Pediatric Orthopaedics Practice Questions

Q: All of the following are described surgical procedures for CTE V except -

Salter's osteotomy. ***Salter's osteotomy*** - **Salter's osteotomy** is a procedure primarily used for treating **developmental dysplasia of the hip (DDH)**, aiming to redirect the acetabulum. - It is not a described surgical procedure for the correction of **congenital talipes equinovarus (CTEV)**. *Dwyer's osteotomy* - **Dwyer's osteotomy** is a surgical procedure performed on the **calcaneus** to correct **hindfoot varus**, typically seen in CTEV. - It involves removing a wedge of bone from the lateral aspect of the calcaneus. *Posteromedial soft tissue release* - This is a common and traditional surgical procedure for correcting severe **CTEV** by addressing the contracted soft tissues on the medial and posterior aspects of the foot. - It involves releasing structures such as the **tibial tendon**, **flexor digitorum longus**, **flexor hallucis longus**, and the **posterior ankle joint capsule**. *Triple Arthrodesis* - **Triple arthrodesis** is a salvage procedure that involves fusing three joints in the foot: the **talonavicular**, **calcaneocuboid**, and **subtalar** joints. - It is used in older children or adolescents with severe, rigid, or recurrent CTEV, often after failed conservative or primary surgical treatments.

Q: Most common orthopaedic manifestation of Neurofibromatosis is:

Scoliosis. ***Scoliosis*** - **Scoliosis** is the most frequent and debilitating orthopedic manifestation of **neurofibromatosis type 1 (NF1)**, affecting approximately *25%* of patients. - It often presents as a **dystrophic curve**, characterized by sharp, short-segment, and rapidly progressive curves that can lead to significant spinal deformities. *Atlanto-axial instability* - While **atlanto-axial instability** can occur in NF1, particularly due to dural ectasia or bony abnormalities, it is a **less common** orthopedic manifestation compared to scoliosis. - It typically requires specific diagnostic imaging and may present with neurological symptoms, but it is not the most prevalent. *Sphenoid dysplasia* - **Sphenoid dysplasia** is a characteristic bony lesion in NF1, often resulting in **orbital pulsatile exophthalmos** due to the absence or hypoplasia of the greater wing of the sphenoid bone. - While diagnostic for NF1, it is a Craniofacial manifestation rather than affecting the Musculoskeletal system *Pseudoarthrosis of the tibia and thinning of the cortex of long bones* - **Pseudoarthrosis of the tibia**, particularly **congenital tibial pseudoarthrosis**, is a significant but **less common** complication of NF1, occurring in about *5%* of patients. - **Thinning of the cortex of long bones** can also occur, contributing to a risk of fractures, but these are not as frequent as scoliosis.

Q: Spinal injury with no radiological finding is commonly seen in:

Children. ***Children*** - Spinal cord injury without radiographic abnormality (SCIWORA) is most common in children due to their inherent **ligamentous laxity**, underdeveloped facet joints, and more **elastic vertebral columns**. - The flexible spine can allow significant displacement that causes cord injury but then recoils, leaving no visible bony or ligamentous damage on imaging. *Older woman* - Older women are more prone to **osteoporotic fractures** and other structural spinal changes that would typically be visible on imaging. - While they can experience spinal cord injury, it is rarely classified as SCIWORA due to the presence of visible pathological findings. *In middle aged* - Middle-aged individuals tend to have more robust bony structures than children and are less prone to SCIWORA. - Spinal injuries in this age group are often associated with **disc herniation**, **fractures**, or **ligamentous tears** that are usually evident on imaging. *Older men* - Similar to older women, older men are more susceptible to age-related degenerative changes and trauma that result in visible damage on radiological scans. - SCIWORA is not a common presentation in older men, as their spinal columns are typically less elastic than those of children.

Q: What is the age of tendon transfer in post polio residual paralysis

>5 years. ***>5 years*** - Tendon transfer surgery is typically delayed until the child is **at least five years old** to ensure maximal spontaneous recovery has occurred and definitive muscle weakness patterns are established. - This age allows for better patient cooperation with **post-operative rehabilitation** and provides sufficient size for effective tendon grafting and fixation. *1 year* - This age is generally too early for tendon transfer, as it does not allow enough time for the **natural recovery process** from polio to conclude. - Performing surgery at this age risks unnecessary intervention if motor function might still spontaneously improve. *2 years* - While some recovery may have occurred, **two years** is still often considered premature for definitive tendon transfer in post-polio paralysis. - The child's growth and neuromuscular maturation are not yet complete, which could impact surgical outcomes and the ability to gauge permanent deficits. *<6 months* - This age is far too early for tendon transfer surgery in post-polio residual paralysis. - Infants require time for initial muscle recovery post-infection and for their skeletal and muscular systems to develop sufficiently for such a procedure.

Q: In extension injuries causing supracondylar fractures, the distal fragment is often displaced to

Posterior. ***Posterior*** - In **extension-type supracondylar fractures** (95% of cases), the mechanism of injury involves hyperextension at the elbow, causing the **distal fragment** to be displaced **posteriorly** due to the backward tilting forces. - This occurs from a fall on an outstretched hand with the elbow extended, where the hyperextension mechanism drives the distal fragment backward. *Anterior* - **Anterior displacement** of the distal fragment is characteristic of **flexion-type supracondylar fractures**, which are much less common (about 5% of cases). - These occur from a direct blow to the posterior elbow with the joint in flexion, not from extension injuries. *Lateral* - While displacement can have a lateral or medial component, pure **lateral displacement** is not the primary direction of the main distal fragment in typical extension-type supracondylar fractures. - The primary displacement is posterior in extension injuries, with secondary varus or valgus angulation potentially leading to lateral malalignment. *Medial* - Similar to lateral displacement, pure **medial displacement** alone is not the defining characteristic of extension-type supracondylar fractures. - Medial malalignment can occur in conjunction with the primary posterior displacement, especially when there is significant varus angulation.

Q: Genu recurvatum is seen in:

All of the options. ***All of the options*** - **Genu recurvatum**, or **hyperextension of the knee**, can result from various conditions that weaken the quadriceps or cause ligamentous laxity. - **Rickets**, **rheumatoid arthritis**, and **poliomyelitis** all compromise the structural integrity or muscular control essential for normal knee alignment. *Rickets* - In **rickets**, defective bone mineralization leads to **softening of bones**, including those of the knee. - This can result in structural deformities and ligamentous laxity, predisposing to genu recurvatum. *Rheumatoid arthritis* - **Rheumatoid arthritis** causes joint destruction, inflammation, and **ligamentous laxity**, particularly in the knee joint. - Chronic inflammation and damage to the knee capsule and ligaments can lead to instability and genu recurvatum over time. *Poliomyelitis* - **Poliomyelitis** by definition is a **paralytic disease**. It selectively attacks **motor neurons**, leading to **muscle weakness** and paralysis, often affecting the quadriceps. - Weakness of the quadriceps muscle, which normally stabilizes the knee, can result in hyperextension (genu recurvatum) for compensatory stability during weight-bearing.

Q: Genu valgus deformity seen when?

Long axis of tibia n fibula moves lateral to the long axis of femur. ***Long axis of tibia and fibula moves lateral to the long axis of femur*** - **Genu valgus**, also known as **knock-knees**, is a deformity where the knees angle inward, causing the lower legs to bow outward. - This alignment means the **long axis of the tibia and fibula (lower leg)** deviates laterally relative to the **long axis of the femur (thigh bone)**, bringing the knees closer together. *Long axis of tibia and fibula moves medial to long axis of femur* - This description corresponds to **genu varum**, or **bow-legs**, where the knees bow outward and the ankles are close together. - In genu varum, the lower leg bones deviate medially relative to the femur. *Long axis of femur is anterior to tibia and fibula* - This describes a sagittal plane misalignment, specifically relevant in cases of **knee hyperextension** or **recurvatum**, rather than typical genu valgus. - Genu valgus primarily involves coronal plane angulation at the knee. *Long axis of femur is posterior to tibia and fibula* - This anatomical relationship would imply a severe and unusual flexion deformity or dislocation, which is not characteristic of genu valgus. - Genu valgus involves a lateral deviation of the distal segment (tibia/fibula) in relation to the proximal segment (femur).

Q: Which fracture results in the 'cubitus varus' deformity?

Supracondylar fracture of humerus. ***Supracondylar fracture of humerus*** - This fracture, especially in children, can lead to **malunion** and subsequent **cubitus varus deformity**, also known as **gunstock deformity**. - The varus angulation occurs due to the medial displacement and rotation of the distal fragment, causing the forearm to deviate medially when the elbow is extended. *Olecranon fracture* - While it affects the elbow joint, an olecranon fracture typically results in loss of **extensor mechanism function** and potentially **elbow instability**, but not primarily cubitus varus. - The deformity associated with an olecranon fracture is usually a prominence of the olecranon or a loss of elbow extension. *Lateral condylar fracture* - A lateral condylar fracture can lead to **cubitus valgus** due to premature epiphyseal closure of the humeral capitellum and continued growth of the medial condyle. - It does not characteristically cause a cubitus varus deformity. *Radial head fracture* - Radial head fractures primarily affect forearm rotation and elbow stability, often leading to **pain with pronation and supination**. - They are not a direct cause of cubitus varus or valgus deformity of the elbow.

Q: In acute septic arthritis of hip in children, which finding indicates poor prognosis?

Delay in Treatment >48 hours. ***Delay in Treatment >48 hours*** - A delay in treatment of **acute septic hip arthritis** beyond 48 hours significantly increases the risk of irreversible cartilage damage and long-term functional impairment due to sustained inflammatory and enzymatic degradation. - This delay can lead to more severe joint destruction, avascular necrosis of the femoral head, and post-infectious osteoarthritis, all contributing to a **poor prognosis**. *Age <2 years* - While younger children can have more subtle symptoms and a higher risk of diagnostic delay, age itself is not the most determinant factor for poor prognosis compared to treatment delay. - Management in this age group focuses on early diagnosis and aggressive treatment to prevent growth plate damage. *Elevated CRP* - **Elevated C-reactive protein (CRP)** is a common finding in acute septic arthritis, indicating systemic inflammation and the severity of infection. - While reflecting disease activity, an elevated CRP alone does not directly indicate poor prognosis as it typically responds well to appropriate antibiotic treatment and surgical drainage. *Gram Negative Infection* - Gram-negative infections can be more challenging to treat and may require specific antibiotic regimens, but the type of organism is generally less critical than the **duration of untreated infection** in determining long-term outcomes. - With prompt and appropriate therapy, many gram-negative infections can be successfully managed without causing poor long-term outcomes.

Question 1

All of the following statements regarding bone remodeling are TRUE EXCEPT

Accepted Answer

Injuries involving the epiphyseal plate are more likely to remodel successfully

Answer

young children have a greater capacity for remodeling than adults

Answer

Remodeling is related to the degree of angulation

Answer

angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion

Question 2

All of the following are described surgical procedures for CTE V except -

Accepted Answer

Salter's osteotomy

Answer

Dwyer's osteotomy

Answer

Posteromedial soft tissue release

Answer

Triple Arthrodesis

Question 3

Most common orthopaedic manifestation of Neurofibromatosis is:

Accepted Answer

Scoliosis

Answer

Atlanto- axial instability

Answer

Sphenoid dysplasia

Answer

Pseudoarthrosis of tibia and thinning of cortex of long bones

Question 4

Spinal injury with no radiological finding is commonly seen in:

Accepted Answer

Children

Answer

Older woman

Answer

In middle aged

Answer

Older men

Question 5

What is the age of tendon transfer in post polio residual paralysis

Accepted Answer

>5 years

Answer

1 year

Answer

2 years

Answer

<6 months

Question 6

In extension injuries causing supracondylar fractures, the distal fragment is often displaced to

Accepted Answer

Posterior

Answer

Lateral

Answer

Medial

Answer

Question 7

Genu recurvatum is seen in:

Accepted Answer

All of the options

Answer

Rickets

Answer

Rheumatoid arthritis

Answer

Poliomyelitis

Question 8

Genu valgus deformity seen when?

Accepted Answer

Long axis of tibia n fibula moves lateral to the long axis of femur

Answer

Long axis of tibia n fibula moves medial to long axis of femur

Answer

Long axis of femur is anterior to tibia and fibula

Answer

Long axis of femur is posterior to tibia and fibula

Question 9

Which fracture results in the 'cubitus varus' deformity?

Accepted Answer

Supracondylar fracture of humerus

Answer

Olecranon fracture

Answer

Lateral condylar fracture

Answer

Radial head fracture

Question 10

In acute septic arthritis of hip in children, which finding indicates poor prognosis?

Accepted Answer

Delay in Treatment >48 hours

Answer

Age <2 years

Answer

Elevated CRP

Answer

Gram Negative Infection

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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