's test** assesses the strength and function of the **hip abductor muscles**, primarily the gluteus medius. - A positive result indicates weakness of the abductors on the standing leg, causing the pelvis to drop on the unsupported side, which is unrelated to fixed flexion deformity. *Nelaton's test* - **Nelaton's test** is used to determine the relative position of the **greater trochanter** in relation to the **ischial tuberosity** and **anterior superior iliac spine (ASIS)**, primarily in cases of hip dislocation or fracture. - It would not specifically identify a fixed flexion deformity of the hip joint itself. *Telescoping test* - The **telescoping test** is used to evaluate for hip instability, particularly in infants with **developmental dysplasia of the hip (DDH)**. - It involves applying axial pressure to the femur while moving the hip, assessing for abnormal movement of the femoral head within the acetabulum, and does not directly detect fixed flexion deformity.
Question 6: Keinbock's disease is osteochondritis of ?
- A. Scaphoid
- B. Lunate (Correct Answer)
- C. Calcaneum
- D. Tibial tuberosity
Explanation: ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.
Question 7: The commonest complication of fracture of clavicle is :
- A. non union
- B. avascular necrosis
- C. Neurovascular injury
- D. malunion (Correct Answer)
Explanation: ***malunion*** - **Malunion** is the most frequent complication following a clavicle fracture, meaning the bone heals in an anatomically incorrect or deformed position. - This often results in a palpable bump or cosmetic deformity, and can occasionally cause functional impairment. *non union* - **Non-union** occurs when the fracture fails to heal completely, leaving a persistent gap between the bone fragments. - While possible, it is less common than malunion in clavicle fractures, especially with appropriate management. *avascular necrosis* - **Avascular necrosis** is rare in clavicle fractures because the clavicle has a rich blood supply. - It typically affects bones with precarious blood supply, such as the femoral head or scaphoid. *Neurovascular injury* - **Neurovascular injury** involving the subclavian vessels or brachial plexus is a serious but relatively rare complication of clavicle fractures. - While possible, especially with displaced fractures, it is not the most common adverse outcome.
Question 8: Avascular necrosis (AVN) is commonly associated with which type of femoral neck fracture?
- A. Transcervical
- B. Basal
- C. Subcapital (Correct Answer)
- D. Intertrochanteric
Explanation: ***Subcapital*** - Subcapital fractures occur at the anatomical **neck of the femur**, just below the femoral head, and often disrupt the **blood supply** to the femoral head due to injury to the lateral epiphyseal arteries. - The high rate of **vascular disruption** in these fractures significantly increases the risk of avascular necrosis (AVN) a condition where bone tissue dies due to lack of blood supply. *Transcervical* - Transcervical fractures are located through the **middle part of the femoral neck**, between subcapital and basal fractures, and also carry a risk of AVN. - However, the risk of AVN is generally considered **lower than subcapital fractures** but higher than basal fractures, due to less consistent disruption of the retinacular vessels. *Basal* - Basal fractures occur at the **base of the femoral neck**, near the intertrochanteric line, and typically have a **better prognosis** regarding AVN. - The principal blood supply to the femoral head is usually **less compromised** in basal fractures compared to subcapital or transcervical fractures, as the fracture line is more distal to the weight-bearing femoral head. *Intertrochanteric* - Intertrochanteric fractures occur **outside the hip joint capsule**, in the region between the greater and lesser trochanters, and are considered **extracapsular**. - Due to their location being well away from the **femoral head's vascular supply**, these fractures have a very low risk of avascular necrosis and primarily raise concerns about stability and healing.
Question 9: Open reduction (OR) is not required in which fracture?
- A. Fracture of the patella
- B. Fracture of the outer one-third of the radius (Correct Answer)
- C. Displaced fracture of the olecranon
- D. Fracture of the condyle of the humerus
Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.
Question 10: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
- A. Hip spica
- B. Nailing
- C. Hemiahroplasty (Correct Answer)
- D. Total Hip Replacement
Explanation: ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.
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