Pediatric Orthopaedics Practice Questions

Q: A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Posterior displacement of the distal radius. ***Posterior displacement of the distal radius*** - The "dinner fork" deformity, or **Colles' fracture**, is characterized by **dorsal (posterior) displacement and angulation** of the distal fragment of the radius. - This posterior displacement, combined with supination and impaction, gives the wrist its characteristic shape resembling a dinner fork. *Anterior displacement of the distal radius* - This describes a **Smith's fracture (or reverse Colles' fracture)**, where the distal fragment of the radius is displaced volarly (anteriorly). - While also a common distal radial fracture, it presents with a different deformity than the "dinner fork." *Lateral angulation of the distal radius* - Angulation away from the midline (laterally or radially) can occur in various distal radius fractures but is **not the primary defining feature** of the classic "dinner fork" deformity. - The most prominent and characteristic deformity is the dorsal displacement, which contributes to the "dinner fork" appearance. *Medial angulation of the distal radius* - This refers to angulation towards the midline (medially or ulnarly) and is **less common as a primary component** of the classic Colles' fracture "dinner fork" deformity. - While some degree of angulation can be present, the distinctive shape of the "dinner fork" is mainly due to dorsal displacement and angulation.

Q: Which deformity is the last to be corrected by Ponseti's method for CTEV?

Equinus Deformity. ***Equinus Deformity*** - The **equinus deformity** (plantarflexion of the ankle) is the *last* component to be corrected in Ponseti's method. - This is because the other deformities (cavus, adduction, varus) must be corrected first to allow for proper manipulation of the ankle. *Heel Varus* - **Heel varus** (inward turning of the heel) is corrected after the cavus and forefoot adduction, but *before* the equinus. - Correction of varus typically precedes the final manipulation for equinus. *Foot Adduction* - **Foot adduction** (inward turning of the forefoot) is one of the *earlier* deformities addressed in the Ponseti method after the cavus. - It is typically corrected by abducting the forefoot relative to the hindfoot. *Cavus* - **Cavus** (high arch or midfoot pronation) is the *first* deformity to be corrected in the Ponseti method. - This is achieved by supinating the forefoot to flatten the arch.

Q: All of the following are true regarding fracture of lateral condyle of humerus except:

Results in gun stock deformity. ***Results in gun stock deformity*** - A **gunstock deformity** is also known as **cubitus varus**, where the forearm is angled inward when the elbow is extended. - This deformity is classically associated with a **malunited supracondylar fracture of the humerus**, not typically a lateral condyle fracture. *Usually seen at 6-10 years of age* - **Lateral condyle fractures** are common in **children**, particularly between the ages of 6 and 10 years, as this is when the secondary ossification center for the lateral condyle is still largely cartilaginous and vulnerable to trauma. - The **ossification center** for the lateral condyle appears around age 1 and fuses around age 16, making the bone susceptible during this growing period. *Cubitus valgus occurs* - **Lateral condyle fractures** can lead to **cubitus valgus** (increased carrying angle) if the fracture heals with lateral displacement or nonunion, causing the elbow to angle away from the body. - The **physis (growth plate)** of the lateral condyle contributes to the normal growth of the elbow joint, and damage can disrupt this alignment. *Tardy ulnar nerve palsy is seen* - **Cubitus valgus** (a common complication of lateral condyle fractures) stretches the **ulnar nerve** behind the medial epicondyle over time, leading to **tardy ulnar nerve palsy**. - This chronic stretching can cause **neuropathic symptoms** such as numbness, tingling, and weakness in the distribution of the ulnar nerve years after the initial injury.

Q: Which of the following statements about manipulation methods for correcting clubfoot (CTEV) is true?

Ponseti's technique has success rate of 90 - 98%. ***Ponseti's technique has success rate of 90 - 98%*** - The **Ponseti method** is highly successful for treating congenital talipes equinovarus (CTEV), with reported success rates in correcting the deformity ranging from 90% to 98%. - This high success minimizes the need for extensive surgery and improves long-term functional outcomes. *Involves serial casting and above knee plaster casting for 6-8 weeks* - While **serial casting** is part of the Ponseti method, the typical duration for the initial casting phase is usually around 5-7 weeks, not strictly 6-8 weeks, and consists of weekly cast changes. - The casting is indeed typically **above-knee** to effectively control rotation and maintain correction, but this option alone doesn't differentiate it sufficiently. *In Kite's method deformities are corrected sequentially equinus → adduction → inversion* - In **Kite's method**, correction is usually attempted in the sequence of **adduction → varus → equinus**, which is the reverse of the sequence stated in the option. - Kite's method is generally considered less effective than the Ponseti method and carries a higher risk of producing a "rocker-bottom" foot due to forceful, incorrect manipulation. *Ponseti's method of correction involves equinus → cavus → adduction → heel varus* - The specific order of correction in **Ponseti's method** is *cavus* (first part of equinus) → *adduction* → *varus* → and finally the *equinus*, with a **percutaneous Achilles tenotomy** often performed to correct the residual equinus. - The goal is to correct the foot by abducting and dorsiflexing it, with the heel varus correcting as the forefoot adduction and varus are addressed.

Q: Which of the following is the management for neglected case of CTEV in a patient > 10 years of age?

Triple arthrodesis. ***Triple arthrodesis*** - In neglected cases of **CTEV** (congenital talipes equinovarus, or clubfoot) in patients older than 10 years, the deformity is often **rigid and severe**, making soft tissue releases or less invasive procedures ineffective. - **Triple arthrodesis** involves **fusion of the talocalcaneal, talonavicular, and calcaneocuboid joints**, which corrects the hindfoot and midfoot deformities, providing a stable, plantigrade foot for weight-bearing. *Ankle arthrodesis* - **Ankle arthrodesis** fuses the **tibiotalar joint**, primarily addressing severe **ankle arthritis or instability**, rather than the complex multi-joint deformities of neglected CTEV. - While it creates a stable ankle, it does not correct the **forefoot and hindfoot deformities** inherent in long-standing clubfoot cases. *Jess fixation* - **JESS fixation** (Joshi's External Stabilisation System) is a type of **external fixator** used for gradual correction, particularly in cases with significant bone deformities or for lengthening procedures. - It is typically used for **limb reconstruction** or gradual correction of deformities in younger patients or less severe cases, but less effective for the significant, rigid deformities seen in older neglected CTEV. *Ponseti casting* - The **Ponseti method** is the gold standard for initial treatment of CTEV in **infants and young children**, using a series of plaster casts to gradually correct the deformity through manipulation. - It is highly effective when started early, but **not suitable for rigid, neglected clubfoot in older children or adults** where soft tissues and bones have adapted to the severe deformity.

Q: Which of the following statements about SCFE is incorrect?

Extension is restricted. ***Extension is restricted*** - In **slipped capital femoral epiphysis (SCFE)**, the femoral head slips posteriorly and medially relative to the femoral neck. - This posterior displacement leads to a characteristic limitation in **internal rotation**, **abduction**, and **flexion**, while **extension** is often preserved or even increased due to compensatory mechanisms. *Males are affected more frequently* - **SCFE** is indeed more prevalent in **males** than in females, with a male-to-female ratio of about 2:1. - This demographic difference may be attributed to hormonal influences and differing growth patterns during adolescence. *Commonly occurs during adolescence* - **SCFE** typically occurs during periods of rapid growth, most commonly in **preadolescent** and **adolescent children**, generally between the ages of 10 and 16 years. - This timing coincides with the weakening of the growth plate before its closure. *Varus, abduction and external rotation deformities are present* - This statement is incorrect. The characteristic deformity in **SCFE** is typically **valgus (coxa valga)**, not varus, due to the posterior and medial slip of the epiphysis. - The hip tends to be held in **external rotation** and **adduction**, with limited internal rotation and abduction range of motion.

Q: Which of the following features are characteristic of Sprengel's deformity?

Elevated shoulder on the affected side. ***Elevated shoulder on the affected side*** - An **elevated and abducted scapula** is the hallmark feature in Sprengel's deformity, occurring due to the scapula failing to descend during fetal development. - This anomalous position results in a noticeable **asymmetry of the shoulders**, with the affected side being higher than the unaffected side. *Hypoplastic scapula* - While often associated with the deformity, **hypoplasia (underdevelopment)** of the scapula itself is not the primary diagnostic criterion. - The main characteristic is the **malposition**, rather than the size, of the scapula. *Short neck appearance* - A **short neck appearance** is a common clinical finding in Sprengel's deformity, however, this is an *effect* of the elevated scapula, not a primary characteristic of the deformity itself. - The elevated scapula restricts cervical movement and obscures the natural contour, making the neck look shorter. *None of the options* - This option is incorrect because **elevated shoulder on the affected side** is a direct and characteristic feature of Sprengel's deformity.

Q: Which of the following statements about Congenital Talipes Equinovarus (CTEV) is correct?

The talus is displaced medially and plantarwards.. ***The talus is displaced medially and plantarwards.*** - In **Congenital Talipes Equinovarus (CTEV)**, the **talus** is typically displaced relative to the calcaneus,navicular, and cuboid, leading to its characteristic position. - This displacement contributes to the foot's **equinus (plantarflexion)**, **varus (inversion)**, **adduction**, and **cavus (high arch)** deformities. *It can occur in both males and females equally.* - **CTEV** has a higher incidence in **males** than in females, with a male-to-female ratio of about 2:1. - While it can affect both sexes, it is not an equally distributed condition. *It can affect either foot equally.* - **CTEV** can be **bilateral** (affecting both feet) in approximately 30-50% of cases. - When unilateral, there is no significant predilection for the left or right foot. *The tibia may show normal alignment.* - In most cases of **idiopathic talipes equinovarus**, the **tibia** itself is structurally normal. - The deformity primarily involves the foot and ankle joints, not the proximal long bones.

Q: The primary diagnostic evaluation for developmental dysplasia of hip is -

USG. ***USG*** - **Ultrasound** is the gold standard for diagnosing **developmental dysplasia of the hip (DDH)** in infants younger than 4-6 months. - It allows for dynamic assessment of hip stability and provides detailed imaging of the unossified cartilaginous femoral head and acetabulum. *Clinical examination* - While initial screening involves clinical examination (e.g., **Ortolani** and **Barlow maneuvers**), it can have false negatives and is less reliable than imaging for definitive diagnosis. - It's a crucial first step but not the primary diagnostic evaluation for confirmation. *X-ray* - **X-rays** are primarily used for DDH diagnosis in infants older than 4-6 months, once the femoral head and acetabulum have begun to ossify significantly. - In younger infants, the cartilaginous structures are not well-visualized on X-ray, limiting its diagnostic utility. *CT Scan* - **CT scans** are generally reserved for complex cases of DDH, typically before or after surgical intervention, or when assessing femoral head reduction in a cast. - It involves radiation exposure and is not the preferred initial or primary diagnostic tool for routine DDH evaluation.

Q: Which of the following deformities is evident in case of Erb's palsy?

Waiter's tip deformity. ***Waiter's tip deformity*** - Erb's palsy primarily affects the C5-C6 nerve roots, leading to paralysis of muscles such as the **deltoid**, **biceps**, and **brachialis**. - This results in adduction and internal rotation of the shoulder, extension of the elbow, and pronation of the forearm, mimicking a **waiter expecting a tip**. *Scapular winging* - This condition is typically caused by damage to the **long thoracic nerve**, affecting the **serratus anterior muscle**. - It results in the medial border of the **scapula protruding** from the back, which is distinct from the upper limb paralysis seen in Erb's palsy. *Ulnar claw hand* - This deformity occurs due to damage to the **ulnar nerve**, which paralyzes the **intrinsics of the hand**. - It leads to **hyperextension** of the metacarpophalangeal joints and **flexion** of the interphalangeal joints of the fourth and fifth digits. *Radial wrist drop* - **Radial nerve** injury causes paralysis of the extensors of the wrist and fingers, leading to the characteristic **wrist drop**. - This involves inability to extend the wrist and fingers, contrasting with the proximal upper limb affected in Erb's palsy.

Question 1

A 10-year-old child presents with a distal radius fracture showing a 'dinner fork' deformity. What is the most characteristic feature of this type of fracture?

Accepted Answer

Posterior displacement of the distal radius

Answer

Anterior displacement of the distal radius

Answer

Lateral angulation of the distal radius

Answer

Medial angulation of the distal radius

Question 2

Which deformity is the last to be corrected by Ponseti's method for CTEV?

Accepted Answer

Equinus Deformity

Answer

Heel Varus

Answer

Foot Adduction

Answer

Cavus

Question 3

All of the following are true regarding fracture of lateral condyle of humerus except:

Accepted Answer

Results in gun stock deformity

Answer

Tardy ulnar nerve palsy is seen

Answer

Usually seen at 6-10 years of age

Answer

Cubitus valgus occurs

Question 4

Which of the following statements about manipulation methods for correcting clubfoot (CTEV) is true?

Accepted Answer

Ponseti's technique has success rate of 90 - 98%

Answer

Involves serial casting and above knee plaster casting for 6-8 weeks

Answer

In Kite's method deformities are corrected sequentially equinus → adduction → inversion

Answer

Ponseti's method of correction involves equinus → cavus → adduction → heel varus

Question 5

Which of the following is the management for neglected case of CTEV in a patient > 10 years of age?

Accepted Answer

Triple arthrodesis

Answer

Ankle arthrodesis

Answer

Jess fixation

Answer

Ponseti casting

Question 6

Which of the following statements about SCFE is incorrect?

Accepted Answer

Extension is restricted

Answer

Commonly occurs during adolescence

Answer

Males are affected more frequently

Answer

Varus, abduction and external rotation deformities are present

Question 7

Which of the following features are characteristic of Sprengel's deformity?

Accepted Answer

Elevated shoulder on the affected side

Answer

Short neck appearance

Answer

None of the options

Answer

Hypoplastic scapula

Question 8

Which of the following statements about Congenital Talipes Equinovarus (CTEV) is correct?

Accepted Answer

The talus is displaced medially and plantarwards.

Answer

It can occur in both males and females equally.

Answer

It can affect either foot equally.

Answer

The tibia may show normal alignment.

Question 9

The primary diagnostic evaluation for developmental dysplasia of hip is -

Accepted Answer

USG

Answer

Clinical examination

Answer

X-ray

Answer

CT Scan

Question 10

Which of the following deformities is evident in case of Erb's palsy?

Accepted Answer

Waiter's tip deformity

Answer

Scapular winging

Answer

Ulnar claw hand

Answer

Radial wrist drop

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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