Pediatric Orthopaedics Practice Questions

Q: The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -

Supracondylar Fracture of the humerus. ***Supracondylar Fracture of the humerus*** - **Anterior humeral line** passes through the **anterior cortex of the humerus** and should intersect the middle third of the capitellum in a normal elbow. - In supracondylar fractures, particularly those with **posterior displacement**, this line is often displaced **anteriorly or posteriorly**, failing to intersect the capitellum correctly. Additionally, the **radiocapitellar alignment** refers to the relationship between the **radius head** and the **capitellum**. Fractures and displacements around the elbow joint, such as supracondylar fractures, can disrupt this alignment. *Fracture lateral condyle of the humerus* - While a fracture of the lateral condyle can affect the elbow joint, it primarily involves a part of the **articular surface** and not necessarily the overall alignment of the entire distal humerus relative to the capitellum in the same way a supracondylar fracture does. - The **lateral condyle** is a smaller segment, and its fracture may not significantly alter the anterior humeral line **unless there is significant displacement** that indirectly affects the alignment of the capitellum. *Monteggia Fracture dislocation* - A **Monteggia fracture** involves a fracture of the **ulna** with dislocation of the **radial head** at the elbow. - While radiocapitellar alignment is severely disrupted, the **anterior humeral line** itself, which assesses the distal humerus, is typically **unaffected** as the primary injury is in the forearm bones and the radial head. *Fracture of Proximal Radius* - A fracture of the proximal radius (e.g., **radial head or neck fracture**) primarily affects the **radial articular surface** and its alignment with the capitellum. - While **radiocapitellar alignment** would clearly be disturbed, the position of the **distal humerus** relative to the capitellum, which the anterior humeral line evaluates, usually remains intact.

Q: The Salter Harris classification is used for classifying which type of injuries?

Fractures involving the physis in children. ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.

Q: 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?

Thomas test. ***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.

Q: Who devised the correction of CTEV by serial casting?

Ignacio Ponseti. ***Ignacio Ponseti*** - Dr. Ignacio Ponseti developed the **Ponseti method**, a non-surgical technique for correcting **congenital talipes equinovarus (CTEV)**, commonly known as clubfoot. - This method involves a series of **gentle manipulations** and **serial casting**, followed by the use of a foot abduction brace. *Gerhardt Kuntscher* - **Gerhardt Kuntscher** was a German surgeon known for developing the **intramedullary nail** for fixing long bone fractures. - His contributions revolutionized the surgical management of fractures, but he did not develop the method for CTEV correction. *Gavril Ilizarov* - **Gavril Ilizarov** was a Soviet orthopedic surgeon famous for inventing the **Ilizarov apparatus**, an external fixator used for limb lengthening and complex fracture treatment. - His work focused on osteogenesis and bone regeneration, not the non-surgical correction of clubfoot. *Hugh Owen Thomas* - **Hugh Owen Thomas** was a Welsh orthopedic surgeon regarded as the "father of British orthopaedic surgery," known for the development of the **Thomas splint**. - His contributions were primarily in managing fractures and tuberculosis of the joints, independent of CTEV correction techniques.

Q: What condition is characterized by a waddling gait?

Bilateral congenital dysplasia of hip. ***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.

Q: 4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -

Greenstick fracture. ***Greenstick fracture*** - This fracture type involves a **broken anterior cortex** but an **intact posterior cortex**, leading to an exaggerated bowing of the bone, characteristic of a greenstick fracture. - It occurs predominantly in **children** due to their softer, more flexible bones, which tend to bend rather than fully break when subjected to force like a fall on an outstretched hand. *Torus Fracture* - A torus fracture, or **buckle fracture**, involves compression of the bone leading to a bulging or buckling of the cortex, usually on one side, without a complete break in the bone. - While it occurs in children, it presents as a compression injury and not with a broken cortex and intact posterior cortex with bowing. *Galleazi Fracture* - A Galleazi fracture is a fracture of the **distal radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This fracture pattern involves two bones and two distinct injuries (fracture and dislocation), which is fundamentally different from the described single-bone incomplete fracture. *Monteggia Fracture Dislocation* - A Monteggia fracture involves a fracture of the **proximal ulna** with **dislocation of the radial head** at the elbow. - This injury also involves two bones and two distinct components (fracture and dislocation) and affects a different anatomical location (ulna and elbow) than described.

Q: The main muscle affected in congenital muscular torticollis is?

Sternocleidomastoid. ***Sternocleidomastoid*** - Congenital muscular torticollis (CMT) is primarily caused by **unilateral fibrosis and shortening of the sternocleidomastoid muscle (SCM)**. - This leads to the characteristic **head tilt towards the affected side** and **chin rotation to the opposite side**. *Trapezius* - The trapezius muscle is primarily involved in **shrugging the shoulders**, extending and rotating the head and neck, but is not the main muscle affected in CMT. - While it can become secondarily tight in response to persistent head positioning, it is **not the primary pathological muscle** in CMT. *Scalenus Anticus* - The scalenus anticus (anterior scalene muscle) is involved in **neck flexion and elevation of the first rib** during forced inspiration. - It plays a role in various neck pain syndromes and brachial plexus compression, but it is **not the defining muscle in congenital muscular torticollis**. *Omohyoid* - The omohyoid is a **strap muscle of the neck** that depresses the hyoid bone. - It has no primary involvement in the **pathophysiology or clinical presentation of congenital muscular torticollis**.

Q: Thurston Holland sign is seen in ?

Type II. ***Type II*** - The **Thurston Holland sign** is characteristic of a **Salter-Harris Type II fracture**, often described as a metaphyseal fragment (the "Thurston Holland fragment") remaining attached to the epiphyseal plate. - This fragment typically occurs at the corner of the **metaphysis**, making the fracture line extend obliquely through the physis and then along the metaphysis. *Type I* - A **Salter-Harris Type I fracture** involves a clean horizontal separation through the **growth plate (physis)** without involving the metaphysis or epiphysis. - No metaphyseal fragment is seen in Type I fractures, distinguishing it from the Thurston Holland sign. *Type III* - **Salter-Harris Type III fractures** extend from the **physis into the epiphysis**, creating an intra-articular fracture involving the joint surface. - These fractures do not involve a metaphyseal fragment, as they solely affect the physis and epiphysis. *Type IV* - **Salter-Harris Type IV fractures** involve a fracture line extending through the **epiphysis, physis, and metaphysis**, effectively dividing the bone into three parts. - While complex, Type IV injuries do not specifically describe the characteristic metaphyseal fragment that defines the Thurston Holland sign.

Q: Radiological sign in case of Perthes disease?

Flattening of femoral head. ***Flattening of femoral head*** - **Flattening** and **fragmentation** of the femoral head are characteristic radiological findings in **early-stage** Perthes disease. - This flattening is a direct consequence of the **avascular necrosis** and subsequent **remodeling** of the femoral epiphysis. *Fragmentation of femoral head epiphysis* - While **fragmentation** is a key feature of Perthes disease, it's typically observed **after** the initial flattening and sclerosis in the avascular stage. - It represents the process of **resorption** and **revascularization** as the bone attempts to heal. *Lateral femoral head displacement* - **Lateral displacement** of the femoral head is a more common finding in conditions like **slipped capital femoral epiphysis (SCFE)**, where the epiphysis slips from the metaphysis. - In Perthes disease, the primary issue is the **necrosis and collapse** of the femoral head itself, rather than displacement from the neck. *Limited hip abduction* - **Limited hip abduction** is a clinical sign, not a radiological sign, and it is a common symptom in Perthes disease due to pain, inflammation, and deformity of the femoral head. - Radiological signs are visual abnormalities observed on imaging studies like X-rays.

Question 1

Greenstick/ Nightstick fractures are seen in -

Accepted Answer

Children

Answer

Elderly

Answer

Common in all age groups

Answer

Young adults

Question 2

The anterior humeral line and radiocapitellar alignment are most commonly disturbed in -

Accepted Answer

Supracondylar Fracture of the humerus

Answer

Monteggia Fracture dislocation

Answer

Fracture of Proximal Radius

Answer

Fracture lateral condyle of the humerus

Question 3

The Salter Harris classification is used for classifying which type of injuries?

Accepted Answer

Fractures involving the physis in children

Answer

Soft tissue injuries in pediatric patients

Answer

Long bone fractures without growth plate involvement

Answer

Joint dislocations in pediatric orthopedics

Question 4

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?

Accepted Answer

Thomas test

Answer

Trendelenburgs test

Answer

Telescoping test

Answer

Nelaton's test

Question 5

Who devised the correction of CTEV by serial casting?

Accepted Answer

Ignacio Ponseti

Answer

Gerhardt Kuntscher

Answer

Gavril Ilizarov

Answer

Hugh Owen Thomas

Question 6

What condition is characterized by a waddling gait?

Accepted Answer

Bilateral congenital dysplasia of hip

Answer

Coxa valga

Answer

CTEV

Answer

Muscular dystrophy

Question 7

4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -

Accepted Answer

Greenstick fracture

Answer

Torus Fracture

Answer

Galleazi Fracture

Answer

Monteggia Fracture Dislocation

Question 8

The main muscle affected in congenital muscular torticollis is?

Accepted Answer

Sternocleidomastoid

Answer

Trapezius

Answer

Scalenus Anticus

Answer

Omohyoid

Question 9

Thurston Holland sign is seen in ?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 10

Radiological sign in case of Perthes disease?

Accepted Answer

Flattening of femoral head

Answer

Fragmentation of femoral head epiphysis

Answer

Lateral femoral head displacement

Answer

Limited hip abduction

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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